• Respond to at least two of your colleagues, on different days, by offering ideas for how their organization might have achieved a better outcome or how they might have more thoroughly addressed SDOH to achieve positive social change. Be specific and cite sources to support your recommendations.

Note: Your responses to colleagues should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or adding a fresh viewpoint and be constructive, enhancing the learning experience for all students.

Angela Renee Williams

The MD Anderson Undiagnosed Breast (UDB) Clinic is a specialized diagnostic center within the University of Texas MD Anderson Cancer Center that assesses patients with abnormal breast findings found on external imaging. These patients are usually referred due to concerns like a palpable lump, focal asymmetry, architectural distortion, or nipple discharge.

The main goal of the UDB Clinic is to quickly provide an accurate diagnosis by matching external imaging with clinical evaluation and, if needed, performing additional imaging or biopsies. The clinic aims to handle complex or unclear breast abnormalities that have not yet been definitively identified as benign or malignant, enabling fast triage and care coordination for patients who may require further diagnostic testing or cancer treatment.

Social determinants of health (SDOH), including economic stability, access to healthcare, education, transportation, and health literacy, play a crucial role in patient access, follow-up, and satisfaction with care. At MD Anderson’s Undiagnosed Breast (UDB) Clinic, a persistent challenge has been patients arriving without previous breast imaging or results from the past five years. Patients are usually referred for abnormal findings such as palpable lumps, focal asymmetry, architectural distortion, or nipple discharge. However, without prior imaging, radiologists cannot interpret the images, leading to visit cancellations and significant patient frustration due to wasted time and financial costs.

Several key SDOH influence this recurring issue. Economic instability can hinder a patient’s ability to obtain prior imaging due to cost-related barriers or inadequate insurance coverage. Transportation and geographic access are especially relevant since some patients may travel long distances to MD Anderson, making it difficult or unrealistic to retrieve imaging from other facilities (Fernandes et al., 2022).

Health literacy and language barriers also play a role, as patients might not fully understand the importance of providing prior imaging or may lack assistance navigating health systems (Rashid et al., 2021). These social factors worsen disparities in timely diagnosis and continuity of care.

To address these challenges, the clinic collaborated with the Access team to establish a structured reminder system that contacts patients 72 and 24 hours before their appointments to notify them of missing imaging and results. This change helped reduce the number of incomplete visits and lowered unnecessary travel and costs for patients.
In this case, positive social change occurred because the system-level intervention addressed barriers related to communication, literacy, and access, improving equity in care delivery (American Hospital Association [AHA], 2020).

Following the steps outlined in Appendix A of Dang et al. (2021), several phases of successful organizational change were observed. The problem was clearly defined
(Step 1), and root causes were examined by understanding the barriers patients face
(Step 2). Key stakeholders, including the Access team and radiology staff, were engaged (Step 3), and a practical solution was developed and put into action (Steps 4 and 6). However, the clinic did not appear to formally pilot the change (Step 5), and although initial outcomes were promising, no comprehensive evaluation metrics or long-term sustainability plans were reported (Steps 7 and 8).

The outcomes were generally positive, especially in reducing incomplete visits.
However, a more rigorous approach could have strengthened the initiative. For example, piloting the reminder strategy with a small group first and collecting baseline and post-intervention data—such as missed appointment rates, patient satisfaction scores, and timelines for imaging receipt—would produce measurable results.

Involving patients in developing communication strategies could improve cultural responsiveness and address literacy barriers. Some institutions have successfully used health navigators or social workers to assist with imaging, which MD Anderson might consider.

In conclusion, the UDB Clinic’s intervention showed early success by reducing the number of patients arriving without prior imaging, which benefits both operations and patients. While the clinic addressed several SDOH-related barriers through improved communication and workflow design, further improvements, including stakeholder involvement, systematic evaluation, and addressing more profound structural inequities,
could help sustain and expand positive social change.

References
American Hospital Association. (2020). Screening for social needs: Guiding care teams to engage patients. https://www.aha.org/center/emerging-issues/social-determinantshealth

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Fernandes, C. A., Bansal, N., Lee, S., & Martinez, K. A. (2022). Missed imaging appointments in underserved populations: The role of transportation and social needs. BMC Health Services Research, 22(1), 783. https://doi.org/10.1186/s12913-022-08784-8

Rashid, M., Saeed, S., & Warraich, H. (2021). Health literacy and breast cancer screening among underserved populations: A review. Journal of Health Disparities Research and Practice, 14(3), 44–58.

KJ Kayla Frizzell Johnson

Addressing Staff Burnout in an Inpatient Mental Health Facility
The organization selected is an inpatient mental health facility, providing specialized care for patients with acute psychiatric conditions. A significant issue within this setting is staff burnout, especially among psychiatric nurses and frontline mental health workers. These professionals face emotionally demanding work, unpredictable patient behaviors, safety concerns, and high workloads, all of which contribute to emotional
exhaustion, depersonalization, and reduced job satisfaction.

Social Determinants of Health (SDOH) Related to Staff Burnout
The Centers for Disease Control and Prevention (CDC, 2024) define social determinants of health (SDOH) as the conditions in which people are born, grow, work, live, and age, encompassing the broader set of forces that shape daily life. While SDOH typically focuses on patients, they are highly applicable to healthcare staff. For psychiatric nurses, determinants such as work environment, access to mental health resources, organizational culture, and economic stability profoundly affect well-being and resilience.

In this inpatient mental health facility, initial approaches failed to address these determinants. According to Zhang et al. (2024), an effort–reward imbalance—where staff perceive their efforts as unrewarded or underappreciated—contributes to burnout and deteriorates well-being.

The lack of psychological safety and limited support exacerbated moral distress and compassion fatigue (Kaya & Molu, 2023). Further, Tao et al. (2024) emphasize the interconnected nature of burnout with depression, anxiety, and stress, particularly in high-pressure environments like psychiatric units during the COVID-19 pandemic.

Were SDOH Addressed?
Initially, the facility did not systematically address these social determinants. Staff burnout was often viewed as an individual failing rather than a reflection of systemic issues. However, rising turnover rates and declining patient safety metrics prompted leadership to implement change initiatives aimed at leadership engagement and employee wellness.

Positive Social Change and Interventions
Leadership introduced several strategies to tackle burnout:

• Enhanced leadership presence and regular listening sessions to promote open communication and psychological safety.
• Employee wellness programs include counseling services, mindfulness workshops, peer support groups, and quiet recovery rooms.
• Initiatives to recognize staff efforts more transparently, aiming to mitigate effort– reward imbalance (Zhang et al., 2024).

These strategies align with the recommendations of White, Dudley-Brown, and Terhaar (2024), emphasizing the importance of stakeholder engagement and leadership commitment in translating evidence into practice to promote sustainable change.

Application of the Johns Hopkins EBP Model (Dang et al., 2021)
Using Appendix A of Dang et al. (2021), the facility’s approach can be mapped as
follows:
1. Identify the problem: Staff burnout and turnover were identified using exit interviews, HR data, and employee surveys.

2. Form a multidisciplinary team: Include clinical managers, nursing staff, HR personnel, and wellness coordinators.

3. Search and appraise evidence: Reviewed literature on burnout, wellness interventions, and leadership strategies.

4. Implement evidence-based interventions: Rolled out leadership engagement and employee wellness programs tailored to staff needs.

5. Evaluate outcomes: Assessed using staff satisfaction surveys, turnover statistics, and patient safety incident reports.

6. Plan for sustainability: Initially limited; efforts are underway to formalize ongoing support and program maintenance.

Outcomes and Evaluation
The interventions led to generally positive outcomes, including improvements in staff retention and enhanced perceptions of support and psychological safety among employees. However, some challenges remained, such as disparities in access to wellness resources among different staff shifts.

The complex relationship between burnout and other mental health symptoms, like anxiety and depression (Tao et al., 2024), underscores the need for ongoing, comprehensive mental health support for staff. Additionally, addressing organizational factors, such as effort–reward imbalance, remains critical to sustaining improvements in staff well-being and reducing burnout (Zhang et al., 2024).

Recommendations for Improved Outcomes
To enhance the effectiveness of this initiative, the organization should:

• Develop a formal sustainability plan incorporating wellness champions and continuous staff feedback loops (White et al., 2024).
• Expand equitable access to wellness resources, ensuring all shifts, including night staff, benefit.
• Implement routine mental health assessments and reflective practice sessions to mitigate moral distress and compassion fatigue (Kaya & Molu, 2023).
• Establish transparent recognition programs addressing the effort-reward imbalance (Zhang et al., 2024).

Conclusion
Staff burnout in inpatient mental health facilities is a complex issue deeply connected to social determinants of health that affect healthcare workers. Leadership engagement, combined with employee wellness initiatives guided by evidence-based frameworks such as the Johns Hopkins EBP model, can lead to positive change. However, sustainability and equity must be prioritized to ensure lasting improvements in staff
well-being and the quality of patient care.

References
Centers for Disease Control and Prevention. (2024, January 17). Social determinants of health (SDOH). CDC. https://www.cdc.gov/socialdeterminants/index.htm

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Kaya, E., & Molu, N. G. (2023). Relationship between moral distress, compassion fatigue, and burnout levels of psychiatric nurses. Journal of Psychiatric Nursing / Hemşireleri Derneği, 14(2), 103–111. https://doi.org/10.14744/phd.2023.09582

Tao, R., Wang, S., Lu, Q., Liu, Y., Xia, L., Mo, D., Geng, F., Liu, T., Liu, Y., Jiang, F., Liu, H.-Z., & Tang, Y.-L. (2024). Interconnected mental health symptoms: Network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1485726

White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2024). Translation of evidence into nursing and healthcare (4th ed.). Springer.

Zhang, X., Zhang, L., Xue, B., Li, Y., Yan, M., Luo, H., & Huang, X. (2024). Effort–reward imbalance and well-being among psychiatric nurses: The mediating role of burnout and decent work. BMC Nursing, 23(1), 1–9. https://doi.org/10.1186/s12912-024-02301-4

Peer Responses

Abimbola Ehimare

Selected Organization and Identified Practice Issue
The organization selected is Aspire Indiana Health, a federally qualified health center (FQHC) and community mental health center (CMHC) located in Indiana. Aspire provides integrated primary care, behavioral health, addiction recovery services, housing assistance, and employment support.

A significant practice issue identified within this organization was the high rate of emergency department (ED) utilization among individuals with co-occurring mental health and substance use disorders. These patients frequently visited EDs for acute stabilization, but often lacked access to continuous outpatient care, leading to fragmented treatment, increased healthcare costs, and poor long-term outcomes.

Relevance of Social Determinants of Health (SDOH)
Social Determinants of Health (SDOH) significantly influence health outcomes by shaping the conditions in which individuals are born, grow, live, work, and age.
Addressing SDOH is essential to reducing health disparities and promoting health equity across diverse populations (Healthy People 2030, n.d.).Social determinants of health (SDOH) were deeply intertwined with this organizational issue. Many of the high ED utilizers were uninsured, experiencing homelessness, unemployed, or lacking reliable access to food and transportation.

These factors significantly limited their ability to engage with consistent care or adhere to treatment plans. For example, patients with schizophrenia who were unhoused struggled with medication compliance and often relied on emergency services for basic needs and crisis management. These SDOH created systemic barriers that contributed to the cycle of ED overuse and poor health outcomes.

Addressing SDOH in Practice
Addressing SDOH in practice such as improving access to housing, transportation, and primary care helps reduce emergency department (ED) overuse by targeting the root causes of frequent visits. By resolving these upstream factors, healthcare providers can improve continuity of care and patient outcomes, breaking the cycle of preventable ED reliance (DeMass et al., 2023). Aspire Indiana implemented a targeted initiative in 2022 called the Whole Health Recovery Initiative to address these underlying social factors (Aspire Indiana, 2023).

Through this program, interdisciplinary teams including behavioral health case managers, peer recovery coaches, and housing specialists were deployed to collaborate with local EDs. Patients identified as frequent ED users were assessed for SDOH-related needs and referred to services such as supportive housing, Medicaid enrollment, and outpatient behavioral health care. The use of Aspire’s Permanent Supportive Housing program enabled many clients to transition from homelessness to stable housing, dramatically improving their engagement in ongoing care and reducing their dependence on emergency services.

Impact on Positive Social Change
This initiative led to measurable positive social change. ED visits were reduced by 45% among enrolled participants over a six-month period, according to internal performance metrics. In addition to reducing healthcare utilization, patients demonstrated improvements in medication adherence, engagement with mental health services, and overall satisfaction with care.

The shift from acute, episodic care to long-term, community-based support models significantly enhanced health equity for vulnerable populations and aligned with Aspire’s mission of promoting integrated whole-person care (Aspire Indiana, 2023).

Application of the Dang et al. EBP Model
Based on the Johns Hopkins Evidence-Based Practice (JHEBP) model presented in Appendix A of the Dang et al. (2021) text, Aspire followed several essential steps of evidence-based practice (EBP) change.

The organization clearly defined the practice issue and used internal data to support the need for intervention (Step 1). They reviewed evidence-based models such as Assertive Community Treatment (ACT) and
Housing First to guide their planning (Step 2). Aspire then adapted these models to meet local community needs and implemented the change in a pilot format (Steps 3–5).

Evaluation of outcomes occurred through both quantitative metrics (e.g., ED utilization rates, appointment attendance) and qualitative feedback from patients and staff (Step 6). However, Step 7; broad dissemination was underutilized, as findings were shared internally but not formally published or presented externally.

Evaluation of Outcomes and Opportunities for Improvement
The outcomes of the practice change were largely positive. Key success factors included interdisciplinary teamwork, patient-centered planning, and continuous data tracking. For example, tracking metrics such as reductions in ED visits, increased outpatient appointment adherence, and patient housing stability enabled the team to adjust strategies in real-time.

However, to strengthen future impact, the organization could have expanded its dissemination efforts to promote cross-sector learning and influence broader policy reforms. Publishing results and sharing insights at professional conferences could also support funding and scalability.

Conclusion
Aspire Indiana Health’s initiative serves as a strong example of how addressing SDOH through evidence-based, community-centered interventions can lead to sustainable health improvements and meaningful social change. By integrating behavioral health, housing, and peer support, the organization effectively reduced ED utilization and improved patient outcomes. While the change process followed key steps of the
JHEBP model, opportunities remain to further enhance its impact through external dissemination and policy advocacy.

References
Aspire Indiana. (2023). Annual impact report. https://www.aspireindiana.org

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

DeMass, R., Gupta, D., Self, S., Thomas, D., & Rudisill, C. (2023). Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina. BMC public health, 23(1), 1527. https://doi.org/10.1186/s12889-023-16136-2

Healthy People 2030. (n.d.). Social determinants of health. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/objectives-and-data/socialdeterminants-health

Jennifer Kolowinski

Week 8- SDOH and Social Change

Jennifer Kolowinski

Doctorate of Nursing Practice, Walden University

NURS 8114- Theoretical and Scientific Foundations of Nursing

Professor Alexa-Marie Ramirez

July 16 , 2025

Organization and organization issue selected
The selected organization for this discussion topic is Oncology departments. The mission of oncology is providing cancer care while advancing research, and preparing oncology professionals for the future (Benedict et al., 2025). Oncology departments focus on the diagnosis, prevention, and treatment of cancer. A primary issue associated with oncology is the lack of accessible care, screenings, and prevention.

How SDOH relates to the issue you selected
Social determinants of health (SDOH) directly affect nursing practices in oncology settings. Patient’s who live in rural areas or lack proper transportation cannot easily access care. Patient’s who do not have stable income or lack of healthcare often cannot afford healthcare services. Also, patients without proper education as to why screenings and prevention are important, most likely will not seek out services.

Were SDOH addressed
Whenever my oncology unit was working with a new patient (not previously established or registered at our hospital), we established a close relationship between case management and the patient. Case management did a wonderful job addressing any barriers that patient may have towards receiving care. Whether it was insurance, transportation, home services, etc. case management worked as the primary resources for patients to get as much care as possible. We also tried to provide mobile healthcare and early detection/screening services to local neighborhoods.

Did positive social change occur
Positive social change did occur to some degree. By having nursing, physicians, and case management work closely together, patient’s needs were addressed in a timely manner. And while all resources might not have been available to every patient, patients typically got majority of their care and were educated on their conditions, and what steps needed to happen in the future.

Appendix A, describe the steps that were followed and/or missing in the organization’s approach
Referring to Appendix A from the Dang et al. text, many of the steps were followed when trying to provide patients with accessible care, screenings, and prevention. However, the facility did not appear to have a continued evaluation process.
While providing resources, mobile screening services, education, none of this process was formalized by an actual organizational committee, therefore there was no formal follow-up/evaluation process.

Were the outcomes positive or negative
The patients were able to receive early detection screenings, education, and treatment, which is a positive outcome. However, since there is not a unified structure to this process, many people still do not receive the same treatment. This is partially due to income and insurance, which we cannot change.

What could have been done differently to achieve a better outcome?
I believe, with the resources we had readily available to us, the results were satisfactory. However, I believe their needs to be a large increase in early detection and patient education to rural areas/areas with lack of healthcare accessibility. If people do not realize they are at risk for cancer and the importance of screenings, they will not seek out help. TeleHealth would be highly beneficial, as it has the capability to reach people in rural areas and provide quicker access to healthcare professionals (Butzner et al., 2021).

What key actions were taken that led to this positive outcome
Multidisciplinary collaboration, while challenging at times, proved to be very successful in reaching new oncology patients in our unit. By involving case management from the start, patients were able to receive more resources, more education, and had higher positive outcomes than those who did not have successful team collaboration.

How was the change measured, if at all? In what ways were the outcomes evaluated?
In my experience, this is the highest area of weakness for the oncology unit’s practice of handling patients. There does not tend to be a viable amount of follow-up or evaluation for patients once they leave our facility. Many patients do return to our facility, to continue treatment or remission was not successful.

But once, a patient leaves our facility, there is very little follow-up that is conducted, therefore we are not sure how successful our efforts truly are. We can only measure success while in the hospital.

References
Benedict, P., Hart, C., O’Leary, S. (2025). Clinical oncology. Journal of clinical oncology. 43:19. https://doi.org/10.1200/JCO.24.0090

Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.

Butzner, M., Cuffee, Y. (2021). Telehealth Interventions and Outcomes Across Rural Communities in the United States: Narrative Review. Journal of Medical Internet Research. 26;23(8):e29575. doi: 10.2196/29575

Flaubert, J., Le, MS., Williams, D. (2021). Social Determinants of Health and Health Equity.

National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK573923/