Table Of ContentIntegrating a Social
Determinants of Health
Framework into Nursing
Education
Jill B. Hamilton
Beth Ann Swan
Linda McCauley
Editors
123
Integrating a Social Determinants of Health
Framework into Nursing Education
Jill B. Hamilton • Beth Ann Swan
Linda McCauley
Editors
Integrating a Social
Determinants of Health
Framework into Nursing
Education
Editors
Jill B. Hamilton Beth Ann Swan
Nell Hodgson Woodruff School of Nursing Emory Nursing Learning Center, Nell
Emory University Hodgson Woodruff School of Nursing,
Atlanta, GA, USA Emory University
Atlanta, GA, USA
Linda McCauley
Nell Hodgson Woodruff School of Nursing
Emory University
Atlanta, GA, USA
ISBN 978-3-031-21346-5 ISBN 978-3-031-21347-2 (eBook)
https://doi.org/10.1007/978-3-031-21347-2
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
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Foreword
The last decade of nursing education and practice has included multiple research,
policy, and practice initiatives to fully recognize the immense influence social deter-
minants of health have on the health and illness experience of human populations.
The integration of social determinants of health into nursing education is critical to
alleviating health disparities and ultimately improving health outcomes. Nurses can
be extremely influential to the global initiative to assuage the suffering from health
inequities, poverty, and social marginalization that contributes to disparities in ill-
ness and health conditions.
However, major changes in nursing curricula can be challenging for a number of
reasons. First, the knowledge of the immensity of social determinants of health is
actively growing necessitating the integration of new knowledge on a regular basis.
Second, we have an aging nursing faculty workforce who were not taught this con-
tent in their nursing programs and therefore need knowledge development in this
area to be effective in the classroom and clinical settings. Finally, nursing curricula
are packed with new and emerging knowledge on the delivery of care to patients. A
common lament from faculty is that there is no room for additional content and/or
courses. Faculty are faced with the challenge of teaching or expanding on content
on social determinants of health when they feel there is no time to do so.
The authors of this text have written this content to assist readers in understand-
ing the journey that we are taking to seriously address the need for full integration
of SDOH into nursing education programs. We hope that it will be an important tool
for nursing educators in the quest to prepare a nursing workforce that is equipped to
address social determinants of health. The journeys that schools will take will be
different, and we welcome feedback from our readers on how helpful this informa-
tion is for your individual journey. We feel that the Emory School of Nursing 4- pillar
SDOH framework is a critical part of the map to teaching strategies in nursing to
protect and promote optimal health of the individuals, communities, and societies
that we serve.
American Nurses Association Ernest J. Grant
Silver Spring, MD, USA
v
Acknowledgments
This book is based on the work and determination of the faculty of the Nell Hodgson
Woodruff School of Nursing at Emory University to integrate social determinants of
health throughout its prelicensure and advanced practice nursing curricula. We are
grateful for the faculty and students who either contributed to the work presented in
this text or informed the content necessary for the implementation of SDOH into
our courses.
Finally, we would like to acknowledge with gratitude the support from Nell
Hodgson Woodruff School of Nursing administrative staff Margie Hutson, Kaye-
Ann Sadler, and Shanice Smith and to Connor Swan for the original artwork in
Chap. 5.
vii
Contents
1 Social Determinants of Health: Call for Nursing
Education Reform . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Linda McCauley
2 Integrating a Social Determinants of Health Framework
into Nursing Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Jill B. Hamilton
3 Canvas Faculty Development Site . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Adarsh Char
4 Curriculum Mapping: Integrating Social Determinants
of Health Within Nursing Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Autherine Abiri, Wanjira Kinuthia, and Elizabeth Downes
5 SDOH in Action: Exemplars of Incorporating SDOH
Content in Entry-Level and Advanced-Level Nursing Education . . . . 131
Beth Ann Swan, Lalita Kaligotla, Autherine Abiri, Lindsey Allen,
Amy Becklenberg, Christina K. Bhatia, Sofia Biller, Susan Brasher,
Rasheeta Chandler, DeJuan Charles, Erica Davis, Anneke Demmink,
Harrison Boyd Diamond, Elizabeth Downes, Rebekah Elting,
Wendy R. Gibbons, Nicholas A. Giordano, Jill B. Hamilton,
Caroline Kee, Stephanie Lee, Alyssa Meadows, Lori A. Modly,
Kenneth Mueller, Caitlyn Plattel, Melissa Poole-Dubin,
Maria-Bernarda Saavedra, Isake Slaughter, Shaquita Starks,
Susan L. Swanson, Isabella Upchurch, Jessica Wells, Phyllis Wright,
and Irene Yang
6 Evaluating Social Determinants of Health Integration
in Nursing Curricula. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Lisa Muirhead, Susan Brasher, Rasheeta Chandler,
and Laura P. Kimble
ix
x Contents
7 Aligning SDOH Pillars to Learning Outcomes and Assessments . . . . . 197
Wanjira Kinuthia, Autherine Abiri, Jill B. Hamilton, and
Adarsh Char
8 Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Jill B. Hamilton, Adarsh Char, Linda McCauley, Autherine Abiri,
Laura Kimble, Lalita Kaligotla, Beth Ann Swan, and Kristy Martyn
Social Determinants of Health: Call 1
for Nursing Education Reform
Linda McCauley
Learning Objectives
1. Describe the roots of public health nursing practice in nursing history and how
this heritage remains a strong influence on the health of individuals and com-
munities today.
2. Explain how Thomas Frieden’s 5-tiered Health Impact Pyramid illustrates the
potential impact of nursing interventions that target social determinants of health.
3. Give examples of the successful integration of SDOH knowledge in nursing
practice, research, and policy.
Introduction
The past two decades have seen increasing attention paid to the roles that social fac-
tors play in determining risk of illness. The World Health Organization’s (WHO’s)
Commission on the Social Determinants of Health (2008) has defined SDOH as
“the circumstances in which people are born, grow, live, work and age” and “the
fundamental drivers of these conditions” (p. 2) [1]. Generally, social determinants
of health refer to broad categories of influence that can affect health-related behav-
iors and outcomes in multiple domains of life. Knowledge is rapidly expanding in
this area, exposing the importance of SDOH in shaping health, including the plau-
sible pathways and biological mechanisms that may explain the broad effects of
SDOH [2].
The large influence of SDOH illuminates, in part, the failure of many countries
to achieve positive health outcomes among all populations, despite rapid advances
in medicine and healthcare. McGinnis, Williams-Russo, and Knickman (2002)
L. McCauley (*)
Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
e-mail: [email protected]
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 1
J. B. Hamilton et al. (eds.), Integrating a Social Determinants of Health
Framework into Nursing Education, https://doi.org/10.1007/978-3-031-21347-2_1
2 L. McCauley
estimated that medical care contributes to only 10–15% of preventable mortality in
the USA [3]. In contrast, a meta-analysis of the issue by Galea and colleagues
(2011) concluded that, in 2000, the number of US deaths attributable to low educa-
tion, racial segregation, and low social support was comparable with the number of
deaths attributable to myocardial infarction, cerebrovascular disease, and lung can-
cer, respectively [4].
Nursing History and SDOH
Nursing has long recognized the link between the social context of one’s life and the
ability to be healthy. Nursing, with its roots in public health, demonstrated that ser-
vices delivered in homes and neighborhoods where people lived and worked were
effective in improving the health of persons in those communities. Lillian Wald first
used the term “public health nurse,” believing that nurses must address social and
economic problems, not simply take care of sick people [5]. Philosophically, Wald
believed that public health nursing should involve the health of an entire neighbor-
hood, as well as cooperation among stakeholders and communities, to help improve
living conditions. In the last decade, public health nurses have remained the largest
sector of the public health workforce, and yet their number is strikingly low given
the total number of four million nurses in the USA [6]. A 2012 study estimated there
are less than 35,000 nurses working in public health departments [7]. While many
nurses work outside acute care settings, it is not known to what extent they practice
public health nursing or if their roles include interacting with social agencies to
improve SDOH in a population framework.
While no one disputes the value of public health nursing, the latter half of the
twentieth century saw an emphasis on medical discovery and hospital care.
Investment in the country’s public health infrastructure was reduced, and fewer city
and county public health departments could maintain a robust nursing workforce to
interact with patients in their homes, schools, and communities. The majority of
new nursing graduates are now employed by hospital systems and have little-to-no
time to focus on the social context of patients’ lives. Decreasing hospital length-of-
stay also has contributed to nursing having less time to interact with patients and
families before discharge and few opportunities to follow up in the community.
Even nurses working in ambulatory settings are often in specialty clinics where the
emphasis is on managing the disease process. Focusing on tertiary care has caused
the profession to lose much of its lens on the importance of SDOH in predicting
patients’ overall health [8, 9].
Nursing Care to Reduce Health Disparities
The ultimate goal of integrating SDOH content into nursing curricula is to improve
health outcomes for all through more nuanced and contextualized nursing care.
Nursing curricula have historically concentrated on individual-level factors to
