1. Public Health Nurse Interventions for Social Determinants of Health
A Project of the PHN Practice Council of Minnesota
Karen A. Monsen, PhD, RN, FAAN
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

2. Presenter Disclosures
No relationships to disclose

3. 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

4. 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

5. 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.

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

7. 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

8. Participating States (109 responses from 16 states)

9. 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%).

10. 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

11. Income

12. Residence

13. Communication with Community Resources

14. Interpersonal Relationship

15. Mental Health

16. Nutrition

17. 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

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

19. Other Interventions

20. 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

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

22. 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.

23. Thank you!