The Patient's Story Matters: Integrating Social Determinants of Health in Graduate Nursing Simulation

Nature and scope of the project

At this institution, while review of Social Determinants of Health (SDOH) were included in the didactic graduate curriculum, there was a need identified for further instruction in graduate nursing simulation.

This program provided a template for graduate nursing simulation focusing on the importance of nursing presence, trust and therapeutic communication in the introductory phase of care when assessing SDOH.

The objectives:

1)Understand the importance of trust in a nurse practitioner-patient relationship during the introductory phase of care to enable the patient to reveal their individual story.

- Provide an explanation of why we focused on and the importance of the introductory phase of the nurse practitioner-patient encounter.

-Illustrate the patient's vulnerability when they reveal their stories and their social determinants of health impact on their wellness.

- Without trust, a patient may be hesitant to share or reveal the most sensitive issues impacting their lives, issues that they are struggling with that impede their obtainment of optimal wellness.

2) Apply the concepts of active listening, inquiry, curiosity and trust when engaging in social determinants of health assessment.-Provide a history and current state of health care environment that is extremely fast paced, technology driven, filled with a multitude of distractions, and health care policy regulations which can easily deter the nurse practitioner from fully engaging with their patient.

- Outline strategies such as intentionality, pause and awareness to aid the NP to not only look at the clinical picture, but to assess and incorporate SDOH stressors which are weighing on the patient.

3)Recognize simulation as a useful learning activity when assessing a patient's social determinants of health and their influence on the patient's obtainment of wellness.

-Highlight the keystones of care which is the relationship.

-Stress the need for the nurse practitioner to assess bravely by asking the patient sensitive questions without judgement.

Synthesis and analysis of supporting literature

The vision of nursing education is rooted in competency-based learning.

Competency encompasses assessment, evaluation and performance (NLN, 2023).

This presentation provides one school's experience developing and implementing a simulation focusing on the introductory phase of the nurse practitioner-patient relationship with an emphasis on the social determinants of health outlined by Healthy People 2030.

This school regarded nursing presence and therapeutic communication as essential components to develop a trusting relationship between practitioner and patient.

Trust is the foundation that allows for the exploration of sensitive topics grounded in Social Determinants of Health (SDOH). Through this simulation learning activity, graduate nursing students were able to actively engage and practice communication skills essential to the core of their nursing practice.

Healthy People 2030 define SDOH as the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

One of Healthy People 2030’s 5 overarching goals is specifically related to SDOH: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”

Social risk factors limit an individual's ability to achieve wellness.

Project implementation

This simulation was part of a DNP Immersion Day where over 100 students participated in an hour-long learning activity which included pre-briefing and debriefing sessions.

Each group consisted of 8 students per group facilitated by 3 simulation faculty.

A psychologically-safe space was created for the student nurses to practice the use of nursing presence, trust, and therapeutic communication in the introductory phase of care which is the keystone of the nurse practitioner-patient relationship.

Evaluation criteria

Students were asked to voluntarily and anonymously evaluate their experience using Likert-type questions and statements provided in electronic form.

The elements evaluated included:

  • Psychologically safe learning environment
  • Facilitator and student engagement
  • Facilitator organization
  • In-depth discussion that led to student reflection
  • Student performance
  • Facilitator constructive feedback
  • Facilitator support
  • Teamwork
  • Confidence
  • Competency
  • Objective completion


The student evaluations and outcomes were overwhelming positive.

Therefore, the simulation will be implemented again at the 2024 DNP Immersion Day.

The simulation is being expanded and further developed by adding a second simulation which addresses additional, ongoing, marginalized populations experiencing contemporary health issues.


  • Nurse practitioners need to pause and reflect not only on the clinical picture, but to understand the patient as an individual . It is important to be intentional about incorporating SDOH stressors that are weighing on the patient in their attainment of optimal health.



The Patient's Story Matters: Integrating Social Determinants of Health in Graduate Nursing Simulation