The TOLERance model for promoting structural competency in nursing

Zvika Orr, Shifra Unger

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Structural competency is the trained ability to recognize how social, political, economic, and legal structures shape diseases and symptoms. Although structural competency has become an increasingly accepted framework for training and teaching, it usually has not addressed nursing students and has not included marginalized patients as trainers. Method: This article analyzes a structural competency training model for nursing students that includes five components: Theory, Observations, Learning from patients, Engagement, and Research (the TOLERance model). Results: The TOLERance model increases the understanding of the interrelation between the individual clinical level and the sociopolitical structural level. It encourages nursing students to actively engage in social, political, and policy issues that affect their patients’ health and to advocate for policy change. Conclusion: The moral and professional commitment of nurses to their patients demands that they do not ignore the structural forces that are detrimental to their patients’ health. The TOLERance model provides nursing students with skills and competencies that help them to fulfill this commitment. [J Nurs Educ. 2020;59(8):425-432.]

Original languageEnglish
Pages (from-to)425-432
Number of pages8
JournalJournal of Nursing Education
Issue number8
StatePublished - 1 Aug 2020
Externally publishedYes

ASJC Scopus subject areas

  • General Nursing
  • Education


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