Social Determinants, Resources, and Health Promotion
Key Takeaways
- Social determinants affect readmission, medication use, nutrition, wound care, follow-up, and safety; they must be assessed before discharge.
- CMSRN questions often test referral to case management, social work, dietitians, rehabilitation, home health, community programs, or financial resources.
- Health promotion on a medical-surgical unit should be prioritized, brief, and linked to the current illness or patient goal.
- Discharge planning starts early and includes transportation, caregiver ability, equipment, medication access, and follow-up appointments.
- Barriers should be documented and communicated to the interdisciplinary team rather than treated as patient nonadherence.
Social Determinants, Resources, and Health Promotion
Medical-surgical discharge plans fail when they ignore the patient's real environment. Social determinants of health include housing, transportation, food access, medication affordability, insurance, employment, health literacy, caregiver support, safety, discrimination, and access to follow-up care. CMSRN questions may describe a patient who understands instructions but lacks refrigeration for insulin, cannot afford anticoagulants, lives alone after a hip fracture, or has no ride to dialysis. The best nursing response identifies the barrier and activates resources.
Assessment Before Teaching Is Finished
Ask practical questions early. How will you get home? Who can help you for the first few days? Can you obtain and pay for these medications? Do you have a place to store supplies? Can you get to follow-up appointments? Do you feel safe where you live? Do you have enough food that matches the diet plan? These questions are not social extras. They determine whether wound care, infection prevention, glucose control, heart failure management, and rehabilitation will succeed.
| Barrier | Risk | Resource to consider |
|---|---|---|
| Cannot afford medication | Relapse or readmission | Case manager, social worker, pharmacy assistance |
| No transportation | Missed follow-up or dialysis | Social work, community transport |
| Unsafe home setup | Falls or failed equipment use | PT, OT, home health, durable equipment |
| Food insecurity | Poor wound healing or glucose control | Dietitian, community food resources |
Interdisciplinary Resources
Case managers often coordinate discharge level of care, equipment, insurance authorization, and home services. Social workers address financial stress, housing, safety, transportation, caregiver strain, and community programs. Dietitians tailor nutrition plans for diabetes, kidney disease, heart failure, wounds, and poor intake. Physical and occupational therapists assess mobility, equipment, transfers, and ability to complete activities of daily living. Pharmacists can support medication reconciliation, affordability alternatives, interactions, and high-risk drug teaching.
The nurse should not wait until the discharge order appears to report barriers. Early referral prevents delays and unsafe discharges. Document specific barriers, not labels. Instead of patient is noncompliant, write patient reports inability to afford copay and no transportation to pharmacy.
Health Promotion In Acute Care
Health promotion in a hospital must be realistic. Patients may be overwhelmed, fatigued, or symptomatic. Focus on the highest-risk behavior connected to the admission and the patient's goal. For pneumonia, discuss vaccines, smoking cessation, breathing exercises, and when to seek care. For diabetes, focus on glucose monitoring, foot care, medication timing, nutrition basics, and sick-day guidance. For heart failure, emphasize daily weights, sodium guidance, medication adherence, symptom zones, and follow-up.
Use motivational interviewing techniques: ask permission, explore importance and confidence, identify one next step, and connect the change to what matters to the patient. A patient who wants to return to work may engage with smoking cessation if it is linked to stamina and wound healing. Avoid long lectures that do not match readiness.
Family And Caregiver Capability
Discharge plans often assume caregivers can perform complex tasks. Verify capability through return demonstration when caregivers will administer injections, change dressings, manage tubes, help with transfers, or monitor symptoms. Assess caregiver strain, work schedule, physical ability, and comfort. If the caregiver cannot safely perform the task, notify the team and revise the plan. A willing caregiver is not automatically a safe caregiver.
Community And Regulatory Awareness
Community resources may include home health, outpatient therapy, disease management programs, transportation services, medication assistance, smoking cessation programs, meal delivery, shelters, domestic violence resources, senior services, and support groups. Facility policies may require screening for abuse, neglect, suicide risk, or trafficking. Mandatory reporting varies by law and patient population, but nurses should recognize when policy and legal processes apply.
CMSRN Practice Points
When a question describes a barrier after the nurse has taught the patient, do not repeat the same teaching as the first action. Assess and refer. If a patient cannot pay for medication, social work or pharmacy assistance is more useful than another explanation of why the drug matters. If a patient cannot climb stairs after surgery, PT, OT, equipment, and discharge planning are priorities. Holistic care means making the plan executable in the patient's life.
Health promotion answers should be specific, timed well, and matched to readiness. The CMSRN exam favors nurses who combine disease prevention with practical discharge safety: immunization review, smoking cessation referral, nutrition support, fall prevention, medication access, follow-up planning, and clear symptom escalation instructions.
A patient with a new anticoagulant prescription says the copay is too expensive and they may skip doses. What is the nurse's best action?
An older adult after hip surgery lives alone and cannot demonstrate safe transfer from bed to chair. Which referral is most immediately relevant?
A hospitalized smoker with pneumonia says quitting feels impossible but wants to breathe well enough to return to work. Which response best supports health promotion?