3.2: Teaching Strategies (classroom, lab, clinical, and simulation)

Classroom Enhancing the classroom through active teaching strategies addressing SDOH will help to bridge students’ clinical knowledge with social considerations. Active learning techniques may include simulation, group discussion, client case videos, guided self-reflection exercises, service learning, team-based learning, book club, or photographic essays. Examples of these learning techniques are described in Table 3.3 below.

TABLE 3.3 Active Learning Activities in the Classroom (Table Source: Kiles et al., 2020)

✓ Use a team-based learning approach to discuss client scenario videos addressing culture, diversity, etc. ✓ Utilize a series of videos addressing SDOH factors to curate group discussion and self-reflection. ✓ Create client cards using the “Think-Pair-Share” method to discuss incorporating the client’s personal beliefs into care recommendations. Rewrite client education at a 6th-grade reading level. ✓ Have students complete a photographic essay where they take a photograph in their local environment that demonstrates social, cultural, or environmental determinants of health. ✓ Practice administering health literacy assessments and identify formal signs of low health literacy. ✓ Have students complete group projects/presentations on cultural healthcare dilemmas. ✓ Create an active learning workshop, including a self-awareness activity for the student to relate to various groups of people in society. May also include implicit bias, cultural humility, and cultural safety. ✓ Create a reflective activity around one’s own cultural awareness and identify personal biases. ✓ Videos and discussions around religious and socioeconomic factors. Have students present on various health disparities ✓ Create a cultural book club and have student(s) champion.

Lab

Using experiential learning has long been a foundation in nursing skills labs. Applying the same experiential learning to expose students to the needs of underserved populations and help them better understand the impact of SDOH on health outcomes in the lab setting is achievable and attainable. Enhancing the skills lab space to reflect a variety of client settings allows for early immersive experiences. Diversifying skills modulars, mannequins, and culturally appropriate resources will enhance SDOH in the lab. Additionally, lab faculty/instructors should consider mini-scenarios or scenario cards outlining the skill being learned in a client situation. For example, the skill being taught is medication administration with an inhaler; however, the client does not speak English. Provide resources or have students develop resources that would allow appropriate learning to occur for the client. Such changes to traditional skills labs will allow students to engage in their learning with acute care and community focus, improving the comfort of students and enhancing their knowledge of the skill.

Clinical

There is a strong need for academic partnerships with communities that incorporate clinical placements and service-learning opportunities for students to emphasize addressing SDOH (NACNEP, 2019). Providing clinical experiences in nursing education related to SDOH requires an adjustment to traditional methods and ways of thinking. Moving some of the clinical experiences outside of traditional acute care settings to work with organizations in the community can provide students with a holistic experience and first-hand see the impact of SDOH. Reconsidering traditional acute care clinical experiences is necessary for preparing nurses for future practice. Including multiple SDOH experiences, community engagement, and purposeful student reflection will support effective curriculum revisions within clinical sites. Designing learning opportunities that occur in a variety of locations, such as nontraditional clinical placements (free clinics, schools, non-governmental organizations, etc.), will provide the students with an opportunity to gain experiential knowledge and insights into the healthcare needs of their community and gain a better understanding to the importance of interprofessional collaboration and its impact on improving health outcomes (Thornton & Persaud, 2018).

Simulation

Simulation offers a unique approach to providing students with purposeful, controlled experiences to increase awareness and support of SDOH and considerations of individual biases. Nurse educators can incorporate SDOH simulations across the curricula. For example, income is one of the most important determinants of health, and there are several ways to simulate poverty conditions and enhance students’ understanding of and attitudes toward working with individuals of low income or in poverty (Thornton & Persaud, 2018). Addressing food, shelter, low income, coping with stressful life situations, and interacting/integrating community resources are all components that could be built into the simulation(s). Such simulation experiences would help students identify life circumstances and SDOH that influence health and health outcomes.

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