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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 continue our discussion of the book Nursing Leaders Driving Health Equity Tackling Social and Structural Determinants.
My guests today are Dr. Melissa Hinds, Dr. Claire McKinley Yoder, and Dr. Jannyse Tapp, three members of the inaugural NLN-Walden University College of Nursing Institute for Social Determinants of Health and Social Change, who are contributors to this book. The book can be purchased on the NLN website through the NLN bookstore. Welcome to all three of you. Thank
you. Thank you. I'd like to start by asking you to discuss the significance of the book and the significance of the book to nursing education and to the growth of your leadership in this area. I'll start thank you again for having us today. Definitely so excited to speak about this book, this work that we did. We spent a lot of time on it and we are just so happy to be here.
But I think that this book really is a critical addition to just the growing body of literature that relates to health equity and social determinants of health. And the great perspective is coming from the nursing lens. So having that different perspective I think is what gives this book a little bit more significance. It's really one of the few texts that really speaks from nursing leaders from a clinical academic and
policy standpoint. So thinking about it that way and also just helps to really operationalize what we mean by social and structural determinants of health. It really can be used for nursing education as a blueprint for faculty, students even nurses, practitioners and just moving from thinking about what social determinants of health to the actionable items that we can do to advance health equity and social determinants of health
in our respective practices. And so having an opportunity to work on his book really just helped to deepen my understanding of leadership and what that means in this health equity space. And so it just helped to further advance my interest in social and structural determinants of health. I agree and and add to that I think because so many of us, you know, as educators or whatever space that we sit in, we're often very siloed and so we don't really understand the bigger picture,
right? The bigger impact that nurses in whatever level can play in the work that we're doing. And so for me, the book really helped break it down at some levels where it could be macro and it could be micro because we all very much sit in different spaces. And honestly, we have more authority than we actually think that we have. We have a larger voice than we think that we have and really allowing nurses to have that understanding, right? To be able to to see it from a lens that
they often don't see it is really helpful. And I think as policy changes, as what we see around us changes, it's really important that we still lean into the thing that's the most important to us as nurses, which is the person. And so at whatever level you can keep leaning into the person, I think this book can really lend to that. It is a social determinant. It is focused on change. And so as a nurse, how are you a change leader and
really in the society that you live in? Thank you. Yeah, I agree with both of you. One thing that I really appreciate about the group who wrote the book is that we are all from very different , we we kind of cross the the breadth of of nursing. We have people we had people who were teaching in at the the associate degree, bachelor's, DNP, and PhD levels and really also people who were
really involved in policy. I know Melissa had a had a big role in New York with mental health and so both the policy and practice and education all together. I think that that helps the book have relevance to all types of nursing. And I think that for me, my growth as a leader with writing this book, I learned so much from my colleagues about writing, you know during
the writing process. But it also you know gave us this opportunity to really think about where should nursing be going instead of you know where have we been. So some of it's looking back but also thinking about like social and structural determinants of health. How do we really integrate those experiences so that our future nurses nurse practitioners researchers are really putting are affecting the social determinants
of health? Not just recognizing them and maybe you know doing something minor, but really having major effects so that we can reach health equity. That goes into the next question. I think when we just asking you to discuss the application of the book for research, dissemination and advancing social and structural determinants of health and social change, especially some of the exemplars like scoping reviews and bibliometric analysis.
You know, how can those exemplars be used by nursing faculty for their research course? Mhm. Well, you know, our bibliometric analysis, which was really looking at racism and where it is in the in the nursing literature. That really came out of a discussion that we had as a group where people were saying like, anytime the word racism is there in the title or the abstract, you know, we're getting push back from
reviewers. And so we explored what is what's been written about racism in the nursing literature and found that it really wasn't used prior to 2020, even though it's really foundational to those social determinants of health. And so there's really this significant bias in the system even though we don't as nurses often
want to acknowledge it. I feel like there are some changes that are starting, but I think that the bibliometric analysis and scoping reviews take this broad view of what what is out there so that we kind of have a place to start. And they're both pretty new forms of research in the last 20 years, but you're seeing they're really exploding.
And I think it there there's a need for more programs earlier in the pipeline to be really introducing students to research so that we can you know advance the numbers of researchers from diverse backgrounds because they're going to ask diverse questions and they're going to they're going to look at at the research through a different lens. So incorporating these types of things earlier on in nursing education can be
really helpful. That's great information and great advice too, especially for those with prospective researchers. Would you discuss the application of the book in the clinical setting now moving from the research setting for advancing social and structural determinants of health and social change in clinical practice? Yeah. I mean, I think
for me at least I'll kick this off. I think for me one of the most important things as I considered what I was going to do for my leadership project for the NLN was thinking about it from a large perspective. Right? So as Claire mentioned, you know, we have an impact throughout the state of New York or where I sit has an impact across
the state of New York. And one of the things that I think we were discovering was there was no commonality in how people were referring to things or how people were understanding things and really bringing it back to that baseline level of what is social determinants, how do you actually address it and then what are some resources that
you can use. I think one of the things that most people struggle with in both clinical settings is like, well, you're asking me to do this thing but how do I do this thing? Like what is the tool you're going to give me to do this thing? So really helping them to have some understanding of tools that are available and how they could apply them in very practical ways because that is the
other push back, right. How can I apply this? You're expecting me to do all this stuff and you know I have this case load that's like really large? And again, bringing it back to reality. We do understand that you know as clinicians, as providers you have a heavy burden. You have a full plate. Right. Social determinants is foundational to really providing competent, right, care. Not even
exemplary care. Competent care. And so really, how can we in our settings, regardless of your setting, really look at the person as a person and then build from there because I think as nurses, we love to say person- centered care, but sometimes we remove ourselves from
the person. And so, you know, social determinants, understanding what they are, understanding how they impact people in your community, in your clinical settings is an important thing to remind people of or introduce them to if they really have not spent time understanding it. Right. And I think, just piggybacking on what Melissa said and speaking from the clinical perspective, it has to
start from the academic portion of it. So in order to truly be able to prepare our future nurses and future practitioners to be able to work toward advancing health equity and recognizing the impact of SDOH, we have to start foundationally. So, Melissa mentioned the foundation of care is SDOH. We have to recognize that and the impact well,
we have to start at the foundational level. So in school and so the portion of my project was really about learning how for students to be able to incorporate SDOH screening into their clinical documentation. So at my institution it was a discussion how are we integrating SDOH in your course? Is it in this class? Is it in this class? And making sure that we're mapping it in and integrated into all courses. And so every
specialty had something different. And so the idea was that if we start to foundationally from the health assessment, this is something that you need to be thinking about as a future nurse practitioner, how is it that we think about SDOH? And then once we get to learn what SDOH means as we integrate it throughout the curriculum, then in your final practicums, being able to say, okay, this is what I learned and this is
how I'm applying it. So your hospital-based and your clinic based settings, they probably are getting that information about SDOH, they probably have some surveys and screeners, but how many of our students are actually looking at it? Are you asking these questions? So the idea that I had was that this is an a part of your clinical documentation. It's required for every single
patient, no matter what they present with. And so that you can start to think about the impact that SDOH has on every single person regardless of their presentation. That's great. Thank you. So, one of the questions I think or one of the main areas of interest that our listeners are going to want to know is how can they use this book in their courses. And some of our nurse educators will also want to know how we can use this for faculty
development. What are your suggestions in this area? Well, I will say as the nurse educator from my facility is that it's a great resource. I think you know our chief nurse officer has really also reviewed this book and she she understands the
importance of the book. I think as nurses again, we really have to understand what it is that we are what our charge is as nurses and and I think whatever we can do to help not only our students, ourselves, but the people above us because leadership is a major part of any organization. And so I think having the perspective in this book where you have it at all levels, right? From you as the clinician, you as the educator, you as the person with authority to
to maybe change policies. It's an important thing for I think anyone any nurse in any position to really understand that and to share that with the people around them. And that was one of the things I think this book can really do. So even if you don't feel like, well, I'm not in policy, that's true. We all impact policy in some way. I'm sure you all got emails recently from some nursing organization asking you to sign a petition
to to do something. That is policy! So you may not see your impact, but you all play a role in policy. And I think this book can do that. And I think that's the beauty of this book, too. So it's not just from one perspective. So we're talking about practice, we're talking about education, we're talking about research and policy. And so regardless of what course it is that you may teach, there's some aspect of this
book that will have relevance. And I think that really is the beauty and how any nursing educator would be able to use it in their courses. Yeah, personally I plan on using aspects of the book in my senior leadership class in the pre-licensure program. I found it very user friendly for that level and I'm excited to start exploring it a little bit more this fall. That's great to hear. Yeah. You know, another way that it could be used is really around faculty
development. So, there are questions for each chapter. And I can I can just definitely see this like even within my own university. You know, a lot of people maybe don't come in, they come into nursing education at first with either not much experience or they have a ton of experience but they don't have that theoretical background. And so you know this can really help with
kind of faculty development. What are, you know, generating ideas, thinking about thinking more deeply about some of these issues that we need so that we can be great educators and you know be sparking, asking those those important questions of our students that that cause them to think critically. I want to thank you three so much for joining us. I think this is an important
conversation. It's an important book. I appreciate your time and expertise and helping us broaden our understanding of your work and how we can begin to introduce this in our own institutions in whatever way that's most appropriate. To our listeners, I really encourage you to please take a look at this book, Nursing Leaders Driving Health Equity, Tackling Social and Structural Determinants. And again, you can find it on the NLN website in
the bookstore. And I think you'll find it very, very useful for the work that you're doing in your courses and in your programs. So again, I want to thank the three of you for joining us. I really appreciate it. Thank you. Thank you. [Music]