Structural competency: A pilot study

Abstract

ObjectiveThe objective of this study is the use of structural competency (SC) as a tool to broaden the view of nursing students beyond individual, behavioral, biological, and cultural frameworks to encompass the structural determinants of health.DesignThis mixed‐methods pilot study consists of a concurrent nested strategy in which close‐ended, forced‐choice questions are the drivers while open‐ended questions are embedded therein.SampleThe sample consists of second‐year doctor of nursing practice students.MeasuresThe short‐term impact is measured through the use of a survey tool.InterventionThe 3‐hr SC educational module focuses on six learning objectives: knowledge of structural terms, identifying SC effects on population and patient health; strategizing responses to these influences, student readiness to create change at the individual, organizational, and systems‐level, identifying needed tools, and assessing empowerment and burnout.ResultsStudents understand structural terms and are willing to create systemic change but lack necessary tools which may result in burnout.ConclusionsCareful thought about curricula incorporating SC and skills to offset the potential impact of burnout is needed.

Global Health in Swedish Nursing Curricula: Navigating the Desirable and the Necessary

“…Similarly, a list of core competencies addressing climate change has been developed by the Global Consortium on Climate and Health Education [42]. Of particular interest to teaching and learning GH, environmental justice and SDH is the concept of "structural competency" [43][44][45][46][47].…”

“…Regardless of the theoretical framework opted for in nursing programmes, curricular content that includes policy, politics, economics and environmental justice, is necessary for making sense of contemporary global inequalities concerning health. A structural competency approach [43,44] appears promising, as well as service learning and course content oriented towards community health work. Compared to other countries, Swedish nursing education and health systems are not oriented towards community health.…”

“…In a study on UK and US student nurses' attitudes to poverty and social justice, Scheffer et al [81] found that teaching content on health inequities and SDH improved attitudes and student nurses' confidence that they could take action. In a study by Woolsey and Narruhn [44], (p. 602), structural competency was used "as a tool to broaden the view of nursing students beyond individual, behavioural, biological, and cultural frameworks to encompass the structural determinants of health". Mohammed et al [82] offer other examples of how social justice is taught in certain US undergraduate nursing programmes, with the aim of critically and morally developing students, and transforming them into agents of social change.…”

Addressing health inequities re‐illuminated by the COVID‐19 pandemic: How can nursing respond?

“…Nursing programs should augment cultural competence or cultural humility program outcomes with structural competency. Structural competency is a means of understanding the institutional forces and social conditions leading to poor health and lack of access to care, 15–18 and provides a broader context for understanding social contributors to health. Other health disciplines have begun to include a focus on structural contributors to health, 16,17 but only one study in nursing has piloted a similar curriculum innovation 18 .…”

“…Structural competency is a means of understanding the institutional forces and social conditions leading to poor health and lack of access to care, 15–18 and provides a broader context for understanding social contributors to health. Other health disciplines have begun to include a focus on structural contributors to health, 16,17 but only one study in nursing has piloted a similar curriculum innovation 18 . A structural competency requirement would present a more accurate portrait of the factors affecting health, correct the tendency to “blame” patients for their current situation, and in the era of precision health, could stimulate robust conversations on how social and structural factors intersect with biology (i.e., epigenetic changes) 19,20 .…”