Bridging education and practice: Examining nursing students' engagement with social determinants of health through patient encounter surveys

BACKGROUND: Nursing education emphasizes social determinants of health (SDOH) to promote health equity and care, but evidence of students' application in practice remains limited. 

PURPOSE: This program evaluation examined the extent to which Bachelor of Science in Nursing students addressed SDOH, and the domains most and least addressed. 

METHODS: Senior bachelor of science in nursing students (N = 137) completed a survey covering 999 encounters in Spring 2025. The survey assessed engagement with 23 SDOH domains using 4 response options: not addressed, observed, collaboratively addressed, and independently addressed. 

RESULTS: Students addressed at least one SDOH in 91% of encounters. Commonly addressed domains were social support, primary care access, health literacy, housing, and employment. Least addressed were immigration status, discrimination, climate change, civic participation, and neighborhood safety. Students addressed SDOH collaboratively or independently in 59% of encounters. 

CONCLUSION: Students engaged with common SDOH, but gaps in structural determinants suggest the need for targeted curricular, clinical, and preceptor-focused training and assessment strategies.