Complete Guide to a Comprehensive Health Assessment

Section A 

Evidence-Based Interview Techniques 

The first technique that was used to establish the patient’s social determinants is the face-to-face interview approach. The interview was conducted in a private setting where only the practitioner and the patient were present. It enabled the care provider to acquire accurate information on the social factors that are likely to affect the health of the patient. Face-to-face interviewing increases the validity of the data that is collected because interviewees cannot lie about demographic data, a phenomenon that is observed in the case of online interviews. Similarly, the mentioned technique enabled the practitioner to account for both the verbal and non-verbal cues during the interview as well as a factor in the emotions and behaviors of the patient in relation to their responses to the questions asked (Adebajo et al., 2014). Thus, the face-to-face interview strategy was crucial to validate the reliability of the information that the patient provided.

Secondly, the practitioner employed a non-judgmental approach to asking questions by ensuring that all queries that were addressed to the patient were open-ended. Using open questions to acquire the required information from the patient was a justified approach because it allowed the patient to give as much information as possible on the subject matter including insights on their attitudes, understanding and feelings. Hence, the care provider was able to understand the patient’s opinions on his social determinants. Additionally, using open-ended questions allowed the patient to express himself freely without fear of judgement because, in such an interview setting, there are no wrong or right answers (Naz et al., 2016). Therefore, open-ended interview questions maximized the accuracy of the information the patient provided.

Thirdly, the nurse also employed the direct questioning strategy to get as much information as possible on the social determinants of the patient’s health. Instead of asking a single question to establish the patient’s status on a sole factor, the interviewer used follow up inquiries on the same subject matter to get maximum information to ascertain JR’s social position (Naz et al., 2016). Hence, direct questioning facilitated the collection of sufficient patient information, allowing the care provider to verify JR’s perceived nature of social determinants.

The last interview technique that was employed is the assessment of social support and the nature of JR’s existing resources and how he uses them. The named strategy allowed the practitioner to directly question the patient about various social determinants of their health to get insights on the relevant factors affecting their health (Naz et al., 2016). This approach enabled the nurse to ask JR targeted questions about the social aspects of his life, providing relevant insights on the social determinants of his health as well as the context of his social well-being.

The four interviewing approaches that the care provider employed allowed JR to reveal the social determinants of his health including education, economic stability, neighbourhood and physical environment, community and social context as well as healthcare systems (Artiga & Hinton, 2018). JR has a Masters in IT and can speak two languages, both of which are factors that ascertain his educational competence. He is economically stable because he has a job as a network engineer, which serves as the income source that allows him to cater to his expenses. The patient lives with his wife in a suburb but has no children and can afford to use either personal or public transportation, factors that define his neighbourhood and physical environment. Moreover, the community and social determinants that JR highlighted are his access to emerging technology and his interest in running, cycling and outdoor activities. His access to emergent technology enables him to remain socially integrated, and his interest in participating in outdoor activities keeps him engaged with members of his community. Moreover, because JR has an insurance cover, he has access to care services and factoring in his high affordability, the care quality thereof is likely to be high. Therefore, it appears that JR’s social determinants positively contribute to his health and personal well-being.

Assessment questions. 

What level of education have you attained? Have you specialized in a specific area of expertise? How many languages do you speak? Can you read and write the languages that you speak?

The questions above were used to asses the education determinant of JR’s health. As depicted above, all the queries are open-ended, short and precise, making them ideal for information gathering. They seek information on different aspects of the patient’s education to establish his literacy levels. JR indicated that he has a Masters in IT and has specialized in network engineering. He also ascertained that he is bilingual and literate in both languages.

Do you have an income source? Is your source of income stable? Does your income source sufficiently cater to your expenses?

The questions stated above sought to assess JR’s economic stability. They pose inquiries about the availability of a source of livelihood, its security and sufficiency to meet the client’s needs. JR expressed that he works as a network engineer, a job that provides him constant income to cater to his needs and expenses.

Are you single or married? Do you have any children? Do you use personal or public transport options? How can you describe your neighborhood?

The questions stated above are clear and precise. They assessed the patient’s physical environment and neighborhood by inquiring about his marital and parenting status, the nature of his community as well as the mode of transport that he uses to move from one place to another. JR’s responses indicated that he is married with no children, lives in a suburb and that he uses both personal and public transport.

Can you access emergent technology like mobile phones, computers, laptops and the likes? Do you use them? What are your hobbies and interests?

These questions determined JR’s social and community context. They have targeted themes that focus on different aspects of community and socialization in the patient’s life. JR’s replies indicated that he could access new technology, implying that he uses it. The hobbies and interests that the patient outlined include cycling, outdoor activities and running.

Do you have an insurance cover? What kind of care does it allow you to access?

The questions stated above were used to assess JR’s healthcare system determinants. The queries are precise and focus on establishing whether he possess insurance coverage and the type of care he accesses. JR said that he has an insurance cover and considering his affordability, it is presumed that it allows him to access high-quality care.

Question answers. 

For the first set of questions assessing the education status social determinant, JR’s responses showed that he has a master’s education level in IT and has specialized in network engineering. These answers are vital to the creation of an appropriate care plan because they provide insights on the patient’s cognitive capacity as well as his intellectual prowess, both of which must be factored in to ensure the development of a plan that meets the client’s holistic needs. JR also indicated that he is bilingual and literate in both languages. The information can be used to determine the appropriate language for communication between the care provider and the patient to facilitate the realization of the objectives outlined in the care plan.

In response to the questions seeking insights about JR’s economic stability, the patient stated that he works as a network engineer, a stable job that is presumed to enable him to generate constant income that meets his needs and caters to his expenses. Since he is economically stable, the care plan that will be developed will seek to factor in his affordability to enhance the patient’s interest in accessing high-quality care services that can positively contribute to the sustenance and maintenance of his good health.

JR also indicated that he is married but has no children during the assessment of the neighborhood and physical environment determinants. The named social aspect suggests that when he grows older, apart from his wife, who is likely to be in the same age bracket as he is, he will have no other care providers. Therefore, it will be necessary that the care plan that is developed covers aspects of old age care advocating for prior preparations to ensure that JR has elderly care plans in place when he becomes older and needs medical attention for from a third party. Additionally, the information indicating that he has a personal vehicle and also uses public transport demonstrates that he is likely to be exposed to disease-causing microorganisms in public transport vessels. Therefore, his care plan must include the measures that he should take when using public transportation facilities to mitigate his susceptibility to disease and infections that may result from the same. Also, stating that he lives in a suburb informs the development of the care plan in terms of JR’s access to facilities.

When asked questions to establish the community and social determinants in JR’s life, he indicated that he could access new technology. Since he is an IT expert, the mentioned response implies that the patient utilizes emergent technology, a factor that suggests that he uses social media and other online platforms to interact with others and expand his social networks. This information can be used to address the role that social relations play in the betterment of health in the patient’s care plan. Moreover, JR’s hobbies and interests include cycling, outdoor activities and running, all of which require physical involvement to participate in. Thus, the care provider can use this information in the care plan to address the patient’s health aspect of physical exercise.

Finally, while assessing the care system determinants, JR provided information indicating that he possesses an insurance cover. Considering his occupation that contributes to heightened affordability, the patient’s insurance coverage is presumed not to be basic. Thus, it allows him to access high-quality care services, which can be exploited to contribute to the betterment of his health. Hence, this information can be used to inform the care plan by advocating for the exploitation of the patient’s insurance cover to maximize the health benefits thereof depending on the nature of his insurance cover.

Effect of Economic Stability on Healthcare Access 

The ease of accessing care services determines the impact that the treatment provided has. Healthcare has been defined as the ability to access timely services that facilitate the attainment of the best possible health outcomes. However, in some instances, individuals are unable to access care services promptly, a factor that heightens the possibility of getting poor health results. In most cases, the limitation to access healthcare services stems from the instability of the economic status of the individual in question which restricts the type and quality of care that a person is eligible for (ODPHP, 2019). Among the crucial aspects of economic stability that affect access to healthcare services are socioeconomic and employment status as well as financial stability.

From a general point of view, JR is an economically stable individual. His socioeconomic status is characterized by high financial stability because he works as a network engineer. The said position affects his healthcare access in terms of the waiting times that are involved when in need of care. JR’s socioeconomic status affects the heterogeneity of his choice of treatment and the facility to receive care services. Since he is more educated and financially stable, he is likely to prefer to travel further to receive healthcare services because of the associated benefits such as getting higher care quality within a shorter period. Similarly, his preference to travel to access healthcare services may be as a result of lesser financial limitations. Moreover, his healthcare access preferences may also be affected by time and risk factors, depicting that the patient’s socioeconomic status can influence his waiting time directly through discrimination and indirectly through his choices (Moscelli et al., 2018). Therefore, JR’s financial stability enhances his access to healthcare services.

Moreover, JR is employed. He works as a network engineer. Therefore, his access to healthcare based on his employment status is affected by the institutional context of the condition of his welfare, the type of care system and the characteristics of the labor market. His welfare condition directly impacts his health outcomes and also mediates between his status in the labor market and access to care. Within healthcare systems that are characterized by high rates of gatekeeping, JR’s position as an employed individual earns him higher medical status. Also, his working conditions determine the rates of access to essential care services. Higher work autonomy, reduced work strain and shorter working hours may promote his care accessibility, whereas the converse results in reduced access to care because of the difficulty to get time off work for healthcare appointments (Roots, 2016). Hence, JR’s employment status impact his access to healthcare both positively and negatively because his ability to pay for care services rendered puts him a favorable position to get medical care whereas a tight working schedule may make it challenging to seek the required medical attention.

Furthermore, JR’s housing stability positively impacts his access to care services. Since he is employed, he can meet his housing needs by paying rent and avoiding the negative implications of his inability to meet the cost of housing. Hence, he can prevent the adversities that are associated with housing instability such as overcrowding, which may impact his physical health negatively and limit healthcare access (ODPHP, 2019). According to Taylor (2018), there is a strong correlation between housing and health. The safety, stability, affordability and quality of housing impact JR’s health as much as the social and physical characteristics of his neighborhood. The patient’s access to stable housing minimizes the cost of care by reducing exposure to adverse health influencers. Moreover, stable hosing enables JR to access features that promote his health, such as parks where he can enjoy outdoor activities, including running and cycling. Therefore, JR’s housing stability contributes to his increased access to facilities that enhance his health.

Impact of Educational Status on Health 

The term health literacy refers to the accuracy that characterizes the interpretation and use of health information advantageously. The functionality of literacy in matters concerning healthcare focuses on an individual’s ability to read, write, compute and communicate to the extent that they can participate in planning therapeutic remedies to enhance their well-being (Remshardt, 2011). The interaction of patients with healthcare staff contributes to the client’s health literacy, necessitating the improved quality of provider-patient communication to impact patient health outcomes positively. Therefore, the health literacy attributes of care organizations, as well as the engagement of patients, is essential to informing patient health behaviors and knowledge as opposed to their individual health literacy skills (Kaphingst et al., 2014). Among the effects that heightened health literacy has on patient health are the utilization of preventive services, reducing hospitalization rates and enhancing knowledge about health conditions and how they should be treated (USDHHS, n.d.). Thus, the maximization of the opportunities to better a patient’s health requires care providers to focus on increasing the health literacy of their patients by eliminating the barriers that can mitigate the successful synthesis of healthcare information.

JR’s health literacy affects his health positively. It has enabled him to choose a healthy lifestyle characterized by his preference for outdoor activities as hobbies, which allow him to engage his body physically. Also, the patient’s literacy in health matters has allowed him to take preventive measures like making care appointments to undergo comprehensive health assessments annually. Such visits enable the detection any anomalies and taking of precautionary measures that mitigate the possibility of getting diseases, especially the terminal illness highlighted in his family’s medical history (USDHHS, n.d.). Thus, JR’s health literacy has increased his ability to obtain, process and understand information about his health, a factor that has enhanced his capability to make informed health-related decisions.

Healthcare opportunities and barriers. 

JR’s education status is characterized by a Masters in IT and specialization in network engineering. His high education level predisposes him to access opportunities that contribute to the lengthening of his lifespan. The health benefits that JR can realize from his educational status include resource and income gains as well as psychological and social advantages. The patient can get better jobs and earn higher income compared to those with lower educational qualifications. Resultantly, the higher income can serve as vital resources that enhance access to top-notch care services. Additionally, JR can benefit from reduced stress levels because of the lack of exposure to prolonged economic and social hardship. Similarly, his educational status can enable him to enjoy favorable health outcomes because of his refined psychological and social skills that can promote increased control, perseverance and personal control. Moreover, he can have access to a more extensive social network that can serve as an emotional as well as financial resources that contributes to the betterment of his health behavior (VCU, 2015). Therefore, without high education status, it is impossible for JR to experience heightened personal well-being that results from the betterment of his health perceptions and decisions.

However, JR’s high education status may have negative implications on his healthcare. One of the care barriers that he may have to deal with is increased affiliation to take preventive measures which are likely to result in long-term saving but increase his health spending in the short term. Also, his high education status may result in increased susceptibility to use drugs as research has shown the correlation between education and substance abuse (Brunello et al., 2016). The pressures that accompany the sustenance of a lifestyle characterized by high educational status heighten the need for coping mechanisms, resulting in JR’s likelihood to turn to drug use to alleviate work and lifestyle related stress. Furthermore, JR’s education status may protect him from depression, but his general happiness and well-being may not experience similar benefits (Brunello et al., 2016). His ability to make a living can reduce exposure to both social and economic stress, but the lack of strain does not translate into guaranteed happiness.

Effect of Health and Healthcare on Quality of Life 

Every individual values and enjoys being in a state of complete social, physical and mental well-being accompanied by the lack of disease. Analyzing the quality of life from a health-related perspective focus on the impact that an individual’s health has on their ability to live fulfilling lives factoring in the social, physical and psychological aspects of the same (John Hopkins Medicine, 2019). Therefore, JR’s current health condition impacts his life quality positively. From the assessment conducted, it appears that his physical health is in peak condition apart from an eyesight issue that requires him to use corrective lenses. He is not on any medication and has no present history of illness, factors that ascertain that his quality of life presently is enhanced by maximal physical and mental health (CDC, 2019) . However, in the long run, the quality of JR’s life may be impacted negatively by the health risks he faces as depicted by his family’s medical history that highlights his vulnerability to coronary artery disease, myotonic dystrophy and hypertension. Moreover, as he ages, he may not have adequate social support and old age care because he has no children that he can depend on to care for him when he becomes an older adult. If not handled appropriately, the named inadequacies will result in lowered life quality.

Moreover, the type of health-related care that an individual gets impacts their quality of life. Healthcare, characterized by maintaining or improving an individual’s well-being through disease prevention, diagnosis and treatment, determines life quality depending on the effectiveness of the measures that are taken (Mohammad Mosadeghrad, 2013). Therefore, JR’s healthcare impacts his quality of life in various dimensions, including economic and social conditions, mental state, motor and physical skills as well as bodily perception. It becomes necessary that JR’s care providers distinguish between his objective health condition, which focuses on the observable symptoms of illness, and his subjective health-related experience, which factors in his emotional state in the determination of his well-being (Sosnowski et al., 2017). JR’s possession of an insurance cover makes it possible for him to easily access healthcare services, a factor that positively contributes to his quality of life. The annual general health tests that he undergoes create the opportunity for the betterment of his well-being through prevention, considering that he has not been ill in the recent past. Additionally, in the long-term, continued healthcare trends will enable early detection of the chronic illnesses that JR is susceptible to, creating a possibility for healing treatment. Thus, his healthcare positively impacts his quality of life and will continue to do so in the future.

Impact of understanding health literacy on health. 

The higher the levels of health literacy an individual has, the more likely they are to implement health safeguards that boost their well-being. Statistics show that there is a strong correlation between health disparities and health literacy, with cultural and linguistic barriers being the most direct influencers of patient health literacy. Therefore, to overcome such obstacles, care providers and patients must work together towards the heightening of health literacy levels within a population (Gele et al., 2016). Understanding health literacy impacts patient health positively because it maximizes their access to care and the maintenance of their wellness. Additionally, it enables individuals to actively participate in making decisions about their health, resulting in the delivery of patient-centred care within medical institutions (USDHHS, 2019). Thus, an individual’s understanding of health literacy impacts their health both directly and indirectly by allowing them to understand their wellness and the role that care systems play in enhancing it as well as increasing the quality of the care they receive because of their active participation in managing their health, respectively.

Effects of Neighborhood and Environment on Access to Health 

People’s living conditions define their state of health and wellness. The type of housing that an individual can access defines the fundamental nature of their health with statistics on the subject matter showing that about 23% of homes in America have safety and health hazards (High, 2017). The most affected regions are those that are poverty stricken because they are characterized by substandard housing that predisposes occupants to adverse health outcomes, both physically and mentally (High, 2017). The converse applies in cases that individuals live in conditions where housing facilities are standardized, as is the case with suburbs, where the inhabitants experience increased health and safety precautions that contribute to the betterment of their wellness. Additionally, the built environment within neighborhoods also contributes to the health outcomes of the people living in the region because it correlates with the quality of available public facilities such as hospitals, municipal services and transportation (Jutte, Miller, & Erickson, 2015). Therefore, more affluent neighborhoods tend to have a better build environment compared to poorer ones resulting in the realization of better health trends in affluent areas.

JR lives in the suburbs. His neighborhood lies outside the city characterized by a quieter and slower paced lifestyle compared to that of the urban core. The built environment has fairly similar housing structures, constructed based on a planned rather than random approach (Grant et al., 2013). Apart from houses, the neighborhood’s built environment also comprises of a healthcare facility, a park and a shopping center. Access to the park and well-organized road systems that also have pavements and sidewalks, enable JR to enjoy outdoor activities, running and cycling, all of which boost his exercise levels and contribute to the betterment of his health. Moreover, the healthcare facility in his area eases his access to care because of its proximity. Furthermore, standardized housing plans enable the maximization of the incorporation of safety and health safeguards, a factor that reduces JR’s vulnerability to negative health consequences. Hence, JR’s suburban neighborhood boosts his access to facilities that contribute to the enhancement of both his health and healthcare.

Healthcare disparities and similarities between low and high-income neighborhoods. 

The socioeconomic status of the inhabitants of a region determine the conditions within a neighborhood, a factor that affects healthcare quality, access, and outcomes, independent of individual characteristics. Access to healthcare depends on the availability of a usual source of care (USC) that offers preventive and treatment services and enables communities to obtain diversified practitioner services. Research shows that in the United States, the availability and type of USC rely on sociodemographic factors. Thus, in low-income areas there is a lesser likelihood of the availability of identifiable USC compared to high-income regions, a factor that impacts the quality and outcome of care as access is a crucial determinant of the same (Hussein, Roux, & Field, 2016). Without adequate access to healthcare facilities, individuals in low-income neighborhoods experience adverse health outcomes and diminished quality of care.

Similarly, a study conducted by Chetty et al. (2016) in the United States showed that between 2001 and 2014, higher income levels were associated with an increased life expectancy. The author explains that the disparities in longevity in low and high-income regions has grown over the years and life expectancy correlates with both local area characteristics and health behaviors. It means, since individuals with high income can afford better quality care, the outcomes of the treatment they receive are better than those which low-income earners get. Moreover, low-income earners subscribe to prioritizing other needs over healthcare, a trend that differs with that of high-income earners who can afford to treat healthcare as a need rather than a want. Therefore, the rate of affordability of care determines the quality of healthcare received and impacts the outcomes thereof.

However, healthcare is similar in both low and high-income regions with regard to emergency and paramedic services that individuals receive. Healthcare facilities offer equal access to emergency treatment regardless of the socioeconomic nature of individuals living in a particular region. The mentioned occurrence results from the need for practitioners to abide by the medical ethical code, which requires the prioritization of a patient’s care needs, as well as the implementation of the Emergency Medical Treatment and Active Labor Act (EMTALA) passed by the US Congress to assure accessibility to emergency care for all Americans (Knowlton, 2019). Also, paramedic services are equally available to individuals. The response to 911 calls does not vary depending on the regions that individuals live in, a factor that equalizes the accessibility of paramedic care within the American population (Blas et al., 2011). Hence, socioeconomic status has no holding on individuals’ access to both paramedic and emergency care.

Difference in healthcare access in rural and urban areas. 

The health of the rural population is reportedly worse than that of the urban community because of a variety of factors such as the likelihood to engage in unhealthy behavior and access to healthcare services. People living in rural areas have limited access to specialized practitioner care, a factor that explains why the level of screening for chronic illnesses in rural areas is lower than in urban regions. Moreover, residents living in rural areas tend to be uninsured, and they remain without insurance plans for extended periods. Resultantly, the rural population experiences reduced access to insurable care services compared to the urban population (Georgetown University, n.d.). Research reports also show that individuals living in rural areas have limited access to good quality care compared to those in urban regions because of the diminished availability of follow-up care (CMS, 2018). The extensive distribution of care facilities in urban areas does not match that of rural regions, making it impossible for the few healthcare institutions available in rural communities to satisfy the wellness needs of their patients fully.

Effects of neighborhood on access to healthy food options. 

A patient’s access to healthy foods contributes to the development of eating patterns that benefit their wellness. Eating healthy requires that an individual control their calories, vary the types of beverages and foods they take and limit the intake of harmful substances such as trans and saturated fats. Depending on where one lives, the access and availability of healthy food options vary (ODPHP, 2019). A survey conducted in the United States showed that between 2012 and 2013, the distance between households and supermarkets in the country averaged at 2.19 miles. Therefore, individuals that did not have vehicles, access to convenient public transport and reduced proximity to sources of healthy foods, adopted unhealthy eating patterns (Wilde, Llobrera &Ploeg, 2016). Therefore, in JR’s case, his neighborhood impacts his access to healthy food options in terms of the proximity of healthy food sources and the availability of different kinds of healthy foods. However, since JR has access to both personal and public transport, he can overcome the distance barrier that mitigates access to healthy foods and maintain a healthy diet.

Section B 

Importance of Assessing Social Determinants in a Comprehensive Health Assessment 

Social determinants impact health outcomes among individuals, especially if they are predisposed to conditions that increase risks on their wellness. Studies conducted have shown that there is a significant correlation between various aspects of social determinants in individuals’ lives, such as education, social status and income, with heightened morbidity rates as well as premature deaths (Andermann, 2018). Additionally, a report by the CDC affirms that poverty reduces access to factors that promote individual health, including access to healthy foods and safe neighborhoods. The availability of resources is associated with the ability to overcome negative social determinants that cause adverse health outcomes (CDC, n.d.). Thus, the assessment of social determinants in comprehensive health assessments enables practitioners to understand the context of a patient’s lifestyle, which has been proven to affect the health outcomes thereof.

Highest priority social determinants. 

The highest priority social determinants in JR’s case are education, economic stability as well as neighborhood and physical environment. The patient has a Masters in IT and has specialized in network engineering. His academic competence has contributed to his economic stability by allowing him to work as a network engineer. Moreover, JR’s neighborhood and physical environment are characterized by living in a suburb with his wife and no children and the availability of both personal and public transport.

Nursing Care Plan 

Assessment	Objectives	Interventions/  Implementation strategies	Rationale	Expected Outcome
Education  JR has a Masters in IT	Short-term  To use his high intellectual capacity to boost his health literacy within the next three weeks. Long-term  To apply his knowledge in IT to increase his ability to manage and plan his personalized care over the next six months.	1. Creating rapport with the patient. 2. Adopting an educator role to increase JR’s knowledge of health literacy. 3. Engaging JR in discussions on health literacy and how his expertise in IT can improve his ability to manage his well-being.	1. Establishing an environment of trust between practitioners and patients is crucial to facilitating the passing of knowledge on health literacy from the professionals to the patients (Bradley University, 2019). Health literacy is vital to the enhancement of patient care. 2. Heightening a patient’s health literacy requires that healthcare practitioners adopt educator roles to provide materials and information that enable patients to understand their health better (AHRQ, 2019). Patients must be taught about health literacy to increase their capacity to apply the concepts thereof. 3. Discussing health literacy with patients enables practitioners to determine what the patients already know and creates a base for building knowledge on the same (Bradley University, 2019). Patient engagement in health literacy education increases understanding of the subject matter and its applicability in real-life situations.	1. JR shows increased health literacy upon verbal evaluation in the next three weeks. 2. In six months, JR can apply his IT knowledge to increase the efficiency of managing his health.
Economic Stability  JR works as a network engineer	Short-term  Increase JR’s knowledge on the role that his financial stability plays on his health within the next three weeks. Long-term  Enable JR to maximize his health and healthcare by exploiting his economic stability within the next six months.	1. Establishing rapport with JR. 2. Discussing the various insurance plans that are available in the market and their benefits with the patient. 3. Explaining how JR can use his economic status to enhance his health outcomes by taking preventive measures to mitigate susceptibility to adverse health outcomes.	1. For JR to diverge details about his economic situation to the care practitioner, he must trust them. Building rapport is essential with that regard (Bradley University, 2019). 2. The available insurance plans in the market vary depending on affordability. The common types are bronze, silver, gold and platinum, listed in the order of increasing benefits and affordability (Thakur & Workman, 2016). Enlightening JR about the variations thereof can inform his choice of insurance coverage. 3. It is vital that JR understands that his increased affordability can enhance his healthcare. It is the role of the care practitioner to enlighten him on how his economic status can enhance his well-being by enabling him to access higher quality care services, healthy food options and fostering disease prevention (Bastable, 2016). The lack of JR’S understanding of the role his economic stability plays on his health renders it useless.	1. JR better understands the impacts of his financial stability on his health in the next three weeks. 2. JR can maximize his health and healthcare based on aspects of his economic security in the next six months.
Neighborhood & Physical Environment  1. JR lives with his wife in a suburb and has no children. 2. He uses personal and public transportation.	Short-term  Ensure that JR exploits his physical environment and neighborhood to maximize his health outcomes within three weeks. Long-term  Enable JR to plan for long-term care that will assure his access to vital care services in his old age within six months.	1. Establish rapport with JR. 2. Enlighten JR on how he can use various aspects of his physical environment and neighborhood to better his health and healthcare. 3. Inform JR about the fundamentals of elderly care and engage in discussions to determine his crucial need for them.	1. JR and the care provider must have a trust-based relationship to facilitate their productive engagement in discussing matters concerning his health in relation to his physical environment and neighborhood. 2. It is the care provider’s role to ensure that JR understands how different components of his community like housing and transportation, can impact his health (Bastable, 2016). The patient can only maximize the health benefits of his physical environment if he is equipped with the strategies to do so. 3. Since JR has no children, it is crucial that he plans his elderly care to ensure that his healthcare is not neglected when he gets older (Sudore et al., 2017). To do so, he must have information on the measures he can take, which the healthcare practitioner should provide.	1. In three weeks, JR can use the components of his neighborhood to maximize his health benefits. 2. Within six months, JR has an elderly care plan in place to cater for his care needs in old age.

Barriers to implementing the nursing care plan. 

The barriers to achieving positive implementation outcomes with regard to JR’s education may include the inadequacy of teaching material to increase his understanding of health literacy and the lack of practitioner skills to pass knowledge on health literacy. Also, achieving the care outcomes associated with the patient’s economic stability may be barred by insufficient information on the types of insurance plans that exist in the market and the practitioner’s inability to engage JR in discussing his financial state with them. Additionally, the nurse may not be able to achieve the desired care outcomes associated with JR’s physical environment and neighborhood because of the inadequacy of knowledge on elderly care plans. Furthermore, the achievement of the results of the entire care plans may be inhibited by the nurse’s inability to communicate effectively. Thus, it is essential that the care provider polish their communication skills because they are vital to implementing care strategies that will facilitate the realization of the outlined outcomes.

Individuals that should be involved in the care plan. 

When planning regarding JR’s education, it is necessary to involve his wife and a psychologist. His wife’s involvement is essential because being the only person that lives with him; she can offer insightful information on JR’s cognitive affiliations to facilitate the development of patient-specific strategies that enhance the chances of care goal attainment. A psychologist’s opinion on the patient’s cognitive capacity would offer a professional viewpoint that would be essential in taking the right steps to maximize JR’s engagement in the care plan (Neisser, 2014). Moreover, planning care with regard to the patient’s economic stability would require the involvement of his wife. She can provide insights that JR may overlook and offer suggestions that can increase his receptiveness to the care practitioner’s recommendations regarding the exploitation of his economic stability to maximize health outcomes.

Additionally, in the case of neighborhood and physical environment planning, JR’s close friends and neighbors can be involved as well as his wife. The named individuals can be recruited to provide a supportive environment that encourages the patient to pursue the goals of the care plan related to the named subject matter (Bright et al., 2012). A support system is crucial to increasing JR’s involvement and participation in realizing the outcomes of the care plan.

Evaluating the Effectiveness of Nursing Care Plan 

Attaining the outcomes of the care plan for all three social determinants depends on the practitioner’s ability to create rapport with the patient. The nature of the relationship between JR and the nurse can be evaluated by comparing the type of the personal information divulged to the care practitioner before the implementation of the care plan and that which is provided during its application (Pattyn, Molenveld & Befani, 2019). A positive difference will indicate the successful establishment of rapport, and the converse will apply in the contrary scenario. Additionally, to evaluate the patient’s understanding of the impact of the three social determinants on their health, interviewing strategies can be employed (Alshenqeeti, 2014). Before implementing the care plan, the patient can be questioned to assess what they know about the social determinants that the program intends to cover. Upon completion of the target period, the same should be done to establish whether there is a positive impact on the patient’s knowledge.

Impact of Social Determinants on Overall Well-Being 

Social determinants affect the health of patients either positively or negatively, depending on their nature. Positive outcomes are realized when the conditions that a person is predisposed to by social determinants are favorable, and the converse applies in the opposite scenario. For instance, high levels of education are associated with better health outcomes and enhanced well-being, as is the case with high economic stability (Bala et al., 2016). JR’s social determinants have impacted his well-being positively, in most cases. He has no present history of illness, a factor that enhances his well-being. However, having no children may be a negative implication of the social determinants that define his life because it is not associated with a medical issue. Perhaps it is a consequence of the pursuit of his high education status and financial stability.

References

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