The socio-ecological framework model connects factors that shape how people perceive concepts within their personal experiences. The socio-ecological model explores relations between individuals, relationships, communities, and societal influences (CDC, 2021).

The individual-level pinpoints aspects such as education, age, race, and income, to name a few (CDC, 2021). Such aspects affect individual beliefs and ones' behaviors. Including biological factors that cannot be controlled, yet have a significant impact on respective outcomes.

The second level surveys close personal relationships. Family, spouses, and peers, all of which influence behaviors that reflect negatively or positively on choices made by any given character (CDC, 2021).

The third level, community, incorporates settings in which relationships occur; districts/regions, states neighborhoods, work settings, and schools (ATSDR, 2015). This too can be a barrier to positive changes when addressing disparities of health.

The fourth level identifies societal relationships, covering broad influences of cultural and social norms (CDC, 2021). These maintain economic, health, political, and legislative regulations that direct elements of belief, and consequently resulting behaviors (Poux, 2017).

Perceptions in each of these categories identify contributing variations in reflecting life choices. To accurately assess the socio-ecological framework model a strategic understanding of how each interconnects to form a "transdisciplinary system" (Spath & Kelly, 2017). Spath & Kelly (2017) further elaborate that this concept generates theories from several influences; social ideologies, public health, medical, and behavioral sciences. Through studying this system model a better understanding of root-cause analysis can calculate the effects of determinants, interventions, impacts, and the evaluation transformations on desired outcomes (Spath & Kelly, 2017). The interconnectedness between variables can impact the success of interventions, depending on the levels of perception.

Before influences can be made to establish a system of health equality, a comprehensive understanding of each individuals' situation must be managed. More importantly, this thoughtful consideration must conclude that each persons' situation is uniquely shaped. This demands a need for patient-centered, evidence-based care practice integration throughout all levels of healthcare, from direct patient care to the highest levels of management.

Quality of Experiences: Excellence

My quality of excellence experience stems from my experience in home health. Generally speaking, the home health population is underserved and undervalued. Leadership can influence the quality of care by incorporating the socio-ecological model. While working as a pediatric nurse, I had the opportunity to see the clinical managers evaluate all components of this framework. The clinical manager would visit patient homes, and complete a thorough assessment of all factors affecting patient care. The dynamics of care included the four levels of the socio-ecological framework model. The assessment included individual factors, more specifically, my patient was a 14-year-old, African American boy who was struck by a vehicle while riding his bike in his neighborhood. Personal relationships included his mother and her boyfriend, little was known about his peer relationships. The community setting was a low-income area within the black community. The patient had been diagnosed with several behavioral disorders that affected school attendance. Societal norms detailed the health inequality of this patient and his family. The clinical manager involved herself in his care and clearly defined and addressed each of the socio-ecological influences to provide concise, patient-centered care. The CM designed a comprehensive plan and took on the role of a case manager to assist this family to provide required care. Watching the CM navigate care practices in such a way motivated me to always see the bigger picture. In this case, positive outcomes were noted because attention to each area of the socio-ecological model was valued and found to be beneficial for this family.

Quality of Experiences: Poor

A poor quality experience was seen as an inpatient nurse at a local hospital. We would often have patients come to our department who had many socio-economic factors that affected care practices. Frequently only the chief complaint was addressed. I consider this to be only "patchwork" healthcare. These same patients would regularly return to our facility over and over again. They fell through the cracks, so to speak. The root cause was not assessed to be properly managed. Had individual, relationships, community, and societal factors distinguished many of these patients would not have returned for related, or the same, treatments. As floor nurses involving case management was a step in the correct direction, however, lack of resources and funding propitiated this ineffective cycle of care practices.

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