The social determinants of health (SDOH) have profound effects on health outcomes, and awareness of the health disparities they generate underscores the significance of emphasizing social justice principles in graduate nursing education. Master's-prepared nurses are well positioned to advance just and equitable policies that address disparities within the health care system. The making a difference project is part of a core course titled Disparity and Social Justice in Health Care, offered in the first year of a general Master of Nursing program that prepares nurses for advanced roles in administrative leadership, education, and population health. The project provides learning opportunities for future nurse leaders and prepares them to advocate for equitable policy decisions. According to Healthy People 2020 (2019a), health disparity is a type of health difference that is closely linked with social, economic, and environmental disadvantage. Equally contributing to health disparities are what Rosenblum and Travis (2012) described as the master statuses of race and ethnicity, sex/gender, sexual orientation/sexuality, social class, and disability. These socially constructed categories of difference in the United States alongside SDOH deeply affect the lives of people in most or all social situations and lead to systematic differences in health outcomes. A critical attribute of social justice is equity in the distribution of power, resources, and processes that affect the sufficiency of the SDOH (Buettner-Schmidt & Lobo, 2012). Although social justice has broad rhetorical popularity within and outside academia, in grey and scholarly literature, and in undergraduate and graduate curricula, pedagogical activities directed at its analysis and application at the graduate level are lacking. The making a difference project fills this gap. The purpose of this project is to help students to articulate the upstream factors that constitute the constant undercurrent for health disparities and the broader roles of nurse leaders as change agents in clinical and community settings. A key student learning objective is to analyze and apply principles of social justice and advocacy in planning for social change and equitable health systems.
The Making a Difference Project Activity
The project starts with identification of a particular health and social issue and concludes with a viable and tangible social action with a “nursing trademark” that makes a direct or indirect difference for individuals and groups affected by the issue. Foundational concepts explored include SDOH, privilege, oppression, stigmatization, social justice, identity, and how to locate oneself in socially constructed categories that constitute the axis of difference in the United States. The project is explained fully to students, and instructions are provided. General thought-stimulating questions are presented by faculty to help guide students' project selection. For example:
- What role could you play right now to reduce or eliminate a health disparity?
- What service could you provide, and what event or activity could you organize?
- What stand could you take, what awareness could you raise, and what idea could you develop and publicize?
A project match-making session pairs two to three students with similar interests. With faculty approval and guidance, they use the Healthy People 2020 MAP-IT (Mobilize, Assess, Plan, Implement, Track) framework (Healthy People 2020, 2019b) to develop and implement their project. They develop project goals and objectives in SMART format, contact appropriate stakeholders, conduct a full assessment of needs, and outline the logistics of project implementation and evaluation. Furthermore, students research specific Senate and/or House bill(s) at the state or federal level that relate to their issues of interest, and they e-mail their legislators urging them to support or repeal the bill. The state governor is copied on the e-mail, as well as a member of the Appropriations Committee for fiscal support of the legislation. This project is completed within a 10-week quarter. Although most project planning activities are done outside class times, approximately three classroom periods are dedicated to project implementation, documentation, and presentation. Examples of making a difference projects include (a) mentoring programs for children of incarcerated parents, (b) anti-bias training in hospital units for staff working with low-income and minority patients, (c) workshop and skills training on the Stop the Bleed initiative to reduce mortality from gun violence, (d) harm reduction education for people fighting opioid addiction and safety workshops for staff of needle exchange programs, and (e) adolescent suicide prevention workshops at high schools.
Student Learning Outcomes
Students articulate how personal and societal issues contribute to inequities and disparities in individual and population-level health outcomes. They gain skills in analyzing social justice and advocacy principles through rigorous review of relevant literature, engaging communities and legislators, and conducting process and outcome evaluations. The project enables graduate nursing students to view the world beyond their own personal and often privileged lenses in order to recognize underlying social conditions that affect the health of patients or clients and to do something about it. These learning outcomes are articulated through a five-to seven-page report, as well as a 3- to 5-minute digital story, that features key elements of the projects, including policy and advocacy actions. Significant numbers of students highlight this project in their final portfolios as a key contributor to their learning during their graduate education.
Mabel C. Ezeonwu, PhD, RN
University of Washington
- Buettner-Schmidt, K. & Lobo, M.L. (2012). Social justice: A concept analysis. Journal of Advanced Nursing, 68, 948–958. doi:10.1111/j.1365-2648.2011.05856.x [CrossRef]
- Healthy People 2020. (2019a). Health disparities data. Retrieved from https://www.healthypeople.gov/2020/data-search/health-disparities-data
- Healthy People 2020. (2019b). Program planning. Retrieved from https://www.healthypeople.gov/2020/tools-and-resources/Program-Planning
- Rosenblum, K.E. & Travis, T.C. (2012). The meaning of difference: American constructions of race, sex, and gender, social class, sexual orientation, and disability (6th ed.). New York, New York: McGraw-Hill.