Abstract
S ocial determinants of health (SDOH) refer to nonmedical social and economic conditions that contribute to health outcomes and health care inequities. 1 Research suggests that SDOH have a greater impact on population health outcomes than clinical interventions alone. 2 However, nursing curricula often focus on acute disease management, with SDOH education primarily addressed in population-based courses. Current recommendations suggest that integrating SDOH education throughout nursing curricula is essential. Simulation-based education is a well-established teaching method that enhances nursing students' knowledge, skills, confidence, and satisfaction. 3 However, traditional manikin-based simulations have limitations in improving students' communication skills and understanding of SDOH. Cinematic simulation incorporates faculty-facilitated fictional video clips to provide a more dynamic learning environment by providing context and emotional depth that may be difficult to achieve using traditional simulation alone. 4 Education on SDOH may help preli-censure nursing students develop a better understanding of non-health-related factors that influence health outcomes and improve their confidence in assessing SDOH in acute and community settings. This educational innovation examined nursing students' perceptions of how SDOH influence patient care and their perceived confidence in recognizing and responding to SDOH after participating in a cinematic pediatric simulation experience. Simulation Design This simulation was designed and implemented using the International Nursing Association for Clinical Simulation and Learning Healthcare Simulation Standards of Best Practice, which emphasize the necessity of a structured debriefing process. 5 This cinematic simulation used guided reflection, a well-established debriefing approach, to help students develop insights and integrate learning into practice. Students participated in a traditional manikin-based simulation involving a pediatric patient with an asthma exacerbation and a complex social history. Prior to the simulation, students were given an initial history and physical of the pediatric patient. Initially, students were challenged to respond to the emergency medical needs of the patient, ultimately treating the asthma exacerbation. After the medical situation was stabilized, the cine-matic simulation component began. This portion of the experience consisted of curated fictional video clips that revealed more of the patient's social history. The clips were selected by faculty and depicted a mother and child experiencing domestic violence, poverty, housing instability, and food insecurity. The video clips allowed for students to be visually introduced to SDOH that were difficult to convey through the manikin-based simulation alone. Students were challenged to consider appropriate nursing responses to the scenarios presented. After completion of the cinematic portion of the simulation , students submitted a written self-reflection as a clinical assignment. Reflection prompts focused on stu-dents' perceptions of SDOH, anticipated practice changes, and confidence in recognizing and addressing SDOH. To build on the cinematic component, students then interacted with a standardized patient portraying the mother of the simulated patient with asthma. By utilizing motivational interviewing techniques and therapeutic communication, students were able to identify and further understand how to address the challenges for this family which included domestic violence, food and medication insecurity, and housing instability. At the end of the simulation experience, students engaged in a faculty facilitated reflective discussion. The faculty had guiding reflective prompts available, but the reflection was student centered to support open discussion on the sensitive materials students were exposed to.