Comprehensive Assessment in healthcare

Comprehensive Assessment in healthcare
Health assessment is a key element in the nursing process. It represents the process of gathering, verifying, analyzing, and communicating information about the health status of a patient. The health assessment process can be done to individuals routinely to detect any health problems especially today that chronic conditions have increased. Nurses have a crucial role in designing care plans and determining nursing interventions Upon performance of health assessment. This process requires providers with high-level skills to enable better judgment and for monitoring of changes within the patient to improve health outcomes. The focus of this discussion is to present the findings from a comprehensive health assessment conducted on a patient and to design a nursing plan of care based on the identified social determinants of health that affect the patient.

Interview Techniques

Planning and preparation of the environment

Lack of adequate planning is the greatest single fault found to impact the interviewing process. There should be adequate planning which should include writing down key points to reinforce the specific purpose of the interview. Secondly, the environment is observed to contribute up to 60% of a successful interview (Philips et al., 2017). It is recommended that a quiet room should be used for interviews to enhance communication. During the interview with Carolyn Cross, I ensured the selected room was clean, well organized, lit, and quiet. The personal distance was well-observed through adequate spacing and I ensured all the writing and assessment material was placed within my reach.

Guiding the conversation with adaptive questioning

A successful interview often starts with building a rapport and presenting guiding questions to promote engagement. The interviewer should use a helpful and friendly tone to minimize immediate barriers to communication. Upon establishment of a rapport, there is a need to generate general questions to enable the patient to open up a one moves to the focused questions. I began my interview by encouraging Carolyn to relax and acknowledging the power of confidentiality during our conversation. I proceeded by presenting the interview questions and borrowing ideas from her responses to ask subsequent questions. This technique ensured that I was attentive and it gave Carolyn the confidence to share more about her health.

Appropriate choice of questions

An interview is a two-way process that involves continuous communication between the two involved parties. The choice of questions asked can greatly affect the response and communication process during the interview. Both open and closed-ended questions should be used to promote engagement and to avoid one-way communication (Philips et al., 2017). Additionally, open-ended questions enable the patient to speak more giving the assessor time to identify the root of identified health problems. I organized my questions well to include both open and closed-ended questions during the interview with Carolyn. I realized that these questions helped me to understand the feelings, attitudes, and perceptions of the patients towards her health status.

Listening and communication skills

Interviews require a high degree of control to ensure time is well utilized and that the interview does not get out of topic. To ensure control, the interviewer must listen carefully, give the respondent time to explain points, and excuse themselves before interruptions. It is also expected that there should be the use of verbal and non-verbal cues to demonstrate understanding and express emotions during an assessment. I ensured that I listened carefully to Carolyn and used body language such as nodding, maintaining eye contact, and gestures appropriately to make the conversation interesting.

Justification of Key Questions

Economic stability

The first question asked was about the economic stability of Carolyn which covered employment, financial status, and housing stability. The questions on these aspects were important to assess the financial stability of the patient which is an important contributing factor to health. How can you describe your economic stability? Carolyn replied that she had a job at a nearby school as a learning specialist but is currently on an absence leave due to the COVID-19 outbreak. She explained that her financial status is unstable because she is currently dependent on her accountant husband. She further added that it has been difficult to pay for her bills including the monthly housing mortgage that is currently unpaid for the last one month.

Education

The level of education is a determinant that affects an individual’s health-seeking behavior. During the assessment, the question of Carolyn’s education aimed to determine her education level and its effect on her health-seeking habits. What can you tell me about your education? She replied by explaining that she graduated from high school, received a full scholarship to the University of Texas. She pursued a bachelor’s degree in elementary education and further advanced to do a master’s in special education (M.Ed.). Carolyn explained how her education enabled her to get a job as a middle school learning specialist.

Health and Healthcare

Access to healthcare services and the health-seeking behavior of individuals are important determinants of health. The questions on this social determinant aimed at identifying potential barriers to healthcare access and the current status of the individual’s health. Do you have easy access to healthcare? How often do you seek medical care? Carolyn explained that she is close to her primary care physician but the COVID-19 pandemic has restricted her visits. The nearby pharmacy was closed recently and she now has to travel for 20 minutes to buy medication when needed. Concerning her health status, she explained that her last breast and cervical cancer screening were done a year ago. Further assessment of present and past medical history revealed she has fibrocystic breast disease.

Neighborhood and Built Environment

The place individuals stay and how they interact with neighbors can have an impact on one’s health. The assessment of Carolyn’s neighborhood aimed at identifying barriers to good health including aspects of safety, food availability, and utilization of available resources. How can you describe your neighborhood? Are there any issues regarding food availability, healthcare access, or security? This question got Carolyn thinking about how the Coronavirus outbreak has affected access to basic services. She explained that she lives in Houston, Texas in a neighborhood that has an adequate supply of food and minimal security issues. It was also observed that she no longer has full access to parks and recreation facilities due to the COVID-19 outbreak. Regarding security, Carolyn explained that she has no past experiences with abuse or violence and the availability of a neighborhood watch system serves to increase safety.

Social and Community Context
Health assessment covers the individual’s well-being including interaction with people both at home and working environment. The question of social and community context is aimed at identifying Carolyn’s social relationships and how she gets along with people. Carolyn explained that she spends her free time with her family but the COVID-19 outbreak has made it difficult to take care of her mother. It was observed that she has little time with social interaction outside the family due to the increased family needs. With her good relationship with people, Carolyn explained to have no issues with unjust treatment at home or in the workplace.

Responses to Key Questions

Carolyn responded well to all the key questions asked during the assessment with clear identification of areas that give her problems. It was observed that she has been economically stable until recently when the COVID-19 outbreak affected her income. Assessment of her education revealed that she holds a master’s degree in special education and has a well-paying job. Her level of education was key to making good health decisions including the timely seeking of healthcare services. Regarding health and healthcare, it was observed that she attends her medical checkups annually. However, the COVID-19 outbreak has greatly affected healthcare access including seeing her primary care physician. On the assessment of neighborhood and built environment, deviations were observed in aspects of exercise and availability of easy transportation. The social and community context assessment revealed that there were issues with social interaction and she was unable to take care of her sick mother due to the COVID-19 restrictions. These responses leave a responsibility to the nurse to plan care that addresses the issues of health and healthcare, economic stability, and social and community context.

Economic stability

Socioeconomic Status

Carolyn and her family are currently in unstable financial status because she is on a leave as a result of the Coronavirus pandemic. Lack of capital has affected the financial capabilities of the family and she has little remaining to cater to other needs. Because of the struggle, Carolyn has limited options to seek medical care when she wants and is likely to face transportation difficulties.

Employment status

Until four months ago, Carolyn had full-time employment as a learning specialist in a nearby school but has since remained at home due to the closure of schools. Failure to work has increased pressure on Carolyn’s support for the family and is unable to generate enough to support her medical bills. Her unemployment status has reduced access to medical care because of financial difficulties including taking care of her sick mother.

Housing stability

Lack of employment has affected housing stability for Carolyn especially payment for her monthly mortgage. With the whole family depending on the husband’s salary, the affordability of some healthcare needs is a problem. Secondly, the location of her home is far from the nearby pharmacy which makes timely access to medication a problem.

Educational Status

A clear understanding of how education impacts health is integral to improving healthcare policy and the promotion of individual health. There is substantial evidence that increased education level is associated with good health while those with lower educational attainment suffer from poor health (Raghupathi & Raghupathi, 2020). Education level is observed to impact income, access to medical care, and interpersonal resources available to promote health. Highly educated individuals have good problem-solving skills and cognitive abilities to ill-health consequences such as stress (Raghupathi & Raghupathi, 2020). Carolyn is a well-educated woman with a master’s degree in special education. She has the intellectual ability to make a good judgment on her health behavior and seek medical care immediately. In her current state, Carolyn can handle work-related stress including financial problems as discussed.

Healthcare Barriers and Opportunities

Carolyn is educated up to the master’s level and has been working until recently when the COVID-19 pandemic struck. With her education level, she can make good health choices including timely access to healthcare. However, her engagement at work hinders the availability of time to exercise and interact well with community members. Her health assessment suggests she is held up leaving less time to interact socially. Carolyn’s education status can be an opportunity to improve her health and cope with the current situation. She can be able to manage stress related to her financial problems and perhaps plan to do something else that can generate income.

Effect of Health on Quality of Life

Quality of life is a concept that is dependent on dimensions such as physical, mental, emotional, and social functioning. According to the conducted health assessment, Carolyn is in good physical condition. However, the lack of social interaction and the financial problems in the family might affect her mental and social functioning. Research establishes that quality of life is dependent on interaction and connection with others. The CDC tool for assessment of the health-related quality of life stresses assessing mental health which includes stress, depression, and problems with emotions (Yin et al., 2016). Carolyn is stressed because she is not able to take good care of her sick mother and this has affected her social life. Additionally, she is having difficult times to take care of her family, pay for her bills, and afford all other necessities.

Health Literacy

Health literacy is the ability of an individual to obtain, process, and understand health information. Health literacy can be a risk factor or an asset to achieving optimum health because it affects one’s decisions. Studies demonstrate that low health literacy is associated with poor health outcomes. Individuals with low literacy levels have poor health status, lack knowledge about medical conditions, and make poor choices in life (Jayasinghe et al., 2016). Additionally, low health literacy impacts aspects such as communication with primary care providers and understanding of healthcare received upon discharge. Health literacy improves how individuals perceive their health, expression of concerns, and management of underlying conditions during routine treatment.

Neighborhood and Environmental Impacts

Carolyn lives in a middle-class suburban neighborhood in Texas. Access to healthcare was easy due to the availability of good transport but since coronavirus struck it has been difficult for Carolyn. She has to walk 20 minutes downtown to access the nearest pharmacy and she no longer has full access to her primary care physician due to the surrounding circumstances. Secondly, the availability of limited transportation can have an impact on accessing timely healthcare in case of emergencies. However, the safety of the neighborhood can promote the accessibility of healthcare services at any time.

Healthcare Received in Low and High-Income Areas

Low and high-income areas exhibit major differences in terms of the quality of healthcare provided to patients. High-income areas receive good quality healthcare services because of the availability of equipment and skilled healthcare personnel. Low-income areas on the other hand have healthcare facilities that lack advanced equipment for the delivery of quality services. Despite these differences, both low and high-income areas face problems with healthcare worker shortage due to the increasing complexity of healthcare services. Timely delivery of healthcare in both areas is a problem because of the numerous patients seeking healthcare services in hospitals.

Rural Versus urban Healthcare Access

Access to primary healthcare services is key to improving the health of individuals and it represents the fit between characteristics and expectations of providers and the patients. Accessibility is demonstrated by aspects such as affordability of services, availability of required services, geographical accessibility of facilities, and acceptability of services provided to patients (Spasojevic et al., 2015). Rural areas battle with problems such as affording healthcare access due to low income and location of the healthcare facilities. There are also accommodation constraints in rural areas where the quality of services provided does not meet the expectations of the clients. In urban areas, geographical accessibility of services is easy because of numerous healthcare facilities and the availability of transportation services. Additionally, the availability of healthcare providers and the availability of medical equipment and supplies makes urban healthcare exceptional.

Neighborhood Health Food Options
Carolyn’s neighborhood is well-stocked with a variety of foods and has several convenience stores including supermarkets. The stores and supermarkets are located within a five miles radius allowing Carolyn easy access to healthy food options. However, the COVID-19 pandemic has restricted Carolyn from easy access to the food because of overcrowding at the markets. She explains that she is reluctant to access sidewalks and parks for fear of contracting the virus.

Discussion of Social Determinants

Social determinants are conditions in the environments in which people are born, live, and work that affects a wide range of health risks and outcomes (Healthypeople.gov, n.d.). While performing a health assessment, addressing the social determinants helps the provider to identify specific areas that impact the patient’s health. Research indicates that people are affected by factors that are beyond their recognition and it’s upon realization of these factors that individuals make a change. As the healthcare sector moves towards value-based care, it is crucial to address the social determinants to make a holistic view of the patient, promote superior outcomes, and drive value in healthcare institutions.

B1 Identification Social Determinants	B2 Patient Plan of Care	B2A Plan Implementation	B2B Implementation Barriers	B2C Individuals Involved in Plan of care	B3 Plan Effectiveness
Economic Stability	To assist the patient cope with current financial status.	Education on priority spending to minimize expenses. Counseling and provision of support.	Prolonged period of unemployment. Uncertainties such as diseases in the family	Family members. The client’s husband will be available to make plans on financial expenditure and to provide moral support during this difficult period. The public health nurse may be available to provide counseling. A financial advisor can be consulted to guide the family in planning for the future.	The patient should verbally demonstrate understanding and use the teach-back method to highlight possible channels to generating income (Talevski et al., 2020).

Health and Healthcare	To enlighten the patient on breast cancer based on her history of fibrocystic breast disease.	Provision of education, screening and providing education material.	Negative family history may cloud the patient’s judgment of future well-being.	Carolyn’s husband will be present to provide support and to promote compliance to the educational programs. The primary care physician should be involved in the provision of preventive care services.	Verbal demonstration of understanding of the content. The client will be asked to perform teach-back for the information provided including preventive measures for breast cancer (Talevski et al., 2020).
Social and Community Context	To actively participate in community activities and engage in interaction.	Enrollment into community women groups. Joining	Lack of time. Restrictions due to COVID-19	Women group leaders will help the client to find local community resources and online groups to join. Church leaders will help the client identify groups within the church community. The public health nurse will be available to provide links to community center meetings including utilization of the town hall.	Active participation in community activity together with developed interest in the activities. A follow-up plan launched to ensure the client joins at least one social group in the community should demonstrate positive results (Crocker et al., 2015).

Impact of Social Determinants
Carolyn is in perfect physical condition but demonstrates ineffective coping due to the COVID-19pandemic. Her economic stability has shifted and she is unable to take care of her bills. These changes have increased stress that could potentially cause health problems. As a learned woman, Carolyn can make healthy life choices and understands the importance of seeking medical care. Regarding health and healthcare access, the COVID-19 pandemic has affected accessibility to medical care including regular visits to her primary care physician. Socially, Carolyn is unable to interact well with other people because she is focused on family problems including her sick mother. Based on the assessment, Carolyn is in good physical condition but requires counseling and support during these difficult moments.

References

Crocker, J. B., Crocker, J. T., & Greenwald, J. L. (2012). Telephone follow-up as a primary care intervention for postdischarge outcomes improvement: A systematic review. The American Journal of Medicine, 125(9), 915-921.

https://doi.org/10.1016/j.amjmed.2015.01.035

Healthypeople.gov. (n.d,). Social determinants of health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Jayasinghe, U. W., Harris, M. F., Parker, S. M., Litt, J., van Driel, M., Mazza, D., Del Mar, C., Lloyd, J., Smith, J., Zwar, N., Taylor, R., & Preventive Evidence into Practice (PEP) Partnership Group (2016). The impact of health literacy and life style risk factors on health-related quality of life of Australian patients. Health and Quality of Life Outcomes, 14, 68.

https://doi.org/10.1186/s12955-016-0471-1

Phillips, A., Frank, A., Loftin, C., & Shepherd, S. (2017). A detailed review of systems: an educational feature. The Journal for Nurse Practitioners, 13(10), 681-686. https://doi.org/10.1016/j.nurpra.2017.08.012

Raghupathi, V., & Raghupathi, W. (2020). The influence of education on health: An empirical assessment of OECD countries for the period 1995–2015. Archives of Public Health, 78, 1-18. https://doi.org/10.1186/s13690-020-00402-5

Spasojevic, N., Vasilj, I., Hrabac, B., & Celik, D. (2015). Rural – urban differences in health care quality assessment. Materia Socio-medica, 27(6), 409–411. https://doi.org/10.5455/msm.2015.27.409-411

Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G., & Beauchamp, A. (2020). Teach-back: A systematic review of implementation and impacts. PloS One, 15(4), e0231350. https://doi.org/10.1371/journal.pone.0231350

Yin, S., Njai, R., Barker, L., Siegel, P. Z., & Liao, Y. (2016). Summarizing health-related quality of life (HRQOL): Development and testing of a one-factor model. Population Health Metrics, 14, 22. https://doi.org/10.1186/s12963-016-0091-3

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