glob nurs insights Global Nursing Insights 3108-3935 Hacettepe University 10.31125/globnursinsights.1753972 Public Health Nursing Nurse Education Nursing Workforce Halk Sağlığı Hemşireliği Hemşirelik Eğitimi Hemşirelik İşgücü Simulation-based teaching on social determinants of health in nursing education: Mixed-method systematic review Bozkurt Aslı Massachusetts College of Pharmacy and Health Sciences https://orcid.org/0000-0002-4707-060X Dursun Ergezen Fatma AKDENİZ ÜNİVERSİTESİ https://orcid.org/0000-0001-8855-9121 Koren Yael Marcus Institute for Aging Research https://orcid.org/0000-0003-2146-4747 Hayman Laura University of Massachusetts Boston 04 23 2026 13 1 112 125 08 13 2025 02 02 2026 Copyright © 2025, Global Nursing Insights 2025 Global Nursing Insights

Aim: To examine the use of simulation to teach social determinants of health (SDOH) to undergraduate nursing students. Material and Methods: This is a mixed-method systematic review. The Conceptual Model of Nursing and Population Health guided this review. Peer-reviewed articles were searched in the Cumulative Index of Nursing and Allied Health Literature, MEDLINE, PubMed, PsycINFO, SocINDEX, and ProQuest Nursing & Allied Health Database. Results: Of 342 articles, six met the criteria. The selected studies used standardized patient simulation, manikin-based simulation, and escape room simulation, with participant numbers ranging from 16 to 570. Two articles used conceptual models to shape their research: Social Empathy and NLN/Jeffries Simulation Theory. The included articles used the following instruments and surveys: Attitudes Toward Poverty-Short Form, Beliefs Related to Poverty and Health, The Undergraduate Perceptions of Poverty Tracking Survey, post-simulation survey, and interview guide questions. Conclusion: This mixed-method systematic review found a lack of scenario diversity in teaching SDOH to nursing students. Randomized controlled trials or quasi-experimental studies are needed to increase the evidence level for this SDOH method. Implications for Nursing Policy: This review examined studies primarily focused on poverty, revealing statistically significant increases. Therefore, policymakers at universities or nursing councils can use the findings of this literature review to develop policies that support the creation of evidence-based simulations on the teaching of social determinants of health. Policymakers can recognize the need to address the existing gap in SDOH simulation scenarios.

 community health services curriculum nursing education nursing models simulation systematic review American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education Amezcua, L., Rivera, V. M., Vazquez, T. C., Baezconde-Garbanati, L., & Langer-Gould, A. (2021). Health disparities, inequities, and social determinants of health in multiple sclerosis and related disorders in the US: A review. JAMA Neurology, 78(12), 1515-1524. https://doi.org/10.1001/jamaneurol.2021.3416 Boersma, P., Black, L. I., & Ward, B. W. (2020). Prevalence of multiple chronic conditions among US adults, 2018. Preventing Chronic Disease Public Health Research, Practice, and Policy, 17, 2-5. https://doi.org/10.5888/pcd17.200130 Borrell, L. N., Rodríguez-Álvarez, E., & Dallo, F. J. (2020). Racial/ethnic inequities in the associations of allostatic load with all-cause and cardiovascular-specific mortality risk in U.S. Adults. PLoS One, 15(2), 1-14. https://doi.org/10.1371/journal.pone.0228336 Cantey, D. S., Randolph, S. D., Molloy, M. A., Carter, B., & Cary, M. P. (2017). Student-developed simulations: Enhancing cultural awareness and understanding social determinants of health. Journal of Nursing Education, 56(4), 243-246. https://doi.org/10.3928/01484834-20170323-11 Daly, K., & Pauly, B. (2021). Nurse navigation to address health equity: Teaching nursing students to take action on social determinants of health. Nurse Educator, 47(1), E5-E6. https://doi.org/10.1097/NNE.0000000000001084 Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins' evidence-based practice for nurses and healthcare professionals model and guidelines (Forth ed.). Sigma Theta Tau International. Fawcett, J., & Ellenbecker, C. H. (2015). A proposed conceptual model of nursing and population health. Nursing Outlook, 63(3), 288-298. https://doi.org/10.1016/j.outlook.2015.01.009 Hong, Q. N., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M., Griffiths, F., Nicolau, B., O'Cathain, A., Rousseau, C., Vedel, I., & Pluye, P. (2018). The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers. Education for Information, 34(4), 285-291. https://doi.org/https://doi.org/10.3233/EFI-18022 Johnson, K. E., Guillet, N., Murphy, L., Horton, S., & Todd, A. T. (2015). “If only we could have them walk a mile in their shoes”: A community-based poverty simulation exercise for baccalaureate nursing students. Journal of Nursing Education, 54(9), S116-S119. https://doi.org/10.3928/01484834-20150814-22 Johnson, K. V., Scott, A. L., & Franks, L. (2020). Impact of standardized patients on first semester nursing students self-confidence, satisfaction, and communication in a simulated clinical case. SAGE Open Nursing, 6, 2377960820930153. https://doi.org/10.1177/2377960820930153 Kameg, B., Fradkin, D., & Lee, H. (2021). Effect of standardized patient simulation on nursing students’ attitudes toward psychiatric nursing and patients with mental health problems. Journal of Psychosocial Nursing and Mental Health Services, 59(8), 15-21. https://doi.org/10.3928/02793695-20210513-01 Kim, E., Kim, S. S., & Kim, S. (2021). Effects of infection control education for nursing students using standardized patients vs. peer role-play. International Journal of Environmental Research and Public Health, 18(1), 1-14. https://doi.org/10.3390/ijerph18010107 Kindig, D. A. (2007). Understanding population health terminology. Milbank Quarterly, 85, 139-161. https://doi.org/ 10.1111/j.1468-0009.2007.00479.x Kucukkelepce, G. E., Dinc, L., & Elcin, M. (2020). Effects of using standardized patients on nursing students’ moral skills. Nursing Ethics, 27(7), 1587-1602. https://doi.org/10.1177/0969733020935954 Kuehn, M. B., Grosch Mendes, C. M., Fukunaga Luna Victoria, G. M., Nemetz, E., & Rigos, Z. C. P. (2020). A poverty simulation’s impact on nursing and social work students’ attitudes towards poverty and Health. Creative Nursing, 26(4), 256-262. https://doi.org/10.1891/CRNR-D-20-00051 Lee, H., Kim, D., Lee, S., & Fawcett, J. (2020). The concepts of health inequality, disparities and equity in the era of population health. Applied Nursing Research, 56. https://doi.org/10.1016/j.apnr.2020.151367 Lowey, S. E. (2021). Impact of a simulation workshop on nursing students’ attitudes toward poverty. Journal of Nursing Education, 60(8), 462-465. https://doi.org/10.3928/01484834-20210722-09 Mauro, A. M. P., Tracey, D. L., LoGrippo, M. T., Brienza-Arcilla, D., Williams-Gregory, M., & Shugg, S. (2018). Innovative PhD-DNP faculty collaboration to advance baccalaureate student population health competencies. Nursing Education Perspectives, 39(5), 305-308. https://doi.org/10.1097/01.NEP.0000000000000377 Mert Karadas, M., & Terzioglu, F. (2019). The impact of the using high-fidelity simulation and standardized patients to management of postpartum hemorrhage in undergraduate nursing students: A randomized controlled study in Turkey. Health Care for Women International, 40(5), 597-612. https://doi.org/10.1080/07399332.2019.1583229 National League for Nursing. (2019). A vision for integration of the social determinants of health into nursing education curricula (Vol. 40). Northrup, A., Berro, E., Spang, C., & Brown, M. (2020). Teaching poverty: Evaluation of two simulated poverty teaching interventions with undergraduate nursing students. Journal of Nursing Education, 59(2), 83-87. https://doi.org/10.3928/01484834-20200122-05 Orr, Z., Machikawa, E., Unger, S., & Romem, A. (2022). Enhancing the structural competency of nurses through standardized patient simulation. Clinical Simulation in Nursing, 62, 25-30. https://doi.org/https://doi.org/10.1016/j.ecns.2021.09.005 Ozkara San, E. (2019). Effect of the diverse standardized patient simulation (DSPS) cultural competence education strategy on nursing students’ transcultural self-efficacy perceptions. Journal of Transcultural Nursing, 30(3), 291-302. https://doi.org/10.1177/1043659618817599 Ozkara San, E., Maneval, R., Gross, R. E., & Myers, P. (2019). Transgender standardized patient simulation: Management of an oncological emergency. Journal of Transcultural Nursing, 30(6), 627-635. https://doi.org/10.1177/1043659619849479 Padilha, J. M., Machado, P. P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical virtual simulation in nursing education: Randomized controlled trial. Journal of Medical Internet Research, 21(3), 1-9. https://doi.org/10.2196/11529 Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., . . . McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372. https://doi.org/ 10.1136/bmj.n160 Phan, Q., Johnson, N., Hillman, J. A., Geller, D., Kimble, L. P., & Swan, B. A. (2020). Assessing baccalaureate nursing students’ knowledge and attitudes of social determinants of health after a health equity simulation. International Journal of Nursing Education Scholarship, 17(1), 1-9. https://doi.org/https://doi.org/10.1515/ijnes-2020-0024 Powers, K., Brandon, J., & Townsend-Chambers, C. (2022). Preparing nursing students for home health using an escape room: A qualitative study. Nurse Education Today, 108, 1-5. https://doi.org/10.1016/j.nedt.2021.105215 Reid, C. A., & Evanson, T. A. (2016). Using simulation to teach about poverty in nursing education: A review of available tools. Journal of Professional Nursing, 32(2), 130-140. https://doi.org/10.1016/j.profnurs.2015.10.002 Rosa, W. E., Hannaway, C. J., Mary, C. M., McManus, F., Alharahsheh, S. T., & Marmot, M. (2021). Nurses for health equity: Guidelines for tackling the social determinants of health. Schams, K., Snyder, A., Zeller, D., & and Caywood, K. (2020). Learning together: Combining undergraduate and graduate simulated learning for practicing physical assessment Skills. Nursing Education Perspectives, 41(3), 177-179. https://doi.org/10.1097/01.NEP.0000000000000533 Tamaki, T., Inumaru, A., Yokoi, Y., Fujii, M., Tomita, M., Inoue, Y., Kido, M., Ohno, Y., & Tsujikawa, M. (2019). The effectiveness of end-of-life care simulation in undergraduate nursing education: A randomized controlled trial. Nurse Education Today, 76, 1-7. https://doi.org/10.1016/j.nedt.2019.01.005 Thornton, M., & Persaud, S. (2018). Preparing today’s nurses: Social determinants of health and nursing education. Online Journal of Issues in Nursing, 23(3), 1-9. https://doi.org/10.3912/OJIN.Vol23No03Man05 Watts, P. I., McDermott, D. S., Alinier, G., Charnetski, M., Ludlow, J., Horsley, E., Meakim, C., & Nawathe, P. A. (2021). Healthcare simulation standards of best practiceTM simulation design. Clinical Simulation in Nursing, 58, 14-21. https://doi.org/10.1016/j.ecns.2021.08.009 World Health Organization. (2025). Social determinants of health. Retrieved December 16 from https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health