wellness model of care

Caring for vulnerable and underserved populations

Caring for vulnerable and underserved populations

The past decade has ushered in notable changes to the way nurses care for patients. Today’s nurses are on the front lines of the industry’s shift from “sick care” to sustainable wellness models. It’s an evolution that demands they move outside the four walls of the traditional acute care centers and into the community to deliver care to all, ensuring the underserved and most vulnerable populations have access to quality, proactive healthcare as well. 

The reality is that many communities are underserved in terms of healthcare services. Correcting that imbalance is a priority among today’s nurses—including millennials who are entering the nurse workforce at nearly double the rate of baby boomers as Health Affairs reports. This is borne out by a recent survey conducted by Wolters Kluwer Health that shows that younger nurses (who have been practicing less than 10 years) prioritized community health initiatives by addressing social determinants of health (SDoH) when asked about nursing priorities over the next few years.

“It’s why I drive two hours to work in a pediatric ICU, volunteer with Mercy Ships and hope to open a clinic in my underserved community one day,” says Tallman. 

Today’s nurses play a critical role in new proactive care models that get out in front disease progression and minimize the potential need for high-cost interventions. The success of these models relies heavily on access and use of SDoH data to drive outreach and decision making.  Linked to roughly 80% of overall health, SDoH encompass the non-clinical factors that can promote or hinder a patient’s ability to comply with care plans such as age, disabilities and access to transportation.

Reaching vulnerable populations

Few populations encapsulate the need for use of SDoH as the most vulnerable: the chronically ill and disabled, low income/homeless, LGBTQ+ and the very young/very old. These groups all experience greater risk factors, poorer care access with higher rates of serious illness and death. And nurses—particularly those who are newest to the profession—are the clinical care givers who are best positioned to effect positive change on these vulnerable populations, thanks to their skill at blending the “art” and “science” of care delivery.

Consider the findings of the Wolters Kluwer study. A full one-quarter of younger nurses believe a top priority for nursing over the next few years is to improve the health of individuals, families and communities by addressing SDoH. Another 29% agree that hospitals need to prioritize gaining access to data that helps them better respond to a patient’s social and/or lifestyle needs.

The reality is that the need to better serve vulnerable, high-risk populations is expected to increase rapidly in the coming years. For example, industry growth projections for Long-Term Services and Supports (LTSS)—care provided to the elderly and patients with disabilities either in the home or in facilities such as nursing homes— reaches 18% expansion by 2020 and a mammoth 100% by 2060. As such, the industry must prepare and equip their clinical teams with critical SDoH data and the right expertise for incorporating it into care planning.

The art and science of healthcare

Moving toward a wellness model of care that brings SDoH into the mix requires nurses possess specific clinical skills while having the necessary clinical decision support tools that can help to improve critical thinking skills when caring for their patients, wherever they may be. It necessitates that all nurses apply both the art and science of care delivery—where they are uniquely positioned to carry out positive change— by applying the latest healthcare evidence to practice in a meaningful way based on a holistic patient view. 

“Consider one of my recent patient encounters that demonstrates this delicate balance,” says Dabrow Woods. “An elderly woman with stage four chronic obstructive pulmonary disease was admitted for an exacerbation of pneumonia. I walked into the intensive care room and found her lying within a tangle of tubing supported by machines. While the industry relies on this advanced technology daily to save lives, she relayed to me her desire to die peacefully. Industry best practices may have pointed to use of the latest technology; however, in this case, the clinical team made the right decision to transfer this patient to an inpatient hospice unit that evening where she could live out her final days.” 

Effectively blending SDoH into care delivery requires nurses, regardless of age or experience, to be able to draw upon critical thinking skills and compassion to deliver optimal care. Nurses are flooded with new information and often find that they are overwhelmed trying to follow new protocols and keep up with science in today’s fast-paced healthcare environments. Consequently, clinical leaders are wise to equip their clinical teams with all the necessary tools needed to hone critical thinking skills and help them effectively balance art and science in practice. 

Supportive environments promote a culture of learning through forward-thinking techniques such as interactive case studies and virtual simulation supported by a strong preceptor program to improve a new nurse’s ability to apply new knowledge. They also ensure nurses have efficient access to the latest evidence (“science”) related to SDoH to ensure they can get back to the bedside to incorporate the proper care (“art”) into their nursing practice.