The Importance of Social Determinants of Health in Nursing Practice: A Focus on Healthcare Access and Quality
Introduction
The delivery of healthcare is shaped not only by clinical expertise and technological innovation but also by the broader social, economic, and political contexts in which individuals live. These contexts are captured by the framework of Social Determinants of Health (SDoH), defined as the conditions in which people are born, grow, live, work, and age. The Healthy People 2030 initiative identifies five domains of SDoH: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context.
For Doctor of Nursing Practice (DNP)-prepared nurses, integrating SDoH into practice is essential for advancing health equity, improving patient outcomes, and shaping organizational and community-level interventions. This essay explains the importance of considering SDoH in nursing practice, identifies Healthcare Access and Quality as the selected domain, and elaborates on how thinking and practice can shift from the patient-level to organizational, community, and broader nursing contexts.
Importance and Value of Considering SDoH as a DNP-Prepared Nurse
DNP-prepared nurses are uniquely positioned to address SDoH because of their advanced training in systems leadership, evidence-based practice, and policy advocacy. Considering SDoH is valuable for several reasons:
Improved Patient Outcomes: Addressing barriers such as lack of insurance or transportation reduces preventable hospitalizations and enhances chronic disease management.
Health Equity: Nurses can advocate for policies that reduce disparities in care delivery, ensuring marginalized populations receive equitable services.
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
Among the five domains, Healthcare Access and Quality is particularly important. This domain encompasses the availability, affordability, and quality of healthcare services, as well as the ability of individuals to navigate complex systems of care.
Why It Is Important to Me
My professional experiences caring for patients with chronic illnesses such as congestive heart failure and diabetes have revealed that outcomes are not determined solely by clinical interventions but by whether patients can access timely, affordable, and culturally competent care. Many patients delay treatment due to cost, lack of insurance, or transportation barriers, leading to avoidable complications.
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 and Practice: From Patient-Level to Organizational, Community, and Nursing Fields
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.
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.
Nursing for Women’s Health (2023): This article discusses moving toward health equity by addressing SDoH, emphasizing the role of nurses in advocating for systemic reforms that improve healthcare access and quality.
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.
Examples of Practice Shifts
Patient-Level: Educating a diabetic patient about diet and medication adherence.
Organizational-Level: Implementing telehealth services to reduce barriers for rural patients.
Community-Level: Partnering with local organizations to provide mobile clinics for underserved populations.
Nursing Field-Level: Publishing research on effective interventions for improving healthcare access.
Conclusion
The Social Determinants of Health framework provides a powerful lens for understanding and addressing health inequities. For DNP-prepared nurses, integrating SDoH into practice is essential for advancing health equity, improving patient outcomes, and shaping organizational and community-level interventions.
By focusing on the domain of Healthcare Access and Quality, nurses can address systemic barriers that prevent patients from receiving timely, affordable, and culturally competent care. Shifting thinking and practice from the patient-level to organizational, community, and broader nursing contexts ensures that interventions are sustainable, equitable, and transformative.
Ultimately, addressing SDoH is not only a professional responsibility but an ethical imperative for nurses committed to delivering safe, effective, and compassionate care in today’s complex healthcare environment.
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