The discussion below will focus on the virtual patient Carolyn Cross. Her health assessment will be founded on the concept of social determinants that tend to be a significant method. She does not demonstrate any substantial problems in the framework of these determinants; nevertheless, it is important to provide a solid rationale regarding this issue to design a nursing plan for Carolyn. Thus, the health assessment below aims to apply the mentioned concept to the patient’s situation to develop this nursing plan coherently and precisely.
Discuss four evidence-based interview techniques you used to assess Carolyn’s social determinants
In order to get the necessary answers from Carolyn, the adapted core questions of the AHC HRSN Screening Tool were asked. This Tool provides a significant interviewing technique that aims to address all the social determinants. CMS (2018) considers the following aspects to ask about as vital – living situation, food, transportation, utilities, and safety. The latter two were replaced by questions about employment and education as they seem more appropriate for Carolyn’s health assessment because she has a happy family and significant neighborhood. However, the Tool considers them supplemental, and I replaced the questions on utilities and safety as it was clear that there will be no issues in this regard after the first two. The Tool’s significance might be justified as follows, “Just like with clinical assessment tools, providers can use the results from the HRSN Screening Tool to inform patients’ treatment plans and make referrals to community services” (CMS, 2018, p. 1). It also addresses all the five vital social determinants, as well as provides the opportunity to assess their extended list.
The second technique that was applied is active listening – every word that Carolyn expressed was taken into account, and her train of thought was followed constantly and precisely. The essence of this technique is to make a patient feel that all of his or her feelings and answers are important, and an interviewer is concerned about the interview’s outcomes (Walden University, n.d.). This was utilized – for instance – when Carolyn did not want to respond to the question about her education, and I did not insist in order to save her trust.
The third technique was adaptive questioning that helped to diversify this interview and get clear answers. The core idea of this approach is to gain maximum from communication with patients by a variety of questions of different characters so that they could open to the interviewer significantly (Walden University, n.d.). For example, I used both open and closed questions, which made it easy to express for Carolyn.
Finally, the technique called patient-centered interviewing was used. It implies the emphasis on patients’ needs and interests from the very first question (Hashim, 2017). Given the virtual format of the interview and the framework of the patient-centered method, it was possible only to provide Carolyn with such questions that would make my concern about her well-being apparent. These questions were developed in a manner that all of the social determinants were addressed, and Carolyn understood that she revealed her essential aspects of life for this assessment.
Justify the questions you used to assess each of the five social determinants of Carolyn, and include her responses
The first social determinants that I aimed to define were social and community context and neighborhood and built environment. I asked her, “what is your ancestry?”; the answer was, “I’m Hispanic descent.” Then, there was a question, “Where and whom do you live with?”; she answered, “My husband and boys. We live not far from here.” These allowed me to identify Carolyn’s culture and her perception of life, which is a necessary foundation for an appropriate nursing plan; in particular, what points from this plan will be acceptable to her from a cultural perspective. Moreover, it became clear that Carolyn lives in a significant neighborhood. The mentioned determinants were also accompanied by the questions, “Do you have children? Spouse? Or significant other?” and “Do you have easy/adequate access to transportation necessary for daily living and healthcare needs?” These questions were essential to figure out her family status and whether she and her closest ones can transport appropriately. It gives a sufficient picture of social and community context and neighborhood and built environment.
It was also vital to deal with Carolyn’s economic stability. I asked her to “tell me about your work,” to which she replied, “I am a middle-school learning specialist. I love my work.” This suggests that Carolyn is financially stable and has a permanent employment status – it is crucial to get a clear vision of what she can afford and to which extent. Then, I asked, “What is your education background?” – apparently, it is a reasonable question to determine Carolyn’s education. Nevertheless, her response was, “Uh, why do you need to know that!”
Finally, I evaluated her social determinant of health and healthcare; I asked, “Do you have medical insurance?”, “Can you tell me about your diet and what you normally eat?” and “Do you use any recreational drug? If so, what?” Such questions seem essential within the scope of the mentioned determinant as they aim to address the vital aspects that are to be considered while designing nursing plans – healthcare opportunities, nutrition, and current medication intakes. She gave a positive answer to the first question and the negative one to the latter. The pivotal points from her response to the second question were, “we do eat out fast food places,” “My guys love the traditional Hispanic diet and love desserts,” and “I try to be aware of calcium intake for myself.”
Explain how Carolyn’s answers to the questions will inform her nursing plan of care
Carolyn’s responses allow identifying the crucial aspects of her nursing plan of care. It is visible that she is in a stable financial situation and has medical assurance, which determines the opportunity to take relatively expensive and high-quality medications. Moreover, there are no expressed obstacles regarding transportation for healthcare needs. This implies the possibility of visiting physicians and hospitals constantly, which might also be reflected in the nursing plan.
According to Carolyn’s replies, the critical issue in the framework of her healthy lifestyle refers to her family’s nutrition. The latter is mostly justified by the tastes of her husband and children that might be characterized as an unhealthy food choice. Then, she admits, “I do have cookies in the house which I raid at night,” which also harms Carolyn’s health significantly. Thus, this should be addressed in the nursing plan that is to take into account a variety of aspects. Finally, her Hispanic descent is also to be considered; for instance, everyday rest might be prescribed during the traditional Spanish siesta.
Explain how Carolyn’s economic stability affects her access to healthcare
The social status of Carolyn affects her health, and the latter, in turn, affects her ability to achieve a higher position in society. Then, a low-paid job is usually associated with difficult circumstances and high levels of stress. Diseases accumulated over many years of labor affect the ability to work further or advance in the service, which leads to a deterioration in the financial security in old age (Wang & Geng, 2019). In contrast, the more part of life Carolyn maintains a high socioeconomic status, the more she gets benefits for health. Immunity is intact, nutrition and regular physical activity create and maintain physical health, and calm working conditions promote psychological health – which is a characteristic of Carolyn’s job.
In contrast, poor health and frequent absence from work due to illness, as well as permanent disability, are most common among people with an insignificant status (Wang & Geng, 2019). Moreover, changes in income levels significantly affect psychological health. Income growth leads to a stabilization of the mental state and a decrease in feelings of anger and depression. Carolyn is involved in a remarkable situation in this regard as her work and salary tend to be stable.
Employment as a factor in health is also correlated with the social gradient through inequality in access to the labor market. Precarious employment is associated with a growing risk of deterioration in physical and mental health, resulting in sick leave from work and then unemployment (Goodman, 2015). Carolyn claimed that she loves her job and no problems are expected in this regard in the future. The link between health and employment is close and reciprocal, based either on notable or difficult working conditions. Unemployment can affect health in several ways; first, financial problems resulting from unemployment can lead to worsening housing conditions, which can reduce social inclusion and self-esteem. Second, unemployment causes psychological distress, feelings of envy towards others, and depression. At the same time, not only the unemployed person but also other members of the household are subject to negative consequences. The loss of a job in a peculiar way symbolizes the loss of a defining role associated with a sense of personality and uniqueness.
Third, unemployment affects the way of life and can lead to a decrease in physical activity, an increase in the use of tobacco and alcohol. Unfavorable working conditions also affect the health of the individual: physical hazards, long or unstable working hours, work injuries, and sedentary work harm the health of the employee (Goodman, 2015). Carolyn has no problems related to her employment – she, again, loves her job – which results in a good psychological state.
Finally, inappropriate housing conditions, such as a leaking tap, poor ventilation, dirty carpets, or insects in the house, can lead to the spread of mold, mites, and other allergens. These, along with poor living conditions, contribute to the spread of respiratory diseases, including asthma. Low temperatures in the living area lead to the weakening of health and the occurrence of diseases of the cardiovascular system. Moreover, constant temperature drops in the house negatively affect health. Overcrowding also adversely affects physical health, contributing to the development of infectious diseases – tuberculosis and respiratory diseases, and also has negative consequences for the psyche of both children and adults. All of the listed is not the characteristic of Carolyn’s housing as her family can afford dignified living conditions, which – as evident from the above – leads to great mental and physical health.
Analyze how Carolyn’s educational status affects her health
Quality education is the shortest route to a prestigious job and high income. However, not many people connect education and health; despite this, there is a lot of empirical evidence of such a connection. People with more years of training tend to live longer, have better health, follow an active lifestyle, and check their health in a timely manner (Lee, 2015). For Carolyn, her education can affect health in several ways. First, there is an effect through the accumulation of information about health and healthy lifestyle. Given Carolyn’s significant knowledge, she realizes the importance of this accumulation problem-solving skills improving, including those related to health. As a result, she makes the best decisions for herself and her family in this regard.
Second, quality education is the shortest path to good work. A good position implies high wages, good working conditions, and benefits associated with the rank held (Lee, 2015). Carolyn stated that she loves her job, and the latter allows her to be above the poverty level. All these conditions lead to the maintenance and strengthening of health – both mental and physical. Finally, high educational status is associated with social factors that promote health (Lee, 2015). Carolyn tends to communicate with people with the same or approximately the same educational level who share her views on the health importance, which contributes to the maintenance of psychological health.
Thus, the relationship between education and health is complicated – the more educated a person, the better his or her health indicators. Of course, this education does not affect health in isolation – many factors are at work, starting from socioeconomic and ending with culture. The level of wages or the neighborhood in which Carolyn lives also has a significant impact on health. Interestingly, better access to health care does not make people healthier by itself. Given the low level of education, even affordable medical services are not able to positively affect health. Also, the level of parental education has a significant impact on the likelihood of a child receiving necessary care – and Carolyn has two boys that require this care.
Discuss the healthcare barriers and opportunities Carolyn might experience because of her educational status
Given Carolyn’s significant educational status, it seems that there are no substantial healthcare barriers to her in this framework. The only issue might occur due to her primary language – Spanish – that may not allow her to understand some specific medical terms sometimes. However, this aspect cannot be considered critical as a plethora of people with English as a primary language may have the same problem – usually, due to the absence of medical specialization.
It should be admitted that Carolyn might have plenty of healthcare opportunities because of her significant education and job that implies intellectual work to an exact extent. Even from Carolyn’s responses, it is evident that she realizes the importance of appropriate healthcare. She reflects on her nutrition and claims that the latter may be improved. Carolyn’s high level of education will allow her to appeal to doctors timely, understand their complex prescriptions, and follow them appropriately. Such an approach will result, again, from an in-depth understanding of healthcare importance.
Analyze how Carolyn’s health and healthcare status affect her quality of life
Carolyn’s quality of life may be determined as the difference between her expectations and current experience. There is a concept of health-related quality of life, which “is primarily concerned with those factors which fall within the spheres of influence of health care” (HealthKnowledge, 2016, para. 13). Hence, it should be stated that many aspects – starting from adequate access to primary care and ending with an understanding of her healthcare plan – contribute to significant quality of life. They meet the essential expectations of a person who cares about his or her health. The only point that reduces this quality in the mentioned scope is fibrocystic breast disease in Carolyn’s medical history.
Analyze how an understanding of health literacy affects health
Health literacy might be defined as the knowledge, motivation, and skills necessary to obtain, understand, evaluate, and apply information related to health (Quaglio et al., 2016). According to Quaglio et al. (2016), this is essential to form one’s own opinion and make decisions in the framework of medical care, disease prevention, and health promotion, as well as to maintain or improve the quality of life at all stages. A person’s health literacy is becoming one of the main factors providing both his or her access to quality medical care and, in general, the ability to manage personal health, including the impact on the healthcare system.
The consequences of low health literacy might be as follows. First, it is an inability to make a choice in favor of health; for example, to provide for physical education at least four times a week. Second, it is an underestimation of the disease and lack of understanding of medical terminology, contributing to late seeking medical care and reducing its effectiveness. Third, it is a lack of knowledge of the importance of early diagnosis of diseases, which leads to ineffectiveness of screening programs and even their inaccessibility. Finally, it is a lack of information about medical programs and services and ignorance of their essence, which is associated with an increase in health care costs.
Explain how Carolyn’s neighborhood and environment affect her access to healthcare
Family plays an important role in the life of every person. Its support has a significant impact on the health of the individual. Hence, married people have better health than single people; a married person is less likely to be exposed to any kind of physical or psychological illness. Marriage also changes a person’s lifestyle: reduces smoking and alcohol consumption, as well as drug use, promotes more frequent cholesterol and exercise checks, and advocates more frequent visits to the dentist and gynecologist. The place of residence largely depends on the material well-being of the family. For Carolyn, this place seems to be significant – her community possesses a neighborhood watch system, full-service supermarkets are close, and there are no issues with transportation. Hence, Carolyn has all the necessary prerequisites to obtain healthy food, high-quality medications, and visit physicians.
Living in an area close to forests, parks, and green spaces improve mental and physical health, regardless of social class. Green spaces also contribute to socialization: it provides space for physical activity and play, improves air quality, and reduces temperatures in a city. In contrast, air pollution causes significant damage to public health. Carolyn’s neighborhood does not have the latter but has many parks and sidewalks. It might be reasonable to state that a friendly community and such a significant environment are essential backgrounds for her healthy lifestyle.
Compare the healthcare received by a patient living in a low-income area to the healthcare received by a patient living in a high-income area
In low-income areas, residents have fewer healthcare opportunities than in high-income ones. Nguyen et al. (2019) found, “In this national [US] study, we documented that physician supply is lower in low-compared with high-income communities and that residents in low-income communities need to travel greater distances to specialty but not necessarily general acute care hospitals” (para. 31). This indicator implies critical access differences in the framework of the mentioned areas. Another crucial aspect is that low-income areas’ representatives cannot afford such expensive health insurance. The financial obstacle also does not allow them to purchase all the necessary medications and adhere to a prescribed diet.
On paper, differences between the quality of personnel in high-income and low-income levels are supposed to be minimal – organizations are similarly accredited and are supposed to follow the same standards of care. In practice, low-income areas are often under-equipped and understaffed (Nguyen et al., 2019). The quality of staff suffers as well – clinicians with better credentials seek employment in large cities and high-paying areas, whereas opportunities in low-paying districts are few and far between. As a result, although hospitals have similar requirements for minimum numbers of personnel on duty, poorer hospitals usually do not meet the quotas (Nguyen et al., 2019). Thus, they are forced to maintain their roster by hiring individuals with subpar qualifications, or forcing the existing personnel to multitask, thus reducing the quality of care.
While hospitals in rich and poor areas typically use the same equipment, the difference lies in their longevity and quality of maintenance. High-income area facilities typically have the opportunity and the financial resources to maintain their equipment and perform routine checks (Nguyen et al., 2019). Facilities on the peripheral area or in poverty-stricken districts cannot replace their facilities as often or perform maintenance. Scheduled visits of technicians are few and far between. Often, they have to rely on purchasing equipment that has previously been in use. Likewise, they could not maintain a competitive edge against better-funded clinics (Nguyen et al., 2019). Finally, the last theoretical similarity lies in the prescribed medicaments. Doctors regardless of the economic status tend to prescribe higher-end medications due to ignorance of cheaper alternatives or lobbying interests of pharmaceutical companies (Unsal, 2020). In practice, customers often have to derive cheaper alternatives themselves, which results in mis-medication.
Discuss how access to healthcare differs for patients living in rural versus urban areas
There is a number of issues regarding the availability and quality of services of rural medical institutions. They are significantly inferior to urban ones, not only in terms of the level of equipment with medical equipment but also in the provision of qualified personnel (Loftus et al., 2018). The main volume of medical care in the countryside is accounted for by nurses, and the time spent by people living in rural areas on visiting medical institutions is much higher than among urban ones.
It should be mentioned that elderly villagers who need medical care most are in a difficult situation. This significantly complicates the implementation of the principle of universal and equal access to medical care, ensuring the right of all citizens, regardless of age, for a full and healthy life (Loftus et al., 2018). In recent years, this problem has become more acute, which is explained by an aging population and an increase in the proportion of retirees due to the rise in life expectancy. Characteristically, villagers are much less likely to report that they have had any health problems or mild ailments during the last 30 days preceding their visit to a doctor. At the same time, in rural areas, many, regardless of age, are forced or prefer to self-medicate instead of seeking qualified help in medical institutions or simply to the health workers they know.
Discuss how Carolyn’s neighborhood affects her access to healthy food options
As mentioned above, Carolyn’s neighborhood might be perceived as significant and appropriate for her healthcare opportunities. The crucial point within the scope of access to healthy food options is that there are two full-service supermarkets located close to her home that provide fresh produce. What is more, there is a weekly farmers market hosted by her community, which makes the prominence of her neighborhood even more obvious. It should be emphasized that this market would not be possible without minimal exposure to environmental toxins, which is also a characteristic of her middle-class suburban area.
Discuss why social determinants need to be addressed in your comprehensive health assessment
Social determinants serve as a foundation for a comprehensive health assessment due to the following reasons. First, the original idea of the concept of these determinants is that health is affected by a plethora of factors, which seems to be a rational assumption. Many scholars and their evidence-based investigations tend to prove the latter. Second, their five key areas are economic stability, education, social and community context, health and healthcare, and neighborhood and built environment (ODPHP, 2020). These areas allow identifying and systematizing all the critical issues that are to be addressed within the assessment. This is vital to develop significant healthcare plans and provide consistent nursing care.
Based on the comprehensive health assessment, identify the three highest priority social determinants that affect Carolyn
Given the discussion above, it seems reasonable to claim that the three highest priority social determinants that affect Carolyn – health and healthcare, social and community context, and economic stability. The latter is a basis for her any life decisions and opportunities. The former is vital to Carolyn’s physical and mental capabilities. Finally, her family is in first place for Carolyn; hence, social and community context might be the third the most substantial determinant.
Based upon the three chosen social determinants, develop a nursing plan of care
The three mentioned determinants contain a number of issues that are to be addressed within the nursing plan. Currently, Carolyn does not demonstrate any problems related to her economic stability; she has a well-paid and beloved job that allows her to pay all the bills. However, in the long term, her children will require more expenses, for example, college and healthcare. Hence, it might be rational to assist her with carrier promotion that implies increased incomes. There will be many courses that will require psychological strength, and a nurse can help to maintain it.
Then, within social and community context, Carolyn is actively involved in her mother’s care for breast cancer. This indicates a considerable extent of stress and mental pressure, keeping in mind Carolyn’s attitude towards the family – she considers it the greatest value. Thus, she will need – again – psychological support, which is to be included in the nursing plan from this perspective. Moreover, Carolyn aims to join local women who run together every weekend – assistance with the appropriate design of exercise stress will be provided.
Finally, the most notable concern exists in the framework of the health and healthcare determinant. Although Carolyn has the necessary access to primary care, can afford prescribed medications, and lives close to pharmacies and hospitals, her medical history includes fibrocystic breast disease. The focus of the nursing plan will be on the latter. It will be vital to encourage Carolyn to maintain regular follow-up care. I will also teach her breast self-estimation to self-monitor changes. I will explain to her that it is important to report all changes so they could be evaluated.
Explain how you would implement your nursing plan of care
In order to implement the plan above, the following actions will be undertaken. First, I will propose Carolyn a prominent psychologist who will assist her in dealing with all the stress and pressure, as well as contact her by myself to provide such help when needed. This approach will allow addressing mental issues related to both career promotion and caring about the mother. Second, I will design an exercise stress timetable, keeping in mind all the essential Carolyn’s indicators – starting from age and ending with weight. Third, I will provide her with a sophisticated and evidence-based plan regarding the dealing with her disease, which will be based on the physician’s recommendations. It should be emphasized that I will meet Carolyn three or four times a week to check the progress of the plan’s implementation, which is the core of my surveillance role in this regard.
Discuss barriers to implementing the nursing plan
The first visible barrier is related to Carolyn’s timetable; with her courses, active lifestyle, and caring about the mother, it will be challenging to find time for the continuous psychologist’s support. The second one might occur within the scope of the running on weekends. In addition to the previous obstacle, in the case of fibrocystic breast disease’s exacerbation, substantial exercise stress will not be allowed. Finally, the implementation of the nursing plan regarding health and healthcare implies a great extent of self-estimation, which will be difficult to evaluate objectively, as Carolyn does not have a medical degree.
Discuss who needs to be involved in the nursing plan
It was stated that Carolyn needs high-quality psychological help, which indicated the involvement of a professional practitioner. Moreover, the family members are also to support her in this regard and do many activities together. Then, it will be important to appeal to community members – women who run every weekend – to assist Carolyn not to exceed her health limitations in the sport’s framework. Finally, a professional physician will be asked to help with the design of recommendations to her regarding the mentioned disease.
Explain how to evaluate the effectiveness of Carolyn’s nursing plan of care
The evaluation of the effectiveness of Carolyn’s plan of care might be as follows. It will be essential to get continuous feedback from Carolyn to check her satisfaction of care in order to determine any possible improvements of this plan (Jones, 2016). Then, according to Jones (2016), outcomes of care may be evaluated by applying a measurement model for health-related quality of life. Moreover, given the mentioned disease, Carolyn has to improve her symptom management and knowledge of this disease, as well as its treatment. I will conduct constant conversations with her in this regard and even develop a number of tests so that the progress would be reasonably estimated.
Summarize the impact of social determinants on Carolyn’s overall well-being
To summarize, the above assessment indicates that social determinants have a significant influence on Carolyn’s overall well-being. Each of these determinants puts an impact on Carolyn through various perspectives, which is justified by the complexity of and diversity of humans’ lives. Throughout her life, Carolyn is being involved in different situations and relations, and it is impossible to assess their influence on well-being sufficiently grounding on a particular aspect. In turn, social determinants – being a comprehensive and sophisticated concept – affect Carolyn simultaneously and apparently. For instance, it is visible from her visit to a pharmacy; she can afford all the necessary medications that were prescribed by a physician, expenses on whom were covered by medical insurance. Economic stability and health and healthcare determinants are working here. Then, there is no unjust treatment due to her race or gender in this pharmacy, which is a notable social and community context. Her education is also important here so that she could evaluate whether a pharmacist gave appropriate medications. Finally, the pharmacy is located close to her home, which indicates a significant neighborhood and built environment.
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