Introduction
Social determinants of health mostly cause unjust and avoidable disparities in health status within and across nations. The social settings in which individuals are born, develop, live, work, and age are social determinants of health (SDOH). The allocation of wealth, authority, and resources at the international, governmental, and local levels influences these conditions. Public health outcomes can be significantly impacted by resources that improve quality of life, such as access to secure and affordable housing, educational opportunities, job opportunities, and nearby medical services. People who live in areas with poor SDOH, such as those with insecure housing, low income, hazardous surroundings, or inadequate educational standards, have dramatically different health outcomes.
Frank, a 56-year-old man, was directed to the primary care clinic following an emergency department (ED) visit for stomach discomfort. This is the first time he has received primary care in many years. He has a history of alcohol and cigarette abuse and has chronic pancreatitis. He is divorced, unemployed, without insurance, and has only completed school through the eighth grade. He has recently been sleeping on the sofa at a friend’s house. He is thin, despondent, and appears unkempt. He frequented the ED since he did not know where to go when unwell. Understanding how the SDOH affects the patient’s health outcome is crucial because it gives the greatest possible strategy for assisting the client in accessing quality care and recovery.
Impact of Social Determinants of Health on the Patient
Socioeconomic position is the main non-medical element that impacts health. Wealth, education, or employment can all be used to determine socioeconomic class. Economic mobility, socioeconomic position, and health are all influenced by education and work status. Lower levels of education are linked to lower incomes and increased unemployment rates (Daniel et al., 2018). Joblessness is an important risk factor for drug use and the associated emergence of substance abuse disorders. Frank finished eighth grade in his school but has no insurance and is presently unemployed. The client’s addiction to alcohol and tobacco misuse may have been fueled by the stress of being unemployed, which ultimately led to chronic pancreatitis. Furthermore, those who worry about finding a secure place to sleep may not be worried about their health and well-being. When seeking shelter, it is more difficult to manage chronic conditions, maintain wellness checks, or access basic preventative treatment for minor diseases. Frank was sleeping on a couch in a friend’s apartment since he did not have his own place.
Dorothea Orem: The Self-Care Deficit Nursing Theory
Self-care, the environment, nursing systems, and health are all aspects of Self Care Deficit Theory. Physical and social settings, healthy habits, financial position, education, and access to health care are all examples of social determinants of health. Nurses are placed on healthcare’s front lines to evaluate SDOH and promote health equality. Once the SDOH has been determined, it is the nurse’s responsibility to cooperate with other healthcare members to assist the patient in dealing with these determinants. In the scenario, for example, Frank accessed primary care for the first time in many years. This might be because he did not have health insurance and hesitated until his condition worsened, resulting in chronic pancreatitis. Studies regularly reveal that the uninsured are far less likely than those with insurance to obtain preventive treatment and services for severe health issues and chronic diseases (Fernandez-Lazaro et al., 2019). The NP can recognize these individuals and direct them to copay assistance initiatives to aid with out-of-pocket medication expenditures.
Social determinants of health can sometimes be mistaken for noncompliance. This might be caused by a lack of transport to hospital appointments, unhealthy behaviors, or financial position. When analyzing the patient, it is critical to address questions about their health, such as why they are losing or gaining weight. In this situation, Frank was noticed to be unkempt and very thin. A patient may be losing weight since they cannot afford quality meals. The patient was unemployed and divorced at the same time. When an individual is unemployed and has no other source of income, they experience a great deal of stress and despair. These people require support, particularly from caregivers like nurses. Orem outlined five techniques for assisting with a lack of self-care: acting for and doing for others, directing others, supporting others, establishing an atmosphere that promotes personal growth to meet future needs, and educating others (Martiningsih et al., 2021). Orem’s theory reinforces the nursing process of evaluation, diagnosis, and implementation.
Using Orem’s Self Care Theory assists nursing personnel in appropriately evaluating patients for whom they provide care. The theory aims to guarantee that patients may be self-sufficient and accept responsibility for their care (LeBlanc & Jacelon, 2018). Self-care involves drinking enough water, eating enough food, taking prescriptions, and sleeping enough. It also involves people maintaining a healthy balance of exercise and rest and having affordable access to medical treatment. If this is not possible during an evaluation, the nurse might act to help the patient by guiding them to the necessary medical treatment. The nurse can collaborate with other healthcare team members, including sociCanal workers, dietitians, and navigators, to help patients with monetary, insurance, and dietary issues.
How the Nurse Practitioner can Promote Social Justice
For nurse practitioners (NPs) to give effective treatments, they must thoroughly understand every patient’s social setting. The practice context requires awareness of the larger political, economic, and social determinants of health. NPs have a social, moral, and ethical need to respond to healthcare disparities on a societal level. NPs must actively advocate social change, a perspective that has to be emphasized and vigorously pushed. Health and well-being are affected by access to housing, public safety, education, and food security.
Encouraging policy change is one way the nurse practitioner may advance social justice. Nurses can have a significant and far-reaching influence on people’s health when they participate in policy reform as an intermediate driver of health. Public policies significantly impact healthcare professionals, institutions, and the communities they serve. In light of this, nurses may support health equality by influencing public policies and decision-making at the local, state, and national levels through a health lens. Interacting with the public, decision-makers, and management staff about health inequalities and SDOH may help guide health-related public policy. The conversation should center on both problems and potential remedies for addressing health via activities aimed at attaining health equality.
Screening Tests
Specialized screening technologies can help medical professionals evaluate and keep track of patients’ demands and risk factors in healthcare institutions. First, the Centers for Medicare & Medicaid Services (CMM) established the Health-Related Social Needs (HRSN) Screening Tool as a classic screening tool. It examines the impact of routinely screening for health-related social needs on healthcare expenses and health outcomes. The HRSN Screening instrument is essential for the patient since it consists of ten elements divided into five domains: housing instability, transportation issues, food insecurity, utility help requirements, and interpersonal safety (Holcomb et al., 2022). The second screening tool, the PRAPARE Implementation and Action Toolkit, gather information, best practices, and insights from treatment centers on conducting an SDOH data-gathering project. In addition, an evaluation tool is included with the toolbox. The tool was created after an evaluation of the SDOH, a collection of national core metrics that aid in standardizing data collecting.
Community Resources
A productive strategy to offer assistance and resources to the patient is by including community groups, social workers, or community health workers in practice. The effect is greater the earlier and more thoroughly healthcare personnel, including community leaders and other partners. Collaboration and multisectoral action are needed to involve other sectors, such as education and employment, in fostering healthier settings to improve individual and population health. This is frequently made possible with public health partners already proactively addressing socioeconomic determinants through increasing community-based initiatives for improving health equality.
The patient and the entire community can benefit from media advocacy by learning more about the problems impacting their health. Media advocacy is the deliberate use of broadcast, newspaper, and social media to promote economic, social, or environmental change. It is a phenomenal method for getting the attention of influential decision-makers and reaching vast populations. Radio, television, newspaper, and other media like Facebook and Twitter are used by mass media campaigns to communicate with the public. Public health mass media initiatives have traditionally emphasized promoting personal behavior change, including reducing cigarette use and underage drinking. As an option, media advocacy may be made to modify social norms, governmental regulations, and community-wide responses to inequalities.
Conclusion
The best method for aiding the client in obtaining high-quality care and recovering depends on a thorough understanding of how the SDOH affects the patient’s health. Social determinants of health account for most of the unfair and preventable health status inequalities within and across communities. Resources that enhance the quality of life, such as accessibility to safe and affordable housing, educational prospects, employment opportunities, and nearby medical services, can substantially influence public health outcomes.
References
Daniel, H., Bornstein, S. S., Kane, G. C., & Health and Public Policy Committee of the American College of Physicians*. (2018). Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Annals of Internal Medicine, 168(8), 577-578. Web.
Fernandez-Lazaro, C. I., Adams, D. P., Fernandez-Lazaro, D., Garcia-González, J. M., Caballero-Garcia, A., & Miron-Canelo, J. A. (2019). Medication adherence and barriers among low-income, uninsured patients with multiple chronic conditions. Research in Social and Administrative Pharmacy, 15(6), 744–753. Web.
Holcomb, J., Oliveira, L. C., Highfield, L., Hwang, K. O., Giancardo, L., & Bernstam, E. V. (2022). Predicting health-related social needs in Medicaid and Medicare populations using machine learning. Scientific Reports, 12(1). Web.
LeBlanc, R. G., & Jacelon, C. S. (2018). Self‐care among older people living with chronic conditions. International Journal of Older People Nursing, 13(3), e12191. Web.
Martiningsih, W., Winarni, S., Acob, J. R., Baua, Ma. E., & Nugroho, H. (2021). Transactional self care and empathy theory in nursing (A perspective). Open Access Macedonian Journal of Medical Sciences, 9(G), 273–280. Web.