WK 8 RESPO 2

 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. 

WEEKLY RESOURCES

Learning Resources

Required Readings

· 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. https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/evidence-based-practice#:~:text=EBP%20is%20a%20process%20used,et%20al.%2C%202022).I

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. https://doi.org/10.55481/2578-3750.1113

· Echevarria, I. M., & Walker, S. (2014).  To make your case, start with a PICOT questionLinks to an external site..  Nursing, 44(2), 18–19. https://doi.org/10.1097/01.NURSE.0000442594.00242.f9

· 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. https://doi.org/10.1111/wvn.12408 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. https://academics.waldenu.edu/library/analyze-evaluate-research-articles

· OASIS. (n.d.).  Break a topic into keywordsLinks to an external site.  [Interactive media]. Walden University. https://academics.waldenu.edu/library/topic-into-keywords

· OASIS. (n.d.).  Evaluate resourcesLinks to an external site.  [Interactive media]. Walden University. https://academics.waldenu.edu/library/evaluate-resources

· OASIS.  Grading evidenceLinks to an external site.  [Interactive media]. Walden University. https://rise.articulate.com/share/--e-gVRMA_y8V2KffxxJAQNb_lswZ2zX

· OASIS. (n.d.).  Locate, cite, and reference journal articlesLinks to an external site.  [Interactive media]. Walden University. https://academics.waldenu.edu/library/locate-cite-reference-articles

· OASIS. (n.d.).  Paraphrase and summarize informationLinks to an external site.  [Interactive media]. Walden University. https://academics.waldenu.edu/writing/paraphrase-summarize

· OASIS. (n.d.).  SynthesisLinks to an external site.  [Multimedia]. Walden University. https://academicguides.waldenu.edu/writingcenter/evidence/synthesis

· OASIS. (n.d.).  Synthesize literatureLinks to an external site.  [Interactive media]. Walden University. https://academics.waldenu.edu/writing/synthesize-literature

· Walden University. (2021).  DNP glossaryLinks to an external site.  [Interactive media]. Walden University Canvas. https://waldenu.instructure.com

· Walden University Library. (n.d.).  Ask a librarianLinks to an external site. . https://academicguides.waldenu.edu/library/ask 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. . https://academicguides.waldenu.edu/az.php?s=19981

· Walden University Library. (n.d.).  Evaluating resources: Primary and secondary sourcesLinks to an external site. . https://academicguides.waldenu.edu/library/evaluating/sources

· Walden University Library. (n.d.).  Subject research: NursingLinks to an external site. . https://academicguides.waldenu.edu/library/subject/nursing 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]. https://academicanswers.waldenu.edu/faq/72613

Optional Resources

· 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. https://doi.org/10.1097/01.NAJ.0000388264.49427.f9 Note: This resource is seminal to the field.

RESO ND TO THIS DISCUSSION POST

PN

Identification of Organization and Practice Issue

For this discussion, I have selected a correctional facility as the focus of analysis, with particular attention given to the issue of inmate non-compliance with prescribed medication regimens. A growing concern within the facility is the increasing rate of medication non-adherence, specifically regarding psychiatric medications and treatments for chronic illnesses, such as diabetes. This issue has contributed to a range of health complications, including deteriorating mental health and poorly managed chronic diseases, which in turn compromise the overall well-being of the inmate population. The implications of this problem are profound, as they affect not only individual inmate health but also the safety and efficiency of the correctional system as a whole. Addressing medication non-compliance is essential to improving both inmate health outcomes and the quality of care provided in the facility, potentially reducing the need for external medical interventions (Wunderlich et al., 2001).

Social Determinants of Health (SDOH) and Their Relationship to the Issue

Social determinants of health (SDOH) significantly influence the issue of medication non-compliance within the correctional environment. Inmates often face a range of socio-economic challenges, including limited access to healthcare, low health literacy, and social isolation, which complicate their ability to manage and adhere to prescribed treatments. For example, inmates with psychiatric conditions may resist taking medications due to a lack of understanding about their necessity, or they may develop mistrust toward healthcare providers (Lamb & Weinberger, 2018). Moreover, the harsh environment of the correctional facility, characterized by overcrowding, heightened stress, and a lack of privacy, further exacerbates mental health issues, making it difficult for inmates to focus on or comply with their treatment regimens (Fazel et al., 2016). In many cases, the correctional setting itself becomes a barrier to effective health management, as inmates often lack the education and resources needed to adhere to complex medication schedules. The absence of supportive social networks within the prison further hinders successful medication adherence, as inmates often lack family or community involvement in their care (Wunderlich et al., 2001). These broader social determinants must be understood and addressed to improve medication adherence among inmates.

Addressing SDOH in the Correctional Facility

The correctional facility has implemented several interventions aimed at mitigating some of the negative effects of SDOH on medication adherence. For instance, health education programs are available, which educate inmates on the importance of adhering to their medication regimens and managing chronic health conditions (Moran et al., 2019). Additionally, mental health professionals provide counseling services to address the stigma surrounding psychiatric medications and to foster greater understanding among inmates about their treatments. However, while these initiatives have had some positive effects, they have not fully addressed the underlying challenges. For example, despite offering educational sessions, the facility struggles with a lack of adequate healthcare staff, making it difficult to provide individualized care or consistent follow-up (Fazel et al., 2016). Furthermore, systemic issues such as overcrowding and limited privacy continue to obstruct effective health management, preventing inmates from fully benefiting from available programs and resources. The facility's efforts to address SDOH have been limited in their scope, and significant barriers remain that impede sustained improvements in medication adherence.

Social Change and Its Impact

The impact of the correctional facility’s interventions on social change has been modest, with some positive results, but also notable limitations. Inmates who engage in educational programs and counseling often report improved understanding and a greater willingness to adhere to their medication regimens. However, these changes are not consistently sustained across the population, as systemic barriers such as overcrowding and insufficient healthcare staff continue to undermine the long-term success of the initiatives. For example, while some inmates benefit from the educational sessions, they often do not receive the necessary follow-up care, leading to a high rate of relapse into non-compliance. Additionally, inmates who have a pre-existing distrust of the healthcare system or who are resistant to treatment due to mental health issues may remain disengaged despite these efforts. Therefore, while there has been some positive change, the broader social and environmental factors influencing inmate behavior have not been adequately addressed, limiting the overall success of the interventions (Fazel et al., 2016).

Steps in Organizational Change (Appendix A from Dang et al.)

In alignment with the steps for successful organizational change outlined in Appendix A of Dang et al. (2020), the correctional facility took initial steps toward addressing the issue of medication non-compliance. These included identifying the problem, engaging key stakeholders, and developing a strategic intervention plan. Healthcare providers, mental health professionals, and facility administrators collaborated to create health education programs and increase access to counseling. Despite these positive efforts, some critical steps were either inadequately executed or missing. For instance, the monitoring of individual inmates’ progress in terms of medication adherence was not systematically tracked, making it difficult to measure the impact of the intervention effectively. Without continuous feedback and evaluation, the facility lacks the necessary tools to determine whether its interventions have led to sustained changes in behavior (Moran et al., 2019).

Outcomes of the Change Effort

The outcomes of the intervention efforts have been mixed. While certain inmates reported improvements in medication adherence and an increased understanding of their treatment regimens, these positive outcomes were not uniform across the population. Many inmates continue to fail to comply with prescribed medications, largely due to the persistent challenges of overcrowding, lack of privacy, and insufficient healthcare staffing. These barriers have limited the overall success of the facility’s efforts to improve medication adherence, suggesting that a more comprehensive, individualized approach is needed. Additionally, the lack of consistent follow-up care remains a significant impediment to ensuring long-term success (Wunderlich et al., 2001).

What Could Have Been Done Differently?

To improve outcomes, the correctional facility could have taken several additional steps. A more personalized approach, including one-on-one case management or counseling for inmates with chronic conditions or psychiatric disorders, could improve medication adherence by addressing the specific needs of each individual. Providing ongoing education throughout an inmate's stay, rather than only during intake, could help reinforce the importance of medication compliance. Furthermore, increasing staffing levels and ensuring more private consultation spaces could improve healthcare access and help inmates feel more comfortable seeking treatment. Another key improvement could involve engaging family members or community support systems, which could help reinforce the importance of adherence upon the inmate’s release, ensuring continuity of care (Fazel et al., 2016).

How the Change Was Measured

The correctional facility measures change through several methods, although a more rigorous approach is needed. One mechanism is the tracking of medication adherence through Medication Administration Records (MARs), which document whether inmates are taking their prescribed medications. Additionally, changes in inmates’ understanding of their health conditions and treatment regimens can be assessed through pre- and post-intervention surveys. These assessments help evaluate whether inmates’ knowledge and attitudes toward their medications have shifted following educational sessions (Moran et al., 2019). Moreover, feedback from healthcare staff and correctional officers can provide valuable insights into inmates’ engagement with the healthcare system and their overall behavior regarding treatment adherence. For a more accurate and comprehensive assessment, the facility could implement more continuous monitoring and regular case reviews to track long-term outcomes and improve the effectiveness of its interventions.

Conclusion

In conclusion, while the correctional facility has made some progress in addressing medication non-compliance, the outcomes have been limited due to systemic barriers such as overcrowding and insufficient resources. Addressing these barriers, improving the monitoring of inmates’ progress, and providing more individualized care could lead to better outcomes. Ultimately, a comprehensive approach that addresses the immediate and broader social determinants of health is essential for achieving sustained improvements in medication adherence and overall inmate health.

References

Dang, D., McGillis, L., & Graff, M. (2020).  Implementing organizational change: A framework for success. Pearson.

Fazel, S., Luntamo, M., & Hagg, R. (2016). Health and social care for prisoners: A review of existing evidence.  Lancet Psychiatry, 3(8), 669-673. https://doi.org/10.1016/S2215-0366(16)30095-6

Lamb, H. R., & Weinberger, L. E. (2018). Deinstitutionalization, medication adherence, and the criminal justice system.  American Journal of Psychiatry, 175(3), 228-232.  https://doi.org/10.1176/appi.ajp.2017.17010077Links to an external site.

Moran, G., Roberts, K., & Bell, J. (2019). Health education for inmates: Addressing chronic conditions and medication adherence.  Journal of Correctional Health Care, 25(1), 26-33.  https://doi.org/10.1177/1078345818789541Links to an external site.

Wunderlich, G. S., Peterson, C., & Correa, N. (2001).  Prison health care: Costs, benefits, and priorities. National Academies Press.

 

 

 

 

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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.