Nurse education today · 2026
Preparing nurses to engage with upstream social determinants of health: A scoping review of nursing educators' approaches and understandings.
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Whitworth Sarah, Sharpe Albie, Saravanakumar Priya, Cutler Natalie Ann
Аннотация
AIMS: To perform a scoping review to examine how nursing educators prepare nurses to engage with upstream social determinants of health (SDOH), and to explore educators' understandings of nurses' roles in addressing these determinants.
BACKGROUND: International policy frameworks increasingly position nurses as key actors in addressing the upstream SDOH. Nursing educators play a pivotal role in developing nurses' capacity to engage with health inequities at this level; however, little is known about how educators prepare nurses for this work or how they conceptualize this role within contemporary nursing practice.
DESIGN: Scoping review guided by PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting framework.
DATA SOURCES: CINAHL, MEDLINE, Embase, and Scopus were searched on 5 September 2026 for peer-reviewed primary studies published with no date restrictions.
REVIEW METHODS: Following full-text screening of 125 papers, 27 studies met the inclusion criteria and were included in the final scoping review.
RESULTS: Studies (2010-2025) were predominantly from the United States. Fifteen examined educational approaches to teaching SDOH at all levels, while 12 explored nursing educators' understandings of SDOH in practice. No studies were explicitly designed to prepare nurses for upstream engagement as a central aim (e.g. policy engagement or structural and systemic advocacy). Nursing educators themselves held varied, and at times conflicting, understandings of the role of upstream engagement within nursing practice.
CONCLUSIONS: This review identifies a critical gap in nursing education related to preparing nurses to address upstream SDOH. Existing educational approaches primarily focus on downstream and midstream determinants, with upstream factors largely absent from curricula. Findings also suggest inconsistent understandings among nursing educators regarding nurses' roles in addressing upstream determinants. Strengthening nurses' capacity to influence the structural and systemic drivers of health inequities will require targeted educational strategies supported by knowledgeable and engaged nursing educators.
BACKGROUND: International policy frameworks increasingly position nurses as key actors in addressing the upstream SDOH. Nursing educators play a pivotal role in developing nurses' capacity to engage with health inequities at this level; however, little is known about how educators prepare nurses for this work or how they conceptualize this role within contemporary nursing practice.
DESIGN: Scoping review guided by PRISMA Extension for Scoping Reviews (PRISMA-ScR) reporting framework.
DATA SOURCES: CINAHL, MEDLINE, Embase, and Scopus were searched on 5 September 2026 for peer-reviewed primary studies published with no date restrictions.
REVIEW METHODS: Following full-text screening of 125 papers, 27 studies met the inclusion criteria and were included in the final scoping review.
RESULTS: Studies (2010-2025) were predominantly from the United States. Fifteen examined educational approaches to teaching SDOH at all levels, while 12 explored nursing educators' understandings of SDOH in practice. No studies were explicitly designed to prepare nurses for upstream engagement as a central aim (e.g. policy engagement or structural and systemic advocacy). Nursing educators themselves held varied, and at times conflicting, understandings of the role of upstream engagement within nursing practice.
CONCLUSIONS: This review identifies a critical gap in nursing education related to preparing nurses to address upstream SDOH. Existing educational approaches primarily focus on downstream and midstream determinants, with upstream factors largely absent from curricula. Findings also suggest inconsistent understandings among nursing educators regarding nurses' roles in addressing upstream determinants. Strengthening nurses' capacity to influence the structural and systemic drivers of health inequities will require targeted educational strategies supported by knowledgeable and engaged nursing educators.