This paper discusses the impact of the wider determinants of health on the individual's and community's health and wellbeing and the role of the nurse in promoting health and wellbeing to address the public health crisis of the COVID -19 pandemic, with a focus on vulnerable groups of older people. It also examines the external factors affecting health and social care delivery including the complexity of treatments, disease management for long-term conditions, and the workforce issue. According to both Dahlgren and Whitehead's 1999 model and the World Health Organisation (WHO, 2013). The determinants of health are the characteristics of an individual's lifestyle, which are influenced by a variety of elements including physical and environmental factors, politics, social policy, and economics. These factors have a significant impact on an individual's health and wellbeing, therefore can affect their quality of life and reduce their life expectancy. Furthermore, according to the Health Profile for 2018, systematic differences in these factors are a source of social inequalities that contribute significantly to health inequalities in the community. They determine the degree to which different individuals have the resources they need to fulfil their aspirations, achieve goals, and adjust to changes in their situation, as well as the resources they need to meet their basic health needs, such as access to healthy food. Consequently, these variables can influence the determinants of overall health outcomes.
According to WHO, health promotion is about empowering individuals to increase control over and improve their health. To underpin this, the Ottawa Charter was further elaborated and key conditions to achieve the goals were identified. These include education, food, income, equity, peace, shelter, etc (WHO, 2012). In promoting health, it is therefore important to understand the different health settings, as they can help accelerate the development and implementation of comprehensive health promotion strategies for the nurse (Darly. E, Dina. C, and Patricia. F, 2014). In this way, the individual's health status and quality of life can be improved quicker. Moreover, as a health promoter, the nurse must have a full understanding of the individual and community needs in order to provide a level of service that satisfactorily meets the needs of the public (Department of Health, 2007). In addition, the nurse must view individuals as part of the socioeconomic environment in which they live and consider the impact on their health so that the nurse knows which setting is most appropriate for promoting health. For example, the nurse may use a behaviour change approach or an empowerment approach, all of which depends on knowing the person as an individual. (Darly. E, Dina. C, and Patricia. F, 2014) HELATH PROMOTION AND PUBLIC HELATH FOR NURSING STUDENTS- DARLY EVANS, DINA COUTSAFTIKI, C. PATRICIA FATHERS. 2014.
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Income, education, access to green space and healthy food, work, and place of residence are important determinants of health, as an individual's health and well-being depend on these factors (King's Fund, 2020). Inequalities in these factors lead to population-wide health inequalities. Therefore, it is critical for nurses to address these broader socioeconomic inequalities in order to reduce population health inequalities. This is because people living in disadvantaged areas may not have the same access to health and social care services as people living in advantaged areas. The nurse's role is therefore to refer them to health services that are beneficial to their health and well-being and to raise awareness about the benefits of using health services. This can reduce unequal access to health services and break down the barriers people face when seeking treatment. Additionally, people may face barriers in accessing health and social services or can be treated unfairly because of their origin. However, as an advocate, the nurse's role is to improve the quality of care they receive, meet their personal needs, and treat them with dignity and respect (Nursing and Midwifery Council, -NMC, 2018). Moreover, the Equality Act 2010 also plays an important role in protecting individuals from being discriminated, harassed and victimised because of their age, race, religion, sex, gender, disability, sexual orientation, marriage, or pregnancy. In contrast, the Equality Act fails to protect the elderly from age discrimination during the pandemic which makes them more vulnerable to inequality. For instance, the Help Age International 2021 noted that older people were separated and isolated, presented as week and helpless and their rights have been ignored which put them at risk of facing more violence, abuse and neglect. Moreover, although there are ethical grounds to consider the patient's age when making a triage decision however, utilising age as a categorical exclusion is not fair (Brown et al., 2021) because using age as a category can perpetuate social inequalities and structural disadvantages as it promotes preconceptions about the quality of life, health status, and broad social utility of the older population (Rueda, 2021).
Furthermore, in promoting health and wellbeing, the recognition and understanding of the social determinants underlying health experiences and health status are fundamental as it can help creating supportive environments, develop healthy public policies and redirect health services, which has a major impact on reducing inequalities in access to health care across the population (Kumar and Preetha, 2012). Additionally, comprehending current science and technology in healthcare is essential for the nurse because technology plays a significant role in 'reducing human errors, improving clinical outcomes, facilitating care coordination, improving practice efficiencies, and tracking data over time' (Alotaibi, 2017) It also has a significant impact on the delivery of health services and the management of health systems (WHO,2018)
Scientifically, as people age, their immune systems also age and become overactive, leading to immunosenescence (immune dysfunction that occurs with age), which reduces the effectiveness of vaccines and making them more susceptible to tissue-damaging inflammation and inflammatory diseases (Sam. W, 2020). As a result, this makes them more vulnerable to the virus. Furthermore, elderly people are at higher risk of suffering more severe COVID -19 consequences because of their frailty, multimorbidity, underlying diseases, social environment, and disability (Swiss Med Wkly, 2020). This is because each of these parameters plays a vital role in viral transmission. Therefore, it is critical for the nurse to consider these aspects when assisting individualsgroups in the community, as this allows the nurse to focus on those who are most at risk. Considering these factors also helps the nurse to provide evidence-based and person-centred care, putting the person at the centre of care. Being person-centred also means meeting the individual's language and communication needs by using a range of verbal and nonverbal communication methods and terms that they understand to minimise misunderstandings (NMC, 2018). When communicating, it is also important for the nurse to consider cultural sensitivities to better understand the patient's personal and health needs (NMC, 2018). Communication is also one of the skills required to successfully promote health.
In March 2020, the government began implementing wide-ranging social restriction measures to reduce the spread of the COVID -19 virus (Boris Jonson, 2020). These restrictions represented an intense stressor that negatively impacted social connectedness (Bricker, 2020) and the mental health of the population (Findlay and Arim, 2020). The social isolation and loneliness experienced by the elderly is one of the factors that increase their vulnerability to COVID -19, because, scientifically, social isolation and loneliness put the elderly at higher risk for some physiological and psychological illness such as hypertension, heart disease, obesity, weakened immune system, anxiety, depression, cognitive decline, Alzheimer's disease, and even death. Likewise, the Age, 2020 also found new emerging cognitive decline that's caused by isolation and makes them forgetful, confused and leads to repeating the same conversation. Based on the Steve Cole Ph.D., the National Institute of Aging also notes that loneliness can biologically affect the immune system by altering the tendency of cells within them which promote inflammation, which is necessary to protect our bodies from injury. Furthermore, the elderly reported unmet personal (Tilburg et al, 2021), housing and social needs, inadequate care, increased domestic abuse, violence, safeguarding issues (SCIE-social care institute for excellence ,2022) and reduced caregiver care throughout the pandemic. This has a negative impact on their health and wellbeing which increase their vulnerability to COVD-19 and many other health illnesses (JMIR Aging, 2021).
Because older people are not very skilled at using technology, the nurse teach them on how to use technology so they can contact their families and friends and feel connected to their loved ones. As a result, this reduces feelings of loneliness. On the other hand, elderly people who live alone are at a disadvantage because they have no one to teach them how to use technology to communicate with their loved ones and friends. The disparity between these two groups is vast but as health promoters and educators, nurses can play a vital role in combating widening digital inequalities by raising their awareness of the support available, however, it's also important to recognise that many people still do not want to use the internet and want to continue using non-digital channels (A Centre for Ageing Better, 2021).
The Age 2020 has found that most elderly people have reduced mobility due to the pandemic and suffer from deconditioning, muscle weakness and joint pain. It has also discovered that their daily activities become difficult for them, leading some of the independent individuals to rely on others or machines like walking aid. This has a negative impact on both their mental and physical health, as reduced mobility can cause, joint and muscle pain and obesity, which in turn affects their self-esteem and causes them to feel stressed and depressed. Moreover, Age 2020, has found that reduced mobility affects their diet and appetite, leading to malnutrition, low energy and weight loss. As a result, increases their susceptibility to COVID -19, as poor nutrition can compromise the immune system, which is essential for fighting the virus (Aman. F, Masood. S, 2020). Not only that, but the fact that they are not a priority for the medical community when infected could lead to them not receiving adequate treatment as younger people come before them. Therefore, older adults may downplay the importance of their physical and mental health complaints (Eva-Marie. K, Catherine. B, 2020). This means that there is a greater risk that their symptoms will go undiagnosed during the pandemic. It can also make them feel like a burden to society, unworthy, and unwanted. Together, a thwarted sense of belonging and feeling like a burden are combined risk factors for suicidality.
According to the Health Foundation 2019, there is a shortage of nurses of over 40,000, which is expected to double by 202324 and reach over 100,000 by 202829. This means that existing NHS staff are under significant stress due to the large amount of work they are expected to do in such a short period of time. As a result, this can lead to errors that have a detrimental effect on an individual's health and wellbeing and can even result in death. To back this up, the Kings Fund 2022 has found that labour shortages are the biggest obstacle to efforts to address the growing backlog in care. Despite this, research has shown that the number of medical and nursing students enrolled in 2021 has increased. This is encouraging as it indicates progress towards the manifesto target of 50000 additional nurses in the NHS by 202425. However, there are still issues around retaining newly qualified staff (Kings Fund 2022)
Furthermore, the complexity of treatments and disease management of long-term conditions is also one of the external factors that have a negative impact on the provision of health and social care negatively. This is because it includes comprehensive knowledge about the disease, behaviour modification of the patient, and improvement of the patient's quality of life to prevent or minimise the deterioration of the disease. Nursing for Public Health 2011. this means there are barriers to managing the disease. For example, even if staff have the knowledge to manage the condition, the patient may be poor and therefore find it difficult to change their lifestyle due to their financial situation, or the patient may not change negative behaviours for many reasons, such as substance dependence. Therefore, exacerbate their condition. Additionally, people with long-term conditions also stay in the hospital longer and their treatment is expensive (Nick. G, et al, 2010). As a result, can lead to people not coming to the hospital as they may feel they are a burden or think their condition is not as serious compared to others. It is therefore important that nurses understand the principles of health promotion, health protection, and health improvement so that communication and promotion of health and wellbeing are effective with these people (Sue. W, 2019). However, despite these challenges, it is the nurse's role and responsibility to educate, monitor, and support patients and their families throughout the process. Nursing for Public Health 2011
In conclusion, this essay critically discussed the role of the nurse in health promotion and the impact of the wider determinant of health on the individual's health and well-being. Furthermore, the finding highlights that COVID-19 has exacerbated many inequalities in the population and has changed individual's daily life. Moreover, research papers also demonstrate that the quality of care that's delivered to elderly were poor as it doesn't meet their needs.
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