If we as nurses are to be the holistic practicioners we claim to be, we have to address the social determinants of health.
This is a scenario I have used to try and explain why it is so important for nurses to be involved in social justice work - it is kind of simplified but hopefully makes its point.

Consider for a minute the example of a diabetic patient who has been readmitted to hospital with symptomatic hyperglycemia for the third time this year. The admitting nursing assessment uncovers that this patient is erratic in his compliance with his medications and does not follow a diabetic diet. The client also states that they do not exercise on a regular basis. If the social determinants of health are not factored into the care of this patient, chances are that this patient will be labeled non-adherent, medical and nursing interventions in the hospital will provide short term resolution of the hyperglycemia, the patient will be discharged home and he will likely be readmitted in a few months with the same issue. This patient’s behaviours may take on a different dimension, however, if examined through the lens of the social determinants of health which acknowledges that health and the provision of health care are imbedded in social and political systems and that health outcomes are inherently tied to these systems.
When social/economic context is brought into the assessment, the nurse might determine that this patient (whose income is limited) does not have the financial resources to pay for all of his medications and he, therefore, rations them so they last longer. His limited income also precludes the purchasing of fresh and healthy foods and he subsists largely on food bank donations which tend to be processed and carbohydrate heavy. Further, this patient has moved into a new neighborhood to find housing within his means. He describes his neighborhood as crime ridden and reports that he does not engage in physical activity outside of his home because he fears for his personal safety. Nursing as a profession is committed to the provision of holistic care. It follows, therefore, that both nursing assessment and nursing intervention need to consider not only the individual patient but also the context in which the patient lives which shapes their opportunities for health and well being.
I don't feel necessarily prepared for the type of work that we as individual nurses need to do to address these types of issues but I am trying to learn because I believe that if I am to provide truly holistic nursing care for those I serve, I have to learn to intervene on a broader level to help create a society in which all members have access to what they need to lead dignified and healthy lives.

Siobhan,

I definitely agree it is a good scenario. Being is a nurse we have the opportunity to spend more time with patients engaging them around lifestyle choices and topics. There is a lot of potential opportunity to help them understand the overall impact of their decisions.

I hope you continue to learn and develop the skills you want to provide holistic advice and treatment of your patients. Let me know if you find any good resources and we can post them, so that other nurses well find them!

Rob

My concern is that not all people have the luxury of making lifestyle choices - their circumstances dictate the choices available to them. The gentleman described above did not have the option of choosing fresh and healthy foods - his lack of money for food created a circumstance where he was dependant on food banks to meet his nutritional needs. He didn't choose to be non-compliant with his meds. He could not afford them so he was forced to ration them etc... If we as nurses are to truly promote health, we must work first to create an even playing field where all persons have access to the necessities required for a healthy life.
Obviously, this is much easier said then done but I think it is something that we as nurses truly have to start thinking about, talking about and working on.
Siobhan