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Why is nursing so important in terms of promoting health and wellbeing (consider MECC and prevention)

Health Profile of an individual

Learning outcomes:

  1. Critically analyse and evaluate the concept of health and wellness, taking in to account the determinants of health, their relevance to health and wellbeing and the impact of inequalities of health on individuals and populations.
  • Critically appraise and develop knowledge to systematically assess the health needs of individuals, families and populations taking account of relevant epidemiological and research evidence.
  • Examine the impact of economics and health and social care policies on public health and provision of healthcare.
Introduction What are you going to discuss in the essay and why • The importance of the role of the nurse in promoting health and wellbeing across the lifecourse. • The importance of your field of nursing in promoting health and wellbeing.Why is nursing so important in terms of promoting health and wellbeing (consider MECC and prevention). What policy influences this role such as NHS long term plan, Future Nurse Standards.
Background (sources and evidence must be cited as appropriate) • As we are exploring the health of an individual, we will need to start with a definition of health and wellbeing. Discuss that you will use the World Health Organization 1948 definition of health as your starting point. • The usefulness of health profile for understanding more about the health status and health risks of an individual, in relation to their family and community/neighbourhood.Critique definitions and concepts of health and wellbeing. Are these achievable? Consider the influences of the wider determinants of health and wellbeing. What do profiles give us in terms of understanding Health status of an individual/community,inequalities in health, Priorities in health, etc.
Body of Essay/Main Section (sources and evidence must be cited as appropriate)   • Identify briefly the individual that will be the focus of your essay. • Identify and discuss demographic (age, sex, ethnicity, employment status, educational achievement, where they live) data that can help to inform you about your INDIVIDUAL’S current health and wellbeing status. • Identify and discuss what physical, mental and social health and wellbeing information about the INDIVIDUAL and what would it tell you about their physical health (height; weight; circumference measurements, lifestyle (information on diet, smoking, drinking and so on); mental health (how satisfied they are with their life, whether they have been feeling happy or unhappy); social health (hobbies, outside interests, what family and friend networks/support they have and so on). • Identify and discuss what the above information could tell us about the health and status risks that your INDIVIDUAL currently has e.g. not eating fruit and vegetable to Public Health England recommended guideline levels; not engaging in physical activity to Public Health England recommended guideline levels; • What advice and support would you give them including who would you signpost/refer them to for further advice. • What Public Health Policy might influence their decisions about their own health and wellbeing? • What things might you look out for about the family, community and neighbourhood which might influence their health and wellbeing and how would you take this into account in the advice and support you give?Give a brief biography of your individual which includes demographic information, e.g. Martha is 38 years old female. She lives in a small flat with her 3 children and partner……. Consider and critique how these demographics, such as age, gender, influence health and wellbeing. Using your findings of your questionnaire, you will critically explore 3 dimensions of health: physical, mental and social. Identify health risks from this information and make evidence based recommendations which promote a healthier lifestyle or maintenance of such. You are not diagnosing – you are using the information to identify health risks of this individual might be taking and considering recommendations. You may wish to include a definition of each dimension of health (physical, mental and social health) and critique this. You will also use some health indicator data from the local fingertips profiles to support your discussions and interpret new determinants influence the health of this individual. You will need to consider how this fits with your profile, but an example, might be the prevalence of physical active adults in the area where they might be living or rates of violence crime in area (relating to someone’s fear of going out impacting on both mental and social wellbeing). You need to consider the recommendations. Need to be realistic and manageable for the individual. For example, if they are on the low income and you recommend organic fresh fruit and veg. Can they manage this? Do you need to think more about other options such as tinned or frozen goods.
Conclusion (sources and evidence must be cited as appropriate) Discuss: • What are the strengths and weaknesses of using a health profile to understand the health and wellbeing of an individual and what additional information could you gather. 
References • Ensure referencing and in-text citation follows Cite Them Right Online recommendations for Harvard-style referencing. Use the short guide to referencing found on the Module Blackboard site.

Introduction

What are you going to discuss in the essay and why

  • The importance of the role of the nurse in promoting health and wellbeing across the lifecourse.
  • The importance of your field of nursing in promoting health and wellbeing.

This essay will examine Mrs X health profile by identifying her health needs and will provide recommendations for improving her health behaviours and wellbeing, considering variety of wider factors that influence health such as family, cultural background, gender, ethnicity, education and social class and inequalities in these factors. These findings will be linked with different policies and strategies that influence population health and wellbeing. The main focus will be on supporting Mrs X wellness rather than treating illness and the main priority will be the empowerment of the individual to take control of their own health and wellbeing. Therefore, this assignment will outline health and wellness and opportunities for health promotion and prevention. Consequently, maximising the impact of nursing and midwifery on improving and protecting the public’s health is one of the six key action areas of the national nursing midwifery and care strategy. Compassion in Practice, launched in December 2012 (Public Health England, 2013). This means that one of the roles of nurses is to support people to make decisions and empower them to make choices which has a positive impact on their health and wellbeing. As stated in Health 2020, the policy framework by WHO, nurses “as front line health workers they have close contact with many people, and therefore they should be competent in the principles and practice of public health, so that they can use every opportunity to influence health outcomes, social determinants of health, and the policies necessary to achieve change” (WHO, 2015). Moreover, as stated in NMC Standards for competence for registered nurses, all nurses must: “support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, inability to engage, ageing or death. Nurses must act on their understanding of how these conditions influence public health” (NMC, 2010).

MECC is one of the toolkits developed by Public Health England (PHE) has been widely used across healthcare settings. It recognises that staff across health, local authority and voluntary sectors, have thousands of contacts every day with individuals and are ideally placed to promote health and healthy lifestyles (NHS, Making Every Contact Count).

Background

  • As we are exploring the health of an individual, we will need to start with a definition of health and wellbeing. Discuss that you will use the World Health Organization 1948 definition of health as your starting point.
  • The usefulness of health profile for understanding more about the health status and health risks of an individual, in relation to their family and community/neighbourhood.

The World Health Organisation (WHO) defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. (WHO, 1948). This definition of health has been commonly used over the 70 years. However, it has been widely criticised as being too ambitious and bold and due to an ageing population and the rise of chronic disease this definition lost its purpose. Consequently, the definition was amended with further clarifications in 1986, stating that the  health is “a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities” (WHO, 1986). Fundamentally, to be able to live a full life it is essential to maintain our physical, mental and emotional health. Everyone should have the same opportunity to lead a healthy life, no matter where they live or who they are (PHE, 2017). Nonetheless, there are various determinants that affect the health of individuals and as identified by Dahlgren and Whitehead (1991), they are: individual lifestyle factors, social and community networks, living and working conditions, unemployment health care services, housing, education, etc. This illustrates, that most of the people do not have the same opportunities to be as healthy as others.

Body of an essay

  • Identify briefly the individual that will be the focus of your essay.
  • Identify and discuss demographic (age, sex, ethnicity, employment status, educational achievement, where they live) data that can help to inform you about your INDIVIDUAL’S current health and wellbeing status.
  • Identify and discuss what physical, mental and social health and wellbeing information about the INDIVIDUAL and what would it tell you about their physical health (height; weight; circumference measurements, lifestyle (information on diet, smoking, drinking and so on); mental health (how satisfied they are with their life, whether they have been feeling happy or unhappy); social health (hobbies, outside interests, what family and friend networks/support they have and so on).
  • identify and discuss what the above information could tell us about the health and status risks that your INDIVIDUAL currently has e.g. not eating fruit and vegetable to Public Health England recommended guideline levels; not engaging in physical activity to Public Health England recommended guideline levels;
  • What advice and support would you give them including who would you signpost/refer them to for further advice.
  • What Public Health Policy might influence their decisions about their own health and wellbeing?
  • What things might you look out for about the family, community and neighbourhood which might influence their health and wellbeing and how would you take this into account in the advice and support you give?

Mrs X is a 56 years old Hungarian woman who lives in Hounslow with her daughter. She is employed part time, however she is temporary laid off of work due to Covid 19. She is separated from her husband who is supporting their daughter financially. Due to lack of income, they are renting a double bedroom in shared accommodation. Her both parents passed away recently and her siblings live in Hungary.

Mrs X physical health

Physical health covers such things as the ability to mobilise, take fluids and complete physical tasks. Physical wellbeing involves pursuing a healthy lifestyle to decrease the risk of disease and injury while maintaining physical fitness (Linsley and Roll, 2020). Mrs X height is 163.5 cm and her weight is 71kg (BMI 26.5). She is considered overweight. Healthy weight range for the height is 49.5kg- 66.8kg (NHS, 2018).  Mrs X has indicated (Household Questionnaire) that her day-to-day activities are limited due to a health problem which is chronic migraine. Also, she spends most of the time at work sitting and her only physical activity is shopping for approximately 2 hours a week (GP physical activity questionnaire). Mrs X diet consists of full fat diary and sugary products. She consumes processed meat 1-2 times a day and does not include oily fish in her diet. The individual has only one serving of fruit and vegetables a day. She loves snacking between the meals.

Mental health

Mental health refers to a person’s emotional, social and psychological wellbeing. Good mental health includes the ability to control and manage emotions, concentrate on what you are doing, use memory and express emotion (Linsley and Roll, 2020). Responses from WEMWBS questionnaire suggest that Mrs X rarely feels optimistic and only some of the time – useful and relaxed. There are no responses higher than three and it suggests low wellbeing and high risk of developing depression.

Social Health

Social health includes the ability to socialise and function as part of a group and use public services, as well as to be liked and accepted (Linsley and Roll, 2020). Mrs X scores indicates (Zimet Questionnaire) that she has moderate support from her friends and family. However, her lowest scores suggest that she does not have a special person who is around when she needs. She cannot always share her feelings and emotions with her family and friends. Social isolation is associated with more than a doubling of the risk of many forms of mental illness, heart disease and early death (Milton and Letwin, 2010, p 6).

Analysing Mrs X responses acquired from the combined questionnaire, we can identify that she may develop a disease due to risk factors such as being overweight, unhealthy diet and  lack of physical and social activity. A health risk is something that increases your chance of developing a disease (NIH, 2017). There are many health risks that an individual can change, for example habits, safety, diet, physical activity, physical environment, etc. However, you cannot change your age, family history or an inherited disease.

Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including the world’s major non-communicable diseases (NCDs) of coronary heart disease (CHD), type 2 diabetes, and breast and colon cancers, and shortens life expectancy (Lee I-Min et al (2012). Furthermore, there is strong emerging evidence that activity delays cognitive decline and is good for brain health as well as having extensive benefits for the rest of the body (Blair, 2009).

Recent objective evidence from England and the USA suggests that low physical activity is the most prevalent chronic disease risk factor, with 95% of the adult population not meeting the modest physical activity guidelines (Weiler, R. And Stamatakis, E. (2010) Nevertheless, evidence shows that even brief interventions (3–10 min) or simple pedometer-based programmes delivered through health professionals can lead to substantial increases in patients’ activity levels (by ~30%) (Weiler, R. And Stamatakis, E. (2010) The UK Chief Medical Officers’ (CMO) Guidelines recommend for adults age 19-64 to do at least 150 minutes of moderate intensity activity, 75 minutes’ vigorous activity, or a mixture of both, strengthening activities on two days and to reduce time spent being sedentary. Moreover, The evidence continues to support the role of physical activity in maintaining weight following weight loss, as well as the health benefits of physical activity in overweight and obese individuals even in the absence of weight loss (Dr Foster, C. Et al. (2019). There are many sources of advice to support and encourage Mrs X to live more active life. For example, NHS.UK and OneYou websites have a variety of information and support for people encouraging them to get fit. Mobile applications like ACTIVE10 encourages people to get into routine of walking and Couch to 5k app motivates individuals to start running. My first step as a future healthcare professional would be providing information to Mrs X about the benefits of physical activity and possible risks of being inactive and making referrals to any services if necessary.

The Marmot review highlights that income, social deprivation and ethnicity have an important impact on the likelihood of becoming obese (PHE, 2017). Moreover, it is estimated that the NHS spent £6.1 billion on overweight and obesity-related ill-health in 2014 to 2015 (PHE, 2017). The numbers are shocking and it is more crucial than ever to take every opportunity to prevent these outcomes and to educate people to change their behaviours leading to an unhealthy weight and obesity.  As mentioned earlier, Mrs X lives in Hounslow, where deprivation is quite high with 16 areas now becoming classified in the 20% most deprived in the country in 2015, compared to 12 areas in the 2010 classification (London Borough of Hounslow, 2017). Also, it is the most diverse populations in London. In Hounslow there are an estimated 126,000 (total population 270,782) overweight adults (63%), and 54,000 adults that do less than 30 minutes exercise a week (27%) (London Borough of Hounslow, 2017). As we can see, Mrs X environment plays an enormous role in her health and wellbeing. It reveals some significant inequalities to access to the opportunities to be healthy. However, these factors can be prevented by implementing government and local policies   that impact on our health. For example, the PHE Eatwell Guide was introduced to illustrate a healthy and balanced diet and looked at the health impacts of the sugar and fibre we eat and concluded that the Government should halve our recommended intake of free sugars and increase recommended fibre (Levy, L 2016). In addition to that, it recommends to eat at least 5 portions of variety fruit and vegetables a day, choosing wholegrain versions as possible, choosing lower fat and lower sugar options, eat some beans, pulses, fish, eggs, meat and other proteins, choose unsaturated oils. Consequently, ignoring these guidelines increases risk to become overweight and obese. However, a study published in BMJ Open looking at the PHE Eatwell Guide highlighted that only very few people follow the dietary guidelines: less than 0.1% of the general population.  As stated by professor Kuhnle (2020) , “while many do follow the recommendations to reduce fat, salt and meat intake, fewer than 10% consume sufficient fibre and only 25% meet the recommendations regarding fish, fruits and vegetables and free sugars”. As a result, it is important to empower and inform the individual about services and tools available to achieve and maintain a healthy weight. Mrs X indicated (UK Diabetes and Diet Questionnaire) that she is concerned about her weight and it would be beneficial to acknowledge her concerns and ask whether she wants to take and action. Furthermore, we need to acknowledge that there could be various ways and solutions that individual could take towards achieving their goals. For instance, adapting to a healthier diet, portion control or increasing activity levels. Additionally, provide information about services available in the individual’s local area. As an example, One You Hounslow is an integrated Health and Wellbeing service. It provides a single point of access though a hub to engage a broad range of advice, information and friendly support to help Hounslow residents Eat well, Move More, Drink Less and Stop Smoking.  

Mrs X health risks are  influenced by her income, housing and work. She is a single mother and the researches say single motherhood is known to be linked to poorer health (Bazian, 2015). Also, it can lead to variety of psychosomatic symptoms (tiredness, insomnia, depression, behavioural problems). (Council of Europe, 2014). Moreover, Income determines people’s ability to buy health-improving goods, from food to gym memberships. Managing on a low income is a source of stress, and emerging neurological evidence suggests that being on a low income affects the way people make choices concerning health-affecting behaviours (Williams, E. Et al., 2020). Another factor that may affect Mrs X health is housing. Poor-quality and overcrowded housing conditions are associated with increased risk of cardiovascular diseases, respiratory diseases, depression and anxiety (Williams, E. Et al., 2020).. Furthermore, Unemployment is associated with lower life expectancy and poorer physical and mental health, both for individuals who are unemployed and for their households. The quality of work, including exposure to hazards, job security and whether it promotes a sense of belonging, affects the impact it has on both physical and mental health. Non-White groups experience higher levels of work stress, controlling for other demographic factors. (Williams, E. Et al., 2020).

In the UK today, behavioural and lifestyle factors are thought to be major contributors in around half of all deaths (Milton and Letwin, 2010). While government playing the main role in creating the environment that influences people’s health and wellbeing, to be able to protect, prevent and promote health, we must understand that not only the government is responsible for it. Everyone is responsible in supporting and promoting health.  In 2010, the government has changed the approach focusing on the behaviours that are causing the illness and it has published a “Public White Paper” focusing on preventing ill-health rather then the illness itself (Milton and Letwin, 2010). It means that our duty is to encourage healthy behaviours by understanding the causes of ill-health and not the treatment of illness. According to The King’s Fund Report (2014) “people are not as involved as they want to be in decisions about health and care, yet when they are involved, decisions are better, health and health outcomes improve, and resources are allocated more efficiently”. People with high levels of activation and health literacy may only require an initial conversation, signposting them to relevant information or guided support. For those with low levels of activation, tailored coaching approaches have proved most effective at supporting behaviour change. In addition to that, it is important for those with low levels of health literacy to be provided with information in different formats and the support necessary for them to understand and use that information (Foot, C. Et al, 2014).

According to statistics, people with serious mental illness die on average 20 years earlier than the rest of the population, and many of these deaths are avoidable. Mental illness affects more than 1 in 4 of us at any one time. The human and economic cost (estimated at £105bn a year) is enormous (Fenton, 2013)

people with higher levels of wellbeing are less likely to smoke and they tend to eat a healthier diet. We also think that healthy behaviours, in turn, promote wellbeing.

For example, the five ways to wellbeing are a set of actions (connect, be active, take notice, keep learning and give)

Making Every Contact Count initiative

NHS strategy, the NHS five year forward view (Forward View), argued that much more needs to be done to draw on what it described as the renewable energy of people and communities, but progress in converting this aspiration into action has been patchy at best.

Conclusion (sources and evidence must be cited as appropriate)

Discuss:

  • What are the strengths and weaknesses of using a health profile to understand the health and wellbeing of an individual and what additional information could you gather.

Reference list

1. Public Health England (2017) Reducing health inequalities: system, scale and sustainability. Available https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/731682/Reducing_health_inequalities_system_scale_and_sustainability.pdf

2. Linsley, P. and Roll, C. (2020) Health promotion for nursing students. London: a SAGE publishing company.

Dahlgren, G. Goran, Whitehead M. (2007) Policies and strategies to promote social equity in health. Arbetsrapport/Institutet för Framtidsstudier. https://www.iffs.se/media/1326/20080109110739filmz8uvqv2wqfshmrf6cut.pdf

Foot, C. Et al. (2014) People in control of their own health and care. The state of involvement. The Kings Fund Report. https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/people-in-control-of-their-own-health-and-care-the-state-of-involvement-november-2014.pdf

Fenton, K. (2013) Promoting wellbeing and mental health: what’s next? Blog Public Health matters. https://publichealthmatters.blog.gov.uk/2013/10/07/promoting-wellbeing-and-mental-health-whats-next/

Milton, A. and Letwin, O. (2010) Applying behavioural insight to health. Discussion paper. Cabinet Office Behavioural Insights Team. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/60524/403936_BehaviouralInsight_acc.pdf

Public Health England (2017) Health matters: obesity and the food environment. Guidance paper. https://www.gov.uk/government/publications/health-matters-obesity-and-the-food-environment/health-matters-obesity-and-the-food-environment–2

London Borough of Hounslow (2017) Joint Strategic Needs Assessment. The Hounslow Story. PDF

Levy, L. (2016) Answering a fundamental question: “What is a healthy, balanced diet?” Public Health England. Public Health matters Blog. https://publichealthmatters.blog.gov.uk/2016/03/17/what-is-a-healthy-balanced-diet/

Kuhnle, G. (2020) Expert reaction to study looking at the PHE Eatwell Guide and health and environmental impacts. Science Media Centre (SMC) https://www.sciencemediacentre.org/expert-reaction-to-study-looking-at-the-phe-eatwell-guide-and-health-and-environmental-impacts/

London Borough of Hounslow (2020). Healthy lifestyles for adults, children and families. https://www.hounslow.gov.uk/info/20049/health_and_well_being/1924/healthy_lifestyles_for_adults_children_and_families

Bazian (2015). Single mothers have ‘worse health in later life’. Analysis. NHS. https://www.nhs.uk/news/pregnancy-and-child/single-mothers-have-worse-health-in-later-life/

Public Health England (2013). Nursing and Midwifery. Contribution to Public Health Improving health and wellbeing. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/210100/NMR_final.pdf

WHO (2015). Nurses and Midwives. European compendium of good practices in nursing and midwifery towards Health 2020 goals. A Vital Resource for Health. https://www.euro.who.int/__data/assets/pdf_file/0004/287356/Nurses-midwives-Vital-Resource-Health-Compendium.pdf

NMC (2010). Standards for competence for registered nurses.https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standards-for-competence-for-registered-nurses.pdf

NHS. Making Every Contact Count. What is Making Every Contact Count? Factsheet. https://www.makingeverycontactcount.co.uk/media/27613/mecc-resources-fact-sheet-v9-20180601.pdf

World Health Organisation (WHO) (1948). Constitution. https://www.who.int/about/who-we-are/constitution

World Health Organisation (WHO) (1986). The 1st International Conference on Health Promotion, Ottawa, 1986. https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference

NHS (2018). BMI healthy weight calculator. Healthy weight. https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

National Institutes of Health (2017). What Are Your Health Risks? Health Capsule. PDF https://newsinhealth.nih.gov/sites/nihNIH/files/2017/August/NIHNiHAug2017.pdf

Lee I-Min et al (2012). Impact of Physical Inactivity on the World’s Major Non-Communicable Diseases. Journal. PMC. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/

Blair, S. (2009). Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med. Vol 43 No 1. PDF https://bjsm.bmj.com/content/bjsports/43/1/1.full.pdf

Weiler, R. and Stamatakis, E. (2010). Physical activity in the UK: a unique crossroad? Br J Sports Med. Vol 44 No 13 https://bjsm.bmj.com/content/bjsports/44/13/912.full.pdf

Dr Foster, C. Et al. (2019). UK Chief Medical Officers’ Physical Activity Guidelines, p 30. Department of Health and Social Care https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf

Council of Europe (2014). Report on Psycho-Social Aspects of Single-Parent Families. Health Policy. https://www.coe.int/t/dg3/health/Reportsingleparents_en.asp

Williams, E. Et al. (2020). What are health inequalities? The Kings Fund. https://www.kingsfund.org.uk/publications/what-are-health-inequalities

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