CEO's Corner July 2019: The Importance of the Social Determinants of Health

Terri Hinkley

The International Council of Nurses (ICN) Congress was an inspirational and educational conference attended by thousands of nurses from around the world. It certainly was enlightening to recognize that nurses around the world face some collective opportunities and challenges. As you read in President Robin Hertel’s ‘Robin’s Nest’, one focus of the conference was the importance of the social determinants of health (SDOH) in managing the health of our patients.

That topic reminded me of the times I spent volunteering as a nurse in a homeless shelter in Alexandria, Virginia. One of the things I learned very quickly was the role social determinants of health play in health and wellness of individuals. We ran a completely volunteer medical clinic once a week in a residential shelter that housed both individuals and families. We saw diabetic patients, patients with hypertension, congestive heart failure, renal disease, liver disease, COPD, and asthma - often made worse due to compliance issues resulting from substance use disorders and/or behavioral health disorders. Some, though, simply didn’t have access to or couldn’t afford medical care, medication, employment, transportation, stable housing, or nutrition.

The patients we saw each week lacked health insurance. We were the only care they received. We counseled them on nutrition, self-care, wound care, alcohol and drug rehabilitation, birth control, and more. We had a small pharmacy that was stocked through financial donations from the shelter and leftover medications from the clinic physicians’ personal practices. I helped patients apply for medication coverage through programs offered to those that couldn’t afford medication by pharmaceutical companies. I gave out medications that were expired, hoping there was enough active pharmaceutical product left in them to be efficacious. I got to truly know them, and their struggles, and I realized what mattered most to their health were basic essentials that many of us take for granted: housing, healthy food, employment, education, and social support.

For many years as an acute care nurse on a medical unit, in the ICU or the ED, I questioned patients and/or family members on the home situation a patient would be returning to. I asked about support systems and help at home. However, often I failed to ask about some of the more basic SDOH, like access to healthy food, proximity to health care, and employment and financial resources. My time in the shelter taught me the importance of those factors. I wish I had worked in the shelter at the beginning of my nursing career, it would have transformed my nursing practice.

AMSN wholeheartedly supports the work of the Future of Nursing 2020-2030 and the importance of the social determinants of health. We will continue to educate our members about SDOH and we will equip you with the knowledge and tools you need to embed their use in your practice, regardless of the practice setting you work in. We know that providing these resources can help you transform your nursing practice and make a difference for your patients – not only for their presenting medical issues, but for their overall health.

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