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Welcome to this episode of NLN podcast Nursing EDge Unscripted. I'm your host, Dr. Steven Palazzo, a member of the editorial board for Nursing Education Perspectives. In this episode, we will discuss the book "Nursing Leaders Driving Health Equity Tackling Social
and Structural Determinants." My guests today are Dr. Deborah Finn-Romero, Dr. Sarah Kaylor, and Dr. Megan Jester, three members of the inaugural NLN Walden University College of Nursing Institute for Social Determinants of Health and Social Change who were contributors to this book. This book can be purchased on the NLN website through the NLN bookstore. I'd like to welcome my guests. Thank you very much Steven. Great to be here. We're happy to
have all three of you. So just to start with just please discuss the significance of your book. I have a copy of it right here. That's it. I'll hold it up again so that everybody can see it. Well I guess I'll start and Sara and Megan will I'm sure jump in and have things to say
for sure. Actually, the work came out of our cohort with the NLN and Walden University and it really was inspired by one of our our colleagues there that really felt like in order to encapsulate all of the projects that were we were moving forward with and taking on to really address issues around social determinants of health and health equity that we should just pull it together and create
a book. And so you know we were sitting in a room of expertise and really, really motivated and passionate individuals and I'm really grateful to Phyllis Morgan. She's our colleague that inspired this for putting it out on the table and we just really tapped each other's expertise and wealth and came together in one collective voice to share it for the communities.
It, you know, there's so much going on out there that doesn't necessarily represent the the social issues around health and this was something very specific for nursing, for nursing education, for nursing leaders to help encapsulate some real usable tools to get out into our profession. I
absolutely agree. I think that at the time of our cohort with the leadership academy, you know, we were kind of coming off of the pandemic and we know that pandemic did not create health inequities but it certainly worked to expose those in ways that our group just could no longer ignore. And so the book that came out of our cohort really was intended to meet that moment.
The book calls us to go beyond what we've always done, beyond just simply recognizing disparities and really wanted to challenge and empower people to address the structures that produce
those disparities. So really it was meeting that moment, that shift from cultural competence to structural competence that the book describes, is really where the work begins I feel like because it's really not just about understanding our patients lives but also understanding and challenging and changing the systems that shape those lives. And I would add on by saying that we all came to that space from different parts
of the country. We represented coast to coast. We represented different backgrounds, different lived experiences and we came together to provide these anchor points that we could disseminate to our broader nursing community and really laying the foundation in this book for solutions-oriented approaches to tackling these issues. So making it not just theoretical but actionable. Wonderful.
Absolutely. I think, I think to piggyback off of what Megan was saying, I think absolutely the work of this book and the work of the cohort was
100% tied to leadership. Our experiences in the academy really helped hone in and emphasize if not develop a unique set of skills, those skills of advocacy, policy engagement, systems thinking, all of these skills were kind of reflected throughout the book in a way that doesn't use those words to mean that they're just buzzwords but instead they're competencies and that this book really
helps leaders build those competencies. Yeah and the process that we went through in the academy
had a lot of crucial conversations in it. It had us really engaged with the complexities as maybe a little bit of a microcosm of what goes on in the broader range of society tackling uncomfortable situations, uncomfortable topics to really dig into the nuance and reflect and hear one another to come together as a collective, as one voice, and the book represents really what that one voice is as a way to move forward in complexity around
equity issues. Provide us with your insight on the importance of the introductory chapter. You know, I ask guests who come frequently to the podcast how do we use your information? How do we practically use it in the classroom? Because there's a lot of great ideas out there and a lot of, like you said, buzzwords and information, but we sometimes lose that just like in the clinical space, right. We use that translational piece from the research
and then to the actual implementation. What I think is so great about this book is that, especially the first chapter and going back to the introduction, is what I want you to speak to, but the first chapter and we'll get to that in the next question, is how practical it is as a tool to develop curriculum and use it to generate outcomes for student learning in these subject matters. And you get great examples and things like
that. So the first question is basically talk about the introductory chapter and the importance of setting that up and then the usefulness of this in the classroom for the the instructor or the professor who wants to use the information. Sure.
I'd love to tackle that first part and then I'll bounce it to a colleague for the second part, but I think, you know, the first sentence of the book is it, you know, "This [chapter] focuses on the interconnectedness between the individual, the family, and the community..." And I think that that right there, that interconnectedness, is the heart of social and structural determinants of health.
These are not just isolated issues; instead they are very layered, multi-faceted, complex and often invisible issues to those who benefit from the way that things are. I feel like that sentence of that first chapter really sets the stage then for the book in terms of why the book centers on
collaboration. Collaboration not just in a cohort of leaders who are writing and collaborating on the project together, but collaboration on ... it's not just nursing versus medicine or versus public health, it's all of us. It's interdisciplinary. It's interprofessional. It's intersectional. And that's also why I think advocacy has a theme in every chapter of the book as well because nurses
have always been advocates. It's what we do. But here the book calls us to scale that advocacy up to the institution, to the state, and to the
national level. And I'll speak to the key terms in the introduction because we really thoughtfully reflected on what we needed in this book beginning in the introduction to establish that shared vocabulary around these challenging and complex concepts to really operationalize these concepts and provide that evidence-based background to define these so that reader can really understand the why behind these definitions
as they go on to the subsequent chapters. Process that theoretical information and then also process those case studies and reflect on how they can turn around and use these case studies to apply in their classroom, but also scale up to meet the needs of their communities. Yeah and just to follow with that a little bit Megan and Steven. The way that the book is structured is outlined in the introduction and so it talks about call to action.
So they're usable tools as Megan's speaking of. We give examples of case studies. We give ways that that the topics have been implemented in communities. So we have the first chapter, as you referred to, on curriculum. So these are some usable ways that you can build into a classroom how you want to start tackling these concepts and bringing these issues forward to the student body. There's a chapter on administration. There's a chapter on
clinical partnerships. There's a chapter on research and dissemination of knowledge and then clinical practice. There's one specifically on clinical practice. So all of these chapters really represent real life experience that has been brought forward as examples of ways that it can be carried out in whatever field of nursing that the nursing leaders are participating in.
Well expand on a little bit of that. What I really wanted to expand on is talking a little bit more about, too, the how nurse education can use this book. So segueing into that because I'm actually considering using it as my book, my textbook for my leadership course that will be a new course that we developed that will be starting this fall. I think it's an interesting leadership course in Florida, you know, we have to be careful about the language we use for course titles.
So it's leadership for systems care. You know, the word equity is not in the title so there are challenges right now with the current political climate of some of the buzzwords and how we can use and facilitate this type of curriculum in more challenging environments. Boy that sounds like a Sarah and Megan question. You know, Sacramento State is all in on doubling down on use of DEI.
We're quite public about it. We're quite open about it, but I know Megan and Sarah are in states that are bit a little bit less open to those terms right now so. And I'm in Florida yeah. So you are too. Yeah. Yeah. So what do you think, Megan and Sarah? How do you want to address these issues? I think it's a challenge that we're going to see unfold. It's unfolding and continue to unfold and it's not something that can have a very simple
and easy fix. In terms of how to use the book, you know, whether you're a faculty member or you know a practice partner, I almost see individuals using the book as a companion particularly in that faculty role. If you're using this, you know use it as a course companion. The book can serve as a lens to help revise curriculum. It can be used as a lens to help review policies and also to help individuals just rethink their assumptions. So a lot of times that work can happen behind
the scenes. We know ... we know we're promoting the work that we're doing without having to explicitly call it things that you know might be frowned upon at certain institutions. But a group of faculty members could certainly use this as a companion when they're looking at their policies to determine which policies support equity, what might be unintentionally maintaining barriers for
admissions. I think one of the examples provided in the book does look at holistic admissions and speaks to making sure that there aren't unintentional structural barriers that might be at play. I also think it's so important as nurses in all areas of practice to be very mindful of the ever-changing landscape not just within your local or state communities but across the country. We really, in some states where we do have state legislation or executive orders that are are
targeting words. We have to phone a friend in another state for additional resources, additional training and we hope that this book can be that resource. And it really begins with us at
an individual level. So looking at the end of the introduction chapter ... and subsequent chapters, there's reflection questions and you can use those as an individual to really look at your own bias, your own assumptions, your own privilege and transform that mindset, but also using it in your classroom, you know.
For example, I think the reflection questions at the end of the introductory chapter are a great way to have a conversation at the end of a clinical day in post-conference with your clinical group or at the pre-licensure level but also scaffolding it to the graduate level if you are rounding and you have driven a few hours to see a student like you would in my state and spend some time with them and talk about the work that they are doing in that local community
and thread those reflection questions in. And there are ways to be that you can be strategic, being mindful of the state you live in. Whether you can say the words out loud or you just you have to be strategic with how you say that, but it really doesn't take, it's not taking away from the work that we are doing. We are just having to pivot for the time being to meet the needs. Yeah.
It's such an integral part of nursing is to provide care for all people and I think that it is so challenging in our current political climate to stand as nurses in that position of what our work is, but yet it's a crucial
component. And I really want to just take a minute to acknowledge Sarah and Megan and my colleagues that are in states that have this at the state level, not just the federal level of what we're currently looking at, and there's you know, the pressure on universities right now is big. And to respond to that in a way that doesn't harm academic freedom, that doesn't harm the integrity of a discipline and a profession has to be done with care and
thoughtfulness. And I really in some ways I feel real fortunate where I'm at, but in other ways there's a whole other set of potential consequences for the position that we take. But the bottom line is is as nurses, as nursing educators, we have a duty to our population. We have a duty to our patients. We have a duty to our communities no matter what. And I think that our cohort fully stands behind that regardless of what's happening in any level of society outside of health
care. We're going to be here for all people. And the book really gives us, it gives educators, it gives the community a roadmap on how to engage with those communities and whatever language is necessary to utilize to still fulfill that purpose that will have to be navigated. But the actual implementation of it is available in the book.
We have tangible tools in here too and I love the fact that Megan talked about the reflection questions because even if you're in a group and you're trying to figure out how to grapple with these concepts where we're getting such conflicted messages from other parts of society, this is a way to have a conversation around these crucial necessary happenings in our society. I'm looking for the right word to describe this. You can see Sarah's like, "Yeah I can hear it Deb."
But the complexity of what we're living in today. Right, right. All right. Well, what a ... that's a great way to end the conversation is we have a duty. And this book, you know, I found it very useful reading through it and very engaging and offering lots of opportunities for us to figure out how to use our language to incorporate this into our our classes and courses when we're talking from the perspective of a student in a university
setting or college setting. And so I want to thank you for joining us so much for this important conversation. I really appreciate your time and your expertise and helping us understand your work and how we can actually start using some of your work in our own institutions. And to our listeners, please, please look for the book, "Nursing Leaders Driving Health Equity Tackling Social and Structural Determinants," on the NLN website. And I want to thank everyone for
joining us today. Thank you so much Steven. [Music]