Write my paper using the rubric headings, as below.
Several of the rubric sections ask you to relate the connection between a specified social determinant and the patient’s access to healthcare. When you see the term ‘access,’ consider the following:
The Agency for Healthcare Research and Quality states that access to health care means having “the timely use of personal health services to achieve the best health outcomes” (IOM, 1993). “Attaining good access to care requires three discrete steps:
Gaining entry into the health care system (Is it available and in close proximity?)
Getting access to sites of care where patients can receive needed services (Can the patient get to it? – transportation)
Finding providers who meet the needs of individual patients and with whom patients can develop a relationship based on mutual communication and trust”.
Healthy People 2020 also has some great information regarding access to health services https://www.healthypeople.gov/2020/topics-objectives/topic/Access-to-Health-Services
There are 2 parts to this section. First, you are required to discuss your approach to asking your social determinants questions. For example, “During the assessment, social determinants were discussed to determine the social status of the patient. Social determinants are important for determining access to health care, ability to afford care, and ability to maintain health and well-being. The questions were presented in a non-threatening, face-to-face format, which allows for improved interpretation of verbal and non-verbal cues and were mostly open-ended to provide an opportunity for the patient to describe and expand on the answers. The patient’s answers help determine if the patient can afford, have access to, and understand importance of healthcare and disease prevention.”
Secondly, you are to present an accurate analysis of the social determinants. Therefore, you could offer a brief statement, beginning with “An analysis of my patient’s social determinants was conducted and revealed…” Using rubric wording may be a good idea to ensure that the evaluator sees that you addressed each component. Also, keep in mind that several parts of this paper are repetitious; however, if the rubric asks for certain items, go ahead and provide them even if you’ve addressed them in another part of the paper. The rubric states that this section must be “well-supported,” so you should cite at least one source to support your interview methodology. Consider reviewing the chapter on interviewing techniques in your Bates eText.
A1a. Discussion of Key Questions
In this section, you are required to identify and discuss key questions that are appropriate for a healthcare setting to effectively assess each of the five social determinants: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. List each question you used and give a brief statement as to why you chose that question.
A1b. Responses to Key Questions
This section requires you to state the patient’s responses to each of the social determinants questions and give a brief statement as to how each answer will promote your thinking in regards to how you will want to change or add to his/her plan of care. Later in the paper, you actually choose the 3 highest priority determinants for which to create a plan of care; however, in this section, it is still important to state how you might address each response. For instance, if the patient says, “My social support system consists of my wife, my parents, and a handful of close friends, all of whom we hang out with on a fairly regular basis.” You can now ascertain that the patient seems to have a solid social support system.
You might then suggest that the patient choose one as an accountability partner for nutrition and exercise since social support is an integral part of following through with wellness activities. If the patient has good access to healthcare, you may suggest that he/she receive annual flu vaccines and be proactive about getting preventive care for which health insurance reimburses. Be creative because most of the assessed “patients” are healthy and have very few priority social determinants. Most of our suggestions and plan of care will focus on prevention. Remember, social determinants do not have to be negative! They can even influence patients positively.
A2. Economic Stability
This section requires you to provide a logical and accurate interpretation of the relationship between the patient’s economic stability and access to healthcare. Start this section with how economic stability impacts access to healthcare in general and then narrow down to your specific patient and make a clear connection as to how his or her economic stability impacts his/her access to healthcare. As noted in the task directions, as you’re describing your patient’s economic stability, you should include socioeconomic status, employment, and housing stability. You may find that you are repeating yourself a bit from the section before, but that is expected and acceptable.
A3. Educational Status
Your discussion of this item should demonstrate a clear understanding of the patient’s educational status and the ways in which it affects his/her health. The analysis should be clearly articulated and well-supported. Again, you should begin by discussing how education affects access to healthcare for anyone and then make a clear connection to the ways education impacts your patient’s access to healthcare. You might think about how a high school education impacts health differently from a college education. If your patient was able to graduate from college and acquire a good job with health benefits, this certainly impacts health positively. Also, generally speaking, any advanced degree usually means the person had some type of nutrition/physical education course(s), which may expand their thinking in terms of health and wellness. This section of the rubric requires the analysis to be “well-reasoned and well supported,” so be sure to include at least one reference to support your comments.
A3a. Health Literacy
Your discussion of this item should demonstrate a clear understanding of the patient’s health literacy and how it affects his/her health. Again, begin with the general discussion of the ways in which anyone’s health literacy impacts access to healthcare and then end with a clear connection between your specific patient’s health literacy and its impact to access to healthcare. If your patient is a healthcare worker, think about how this impacts his/her ability to navigate the healthcare system and understand health information. If your patient has no college education, does this impact his/her health literacy, and if so, how? Sometimes patients without advanced education haven’t learned to read/write at a higher level and may find health information difficult to comprehend or interpret. They may also have trouble communicating their health needs. This section of the rubric requires the analysis to be “well-reasoned and well supported,” so be sure to include at least one reference to support your comments.
A3b. Educational Opportunities and Barriers
Under this item, you are required to discuss specific, plausible healthcare barriers, as well as opportunities the patient might face because of his or her educational status. Begin with a general discussion and end with your specific patient. Remember, barriers occur even for healthy people. If someone is highly educated, that may serve as a positive opportunity, but it may also prevent the individual from adequately addressing health issues. Think about opportunities a person may have due to higher education (a good job with health benefits, access to better healthcare providers/specialists). Also, think about opportunities education provides – ability to read and understand health information and ability to understand the importance of healthcare and self-care. Think about barriers, as well. If your patient is a healthcare worker, what barriers may he/she possess? Maybe the patient is too embarrassed to ask questions because the provider is aware of his/her employment in the healthcare field and assumes a certain level of understanding and health literacy without further explanation. Opportunities and barriers exist for all people! We each have unique motivators and perspectives. Think about how you are able to access healthcare and how you perceive your education to help and/or hinder you. Your patient may not be that different! Again, your discussion must be well-supported, so include at least one reference.
Note: You are asked to include both opportunities and barriers. Both are plural, indicating the need to address two or more of each.
A4. Effect of Health on Quality of Life
Your analysis in this section should demonstrate a clear understanding of how the patient’s health/healthcare status affects quality of life. The analysis should be well-reasoned and supported by evidence. Again, start with a general discussion (as stated in the sections above) and end with your specific patient. Notice that the rubric wants a well-supported discussion, so please include a reference to support your statements.
A5. Neighborhood and Environmental Impacts
In this section, you are required to discuss how the patient’s neighborhood and environment affects access to health, ensuring that your analysis is both logical and clear. As in other sections, begin with a general discussion and end with your specific patient.
A5a. Healthcare Received in Low- and High-Income Areas
Your discussion of this item should highlight the similarities and differences in the healthcare a patient receives in low- and high-income areas. Your comparison should be both clear and effectively articulated. Make sure that at the end of this section you include the specifics related to your patient– do he/she live in a high- or low-income area and how does this impact him/her?
For your discussion of similarities in healthcare received in low- and high-income areas, think about how healthcare settings provide care, to whom they provide it, and the guidelines they follow. Also, think about emergency services and to whom/how they respond. For differences in healthcare received in low- and high-income areas, think about healthcare services offered in high-income areas. Consider how provider offices/hospitals look, what specialties are offered, and whether or not services are covered by health insurance. What type of clinics does one find in low-income areas, and what type of services do they provide? How are these clinics staffed, and how well are they maintained? Is it possible that someone in a high income area and one in a low income area prioritize health care in the same way? Just some ideas…
Note: You are asked to include both similarities and differences. Both are plural, indicating the need to address two or more of each.
A5b. Rural versus Urban Healthcare Access
Your discussion should logically address how access to healthcare differs for patients living in rural versus urban areas, and the discussion should be well-supported – and then you should add relevant information specific to your patient in this category – rural or urban – and how this impacts him/her. Please use a reference to support your statement since the rubric asks for a “well-supported” discussion.
A5c. Neighborhood Healthy Food Options
The discussion of this item should provide specific, plausible reasons for how a patient’s neighborhood affects his or her access to healthy food options. Your reasons should be logical and supported. At the end of this section, you want to bring it back to your specific patient and how his/her neighborhood food options impact his/her ability to eat healthy foods. Please use a reference to support your statement since the rubric asks for a “well-supported” discussion.
Discussion of Social Determinants
In this section, you are required to provide an accurate interpretation of why it is necessary for social determinants to be explored in the comprehensive health assessment. Please support your statements with a reference.
Note: You can address B1-B3 in table format if you wish, or put it in narrative format. It doesn’t matter, as long as you clearly address what the rubric is asking for. If you utilize a table, you’ll need to include a row for each of the three highest priority social determinants.
B1 Priority Social Determinant B2 Interventions B2a Implementation B2b Barriers B2c Individuals involved B3 Plan Effectiveness
B1. Identification of Social Determinants
You are required to identify the 3 highest priority social determinants for your patient. These should be accurate and logical and should relate to the patient. Be creative as you will probably need to focus on prevention for most of your patients (primarily education). For instance, you might use access to healthcare and focus on educating your patient on identifying whether or not your patient understands the importance of prevention and educating your patient on finding out what incentives his/her insurance offers in the way of participating in wellness programs. For neighborhood/home environment, you might educate your patient on importance of home safety, i.e. having handrails on stairwells, non-skid rugs next to showers and tubs, and smoke alarms in place as well as developing a fire evacuation plan.
B2. Patient Plan of Care
The patient plan of care that you develop should be logical and plausibly address the three priority social determinants that you identified in B1. Any plan that is logical and presents a plausible plan implementation has worked for many students. For this particular section, however, you should just summarize your plan of care, telling ‘what’ you will do (i.e. interventions). Detail on actual implementation will be provided in the next section.
B2a. Plan Implementation
Your discussion should address implementation of the plan based on the social determinants
that you identified. Your implementation need not be fancy. Here you will tell ‘how’ you would implement the interventions in B2. Maybe your plan will just consist of verbally educating your patient and/or printing out the information in handouts so that information can be reviewed at home. Your statements need to be well-supported, so be sure to use a reference.
B2b. Implementation Barriers
Discuss any identified barriers in detail. Your discussion should be logical, and relevant to the interventions discussed in part B2. Again, these do not need to be fancy. The barriers could be present or potential. Many times our implementation barriers are time constraints, a patient’s
lack of interest, or a lack of assigning importance to issues.
B2c. Individuals Involved in Interventions
Your discussion should provide an accurate analysis of those that need to be involved in the interventions. The ideas that you present should be logical and well supported. Always include the patient! Typically, interventions are most effective when we include the closest members of the patient’s social support system. Remember to support your statements as requested in the rubric.
B3. Plan Effectiveness
Your discussion of this item should demonstrate an accurate evaluation of the effectiveness of the patient’s plan of care. The discussion should be well supported and relevant. There is no need to develop elaborate evaluation plans for this section. Whatever evaluation method you propose, it should be measurable. You might just use the teach-back method to evaluate education. Again, please support your statements.
B4. Summation of the Impact of Social Determinants
Your summary should be logical and relevant and should demonstrate an accurate understanding of the impact of social determinants on the patient’s well-being. Be sure to speak about each of the five social determinants and their specific impact on your patient.
Your submission should include in-text citations for sources that are properly quoted, paraphrased, or summarized, as well as a reference list that accurately identifies the author,
date, title, and source location. Use the APA 6th edition format.
Instructions for Paper
Reflect on the comprehensive health assessment you performed in task 1 by doing the following:
- Discuss the strategy you used to assess your patient’s social determinants.
- List five key questions you used to assess social determinants.
- Explain what you would add to the patient’s plan of care based on the patient’s responses to key questions in A1a.
Explain how your patient’s economic stability affects his or her access to healthcare, including each of the following points:
- socioeconomic status
- employment status
- housing stability
Analyze how your patient’s educational status affects his or her health.
- Analyze how your patient’s health literacy affects his or her health.
- Discuss the healthcare barriers and opportunities the patient might face because of his or her educational status.
- Analyze how the patient’s health and healthcare status affect his or her quality of life.
- Explain how the patient’s neighborhood and environment affect his or her access to health.
- Compare the healthcare (e.g., quality, access, outcomes) of a patient living in a low-income area is likely to receive with the healthcare of a patient living in a high-income area is likely to receive.
- Discuss how access to healthcare differs for patients living in rural versus urban areas.
- Discuss how a patient’s neighborhood affects his or her access to healthy food options.
- Discuss why social determinants need to be addressed in your comprehensive health assessment.
- Based on the assessment, identify three highest priority social determinants that affect your patient.
- Based upon the three chosen social determinants, develop a patient plan of care.
- Explain how you would implement your plan based upon the social determinants identified.
- Identify any barriers to implementing the interventions from part B2.
- Discuss who needs to be involved in the interventions (e.g., healthcare practitioners, community members, family).
- Explain how you would evaluate the effectiveness of your patient’s plan of care.
- Summarize the impact of social determinants on your patient’s overall well-being.
Patient: 24yrs old Persian female with no chronic health conditions,
HT: 5ft 1in, Wt.: 175#. Denies any ongoing health problems.
Has had preventative care/screenings –pap smear (june 2017),
vaccines, (Tdap – does not recall),
Last visit was 1yr ago for UTI.
STD screening June 2017. (IUD) placed 4yrs ago.
Currently works as a project manager for a local flooring company.
Has completed some college but no college degree, smokes and drinks occasionally (socially)
Lives with Boyfriend and his mother in Elk Grove, CA
Has health insurance through Father’s employment for 1 more year, employer offers health insurance, (40-50$ per month) plans on seeking health coverage from employer.
Social History: Divorced Parents, Immigrants from Iran (mom) and Pakistan (dad)
Family Hx: Father recently diagnosed Prediabetic , living, works at a local factory (Campbell Soup) for almost 20yrs. Mother, living, unemployed, suffers from PTSD (rape) also recently diagnosed with Breast Cancer – undergoing Chemo. Mom is bisexual, currently living with female partner.
Denies any problems seeking care but has reservations about getting medications due to cost.
1 biological sister, 3 step sisters and 2 half-brother’s.
Has occasional pelvic pain – left side – intermittent mostly after menses, lasts for about 3-4 days, managers pain with ibuprofen 400mg no increased vaginal bleeding, mild spotting.
HX of tonsillectomy at 10yrs old. Last dental visit 2yrs ago.