There are various concepts of health both lay and professional. Health is a complex subject and one that can be difficult to define, however The World Health Organisation, WHO (1984) cited inâ€¦. defines it as “The extent to which an individual or (group of individuals) is able, on one hand to realise aspirations and satisfy needs, and on the other hand to change or cope with the environment. Therefore seen as a resource for everyday life, not an object of living. It is a positive concept. Emphasising social and personal resources as well as physical capacity. This definition recognises that health is multi dimensional. (Lloyd, Hancock and Campbell, 2007)This piece of work will explore the concept of health and nursing, firstly describing the dimensions of health. It will then go onto give an overview of an adult individual including their health history. It will identify what determinants affect the individual’s health. The underpinning professional, legal and ethical principles of nursing that would apply in the event that the individual would require care will be explained. Finally the writer will identify how this piece of work has informed their personal concept of nursing. 192
There are various aspects of health to consider when aiming to achieve overall good health and wellbeing, known as the dimensions of health. According to Ewles and Simmett (2004) there are six dimensions. Physical, intellectual, emotional, social, spiritual and environmental health also referred to as societal health. Physical health is concerned with the state of the body including its development, functions and maintenance. Good physical health can be achieved by eating a nutritious diet including drinking adequate amounts of water, participating in regular exercise and having regular health checkups. By doing so this will ensure the body is cleansed, energized, fit and that disease and illness is minimised. Intellectual health is being able to enhance knowledge and skills, make decisions, are creative, and have comprehension and common sense. Through interactions, being open minded, questioning and challenging things an individual is stimulating their mind therefore enhancing their cognitive ability and intellectual health. Emotional health which is sometimes referred to as psychological health is about acceptance of one’s own emotions, being able to cope and express them appropriately and recognise others feelings. It also takes into account the value they hold of themselves and their self esteem. Each individual has different ways of coping and enhancing their emotional health. Social health is having the ability to develop relationships with others including the wider community and maintain such relationships. It is also the ability to participate in society, have an active societal role and be socially accepted. One should be accepting and understanding of other cultures and the values and beliefs they hold. Spiritual health can vary in meaning for individuals. To many, spiritual health is considered to be about religious beliefs and about having faith, for others it is about the meaning of life and their own values and how they cope with certain aspects of their life. “Spiritual wellness combines a person’s ethics, values and morals. This component is what gives life meaning and purpose. It is based on faith, hope, love, optimism and forgiveness.”(Floyd, Mimms and Yelding, 2008) Environmental health can comprise of both internal and external. There are some aspects to individuals environmental health they have no control over but there are some in which they do; for instance their lifestyle. Everything that surrounds an individual can contribute to their health. Individuals usually cannot change their internal environment, their genetic blueprint and pre-dispositions. “Balancing of these components is necessary to achieve a high level of wellness” (Floyd, Mimms and Yeilding, 2008) Each dimension is of equal importance and each should be considered in order to view an individual’s health holistically. All overlap to an extent; they interact and influence one another. One imbalanced dimension can significantly impact on the others. These dimensions are also reflected In Maslow’s hierarchy of needs in order to reach self actualization, a person must move through the stages meeting fundamental needs, physiological, safety, love and belonging, esteem and the self actualization. 487
OVERVIEW OF INDIVIDUAL
For the purpose of this assignment the individual will be referred to as Mrs. X to maintain confidentiality. Consent has been obtained from the concerned individual.
Mrs. X is a 43 year old, single mother of three children who lives in a socially deprived area of north Lanarkshire. Mrs. X was raised in North Lanarkshire with mother, father, older brother and younger sister. Mrs. X is very intelligent and achieved well at school. When she left school she went on to become a psychiatric nurse. She worked at hardwood hospital and carstairs state hospital at this time Mrs. X earned a good living and was financially secure. In 1993 shortly after the birth of her second daughter, Mrs. X’s father to whom she was very close to died. Mrs. X never returned to work as a nurse after this time. She was a fulltime mother for a number of years, during this time she met her husband and had a son. She divorced after 4 years. When her youngest child started school she returned to work and now works in social work department as a carer on a relatively low income. Over time Mrs. X has suffered numerous health issues, when pregnant with her first child she suffered a deep vein thrombosis, it has recently been discovered she suffers a genetic blood disorder. She has trouble with her bowels however after many investigations a cause or diagnoses has yet to be identified. She has allergies, suffers back ache, and has early onset menopause and related symptoms. She is currently undergoing investigations into her liver function which is thought to be associated with her alcohol consumption. 275
DETERMINANTS OF HEALTH
Naidoo and Wills (2009) discuss the many factors that can contribute to an individual’s health. These factors are known as the determinants of health. According to WHO (n.d) these are “the social and economical environment, the physical environment and the individuals own characteristics and behaviours”. Much research is conducted into such determinants to identify causes and help establish ways of reducing health inequalities. Health promotion programmes are one way of trying to reduce inequalities though raising awareness of such factors. In relation to Mrs. X there are many determinants that affect her health. Statistics show the area in which she lives has one of the lowest life expectancies in Scotland especially amongst woman, it also has a high number of drug and alcohol misuse, single parent household, cases of individuals with mental illness, and poverty. All of which are evident in Mrs. X situation suggesting her health are compromised by living in this area. Although Mrs. X is employed she is not financially secure and does not have disposable income. This affects her self esteem and the value she holds of herself. Her financial situation prevents her from participating in many things, therefore impacting on her social and emotional health. Her occupation involves manual handling, which with her existing back trouble can impact on her physical health. Being single impacts on Mrs. X, she lacks interaction with other adults, preferring her on company. Being alone leads to her consumption of alcohol. Mrs X knowledge and education also influences her health, having previously been a nurse she is well away of the impact certain things have on her health, however does not use this to her advantage, she tries to avoid going to her GP and usually self diagnoses which means she is depriving herself of what could be necessary treatments. Mrs X has an unhealthy relationship with alcohol although she does not think she has a problem. She consumes alcohol most days. This aspect of her lifestyle is impacting greatly on her health. Her diet is poor as she replaces food with alcohol, she has substantial problems with her liver, and she is deficient in most essential vitamins and mineral. Her emotional and social health is also being affected, she has low self esteem, suffers depressive moods, she withdraws and isolates herself. Her cognitive ability will start to suffer with the continuous consumption of alcohol.mrs x is overweight; this is likely due to her diet, alcohol consumption and lack of exercise. This affects her self esteem. Many of Mrs. X physical health troubles are genetic. She suffers from hypertension as does her mother and sister, she also has a hereditary hypercoagulability disorder. She also has pre-dispositions to other illnesses. Heart disease and cancer are common in the immediate family as are diabetes mellitus and glaucoma. Many of the medications that Mrs. X takes have contributory effects that add to the state of Mrs. X overall health. Many of the determinants that evidently contribute to her health are within her control, given the appropriate support and advice of healthcare professionals Mrs. X can take steps to improve her health. 518
PROFESSIONAL, LEGAL AND ETHICAL PRINCIPLES
In the event that Mrs. X would require nursing care there are many professional, legal and ethical principles that would apply to her care.
“The law and ethics is the framework in which professional issues are discussed and measured”. (reeves and orford, 2003). Therefore all three combine together in most situations in practice. The Nursing and Midwifery Council (NMC) are the regulators for nurses and midwifes. The NMC is in place to safeguard the health and wellbeing of the public by setting standards that must be followed,” the code of professional conduct, performance and ethics” (nmc, 2004) Individuals being cared for must be able to trust those delivering their care therefore nurses must act with integrity. Nurses must treat each person as an individual and respect them, be non-judgemental and not discriminate. They must demonstrate consideration when delivering care and respect ones privacy and dignity. People have the right to confidentiality. Information should only be shared with necessary people in the interest and safety of the person being cared for. This is a legal aspect; confidential information is protected under the data protection act 1998. Nurses should act as an advocate for those in their care to help them receive appropriate treatment, support and information. When acting as an advocate a nurse should be aware of legislation regarding mental capacity such as Adult with Incapacity (Scotland) Act 2000 to ensure those who lack capacity are safeguarded. Nurses should involve people in their own care as far as reasonably possible to promote their independence. Another principle that’s not only a professional principle but also a legal requirement is consent. Nurses must gain consent before carrying out any procedure of care. They must respect that person’s choice and be able to justify their actions in the event they had to provide care in an emergency. Professionals must work effectively together in a multi disciplinary team to ensure the best possible care is being provided. Nurses must be aware of professional bounderies and not conduct themselves in such a way as to compromise their professional relationships. Nurses have a professional and legal duty of care, they are accountable for their own actions and they must uphold the reputation of the nursing profession. A nurse must take reasonable care to avoid causing harm or injury to any person through negligence. They must also demonstrate competence and should keep their knowledge and skills up to date. Recordkeeping is a profession principle but it is also a legal requirement. It is the nurse’s responsibility to ensure records of care and assessments they have made are up to date, accurate and clear. They should be kept secure and should not be altered or tampered with. Recordkeeping is evidence that a nurse is fulfilling their professional duty. Nurses have a legal responsibility to report and record accidents and incidents. There are many legal boundaries that apply to healthcare situations. It is therefore important that nurses are aware of legal principles (kenworthy, snowley and gilling, 2006). Legislation is a fundamental part of healthcare with many acts in place to protect both the professional and the person being cared for. All professionals should be familiar with current legislation relevant to their practice. The law can be divided into two, criminal law and civil law. “The majority of healthcare situations that need legal involvement will be civil matters”.(kenworthy, snowley and gilling, 2006). Ethics and morals play a huge role in nursing practice. Downie and calman(1994) cited in Brooker and Waugh (2007) argue that all clinical and professional decisions have a moral aspect to them. Nurses have to make decisions when faced with dilemmas with the intensions of doing good for the person being cared for and avoid causing them harm. They have to decide whether they ought to carry out certain actions, if they have a duty to do such things. There are two main ethical theories deontology which is concerned with ones motives for action, their duties and responsibilities. Utilitarianism is to do with the consequences of actions, what the outcome would be. A nurse should have knowledge and awareness of not only the professional morals and ethical values but their own as well. Brooker and Waugh(2007) discuss the main principles of ethical practice, that nurses have to respect individual’s rights to autonomy, the right to make their own decisions and choice however this can be overruled in the interest of others of if one is unable to make decisions clearly. Individuals have a right to justice, they have protection under law, and they should have a choice as to what course of action they wish to pursue to obtain justice. Nurses should be aware of their accountability. Another principle that should be applied in care is non- malefience which means to do no harm. This is part of a nuses duty as stated by the NMC. They should carry out care in the best interests of the individual known as beneficence and be able to justify that care. Nurses must be truthful, referred to as veracity this is essential in building meaningful trusting relationships with others, not only those in their care but also their relatives, other colleagues and professionals this is important to deliver the best possible care. 870
Since researching the different aspects of nursing and writing this assignment my concept of nursing has definitely changed. I feel I held many of the lay concepts of health however now I feel I am beginning to look at health from a professional perspective. I am more aware of the factors that contribute to people’s health and how many of these can be influenced. Gaining an understanding of how these factors affect the dimensions of one’s health and having gained an awareness of how these dimensions interact and impact on one other I can see why taking a holistic approach in assessing individuals is a positive aspect and one that is promoted. It has also enhanced my knowledge of the principles that are applied to the nursing profession, the professional principles, guided by the NMC’s code of conduct, the legal principles, relevant legislation and the ethical principles that should be applied in decision making in clinical practice. Overall I have been informed of the concept of health as viewed from the nursing profession which I feel will benefit me immensely as I continue the programme of study and practice with outcome of having a career in nursing. 197
This assignment has concluded that there are various dimensions to one’s health that can be affected, therefore taking a holistic approach in assessing an individual aims to ensure all these dimensions are addressed. It has identified the many factors that can influence and determine ones health although these vary for each individual. The assignment has discussed which determinants can be influenced to improve health and wellbeing. The underpinning professional, legal and ethical principles that apply in the delivery of care have been explained. The writer has also mentioned how writing this assignment has informed their concept of nursing. Overall it has been identified that there are many aspects to consider when providing care to achieve a standard of excellence. 120
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