Income
Why is "INCOME", as a determinant of health important?
Level of income shapes overall living conditions, affects psychological functioning, and influences health related behaviours such as quality of diet, extent of physical activity, tobacco use, and excessive alcohol use
Why is "EDUCATION", as a determinant of health important?
Every child, including the world's most disadvantaged, has the right to an education because it has the power to change lives. Education is a powerful tool for breaking the cycle of poverty; supporting child survival, growth, development and well-being; and closing the gap in social inequality.
Why is "FOOD INSECURITY", as a determinant of health important?
Adults in food-insecure households have higher rates of developing chronic diseases – mental health issues, arthritis, asthma, diabetes – and are more likely to die early.
Increasing access to healthy food corresponds to the likelihood of healthier eating, healthier weights, and reduced rates of diabetes
Why is "SOCIAL SAFETY NETWORK", as a determinant of health important?
SSN refers to a range of benefits, programs, and supports that protect citizens during various life changes that can affect their health
Why is "HEALTH SERVICES", as a determinant of health important?
High quality health care service is a SDoH and a human right
Main purpose of universal health care:
Protect the health of citizens and spread health costs across society
Effective in protecting citizens with lower incomes who cannot afford private health care insurance
Based on your nursing assessment or interview, what is the reason for Nate’s financial decline?
Nate lost his job due to closure of the mall which he worked at. This was due to COVID.
What unhealthy lifestyle practices is Nate partaking in?
The use of alcohol
Purchasing alcohol over a proper meal
Getting drunk often
Poor self care practices- delay in getting treatment for infected wound
frequent colds, skin infections, and injuries
Give an example of someone experiencing food insecurity
All answers are correct
Example: people with type 2 diabetes may find themselves limited to purchasing inexpensive, high-calorie, nutritionally poor foods (eg, foods high in refined carbohydrates) instead of foods that are more healthful, such as vegetables, lean proteins, and whole grains
What caused the decline in Nate’s social network?
In Nate's case, his decline came from unemployment, loss of family and friends and the use of alcohol.
What were some of the barriers that Nate faced in accessing health care?
Lack of telephone service
Alienation from the healthcare system
Lack of preventive care
Poor nutrition
Feelings of stigma
Multiple day-to-day stressors
Difficulty keeping up with medical plans
How does his income affect his current life status?
He does not have a job and thus has no means to support himself. Losing his source of income resulted in him not being able to pay his rent; this caused him to become homeless.
What are some indicators in the scenario that states Nate needs health teaching?
Consuming alcohol in heavy amounts
Continuous skin infection which means he is not taking proper precautions with his cellulitis.
Based on the scenario, what indicates Nate is experiencing food insecurity?
Nate is prioritizing alcohol for meals
He is homeless and unemployed which usually leads to food insecurity
He asks for money but does not get enough to satisfy all his needs
It is difficult to get social assistance when you are homeless due to not having a set address.
How did losing his family (wife and daughter) impact his life choices?
His wife left, leaving him with no financial support, led him to be evicted from his apartment.
Nate also developed anger, panic and depression, which led to the overuse of alcohol.
The loss of family impacted his self-esteem which was already low from the unemployment; he struggled to seek help because of his way of living and appearance
If you were a community health nurse, how would you make Nate feel comfortable speaking to you; how would you build a trusting relationship?
Must be aware and open that Nate is vulnerable physically, socially, psychologically and spiritually
Must understand Nate’s personal values and beliefs
Building rapport may be easier if Nate is met through community outreach and case-finding as it may be a more comfortable environment on the streets than at an ER department
Must exercise patience and avoid stereotyping
Follow Nate’s lead and respect his comfort level on personal space, and communication manners
Listen to the patient’s stories - it helps people create their idenitites and allows nurses to find common themes; story-telling can also clue in patient concerns and anxieities
Open-ended questions are a must
Create viable care plans that are individualized with Nate
How can the CHN assist Nate with his financial complications?
The CHN can help to connect Nate with services that will help in this situation; for example, HouseLink is an program which moves people experiencing homelessness into independent and permanent housing and then providing additional supports and services as needed.
What are some questions that you could ask to assess Nate’s Health literacy? I.e. Knowing his health condition.
Do you understand the nature of your illness? Illness being cellulitis
Can you tell me about your alcohol urges?
What social determinants of health does food insecurity overlap with?
All answers are correct
Aboriginal status
gender
disability
housing
early life
income and income distribution
education
race
employment and working conditions
social exclusion
food insecurity
social safety net
health services
unemployment and job security
How would you assess Nate for loneliness and why is that assessment important?
First you would interview Nate to find out what loneliness means to him
Ask questions to understand what he may be experiencing while living without his family.
It is important because loneliness could lead to depression, alcohol or substance abuse tendencies. Which is evident in Nate’s behaviour.
An assessment could be carried out using a scale such as the one below
UCLA Loneliness Scale Version 3 include questions such as:
How often do you feel a lack of companionship?
How often do you feel left out?
How often do you feel isolated from others?
How might the emergency department improve care for patients like Nate?
Provide an environment of support; make him feel comfortable going into the ER
Confront personal biases and ensure that they do not affect the quality of service that you are providing to your patients
ER nurses and doctors did not ask Nate if he was homeless when discharging him “back to home”; if they had asked they could of provided him with services to help with the effects of homelessness
In the article, “they blew the levee”, it states how disaster and public health officials must learn to build trust among people, especially those considered to be vulnerable. Explain how socioeconomic statuses create distrust among vulnerable populations.
- Belief that the rich are privileged over the poor -
People of low socioeconomic statuses express distrust due to ineffective or slow response times. This is prominent when comparing the level of help and support, given to different socioeconomic neighbourhoods.
How can you promote healthy lifestyle changes for Nate?
Communicate with him and understand the changes he is going through and how it affects him
Mental assessment could lead to referral to a psychologist for help with his depression.
Nate could be referred to alcohol Awareness classes
Referral to employment agencies
Referral to housing agencies
What are some organizations that you could refer to Nate to get assistance with food insecurity?
Food banks
The scott mission- Christian organization that offers food, shelter and clothing to those in need
Canadian Red Cross- they launched Toronto Emergency Food Assistance
In the Rodriguez article, there is a component that lists how we assess patient environment and resources. List important questions to ask when assessing Nate’s family and social networks. How can a community nurse help Nate from this standpoint?
What is family to you?
Are you in contact with any family or friends?
What community partners are you in contact with?
Community nurses need to be open and non-judgemental
- Need to assess Nate’s needs and wants, from his own perspective
- Provide referrals/contact information of community facilities that can help meet their needs
How does alcoholism affect health?
Alcoholism has many detrimental effects on health
Short term effects include: dizziness, lack of judgment, vomiting, accidental and injuries, etc.
Long term effects include:
Brain: Concentration, mood, memory & increases risk for stroke
Heart: increases BP & can lead to heart damage and heart attacks
Liver: increased risk of developing liver cirrhosis, cancer and death
Stomach: increased risk of stomach and bowel cancer
Having a support network is important when discussing mental health; his anger and outbursts (fueled by the alcohol) caused Nate to lose all of his social support which then resulted in him being homeless