Major Health Issues Community Health And Social Care Essay

5423 words (22 pages) Essay

1st Jan 1970 Health And Social Care Reference this

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The Klinefelter’s Support Group endeavors to afford the community, doctors and nurses with information about Klinefelter’s syndrome. It offers resource material, information and support about the syndrome to affected persons and families in Western Australia. This paper aims to outline the concept of community in the context of the Klinefelter’s Support Group and its related characteristics. A community is not just a group of people bounded by geographical boundaries; it also includes people brought together by religion, lifestyles, hobby and interests among other common interests, goals and concerns. The Klinefelter Support Group members have been brought together by common interests. The author used the community health assessment tool (Clarke, 1992) to collect necessary information related to the chosen community in terms of health status and the surrounding environment. Information from Government and related heath websites were used to verify the number of people affected by related health problems around Western Australia. The community’s health problems exhibited by the majority of people within the Klinefelter Support Group were prioritized as Klinefelter Syndrome. The community assessment report focuses on the interests, goals and concerns of the members.

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Concept of Community

The community concept has a wide range of definitions. Bartle (2007) argued that the concept does not necessarily denote a physical location; however, it is demarcated by a group of people who share a common interest (par. 6). A community refers to a group of people who share common characteristics like gender, age, race, religion, culture, place, vulnerability and interests (McMurray, 2007, p. 6). A community may be characterized by one or more of the common characteristics. Bartle (2007) argued that the concept of community accrues from having something in common that is a common interest, place and distinction (par. 19). It is full of conflicts, struggles and factions based on differences in religion, access to wealth, class, educational level, language, ownership of capital, gender and many other factors (Bartle, 2007, par. 46). McMurray (2007) also states that “each member of a community influences the other members, sharing knowledge and life skills or simply companionship” (p.6). The definition of community will be the following: a group of people, who share commonalities, who interact with one another and who function as one within a related social structure to address common concerns, as it fits well with the Klinefelter group.

How the Klinefelter’s group acts in accordance with the distinctiveness of chosen concept

In this case, the chosen respondents under study fulfill the chosen concept of community by having the following related characteristics; it has twelve members who have the Klinefelter Syndrome or whose relative has the Klinefelter Syndrome. Ten of the target groups are male, two are females, their ages range from 14 to 75 years. Through talking to every individual these people mentioned out that they were affected by the Klinefelter Syndrome and that is the reason why they decided to join the group of their interest. The members are persons with the condition, parents of a child, family member of person with the condition and medical professionals. Most of them outlined the reasons why they go and meet at the Shetland Drive premises as a socializing agent, creating friendship, getting some education on how to take good care of their health. They do all these under supervision of the medical professionals. This community resides in places called Henry Brook WA. However, they meet at Shetland Drive center on Fridays and Saturdays for about 5 hours daily, they do that as to create friendship, share about any challenges regarding their health issues they face when they are at their individual places and sharing on their likes, play games and engage in some exercises under the supervision of medical professionals.

Relationship between the major health issues of the community under study and the chosen concept of community.

With the assistance of Clark’s assessment tool, the author was able to gather all the information related to the community’s major health problems. Surprisingly all the twelve people who were interviewed through the questionnaire suffered from Klinefelter Syndrome or their relatives had the syndrome. However, they outlined that is the reason why they meet together to interact and share their problems. And with the help of health professionals they get some education and related therapies as the health professionals continue holding health promotion to try and alleviate or reduce the health problems they are experiencing.

Identifying and justifying preference of the tool used for assessment

The researcher used Clarke’s assessment tool (1992). The tool fulfills its requirements as it guide in collecting useful information related specific study questions. Beck, (2006), pointed out that health assessment tools are used as they have been tested and proven as reliable, systematic and broad (p. 20). This tool has specific questions relating to the target group, physical and social environments, consumption patterns, occupation, leisure pursuits and health services.

Methodology

Quantitative and Qualitative methods and data collection

The researcher used Klinefelter articles and pamphlets, which were at Shetland drive to acquire some qualitative information about the aim of that community. However, data that was more detailed was collected from each individual related to their own health status. Clarke’s tool, (1992) was used as an open-ended questionnaire to collect all the subjective information relating to the members. Moreover, the researcher used objective data to add on the data. Quantitative data from Australian Bureau of statistics and Australian government were used to verify the number of people affected by the Klinefelter Syndrome.

Verification of Subjective Data

Subjective data was verified through use the community member’s records kept by the health professionals who supervise them. The records verified all the information as correct. Also responds on above confirmed prevalence of issue, which is associated with persons with the syndrome.

RESULTS -COMMUNITY ASSESSMENT DATA

Human biology

Description of the chosen Community using Epidemiological data; According to Bojesen & Gravholt (2009, p. 624)

Table: 1 Henley Brook Population Profile

Total population of Henley Brook

3953

100%

Population of 65 and over

6

0.52%

In 2009, 0.52 % of the entire population had the Klinefelter Syndrome. The results show that out of every 650 men, one man had the syndrome.

Physical Environment

Klinefelter’s Support Group is located in Henley Brook, Western Australia. It is surrounded by residential buildings and situated at 14 Shetland Drive. All the community members live in different places in Western Australia such as Bunbury, Fremantle, Mandurah, Perth and Geraldton. Psychological Environment

Psychological environment has been defined as the interrelation between the environments and human behavior ((Issel, 2004, p. 77). Through using Clark, 1992 tool, and the author has found that nearly every member of the understudy community stated that, they suffer from Klinefelter Syndrome. Moreover, members of the community mention that, it is the reason why they choose to join Klinefelter’s Support Group. They said that the group provides them with appropriate and comfortable place to relax and socialize as a way of avoiding and reducing stresses they face in their day-to-day lives as they share with people who have been affected by the same condition. It was noted through the clients’ medical records that all of them were under the syndrome medication. The condition was prevalent in people of all ages from young people of 14 years to middle aged people to old people. The male demonstrated breast enlargement, testicular failure and inability to produce sperms. Most of them were depressed when alone and they argued. The syndrome was a basis of much personal anguish, unceasing morbidity and financial costs. According to Frisch & Frisch (2009), in addition to biological determinants, the quality of familial and marital relationships and other social support networks also play important roles in the occurrence and outcome of the syndrome (, p. 4).

Social Environment

There is a lot of support from the counselors. Infertility counseling is accessible for men coming to terms with barrenness and the way it affect them and their partners. Some of the middle-aged men had lost their spouses since they could not make them. They stated that they feel so lonely and socially isolated when they are in their own homes without the spouses. Those with children who had the condition were scared because their children would go through the same fate. They only tend to socialize and learn new things from each other through meeting at their community center. However, they were all educated and had good jobs before they joined Klinefelter’s Support Group. They did not have any other problems but viewed the syndrome as a major problem. The members of the community understudy stated that they depend on their salary, benefits, savings as well as some government benefits from Centre link to support their daily needs.

Consumption

The members of the community stated that they usually try to eat healthy and balanced diet and revealed that they take some medications to boost their hormones. They said that adults and teenager are mostly driven to suicide by the syndrome because they do not know how to cope with the symptoms. Since the group started, none of the community members has committed suicide or given up on life. The community mentioned out that they really like to do some exercises and socialize that are the reasons they belong to Klinefelter’s Group. The group is fully equipped with medical experts to help the community fulfill their goals. None of the community members complained about any after effects from doing exercises.

Occupation

Some of the group members are teenagers and are still in schools. Their parents however work and provide for all their needs and thus considered by the group. The middle aged affected by the disease worked whereas some of the members are already retired. Most of them mentioned that they were involved in volunteer work. (Personal contact 25 April 2011)

Leisure Pursuits

Klinefelter’s Support Group is close to numerous recreational places and apparently, the community members did mention that they occasionally spend their time relaxing and talking with the other members and health professionals. The health professionals verified that, they do visit certain parks to play games, and engage in some simple exercises as to promote individuals wellbeing, form friendships and enhance their self-perception. Moreover, most of the community members regarded telling stories as their constant leisure activity. (Personal contact 25 April 2011).

Health Services

The community has easy access to health care services. The members attend different hospitals in their localities. However, the community does have a group of health professionals as been stated earlier, which include the health professionals such as doctors and nurses to help with day-to-day health issues. The community mentioned that they normally fund their health care although they had been soliciting for funds from the ministry of health. Moreover, the community members stated that they get some prescribed medications at a reduced price. The PBS (Pharmaceutical Benefits Scheme) schedule states that the holders of a pensioner card and senior’s health card are authorized to receive subsided medications at low price (Australian department of health in aging, 2010).

Community perception of health

One of the members of the community stated that, he feels much better since he joined Klinefelter’s Support Group. He mentioned out that, he had been so lonely before with no one to talk to, and share his health problems with before he joined the group (Mr. M. personal contact on 25 April 2011). Moreover, other members of the community stated that, they have improved so much in the level of knowledge about their health conditions and how well to take control. For example, they mentioned out that they now know more about the syndrome that they initially did before they joined the group. They even went on to say that, they have come up with certain strategies to overcome stressful situations and move on. Most of the members in this community showed that they have optimistic minds towards their condition. They told the researcher that they are very keen to understand more about their health problems and the way to manage and deal with syndrome. All the members mentioned that they do enjoy each other’s company, participating in all therapeutic programs such as hand therapies and games, Garden activity. Most of them mentioned that the activities they carried out in the center assist in enhancing memory skills, improving health and assist them in living a stress free life. (Personal contact on 25 April 2011).

Excessively, all the members stated that they feel much better now since they joined the Klinefelter’s Support Group. They rated their health as individually 6/10, 7/10, 9/10, and 8/10.

ANALYSIS OF DATA

According to Community data, one of the strength of the community is easy access to the health services in main areas of the city. The community can access the Primary Health care services easily. The community benefits by getting prevention of certain diseases that comes with the syndrome, early diagnosis and treatment of some of those diseases. Moreover, community benefit from various recreational places as it offers them with a conducive place to meet and relax. Thus, it is also strength as the community benefit from this local government belonging as they can access social network. Every feature above is a benefit to the lives of people living Western Australia and the community under study in one way or the other. Of the twelve community members, three mentioned that they were employees of one of the above-mentioned organizations or features. Thus, it is strength to the community as there is provision of jobs within the City. Moreover, there is community networking and it is strength as the members mentioned that they contact one another in case if one of them is in trouble, or is having coping problems. The members have access to Internet and telephone networks from their homes, which enable them to interact frequently.

Application of Social Determinants of health

This is the interpretation and analysis the above community assessment data to find out how social determinants influences on community’s health. Immigrants’ health needs are very complex and wide-ranging, especially given the diversity in background socioeconomic status, ethnicity, geography and culture. Social determinants of health are the conditions in which people are born, grow, live, work, including the health system (Chapman et. al, 2008, p. 68). The social determinants of health are mostly responsible for health inequities and they include the social gradient, housing, education, work, unemployment, social support, health services, food and transport (Chapman et. al, 2008, p. 160) The researcher is going to explain how social determinants are influencing the community’s health. The community understudy mentioned that some of them are in schools; others are employed while some have already retired and now enjoying their superannuation benefits and some center link benefits. Those employed mentioned that they earn good household income ranging from $2000 to $3000 weekly. They mentioned that they could eat good balanced diet but they were lonely and socially isolated which contributed other health issues such as depression, stress and even suicidal thoughts etc. This shows how social gradient has influence on the communities’ health. The members also stated they own their own accommodation such as houses, thus there is no poverty and there is less spread of communicable diseases within the members. Moreover, education is another social determinant of health found in this community, however, the community holds high educational qualifications, which are represented by the knowledge, and understanding of their own problems and knowing how to overcome them. In addition, the locality has a lot of schools and Universities showing the availability and easy access of education in the community. Many social support networks are available for the community and they really support and recommend Klinefelter’s Support Group, where the members create friendships, socialize and share their problems. Thus, this enables reduction in the levels of life stresses, which causes suicidal thought, depression and stress. Moreover, many health services from hospitals are also available nearby and thus enable the community to get medication and to be attended to and diagnosed early in case of any emergency of health problem. The community is very aware of preventative measures of health for example by making use of particular medications that have to do with the syndrome. Lastly, easy access to transport helps the community to get wherever they need to be on time. For instance, medical centers and it really saves people’s lives and further health complications as the community will be able to reach to related places on time. According to the demography and subjective data, the physical environment of the locality notably their road infrastructures, dwellings, community services and facilities are adequate and modern to support its consumers. These infrastructures and accommodation are very much important to keep their social life fit and healthy. Their high socioeconomic status due to employment, high educational level and diverse backgrounds may influence their consumption patterns. They maintain basic living standards but when they have special health care needs, such as specialist treatment services or elective surgery, which are excluded from Medicare or schedule surgery, which most of them can afford. In addition, social exclusion resulting from the condition could prevent the members from participating in education or training and gaining access to health services and other activities, which could be socially and psychologically damaging and harmful to health (Wilkinson & Marmont, 2003, p. 16). The transport services, Internet facilities and telecommunication are sufficient according to their needs.

Application of primary healthcare principles in the community

Primary health care has been explained as the initial care to the problem (McMurray, 2007, p. 41). The main aim of this care is to provide and improve initial health for the community and the whole society at large (McMurray, 2007, p. 41). Primary health care includes principals such as equity, appropriate technology, accessibility, intersectional collaboration, increased emphasis on health support, public contribution, and empowerment (McMurray, 2007). The researcher is going to apply these health care principles to the community understudy.

Equity

The community understudy does not choose on who should join the group, but it is a program for all the residents of Western Australia who suffer from the Klinefelter’s condition. It does provide many services to its members, such as exercises, dancing, hand therapy, games and health education on how to cope with life. It provides equal distribution of care to all the members regardless of race, age, language and functional capacity (McMurray, 2007, p. 37). The community provides transportation and free medication.

Appropriate technology

The main aim of technology is to improve the health status of the community. The community has an intranet database system in which all the health professionals keep information about the patients. In addition, the community member’s information is all collected and imputed into the community’s computer system. Moreover, all the community members have access to mobile phones and Internet at their homes for communication purposes with their families, community members and their health professionals for any appointments and arrangements. The community has big television and radio to ensure the community is up to date with what is happening in the world and to provide relaxing music to the stressed ones. In addition, the health professionals make use of stethoscopes, and other medical equipment’s need to check members vital signs if required. McMurray (2007, p. 38) mentioned out that although technological advances have helped health status improves over the years. Issues such as abortion, IVF and organ harvesting have raised serious ethical questions (McMurray, 2007, p. 38).

Accessibility

McMurray (2007) stresses the importance of equal access of all people to health services in helping eliminate disadvantage (p. 37). Health opportunities should be available to all despite their ethnic, financial and geographical status. The weakness of this community is that members fund their own hospital expenses and the group does not offer much help because of limited resources, members normally fund the group to keep it going. However, the community center is situated at a central point such that its members will be able to access it easily. The community center caters for the health care professionals who ask for very small salaries in order to assist the community cope well with the syndrome.

Intersectoral Collaboration

This involves the cooperation of different service providers to provide the needs of the community (McMurray, 2007, p. 88). In the community understudy, intersectoral collaboration is established by the availability and cooperation of doctors and nurses from different hospitals and who assist in providing related care to the members. The community has got other staff members DSW (disability worker supporter) who do work in the kitchen to provide meals for the members during their meeting times, clerks, and administration personal. These also work in hand with the all the above-mentioned health professionals to provide the required essential care.

Increased emphasis on health promotion

This refers to the process of allowing people to acquire more control and boost their healthiness (WHO, as cited in McMurray, 2007, p. 39). McMurray, (2007) also states that health promotion empowers people to take charge and boost their own healthiness and is vital for health professionals (p.39). Health professionals fully involve clients in their health care by continuously educating them on their medical conditions and how well to continue taking good care of them self. In the community center, many various pamphlets and articles cover education on the Klinefelter’s condition such as hand washing, immunizations, The health professionals under supervision mentioned out that, they do present on a certain health topic and its management each week.

Public Participation

According to McMurray (2007), public empowerment is the key to public participation (p 44). The community demonstrates good public participation, as the members have been able to recognize that for their health to improve, they are supposed to change their lifestyle patterns and adhere to their day therapies. An example of public participation to this community was, most of members were contributing to some questions asked by the health professionals relating to what actions to take when feeling stressed.

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Empowerment

Empowerment has been described as social action, which includes education of the community to a sense of ownership and how well to take control of their health problems as to ensure better, and improved health (McMurray, 2007, p. 2). Community members are motivated by the education, health promotions, exercises, games they receive from the health professionals to help them develop their health.

Affordability

The community mentioned out that they fund their health care but they have been soliciting for help from health department care, which would make it easier for them to afford and access the health care they need. Nevertheless, on top of that, the members are asked to pay a certain amount of money every month to Klinefelter’s Support Group, which they stated that it was quite sensible and affordable.

Brief Conclusion of the data importance

Excessively, the collected data showed that, the community under study involves twelve people who suffer from the Klinefelter’s condition. However, the data reveals that the syndrome affects people of all ages and thus the community group has students who suffer from the syndrome, their parents, middle-aged men and health care professionals. The data shows that the syndrome and stress that come with it are the most significant health issue in this community. According to the community member’s data, the main aim they joined this community is to enhance socialization, exercises, create friendship, sharing ideas and success education from the related health professionals at the community.

Health/ Social Issues

Health/Nursing Issues

The health assessment of the chosen community indicates most of the members in this community have confidence in their health status although they have the same medical condition. The most significant medical condition is the stress and depression that comes with how the sufferers are treated by their spouses. The typical lifestyles of majority of them are good which is different to the same age groups (65% reported to have any form of exercise) that appear in the National Health Survey (Australian Bureau of Statistics, 2007-08).

Potential problem of failing to take medications in adults and children was related to the fact that some of the members give up on life before they even take medications. Adults and children delaying their medication related to lack of proper psychological treatment, not enough communication and collaboration between different sectors involved in health service delivery, not enough health education for immigrants.

Potential risk of nutritional deficiencies among the community members evidenced by their food and nutrition habits, also prevalence of anemia and Vitamin D deficiency.

High level of stress related to concern about the condition, isolation, personal and community safety and traumatic experiences upon discovering that one has a condition and may not get better.

Social isolation especially for men related to their lack of ability to have children, lifestyle differences and chosen sedentary lifestyle that may affect their psychological and physical health status in the long term.

NURSING PLAN FOR HIGHEST PRIORITY ISSUE According to data analysis and community assessment, the Klinefelter’s condition is chosen as the highest priority health issue for the community understudy. Men suffering from this condition have a high rate of being associated with affective disorder such as depression. The author determined objectives to find out the modifiable risk factors and the appropriate interventions to prevent community from further complications from life stresses and depression.

Nursing Problem:

Depression related to feelings of worthlessness, failure of interaction, lack of positive feedback as manifested by withdrawal from social isolation, expression of feelings of loneliness.

Expected Outcomes

The community member will have desire to live and lists several reasons for wanting to live.

The community initiates social interactions with peers and health professionals: Should verbalize satisfaction with social interactions:” I really enjoyed our conversation.”

Individuals will demonstrate effective copying strategies.

INTERVENTIONS

Liaise the community members with other multidisciplinary teams, support groups, or community based services and programs. For example, if the community needs special social support, liaise with the appropriate social or indigenous community services. The social service will assist the member to learn new coping methods such as psychosocial and problem solving techniques.

Empower the community to have enough knowledge about risky behaviors on being socially isolated with no interactions with other people in the community or families. Assist in offering health education about risk factors by means of pamphlets, through local communication networks or counseling.

Emphasize public participation by way of group involvement for example psychosocial therapies, outings, activities organized by the community board or local governments.

Help the community individual to list their problems from maximum to minimum urgent and assist them to find immediate solutions for most troubling problems, postpone those that can wait, delegate some significant others and knowledge those beyond the individuals control.

Hold some health promotion specifically relating to depression and should include health education with such issues as, self-care to those with self-care deficit and ensure that there is use of visual and audio technologies or even pamphlets.

Rationales

Learning new coping methods from related multidisciplinary team for example social support service can help in problem solving and getting involved in community programs which will help the individuals to manage internal and external stressors successfully (Fortinash & Holoday-Worret, 1991, p. 5)

This will enable the individuals to demonstrate that feeling of empowerment and to have much knowledge about their goals (McMurray, 2007, p. 304)

Group involvement will make the individuals to gain support from others and will learn social skills vicariously and will be able to see that his/her problems and concerns are similar to those of others (Clark, 2009, p. 23)

Listing problems in priority helps to reduce their overwhelming effects and breaks them into more manageable increments (Fortinash & Holoday-Worret, 1991, p. 5)

Health promotions will make it easier for the health professionals in terms of conveying the message to individuals and even they will tend to understand more since there will be use pamphlets, projectors etc. (Clark, 2003, p. 46)

Evaluations

A feedback will be taken from the community on whether their expected outcomes were met and this can be achieved within a survey from the community.

By getting feedback from the community services, programs or multidisciplinary teams whether the community worked with them and remain if they were actually cooperating with them to get expected outcomes or not.

Over qualitative data from the personal interviewing with the patients from the community, evaluate the perception of community towards the whole varieties of therapies provided at the day care Centre.

By assessing the communities depression level through taking mini mental state examination and compare the results from the one’s they had before they joined the day care therapy.

Nursing interventions:

Nursing intervention

Rationale

Encourage the group members to take part in social activities.

Participation in social activities can provide the opportunities to a person to meet new friends. Moreover, people are more likely to share his or her feelings and receive supports from others with similar problems (Hinchliff, Norman & Schober, 1993, p. 53).

Encourage expression of feelings and needs

The Klinefelter’s Support Group endeavors to afford the community, doctors and nurses with information about Klinefelter’s syndrome. It offers resource material, information and support about the syndrome to affected persons and families in Western Australia. This paper aims to outline the concept of community in the context of the Klinefelter’s Support Group and its related characteristics. A community is not just a group of people bounded by geographical boundaries; it also includes people brought together by religion, lifestyles, hobby and interests among other common interests, goals and concerns. The Klinefelter Support Group members have been brought together by common interests. The author used the community health assessment tool (Clarke, 1992) to collect necessary information related to the chosen community in terms of health status and the surrounding environment. Information from Government and related heath websites were used to verify the number of people affected by related health problems around Western Australia. The community’s health problems exhibited by the majority of people within the Klinefelter Support Group were prioritized as Klinefelter Syndrome. The community assessment report focuses on the interests, goals and concerns of the members.

Concept of Community

The community concept has a wide range of definitions. Bartle (2007) argued that the concept does not necessarily denote a physical location; however, it is demarcated by a group of people who share a common interest (par. 6). A community refers to a group of people who share common characteristics like gender, age, race, religion, culture, place, vulnerability and interests (McMurray, 2007, p. 6). A community may be characterized by one or more of the common characteristics. Bartle (2007) argued that the concept of community accrues from having something in common that is a common interest, place and distinction (par. 19). It is full of conflicts, struggles and factions based on differences in religion, access to wealth, class, educational level, language, ownership of capital, gender and many other factors (Bartle, 2007, par. 46). McMurray (2007) also states that “each member of a community influences the other members, sharing knowledge and life skills or simply companionship” (p.6). The definition of community will be the following: a group of people, who share commonalities, who interact with one another and who function as one within a related social structure to address common concerns, as it fits well with the Klinefelter group.

How the Klinefelter’s group acts in accordance with the distinctiveness of chosen concept

In this case, the chosen respondents under study fulfill the chosen concept of community by having the following related characteristics; it has twelve members who have the Klinefelter Syndrome or whose relative has the Klinefelter Syndrome. Ten of the target groups are male, two are females, their ages range from 14 to 75 years. Through talking to every individual these people mentioned out that they were affected by the Klinefelter Syndrome and that is the reason why they decided to join the group of their interest. The members are persons with the condition, parents of a child, family member of person with the condition and medical professionals. Most of them outlined the reasons why they go and meet at the Shetland Drive premises as a socializing agent, creating friendship, getting some education on how to take good care of their health. They do all these under supervision of the medical professionals. This community resides in places called Henry Brook WA. However, they meet at Shetland Drive center on Fridays and Saturdays for about 5 hours daily, they do that as to create friendship, share about any challenges regarding their health issues they face when they are at their individual places and sharing on their likes, play games and engage in some exercises under the supervision of medical professionals.

Relationship between the major health issues of the community under study and the chosen concept of community.

With the assistance of Clark’s assessment tool, the author was able to gather all the information related to the community’s major health problems. Surprisingly all the twelve people who were interviewed through the questionnaire suffered from Klinefelter Syndrome or their relatives had the syndrome. However, they outlined that is the reason why they meet together to interact and share their problems. And with the help of health professionals they get some education and related therapies as the health professionals continue holding health promotion to try and alleviate or reduce the health problems they are experiencing.

Identifying and justifying preference of the tool used for assessment

The researcher used Clarke’s assessment tool (1992). The tool fulfills its requirements as it guide in collecting useful information related specific study questions. Beck, (2006), pointed out that health assessment tools are used as they have been tested and proven as reliable, systematic and broad (p. 20). This tool has specific questions relating to the target group, physical and social environments, consumption patterns, occupation, leisure pursuits and health services.

Methodology

Quantitative and Qualitative methods and data collection

The researcher used Klinefelter articles and pamphlets, which were at Shetland drive to acquire some qualitative information about the aim of that community. However, data that was more detailed was collected from each individual related to their own health status. Clarke’s tool, (1992) was used as an open-ended questionnaire to collect all the subjective information relating to the members. Moreover, the researcher used objective data to add on the data. Quantitative data from Australian Bureau of statistics and Australian government were used to verify the number of people affected by the Klinefelter Syndrome.

Verification of Subjective Data

Subjective data was verified through use the community member’s records kept by the health professionals who supervise them. The records verified all the information as correct. Also responds on above confirmed prevalence of issue, which is associated with persons with the syndrome.

RESULTS -COMMUNITY ASSESSMENT DATA

Human biology

Description of the chosen Community using Epidemiological data; According to Bojesen & Gravholt (2009, p. 624)

Table: 1 Henley Brook Population Profile

Total population of Henley Brook

3953

100%

Population of 65 and over

6

0.52%

In 2009, 0.52 % of the entire population had the Klinefelter Syndrome. The results show that out of every 650 men, one man had the syndrome.

Physical Environment

Klinefelter’s Support Group is located in Henley Brook, Western Australia. It is surrounded by residential buildings and situated at 14 Shetland Drive. All the community members live in different places in Western Australia such as Bunbury, Fremantle, Mandurah, Perth and Geraldton. Psychological Environment

Psychological environment has been defined as the interrelation between the environments and human behavior ((Issel, 2004, p. 77). Through using Clark, 1992 tool, and the author has found that nearly every member of the understudy community stated that, they suffer from Klinefelter Syndrome. Moreover, members of the community mention that, it is the reason why they choose to join Klinefelter’s Support Group. They said that the group provides them with appropriate and comfortable place to relax and socialize as a way of avoiding and reducing stresses they face in their day-to-day lives as they share with people who have been affected by the same condition. It was noted through the clients’ medical records that all of them were under the syndrome medication. The condition was prevalent in people of all ages from young people of 14 years to middle aged people to old people. The male demonstrated breast enlargement, testicular failure and inability to produce sperms. Most of them were depressed when alone and they argued. The syndrome was a basis of much personal anguish, unceasing morbidity and financial costs. According to Frisch & Frisch (2009), in addition to biological determinants, the quality of familial and marital relationships and other social support networks also play important roles in the occurrence and outcome of the syndrome (, p. 4).

Social Environment

There is a lot of support from the counselors. Infertility counseling is accessible for men coming to terms with barrenness and the way it affect them and their partners. Some of the middle-aged men had lost their spouses since they could not make them. They stated that they feel so lonely and socially isolated when they are in their own homes without the spouses. Those with children who had the condition were scared because their children would go through the same fate. They only tend to socialize and learn new things from each other through meeting at their community center. However, they were all educated and had good jobs before they joined Klinefelter’s Support Group. They did not have any other problems but viewed the syndrome as a major problem. The members of the community understudy stated that they depend on their salary, benefits, savings as well as some government benefits from Centre link to support their daily needs.

Consumption

The members of the community stated that they usually try to eat healthy and balanced diet and revealed that they take some medications to boost their hormones. They said that adults and teenager are mostly driven to suicide by the syndrome because they do not know how to cope with the symptoms. Since the group started, none of the community members has committed suicide or given up on life. The community mentioned out that they really like to do some exercises and socialize that are the reasons they belong to Klinefelter’s Group. The group is fully equipped with medical experts to help the community fulfill their goals. None of the community members complained about any after effects from doing exercises.

Occupation

Some of the group members are teenagers and are still in schools. Their parents however work and provide for all their needs and thus considered by the group. The middle aged affected by the disease worked whereas some of the members are already retired. Most of them mentioned that they were involved in volunteer work. (Personal contact 25 April 2011)

Leisure Pursuits

Klinefelter’s Support Group is close to numerous recreational places and apparently, the community members did mention that they occasionally spend their time relaxing and talking with the other members and health professionals. The health professionals verified that, they do visit certain parks to play games, and engage in some simple exercises as to promote individuals wellbeing, form friendships and enhance their self-perception. Moreover, most of the community members regarded telling stories as their constant leisure activity. (Personal contact 25 April 2011).

Health Services

The community has easy access to health care services. The members attend different hospitals in their localities. However, the community does have a group of health professionals as been stated earlier, which include the health professionals such as doctors and nurses to help with day-to-day health issues. The community mentioned that they normally fund their health care although they had been soliciting for funds from the ministry of health. Moreover, the community members stated that they get some prescribed medications at a reduced price. The PBS (Pharmaceutical Benefits Scheme) schedule states that the holders of a pensioner card and senior’s health card are authorized to receive subsided medications at low price (Australian department of health in aging, 2010).

Community perception of health

One of the members of the community stated that, he feels much better since he joined Klinefelter’s Support Group. He mentioned out that, he had been so lonely before with no one to talk to, and share his health problems with before he joined the group (Mr. M. personal contact on 25 April 2011). Moreover, other members of the community stated that, they have improved so much in the level of knowledge about their health conditions and how well to take control. For example, they mentioned out that they now know more about the syndrome that they initially did before they joined the group. They even went on to say that, they have come up with certain strategies to overcome stressful situations and move on. Most of the members in this community showed that they have optimistic minds towards their condition. They told the researcher that they are very keen to understand more about their health problems and the way to manage and deal with syndrome. All the members mentioned that they do enjoy each other’s company, participating in all therapeutic programs such as hand therapies and games, Garden activity. Most of them mentioned that the activities they carried out in the center assist in enhancing memory skills, improving health and assist them in living a stress free life. (Personal contact on 25 April 2011).

Excessively, all the members stated that they feel much better now since they joined the Klinefelter’s Support Group. They rated their health as individually 6/10, 7/10, 9/10, and 8/10.

ANALYSIS OF DATA

According to Community data, one of the strength of the community is easy access to the health services in main areas of the city. The community can access the Primary Health care services easily. The community benefits by getting prevention of certain diseases that comes with the syndrome, early diagnosis and treatment of some of those diseases. Moreover, community benefit from various recreational places as it offers them with a conducive place to meet and relax. Thus, it is also strength as the community benefit from this local government belonging as they can access social network. Every feature above is a benefit to the lives of people living Western Australia and the community under study in one way or the other. Of the twelve community members, three mentioned that they were employees of one of the above-mentioned organizations or features. Thus, it is strength to the community as there is provision of jobs within the City. Moreover, there is community networking and it is strength as the members mentioned that they contact one another in case if one of them is in trouble, or is having coping problems. The members have access to Internet and telephone networks from their homes, which enable them to interact frequently.

Application of Social Determinants of health

This is the interpretation and analysis the above community assessment data to find out how social determinants influences on community’s health. Immigrants’ health needs are very complex and wide-ranging, especially given the diversity in background socioeconomic status, ethnicity, geography and culture. Social determinants of health are the conditions in which people are born, grow, live, work, including the health system (Chapman et. al, 2008, p. 68). The social determinants of health are mostly responsible for health inequities and they include the social gradient, housing, education, work, unemployment, social support, health services, food and transport (Chapman et. al, 2008, p. 160) The researcher is going to explain how social determinants are influencing the community’s health. The community understudy mentioned that some of them are in schools; others are employed while some have already retired and now enjoying their superannuation benefits and some center link benefits. Those employed mentioned that they earn good household income ranging from $2000 to $3000 weekly. They mentioned that they could eat good balanced diet but they were lonely and socially isolated which contributed other health issues such as depression, stress and even suicidal thoughts etc. This shows how social gradient has influence on the communities’ health. The members also stated they own their own accommodation such as houses, thus there is no poverty and there is less spread of communicable diseases within the members. Moreover, education is another social determinant of health found in this community, however, the community holds high educational qualifications, which are represented by the knowledge, and understanding of their own problems and knowing how to overcome them. In addition, the locality has a lot of schools and Universities showing the availability and easy access of education in the community. Many social support networks are available for the community and they really support and recommend Klinefelter’s Support Group, where the members create friendships, socialize and share their problems. Thus, this enables reduction in the levels of life stresses, which causes suicidal thought, depression and stress. Moreover, many health services from hospitals are also available nearby and thus enable the community to get medication and to be attended to and diagnosed early in case of any emergency of health problem. The community is very aware of preventative measures of health for example by making use of particular medications that have to do with the syndrome. Lastly, easy access to transport helps the community to get wherever they need to be on time. For instance, medical centers and it really saves people’s lives and further health complications as the community will be able to reach to related places on time. According to the demography and subjective data, the physical environment of the locality notably their road infrastructures, dwellings, community services and facilities are adequate and modern to support its consumers. These infrastructures and accommodation are very much important to keep their social life fit and healthy. Their high socioeconomic status due to employment, high educational level and diverse backgrounds may influence their consumption patterns. They maintain basic living standards but when they have special health care needs, such as specialist treatment services or elective surgery, which are excluded from Medicare or schedule surgery, which most of them can afford. In addition, social exclusion resulting from the condition could prevent the members from participating in education or training and gaining access to health services and other activities, which could be socially and psychologically damaging and harmful to health (Wilkinson & Marmont, 2003, p. 16). The transport services, Internet facilities and telecommunication are sufficient according to their needs.

Application of primary healthcare principles in the community

Primary health care has been explained as the initial care to the problem (McMurray, 2007, p. 41). The main aim of this care is to provide and improve initial health for the community and the whole society at large (McMurray, 2007, p. 41). Primary health care includes principals such as equity, appropriate technology, accessibility, intersectional collaboration, increased emphasis on health support, public contribution, and empowerment (McMurray, 2007). The researcher is going to apply these health care principles to the community understudy.

Equity

The community understudy does not choose on who should join the group, but it is a program for all the residents of Western Australia who suffer from the Klinefelter’s condition. It does provide many services to its members, such as exercises, dancing, hand therapy, games and health education on how to cope with life. It provides equal distribution of care to all the members regardless of race, age, language and functional capacity (McMurray, 2007, p. 37). The community provides transportation and free medication.

Appropriate technology

The main aim of technology is to improve the health status of the community. The community has an intranet database system in which all the health professionals keep information about the patients. In addition, the community member’s information is all collected and imputed into the community’s computer system. Moreover, all the community members have access to mobile phones and Internet at their homes for communication purposes with their families, community members and their health professionals for any appointments and arrangements. The community has big television and radio to ensure the community is up to date with what is happening in the world and to provide relaxing music to the stressed ones. In addition, the health professionals make use of stethoscopes, and other medical equipment’s need to check members vital signs if required. McMurray (2007, p. 38) mentioned out that although technological advances have helped health status improves over the years. Issues such as abortion, IVF and organ harvesting have raised serious ethical questions (McMurray, 2007, p. 38).

Accessibility

McMurray (2007) stresses the importance of equal access of all people to health services in helping eliminate disadvantage (p. 37). Health opportunities should be available to all despite their ethnic, financial and geographical status. The weakness of this community is that members fund their own hospital expenses and the group does not offer much help because of limited resources, members normally fund the group to keep it going. However, the community center is situated at a central point such that its members will be able to access it easily. The community center caters for the health care professionals who ask for very small salaries in order to assist the community cope well with the syndrome.

Intersectoral Collaboration

This involves the cooperation of different service providers to provide the needs of the community (McMurray, 2007, p. 88). In the community understudy, intersectoral collaboration is established by the availability and cooperation of doctors and nurses from different hospitals and who assist in providing related care to the members. The community has got other staff members DSW (disability worker supporter) who do work in the kitchen to provide meals for the members during their meeting times, clerks, and administration personal. These also work in hand with the all the above-mentioned health professionals to provide the required essential care.

Increased emphasis on health promotion

This refers to the process of allowing people to acquire more control and boost their healthiness (WHO, as cited in McMurray, 2007, p. 39). McMurray, (2007) also states that health promotion empowers people to take charge and boost their own healthiness and is vital for health professionals (p.39). Health professionals fully involve clients in their health care by continuously educating them on their medical conditions and how well to continue taking good care of them self. In the community center, many various pamphlets and articles cover education on the Klinefelter’s condition such as hand washing, immunizations, The health professionals under supervision mentioned out that, they do present on a certain health topic and its management each week.

Public Participation

According to McMurray (2007), public empowerment is the key to public participation (p 44). The community demonstrates good public participation, as the members have been able to recognize that for their health to improve, they are supposed to change their lifestyle patterns and adhere to their day therapies. An example of public participation to this community was, most of members were contributing to some questions asked by the health professionals relating to what actions to take when feeling stressed.

Empowerment

Empowerment has been described as social action, which includes education of the community to a sense of ownership and how well to take control of their health problems as to ensure better, and improved health (McMurray, 2007, p. 2). Community members are motivated by the education, health promotions, exercises, games they receive from the health professionals to help them develop their health.

Affordability

The community mentioned out that they fund their health care but they have been soliciting for help from health department care, which would make it easier for them to afford and access the health care they need. Nevertheless, on top of that, the members are asked to pay a certain amount of money every month to Klinefelter’s Support Group, which they stated that it was quite sensible and affordable.

Brief Conclusion of the data importance

Excessively, the collected data showed that, the community under study involves twelve people who suffer from the Klinefelter’s condition. However, the data reveals that the syndrome affects people of all ages and thus the community group has students who suffer from the syndrome, their parents, middle-aged men and health care professionals. The data shows that the syndrome and stress that come with it are the most significant health issue in this community. According to the community member’s data, the main aim they joined this community is to enhance socialization, exercises, create friendship, sharing ideas and success education from the related health professionals at the community.

Health/ Social Issues

Health/Nursing Issues

The health assessment of the chosen community indicates most of the members in this community have confidence in their health status although they have the same medical condition. The most significant medical condition is the stress and depression that comes with how the sufferers are treated by their spouses. The typical lifestyles of majority of them are good which is different to the same age groups (65% reported to have any form of exercise) that appear in the National Health Survey (Australian Bureau of Statistics, 2007-08).

Potential problem of failing to take medications in adults and children was related to the fact that some of the members give up on life before they even take medications. Adults and children delaying their medication related to lack of proper psychological treatment, not enough communication and collaboration between different sectors involved in health service delivery, not enough health education for immigrants.

Potential risk of nutritional deficiencies among the community members evidenced by their food and nutrition habits, also prevalence of anemia and Vitamin D deficiency.

High level of stress related to concern about the condition, isolation, personal and community safety and traumatic experiences upon discovering that one has a condition and may not get better.

Social isolation especially for men related to their lack of ability to have children, lifestyle differences and chosen sedentary lifestyle that may affect their psychological and physical health status in the long term.

NURSING PLAN FOR HIGHEST PRIORITY ISSUE According to data analysis and community assessment, the Klinefelter’s condition is chosen as the highest priority health issue for the community understudy. Men suffering from this condition have a high rate of being associated with affective disorder such as depression. The author determined objectives to find out the modifiable risk factors and the appropriate interventions to prevent community from further complications from life stresses and depression.

Nursing Problem:

Depression related to feelings of worthlessness, failure of interaction, lack of positive feedback as manifested by withdrawal from social isolation, expression of feelings of loneliness.

Expected Outcomes

The community member will have desire to live and lists several reasons for wanting to live.

The community initiates social interactions with peers and health professionals: Should verbalize satisfaction with social interactions:” I really enjoyed our conversation.”

Individuals will demonstrate effective copying strategies.

INTERVENTIONS

Liaise the community members with other multidisciplinary teams, support groups, or community based services and programs. For example, if the community needs special social support, liaise with the appropriate social or indigenous community services. The social service will assist the member to learn new coping methods such as psychosocial and problem solving techniques.

Empower the community to have enough knowledge about risky behaviors on being socially isolated with no interactions with other people in the community or families. Assist in offering health education about risk factors by means of pamphlets, through local communication networks or counseling.

Emphasize public participation by way of group involvement for example psychosocial therapies, outings, activities organized by the community board or local governments.

Help the community individual to list their problems from maximum to minimum urgent and assist them to find immediate solutions for most troubling problems, postpone those that can wait, delegate some significant others and knowledge those beyond the individuals control.

Hold some health promotion specifically relating to depression and should include health education with such issues as, self-care to those with self-care deficit and ensure that there is use of visual and audio technologies or even pamphlets.

Rationales

Learning new coping methods from related multidisciplinary team for example social support service can help in problem solving and getting involved in community programs which will help the individuals to manage internal and external stressors successfully (Fortinash & Holoday-Worret, 1991, p. 5)

This will enable the individuals to demonstrate that feeling of empowerment and to have much knowledge about their goals (McMurray, 2007, p. 304)

Group involvement will make the individuals to gain support from others and will learn social skills vicariously and will be able to see that his/her problems and concerns are similar to those of others (Clark, 2009, p. 23)

Listing problems in priority helps to reduce their overwhelming effects and breaks them into more manageable increments (Fortinash & Holoday-Worret, 1991, p. 5)

Health promotions will make it easier for the health professionals in terms of conveying the message to individuals and even they will tend to understand more since there will be use pamphlets, projectors etc. (Clark, 2003, p. 46)

Evaluations

A feedback will be taken from the community on whether their expected outcomes were met and this can be achieved within a survey from the community.

By getting feedback from the community services, programs or multidisciplinary teams whether the community worked with them and remain if they were actually cooperating with them to get expected outcomes or not.

Over qualitative data from the personal interviewing with the patients from the community, evaluate the perception of community towards the whole varieties of therapies provided at the day care Centre.

By assessing the communities depression level through taking mini mental state examination and compare the results from the one’s they had before they joined the day care therapy.

Nursing interventions:

Nursing intervention

Rationale

Encourage the group members to take part in social activities.

Participation in social activities can provide the opportunities to a person to meet new friends. Moreover, people are more likely to share his or her feelings and receive supports from others with similar problems (Hinchliff, Norman & Schober, 1993, p. 53).

Encourage expression of feelings and needs

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