Integrating the social determinants of health into nursing practice: nurses' perspectives

Purpose: The purpose of this study was to assess nurses' knowledge, perceived self-efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice.

Design and methods: A cross-sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71-item SDoH Survey, which measured nurses' confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients' social and economic conditions, and awareness of their institution's health equity strategic plan to achieve health equity. The institution's health equity strategic plan reflects the organization's commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings.

Findings: Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers.

Conclusions: Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs.

Clinical relevance: Findings from the study have implications for supporting the educational and resource needs of front-line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.