Dean Neubrander on understanding how social determinants affect your health
Increasingly, health care professionals agree that the current health care delivery system—hospitals, clinics—is only a small part of what keeps each of us healthy. In the August edition of the Journal of Nursing Education, Teri A. Murray, Ph.D., APHN-BC, RN, FAAN wrote, “It is critical to recognize that interventions outside the health care system are more likely to affect health and well-being than care rendered within institutions.” She goes on to say, “illness, premature death, and disability disproportionately affects underserved populations,” and that these disparities “are often rooted in the environmental contexts and conditions in which people live.”
What Murray is saying, in simple English, is that oftentimes, information delivered during a person’s visit to the hospital is not nearly as impactful as when that information is delivered in a way that is incorporated into a person’s day-to-day life. As nurses, we all know that educating a patient is a huge—and often the underrepresented and underemphasized—part of the job. We also know that caseload, time, and a variety of other factors make doing so effectively increasingly challenging.
We are also acutely aware that many times, a patient’s living situation shapes how successful a treatment will be and whether or not we see readmission in that patient. Any ER nurse will tell you the same story—the story of the same patients cycling in and out of the ER, for the same things, week after week after week.
And, as with many other challenges we face as a society today, socio-economics have a huge impact on health. As Murray states, “illness, premature death, and disability rates are higher in underserved populations.” “Underserved” in this context means people who lack access to primary care services, who may face geographic, economic, cultural, or linguistic barriers to health care. Examples of these populations are the homeless, low-income, Medicaid-eligible, Native Americans, and migrant farmworkers.
So, what is the answer? What do we do when the education provided in health care institutions is not enough to improve the standard of health in our communities?
We expand the role of the primary care nurse and take health care into the community—at least, that’s what we’re doing at MCN, through our Change Agents for the Underserved: Service Education (CAUSE) initiative. A grant-funded research initiative, CAUSE aims to increase the number of nurses working in primary care, while preventing hospital readmission and improving health in our communities. Below are three ways CAUSE is taking healthcare out of the hospital.
1: Through Patient Advocacy
The CAUSE initiative is exploring the effect of embedding registered nurses as “primary care coordinators” with our partner organizations—Chestnut Family Health Center, the McLean County Health Department, and the Community Health Care Clinic. These RNs are tasked with the management and oversight of a patient’s care plan. They follow up with the patient on an ongoing basis—not just at the clinic—but via the telephone and telehealth. Because of this, a patient’s education does not end when they walk out the door. Instead, the nurse serves as an educator, advocate, and supporter on an ongoing basis—ultimately, with the goal of improving health outcomes.
2: Through Curriculum & Primary Care Experiences
For approximately 100 years, a focus on community and holistic health—especially for the vulnerable and undeserved—has been woven throughout MCN’s curriculum. CAUSE deepens that commitment, extending our focus into primary care. Through CAUSE we have developed comprehensive, community-based immersive experiences that prepare students to tackle challenges driven by socio-economic factors. Now, students in MCN’s prelicensure program have the opportunity to raise their hand and declare their desire to work in this arena. Those students are then able to do the “meat” of their clinical experiences at one of our partner institutions, and ultimately, graduate with primary care experience.
3: Through Cross-Disciplinary Collaboration
At MCN, we believe that if we truly want to improve health, we need to stop just treating symptoms and start educating people. The CAUSE model pulls together a diverse set of health professionals—audiologists, nutritionists, pharmacists, social workers, exercise specialists—to work collectively for the health of a patient. Under this model, the RN serves as the manager for this collaboration, pulling in necessary team members at the right time and connecting those individuals with the patient.
Over the next two years, MCN will continue blazing the path. Ultimately, we hope to create a model that other healthcare systems across the US can replicate. I truly believe that via collaboration, we have the answer to improving the health outcomes for all of us—stay tuned!
Dean, Mennonite College of Nursing
About this column
In today’s fast-paced environment, it is often easy to get so deep in the “doing” of something that we forget to take a moment to pause, step back, and reflect on what we have accomplished. Going forward, each month this column will reflect on the great work and progress this College is making, not only promoting health but also in shaping the future of health care. Stay tuned!
Dean, Mennonite College of Nursing
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