C350 Comprehensive Health Assessment Task 2 (Complete Document) Questions and Answers

Running head: SOCIAL DETERMINANTS OF HEALTH 1 Social Determinants of Health C350 Comprehensive Health Assessment Task 2 A1. Interview Techniques Four evidenced based inte rview techniques I used to assess my patient’s social determinants during his comprehensive health assessment were first I used guided questioning using open-ended questions to allow him the opportunity to open up and share with me. I began by providing a quiet private area with no interruptions, so that he would feel comfortable speaking openly and honestly. I used active listening throughout the interview focusing on what he was sharing with me and gave empathetic responses when necessary. I used non-verbal communication by paying attention to my body language throughout the interview. I kept my posture relaxed and used non-verbal signs of validation by nodding my head, maintaining eye contact, and a relaxed facial expression, especially when discussing issues that may be sensitive in nature. Lastly. I used summarization to assure him that I was fully understanding to avoid any miscommunication. Using all these techniques when conducting a comprehensive health assessment helps facilitate full communication, improves the flow of the interview and ensures that the patient’s whole story is obtained. (Bickley, 2017). A1a. Justification of Social Determinant Questions The social determinants of health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health for all. Those five determinants are economic stability, education, social and community context, health and health care, and neighborhood and built environment (Healthy P 2020). In order to assess these five areas during my interview with Mr. D, I asked him specific questions relating to each of the social determinants. Economic stability was assessed by asking Mr. D what he did for a living. He responded that he was a maintenance technician full time doing apartment maintenance. He is able to pay his bills on time every month, but he stated he had very little debt. He stated he lives comfortably and is able to save money on a monthly basis. This is important to assess because the patient may not be employed and not have enough money to support himself, if that’s the case, he may need some assistance with his financial resources. Education was assessed by asking Mr. D what was the highest level of education he had completed? By asking this question I can see the educational status and health literacy of my patient. I can determine how to explain medical tests and procedures to him in a way that will make it easy for him to understand. Mr. D. stated that he had graduated from high school and had attended two years of college but did not graduate college. Social and community context was assessed by asking Mr. D. about his marital status, and family support system. He stated that he had a longtime girlfriend that he lives with that was a registered nurse and that he has many siblings living in close proximity for support. These questions helped me assess his social support system. I asked Mr. D. about behavioral habits that could potentially affect his health such as drinking, smoking and the use of recreational drugs. He responded that he does drink socially 2-3 beers per day and uses marijuana occasionally. He denied tobacco smoking and cocaine or methamphetamine use. I didn’t ask the patient about community involvement or volunteer activities to assess his involvement in the community. I asked Mr. D if he had medical insurance, he responded that he did not have medical insurance because it was not offered through his present employer. Asking about medical insurance helps me assess health and healthcare determinant. I asked him when the last time he saw a PCP, which he responded ten years ago because he has no insurance. Mr. D did say that he does get an annual eye exam and has seen a dentist two years ago. The purpose of these questions is to help to identify any barriers to healthcare. Having no medical insurance is a barrier to health and healthcare. I asked Mr. D did he exercise regularly, which will evaluate what he does for his own health benefit. He responded that he does go to the gym a few times a week. Neighborhood and built environment are assessed by asking Mr. D about his living situation. Asking this assesses the quality of housing the patient resides in. He lives in a single- family home with his girlfriend in a nice quiet neighborhood in a suburban community in Columbia County Georgia which is considered an affluent area. The town has a low crime rate and the neighborhood is quiet and he has friendly neighbors. A1b. Developing a Nursing Care Plan The answers to the questions about economic stability will help a practitioner to make a care plan to assist a patient with getting resources to help with any financial burdens that may affect his ability to receive medical care or pay for medications if needed. We may have to get assistance from social work to ensure the patient gets the assistance he needs. My patient works full-time so he is able to pay for personal bills without any problems and he is able to save money. If he had any medical needs, he would probably be able to pay for it. I would include in his plan of care to continue to manage his finances appropriately to minimize potential financial stress that could affect his health. My patient’s answer to the questions about his educational level helps assess his health literacy. My patient is a high-school graduate and has attended two years of college. He also speaks two languages. He is fairly well educated and is able to understand some medical terminology. The care plan I develop would adapt to his level of education, which will allow him to better understand more. Assessing the social context of my patient through questions regarding his social support system and social behavioral habits assist the practitioner to evaluate his support system and any behaviors he may have that would positively or negatively affect his health and well-being. Health behaviors such as drinking, smoking, and the use of recreational drugs can negatively affect his health. I would include in my patient’s care plan to encourage him to discontinue those behaviors. Assessing his social support system allows a practitioner to assess what kind of emotional support or isolation the patient may have. The practitioner will have to evaluate the patient for signs of depression or social isolation. My patient has a strong support from many siblings that are close to him and he has a longtime companion that is loving and is right there by his side. He has no signs of depression or social isolation. His care plan would include to continue to maintain his personal relationships. I would also encourage my patient to possibly increase his community involvement through volunteer work in order to improve his personal growth. The questions asked about health and healthcare context are asked to assess the patient’s history of preventative health screenings and access to care due to lack of medical insurance. If a patient has no medical insurance, they are not going to go see a health practitioner until it is absolutely necessary because of fear of large medical costs. The patient’s care plan may have to include a more in-depth health screening, and a referral to a community health clinic that provides care to the uninsured or underinsured. I would include this recommendation for my patient since he is not insured. Neighborhood and built environment questions are asked to assess the patient’s access to adequate housing, proximity to crime, availability of resources to healthy food, and safe places to get physical activity. Having access to healthy food choices and safe places to get out and exercise are not a problem for my patient. He lives in a community with plenty of resources to access healthy food. His girlfriend does most of the cooking, so she prepares healthy meals for him. When he plans his meals, he maintains that he tries to eat a well-balanced diet. He lives in a safe neighborhood with access to parks and gyms nearby for getting physical activity. I would include in his care plan to continue to take advantage of the resources available to him to promote a healthier lifestyle. A2. Economic Stability Socioeconomic status, employment status, and housing stability are each important components of a patient’s overall economic stability. Each of these elements can affect a patient’s access to healthcare. My patient is fortunate that he is employed full time, financially secure with very little debt, and lives with his girlfriend in safe housing. He is able to pay his own bills while saving money for emergencies that may arise. If he were to have a healthcare emergency, he would be able to pay for it or get some assistance from his family support system. His employer does not offer medical insurance, so he has not seen a PCP in ten years due to lack of insurance. My patient stated he felt okay, so he really hasn’t had the need to see a PCP but does know how to get access to a PCP if needed. He lives with his girlfriend who is a RN and her family in her home, so the additional income in the household provides stability and buffers the patient from losing his housing status. A3. Educational Status Impact Education is an integral part of being healthy. Education is a fundamental social determinant of health. According to ongoing research, there is a causal association between education and health. Many factors were said to contribute to this association by various health- related outcomes including health risk and protective behaviors, wages and income (resources for health), self-assessed health, morbidity, mortality, and life expectancy. (Hahn and Truman, 2015). Education teaches a person to use his/her mind through learning, thinking, reasoning, and problem-solving. These mental exercises keep the brain in shape the same way physical exercise keeps the body in shape. Higher levels of education are associated with improved health outcomes and increased life expectancy. A person with a higher educational level is more likely to have an increased earning potential and greater economic stability which allows them to have greater access to healthcare and a better understanding of factors that can negatively affect their health. My patient graduated high school and completed two years of college but did not complete his degree. He went to technical school to learn HVAC, basic plumbing and electrical skills, as well as other skills that are valuable to him in his job as a maintenance technician. Based on the research, my patient would be at an increased risk of developing poor health due to his decreased access to healthcare because of lack of health insurance. His health literacy is less than someone who did graduate college and earn a degree. However, given that my patient is economically stable, despite earning a college degree, I would be hesitant to conclude that his educational status would have a negative impact on his health. He is in a long term committed relationship with a RN, who has a higher health literacy and she educates him. This allows him to better understand health and wellness as well as disease states. A3a. Healthcare Barriers and Opportunities My patient’s lack of health insurance is a barrier to him getting the proper healthcare and preventative screenings. His current job does not offer health insurance. He would be hesitant to seek out medical attention for any symptoms of declining health due to fear of accruing a large medical bill that could cause him financial hardship. His lack of a college degree may lead to less chances to obtain a job that offers better healthcare options such as health insurance, paid sick leave and retirement benefits. His lack of paid sick leave will decrease his ability to take time off work if he is feeling ill. Lack of retirement benefits may lead to him working well into his senior years, which will increase the likelihood that he develops a medical condition such as hypertension, diabetes, or suffer from a job-related injury. Healthcare opportunities that my patient may have as a result of his educational status includes access to healthcare information from his RN girlfriend and his ability to understand his current health status. With his educational level, he is fully literate and is able to understand healthcare information given to him by a healthcare provider. He currently has no complaints of any medical problems, but if he were to have any problems, he would be able to get the access to healthcare and better manage his health with help from his girlfriend. A4. Effects of Health on Quality of Life “Quality of life is a measure of the difference between the hopes and expectations of the individual and the individual’s present experience.” (Currie, 2016) The social determinants of health proposed through Healthy People 2020 serves to explain how health and healthcare can impact quality of life. Health-related quality of life looks at the overall health and well-being of a person by including all aspects of physical, mental, emotional, and social functioning. When asking my patient about his health and quality of life he states that he has been blessed with good health. He denies any current medical conditions. He has a good quality of life. He is able to work full time, exercise regularly, eat a well-balanced diet, and maintain good social relationships. His health is allowing him to live a full quality of life. A4a. Health Literacy The Patient Protection and Affordable Care Act of 2010, Title V, defines health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decision. (CDC.gov, 2019). Health literacy is important for everyone because we all need to be able to find, understand, and use health information and services. People need information they can understand and use to make the best decisions for their health. Health literacy can help us prevent health problems and protect our health. Health literacy affects people’s ability to: • navigate the healthcare system, including filling out complex forms and locating healthcare providers and services • share personal information, such as health history • engage in self-care and chronic-disease management • understand mathematical concepts such as probability and risk (H, 2019) In addition to basic literacy and numeracy skills, health literacy requires knowledge of health topics. People with limited health literacy often lack knowledge or have misinformation about the body as well as the nature and causes of disease. Without this knowledge, they may not understand the relationship between lifestyle factors such as diet and exercise and various health outcomes. (H, 2019). A5. Neighborhood and Environmental Impacts When you look at Healthy People 2020, it is possible to understand why neighborhood and built environment are included in the social determinants of health. Lack of access to healthy foods, crime and violence, poor air quality from pollution, poor housing conditions, and lack of transportation are all neighborhood and environmental factors that can negatively impact a patient’s health and access to healthcare. Lack of access to healthy foods leads to overeating of unhealthy foods which leads to obesity. Crime and violence present within a neighborhood would make it unsafe for a person to get outside in public places to walk and get physical activity. Poor air quality from pollution leads to respiratory problems such as asthma. Poor housing conditions can put people at risk for respiratory infections, asthma, lead poisoning and other diseases caused by living in substandard housing. Lack of transportation would make it difficult for people to get around town to gain access to healthcare. All these factors can affect quality of life and can have significant influence on health outcomes. My patient lives in a quiet, safe suburban, middle-class community where he has ready access to public parks with lots of green space and ample shopping options to purchase healthy foods. He lives in single-family home with his RN girlfriend that is well-maintained in good condition. My patient has reliable transportation so he can get around town to get access to medical centers, offices and clinics that are available within the community. My patient’s neighborhood and environment beneficially impact his ability to access adequate healthcare. A5a. Compare Healthcare Received in Low and High-Income Areas “The greater one’s income, the lower one’s likelihood of disease and premature death.” “Americans at all income levels are less healthy than those with incomes higher than their own.” “Not only is income associated with better health, but wealth affects health as well.” (Woolf, et al., 2015). People who have low incomes tend to receive healthcare from free clinics or public health clinics within the community with little follow-up, or not receive healthcare at all, usually due to lack of insurance. People in low-income areas will be less likely to seek preventative healthcare than people in high-income areas. People in low-income areas are more likely to experience more barriers to care and receive poorer quality care than high-income people. American adults in low-income areas have higher rates of heart disease, diabetes, stroke, and other chronic disorders than wealthier Americans. (Woolf et al., 2015). People who live in low- income areas they have less access to quality care due to lack of insurance and high out of pocket costs for medical visits. They tend to have less access to healthy foods, which leads to poor nutrition and poor health outcomes. High-income area people have better access to healthcare and receive a higher quality of healthcare because they tend to have health insurance which means they are more likely to have a PCP that they see regularly to seek preventative care. This puts them at a lower risk to develop chronic diseases or get better treatment if they already have a chronic disease. High income area people have improved health outcomes with higher life expectancy. High-income area people have a higher health literacy compared to low-income area people which also gives them a better understanding of the risks of poor nutrition, smoking and other poor health habits, as well as the benefits of a healthy diet and exercise. While differences exist between low-income and high-income areas, there are also similarities in regard to access to care. The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires anyone coming to an emergency department to be treated and stabilized, regardless of whether they have insurance or an ability to pay for medical services. (Center for Medicare and Medicaid Services, 2012). This law ensures that all patients are treated appropriately for emergency medical treatment regardless of their socioeconomic status. Another similarity between the two is the presence of community health events that aim to promote good health through screenings and preventative measures such as community health fairs sponsored by local hospitals, schools, and churches. These events take place in both low- income and high-income areas to improve health literacy for all individuals within the community. A5b. Healthcare in Rural and Urban Areas More than 59 million people live in rural areas of the United States. Research data shows that people in rural areas are more likely to be in poor health and have higher mortality rates for chronic conditions. These challenges are in part a result of the poor access to care compared to urban and suburban communities. (Health Affairs, 2018). Access to care in rural areas focuses on three aspects of access: availability, accessibility, and affordability. There is a shortage of clinicians in rural areas, specialty care is often not available in the local vicinity, long distances and transportation needs make it difficult to take necessary trips to get medical care, and lack of insurance or underinsurance make care unaffordable. (Health Affairs, 2018). Most urban areas have more access to healthcare providers and specialists, but sometimes it is more difficult to get appointments because they aren’t enough appointments to go around. A5c. Access to Healthy Food Options Patient’s that live in low-income neighborhoods are offered greater access to food sources that promote unhealthy eating such as fast food restaurants and convenience stores. There is limited access to healthy foods from fresh markets, supermarkets and grocery stores in low- income neighborhoods. This results in higher prevalence of obesity among low-income and minority populations. My patient lives in a suburban neighborhood where he has plenty of access to healthy grocery stores and restaurants to purchase healthy foods. He has access to The Fresh Market and the store Sprouts to purchase fresh, organic fruits and vegetables. The neighborhood he lives is primarily composed of well-educated, economically secure people which contributes towards the healthy food options available to him within the community. B. Importance of Social Determinants in Comprehensive Health Assessment Social determinants need to be addressed in the comprehensive health assessment because it is important for healthcare providers to understand the social determinants that affect their patient’s health. Conditions in the environments in which people are born, live, learn, work, worship, play and age all affect a wide range of health, functioning, and quality of life outcomes and risks (Health P 2020). The comprehensive health assessment gives the healthcare provider the opportunity to identify and explore potential health patterns, concerns, and barriers to health that present due to social determinants (Bickley, 2017). B1. Three Highest Priority Social Determinants The three highest priority social determinants that affect my patient are economic stability, social and community context, and health and healthcare. My patient’s economic stability could change quickly. His job as a maintenance technician meets his cost of living currently, but his situation has the potential to change without advance notice and that would make it difficult for him to maintain employment. Social and community is important to address in my patient because he has little community involvement. He does have a strong family support system. He has some unhealthy behavioral habits like smoking marijuana that needs to be addressed also. Health and healthcare needs to a priority because my patient has limited access to healthcare due to lack of insurance. B2. Nursing Plan of Care Economic Stability- I would include in my care plan for my patient to continue to manage his finances appropriately, including saving money for any unexpected medical emergencies that may arise. I would suggest that he look into an Individual Retirement Account (IRA) to begin saving for retirement, because his current employer does not offer a retirement plan. Delaying retirement too long with his advancing age could negatively impact his future health. Social and community context- I would include in my care plan for my patient to consider increasing his participation in community activities or volunteering in the community to increase his knowledge of what resources are available within the community that are geared toward improving health and wellness. I would also include in my plan of care for my patient to discontinue his unhealthy social behaviors(smoking/drinking) that may impact his health. Health and healthcare- I would include in my care plan for my patient to do research to find affordable health insurance options to improve his ability to access healthcare to receive some preventative screenings needed for someone his age. I would include in the care plan to continue to be compliant with his eye exams and dental screenings as needed. B2a. Implementation of Nursing Care Plan Economic stability- Encourage my patient to seek financial counseling from his local bank on how to begin to save for retirement. This will teach my patient the importance of planning for retirement especially at his advance age. Social and community context- Encourage patient to participate in community events, volunteer at community events, get information from his RN girlfriend about community events that he could participate in. Encourage patient to continue to maintain his family and social relationships. Encourage patient to stop smoking and decrease his drinking, seek assistance from a professional counselor if he feels like he has a problem stopping. Health and healthcare- Educate patient on the importance of preventative healthcare screenings, encourage patient to go to a community health clinic to seek care because he is not insured. Encourage patient to continue his compliance with his eye exams and dental visits. Encourage patient to research affordable healthcare plans. B2b. Barriers to Implementation Potential barriers to implementing the care plan to maintain economic stability and saving for retirement could be loss of current job, increase in cost of living expenses, or unexpected medical emergency. A barrier to encouraging participation in community events or volunteering could be if the patient is really not interested in increasing his community involvement. A barrier to getting the patient to stop smoking or drinking could be his unwillingness to discontinue those behaviors. A barrier to the health and healthcare care plan would be my patient’s unwillingness to seek preventative healthcare screenings because of fear of high medical costs. This could also lead to him not research health plans to get insurance. B2c. Individuals Involved in the Nursing Care Plan In order for this nursing care plan to be effective other people need to be involved to assist the patient to achieve the desired goals. The goal of maintaining economic stability and saving for retirement the patient, the healthcare practitioner, a financial counselor and the patient’s girlfriend need to be involved. The healthcare practitioner will do the comprehensive health assessment to develop the care plan, the financial counselor will give the patient and his girlfriend the information about savings and retirement. The girlfriend will need to be involved because she can help by encouraging the patient, but also because she is living with the patient in the same house financially contributing to the household. Her economic stability could affect my patient’s economic stability and his living situation. The goal of increasing my patient’s community involvement will take the patient, community members that he speaks with about volunteering and his girlfriend for this to be successful. The goal of discontinuing the patient’s unhealthy behaviors the healthcare practitioner will educate the patient on the importance of stopping these habits, the girlfriend will help by encouraging the patient to stop also. Health and healthcare maintenance will take the involvement of the healthcare practitioner, the patient and his girlfriend. The patient will be educated on the importance of healthcare maintenance by the practitioner and his RN girlfriend. The healthcare practitioner and the patient’s girlfriend will assist the patient to find affordable healthcare to seek preventative screenings. B3. Evaluation of Nursing Care Plan In order to evaluate the effectiveness of my patient’s nursing care plan I would use the teach-back method outlined by the Agency for Healthcare Research and Quality (2015). Studies have shown that 40-80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect. (AHRQ, 2015). Regardless of a patient’s health literacy level, it’s important that healthcare professionals ensure that patients understand the information being given to them. The teach-back method is a way of checking understanding by asking patients to state in their own words what they need to know or do about their health and wellness. (AHRQ, 2015). The teach-back or show-me methods can help healthcare providers improve patient understanding and adherence to the nursing care plan thereby improving patient satisfaction and outcomes. To evaluate whether this teach-back method is effective for my patient I spent some time educating my patient on several community resources to find access to affordable healthcare services and volunteer opportunities within the community. He was able to “teach-back” to me how to access those resources and tell me which ones would be the most helpful for him. B4. Impact of Social Determinants The impact of social determinants on my patient’s overall well-being should be improved health and quality of life. Social determinants influence a person’s health on a daily basis. We all know that eating well, staying physically active, not drinking or smoking, getting the recommended immunizations and screening tests, and seeing a doctor on a regular basis is how we take of ourselves. Our health is also determined by our economic and social opportunities, resources available to us within our homes, neighborhoods, and communities, the safety of our workplaces, and the nature of our social and personal relationships. (Healthy P 2020). My patient has lived 56 years without any major medical problems, he works full-time as a maintenance technician and makes an adequate income for his cost of living, plus his household is supported by his girlfriend’s income. He has an overall moderate health literacy. He understands the importance of good health and taking care of himself. I would say my patient’s social determinants have positively affected his quality of life and overall well-being. References Agency for Healthcare Research and Quality (AHRQ) (2015) Health Literacy Universal Precautions Toolkit, 2nd Edition. Retrieved from ...literacy/ quality-resources/tools/literacy-toolkit/. Bickley, L. (2017) Bates’ Guide to Physical Examination and Health History. 12th edition Retrieved from