WGU C350 Comprehensive Health Assessment for patients and population

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WGU C350 Comprehensive Health Assessment for patients and population

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Comprehensive Health Assessment for Patients and Populations
“Social determinants of health care conditions in the environments in which peop…View more

University
Western Governors University
Course
Comprehensive Health Assessment for Patients and Populations (C350)
Academic year2020/2021

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Social Determinants

“Social determinants of health care conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks” (U. Department of Health and Human Services, 2014). Healthcare providers need to take social determinants into the reason for the general health of the patient. Having the ability to assist a patient with weak social determinant can profoundly positively impact the patient’s health and well-being. Many factors affect the health of a person, the population, and the community.

Evidence-Based Interview Techniques

In the complete health assessment, four evidence-based interview techniques were used. The four techniques included guided questioning, active listening, non-verbal communication, and transitions. While virtually interviewing Carolyn Cross, I was able to conduct a non-threatening interview and initiate conversation. It is essential to have a face-to-face interview, which will allow the provider and Carolyn Cross to see each other’s body language, which allows us to see each other’s feelings or concerns by observing each other.

The first interview technique that was used to speak with Carolyn Cross was active listening. This method includes paying close attention to the patients’ needs by using both verbal and nonverbal language. When using this technique, I am focusing on Carolyn Cross in the current moment and not thinking of anything else. By using active listening, I can get a picture of what is going on with Carolyn Cross’s social determinants and allows Carolyn to speak about her thoughts and feelings about her access to healthcare. I was able to keep the focus of her answers, showing her that I understand her feelings and allowing her to complete her answers. I would also summarize her answers and use closed- loop communication, so no misinterpretations were occurring. Another feature of using active listening is to answer their questions in a nonjudgmental way (Bickley & Szilagyi, 2017).

Health and Health Care

Asking questions about the social and physical environment surroundings for Carolyn Cross is the best way to identify social determinations. I asked Carolyn questions like, “does she go to the doctor’s regularly?” and “does she have medical insurance?” Carolyn answered that she regularly sees the doctor for appointments and wellness visits, similar to her visit today. The question is attempting to recognize Carolyn’s access to healthcare and determine how important health is for her. It can be implied that she does care about since she attended today’s appointment. Carolyn stated that she regularly attends doctor’s appointments for yearly checkups and is now concerned about her health after her mother and cousins’ diagnosis of breast cancer. Carolyn does have a history of fibrocystic breast disease but has had a regular mammogram approximately one year ago. Her last Pap smear was about three years ago. Carolyn does have medical insurance and takes advantage of preventative services. Carolyn also reports that she is fully competent and denies having learning or mental disabilities.

Economic Stability

The healthcare provider tries to identify if a patient can afford healthcare costs and if they have an income. The provider will ask a question like: Do you have a job? Can you tell me about your job? Are you married? Does your spouse have a job? After asking these questions, Carolyn responded that she has a full-time job as an education specialist in a middle school, and she is delighted with her job. Her husband is also working full time as an accountant. Both Carolyn and her spouse have healthcare and retirement benefits. Asking these questions will determine if Carolyn has an income source and if the income is stable every month. By asking if Carolyn is married will determine if she has additional income sources, which she does with her husband. Carolyn has financial, economic stability; she has also expressed that she owns her home with her spouse. Therefore, they are above the poverty level.

Neighborhood & Built Environment

To assess Carolyn’s neighborhood and environment, I would ask the following questions; Where do you live? Do you have appropriate housing? Do you feel safe where you live? Do you drive?

Carolyn Cross answered all questions. She responded that she lives in a family home with her spouse and two sons relatively close to the doctor’s office. She reports she lives in a middle-class residential area with minimal exposure to toxins. The house is near convenience stores and supermarkets within a five-mile radius providing ample access to food. Carolyn reports that she is trying to provide healthier foods for her family. She states that her home and neighborhood are safe, with no gang-related activity in the area. The neighborhood has multiple sidewalks and parks within walking distance. The questions assisted in assessing if Carolyn is safe and has appropriate housing for her and her family. Knowing the living settings helps assess the impact a patient’s healthcare access and quality of care they are receiving. Determining how safe Carolyn feels in her home and her community would help assess potential dangers that could impact Carolyn’s health. Carolyn states that she owns her car but also has access to public transportation.

Social and Community Context

This section attempts to find out how Carolyn uses her free time. Questions asked to include social and leisure activities? How often does she see her family? Does she smoke? Does she drink alcohol regularly? Does she participate in extracurricular activities? How does she feel she is treated regarding race and ethnicity? Carolyn stated that she works during the week and occupies her spare time with her family, and enjoys cooking, reading, and gardening when she is not working. Carolyn reports that she sees her mother about once a week, and since she spends free time with her mother, she does not have free time for additional activities. Carolyn states she does not smoke and has a glass of wine with dinner at night. She would like to start running or join a jogging group with other women. She also does not believe she is mistreated due to race or ethnicity. Asking these questions allows me to understand the

insurance will fully cover most preventative measures like vaccinations, cholesterol, and cancer screening tests and procedures like biopsies.

She mentioned eating healthier, so I would recommend healthier eating habits like increasing fruits and vegetables in her diet and making more food at home and less eating in fast food places. I would also suggest considering substituting cookies for a healthier snack like legumes, fruits, or nuts. I would also encourage her to take a daily multivitamin as she did not mention she takes only taking Vitamin E for her cysts. Carolyn also reported that she resides in a single-family home close to grocery stores, so she has plenty of time to buy healthy foods. A good idea for her would be to start meal planning and prepping foods to rely on fast foods.

Carolyn reported that she has parks, sidewalks, and hiking paths close to her. I would recommend that she begin walking daily for approximately thirty minutes to help with her overweight issue. She lives in a safe neighborhood to perform outside safely, and her sons can walk with her. These suggestions should go over well with her since she wants to maintain a healthy lifestyle.

Carolyn stated she wanted to start jogging and join with a group of women to go regularly. I would highly encourage her to participate in jogging to help promote her health. She stated that she does not participate in extracurricular activities since she cares for her mother, so being involved with other women will provide her with emotional and physical support for her health. Due to her high literacy level, I would encourage her to read more about health maintenance and prevention so that she can not only educate herself but for others around her, including her husband and children. She has the Education to present information in a way that can be easily understood. It may also be a good idea to cut down on her daily glass of wine with dinner, preferably cut alcohol out altogether but start by cutting back. It would also be a good idea for her husband to practice healthy behaviors so they can both set a good example for their children.

Economic Stability

Economic status plays a part in the attainment of healthcare services because if there are no adequate funds to purchase food, the person will not spend money on prescriptions and doctors’ visits. A person with high socioeconomic status will have the ability to purchase food, spend money on prescriptions, see the doctor when needed, and have time off work for procedures or vacation time. However, to be off of work, you need to be able to afford to be off. Economic stability is not a problem for Carolyn, who has a full-time job, and her husband, who can provide the additional income should she need it. She has medical insurance, which covers preventative health costs. Economic stability is one of the most critical factors affecting healthcare. Carolyn’s socioeconomic status is above the poverty level, meaning she has financial security. She lives in a single-family home, she can afford to pay her bills for the house and the mortgage, and the house has electricity and running water. She has a full-time steady job working in the school. She lives in a safe, quiet neighborhood with walking sidewalks and parks close to stores and healthcare facilities. A patient who does not have a stable job could affect their health status, as they may not afford healthcare or insurance. A patient who has housing uncertainty may also have trouble accessing healthcare, or a patient who moves frequently may not have time to establish a primary care provider. Not having suitable housing may also affect a person’s ability to obtain a job that offers medical insurance and the means to afford healthcare options.

Educational Status

The level of Education can affect a person’s health status as it affects their income, affecting their health. College graduates may be able to obtain a better job with fewer hazards. Education is linked to employment disparities because it affects the type of work people do, the working conditions they experience, and the income they earn (ODPH, n.-b). People who lack an education may find themselves without employment or jobs that can put them at higher risks for specific comorbidities and

(Hahn & Truman, 2015). A higher level of Education correlates to healthier neighborhoods and more resources and opportunities. The neighborhoods typically have other educated people with healthy lifestyles and behaviors that influence others. If a person has little to no education or living in a low or unsafe neighborhood, they may be unable to participate in outdoor activities as if they may not be safe. Educational fortitudes play a vital part in choices being made by a patient and healthy lifestyles for children since the correlation between health and Education are interconnected.

Healthcare Barriers and Opportunities

Multiple factors affect opportunities for access to healthcare, like environmental and biological factors that may contribute to poor health. An important factor is a social factor since it substantially impacts a person and starts early in family development. “Having a comprehensive understanding of underlying causes of adult diseases (including social, physiological, biological, and environmental) is necessary to successfully approach the problems seen in populations” (Curley & Doherty, 2015). People exposed to violence, neglect, and being a victim of violence could lead to poor health. A person’s risk and access to healthcare can be influenced by a person’s Education, social class, marital status, social status, salary level, and geographic location. People with chronic conditions who do not manage them regularly will have their health status affected even more. People with chronic conditions have most likely got them from preventable factors like poor eating habits, smoking, and lack of exercise. If people were educated earlier about the importance of prevention of chronic diseases, they might be able to change their bad habits and choose to improve their health (Curley & Doherty, 2015). In many situations, people with a lower socioeconomic status will seek medical care only when they reach the crisis level and go to the emergency room, which has the highest care level and the highest cost. Some people do not have access to reliable transportation, which creates barriers to attaining healthcare. For example, a person living in a rural area may not have access to public transportation. People with a low

socioeconomic status may live in a community where health threats like lead paint in a house or an area with increased crime and violence.

A person who possesses a high school diploma would have received instruction in school about physical activities, healthy habits, good hygiene, and nutritional recommendations (ODPH, n.-b). While in school, medical, dental, hearing, and vision services are offered and immunizations. High school graduates may have a lower entry job, continue schooling in a college, or train schools (ODPH, n.-b).

Carolyn Cross has more opportunities for better healthcare due to her higher education level, salary level, social class, and marital status. Carolyn possesses a master’s degree and has a job that offers her medical insurance, which allows her to see doctors for both acute and preventative services. Since she has an advanced level of Education, she has better pay and can pay her bills and continue to save money, and use some of the extra money to pay copays for doctors, gas for her car, groceries, and medications.

Carolyn may have a barrier because her background is in Special Education; she may not know what to look for when it comes to illness and may not know what to tell a doctor who could delay her care plan. Another barrier is that she may not be aware of new technologies or terminologies in the healthcare system. Even though she is educated, she may need to ask questions about her conditions and look into the meaning of specific medical terms to completely understand her health.

Effect of Health on Quality of Life

Health-related quality of life is complicated, looking at an individual’s overall health and well- being by including all aspects of physical, emotional, mental, and social functions (ODPH, n.-b). A person’s view on the quality of life comprises cognitive, physical, emotional, and social processes and how their outlooks satisfy their quality of life. Someone who has a disease and requires treatments and cannot afford it may have their quality of life affected. The financial burden would decrease the patient’s quality of life due to the increased stress it puts on a patient’s daily life. If the patient has heart failure,

The healthcare provider needs to have efficient assessment skills to identify the patient understanding of what is being explained. The provider should pay attention to verbal and non-verbal clues to determine the patient’s level of knowledge and if more Teaching is needed. Individuals with a low health literacy rate are usually those with low income and are underinsured. This means they need to be explained at a lower level of functioning if required (CDC, n.-1). The patient should be able to read and comprehend the resources delivered to them by the provider. To be considered healthcare literate, it means the patient understands their disease processes and knows how to manage the disease and symptoms at a knowledgeable level. If the patient understands their illness, they will most likely have a better outcome. A patient who has a better understanding of their medical condition, medications they are taking and know what changes to look for with their condition will overall do better than someone who does not fully understand their situation. Understanding healthcare conditions should be assessed during each healthcare visit to ensure understanding of the disease process and self- management to lead to a better quality of life. The more they understand, the better their outcome. The additional information the hospital and employees can communicate with a patient and the patient’s families, the more the patient will accomplish and manage the symptoms of their illness (CDC, n.-1).

Carolyn is college-educated, has medical insurance, and lives above the poverty line, so she should have a higher health literacy. She has been exposed to information regarding her health since her mother’s diagnosis of breast cancer. She can also learn about breast cancer when she sees her physician for her wellness visit. She will complete a mammogram and a pap smear and do regular self-breast exams. The more information she has, the more her knowledge base is increased to identify the disease’s signs and symptoms. Preparation will give Carolyn health materials and awareness to help her live a better lifestyle and preemptive care.

A barrier to providing Carolyn education is that if she feels she has all the information she needs about breast cancer, she may not ask questions or feel embarrassed to ask questions about the disease. The healthcare provider may not provide Education to Carolyn if she appears to know more about the condition.

Neighborhood and Environmental Impacts

Carolyn resides in a neighborhood with access to two grocery stores, multiple convenience stores, and a fresh market. She resides in a single-family home, along with her husband and two sons. Having access to two grocery stores and a fresh market allow Carolyn to have better food options that are healthy. Eating healthy foods like fresh fruit and vegetables will help Carolyn fight obesity and better life quality. Her neighborhood has parks and sidewalks, allowing her to exercise when she is not assisting her mother. Carolyn lives in an area that is close to healthcare services, allowing Carolyn to seek routine treatment. She also has access to public transportation, so she will still attend appointments and get to her job if she is unable to drive.

Environmental factors impact the population and overall health of an individual in an area. The environmental factors include the water and quality of the water-based on where a person lives; the water could be polluted due to industry, construction, transportation, or agriculture. The water could also be polluted due to insects, water disasters, or animals. What categories of transportation is available? What does the environment look like? What is the quality of the homes built in the area like? Does the area have sidewalks, open spaces, or schools? What is the income in the community, high or low? Is the community considered rural or urban? These environmental factors impact access to healthcare and the promotion of health (CDC, n.-1).

Healthcare Received in Low- and High-Income Areas

Both high and low-income areas can seek care from an emergency room with little effort. High and low-income people are not denied healthcare due to gender, race, ethnicity, or ability to pay. Emergency care will be provided the same regardless of is they have money or not. In an emergency setting, all patients are treated somewhat based on their needs, regardless of their insurance coverage, or if they do not have insurance, the provider cannot refuse care. The same goes for if a high or low- income person would call for emergency services or 911. They will receive the same care regardless of the kind of insurance they have or their income. All Americans will receive 911 services regardless of where they live; they will receive the same skill (Spasojev et al, 2015).

Hospitals cannot deny high and low-income patients based on money or if they have or do not have insurance. Healthcare needs to be provided to all; tests, labs, diagnostics, procedures, physician consults, and admissions to the hospital would be the same for the patient’s needs.

Carolyn’s neighborhood and environment affect her access to healthcare. She lives in a safe middle-class suburban neighborhood with access to fresh, clean water. The area does not have many toxins like areas with factories and plants. The grocery stores and fresh markets are located within walking distance to her home. She does not need to travel far to make healthy choices for her and her family. She is within walking distance to the pharmacy and the doctor’s office, and closer access means better quality of life.

Carolyn lives in a higher income area that confidently affects her quality of life. She has private health insurance through her employer and lives close to pharmacies and doctors. Living in a higher income area allows her to attend wellness visits yearly and visits when she needs it. She can get prescribed medications promptly due to the proximity of the pharmacy. The air quality is good, and she is not exposed to chemicals or toxins. Carolyn owns her car, which allows her to attend her healthcare appointments and has public transportation in her town.

Rural vs. Urban Healthcare Access

Rural areas have more limited access to healthcare. Rural areas are open land spaces with fewer homes and buildings with fewer people in the area and low population density. Rural areas have lower levels of Education, fewer employment opportunities, and limited public transportation. Rural residents tend to travel more than fifteen miles to see primary care providers, specialty or emergency care, and health literacy concerns for urban and rural areas (Spasojevic et al., 2015). There are fewer employment opportunities in rural areas when compared to urban areas. People who are employed have economic stability and can have access to preventative healthcare. Rural areas typically do not have affordable public transportation or transportation is limited to specific areas. Public transportation like taxis could cost lots of money because of the distance between the home and the closest doctor’s office. People who have disabilities in wheelchairs could use the services of an independent company for transportation but may not be able to travel outside of the city. In rural areas, access to healthcare services is limited due to dependable transportation. Urban areas have public transportation everywhere, like buses, subways, and taxis. The suburban areas are on the cities’ outskirts and consist of dense houses, buildings, and road access. Healthcare is more available in urban areas, and there are more physician’s offices closer together (Spasojevic et al., 2015).

Carolyn lives in a suburban neighborhood with access to healthcare services and pharmacies with reliable transportation to get to her appointments and pharmacies as needed. Carolyn also has sufficient access to grocery stores and fresh markets.

Neighborhood Healthy Food Options

Individual factors like race, age, ethnicity, Education, and income affect if a person is overweight (Halpern et al., 2017). Sociodemographic factors like poverty and less educated people are more likely to be obese or overweight, and community food is a predictor for the home food environment. People

o Health Knowledge- Health and Healthcare

o Atmosphere and Community- Access to foods that support healthy eating

o Community and societal content- social unity

B2. Care Plan

o A consistent healthcare routine will be established by the patient to ensure early detection of breast cancer at least once per year or as needed based on increased risk factors.

o An average body mass index will be reached by the patient within six months.

o Regular, consistent physical activity will be engaged in on most days for twenty to forty minutes per day (CDC, n.-c).

B2a. Implementing the Plan

o The patient will be educated for signs and symptoms associated with breast cancer by the nurse.

o Follow up appointments will be scheduled for mammograms by the patient.

o Teaching will be provided on healthy foods, plan healthy meals, and correct the nurse’s correct serving size.

o Healthy food planning will take a plan daily by the patient, which will avoid eating junk and fast food.

o The patient will be educated on the benefits of joining a women’s jogging group and the benefits of physical activities in her neighborhood.

B2b. Barriers

o The patient may not have the motivation to attend the appointment, or a potential schedule conflict could occur.

o The patient may develop anxiety that may prevent her from attending the appointment.

o A barrier will be the convenience of buying fast food.

o The patient may lack the motivation to continue making healthy food choices.

B2c. Involved Individuals

o Teaching will be provided by the nurse regarding signs and symptoms for early detection of breast cancer.

o A follow-up appointment for a mammogram will be scheduled by the secretary, and the gynecologist will review the mammogram.

o Moral support and encouragement to attend mammograms will be given by the patient’s mother.

o Education will be provided on healthy foods and preparing healthy foods and portion sizes by the nurse.

o An explanation of foods’ nutritional values and healthy caloric intake will be taught by the dietician. Support will be given by the patient’s husband to encourage buying healthy foods and provide help in preparing meals.

o Education will be provided on the benefits of joining a jogging group and how physical activity benefits a patient’s health.

o Emotional support will be provided by the patient’s husband to participate in a jogging group. The husband will participate in walking and exercising with the patient during the week. Support from the jogging group will be provided to all group members. The healthcare provider will continue to encourage the importance of physical activity and lower the body mass index.

B3. Evaluation
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Running head: SOCIAL DETERMINANTS 1
Social Determinants
Western Governors University
October 27, 2020

Running head: SOCIAL DETERMINANTS 3
The second interview technique includes empathetic responses. This technique is critical when
interviewing Carolyn about her mother and cousin’s concerns recently being diagnosed with breast
cancer. Providing compassion and empathetic responses let the patient know that the provider is trying
to identify with the patient’s feelings and understand them as if they were their own (Bickley & Szilagyi,
2017). A compassionate response needs to convey that the provider is feeling what is being felt by
Carolyn. The provider needs to respond with acceptance and understanding.
The third technique used is non-verbal communication. Non-verbal communication is constant
from both patients and providers that can suggest underlying emotions or feelings. Echoing the patient’s
mannerisms can provide the patient feeling of connection, increasing and building a relationship with
the patient. This technique also allows for a better assessment with information while the patient did
not have to say anything. While interviewing Carolyn, the provider would pay more attention to the tone
of voice, eye contact, and facial expressions being seen from Carolyn. Carolyn Cross is a Hispanic, so I
would need to be aware of cultural differences for nonverbal and verbal communication as a provider. If
a healthcare provider is knowledgeable about cultural differences, they would be more capable of
addressing a patient’s needs and providing better quality care (Bickley & Szilagyi, 2017). Sometimes non-
verbal communication provides more information than verbal communication (Bickley & Szilagyi, 2017).
The final technique used was validation. Using this technique allows Carolyn Cross to that that
her fears and feelings about breast cancer matter. Carolyn Cross does not have breast cancer; however,
she is worried that she may have it since her mother and cousin have been recently diagnosed with it.
Since her cousin is only forty-four and diagnosed and Carolyn is forty-one, she has reason to be
concerned. While interviewing Carolyn, her feelings need to be validated regarding her fears and
concerns. Her stress should be reduced as well as allowing her to express her feelings.
Justifying Key Questions
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Running head: SOCIAL DETERMINANTS 4
Health and Health Care
Asking questions about the social and physical environment surroundings for Carolyn Cross is
the best way to identify social determinations. I asked Carolyn questions like, “does she go to the
doctor’s regularly?” and “does she have medical insurance?” Carolyn answered that she regularly sees
the doctor for appointments and wellness visits, similar to her visit today. The question is attempting to
recognize Carolyn’s access to healthcare and determine how important health is for her. It can be implied
that she does care about since she attended today’s appointment. Carolyn stated that she regularly
attends doctor’s appointments for yearly checkups and is now concerned about her health after her
mother and cousins’ diagnosis of breast cancer. Carolyn does have a history of fibrocystic breast disease
but has had a regular mammogram approximately one year ago. Her last Pap smear was about three
years ago. Carolyn does have medical insurance and takes advantage of preventative services. Carolyn
also reports that she is fully competent and denies having learning or mental disabilities.
Economic Stability
The healthcare provider tries to identify if a patient can afford healthcare costs and if they have
an income. The provider will ask a question like: Do you have a job? Can you tell me about your job? Are
you married? Does your spouse have a job? After asking these questions, Carolyn responded that she
has a full-time job as an education specialist in a middle school, and she is delighted with her job. Her
husband is also working full time as an accountant. Both Carolyn and her spouse have healthcare and
retirement benefits. Asking these questions will determine if Carolyn has an income source and if the
income is stable every month. By asking if Carolyn is married will determine if she has additional income
sources, which she does with her husband. Carolyn has financial, economic stability; she has also
expressed that she owns her home with her spouse. Therefore, they are above the poverty level.
Neighborhood & Built Environment
Running head: SOCIAL DETERMINANTS 5
To assess Carolyn’s neighborhood and environment, I would ask the following questions; Where
do you live? Do you have appropriate housing? Do you feel safe where you live? Do you drive?
Carolyn Cross answered all questions. She responded that she lives in a family home with her
spouse and two sons relatively close to the doctor’s office. She reports she lives in a middle-class
residential area with minimal exposure to toxins. The house is near convenience stores and
supermarkets within a five-mile radius providing ample access to food. Carolyn reports that she is trying
to provide healthier foods for her family. She states that her home and neighborhood are safe, with no
gang-related activity in the area. The neighborhood has multiple sidewalks and parks within walking
distance. The questions assisted in assessing if Carolyn is safe and has appropriate housing for her and
her family. Knowing the living settings helps assess the impact a patient’s healthcare access and quality
of care they are receiving. Determining how safe Carolyn feels in her home and her community would
help assess potential dangers that could impact Carolyn’s health. Carolyn states that she owns her car
but also has access to public transportation.
Social and Community Context
This section attempts to find out how Carolyn uses her free time. Questions asked to include
social and leisure activities? How often does she see her family? Does she smoke? Does she drink alcohol
regularly? Does she participate in extracurricular activities? How does she feel she is treated regarding
race and ethnicity? Carolyn stated that she works during the week and occupies her spare time with her
family, and enjoys cooking, reading, and gardening when she is not working. Carolyn reports that she
sees her mother about once a week, and since she spends free time with her mother, she does not have
free time for additional activities. Carolyn states she does not smoke and has a glass of wine with dinner
at night. She would like to start running or join a jogging group with other women. She also does not
believe she is mistreated due to race or ethnicity. Asking these questions allows me to understand the
Running head: SOCIAL DETERMINANTS 6
factors that may be affecting Carolyn’s health. It is essential that Carolyn has the support of her family
and how she spends her time outside of work. Depending on how she answered the race and ethnicity
questions, I would look further into concerns as discrimination is real, and we do not want it to affect
her.
Education
I want to know about Carolyn’s Education and her background and her native language, and
how well she understands English.
Carolyn’s responses included that she is fluent in both English and Spanish. Carolyn possesses a
master’s degree in Special Education and a bachelor’s degree in Elementary Education. Questions like
this help determine a patient’s literacy level and are essential to identify literacy issues early so
healthcare education can be presented at an appropriate patient level. If Carolyn did not have a high
level of literacy, Education would need to be provided on a level that she could understand
Responses to Key Questions
Carolyn informs that she gets wellness checkups yearly and knows the significance of her health.
Nursing care plans help recognize areas where a patient could be at risk and find ways to address those
risks. She is due for a pap smear and flu vaccine; I would recommend them while doing her wellness
checkup. I would also mention that she does self-breast exams once a week to look for any new lumps or
changes, showing her that I recognize her breast cancer concerns. This will also help her sustain
compliance and help notice changes that could indicate breast cancer.
Carolyn and her husband both have medical insurance to most likely afford to see doctors and
purchase medications. I would encourage her to continue with wellness visits and explain that her
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Running head: SOCIAL DETERMINANTS 7
insurance will fully cover most preventative measures like vaccinations, cholesterol, and cancer screening
tests and procedures like biopsies.
She mentioned eating healthier, so I would recommend healthier eating habits like increasing
fruits and vegetables in her diet and making more food at home and less eating in fast food places. I
would also suggest considering substituting cookies for a healthier snack like legumes, fruits, or nuts. I
would also encourage her to take a daily multivitamin as she did not mention she takes only taking
Vitamin E for her cysts. Carolyn also reported that she resides in a single-family home close to grocery
stores, so she has plenty of time to buy healthy foods. A good idea for her would be to start meal
planning and prepping foods to rely on fast foods.
Carolyn reported that she has parks, sidewalks, and hiking paths close to her. I would
recommend that she begin walking daily for approximately thirty minutes to help with her overweight
issue. She lives in a safe neighborhood to perform outside safely, and her sons can walk with her. These
suggestions should go over well with her since she wants to maintain a healthy lifestyle.
Carolyn stated she wanted to start jogging and join with a group of women to go regularly. I
would highly encourage her to participate in jogging to help promote her health. She stated that she
does not participate in extracurricular activities since she cares for her mother, so being involved with
other women will provide her with emotional and physical support for her health. Due to her high
literacy level, I would encourage her to read more about health maintenance and prevention so that she
can not only educate herself but for others around her, including her husband and children. She has the
Education to present information in a way that can be easily understood. It may also be a good idea to
cut down on her daily glass of wine with dinner, preferably cut alcohol out altogether but start by cutting
back. It would also be a good idea for her husband to practice healthy behaviors so they can both set a
good example for their children.
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Economic Stability
Economic status plays a part in the attainment of healthcare services because if there are no
adequate funds to purchase food, the person will not spend money on prescriptions and doctors’ visits.
A person with high socioeconomic status will have the ability to purchase food, spend money on
prescriptions, see the doctor when needed, and have time off work for procedures or vacation time.
However, to be off of work, you need to be able to afford to be off. Economic stability is not a problem
for Carolyn, who has a full-time job, and her husband, who can provide the additional income should she
need it. She has medical insurance, which covers preventative health costs. Economic stability is one of
the most critical factors affecting healthcare. Carolyn’s socioeconomic status is above the poverty level,
meaning she has financial security. She lives in a single-family home, she can afford to pay her bills for
the house and the mortgage, and the house has electricity and running water. She has a full-time steady
job working in the school. She lives in a safe, quiet neighborhood with walking sidewalks and parks close
to stores and healthcare facilities. A patient who does not have a stable job could affect their health
status, as they may not afford healthcare or insurance. A patient who has housing uncertainty may also
have trouble accessing healthcare, or a patient who moves frequently may not have time to establish a
primary care provider. Not having suitable housing may also affect a person’s ability to obtain a job that
offers medical insurance and the means to afford healthcare options.
Educational Status
The level of Education can affect a person’s health status as it affects their income, affecting their
health. College graduates may be able to obtain a better job with fewer hazards. Education is linked to
employment disparities because it affects the type of work people do, the working conditions they
experience, and the income they earn (ODPH, n.d.-b). People who lack an education may find
themselves without employment or jobs that can put them at higher risks for specific comorbidities and
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employment based on dangerous working conditions. It may also be hard to find an employer with
medical insurance, which makes an obstacle to healthcare access. Income from better employment may
improve health status and accrue better resources, such as higher housing and higher social status
(ODPH, n.d.-b).
Carolyn possesses a higher education degree; she possesses a master’s degree in Special
Education, which gives her access to a higher paying job. The job will keep her out of hardship, and she
will have enough money for healthcare. She lives in a single-family home in a safe neighborhood close to
stores where she can obtain nutritious food choices for her family and herself. She is also within walking
distance to the doctor’s office and pharmacy, providing easy access to healthcare should she need it.
Since she has a higher education level, she is more likely to get a higher paying job that offers medical
insurance. During her interview, Carolyn stated that she has medical insurance through her job, so she
has access to both acute and preventative care and medical supplies. Carolyn will be more likely to seek
care because she has the insurance and services needed to help her. Since Carolyn has a master’s
degree, she most likely has taken health promotion and disease prevention and is familiar with healthy
behaviors and disease prevention. Having a master’s degree would increase her knowledge about
making healthier decisions, giving her a more excellent life quality. Carolyn is of Hispanic origin and is
also fluent in English and Spanish, which will help educate others who may not understand healthy
practices.
According to Hahn & Truman (2015), understanding the treatment plan and medication
management is essential for health care. A person would not be able to have a quality life if they do not
understand disease management. A person may recognize the dangers of smoking but not realize the
risks of secondhand smoking exposure or its dangers. “Education improves health because it increases
effective agency, enhancing a sense of personal control that encourages and enables a healthy lifestyle”
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Running head: SOCIAL DETERMINANTS 10
(Hahn & Truman, 2015). A higher level of Education correlates to healthier neighborhoods and more
resources and opportunities. The neighborhoods typically have other educated people with healthy
lifestyles and behaviors that influence others. If a person has little to no education or living in a low or
unsafe neighborhood, they may be unable to participate in outdoor activities as if they may not be safe.
Educational fortitudes play a vital part in choices being made by a patient and healthy lifestyles for
children since the correlation between health and Education are interconnected.
Healthcare Barriers and Opportunities
Multiple factors affect opportunities for access to healthcare, like environmental and biological
factors that may contribute to poor health. An important factor is a social factor since it substantially
impacts a person and starts early in family development. “Having a comprehensive understanding of
underlying causes of adult diseases (including social, physiological, biological, and environmental) is
necessary to successfully approach the problems seen in populations” (Curley & Doherty, 2015). People
exposed to violence, neglect, and being a victim of violence could lead to poor health. A person’s risk
and access to healthcare can be influenced by a person’s Education, social class, marital status, social
status, salary level, and geographic location. People with chronic conditions who do not manage them
regularly will have their health status affected even more. People with chronic conditions have most
likely got them from preventable factors like poor eating habits, smoking, and lack of exercise. If people
were educated earlier about the importance of prevention of chronic diseases, they might be able to
change their bad habits and choose to improve their health (Curley & Doherty, 2015). In many
situations, people with a lower socioeconomic status will seek medical care only when they reach the
crisis level and go to the emergency room, which has the highest care level and the highest cost. Some
people do not have access to reliable transportation, which creates barriers to attaining healthcare. For
example, a person living in a rural area may not have access to public transportation. People with a low
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socioeconomic status may live in a community where health threats like lead paint in a house or an area
with increased crime and violence.
A person who possesses a high school diploma would have received instruction in school about
physical activities, healthy habits, good hygiene, and nutritional recommendations (ODPH, n.d.-b). While
in school, medical, dental, hearing, and vision services are offered and immunizations. High school
graduates may have a lower entry job, continue schooling in a college, or train schools (ODPH, n.d.-b).
Carolyn Cross has more opportunities for better healthcare due to her higher education level, salary
level, social class, and marital status. Carolyn possesses a master’s degree and has a job that offers her
medical insurance, which allows her to see doctors for both acute and preventative services. Since she
has an advanced level of Education, she has better pay and can pay her bills and continue to save money,
and use some of the extra money to pay copays for doctors, gas for her car, groceries, and medications.
Carolyn may have a barrier because her background is in Special Education; she may not know
what to look for when it comes to illness and may not know what to tell a doctor who could delay her
care plan. Another barrier is that she may not be aware of new technologies or terminologies in the
healthcare system. Even though she is educated, she may need to ask questions about her conditions
and look into the meaning of specific medical terms to completely understand her health.
Effect of Health on Quality of Life
Health-related quality of life is complicated, looking at an individual’s overall health and well-
being by including all aspects of physical, emotional, mental, and social functions (ODPH, n.d.-b). A
person’s view on the quality of life comprises cognitive, physical, emotional, and social processes and
how their outlooks satisfy their quality of life. Someone who has a disease and requires treatments and
cannot afford it may have their quality of life affected. The financial burden would decrease the patient’s
quality of life due to the increased stress it puts on a patient’s daily life. If the patient has heart failure,
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multiple medications daily are required, and frequent physician visits are required affecting the patient’s
quality of life.
Healthcare is considered a privilege for many people. Carolyn’s healthcare and overall health
affect her quality of life. Carolyn has medical insurance, a steady income, and can afford medications and
treatments needed. Carolyn most likely has a better quality of life due to her increased access to
healthcare and treatment resources. Because of her insurance, she has access to preventative care
services, follow up on treatments, and appointments necessary. Carolyn stated that she would see her
physician and make an appointment for a pap smear and a mammogram. She knows that she is
considered high risk for breast cancer and plans on using her insurance to get the treatment that she
needs, which is being proactive about her health status. She plans on doing regular self-breast exams,
which can detect a problem sooner, and then she can address it with her doctor.
Health Literacy
Health literacy is a person’s ability to gain, communicate, process, and comprehend the
necessary health information (CDC, n.d.-1). Nurses need to assess a patient’s ability to read and the best
method for them to learn. A comprehensive assessment that uses open-ended questions, using the
teach-back method, and speaking slowly can help assess a patient’s ability to learn. The teach-back
process allows the patient to “teach-back” their understanding of a concept using their own words.
Multiple factors affect health literacy like the patient understanding of written health materials or the
ability to interpret written information and the level of communication between healthcare providers.
Health literacy can be differentiated between patients obedient with their illness managing or
accidentally non-compliant (CDC, n.d.-1). A patient may not understand a concept on a perceptional level
and may not understand the treatment plan, so the provider should address the issue at that time.
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Running head: SOCIAL DETERMINANTS 13
The healthcare provider needs to have efficient assessment skills to identify the patient
understanding of what is being explained. The provider should pay attention to verbal and non-verbal
clues to determine the patient’s level of knowledge and if more Teaching is needed. Individuals with a
low health literacy rate are usually those with low income and are underinsured. This means they need
to be explained at a lower level of functioning if required (CDC, n.d.-1). The patient should be able to
read and comprehend the resources delivered to them by the provider. To be considered healthcare
literate, it means the patient understands their disease processes and knows how to manage the disease
and symptoms at a knowledgeable level. If the patient understands their illness, they will most likely
have a better outcome. A patient who has a better understanding of their medical condition,
medications they are taking and know what changes to look for with their condition will overall do better
than someone who does not fully understand their situation. Understanding healthcare conditions
should be assessed during each healthcare visit to ensure understanding of the disease process and self-
management to lead to a better quality of life. The more they understand, the better their outcome. The
additional information the hospital and employees can communicate with a patient and the patient’s
families, the more the patient will accomplish and manage the symptoms of their illness (CDC, n.d.-1).
Carolyn is college-educated, has medical insurance, and lives above the poverty line, so she
should have a higher health literacy. She has been exposed to information regarding her health since her
mother’s diagnosis of breast cancer. She can also learn about breast cancer when she sees her physician
for her wellness visit. She will complete a mammogram and a pap smear and do regular self-breast
exams. The more information she has, the more her knowledge base is increased to identify the
disease’s signs and symptoms. Preparation will give Carolyn health materials and awareness to help her
live a better lifestyle and preemptive care.
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A barrier to providing Carolyn education is that if she feels she has all the information she needs
about breast cancer, she may not ask questions or feel embarrassed to ask questions about the disease.
The healthcare provider may not provide Education to Carolyn if she appears to know more about the
condition.
Neighborhood and Environmental Impacts
Carolyn resides in a neighborhood with access to two grocery stores, multiple convenience
stores, and a fresh market. She resides in a single-family home, along with her husband and two sons.
Having access to two grocery stores and a fresh market allow Carolyn to have better food options that
are healthy. Eating healthy foods like fresh fruit and vegetables will help Carolyn fight obesity and better
life quality. Her neighborhood has parks and sidewalks, allowing her to exercise when she is not assisting
her mother. Carolyn lives in an area that is close to healthcare services, allowing Carolyn to seek routine
treatment. She also has access to public transportation, so she will still attend appointments and get to
her job if she is unable to drive.
Environmental factors impact the population and overall health of an individual in an area. The
environmental factors include the water and quality of the water-based on where a person lives; the
water could be polluted due to industry, construction, transportation, or agriculture. The water could
also be polluted due to insects, water disasters, or animals. What categories of transportation is
available? What does the environment look like? What is the quality of the homes built in the area like?
Does the area have sidewalks, open spaces, or schools? What is the income in the community, high or
low? Is the community considered rural or urban? These environmental factors impact access to
healthcare and the promotion of health (CDC, n.d.-1).
Healthcare Received in Low- and High-Income Areas
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Access to healthcare is determined by coverage, services, and timelines (ODPH, n.d.-b). Insurance
coverage has enhanced for most people, and coverage continues to be a worry for a lower-income area
and is less of a worry for high-income areas.
A factor in indicating what type of medical coverage the patient has is the change between low
income and high-income areas. A person from a lower-income region would be less likely to search for
preventative healthcare coverage, causing the lower-income people to wait until an advanced stage of
their disease to look for and see care. Low-income people tend to look for cheaper coverage, which
could, in turn, give them limited access and higher deductibles and copays, which patients will only use
when inevitable. Lower-income and lower area people may not see healthcare as a priority but as
another expense. Lower-income patients will typically only go to the hospital for a life-threatening
problem, or their health status is so bad that they have no other choice. Access to specialty doctors and
clinics are harder to come by in lower-income areas. To see a specialty physician, a person may need to
drive a long distance and pay out of pocket costs for a visit (ODPH, n.d.-b). Lower-income people usually
do not receive current drugs since non-generic drugs are too expensive and unaffordable. People who
live in a high-income area will typically have medical insurance that includes preventative coverage. Early
intervention of medical conditions leads to a better quality of life when patients use their coverages to
lengthen their lives. People in higher-income areas are more likely to take their health more seriously.
People in higher-income areas tend to have higher-paying jobs, pay their bills on time, and purchase food
without difficulty. These people are also more likely to have medical insurance and plan wellness visits
for examinations, and are more likely to see doctors before their problems worsen. Higher-income areas
also usually have access to better specialty healthcare providers or can afford the driver a greater
distance to get their care. Occasionally, specialty providers are close in high-income areas (ODPH, n.d.-b).
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Both high and low-income areas can seek care from an emergency room with little effort. High
and low-income people are not denied healthcare due to gender, race, ethnicity, or ability to pay.
Emergency care will be provided the same regardless of is they have money or not. In an emergency
setting, all patients are treated somewhat based on their needs, regardless of their insurance coverage,
or if they do not have insurance, the provider cannot refuse care. The same goes for if a high or low-
income person would call for emergency services or 911. They will receive the same care regardless of
the kind of insurance they have or their income. All Americans will receive 911 services regardless of
where they live; they will receive the same skill (Spasojev et al, 2015).
Hospitals cannot deny high and low-income patients based on money or if they have or do not
have insurance. Healthcare needs to be provided to all; tests, labs, diagnostics, procedures, physician
consults, and admissions to the hospital would be the same for the patient’s needs.
Carolyn’s neighborhood and environment affect her access to healthcare. She lives in a safe
middle-class suburban neighborhood with access to fresh, clean water. The area does not have many
toxins like areas with factories and plants. The grocery stores and fresh markets are located within
walking distance to her home. She does not need to travel far to make healthy choices for her and her
family. She is within walking distance to the pharmacy and the doctor’s office, and closer access means
better quality of life.
Carolyn lives in a higher income area that confidently affects her quality of life. She has private
health insurance through her employer and lives close to pharmacies and doctors. Living in a higher
income area allows her to attend wellness visits yearly and visits when she needs it. She can get
prescribed medications promptly due to the proximity of the pharmacy. The air quality is good, and she
is not exposed to chemicals or toxins. Carolyn owns her car, which allows her to attend her healthcare
appointments and has public transportation in her town.
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Rural vs. Urban Healthcare Access
Rural areas have more limited access to healthcare. Rural areas are open land spaces with fewer
homes and buildings with fewer people in the area and low population density. Rural areas have lower
levels of Education, fewer employment opportunities, and limited public transportation. Rural residents
tend to travel more than fifteen miles to see primary care providers, specialty or emergency care, and
health literacy concerns for urban and rural areas (Spasojevic et al., 2015). There are fewer employment
opportunities in rural areas when compared to urban areas. People who are employed have economic
stability and can have access to preventative healthcare. Rural areas typically do not have affordable
public transportation or transportation is limited to specific areas. Public transportation like taxis could
cost lots of money because of the distance between the home and the closest doctor’s office. People
who have disabilities in wheelchairs could use the services of an independent company for
transportation but may not be able to travel outside of the city. In rural areas, access to healthcare
services is limited due to dependable transportation. Urban areas have public transportation
everywhere, like buses, subways, and taxis. The suburban areas are on the cities’ outskirts and consist of
dense houses, buildings, and road access. Healthcare is more available in urban areas, and there are
more physician’s offices closer together (Spasojevic et al., 2015).
Carolyn lives in a suburban neighborhood with access to healthcare services and pharmacies with
reliable transportation to get to her appointments and pharmacies as needed. Carolyn also has sufficient
access to grocery stores and fresh markets.
Neighborhood Healthy Food Options
Individual factors like race, age, ethnicity, Education, and income affect if a person is overweight
(Halpern et al., 2017). Sociodemographic factors like poverty and less educated people are more likely to
be obese or overweight, and community food is a predictor for the home food environment. People
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need to be educated more about healthy food choices and what is accessible in their community
(Halpern et al., 2017).
Diet is directly related to the health status of a person (ODPH, n.d.-a). The neighborhood presents
physical and social determinations to access, knowledge, the attitude of healthy food, and availability in
order to maintain a healthy diet and reduce the risk of diseases like high blood pressure, diabetes, heart
disease, and obesity. Neighborhoods built in rural or low-income areas have more challenges due to less
healthy food options and other fast food and convenience stores. Food quality is affected by nutrition
and calorie values; unhealthy or lower quality food would have higher calories but fewer nutritional
values (ODPH, n.d.-a). Healthy food options are depended on the neighborhood a person lives in.
Carolyn can afford to purchase healthy foods and fresh fruits and vegetables. There are multiple
convenience stores and grocery stores within five miles of her house. Each week there is a fresh market
where she can purchase fresh fruits and vegetables. Carolyn did state that she wishes to eat more salads
and decrease her sugar intake. Carolyn understands that she needs to decrease her fast food intake and
snack at night, increasing her body fat.
Discussion of Social Determinations
Performing a thorough health assessment is an excellent time for the provider to learn about the
patient and listen to its concerns. Doing this builds a strong provider-patient relationship, which can help
the treatment plan for the patient. The healthcare provider needs to understand where the patient lives,
works, and what affects a patient’s quality of life (ODPH, n.d.-b). The provider can identify health
concerns and healthcare barriers while performing a health assessment presented by social
determinants. Using this information, the provider can create a plan that addresses the patient’s needs
and healthcare barriers.
B1. Social Determinants Priority
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Running head: SOCIAL DETERMINANTS 19
o Health Knowledge- Health and Healthcare
o Atmosphere and Community- Access to foods that support healthy eating
o Community and societal content- social unity
B2. Care Plan
o A consistent healthcare routine will be established by the patient to ensure early detection of breast
cancer at least once per year or as needed based on increased risk factors.
o An average body mass index will be reached by the patient within six months.
o Regular, consistent physical activity will be engaged in on most days for twenty to forty minutes per
day (CDC, n.d.-c).
B2a. Implementing the Plan
o The patient will be educated for signs and symptoms associated with breast cancer by the nurse.
o Follow up appointments will be scheduled for mammograms by the patient.
o Teaching will be provided on healthy foods, plan healthy meals, and correct the nurse’s correct serving
size.
o Healthy food planning will take a plan daily by the patient, which will avoid eating junk and fast food.
o The patient will be educated on the benefits of joining a women’s jogging group and the benefits of
physical activities in her neighborhood.
B2b. Barriers
o The patient may not have the motivation to attend the appointment, or a potential schedule conflict
could occur.
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o The patient may develop anxiety that may prevent her from attending the appointment.
o A barrier will be the convenience of buying fast food.
o The patient may lack the motivation to continue making healthy food choices.
B2c. Involved Individuals
o Teaching will be provided by the nurse regarding signs and symptoms for early detection of breast
cancer.
o A follow-up appointment for a mammogram will be scheduled by the secretary, and the gynecologist
will review the mammogram.
o Moral support and encouragement to attend mammograms will be given by the patient’s mother.
o Education will be provided on healthy foods and preparing healthy foods and portion sizes by the
nurse.
o An explanation of foods’ nutritional values and healthy caloric intake will be taught by the dietician.
Support will be given by the patient’s husband to encourage buying healthy foods and provide help in
preparing meals.
o Education will be provided on the benefits of joining a jogging group and how physical activity benefits
a patient’s health.
o Emotional support will be provided by the patient’s husband to participate in a jogging group. The
husband will participate in walking and exercising with the patient during the week. Support from the
jogging group will be provided to all group members. The healthcare provider will continue to encourage
the importance of physical activity and lower the body mass index.
B3. Evaluation

WGU C350 Comprehensive Health Assessment for patients and population