From Structural Blindness to Structural Perception: Theorizing LUMEN, a Multisensory Pedagogy for the Structural Determinants of Health in Nursing Education

Structural competency has advanced health-professions education by orienting clinicians to the social, political, and economic structures that produce health inequities, yet its nursing applications treat experiential and sensory teaching methods as instructional delivery rather than explaining why such methods work, and assume rather than cultivate the perceptual acts, recognition, and responses that they depend on. This conceptual paper develops LUMEN, a multisensory pedagogy for teaching the structural determinants of health in nursing, and introduces structural perception as the foundational competency it cultivates. Through an argument-based synthesis integrating structural competency, critical pedagogy, transformative learning, embodied and grounded cognition, social theory, and the arts with the nursing literature, we argue that structural determinants are pedagogically difficult because they are imperceptible, abstract, upstream, and naturalized, making the foundational educational task perceptual rather than informational. Because perception is sensory and embodied, multisensory pedagogy is its fitting mechanism. LUMEN operationalizes this through five domains, Look, Uncover, Mirror, Engage, and Navigate, sequenced across a three-phase arc moving learners from structural blindness through critical consciousness to structural action. LUMEN names a competency the field has assumed and theorizes a mechanism it has used but not justified, offering nurse educators a theoretically grounded, testable foundation for teaching structural perception. We also subject the framework to critique, including the risk that adding another model to a crowded field could individualize what is ultimately an institutional problem.