Public Health Nurse Interventions for Social Determinants of Health A Project of the PHN Practice Council of Minnesota Karen A. Monsen, PhD, RN, FAAN mons0122@umn.edu University of Minnesota School of Nursing   Marie Margitan, RN, PHN, MS; Linda Bauck, RN, PHN, MS; Maureen Alms, RN, PHN, MS Minnesota Department of Health Neva Kayaani, RN, BSN, Albuquerque Area PHN Consultant, Indian Health Services Karen S. Martin, RN, MSN, FAAN, Martin Associates, Omaha, NE

Presenter Disclosures No relationships to disclose

Background The social determinants of health (SDOH) such as poverty and racism are well documented Public health nurse (PHN) interventions related to SDOH have not been standardized and described

Overview of Project PHN Practice Council Community level practice Documenting outcomes Passion for Social Determinants of Health Opportunity to use Omaha System to survey state National enthusiasm for project

Purpose The objective of this study was to describe PHN interventions regarding the SDOH at different levels of practice individual community system The objective of this study was to explore the extent of PHN practice and influence regarding the SDOH at individual, community, and system levels.

Omaha System Concepts r/t SDOH Income Residence Communication with community resources Interpersonal relationship Mental health Nutrition

Method A survey of 53 interventions was developed by the PHN Council using clinical expert consensus and the Omaha System PHNs were invited to respond via national professional listservs Publicly available staffing and financial data were added to the survey response database

Participating States (109 responses from 16 states)

All 53 SDOH interventions were reported by PHNs, with responses varying by population and level: individual level for maternal-child health (85.4%), adults (85.1%) and families (84.6%); community level (49.4%), and system level (36.4%).

In MN, total interventions for SDOH are associated with: Total agency funding r=0.11 Total nurse FTE r=0.30 PHN FTE r=0.38

Income

Residence

Communication with Community Resources

Interpersonal Relationship

Mental Health

Nutrition

Additional Problems Environmental domain Neighborhood/workplace safety Psychosocial domain Caretaking/parenting, Growth and development Physiological domain Oral health, Pregnancy, Postpartum, Communicable/infectious condition Health-related behaviors domain Physical activity, Substance use, Family planning, Health care supervision

Additional Interventions 47% - Systems level interventions 17.6% - Community level interventions 23.5% - Individual level interventions 35% - both Community and Systems level interventions

Other Interventions

Implications PHNs are engaged in addressing the social determinants of health across many levels and problems A strong PHN workforce should be supported to leverage PHN expertise and impact on costly population health disparities

Future Research Develop evidence-based care plans addressing the SDOH encoded using the Omaha System Measure outcomes relative to SDOH interventions

Conclusions PHNs address SDOH among diverse populations at individual, community, and system levels. In Minnesota, agencies employing a higher ratio of PHNs may have greater focus on addressing SDOH. The Omaha System supports documentation of SDOH interventions.

Thank you! mons0122@umn.edu