SDOH AND SOCIAL CHANGE
“A good intention, with a bad approach, often leads to a poor result.”
―Thomas Edison
The U.S. Department of Health and Human Services (HHS) has identified five areas that impact one’s social determinants of health (SDOH), which include economic stability, education, social and community context, health and healthcare, and neighborhood and surrounding environment (ODPHP, 2020). And although the United States spends more money on healthcare than other highly industrialized countries, according to the National Academies of Sciences, Engineering, and Medicine (2021), it has some of the poorest health outcomes of other developed countries.
As nurses, we identify the inequities that affect our patients outside of medical care, such as lack of money to purchase needed medications, transportation, food insecurity, poor housing, and fear of safety in the neighborhood. Because of these factors, understanding the impact of the SDOH, in shaping one’s health, is critical to today’s nursing workforce.
As noted in the introductory quote from Thomas Edison, addressing SDOH and developing strategies with good intentions and a bad approach, to promote positive social change, may not help the patient, the community, nor the organization. Planning for change by using a translation model, instead, assists the organization and ensures that a variety of stakeholders have plan input, implementation time is decreased, and outcomes are clearly identified.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Learning Resources
· Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
· Chapter 8, “Translation” (pp 189–205)
· Chapter 10, “Exemplars” (pp 223–243)
·
Appendix A, “PET Process Guide” (pp. 279–282)
Download Appendix A, “PET Process Guide” (pp. 279–282)
Note: You previously purchased this text for NURS 8002.
· White, K. M., Dudley-Brown, S., & Terhaar, M. F. (Eds.). (2024). Translation of evidence into nursing and healthcare (4th ed.). Springer.
· Chapter 19, “Population Health Exemplars” (pp. 355–380)
· Chapter 20, “Specialty Practice Exemplars” (pp. 381–426)
· Chapter 21, “Healthcare System Exemplars” (pp. 427–466)
Note: You are only required to read
one of the three exemplars above. Select the exemplar that best aligns with the practice or organization issue you select for the Week 8 Discussion.
· Johns Hopkins Nursing Center for Nursing Inquiry. (n.d.).
Evidence-based practiceLinks to an external site.
. Johns Hopkins Medicine.
Literature Review Assignment Resources
· Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021).
Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
· Chapter 5, “Searching for Evidence” (pp. 99–128)
· Chapter 6, “Evidence Appraisal: Research” (pp. 129–162)
· Chapter 7, “Evidence Appraisal: Nonresearch” (pp. 163–188)
·
Appendix B, “Question Development Tool” (pp. 283–288)
Download Appendix B, “Question Development Tool” (pp. 283–288)
·
Appendix E, “Research Evidence Appraisal Tool” (pp. 297–306)
Download Appendix E, “Research Evidence Appraisal Tool” (pp. 297–306)
·
Appendix F, “Nonresearch Evidence Appraisal Tool” (pp. 307–314)
Download Appendix F, “Nonresearch Evidence Appraisal Tool” (pp. 307–314)
·
Appendix G, “Individual Evidence Summary Tool” (pp. 315–316)
Download Appendix G, “Individual Evidence Summary Tool” (pp. 315–316)
·
Appendix H, “Synthesis and Recommendations Tool (pp. 319–323)
Download Appendix H, “Synthesis and Recommendations Tool (pp. 319–323)
Note: Be prepared to complete and submit Appendices B, G, and H for your Assignment this week.
Also Note: You previously purchased this text for NURS 8002.
· Bermudez, N. (2021).
Formulating well-written clinical practice questions and research questionsLinks to an external site..
Nursing and Health Sciences Research Journal, 4(1), 70–82.
· Echevarria, I. M., & Walker, S. (2014).
To make your case, start with a PICOT questionLinks to an external site..
Nursing, 44(2), 18–19.
· Ford, L. G., & Melnyk, B. M. (2019).
The underappreciated and misunderstood PICOT question: A critical step in the EBP processLinks to an external site..
Worldviews on Evidence-Based Nursing, 16(6), 422–423.
Note: The following resources also appear in NURS 8002.
· OASIS. (n.d.).
Analyze and evaluate research articlesLinks to an external site.
[Interactive media]. Walden University.
· OASIS. (n.d.).
Break a topic into keywordsLinks to an external site.
[Interactive media]. Walden University.
· OASIS. (n.d.).
Evaluate resourcesLinks to an external site.
[Interactive media]. Walden University.
· OASIS.
Grading evidenceLinks to an external site.
[Interactive media]. Walden University.
· OASIS. (n.d.).
Locate, cite, and reference journal articlesLinks to an external site.
[Interactive media]. Walden University.
· OASIS. (n.d.).
Paraphrase and summarize informationLinks to an external site.
[Interactive media]. Walden University.
· OASIS. (n.d.).
SynthesisLinks to an external site.
[Multimedia]. Walden University.
· OASIS. (n.d.).
Synthesize literatureLinks to an external site.
[Interactive media]. Walden University.
· Walden University. (2021).
DNP glossaryLinks to an external site.
[Interactive media]. Walden University Canvas.
· Walden University Library. (n.d.).
Ask a librarianLinks to an external site.
.
Note: Use this website to find answers to common questions or to contact a librarian directly.
· Walden University Library. (n.d.).
Databases A–Z: NursingLinks to an external site.
.
· Walden University Library. (n.d.).
Evaluating resources: Primary and secondary sourcesLinks to an external site.
.
· Walden University Library. (n.d.).
Subject research: NursingLinks to an external site.
.
Note: This database is a good starting point for nursing related searches.
· Walden University Quick Answers. (n.d.).
How do I verify that my article is peer reviewed?Links to an external site.
[Multimedia].
· Fineout-Overholt E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010).
Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studiesLinks to an external site..
AJN American Journal of Nursing, 110(9), 41–48.
Note: This resource is seminal to the field.
RESOND TO THIS DISCUSSION POST
Jess OKp
Overcrowding in the Emergency Room at Grady Memorial Hospital
Overcrowding in emergency rooms has emerged as a multifaceted issue, notably at Grady Memorial Hospital in Atlanta, Georgia, known for its pivotal role in providing emergency care to a diverse, often underserved population. While the surge in demand for emergency services can be attributed to various factors, the influence of Social Determinants of Health (SDOH) remains paramount in understanding the root causes of this overcrowding.
Understanding SDOH and Their Connection to ER Overcrowding
SDOH encompasses the economic and social conditions influencing individual and community health outcomes. These determinants include factors such as income level, education, healthcare access, and neighborhood characteristics. In the case of Grady Memorial Hospital, patients often arrive in crisis due to issues like inadequate access to primary care, lack of health insurance, and socioeconomic vulnerabilities. For instance, individuals from lower-income neighborhoods may forgo routine medical visits due to financial stressors, thus relying on the ER for both urgent and non-urgent health issues, inadvertently contributing to overcrowding.
Grady Memorial has attempted to address some SDOH issues through outreach programs designed to connect patients with community resources. Initiatives such as education on managing chronic illnesses, transportation assistance for medical appointments, and integrated mental health services aim to alleviate the factors that push individuals toward emergency care. Despite these efforts, overcrowding persists, indicating that although SDOH has been acknowledged, comprehensive solutions remain elusive.
Examining the Impact of Initiatives: Did Positive Social Change Occur?
Positive social change has occurred to some extent, as initiatives aimed at addressing SDOH have improved health literacy and community engagement. However, the direct impact on ER overcrowding has been limited, as many patients still lack alternatives to seeking care in the ER. The emergency room continues to be viewed as the frontline for healthcare access, particularly for those who might be facing economic barriers or systemic inequalities.
Analyzing Grady’s Approach Using the Johns Hopkins Evidence-Based Practice Model
According to the Johns Hopkins Evidence-Based Practice Model outlined by Dang et al. (2021), addressing the issue of overcrowding at Grady Memorial Hospital involved several critical steps that may have been partially followed or overlooked. First, the assessment phase recognized overcrowding as a significant practice issue, particularly acknowledging the role of social determinants of health in driving emergency room utilization. This aspect has been adequately addressed. However, during the evidence-based solution identification phase, while efforts like outreach and education were implemented, a more systematic review of best practices from other institutions facing similar challenges could have enhanced the response. The implementation of initiatives targeting SDOH was initiated, but gaps in patient follow-up and continuity of care raised concerns about the sustainability of these efforts. Lastly, the evaluation phase lacks robust mechanisms for ongoing assessment of the outcomes associated with the implemented strategies. Without thorough data collection and analysis, accurately measuring the effectiveness of these interventions remains a challenge, underscoring the need for a more comprehensive approach to addressing the complex issue of overcrowding in emergency services (Dang et al., 2021).
Evaluating Outcomes: Positive or Negative?
The outcomes at Grady Memorial Hospital can be characterized as mixed. While some initiatives have improved health literacy and preventive care awareness, the persistent challenge of ER overcrowding suggests that the measures taken have not sufficiently impacted the underlying issues.
To achieve a better outcome, a comprehensive strategy focusing on expanding primary care access, enhancing public transportation to healthcare facilities, and fostering community partnerships could yield significant results. For instance, establishing a system of mobile clinics in underserved neighborhoods could divert non-emergency cases from the ER, alleviating overcrowding and providing timely care.
Conversely, if the outcomes were satisfactory, it would be essential to identify the key actions that led to this success. Such actions include effective stakeholder collaboration and healthy patient engagement strategies that promote trust and improve healthcare adherence.
Measuring Change and Evaluating Outcomes
To estimate the effectiveness of implemented strategies, outcomes should be quantitatively measured using metrics such as ER wait times, patient satisfaction scores, and medical outcome data. Such evaluations could involve regular patient surveys and data analytics to assess the flow of patients through the ER. For example, implementing an information system to track patient demographics and service efficiency can allow for targeted interventions based on data-driven insights.
In conclusion, while the issue of overcrowding in the ER at Grady Memorial Hospital highlights systemic challenges rooted in SDOH, adequate strategies centered on patient access and community engagement are critical for combating this growing crisis. By applying evidence-based practices and continuously evaluating outcomes, Grady Memorial can advance toward a more sustainable healthcare delivery model, ultimately improving patient care and community health.
References
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021).
Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines (4th ed.). Sigma Theta Tau International.
To Prepare
· Review the Week 8 Learning Resources. Pay particular attention to Chapter 10 and Appendix A in the Dang, et al. text. Also, review the three exemplars provided in the White et al. text.
· Select an organization with which you are familiar that went through a practice change to address a practice or organization issue.
Note: You may reuse organizations and/or issues that you selected earlier in this course. Or you may select new ones.
· Consider how SDOH and positive social change relate to the issue you selected.
· Consider how the approaches used by the organization to address the practice or organization issue were decided upon and received, as well as if the outcome was satisfactory or not.
By Day 3 Of Week 8
Post the following:
· Identify the organization you selected. Describe the practice or organization issue you selected.
· Explain how SDOH relates to the issue you selected. Be specific and provide examples.
· Were SDOH addressed? If so, in what ways?
· Did positive social change occur? Why or why not?
· Using Appendix A from the Dang et al. text. Briefly describe the steps that were followed and/or missing in the organization’s approach to the practice or organization change.
· Were the outcomes positive or negative?
· If the outcome was less than satisfactory, what could have been done differently to achieve a better outcome? Be specific and provide examples.
· If the outcome was satisfactory, what key actions were taken that led to this positive outcome? Be specific and provide examples.
· How was the change measured, if at all? In what ways were the outcomes evaluated? Be specific and provide examples.
Note: Your posts should be substantial (500 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful post but cannot stand alone as the entire post.
Read a selection of your colleagues’ posts.
By Day 6 of Week 8
Respond to at least
two of your colleagues, on different days, by offering ideas for how their organization might have achieved a better outcome or how they might have more thoroughly addressed SDOH to achieve positive social change. Be specific and cite sources to support your recommendations.
Note: Your responses to colleagues should be substantial (250 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful response but cannot stand alone as a response. Your responses should enrich the initial post by supporting and/or adding a fresh viewpoint and be constructive, enhancing the learning experience for all students.
Return to this Discussion in a few days to read the responses to your initial posting. Note what you have learned and/or any insights that you have gained because of your colleagues’ comments.
