Integrating the impact of the social determinants of health (SDOH) on individuals, families, and communities is vital in nursing education as the focus of nursing continues to shift toward population health (Thornton & Persaud, 2018). Traditionally, undergraduate nursing students are introduced to SDOH in course didactic content. However, the question remains whether didactic content alone is sufficient for nursing students to understand the real-life impact of SDOH. Transformational learning theory posits that reflection is essential for understanding; therefore, student clinical experiences that complement didactic content and create a robust physical environment for student reflection are needed for true understanding (Mezirow, 1994). A unique clinical practicum was implemented at a local free clinic with the objective of creating an environment where students could easily assess the impact of SDOH on overall heart health in a disadvantaged population.
A preexisting program at the free clinic entitled “Walk on Wednesday” was adapted to an educational walk and talk program based on research data indicating walking improves health and improves learning and retention of information (Centers for Disease Control and Prevention, 2020; Weight et al., 2018). As part of a classroom assignment, students were asked to collect information on eligibility requirements for adult patients who used the free clinic and create population-appropriate, evidence-based patient education brochures on the benefits of exercise to overall heart health.
The practicum occurred each Wednesday for 4 weeks and paired one patient with two nursing students on a 10-minute educational walk and talk. Faculty preselected potential patient participants based on the presence of obesity, hypertension and/or diabetes. Students assumed the rooming responsibilities for identified patients, which included assessment of vital signs, medication reconciliation, and collecting answers to three questions predetermined by the free clinic:
Do you currently have a place to live where you feel safe?
In the past 2 weeks, have you worried about not having enough food to eat or been hungry?
Do you have trouble paying for your medications?
Clinical faculty verified health appropriateness of the patient for walking and obtained verbal consent.
During the walk, students used a preset outline from the educational brochures for providing patient education. When the walk was completed, students provided the patient with a personalized water bottle and the educational brochure to reinforce learning, as well as encouraging the patient to return the following week for another walk and talk. Patients with identified food insecurities were provided with a food box from the local food bank—part of an existing program in the free clinic. Patients identified as at risk for safety concerns were referred to clinic staff. Students completed the practicum by electronic medical record documentation of patient education and completion of a reflection journal.
A total of four nursing students and 10 patients participated in the 4-week practicum walking an average of 2,000 steps every Wednesday. Overall feedback from students, patients, and the clinic was positive. Patient participants noted: “I never knew my blood pressure could be better just by walking”; “I like to walk and I feel safe walking here”; “The time went by so fast, I could've kept walking and learned even more.” Student journal entries included: “I've never worried that where I live is unsafe for me to even go outside”; and “We read about this in our textbooks, but I now understand what it means. This is a reality I didn't really know about. This needs to be fixed.”
Although small scale, this clinical practicum was a tremendous success and plans are to continue the practicum each semester at the free clinic. Plans are also in place to identify additional safe walking sites in the community for expansion of the “Walk on Wednesday” program, as well as creating additional clinical practicum sites for students.
Cheryl L. Pullium, DNP, APRN, ACNS-BC
Texas A&M University College of Nursing
- Centers for Disease Control and Prevention. (2020, February25). Benefits of physical activity. https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
- Mezirow, J. (1994). Understanding transformation theory. Adult Education Quarterly, 44(4), 222–232 doi:10.1177/074171369404400403 [CrossRef]
- Thornton, M. & Persaud, S. (2018). Preparing today's nurses: Social determinants of health and nursing education. Online Journal of Issues in Nursing, 23(3). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-23-2018/No3-Sept-2018/Social-Determinants-of-Health-Nursing-Education.html
- Weight, E., Harry, M., Lewis, M., Jensen, J. A., Popp, N. & Osborne, B. (2018). Oak Foundation walking classroom testing study. The University of North Carolina at Chapel Hill. https://www.thewalkingclassroom.org/wp-content/uploads/2018/09/TWC-Final-Report-Classroom-Testing-Project.pdf