Nursing Plan and Implementation

A1. Strategy 

There are multiple strategies used in the assessment of the patient’s social determinants of the patient’s health. The first is the use of internal awareness where medical workers demonstrate a clear understanding of the patients and other members of the community in the location. This enables high understanding of the risks that the client is likely to experience. Resource networks and curiosity are alternative ways of assessing social determinants of health. This involves the use of technological capabilities and available connections to other professionals to offer and receive information on the health of the patients in questions. According to de Andrade et al (2015) a critical understanding of the Latina community is an effective means of identifying how to incorporate the use of technology in achieving optimal health status. The patient in question may have some level of technological competency which will help in developing appropriate strategies to keep her health in optimal condition. There are different factors to take into consideration where evaluating the health status of the community. Some of the considerations include economic stability, education, social and community context, health and healthcare, and the neighborhood and built environment. The above considerations identify all aspects of the patient’s social life that have significant influence on the qquality of health and current status. 

A1a. Discussion of Key Questions 

Social Determinant	Patient Question	Patient Response
Economic Stability	What is your occupation?  Where are you employed?  Are you able to pay for your health insurance?	Administrative personnel  Local flooring company  I am currently under my father’s insurance, but I will have my own in the net year.
Education	What level of education have you attained?	I have completed some college education.
Social and Community Context	What is your marital status?  Do you practice safe sex?  How often do you smoke and/or drink alcohol?  Do you consume any illegal or hard drugs?  How would you describe your relationship to family members?	I am currently dating.  Yes, I am in a monogamous relationship.  I drink at least once a week and smoke like three times in a week.  I do not consume any illegal drugs.  I am close with my father and mother as well as my biological sister, not so much with my step sisters and half brothers.
Health and Healthcare	Do you have any ongoing health conditions?  What are some of the illnesses affecting your immediate family members?  Do you have health insurance?  Have you received any recent immunization?	I do not have any health issues.  My father was diagnosed Pre-diabetic, my mother suffers from PTSD, and breast cancer as she undergoes chemo.  I do not yet have health insurance, but I feel it is too expensive.  I recived the Tdap vaccine, but I cannot remember when it was exactly.
Neighborhood and Built Environment	Where do you live?  What is your current living situation?  Is your neighborhood safe and secure from chronic violence and crime?	I live in Elk Grove, CA.  I live with my boyfriend and his mother.  The neighborhood is well lit, serene parks, and recreational centers for relaxation and exercising. I usually feel safe even at night walking around in the neighborhood.

Some of the key questions asked by the medical workers in assessing the social determinants include: 

Economic Stability 

What is your occupation? 

Where are you employed? 

Are you able to pay for your health insurance? 

Education 

What level of education have you attained? 

Social and Community Context 

What is your marital status? 

Do you practice safe sex? 

How often do you smoke and/or drink alcohol? 

Do you consume any illegal or hard drugs? 

How would you describe your relationship to family members? 

Health and Healthcare 

Do you have any ongoing health conditions? 

What are some of the illnesses affecting your immediate family members? 

Do you have health insurance? 

Have you received any recent immunization? 

Neighborhood and Built Environment 

Where do you live? 

What is your current living situation? 

Is your neighborhood safe and secure from chronic violence and crime? 

The following plan of care sought to incorporate economic stability, social and community context, and health and healthcare as the primary social determinants. The responses provided will help develop an appropriate plan of care that suits the patient’s needs. 

A1b. Responses to Key Questions 

The above questions are integral to understanding and assessing the social determinants of health as it affects the patient in question. The additional help provided to the patient through the plan of care could vary based on the responses. For instance, as the patient is living close to the hospital setting, it would be appropriate to provide multiple recommendations that would allow her to receive quality care for specific conditions. The education that the patient has received has enabled her to embrace the value of preventive care. However, the patient seems to lack the appropriate attitude as she smokes and drinks occasionally increasing her risks of contracting chronic illnesses. Her current residential environment is made of a middle-class population where health concerns matter and individuals take measures to embrace the same. She is not exposed to significant criminal activity or violence that would significantly affect her health. 

A2. Economic Stability 

It is evident that economic stability is a basic factor for ensuring the patient’s access to healthcare. The 24 year old patient is experiencing economic stability. She is still receives appropriate health services through her father’s employment, which is only available for one more year. However, being a project manager at a local flooring company, the patient will receive contribution from her employer to her health insurance from $40-50 per month. She also has stable housing status as she is living with her boyfriend along with his mother. In this case she is able to keep optimal health status. 

A3. Educational Status 

Education plays a major role in social and economic development and in so doing influences the overall health of a given population. According to de Andrade and colleagues (2015) a proper educational background is a critical factor in achieving significant health benefits. The health benefits are evident at the individual and community levels such as development of skills to gain access to resources and characteristics associated with health on the environment where people live respectively. The larger social cultural context may be affected owing to cases of unequal access to educational resources and residential segregation. Lack of high educational background may also influence chronic stress, difficulty in navigating the health care system, and education-related disparities in personal health behaviors. 

The patient in this case has only achieved some education in college, but has not yet attained a bachelor’s degree. The modern labor pool is becoming more and more competitive as the years go by with employers in the private and public sector seeking to attract individuals with the highest qualifications who can orchestrate significant growth in the company. In this regard, the patient does not have a stable employment as she may be replaced at any time. As described by Zimmerman, Woolf, and Haley (2014) low education status is likely to reduce an individual’s ability to access resources. This issue is particularly important where the patient;s health future is in jeopardy. She may not have enough funds to pay off health insurance premiums in future and may have to depend on welfare programs like affordable care act (ACA). Additionally, it is research also shows that the likelihood of death or contracting chronic illnesses was higher for individuals with low education levels as opposed to those with a professional degree. The concern is even higher for women in this category. 

A3a. Health Literacy 

Research shows that health literacy has a direct influence on the health outcomes of the individual. Approximately 80 million Americans have limited health literacy levels placing them at risk of negative outcomes and poor access to health care (Berkman, Sheridan, Donahue, Halpern, & Crotty, 2011). The lack of dequate health literacy was consistently associated with multiple hospitalization, regular use of emergency care, lower receipt of preventive care services like influenza vaccination, inability to interpret health messages, difficulty in self-administering medication, and higher mortality rates. 

The patient in this case demonstrates a high level of health literacy. She has adequate health literacy as she receives preventive care services like pap smear and Tdap immunization. This behavior is a clear indicator that the patient understands that diagnosing some chronic illnesses early is integral to achieving optimal health status. Her literacy levels may eplain why she does not have ongoing health problems as she knows the appropriate behaviors to employ to avert incidences of illness. She is able to understand health messages and can appropriately take medication on her own. 

A3b. Educational Opportunities and Barriers 

There are various educational opportunities and barriers that the patient may experience due to her educational status. For instance, community education seminars may be of benefit to the patient as she can appropriately communicate with health providers and comprehend some of the health lingo (Kadu, & Stolee, 2015). This increases opportunity to incorporate preventive care measures (Zimmerman, Woolf, & Haley, 204). Higher education is also associated with a significant increase in income. This is an opportunity that the patient may not enjoy as she does not even have a college degree. Some of the barriers to having low educational status include hesitance by the individual to ask health-related questions due to fear of appearing ignorant. Low educational status hinders the patient’s understanding of health messages particularly that which communicated electronically or on the web. 

A4. Effect of Health on Quality of Life 

The patient denies experiencing any ongoing health problems or chronic conditions. In this regard, she is likely to experience a high quality of life. It is evident that she has undertaken preventative measures to prevent incidence or identify early onset of diseases. The patient has undergone STD screening, a pap smear and was administered vaccines in the past year. Through the various preventive care practices it is evident the patient can avoid unnecessary risks that would jeopardize her health status. However, the patient’s attitude to participate in unhealthy behavior like smoking and drinking alcohol increases possibility of becoming ill and reducing the overall quality of life (Davy et al., 2015). The patient’s experience of her parents’ divorce may have negatively affected her psychologically and emotionally, an incidence that could lead to declining health status. However, the presence of a romantic partner with whom she can confide in can help her deal with her emotional struggles. The patient does not demonstrate to have an enthusiastic life in general which may result in cases of depression and a feeling of worthlessness. 

A5. Neighborhood and Environmental Impacts 

The environment of the patient is a basic factor that influences overall health outcomes. The physical environment includes the “built environment” the environment resulting from structures built by humans as well as the natural environment. Neighborhoods can influence health in many ways. First is through the physical characteristics of neighborhoods. Health can be adversely affected by poor air and water quality or proximity to facilities that produce or store hazardous substances. Elk Grove, CA is an appropriate neighborhood where members have easy access to healthcare and there is little contamination from the physical environment. The area has multiple healthcare institutions that serve different conditions that the patient may encounter. The availability of quality services such as serene parks for relaxation and exercising allows for optimal health outcomes. The patient also asserts that she feels safe in her neighborhood and will not be moving anytime soon. Occasionally, she wanders into other neighborhoods which may be considered dangerous, but she has been used to this based on her background. 

A5a. Healthcare Received in Low- and High-Income Areas 

Among low-income adults age 50 or older, just 22% to 42% received recommended preventive care. This means that even in the leading state, fewer than half of low-income older adults received recommended cancer screenings and vaccines for their age and gender. Among adults from low-income communities, rates of hospital admissions for respiratory disease or diabetes complications were four times higher in the worst-performing states compared with the top performers. Furthermore, in 22 states, more than 30% of low-income Medicare beneficiaries were prescribed medications that are considered high-risk. On the other hand, healthcare in the high-income neighborhoods is likely to be of the highest quality. However, they are the highest spenders of healthcare in the recent times. Despite the fact that the poor are in more need of healthcare, they are less likely to get access to care as opposed to the high income earners and still receive poor quality services when they get it. Some of the similarities include despite the economic capability of a patient, each individual has the right to receive stabilizing treatment for an emergency medical condition. This is particularly in Medicare-participating hospitals. Additionally, patients from high-and low-income settings are eligible for provider attention depending on the severity of the medical concern. 

A5b. Rural versus Urban Healthcare Access 

It is evident that there are some experiences of healthcare that are common among individuals from both rural and urban areas. For instance, both the people that are living in high and low income areas are affected by the high healthcare costs in America. The US is one of the leading countries in the world with high healthcare costs (Hill, 2014). However, the individuals in urban areas are more likely to encounter a variety of institutions where they can receive treatment. This is not the case for members in the rural areas as they struggle to get access to medical care. In the latter case, it also evident that specialized care is also difficult to come by resulting in suffering for the people living in rural areas (Hill, 2014). Regardless of their location, it is evident that the high cost of care is a major concern for both rural and urban residents. 

A5c. Neighborhood Healthy Food Options 

Availability and price of healthy foods in food stores has the potential to influence purchasing patterns, dietary intake, and weight status of individuals. Studies have shown there is a relationship between neighborhood deprivation and a high density for fast-food outlets (Hill, 2014). These are the restaurants that provide unhealthy food and make it difficult for its members to achieve the highest standard of quality health. In the high-end neighborhoods, there are options of expensive dining places where healthy foods are available, individuals may choose based on their preferences or medical conditions. 

B. Discussion of Social Determinants 

It is important that health workers undertake a critical evaluation of the social determinants of the patient’s health as a means of creating a deeper understanding to all the risks that the patient could experience. Through identification of each social determinant the medical practitioners can effectively and proactively influence positive health outcomes in the community. The implementation of the Affordable Care Act in 2010 made it necessary for the use of social determinants in the implementation of predictive analytics for new system enrollees. It was noted that the community will receive a critical assessment and prediction of health risks without the use of medical history. 

B1. Identification of Social Determinants 

The three major social determinants in the case of this patient include socioeconomic, educational and health literacy, and individual behavior. In the case of socioeconomic aspect, the young female patient identifies her particular financial situation and the impact it has on her decisions and behavior on health concerns (de Andrade et al., 2015). Education and health literacy will help the patient undertake preventive measures to ensure she does not get infected or at least manages her health. The patient’s individual behavior is regarding her lifestyle whereby exposing her body to toxins like drugs and substances could lead to the development of numerous chronic illnesses. 

B2. Patient Plan of Care 

The plan of care will involve the ensuring that the patient can evaluate appropriate health insurance that will fit into her socioeconomic status as she prepares to become an independent holder of health insurance. The practitioners will also offer the patient adequate education on health issues such as how to incorporate preventive health practices into her daily life. Furthermore, the need to develop health appropriate behavior to achieve optimal health status. 

B2a. Plan Implementation 

To achieve appropriate insurance coverage for the patient, it is important that the health practitioners educate the patient on the Affordable Care Act that offers individuals of particular income bracket coverage (American Diabetes Association, 2015). In this regard, they can also help identify measures of ensuring access to healthcare without compromising their health status as it is seen the client does not visit medical institutions regularly and cannot recall the last time she received vaccination. Due to family medical history, the healthworkers will offer the patient basic measures of ensuring she does not develop chronic illnesses like diabetes and cancer that has affected her father and mother respectively. 

B2b. Implementation Barriers 

It is evident that despite the efforts of medical practitioners, it is likely that there are significant barriers that will prevent the patient from achieving optimal health. The first is failure to be enrolled in an appropriate insurance coverage which makes it more expensive for the patient to receive affordable care (Davy et al., 2015). The patient’s attitude towards education offered by the health workers could hinder possibility of achieving optimal health. The inappropriate lifestyle behavior adopted by the patient will eradicate the positive influence of the interventions provided. 

B2c. Individuals Involved in Interventions 

The interventions offered to the patient will incorporate an interdisciplinary team where through their various expertises they can achieve maximum assistance to the patient. It is evident that the team will involve experts in oncology, diabetes, and cardiology who will address preventive measures that will help alleviate the problem of chronic illnesses occurring in future. The team will involve nurses, pharmacists, physicians, social worker, and nutritionists (Kadu & Stolee,, 2015). These members will also offer education on inappropriate lifestyle behaviors as well as the measures to acquire an affordable health insurance. 

B3. Plan Effectiveness 

The effectiveness of the interventions mentioned above takes into consideration the importance of interprofessional collaboration as a basic measure of ensuring optimal delivery of care (Nilsen, 2015). The caregivers will also incorporate the most recent laws and regulations set by the legislatures in the delivery of quality and affordable care to the patient. Finally, the intervention incorporates the use of best practices for achieving optimal outcomes for preventing illnesses rather than curing them. It is important that the healthcare plan incorporates significant measures that can be used to evaluate its effectiveness. In this regard, clear definition of causes and objective goals of the intervention will be laid out to measure achievement. Identifying particular priorities such as improving education status and ability to acquire an affordable health insurance should be maintained as a means of ensuring the patient can achieve optimal health condition. 

B4. Summation of the Impact of Social Determinants 

The above report is a clear indicator that social determinants have a great impact on the overall delivery of healthcare services to the patients. As is the case with this patient, there is minimal access to medical history of the patient. Therefore, the social determinants will offer additional information that can help lead preventive practices and identification of risks that the patient could encounter. It is evident that economic stability is important as ensures that the the patient has access to healthcare services and ability to afford housing to protect oneself from the dangers of climate conditions. Education is another important factor closely related to employment as it ensures the patient can compete in the labor pool for available jobs. Attaining undergraduate and graduate level degrees will help make it easy to receive employment and significantly increases income that is essential to cater to the high costs of healthcare. The social and community context identifies the nature of relationships and behavior depicted by the patient. An individual who cares about their health will take appropriate measures to prevent occurrence of illnesses. It is evident that health and healthcare attitudes also influence the patient’s ability to incorporate preventive measures of care. The neighborhood and built environment will also influence possibility of ensuring physical safety while protecting the physiological and mental health status. 

References 

American Diabetes Association. (2015). Standards of medical care in diabetes—2015 abridged for primary care providers. Clinical Diabetes, 33 (2), 97. 

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J., & Crotty, K. (2011). Low health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 155 (2), 97-107. 

Davy, C., Bleasel, J., Liu, H., Tchan, M., Ponniah, S., & Brown, A. (2015). Factors influencing the implementation of chronic care models: A systematic literature review. BMC Family Practice, 16 (1), 102-114. 

de Andrade, L. O. M., Pellegrini Filho, A., Solar, O., Rígoli, F., de Salazar, L. M., Serrate, P. C. F., ... & Atun, R. (2015). Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. The Lancet, 385 (9975), 1343-1351. 

Hill, D. (2014) A Neighborhood's Built Environment May Have Numerous Effects on Its Residents' Health . Robert Wood Johnson Foundation, Retrieved from https://www.rwjf.org/en/library/research/2014/01/a-neighborhood-s-built-environment-may-have-numerous-effects-on-.html 

Kadu, M. K., & Stolee, P. (2015). Facilitators and barriers of implementing the chronic care model in primary care: a systematic review. BMC Family Practice, 16 (1), 12-26. 

Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10 (1), 53-65. 

Zimmerman, E. B., Woolf, S. H., & Haley, A. (2015). Understanding the relationship between education and health: a review of the evidence and an examination of community perspectives. Population health: behavioral and social science insights. Rockville (MD): Agency for Health-care Research and Quality , 347-84.