Social epidemiology and social determinants of health: Implications for nursing education

Background and issues: Bekemeier& Butterfield's 2005 examination of national nursing documents for concepts of social justice revealed that the mission had been subsumed by an individualistic biomedical model. Epidemiology has also been criticized for its individualistic focus on “risk factorology” (McKinlay, 2000). McDonald (2009) also suggests that nursing has been remiss in failing to teach epidemiology in professional practice. Nursing and epidemiology share a need to return to their public health roots in social justice. Sistrom and Hale (2006) recommend that for public health nursing to be effective, the profession must rediscover its roots in social justice. This project describes the development of a curriculum to address teaching epidemiology and the social justice mission to undergraduate nurses. Description: Population-based care and epidemiology courses were developed as part of the Oregon Consortium for Nursing Education curriculum. The epidemiology course includes a substantial component of social epidemiology and skill building strategies applied in the population course. The population course uses the “Unnatural Causes” films (2009) as its core. Films are complemented with research authored by the scientists depicted, and epidemiologic exercises were developed for each film. Student discussion fosters critical thinking and reflection on the role of epidemiology and nursing in social justice. Courses have been evaluated by approx. 200 students. Lessons learned: Nursing students reviewed the curriculum positively. Some students complain of a ‘liberal bias' in the curriculum and ask for a more balanced view. Students also complain they have invested in the individualistic approach and now discover that approach to practice is unlikely to improve population health. Finally, the curriculum results in greater student satisfaction and learning when it is delivered by an expert in the field. Recommendations: Nursing as a field must return to its roots in social justice in order to address population health. Faculty need to acquire expertise in population health, beyond individualistic models, and in epidemiology to be most effective in fostering this approach to the nursing role. Students will find greater satisfaction and broader nursing roles in practice, given this preparation.