Peer Responses

Respondimg to Adebayo M Arowolo

Hi Adebayo,

Great work, your consideration of financial security as a social determinant of health (SDoH) is reflective and supported with sound evidence. Your consideration of financial uncertainty as a barrier to care access and care follow-through is a sound argument for why nurses have a role to become advocates for policies and programs that promote financial security for all (Flaubert, 2021). I appreciate your thinking regarding including routine economic assessments in patient assessments and connecting with financial guidance programs. By taking a proactive role, such interventions can significantly prevent readmissions and improve patient care, and it is best practice: Peer Responses.

While economic security is a beginning, I also encourage consideration of a broader picture through consideration of how other SDoH, such as education, intersects with financial security. For instance, economically disadvantaged groups can have enhanced access to make educated medical care decisions through interventions in health literacy (Kreuter et al., 2021). Policies for accessible transportation and affordable care for kids can enhance job security, closing economic inequity gaps.

References

Flaubert, J. (2021). The Role of Nurses in Improving Health Care Access and Quality. In www.ncbi.nlm.nih.gov. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK573910/

Kreuter, M. W., Thompson, T., McQueen, A., & Garg, R. (2021). Addressing Social Needs in Health Care Settings: Evidence, Challenges, and Opportunities for Public Health. Annual Review of Public Health, 42(1), 329–344. https://doi.org/10.1146/annurev-publhealth-090419-102204

Responding to Andre Augustin

Hello Andre,

Good work. Your discussion of access and quality in medical care accurately portrays its significant contribution to medical outcomes. One significant contribution your discussion brings is an examination of bias and cultural competency in providers and their contribution to access to care.

Even when care is accessible, bias and lack of culturally competent care can result in miscommunication, misdiagnosis, and less-than-desired care, most specifically for minorities (Stubbe, 2020). Overcoming such barriers through training providers in cultural humility and awareness of bias can improve patient-provider encounters and trust in the medical system.

Additionally, social networks have a profound impact on access to care. Patients with supportive family and community networks have a better chance of working through care systems and, subsequently, following through with preventive care and treatment compliance. Patient medical homes and multidisciplinary care can bridge care gaps and promote overall care through supporting networks (Karam et al., 2021). Widespread expansion of such care will promote increased access to care and enhanced patient outcomes even more.

References

Karam, M., Chouinard, M.-C., Poitras, M.-E., Couturier, Y., Vedel, I., Grgurevic, N., & Hudon, C. (2021). Nursing Care Coordination for Patients with Complex Needs in Primary healthcare: a Scoping Review. International Journal of Integrated Care, 21(1), 16. https://doi.org/10.5334/ijic.5518

Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041

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Adebayo M Arowolo

The Social Determinants of Health

Social Determinants of Health (SDoH) have a significant role in shaping health outcomes; therefore, it is necessary for DNP-prepped nurses to incorporate them in clinical practice. SDoH represent socioeconomic status, education, employment, physical environment, and social support networks, which, beyond medical interventions, play a key role in shaping patient outcomes.

Healthcare professionals have traditionally focused on clinical treatments in enhancing patient care, but addressing SDoH can improve the patient experience, serve as an alternative to the downstream effects of clinical treatment, promote health equity at population and individual levels, and reduce disparities.

A DNP-prepared nurse is in a position to integrate SDoH in practice to allow holistic, evidence-based care that includes families and community beyond the bedside and influence policy, education, and strategies that affect the health system.

To some extent, economic stability is the most influential of the five SDoH factors that shape health outcomes.

Economic-related factors such as access to stable employment, income flow, food security, and housing security determine an individual’s ability to pay for healthcare and live a healthy life (Slavin et al., 2021).

Personally, I have worked with patients whose chronic illnesses degenerated due to their inability to afford medications, nutritious food, or preventive care.

Evidence indicates a correlation between limited access to basic financial services and the increase in hospitalization rates, nonadherence to treatment, and heightened mental health burdens (Slavin et al., 2021).

Therefore, by focusing on economic instability as a social determiner of health, I can advocate for initiatives and programs that allow economically disadvantaged individuals and populations to access financial assistance, employment opportunities, and social services to enhance their long-term health outcomes.

Conventionally, nurses addressed SDoH at the patient level through strategies by conducting individual assessments and referring the patients to available social services.

However, for more meaningful changes, the nurse intervention should be expanded to organizational, community, and policy levels (Wise et al., 2023).

This would foster a systemic and sustainable improvement in patient outcomes by promoting the integration of the SDoH considerations into hospital policies and ensuring the involvement of diverse stakeholders such as local advocacy groups to address broader determinants of health such as access to education and transportation (Wise et al., 2023).

Therefore, my approach to shifting the thinking and practice related to economic instability as SDoH, from patient-level to the organizational, community, and field of nursing levels, will involve strategies such as institutional integration and policy advocacy.

As a DNP-prepared nurse, I will work with my healthcare organization to incorporate economic stability screenings into standard assessment.

A standardized screening tool for financial insecurity and referral to financial counselors or social workers can inform the implementation of patient-centered care.

Evidence has shown a reduction in readmissions and an improvement in patient outcomes following the embedment of a social service team in hospitals (Akiya et al., 2021).

I will also work with healthcare administrators to create partnerships with local businesses and workforce development programs that will be willing to help unemployed patients find job placement.

Policy advocacy to promote health equity provides an opportunity for addressing economic stability on a larger scale.

As a DNP-prepared nurse, I will apply my knowledge and experience working with policymakers and professional nursing organizations to develop legislation that will benefit the working families with minimum wages, provide tax incentives to businesses that provide employee wellness programs, and expand Medicaid coverage.

Nurses, as key frontline workers in the healthcare system, have a unique opportunity to influence healthcare-related policies by presenting evidence-based recommendations (Bartmess et al., 2021).

Therefore, I will present evidence-based and practical recommendations on how to reduce the proven effect of economic instability on health.

In conclusion, incorporating SDoH considerations is crucial to advancing health equity and improving patient outcomes. In particular, economic instability significantly influences an individual or population’s ability to maintain healthy life habits and access healthcare.

As a DNP-prepared nurse, I can contribute to addressing the economic disparities of health through institutional integration, partnerships, and policy advocacy.

Through these advanced approaches, I can drive meaningful changes in reducing health disparities and improving patient outcomes.

References

Akiya, K., Fisher, E., Wells, A., Li, Y., Peck, C., & Pagán, J. A. (2021). Aligning health care and social services to reduce hospitalizations and emergency department visits: an evaluation of the community care connections program. Medical care, 59(8), 671-678. DOI: 10.1097/MLR.0000000000001578

Bartmess, M., Myers, C. R., & Thomas, S. P. (2021, July). Nurse staffing legislation: Empirical evidence and policy analysis. In Nursing forum (Vol. 56, No. 3, pp. 660-675). https://doi.org/10.1111/nuf.12594

Slavin, S. D., Khera, R., Zafar, S. Y., Nasir, K., & Warraich, H. J. (2021). Financial burden, distress, and toxicity in cardiovascular disease. American heart journal, 238, 75-84. https://doi.org/10.1016/j.ahj.2021.04.011

Wise, J., Caiola, C., & Njie-Carr, V. (2023). A fundamental shift in nursing is a requisite for achieving health equity: The nurses’ role in addressing social determinants of health. Journal of the Association of Nurses in AIDS Care, 34(1), 125-131. DOI: 10.1097/JNC.0000000000000383

AA Andre Augustin

Main Initial post

An explanation of the importance and value of taking the SDoH into consideration as a DNP-prepared nurse.

By comprehending and tackling the more extensive social, economic, and environmental elements that profoundly impact a person’s health outside of medical care, a DNP-prepared nurse can take a more holistic and impactful approach to patient care, ultimately leading to improved health outcomes and reduced health disparities.

In other words, SDoH is about looking beyond symptoms to address the underlying causes of a patient’s health issues by taking into account their living conditions, education, income, access to food, and more.

Everyone is impacted by SDOH (Flaubert et al., 2021). Both the good and the bad of the circumstances in which people are born, grow, live, work, and age are included (Flaubert et al., 2021). When used effectively, SDOH can safeguard health (Flaubert et al., 2021).

However, a pattern of social risk factors, the detrimental characteristics of SDOH is present in many people, which leads to higher rates of morbidity and mortality (Flaubert et al., 2021).

Identify the one SDoH Domain you selected and explain why it is particularly important to you.
Health care access and quality is one of the social determinants of health which describes how easily people may obtain and make use of health care services.

That is the SDoh domain that the writer is selected for this discussion. Having health insurance, visiting a physician, and receiving mental health services are all part of it.

This domain is particularly important to me because it enables people to easily access necessary medical services when needed, improving overall health outcomes and a higher quality of life, access to high quality healthcare is essential for preserving and advancing health, avoiding illnesses, treating current problems, lowering disability and early mortality, and attaining health equity for all people.

In contrast, a lack of access to high-quality healthcare can result in delayed diagnosis, poorer treatment outcomes, and increased health disparities.

The timely use of personal health services to achieve the best health outcomes” is what it means to have access to healthcare (National Library of Medicine, 2021).

Promoting and maintaining health, preventing and controlling disease, lowering needless disability and early death, and attaining health equity for everyone depend on having access to comprehensive, high quality healthcare services (National Library of Medicine, 2021).

An explanation of why and how you intend to shift your thinking and practice related to the SDoH from the patient-level to the organizational, community, and/or larger field of nursing levels.

A more comprehensive approach that includes organizational policies, community partnerships, and advocacy within the nursing profession as a whole is essential to effectively addressing Social Determinants of Health (SDoH);

Instead of only treating specific symptoms in a therapeutic setting, it is better to promote systemic change by changing the variables that lead to health disparities among communities.

To have more of an impact on health, for instance, SDoH should address issues at the organizational and community level, which can affect a larger population by influencing policies, promoting the distribution of resources, and enacting systemic changes that benefit entire communities rather than just individual patients.

In another word, is that by tackling the underlying issue, working with community partners, and pushing for legislative changes, where nurses are able to address the underlying causes of health disparities such as limited access to good housing, education, and employment instead of only treating the health problems that come from them.

Addressing the ways that social determinants of health (SDOH) raise or lower the risk of unfavorable health outcomes is essential to enhancing the health and wellbeing of the country, even as chances to promote health equity through clinical care remain significant (Whitman et al., 2022).

In conclusion, It is essential to use Social Determinants of Health (SDOH) when treating patients because it gives medical professionals a better understanding of their life circumstances and enables them to address the social factors that have a significant impact on their health outcomes—often even more so than their clinical presentation alone.

This results in more effective and holistic care delivery and helps to address potential health disparities.

References

Flaubert, L.J., Le, M. S., Wiliams, D. R. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK573923/

National Library Of Medicine (2021). National Healthcare Quality and Disparities Report.
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK578537/

Whitman, A., De Lew, N., Chappel, A., Aysola, V., Zuckerman, R., Sommers, D. B.(2022). Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. Retrieved from
https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOHEvidence-Review.pdf

NA Naah Allotey

Main Post

Healthcare Access and Quality (SDOH)
As a doctor of nursing practice, it is very vital to deal with the various healthcare access and quality which is considered vital when it is providing equitable, effective, and patient centered care.

They include the barriers like lack of insurance, provider shortages, and systemic discrimination which have an impact on the mental health outcomes directly.

Importance of Access to Mental Health Care
There is improvement of access to mental health care where most of the individuals with the psychiatric disorders do not receive timely care because of the limited provider availability and other aspects like financial constraints or lack of mental health parity when it comes to issues of insurance coverage.

They can advocate for the policy changes which improve coverage for mental healthcare services, development of programs and integrating telepsychiatry to underserved populations (Coombs et al., 2021).

There is reduction in health disparities.

Ethnic and racial minorities, rural populations, and those with lower socioeconomic status face significant disparities in mental health treatment.

In consideration of the SDoH, the DNP prepared can implement culturally competent, trauma informed, and holistic care models that address underlying social barriers (Htay & Whitehead, 2021).

Enhancement of preventative and early intervention strategies where unmet mental health needs can lead to crisis situations, hospitalizations, and chronic conditions.

the identification and addressing barriers to healthcare access early can prevention long term complications, reduce emergency department visits, and improve overall mental wellbeing.

Selected SDoH Domain

As a future DNP prepared nurse, I am interested in ensuring healthcare access and quality because it has an impact on the access to mental health services and remains a significant barrier for various individuals and more so those in the underserved and marginalized communities (Thomeer et al., 2023).

I have been able to see various gaps in access whether they are financial constraints, provider shortages, and other systemic barriers like worsening of the psychiatric manifestations, increased hospitalizations and poor overall healthcare outcomes (Htay & Whitehead, 2021).

The domain is vital because many patient cannot get the care that they need and mental health services are limited because of the shortage of the healthcare providers, long wait times, and inadequate insurance coverage.

Another importance is that the mental health disparities are widespread in that racial and ethnic minorities, rural populations and others of socioeconomic status tend to experience some disproportionate challenges in accessing quality psychiatric care (Coombs et al., 2021).

I aim to reduce the disparities by advocating for equitable access to the mental health services.

I will have the opportunity to advocate for policy changes which expand the mental health services and improve insurance coverage and also includes an integration of the behavioral health into primary care settings.

Shifting of my Practices
As a future DNP prepared nurse, my focus will be on healthcare access and quality will extend beyond individual patient care to broader organizational, community, and policy level interventions.

I will focus on helping individual patients navigate mental health systems and connecting them with the resources and management of their psychiatric conditions.

I will also ensure integration of behavioral health into primary care settings and develop mental health screening protocols within the clinics and hospitals (Coombs et al., 2021).

For instance, advocating for the anxiety and depression universal screenings.

I will help patients access local resources like support groups, therapy programs, and medication assistance programs.

I will focus on navigation of insurance issues for individual patients and help them apply for coverage and seek assistance via advocacy groups.

I will advocate for policy changes at the state and national levels to further expand the mental health coverage and also improve telehealth access.