NUR4032 - Wider determinants, health screening, holistic assessment, care planning

wider determinants of health

A social, economic and environmental factor that influences a persons health and wellbeing beyond access to healthcare services.

Also known as social determinants of health

Examples of wider determinants of health

Income

Employment

Education

Crime

Social capital

Social capital

The ability to work together effectively to achieve a common goal.

Low social capital = antisocial behavior

Natural and built environments

Natural - nor green and blue areas like parks and lakes.

Built - areas of more infrastructure like hospitals and transportation

Social gradient of health

The relationship between wider determinants of health on health outcomes.

Lower socioeconomic status = poorer health outcomes

Health inequalities

The avoidable unfair differences in health outcomes caused by wider determinants of health.

Examples of health inequalities.

Protected characteristics - unconscious bias, lack of research

Geography - rural and city

Socioeconomically deprived - poor education, labour intensive jobs

Socially vulnerable and excluded groups- sex workers and gypsies

The Marmot Review

Identifies aims to reduce health inequalities by addressing the impact of wider determinants of health across the lifespan.

Marmots aim

Decrease social gradient and increase health outcomes

Examples of Marmots recommendations

Give every child the best start in like

Fair employment

Healthy standard of living

Health places and communities

Prevention of illness

Example of health inequality

Black women are more likely to die from pregnancy/childbirth than white women in the uk due to wider determinants of health

Importance of 1001 Critical days according to marmot 2020

To ensure children have the best start in life and reduce negative health outcomes in the future due to wider determinants of health

Health screening

A process to identify apparently healthy individuals who may have an increase risk of a particular health condition or disease.

Use of health screening

Early recognition of health conditions and risk mitigation to encourage better health outcomes.

Is health screening compulsory

No it’s not compulsory

Types of health screening

Stratified - on an individual basis

Population - healthcare providers reaching out to a populations of a group who may be at increased risk to developing a health condition (smear)

Targeted - aims to identify groups of people who may be at increased risk to developing a health condition beyond demographics (cancer screening in smokers)

Health screening programs offered in the UK

Pregnancy - foetal anomaly screening programs

Newborn - hearing screening program

Young people / adult - cervical screening program

Female - breast screening program 50-70

Male - bowel cancer screening program 54-74

Benefits of health screening

Reduce cost to NHS

Reduce use of toxic interventions

Reduce risks of some health conditions

Stages of screening

Identify

Invite/inform

Test and screen

Results

Diagnosis

Treatment

Evaluation

Number of health screening programs in the UK, according to NHS and PHE

11

Number of conditions screening cover

36

Methods of evaluating screening programs.

Randomised control trials

Time trend studies

Case control studies

Why evaluate screening programs

To see if they effectively reduce risks of serious health outcomes and provide a benefit to the population.

Does health screening diagnose heath conditions

No it doesn’t diagnose health conditions.

Does Heath screening produce accurate results.

It doesn’t produce accurate results

False negative

A test that shows an individual is not at higher risk of developing a health condition when they are.

False positive

A test that shows an individual is at higher risk of developing a health condition when they aren’t

Ethical principles of health screening

Improved health and wellbeing

Treat people with respect

Promote equality and inclusion

Use public resources fairly and proportionately

Number of informed choice principles

8

Informed choice principles

Personal informed choice

Respect for choice

Evidence based information

Timeless information

Consistency of information

Opportunity for discussion

Accessibility to everyone

Used involvement

Holistic care

A nursing approach.

Considers the biological, psychological, social and spiritual components of health. Not just the clinical diagnosis

NMCs model of the holistic approach

Biological

Psychology

Behavioural

Cognitive

Social

Spiritual

Wider determinants

Person-centred care

A collaborative approach that involves both heath professionals and patient to make care decisions in line with the patients values

Nursing Process model

Assessment

Nursing diagnosis

Planning

Intervention

Evaluation

Ensure success in “assessment”

Clinical judgment

Build relationships

Gather information

Use assessment tools

Roper, Logan and Tierny’s 12 activities of daily living

Maintaining a safe environment

Breathing

Eating and drinking

Controlling body temperature

Washing and dressing

Working and playing

Mobilising

Eliminating

Expressing sexuality

Sleeping

Dying

Influencing factors in Roper, Logan and Tiernys model of nursing

Physical

Psychological

Sociocultural

Politico economic

Environmental

Dependence/independence continuum

The scale used to assess people ability to complete their activities of daily living, which in turn informs the holistic assessment

FICA

Faith

Influence/importance

Community

Address

Patient population who may experience higher spirituality demands

End of life

Terminal (palliative)

How a nurse can gather information

Looking

Touching

Observing

Listening

Smelling

Talking to them

Family

Notes

MDT

Objective data

It is fact.

Measured through observation, physical examination and diagnostic testing

Subjective data

Secondary information. Gathered from patient, persons or MDT

Assessment tools

NEWS2

PEWS

Bristol stool chat

Glasgow coma scale

Falls risk assessment

Wong Baker pain facial scale

Waterlow

Continence

MUST

Bed rails assessment

Patient handling

Care planning

Nurse acts for or with the patient to address specific problems or needs.

Typically consists of two stages - identifying actions and setting goals

Care plan

Written record of the care planning process

Documenting the nurses clinical decision making while justifying their actions and evaluating the outcomes

Types of care planning

Initial

Ongoing

Discharge

Components of an effective care plan

Patient centred

Clear and concise

Understood by all

Based on holistic approach and assessment of needs

Collaborative with patient and MDT

Manages risks

Up to date

Individualised care plan

Written from scratch with the patient

Standardised care plan

Evidence based

Prewritten plan for people with specific needs or groups of patients

Care pathway

Multidisciplinary.

Used by all members of health care team.

Evidence based and outlined care protocols for specific groups of patients

Advantages of individualised care plans

Free of preconceptions

Aligned with patient values

Improves patient care

Disadvantages of individualised care plans

Time consuming

Not evidence based

Difficult to master and teach

Advantages of standardised care plan

Time effective

Consistency of treatment in the same health conditions

Evidence based

Disadvantages of standardised care plans

Can be used as checkbox exercises

Not personalized to patients needs

May not be up to date

Example of standardised care plan

NEWS2

Wound care

Falls prevention

Aim of care pathway

Reduce cost to NHS

Improve quality of care

Encourage continuity of care

Examples of groups who may have care pathways

Diabetics

Cancer

End of life

Kidney failure

Principles of capacity

Assume capacity unless evidence otherwise.

Do not treat a person as unable to make a decision unless you have done all you practically can to help them reach that decision.

Unwise or eccentric decisions on their own do not prove lack of capacity.

If you are making decisions for or acting on behalf of someone you should always do so in the best interest.

Look for the least restrictive option that will meet the need.

When supporting someone to decide. This must be documented

Nature of decision

Options available

Consequences of each option/decision

VIPS

Values

Individualised

Perspective

Social factors

SMART

Specific

Measurable

Achievable

Relevant

Time based

PRODUCT

Patient centred

Recordable

Observable

Directive

Understandable

Credible

Time related

What nursing interventions should be

Clinically justified

Evidence based

Improve specific outcome

Advanced care planning

Ensuring the wishes of patients approaching end of life care, and may lack capacity, are respected

Are advance statements legally binding

No they’re not legally binding

Example of advance care plan

ReSPECT