Healthcare Access and Quality as a Social Determinant of Health: Implications for DNP Practice
Introduction
The Social Determinants of Health (SDOH) framework highlights the non-medical factors that profoundly influence health outcomes. Among the five domains identified by Healthy People 2030—economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context—healthcare access and quality is particularly critical. This domain encompasses the availability, affordability, and quality of healthcare services, as well as the ability of individuals to navigate complex systems of care.
As a Doctor of Nursing Practice (DNP)-prepared nurse, understanding and addressing healthcare access and quality is essential for advancing health equity, improving patient outcomes, and shaping organizational and community-level interventions. This essay explores the importance of this domain, explains why it is personally significant, and outlines how my practice will shift from the patient-level to broader organizational and community perspectives. Three recent scholarly articles are used to support this discussion: Adeyemi et al. (2021), Burton & Voss (2024), and CDC Public Health Infrastructure Center (2023).
Importance of SDOH for DNP-Prepared Nurses
DNP-prepared nurses are uniquely positioned to integrate SDOH into practice because of their advanced training in clinical leadership, systems thinking, and evidence-based practice. Taking SDOH into consideration is vital for several reasons:
Improved Patient Outcomes: Addressing barriers to healthcare access reduces preventable hospitalizations and improves chronic disease management.
Health Equity: DNPs can advocate for policies that reduce disparities in care delivery.
Systems-Level Impact: By analyzing organizational processes, DNPs can implement interventions that expand access to underserved populations.
Interdisciplinary Collaboration: DNPs often lead teams that integrate nursing, medicine, social work, and public health to address systemic barriers.
Ignoring SDOH risks perpetuating inequities and undermining the effectiveness of clinical interventions.
Selected Domain: Healthcare Access and Quality
I have chosen Healthcare Access and Quality as my focus domain. This domain is particularly important to me because of my experiences caring for patients with chronic illnesses such as congestive heart failure and diabetes. Many of these patients rely on Medicaid or charity care, face long wait times, and struggle to navigate fragmented healthcare systems. Their outcomes are not determined solely by clinical interventions but by whether they can access timely, affordable, and culturally competent care.
Healthcare access and quality is also deeply relevant to my professional goals of advancing health equity and improving continuity of care. Without addressing systemic barriers, even the most advanced clinical interventions will fail to achieve sustainable outcomes.
Shifting Thinking from Patient-Level to Organizational and Community-Level
Traditionally, nursing practice has focused on the patient-level: providing direct care, education, and support. While this remains essential, addressing healthcare access and quality requires a broader perspective. As a DNP-prepared nurse, I intend to shift my thinking and practice in the following ways:
1. Organizational Level
Quality Improvement Initiatives: Implement evidence-based protocols to reduce avoidable emergency department visits.
Telehealth Expansion: Advocate for organizational investment in telehealth platforms to increase access for rural and underserved populations.
Workforce Training: Develop staff education programs on cultural competence and health literacy to improve patient-provider communication.
2. Community Level
Community Partnerships: Collaborate with local organizations to provide mobile clinics and outreach programs.
Health Literacy Campaigns: Lead initiatives to improve patient understanding of chronic disease management.
Policy Advocacy: Engage with local policymakers to expand Medicaid coverage and funding for safety-net hospitals.
3. Larger Field of Nursing
Research and Scholarship: Contribute to nursing literature on interventions that improve healthcare access.
Leadership in Professional Organizations: Advocate for nursing-led initiatives that address systemic inequities.
Mentorship: Train future nurses to adopt a systems-level perspective on SDOH.
Scholarly Evidence
Three recent scholarly articles provide evidence for the importance of healthcare access and quality at organizational, community, and nursing levels:
Adeyemi et al. (2021): This framework-based review emphasizes strategies for integrating SDOH into nursing practice to advance health equity. It highlights organizational interventions such as workforce training and policy advocacy as critical for improving healthcare access.
Burton & Voss (2024): This editorial in Clinical Nursing Research underscores the importance of nursing scholarship in addressing SDOH. It argues that nurses must move beyond patient-level care to engage in community-based interventions and systems-level research.
CDC Public Health Infrastructure Center (2023): This overview of CDC research demonstrates how healthcare access and quality is linked to broader public health outcomes. It emphasizes the role of organizations and communities in shaping access to care, reinforcing the need for nurses to engage at these levels.
Together, these articles support the argument that healthcare access and quality must be addressed not only at the bedside but also through organizational leadership, community engagement, and nursing scholarship.
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