SDH

So, the goal of the Social Determinants of Health Project is really to understand how the social determinants of health affect our patient populations and then what we as nurses can do about it. So as I go through this explanation, we're really going to follow the nursing process like you all have been doing for the last several semesters, so we're going to talk about assessing, diagnosing the issue, planning implementation of that plan, and then how we're going to evaluate that plan when it comes to tackling these social determinants of health problems. I just want to be clear that this is not how you need to set up your project. I'm really just giving you kind of a way to think through the project by using the nursing process so that you can get all of the pieces of data and compile them in a way that really makes sense and helps you understand what really the intent of this project is.

So first, we're going to start with assessing and this is really all about data collection, right? You're going to get all of that statistical information about your county that you're researching. And then we have to really think about what do what does the data mean? Like a bunch of numbers is not really telling us anything. Right. I want to take those numbers and figure out what is this actually telling me about this county, about the people who reside in this county. And you can do that by looking at your county population versus the population of the state or maybe even of the United States. But what we want you to do is not just give us a bunch of numbers about a county. It's this many people. It's this big. You know, there’s this many of this kind of person and et cetera, et cetera. We want you to take that information and really take it a step further. Right. We want to know what does it actually mean, particularly in regards to what the social determinants of health issues are.

In order to create your diagnosis, for lack of a better word, that data analysis piece has to be done. You have to look at all of that data and figure out what is the social determinants of health issue or issues in the county that you're researching. And the way you determine what the social determinants of health issue is, is by figuring out what the data is telling you. Right. So, if you learn that your county only has one bus and has no taxi service and you find out that, you know, a large population of people have untreated diabetes, well you can kind of make the correlation that perhaps people don't have transportation to get to a doctor, to be able to get treated for their diabetes. So, it's not just that list of statistics and no correlation to what's actually going on in the county and what are the issues within that county. So that's kind of how you get to your diagnosis or what the social determinants of health issues are. And many counties have a lot of social determinants of health strengths. Maybe they have a ton of transportation, maybe they have lots and lots of doctors. Those are good social determinants of health strengths for that county. You want to determine those along with what are really the core issues for the county and then how do the needs really fit into the data? Is the important piece, right? The data is really you're supporting evidence of what the social determinants of health issues are for your county.

So, once you've determined the issues in your county as far as the social determinants of health, then we need to determine our plan. We need to develop that plan. Right. What are we going to do about it? Because we've determined there's a problem. How do we fix it? And nurses are great at always wanting to fix everything. So, these are things that we can work towards fixing as a profession. First, we need to find our resources right. We are not going to just save the world by ourselves without any help. County resources are in abundance and there is a lot of good places to find those resources right under Google, right. So, you can find specific resources for your county and make sure they're specific to your county. And then you can also find state resources and country wide the country wide resources that you can give to your patients. But we have all these resources, right. We need to really think about how are they going to be utilized. So, for instance, going back to the diabetes and lack of transportation, if we have all these diabetes, diabetes educators and free education for patients with diabetes, but they don't have the transportation to get there because you've determined that that's the problem in that county, is lack of transportation. How are they going to get those resources? So, you kind of have to think about, you know, what are the resources, what are the problems? How can we utilize the resources? How can we get them to our patients? How can they actually be used? And then how will those resources actually help that issue? So, if we get the transportation, the patients can get to, you know, the diabetes educator, the free diabetes education, and then we'll hopefully drop our prevalence of diabetes in that county. Or we have volunteers who are going to go take pamphlets and drop them off at the library or whatever. This is where you kind of have to get creative and figure out, OK, what do we actually do to try and start to solve whatever problem we found?

So, when it comes to the implementation and evaluation piece of this project, this is where you get to kind of have fun and be creative, right? So, you have to make a patient case study. Your patient that you create could be based off of personal experience, could be based off of a patient that you've had in the past or something that you've seen. But whatever patient you create really needs to fit your county demographics needs to be realistic and fit the data that you have found. When you did your assessment piece. When you develop your plan to implement county resources to help the patient that you've created, you need to be specific. You need to actually take the county resources that you have found and figure out what your plan is to implement those resources within the patient that you've created. So, you need to think about what is the role of the nurse. You all are going to be nurses super soon. What is your role? How do you kind of fit in to getting these resources to patients, giving them to them in the hospital? What's your role in the community? How can we take our role one step further? And how will your plan really be implemented? Specific, specific, specific to your patient and then think about evaluation. How can we evaluate whether or not what our plan was, if that actually works or not? What will we see? How can we determine that we are actually making a difference and where will we even see that?

So, lots of kind of things to think about as you are developing your project and putting together this patient and plan. It's all about bringing everything that you've kind of research together into this nice little package to present to your peers. So be creative. There is no right way or no wrong way to do this project, to present this project, I should say, as long as you're following what you need to include on the rubric, this is your chance to be creative. These presentations are really going to help your peers, right? Everybody is going to be going out into practice in just a short amount of time. And we're not all going to be at Baltimore, Washington Medical Center or Anne Arundel Medical Center. People are going all around the county. There are more than just those two hospitals. So it and we are also serving populations of people that are not just from enterable county or P.G. County. There are people from all over the state. So, the information that you provide to your peers is really going to be helpful to them and give them kind of a jumping off point if they're going to go work in P.G. County or in Howard County or, you know, in any of the counties that you will present. So make it interesting. Don't rattle off a bunch of statistics at us please. Think small meaning think about just how you can make an impact as a nurse with one patient, but also think bigger. Think about what is your role in the profession as a whole and how can you drive change so that we can decrease equity gaps and decrease the social determinants health issues. Being a nurse is more than just being at the bedside. We have a greater responsibility to our patients in our communities. So, think big and think small. Every little patient makes a difference, but collectively, nursing can make, I think, even bigger difference in our communities and for the world as a whole.

So that about wraps it up. Just wanted to kind of give you a brief little introduction and kind of get you started on your way of doing this project. If you have any questions, please reach out and ask them. And thank you so much for listening. Bye!

Anne Arundel Community College Department of Nursing

Arnold Maryland NUR 230

County Research Worksheet for Social Determinants of Health Presentation

Use this worksheet as a guide to research information about your assigned Maryland county.

The goal of this project is to understand the “why” behind your county’s common health issues. You should be able to find most of the information about your county. The more data you have, the better you will be able to identify and understand your county’s social determinants of health strengths and weaknesses.

County Name:_______________________________________________________________

Topics	County Statistics	State of Maryland Statistics	Compare County to State Statistics. What is this information telling you about your county?
Population: (2010 census or current)
Geographics: Miles/space (small county or large county)
Demographics: · # of People/Density per square meter · # of Households · How many had child <18 yr · How many married households · How many single moms · How many single · Ave household size · Ave family size · # of families · Median Household Income · What is % of families/population below poverty line · What is % of those below poverty that are <18yr / >65 yr
Ethnicity (%/#): · White · Black/African American · American Indian · Hispanic · Native Hawaiian · German · Irish · English · Italian · Polish · Other
Religion (%/#): · Baptist/Protestant · Catholic · Judaism · Eastern Faith · Affiliate of Islam · Other
Number of Health Departments in county · # of population HD serves per facility
HEALTH OUTCOMES
Quality of Life: · Poor or Fair Health: % of adults reporting fair/poor health · Poor physical health days: Ave of unhealthy days reported in last 30 days · Poor Mental health days: Ave of MH days reported in last 30 days · Diabetes Prevalence: · Other:
HEALTH BEHAVIORS
· Adult Smoking: % of adults who are current smokers · Adult Obesity: % of adults 20+ yrs that report BMI > 30kg/m · Physical Inactivity: % of adults 20+ yr reporting no leisure time for physical activity. · Excessive drinking: % of adults reporting binge/heavy drinking · Other:
Social Determinants of Health
SDoH DOMAINS			Is this domain a strength or a weakness for your county?
Domain: Social and Community Context: · Violent Crime: annual ave # of reported violent crime offenses per 100,000
Domain: Access to Healthcare · Uninsured: % of population <65yr without Health insurance · Primary Care MD: Ratio of population to PCMD providers · Dentists: Ratio of population to dental providers · Mental Health Providers: Ratio of population to MH providers · FLU Vaccinations: % of free-for service Medicare enrollee that had annual vaccine. · Other:
Domain: Economic stability · Unemployment: % of population 16+ yr unemployed but seeking work. · Children in poverty: % of people <18 yr in poverty · Income Inequality: Ration of household income at the 80th % to income at the 20% %. · Children in Single Parent Household:
SDH Domain: Education access and quality: · High School Graduation: % of 9th grade cohort who graduates in 4 yrs · Some College: % of adults 25-44yr with some post-secondary education
SDH Domain: Neighborhood and built environment: · Severe Housing Problems: % of households with at least 1 of 4 housing problems (overcrowding, high housing costs, lack of kitchen facilities, lack of plumbing) · Severe Housing cost burden: % of households that spend 50% or more of their household income on housing. · Home Ownership: % of occupied housing units that are owned. · Food Environment Index: Index of factors that contribute to a health food environment. 0 = worst / 10 = best (The next three bullets can be neighborhood built if proximity is the problem or economic if cost is the issue, place in the correct domain that applies to your county) · Limited Access to health foods: % of population who are low-income & not live close to grocery store · Food Insecurity: % of population who lack adequate access to food. · Access to exercise opportunities: % of population with adequate access to locations.
Common Health Issues reported:		N/A
Area Hospital Focus of care: What are the local hospitals health survey results and goals?		N/A
Additional Data (If applicable)

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