Certified Nurses Day: Nursing’s involvement with social determinants amid COVID-19
Certified Nurses Day on March 19 was established to honor and recognize the important achievements of these professionals who make a difference in the lives of patients every day.
As a fellow nurse, I want to discuss nursing’s involvement with an important topic we have discussed before, Social Determinants of Health (SDOH). Nursing has always had a strong focus on SDOH.
Social Determinants of Health are relevant to our current and evolving COVID-19 crisis. While communicable infections can impact anyone, the susceptibility, risk and degree of impact are exacerbated by underlying health conditions. Underlying conditions can be linked to social issues like poverty, overcrowded housing, low quality food access, no health insurance and poor access to Health Care. Those same conditions can directly impact the spread of infections. SDOH set the stage and assists in the spread of infection creating a dangerous cycle.
According to the American Journal of Nursing, the holistic model of healthcare positions nurses to be leaders in improving health by linking SDOH to outcomes through analysis and action.
The Code of Ethics for Nurses of the American Nurses Association emphasizes the need to integrate social concerns into nursing and health policy. Nursing can lead in translating SDOH awareness into action by:
- Teach SDOH content in all clinical courses
- Prioritize nursing research on social aspects of health to connect SDOH to health outcomes and develop nursing interventions that alleviate problematic SDOH
- Collaborate with social and community agencies and institutions to recommend that health policy address harmful SDOH.
Nurses have always been looking at SDOH
This is intrinsically part of the nursing process and development of Patient Centered Nursing Care Plans. The Nursing Process is:
- Discovering and making decisions about the nature of the patient’s problems or needs.
- Nursing diagnosis:
- A clinical judgement about individual, family or community responses to actual and potential health problems or life process.
- There are three diagnosis types: Wellness Diagnosis, Risk Diagnosis, Actual Diagnosis with etiologies and related factors specified.
- Establishment of desired and achievable outcomes, validation of expected outcomes with the patient, selection of interventions to achieve the outcomes.
- Nursing intervention:
- Any treatment based upon clinical judgement and knowledge to enhance the patient’s outcomes. The forms may be: Direct care, teaching, counseling, coordination, health promotion, disease prevention, health maintenance, restoration and rehabilitation.
- Determining the patient’s progress to the planned outcomes and the efficacy of the planned interventions.
While physicians are aware and concerned, they typically spend much less time with their patients than nurses do, so their focus is more specific to the presenting condition and diagnosis. Additionally, individual providers have limited ability to impact many social determinants potentially impacting their patients, such as housing, transportation, education, access to food. Social-political conditions are beyond the scope of individual providers. It takes a team.
A deeper view of SDOH brings realization that the information is localized and specific to the patient’s context of interaction. What has historically been missing is the ability to share that information beyond that context. The ability to share requires standardization and codification of SDOH. That’s the current focus of standards organizations working with governing bodies, payers and clinical organizations.
As a nurse, it is exciting and heartening to see the spreading recognition, voluntary implementation and potential regulatory impact for SDOH. While this is exciting, we must not become complacent.
SDOH as a population-level health factor is huge and complex. Planning and interventions require a team effort on behalf of the patient.
EHR vendors should consider what they build and support as it relates to SDOH
As an EHR vendor, we can incorporate SDOH assessments as codified data. We can add them to Consolidated-Clinical Document. Architecture (C-CDA) Exports. We can used Clinical Decision Support to notify providers of identified issues. Lastly, add SDOH items to dashboards to essentially create and support workflows.
There are concerns around sharing SDOH. As a patient, I might not want you to share the fact that I drink excessively. I recommend documenting that information for providers assigned to the patient, flagging it as sensitive and blocking it from being exchanged outside of your organization.