Defining the social determinants of health for nursing action to achieve health equity: A consensus paper from the American Academy of Nursing.

BACKGROUND: The 2019-2020 American Academy of Nursing (Academy, 2019) policy priorities document states that "they have a clear and distinct focus on social determinants of health and uses this lens to advance policies and solutions within each of the three overarching priorities" PURPOSE: This consensus paper seeks to establish conceptual clarity and consensus for what social determinants of health mean for nursing, with emphasis on examples of health policies that advance planetary health equity and improve planetary health-related quality of life. METHODS: Volunteers from five Expert Panels of the Academy met via videoconference to determine roles and refine the focus of the paper. After the initial discussion, the first draft of the conceptual framework was written by the first three authors of the paper and, after discussion via videoconference with all the co-authors, successive drafts were developed and circulated for feedback. Consensus was reached when all authors indicated acceptance of what became the final version of the conceptual framework. FINDINGS: A conceptual framework was developed that describes how the social determinants of health can be addressed through nursing roles and actions at the individual, family, and population levels with a particular focus on the role of health policy. The paper provides a specific health policy example for each of the six key areas of the social determinants of health to illustrate how nurses can act to improve population health. DISCUSSION: Nursing actions can support timely health policy changes that focus on upstream factors in the six key areas of the social determinants of health and thus improve population health. The urgent need to eliminate systematic and structural racism must be central to such policy change if equity in planetary health-related quality of life is to be attained.

Nursing science and public health: contributions to the discipline of nursing.

This column highlights the unique relationship of nursing science and public health in the broader context of the discipline of nursing and healthcare. An integrated framework is used to illustrate that nursing knowledge is the product of interaction and interdependence of four domains -the discipline and science of nursing, the philosophy of nursing, the nursing profession, and nursing practice. In the context of the integrated framework, knowledge specific to public health nursing is shown to inform the discipline of nursing and other health disciplines. Ongoing challenges related to clarifying and describing unique contributions to nursing and public health are explored. In addition, under utilization of theoretical and conceptual nursing knowledge from public health nursing for the advancement nursing science in education, practice, and research is addressed.

Caseload management skills for improved efficiency.

This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.

Clinical specialist in community health nursing: advanced practice fit or misfit?

The purpose of this paper is to address several questions and issues about the clinical specialist role in community health nursing. A brief history of the development of the clinical specialist role sets the background for a discussion of how the community health nurse specialist fits within advanced practice nursing. The rationale for including the community health nurse clinical specialist role with other specialist roles is presented. The purpose and importance of certification at the advanced practice level in community health nursing are presented. Continued discussion about these and other issues of importance for the specialty is encouraged.

Community readiness for a computer-based health information network.

The need for timely and accurate communication among healthcare providers has prompted the development of computer-based health information networks that allow patient and client information to be shared among agencies. This article reports the findings of a study to assess whether residents of an upstate New York community were ready for a computer-based health information network to facilitate delivery of long term care services. Focus group sessions, which involved both consumers and professionals, revealed that security of personal information was of concern to healthcare providers, attorneys, and consumers. Physicians were the most enthusiastic about the possibility of a computer-based health information network. Consumers and other healthcare professionals, including nurses, indicated that such a network would be helpful to them personally. Nurses and other healthcare professionals need to be knowledgeable about the use of computer-based health information networks and other electronic information systems as this trend continues to spread across the U.S.

Does patient satisfaction contribute to nursing care quality?

The use of patient satisfaction tools is routine in healthcare facilities. What actually do the results of patient satisfaction surveys tell us about the quality of nursing care? The purpose of this article is to provide a discussion about patient satisfaction and nursing care. Recommendations are offered about how patient satisfaction may be used to improve nursing care and what changes may be needed to achieve a high level of patient satisfaction.

Environments of care: a curriculum model for preparing a new generation of nurses.

This article provides a perspective on the community-based curriculum model that has guided undergraduate education for the past decade, discusses some of the problems that have emerged with the community-based approach, and proposes an alternative approach for consideration and discussion. The community-based model is discussed in relation to three major areas of concern: faculty and preceptor implementation of the curriculum, entry into practice and hiring pattern disjunctions, and trends and unexpected consequences of changes in the health care system. The Environments of Care Model, proposed as an alternative curriculum approach, conveys a broad perspective on health and illness, based on a multiple determinants of health paradigm and a systems framework.

Nursing care quality: process and outcome relationships.

The relationships between variables in a proposed model for the quality of nursing care provided in the home were examined using a cross-sectional correlational design. Sixty patients discharged from a home-care agency were interviewed in their homes using instruments to measure the model's 7 variables. It was proposed that nursing care provided is related to 3 aspects of the interpersonal process--affective support, health information adequacy, and decisional control--and that these 3 variables are related to 3 outcomes--adherence, symptoms, and well-being. The findings support relationships between technical and interpersonal process components. Significant relationships were found between health information adequacy and adherence and between decisional control and well-being. The authors conclude that further refinement of the model will help to build a stronger foundation for the study and provision of quality nursing care.

Heart failure and weight gain monitoring.

Heart failure is one of the most common diagnoses of the elderly in the United States. The nursing literature has demonstrated that nursing interventions aimed at effective discharge planning and appropriate self-care activities can improve outcomes for patients hospitalized with heart failure. The purpose of this research was to identify, through retrospective medical record review, the discharge instruction related to self-weight monitoring provided to a sample of heart failure patients. The patients in the sample were 65 years and older with an ICD-9 diagnostic code of heart failure upon discharge from an acute care hospital in the Midwest. Results demonstrated the lack of nursing attentiveness to teaching self-monitoring weight gain to heart failure patients while hospitalized and the need for more comprehensive planning for appropriate discharge referrals. Suggestions are made for expanding documentation tools to improve nursing discharge planning and case management to ensure that the patient or caregiver is able to carry out self-care activities at home.

Development of an instrument measuring family care.

This study developed and evaluated an instrument to measure the quality of care given by family members to a patient in the home. The Family Care Measure consisted of 11 items, each of which was rated on a visual analogue scale. Fifteen registered nurses rated the care given by families of 72 eligible patients for whom the nurses had provided nursing care. Estimation of the reliability resulted in a high internal consistency. With deletion of five items from the measure, the internal consistency reliability resulted in a Cronbach's alpha coefficient of .93. The six-item instrument correlated moderately, as predicted, with a scale of family coping (r = .76). With acceptable reliability and evidence of construct validity, this measure may be used in research studies, but further testing to assess its usefulness in clinical situations is recommended.

Clinical coaching: a strategy for enhancing evidence-based nursing practice.

PURPOSE: The purpose of this article is to describe how clinical nurse specialists can promote the development of knowledge and skills in nurses as one step toward making evidence-based nursing practice the norm in all patient care settings. BACKGROUND: The need for the use of evidence in nursing practice has been highlighted for several decades. Moving evidence more quickly into practice requires that nursing use many strategies. DESCRIPTION OF STRATEGY: The strategy of clinical coaching is proposed in this article for the development of skills in nurses specifically to promote evidence-based nursing practice. Clinical coaching is a relationship for the purpose of building skills. This strategy is aimed at increasing foundational staff nurse knowledge and skills. CONCLUSION: The achievement and maintenance of evidence-based nursing practice take continuous attention from clinical nurse specialists. Clinical coaching is only one part of a comprehensive approach for establishing and sustaining evidence-based nursing practice.