NUR134 Primary Healthcare : Social Determinants of Health

NUR134 Primary Healthcare : Social Determinants of Health

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NUR134 Primary Healthcare

Question

Case Study

Mina arrived in Australia when she was 6 years old. Her family originated from South Sudan, which they fled due to ongoing conflict. Her parents and older brothers had joined other refugees on a long walk to Kenya. Many people died along the way due to illness and attacks, food and water were scarce. The family had to rely on rations provided by the United Nations. Eventually the family were settled in the Kakuma refugee camp, where Mina was born.

When Mina arrived in Australia no one in her family could speak English, and although over time everyone learnt to speak English, it was not the language used at home. When Mina started at school, she understood very few words that were spoken to her. She was very shy, especially as when she did try to participate in games and activities, she often did not follow instructions properly and some of the other children made fun of her, calling her “stupid”, and sometimes more hurtful names. There were a few other Sudanese families in the neighbourhood, but none of the children in those families were similar ages to Mina, and she felt very alone.

Mina’s father Jacob worked driving taxis, often working long hours to make sure the family could pay the rent and keep food on the table. When Mina did see her father, he was often tired, however he would try to spend his free time with her and her siblings. Her second oldest brother Martin was a great athlete and played football for the local team. One of Mina’s favourite memories was of the whole family going together to watch Martin play and cheer him on. Even Mina’s mother, Sara, would join in the outing. Sara didn’t leave the house very often, and never alone. Mina knew something bad had happened to her mother in the refugee camp, but it was never spoken about. Sara didn’t like Mina to leave the house either, except for school and occasionally when one of her brothers or her father would accompany her somewhere. Some of the girls at Mina’s school spoke about having dance classes and clubs that they were in, but Sara was worried about Mina attending these types of groups, and money was tight, so she never got to go.

Mina struggled at school and was placed in remedial classes at primary school to help her reach an acceptable academic level. When she got to secondary school, she met Roxy who became her closest friend. Roxy introduced Mina to a whole new world of music, fashion and crushes on T.V stars. Roxy laughed at everything and everyone and didn’t seem to care about not being good at school or getting into trouble from the teachers. Mina and Roxy would skip classes from time to time to go hang out at Roxy’s place to watch Netflix or dance. When Mina invited Roxy over to her house, Roxy would say that she wouldn’t be allowed to go because her parents would think that Mina’s brothers were in a gang, because Sudanese gangs were always being talked about on the news. However, they would be Ok with Mina coming over to visit her, whenever she wanted. Over time Sara and Jacob noticed that Mina seemed happier and more confident since having Roxy as her friend and allowed Mina to visit after school and sometimes on the weekend. Eventually this extended to overnight stays as well.

Through Roxy, Mina expanded her group of friends, especially once they started going to parties when Mina was having an overnight stay at Roxy’s place. Roxy taught Mina how to smoke, saying that if you smoked you could always find people to hang out with. This was particularly useful advice once Roxy got a boyfriend who she would often disappear with when they were at parties, leaving Mina alone for hours at a time. Mina’s new friends understood that it was difficult for her to get alcohol and cigarettes, and generously shared what they had with her. Mina was grateful for this but began to resent her family being different from everyone else’s. When they were 16 Roxy began to worry that they were putting on too much weight and thought it would be good to switch their party alcohol with ice instead. She warned Mina that she would have to get a job or find some other way to pay for her own supply, as everyone couldn’t keep helping her out.

Sara and Jacob became worried about Mina, when they noticed she was losing weight, was sometimes happy and cooperative and at other times angry and aggressive at home. She appeared to be getting into trouble at school more and they were contacted several times about her missing classes or being disruptive in class. They tried talking to with her, giving her extra responsibilities at home and grounding her. Often Mina would simply leave the house angry or even climb out window when they tried to keep her in her room as punishment. In desperation they went to discuss their concerns with the Minister at their church, who suggested that Mina might need professional counselling. He assisted Sara and Jacob with contacting Headspace, the local youth mental health service which offered free counselling. They were told that they would be happy to see Mina for an appointment in 6 -8 weeks, however Mina had to make the appointment for herself, her parents couldn’t make it for her.

When Sara and Jacob tried to talk with Mina about seeing a counsellor at Headspace, she became very angry with them, saying it wasn’t her that needed counselling, but them. Not knowing how to manage the situation Mina’s parents decided not to push the issue any further at the time. Two weeks later Mina had an argument with Roxy ending their friendship. Mina’s brother Martin found her with self-inflicted deep cuts to wrists in the family bathroom later that night. An ambulance was called, and Mina was hospitalised for several days. She was assessed and later diagnosed as having bi-polar disorder. Mina was prescribed medications that her parents are struggling to pay for. After the initial regular visits with psychiatric services, Mina is now managed by her GP, as she will provide these at the Medicare rebate rate, and Mina can access 10 free psychologist visits for year organised by the GP with the potential for a 6-month extension. Sara and Jacob are unable to afford accessing any sessions privately.

When planning your assignment, it is useful to deconstruct the assessment question and marking rubric to see what the examiner is looking for you to include in your response.

In this assessment task you are required to write an essay which has three components that need to be addressed. These components are easier to identify when you separate out the assessment instructions.

Analyse the question

Let’s review the what the assignment question and marking rubric are informing you about what is required for this task.

1. Analysethe client scenario provided. Examine relevant social determinants of health and their influence on the client.

This instruction informs you that by identifying and explaining the social determinants that are influencing the health of the people in the case study, you are analysing the situation. Note that if you are discussing a theoretical concept, such as the social determinants of health, you will first need to explain or define this concept.

2. Considerpotential enablers or barriers to health equity.

This instruction requires you to explain the concept of health equity, before you can discuss what might aid or inhibit the achievement of this for the characters in this case study.

3. Applyappropriate health promotion strategies to develop a plan of action using three of the five strategies presented in the Ottawa Charter to mitigate the influence of one of the social determinants identified.

This instruction identifies several concepts that need to be explained in your answer. First, explain what the Ottawa Charter is. Second, identify and explain the five strategies outlined in the Ottawa Charter. You then need to select one of the social determinants that you have previously identified as influencing the health of a character in the case study. Discuss how you could use three of the strategies identified to minimise or overcome the negative influence of the social determinant or the barriers related to this social determinant that prevents health equity.

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