Reflection
Interview Techniques
It is critical for a nurse to develop an understanding of external factors that may shape a patient’s health. Social determinants of health help to build a profound assessment of the key phenomena that influence a patient, as well as create an effective tool for managing current threats to their health. In the case under analysis, the interview techniques such as active listening, a combination of empathy, validation, and reassurance, adaptive questioning, and collaborating and summarization were utilized. According to Corcoran and Roberts (2015), the selected strategies allowed setting the environment in which the patient (PR) would feel encouraged to share his experience and be empowered to change his attitude toward self-care.
To assess each of the social determinants of health (SDH), five questions were modeled (see Table 1). These questions allowed identifying the problems in the patient’s environment and deigning the approaches for managing the threats to which the patient was exposed. Each of the questions encouraged the patient to identify key factors shaping his health and build awareness about them to encourage further self-directed care.
Table 1. Questions: SDH.
The answers that the patient will provide will contribute to defining the issues that may hamper the process of delivering care to him. Specifically, the concerns regarding infrastructure, communication, and education should be deemed as the most important ones. The responses to these questions will shed light on the obstacles to providing proper care to the patient. For instance, the complicated infrastructure may cause delays in providing appropriate care, which is likely to have a detrimental effect on the efficacy of healthcare services.
The responses provided by the patient informed the design of the treatment plan since they provided extensive information about the factors that affect the patient’s health negatively. For example, the information that the patient provides concerning the lack of communication with nurses and community members, as well as complex infrastructure, require changes to the patient’s environment that were included in the intervention plan.
Economic Stability and Access to Healthcare
Economic factors have a direct effect on patients since they define the extent of one’s ability to receive proper care. The results of the interview with PR showed that being an elementary school teacher, PR earns enough to afford quality healthcare. The current location of the patient, in turn, allows balancing the problem of health access since living in the suburban setting implies the ability to obtain healthcare services comparatively fast. Being in the vicinity of a healthcare facility, PR can access it comparatively fast, thus preventing the instances involving the aggravation of a particular disease or disorder. Consequently, the patient’s location can be considered an important advantage in receiving the required care.
Nonetheless, there are certain disadvantages to the patient’s current location. For instance, the urban setting may imply that the environmental standards are not met properly due to the high levels of pollution caused by the traffic and the number of vehicles producing CO2. Thus, additional measures will have to be taken to address possible impediments to delivering the care or the required quality to the patient.
Educational Status and Health
The patient’s educational status also indicates that he is likely to be fully aware of the health issues that he may face. Having a pedagogical background and, thus realizing the importance of education in every domain of an individual’s life, PR acknowledged the need for him to improve his current knowledge of self-care and especially the ability to determine threats to his health. Thus, in the case under analysis, the direct correlation between the health status and the education level allows a nurse to build a platform for introducing the patient to the principles of self-care.
Furthermore, due to his education level, PR is unlikely to engage in the behaviors that affect health negatively. For example, the probability of PR starting smoking or abusing substances is relatively low (Skalamera & Hummer, 2016). Besides, studies show that people with higher education backgrounds such as PR are prone to exercising more often and leading a generally healthier lifestyle than those with lower education (Zimmerman, Woolf, & Haley, 2015). However, the current weight of the patient shows that he could use a more active lifestyle. Thus, even though PR can acknowledge and accept the importance of healthy habits, it will be crucial to allow him to develop these habits.
Health, Healthcare Status, and the Quality of Life
While the patient has not been complaining about any chronic issues and health concerns, the fact that his weight reaches 230 lbs even with his height of 6 feet shows that the patient has developed obesity (Batsis et al., 2016). Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004. International journal of obesity, 40(5), 761.). With a BMI of 31.2, PR will have to reconsider his current lifestyle and dieting (National Institute of Health, n.d.).
The identified concern might seem to be misaligned with the fact that PR with his education and knowledge should be able to prevent the development of obesity or, at the very least, identify it and address a healthcare provider.
However, due to the sedentary lifestyle that a teacher typically leads and the age of the patient, weight issues can be expected. Therefore, the health status of the patient currently does not meet the standards of the Healthy People 2020 initiative since PR does not address his problem of obesity. The latter, in turn, is currently ranked as one of the most common issues affecting people’s health worldwide and causing serious complications ranging from blood pressure increase to diabetes and asthma (Office of Disease Prevention and Health Promotion, 2014). Therefore, immediate measures have to be taken to manage the identified health concern.
Neighborhood, Environment, and Access to Healthcare
The community in which the patient lives is characterized as rather diverse. As a result, communication could be improved significantly compared to the present-day situation. However, PR is likely to experience difficulties receiving social support and even may face the threat of being shunned for his current weight issues as a result of social stigma for overweight people (Phelan et al., 2015). Thus, it will be necessary to introduce a community awareness program that will help unify the neighborhood and encourage communication across it.
The proposed change can be implemented by utilizing IT tools and creating a network in which nurses and patients will share information. Moreover, the environment in which the patient lives can be regarded as supportive of the management of his health issues. Being married and having two children, PR is likely to be under a certain pressure due to the need to support his family.
When considering how PR’s neighborhood and environment effect is access to care, one should mention poor transportation options. Since there are no healthcare services in the vicinity, and PR has to ride at least one hour to the nearest health care facility, the threat of him failing to receive proper care increases exponentially. Moreover, the lack of healthy dieting options in the community also causes the problem of PR’s obesity spin out of control. For instance, Whole Foods located in the patient’s area of residence sets very high prices compared to local fast-food chains. The described environment leads to the aggravation of PR’s obesity problem.
Finally, the fact that PR lives in a low-income area also indicates that he is likely to face significant challenges in accessing healthcare services. As the study by Mounier-Jack, Mayhew, and Mays (2017) confirm, the differences include not only the efficacy of healthcare approaches but also the scope thereof. Specifically, in high-income areas, health issues can be resolved successfully not only on an individual level but also on the community one due to the availability of resources.
However, in low-income areas, people do not have the opportunity to receive proper care due to their inability to buy health insurance (Mounier-Jack et al., 2017). Furthermore, in contrast to high-income areas, where several healthcare services are typically present, low-income ones usually have a limited number of healthcare facilities. Finally, while the residents of high-income areas can enjoy a wider range of support and a greater number of technological innovations compared to low-income ones.
Similarly, when considering PR’s health management options, one has to keep in mind that there are numerous differences between rural and urban healthcare. Specifically, the fact that the urban setting implies a greater range of services and improved quality should be mentioned. However, the lack of recreation areas in the urban setting makes it more difficult for residents to maintain good health (Mounier-Jack et al., 2017). Also, the rural setting can be described as a healthier one than the traditional urban setting due to a fewer number of vehicles and less developed industries. Finally, unlike in the urban setting, in the rural one, the infrastructure is less developed.
The patient currently faces several healthcare opportunities that include building communication with local healthcare practitioners and developing a better understanding of his disorder. Furthermore, PR can explore multiple options for addressing his obesity problem, including changes in his diet and physical activity. These opportunities need to be discussed with a nurse to ensure that the patient should manage his health issue accordingly.
Barriers to Health
To meet the patient’s needs fully, one should consider the obstacles on his way to receiving proper healthcare services. The lack of patient-nurse communication and the information required for maintaining good health are the key barriers to the patient’s health at present. Besides, one should keep in mind that the local infrastructure represents a hindrance to receiving the necessary health services. Finally, insufficient community and family support also present a barrier to health that needs to be overcome.
The patient is also likely to face barriers to health associated with his educational status. Particularly, due to the amount of workload with which the patient has to deal due to his educational status and his current job, high levels of stress and fatigue are expected. Thus, the patient becomes particularly vulnerable to diseases and disorders, which should be seen as a critical barrier to health.
Quality of Life
The issues described above affect the patient’s quality of life significantly. Leaving him exposed to the threat of comorbid diseases such as hypertension and possibly diabetes, obesity reduces the quality of his life significantly Also, the lack of community and family support, as well as health education, makes the patient especially vulnerable to health issues and prejudices associated with obesity (Kitzman et al., 2016). Given the patient’s education level, he is capable of embracing complex concepts of self-care and, thus is likely to suffer from the lack thereof.
Social Determinants
The significance of social determinants of health (SDOH) on a patient’s well-being is huge due to the effect that they produce. SDOH explains the current status of a patient’s health (Halmo, Galuszka, Langova, & Galuszkova, 2015). Moreover, by considering SDOH, one can locate the nature of a particular disease and design the approach for reducing the impact of the identified SDOH (Garcia-Mayor, 2018). Therefore, an analysis of the SDOH that affects the patient’s life is essential for a comprehensive assessment of health.
Three Highest Priority Social Determinants
At present, the patient suffers from weight issues, which implies the necessity to manage the health concern on several levels, including communicational, educational, and economic ones. Thus, the SDH of health and healthcare, education, and social and community context are the key constituents of a successful treatment plan. Because of the stigma that is typically associated with weight issues, the patient will need the support of his family and friends. Therefore, the social community context should be seen as one of the SDHs of the highest priority.
The issue of education also bears a very high priority since PR could use the skills of identifying health threats and reaching out for the assistance of a healthcare practitioner. To attain high rates of patient awareness and increase PR’s education level, one will have to use Dorothea Orem’s Self-Care Deficit Theory (SCD) (Halmo et al., 2015).
The significance of education on the promotion of health literacy should not be underrated when approaching complex health issues. By promoting health literacy and educating patients about the means of locating threats to their health, preventing them, and determining key symptoms, one will be able to reduce the number of negative patient outcomes (Halmo et al., 2015). Therefore, health literacy is critical to the promotion of health.
Health and healthcare, in turn, should also become the issue of the highest priority since the patient is currently facing the threat of acquiring a range of diseases and disorders associated with obesity. Apart from introducing an immediate plan for managing the issue, a nurse will also have to consider the health problems linked to obesity, such as blood sugar levels, blood pressure rates, and the relevant concerns. Thus, a range of negative outcomes will be prevented successfully.
The identified SDOH has to be addressed to improve the existing infrastructure and create the setting in which PR will be able to access healthcare services. Thus, the aggravation of the patient’s condition will be avoided successfully. It is critical to remove the factors that cause PR to gain weight. Thus, community support, availability of health services, and patient education have to be provided to ensure successful management of obesity in the patient.
Nursing Plan of Care
Implementation
The introduction of a more balanced nutrition strategy will have to be viewed as the first step toward improving the patient’s current situation. The diet that PR follows will need to be analyzed thoroughly, with the ingredients that contribute to obesity development, including the food that is high in fat and simple carbohydrates removed from it. The promotion of a positive shift in the attitudes of PR’s family members toward his health issue will also be required. An intervention involving the education of all family members will have to be performed.
Barriers
The lack of community support and the patient’s current sedentary lifestyle are the primary areas for concern when it comes to the barriers to health. Indeed, negative attitudes toward obesity enforced by media will be quite difficult to fight (Garcia-Mayor, 2018). The patient’s reluctance to change his current diet, as well as the lack of opportunities for him to choose other dieting options during his lunch break at work are also going to be rather problematic issues to address (Alexander & Wang, 2015). Moreover, the absence of the required skills for supporting PR in his family members, as well as the levels of stress in the home environment, are going to contribute to making the setting rather strenuous for PR.
Participants
The patient and an interdisciplinary team of experts will be the key participants of the treatment plan. With PR being the focus of the treatment process, a team consisting of a physician, a dietician, a nurse administrator, and a nurse educator will be needed to manage the needs of the patient. The physician will perform the general assessment and decide upon the treatment tools, whereas the dietician will analyze the current diet of PR and offer their suggestions to shape it appropriately. A nurse educator, in turn, will offer the patient the required information, increasing the quality of communication, and enhancing the patient’s ability to learn. Finally, a nurse administrator will arrange the treatment process and schedule the key stages thereof.
Evaluation
To assess the efficacy of the proposed intervention and the healthcare plan, one will need to prove that changes have occurred on several levels. These include the physiological one, which is the patient’s weight, a psychological one, which includes the patient’s attitude toward the issue, and communicational one, which concerns the quality of patient education, the support of family and friends, and the management of social prejudices (Nicolaije et al., 2015).
The efficacy of the action plan will also be demonstrated by the increase in the quality of patient-nurse interactions (Ahmed, Abbas, & Khalil, 2017). The assessment will have to be performed in several stages and will require different types of measurement. Besides, the evaluation of societal changes, as well as the changes in the PR family’s attitude, will also have to be examined. A quantitative approach will be adopted to determine the efficacy of the selected awareness building strategy.
Summary
Health concerns associated with obesity have become quite common nowadays, mostly due to the drop in the levels of physical activity and the propensity toward unhealthy eating among some people. In the case under analysis, a patient that has developed weight issues in his 50ies requires the active care of a nurse, the services of a health educator, and the support of his family and community. The impact of social determinants determines the success of further intervention. While PR has quite a few resources for handling his current health concern and maintaining good health in the future, it will be critical to ensure that his family members receive proper instructions for supporting him and that the patient should manage social prejudices.
References
Ahmed, S. E. S., Abbas, N. I., & Khalil, S. S. (2017). Effect of implementing clinical pathway guidelines on patients’ clinical outcomes with acute coronary syndrome. American Journal of Nursing Science, 6(5), 401-417. Web.
Alexander, C. A., & Wang, L. (2015). Obesity and nutrition epidemiology: A study of cause and effect. Journal of Nutrition, 3, 8-15. Web.
Batsis, J. A., Mackenzie, T. A., Bartels, S. J., Sahakyan, K. R., Somers, V. K., & Lopez-Jimenez, F. (2016). Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004. International journal of obesity, 40(5), 761-767. Web.
Corcoran, C., & Roberts, A. R. (Eds.). (2015). Social workers’ desk reference. Oxford, UK: OUP.
Garcia-Mayor, R. V. (2018). Management of obese people: the others barriers. International Journal of Endocrinology and Metabolism, 6(3), 213. Web.
Halmo, R., Galuszka, J., Langova, K., & Galuszkova, D. (2015). Self care in patients with chronic heart failure. Pilot study-self care includes problems. Biomedical Papers, 159(1), 124-130. Web.
Kitzman, D. W., Brubaker, P., Morgan, T., Haykowsky, M., Hundley, G., Kraus, W. E.,… Nicklas, B. J. (2016). Effect of caloric restriction or aerobic exercise training on peak oxygen consumption and quality of life in obese older patients with heart failure with preserved ejection fraction: A randomized clinical trial. JAMA, 315(1), 36-46. Web.
Mounier-Jack, S., Mayhew, S. H., & Mays, N. (2017). Integrated care: Learning between high-income, and low-and middle-income country health systems. Health Policy and Planning, 32(suppl_4), 6-12. Web.
National Institute of Health. (n.d.). Calculate your body mass index. Web.
Nicolaije, K. A., Ezendam, N. P., Vos, M. C., Pijnenborg, J. M., Boll, D., Boss, E. A.,… van Loon-Baelemans, I. E. (2015). Impact of an automatically generated cancer survivorship care plan on patient-reported outcomes in routine clinical practice: longitudinal outcomes of a pragmatic, cluster randomized trial. Journal of Clinical Oncology, 33(31), 3550-3559. Web.
Office of Disease Prevention and Health Promotion. (2014). General health status. Web.
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319-326. Web.
Skalamera, J., & Hummer, R. A. (2016). Educational attainment and the clustering of health-related behavior among US young adults. Preventive Medicine, 84, 83-89. Web.
Zimmerman, E. B., Woolf, S. H., & Haley, A. (2015). Population health: Behavioral and social science insights. Understanding the relationship between education and health. Web.