Clinical Nursing Research: Social Determinants of Health

BY Dr. Candace W. Burton

Over the last several months, my co-editor Dr. Joachim Voss and I had the pleasure of editing CNR’s special issue on the Social Determinants of Health (SDoH). In this process we read and reviewed dozens of papers on topics ranging from refugee health needs to health literacy and working with vulnerable young adults. One of the most exciting parts of this work was seeing all the ways that the SDoH were operationalized across so many issues of health and health-related conditions, and how nurses and nurse scientists address them. Editing this special issue made me realize how important it is that we recognize the ways nurses implement translational health care to manage the SDoH every day.

As educators, scientists, and clinicians, nurses are often the “face” of health care. What I mean is that we are often the most involved in the parts of care that physically touch each patient, student, or population. We are the ones assessing accident victims in the emergency department, teaching nursing students how to start an IV, trying to discover how things work outside the clinical setting. This gives us unique and often crucial insights into how “health” and “health care” actually happen. Indeed, assessing and responding to what we perceive about the person or people in front of us is such a fundamental part of nursing that we often do it without realizing the importance of our actions. It happens when a nurse helps a patient with poor vision color code medications so they know which to take and when, when students have opportunities to practice cultural safety with vulnerable patients, and even when nurse researchers change the language of a questionnaire to make it more legible to a specific population.

In each of these examples, nurses are addressing the SDoH and immediately engaging in translational work to account for them with those for whom we care. Such examples of creativity and patient-centering are so embedded in the ways nurses practice, even across different areas of focus, that they become practically invisible—to colleagues in other disciplines, to students…even to us! While as nurses we are very much aware that we often manage issues of life and death, what we don’t always recognize is how these apparently small acts can make big differences in quality of life and even in survival . Almost without realizing it, nurses often become experts in addressing the SDoH. We think of actions like the ones described above as being the right thing to do, or part of safe and effective care…but not as critical interventions that reduce risk and vulnerability. These “invisible” acts are based on very complex clinical and scientific reasoning and understanding of health care, but may be barely even documented in a chart, a curriculum document, or a publication.

In thinking about all of this, I now see that a yawning gap in the nursing and health literature—and in that gap lie elements of the “mysterious” phenomena of what we call clinical judgement or nurses’ intuition, or even what we mean when we say that, “Nurses get it done,” whatever “it” may be. Parts of the attention to the SDoH upon which nurses act so regularly are embedded in the idea of a holistic health and nursing practice paradigm, other parts captured in scope and standards of practice documents—the ANA Code of Ethics for Nurses for example, and still other parts reflected in the theoretical framing of nurse-driven research work. Pulling these together and filling the gaps in understanding of how nurses attend to the SDoH and what that means for patients, students, communities, and everything beyond presents some truly exciting opportunities in all aspects of the nursing profession. I look forward to seeing what we do next!

explore more

Article details

Special Issue: Social Determinants of Health
Volume 33 Issue 5, June 2024
Clinical Nursing Research

About the Author

Featured

Dr. Candace W. Burton is an Associate Professor in Nursing at the University of Nevada Las Vegas. Her research focuses on stress and trauma, particularly in the context of health disparities, and she is the Faculty Liaison for the UNLV Interdisciplinary Research Development Area in Addictions. Dr. Burton is a trained qualitative and mixed methodologist, and has published on the social determinants of health, structural violence, the trauma of violence and abuse, and nursing education on vulnerable populations. She holds undergraduate degrees in Studies in Women and Gender and in Nursing from the University of Virginia, and a PhD in Nursing Research from the University of California, San Francisco. Dr. Burton is certified by the American Nurses Credentialing Center in Advanced Forensic Nursing, and holds a post-graduate certificate in Diversity, Equity, and Inclusion from Cornell University. She is a Fellow of the American Academy of Nursing, and her innovative work has received both national and international attention from diverse audiences of advocates, researchers, and community-based care providers. She practices as a consulting forensic nurse, and her research has been funded by the Health Resources and Services Administration (HRSA) and Robert Wood Johnson Foundation among others. She teaches at all levels of nursing education on topics including care of vulnerable populations, the social determinants of health, and qualitative and research mixed methodologies.