by Kate Bernheisel, DNP, MPH, APRN, FNP-BC
Teaching nursing students about the real-life complexities of social determinants of health (SDOH) and patient care is challenging. In nursing education, we focus on SDOH, health equity, and health disparities, and these concepts are highlighted throughout the AACN Core Competencies for Professional Nursing Education (American Association of Colleges of Nursing, 2021). In most nursing programs, SDOH are central to community or population health courses, although students may not have direct exposure to the communities affected by various social determinants. Without firsthand experience or exposure, understanding the real impact of these determinants can be challenging.
Our community health nursing heroes of the past, like Lilian Wald and Mary Breckinridge, provide inspiration but the significant social needs experienced then seem distant to students now. Students now live in a world filled with social media and artificial intelligence-driven content. Social media opens doors to places and people worldwide, increasing student exposure to new ways of thinking and serving as a platform for initiating conversations about social determinants of health. It is essential though, to critically evaluate the information shared and recognize that it might not always provide a complete or accurate portrayal of these complex issues. So, how do we engage nursing students in the lives of patients so different from their own?
Experiential learning opportunities focused on SDOH engage students in real-world experiences through community service-learning opportunities, clinical placements, and academic-practice partnerships. Immersive experiential learning, such as Virtual Reality (VR), allows students to experience the impacts of SDOH and develop creative solutions to improve health outcomes while encouraging students to learn from another person’s perspective. This “sense of presence” gained from VR can heighten student learning and empathy related to SDOH (Cypress & Caboral-Stevens, 2022; Gillespie et al., 2021).
We recently piloted a project using VR to communicate SDOH in a pre-licensure community health nursing course. Students watched a 360-degree video of a patient in a wheelchair experiencing the negative impacts of SDOH. In the scenario, the patient experiences barriers to healthcare, transportation difficulties, food insecurity, housing instability, and financial decline. After watching the video immersively in VR, students expressed increased empathy toward the patient in the scenario. Students said that they were “frustrated” and “sad” for the patient and that they “didn’t know that people lived this way.” They reported that this VR experience gave them new insight into how social determinants of health impact the lives of their patients. Surprisingly, they expressed the desire to be “shocked” with similar VR content in other classes. They want to see challenging aspects of their patients’ lives before working with them directly, perhaps allowing desensitization to the differences in lifestyle. Due to the pilot project’s success, we are expanding to include other scenarios highlighting vulnerable populations in community settings.
Integrating social determinants of health into nursing programs empowers future nurses to be more effective, compassionate, and culturally sensitive as they address the needs of their patients and communities. By including experiential and immersive teaching methods, educators can create a comprehensive learning experience that helps nursing students understand and address social determinants of health in their future practice.
American Association of Colleges of Nursing. (2021). The Essentials: Core competencies for professional nursing education. Accessible online at https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
Cypress, B. & Caboral-Stevens, M. (2022). “Sense of presence” in immersive virtual reality environment: An evolutionary concept analysis. Dimensions of Critical Care Nursing, 41 (5), 235–245. https://doi.org/10.1097/DCC.0000000000000538.
Gillespie, G. L., Farra, S., Regan, S. L., & Brammer, S. V. (2021). Impact of immersive virtual reality simulations for changing knowledge, attitudes, and behaviors. Nurse Education Today, 105, 105025–105025. https://doi.org/10.1016/j.nedt.2021.105025
Dr. Bernheisel is an Assistant Professor at the University of South Carolina College of Nursing and a member of the Association of Community Health Nursing Educators. She has experience working as a Family Nurse Practitioner with homeless and migrant populations, both in clinic and shelter settings. She also has clinical experience in Emergency Medicine, Urgent Care and Occupational Medicine. Dr. Bernheisel has a strong interest in developing interprofessional community health programs, using social innovation and entrepreneurship to support community and global health, and the use of innovative technology to support healthcare in medically underserved areas. She also has technical expertise in virtual (VR) and augmented reality (AR), artificial intelligence (AI), and video production.