Re-examining Social Determinants of Health During COVID-19: Screening and Community Resources
This article was co-written by Diana-Lyn Baptiste, DNP, RN, CNE and Nia A. Josiah, BA, MSN
The sudden and rapid progression of COVID-19 pandemic has led to an unprecedented public health crisis, challenging nurses and cardiovascular nurses particularly to re-examine factors contributing to increased risks of exposure and severe complications1.
Cardiovascular nurses are dedicated to improving the health of patients through advancing nursing practice and science and must be attentive to the impact of the COVID-19 pandemic on vulnerable populations. There is an urgent need to protect the health and well-being of those with underlying cardiovascular conditions such as hypertension, heart failure, coronary heart disease and stroke 2. Although all persons should follow the recommended Centers for Disease Control and Prevention (CDC) guidelines to avoid contracting or transmitting the coronavirus, cardiovascular nurses need to be hyper-vigilant about protecting those who are already in poor health, or from socially at-risk populations 1,3
Social determinants of health (SDoH) contributing to increased exposure and transmission of COVID-19 are identified among those with lower socioeconomic status, living in multigenerational homes and densely populated areas3-5. Furthermore, there is an urgent need to examine the SDoH among older adults living in nursing homes or assisted living facilities, as well as individuals habiting in close quarters such as prisons, group homes, and those who are homeless4,6.
The CDC mandates health care providers use a COVID-19 questionnaire to assess risk and exposure among patients before each health care visit 6. However, additional screening is necessary to assess patients with underlying chronic illnesses, as these conditions may be undetected or can be exacerbated during the pandemic1,7. Hence, cardiovascular nurses should consider implementing a screening assessment that includes the following:
- Mental health issues including depression, anxiety, possible loss of loved ones, and social isolation
- Exacerbation of underlying conditions such as diabetes, hypertension, and respiratory illnesses
- Housing, food, or financial insecurity
- Intimate partner or domestic violence, abuse or neglect
- Substance use disorder
- Digital access and literacy for telehealth appointments
When screening patients, it is important to consider their risks for the aforementioned problems due to stay-at-home orders, restricted travel, and limitation of visitation and other activities over the first half of 2020. The goal is to meet patients where they are by providing access to resources within their local communities. Cardiovascular nurses should employ a socio-ecological approach to caring for populations during the COVID-19 pandemic, acknowledging the impact of their social environment on their overall safety and wellness1,5. The following resources or referrals can be considered for patients impacted by said SDoH:
- Supplemental nutrition assistance program (SNAP), emergency cash assistance and state eviction protection programs
- Access to COVID testing centers
- Call centers to address substance use and mental health concerns
- Reliable sources of information from the CDC and state health departments
To best serve our patients, cardiovascular nurses must pay close attention to the contextual factors and health care needs of vulnerable and socially at-risk patients. Amid the COVID-19 pandemic, cardiovascular nurses should reinforce general guidelines and recommendations but also address the SDoH that influence exposure, transmission, and health outcomes by employing additional screening measures and utilization of available community resources 1,4,5.
- Dennison Himmelfarb CR, Baptiste D. Coronavirus Disease (COVID-19): Implications for Cardiovascular and Socially At-risk Populations. J Cardiovasc Nurs.2020;35(4):318-321.
- Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol.2020.
- Havranek EP, Mujahid MS, Barr DA, et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation.2015;132(9):873-898.
- Prevention CfDCa. COVID-19 in Racial and Ethnic Minority Groups. 2020; https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html?deliveryName=USCDC_2067-DM26555. Accessed July 30, 2020.
- Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med.2020;8(7):659-661.
- Prevention CfDCa. Coronavirus Disease 2019 (COVID-19). 2020; https://www.cdc.gov/coronavirus/2019-nCoV/index.html. Accessed July 31, 2020.
- Sanchez E. Coronavirus precautions for patients, others facing higher risks. American HeartAssociation. Retrieved from: . Alert- Coronavirus and heart health- information for all 2020;https://www.heart.org/en/around-the-aha/coronavirus-precautions-for-patients-others-facing-higher-risks. Accessed March 28, 2020, 2020.