Factors Defining Patient Health
Health is largely determined by the environment in which people live and by the members of the community with whom they interact. When substantial support sources are missing, and if potentially harmful environmental factors are present, the involvement of community/public health nurses in an intervention is essential. According to Muntean, Tomita, and Ungureanu (2013), community nurses provide education and care to individuals and families, show respect and support human dignity, and maintain positive bonds between community values and individuals‘ health. This means that not only do they attend to the physical and functional needs of patients, but they also address patients’ social, psychological, and spiritual needs. For instance, by taking care of H. and assisting him in the performance of routine tasks, a nurse will indirectly help G. by giving her more opportunities for better self-care. A nurse may also utilize active listening skills to comfort G. and enhance her ability to cope with stress.
An analysis of the case study reveals that the family is exposed to both negative and positive environmental conditions. Currently, such social determinants of health (SDOH) as the availability of resources to meet daily needs, stable housing, economic conditions, and public safety help G. and H. maintain their health. Nevertheless, the level of their social engagement is limited. As stated by Shrivastava, Shrivastava, and Ramasamy (2013), isolation due to a lack of family support and communication is a significant determinant of morbidity in older adults. Moreover, although some healthcare facilities are available in the community, the family has no access to relevant in-home medical services, which are crucial for the improvement of its health-related behaviors. All of the identified SDOH contribute to the spouses’ inability to carry out their daily activities properly, and they contribute to the deterioration of their health condition due to stress and inadequate self-care. At the same time, community/public health nursing and community partnerships can help improve these SDOH to a large extent.
Epidemiological Data
The epidemiological data that is relevant to the family’s health is insurance coverage, behavioral health risks, and morbidity due to chronic conditions. In Broward County, over 4% of people older than 65 did not have insurance in 2013, compared to 1.7% on the state level, and 1% on the national level (Broward Regional Health Planning Council [BRHPC], 2015). The evidence indicates that the county is affected by a lack of health care coverage, suggesting the presence of health disparities.
As for behavioral health risks in the adult population, 21% of individuals in Broward County are limited in their activities due to various diseases, compared to 21.2% of people in Florida (BRHPC, 2015). Additionally, 27.4% of adults in Broward County are diagnosed with hypertension, compared to 34.6% of adults in Florida (BRHPC, 2015). Statistics show that overall health-related behaviors (namely, healthy/unhealthy lifestyles) do not differ much at the local and state levels, while a lower percentage of people diagnosed with hypertension may indicate that the community members may not have regular medical checkups.
Heart disease and stroke are among the major causes of mortality and morbidity in both Broward County and Florida. The average age-adjusted death rate due to coronary heart disease in the county was 97.4 and 99.6 in the state in 2013 (BRHPC, 2015; “Coronary heart disease deaths,” 2018). The death rate due to stroke was 30.6 in Florida and 33.3 in Broward the same year (BRHPC, 2015; Centers for Disease Control and Prevention, 2015). As for Alzheimer’s disease, the death rate was 14.7 in the county and 21 in Florida in 2017 (“Alzheimer’s disease deaths,” 2018). This means that except for stoke, mortality due to these chronic conditions is below the state average.
Nursing Diagnosis
The main nursing diagnosis for the family is a self-care deficit. This relates to both spouses, but while in the case of H., it is caused by his physical and mental condition, in G.’s case, it is substantially determined by adverse SDOH. The 2020 Leading Health Indicator topic linked to the diagnosis is social determinants. As stated by the Office of Disease Prevention and Health Promotion (2014), “increased levels of social support are associated with a lower risk for physical disease, mental illness, and death” in elder people (para. 5). It has been suggested that better access to community-based resources will improve the family’s therapeutic self-care.
Interventions
The objectives of the nursing interventions are the prevention of further functional decline in H. through the improvement of gait and balance, and the enhancement of G.’s self-care by providing a supportive-educative nursing system. Tolea, Morris, and Galvin (2016) state that since cognitive and physiological elements of functionality are directly linked, interventions involving the promotion of physical performance may benefit patients with Alzheimer’s disease. Short sessions conducted twice a week may both improve the cognitive status of the patient and lower the risk of severe mobility-related disability (Tolea et al., 2016). Although such interventions are more effective at the initial stages of cognitive impairment, they still may help slow down the progression of the disease in H.
As for the second intervention, it entails informing the patient about vital self-care practices and provision of support needed to eliminate current barriers to their implementation. Both of the interventions may take the form of time‐limited home‐care reablement services, which involve visits to the family home by multiple health care professionals (Cochrane et al., 2016). A partnership among the community nurse, social work specialists, and professionals working at Memorial Adult Day Care could facilitate this service for the family.
Health Plan
In light of the current lack of a partnership that could assist the family in improving its health outcomes, the nurse must advocate for its creation. The goal of the advocacy program would be the establishment of time‐limited home‐care reablement services for those in need. The action plan would comprise the following steps: gathering of evidence regarding the problem/solution, design of stakeholder education materials, development of relationships with the members of the inter-professional team needed to carry out the project, trial implementation, post-assessment, and dissemination of results. As is evident from the suggested plan, the main resources include research-based evidence and healthcare/social professionals. As for the program effectiveness evaluation, it may take four months, as the project implementation stage would last for three months.
References
Alzheimer’s disease deaths. (2018).
Broward Regional Health Planning Council. (2015). Community health status profile.
Centers for Disease Control and Prevention. (2015). Stats of the state of Florida.
Cochrane, A., Furlong, M., McGilloway, S., Molloy, D. W., Stevenson, M., & Donnelly, M. (2016). Time‐limited home‐care reablement services for maintaining and improving the functional independence of older adults. Web.
Coronary heart disease deaths. (2018).
Muntean, A., Tomita, M., & Ungureanu, R. (2013). The role of the community nurse in promoting health and human dignity ̶ Narrative review article. Iranian Journal of Public Health, 42(10), 1077-1084.
Office of Disease Prevention and Health Promotion. (2014). Social determinants.
Shrivastava, S. R. B. L., Shrivastava, P. S., & Ramasamy, J. (2013). Health-care of elderly: Determinants, needs and services. International Journal of Preventive Medicine, 4(10), 1224-1225.
Tolea, M. I., Morris, J. C., & Galvin, J. E. (2016). Trajectory of mobility decline by type of dementia. Alzheimer Disease and Associated Disorders, 30(1), 60-66.