w15003082 NS0500 Francesca Grainger

Introduction
Firstly, before I start this presentation, I would like to point out that I will be abiding by the standards of the Nursing and Midwifery Council (NMC) to protect the service
users identity and for the protection of confidential information. To quote the NMC; as a nurse or midwife you owe a duty of confidentiality to all those who are receiving
care. This includes making sure that they are informed about their care and that information about them is share appropriately. (NMC, 2015). For the purposes of this
assignment, I will be using the pseudonym John Smith to describe my client and I have changed the details regarding the client who I am basing my assignment upon,
additionally like my fellow peers on this public health module I will be using the area of Byker Newcastle to inform my community profile.
Alcohol & Substance
What do we mean by public health?
John Smith is a single and unemployed fifty-five years Black Report Misuse Statistics
old man who is currently suffering from paranoid "The Report concluded that these inequalities 9 million adults drink at
Donald Acheson, who serves as the UKs
schizophrenia and drug-induced psychosis. John were not mainly attributable to failings in the levels the risk of harm
chief medical officer from 1983 to 1991 and
identifies himself as bisexual. He has a problem with NHS, but rather to many other social inequalities to health
epidemiologist defined public health as:
dabbling in amphetamines and alcohol, and is suffering influencing health: income, education, housing, 1.6 million adults show
"The science and art of preventing disease,
from aspirated pneumonia which was thought to be due diet, employment, and conditions of work." (Black signs of dependence
prolonging life and promoting health
to his environment and how his lungs have naturally Report, 1980) Alcohol is the third
through the organised efforts of society."
weakened from the alcohol and substance misuse. My biggest risk factor for
(Acheson, 1988).
rationale for using a case like John is that in the field of Today, these health inequalities are still prevalent illness and death.
mental health services, is becoming more common, in our society and there has been a great deal of 2.7 million adults have
Immediately this suggest the goals of public
working age older males have become a high risk group criticism on our political landscape regarding tried a drug in the last
health are to focus on benefitting society
at risk of suicide especially those who are socio- public health. (Wollaston, 2016) which is year
and to install a sense of social justice,
economically disadvantaged. (Samaritans, 2016) interesting considering the report was wrote in 1.2 million families have
health organisations advocate this such as
the World Health Organisation (WHO), the 1980 and we are now in 2017, 37 years on. been affected by drug
In the first stage of care-planning we would look into However there has been amazing work done in
Institute of Medicine and the NHS Kings usage and in poorer
Johns physical health checks, when John was referred public health and there are new policies, community. (Public
Fund.
onto my placement from a physical health hospital; he safeguards and community work done. Health England, 2012)
was allocated two key members of nursing staff and the (Department of Health,
"Public health is the combination of
nursing staff were given a medical handover off the The Ottawa Charter In the area of Byker
sciences, skills, and beliefs that is directed
specific medical staff in his care. ADVOCACY. ENABLING. MEDIATION. Newcastle -
towards the maintenance and improvement
In my capacity as a student nurse I was involved in: The Ottawa Charter is an agreement that was Reported Smoking:
of the health of all people through collective
(More physical health checks next slide) held in 1986, so that governments could come
or social actions. (Milbank Memorial 29.7%
Fund, 1976)
At this main point, you have to establish his baseline together and achieve Health for All. It was Drinking at high risk:
NEWs score, which involves taking his respirations, designed to empower, advocate and enable. 44..4%
blood pressure, pulse, temperature and oxygen The fundamental conditions and resources for ( Residents Survey,
Public health aims to provide maximum
saturation. Johns baseline was three and four. health are: peace, shelter, education, food,
benefit for the largest number of people. Wellbeing For Life,
We would enquire about his smoking, alcohol and drug income, a stable eco-system, sustainable 2012 )
World Health Organisation (WHO)
usage. Use the nutritional screening tool and work out resources, social justice, and equity. (WHO,
Johns BMI, he was underweight. 1986)

Physical Health Checks that a nurse will be involved with:
Figure 1 Ottawa Charter
The Value and Contribution of
Figure 2 The Determinants of Health
Nursing to Public Health in the UK:
Final Report (RCN, 2016) suggests
that nurses are ideally placed to
contribute significantly to the public
health agenda because nurses
commonly have extensive
knowledge of their patients, their
patients needs, and their
communities, and can deliver
health messages to their patients
in a holistic, patient-centred way.
This reflects the nursing
relationship with John.
Substance breakdown of all clients in treatment 2014-15 ( Public Health
England, 2014)
w15003082 NS0500
Francesca Grainger
Public Health & Nursing Challenges
The nurse will offer to weigh you and measure your waist. This is a preventative measure to recognise if you are at risk of developing
diabetes, heart attack or stroke.
Nurses can also assess and detect heart abnormalities by using an electrocardiogram machine. This is very important for John and menta
health services as Johns anti-psychotic medication requires this.
Nurses additionally give you the option of receiving a influenza vaccine or in lay terms a flu jab, this helps to act as a preventative to catch
the illness. This is helpful for John because since he is over the age of fifty and research has shown that people over the age of 50 who go
a flu vaccine reduced their risk of being hospitalised from from influenza by 57%. (Centers for Disease Control and Prevention, 2016)
Nurses would also take a blood check whether your cholesterol and sugar are not too high as raised cholesterol can increase the chances
of a heart attack or stroke, high blood sugar also indicates whether or not you have diabetes.
Nurses also undertake holistic assessments and discuss additional physical health problems such as smoking, alcohol and drugs, exercise
and diet. The Nurse would also ask how you keep yourself well. This is all important information for John as it improves his physical health
and particularly for his medication regime, to achieve good physical health we have to look into all his holistic needs as these factors can
affect his anti-psychotic medication.
Figure 2 shows the social determinants of health, these are responsible for health
inequalities.
To reduce health inequalities and health status of people, we need to identify the
main factors which affect health (Dahlgren and Whitehead)
in Roberts case, with his physical health history he is at higher risk of problems
such as heart disease and strokes. In general setting, people suffering from mental
health illnesses are more likely to suffer from diabetes, obesity and various cancers.
Dahlgrens & Whitehead research has been reflected in mental health studies
because lifestyle choices, side effects of medication and genetic factors are the key
determinants for Mental Health Disorders. (Royal College of Psychiatrists
To benefit the largest amount of people in public health, we would use health
screenings. For John, since his age is 55 I would firstly recommend him
thinking about getting the Bowel Scope Screening, uses a thin flexible tube
with a tiny camera. Since John identifies as a bisexual man, you would also
recommend that he goes to a sexual health clinic and consider referring him
to a sexual health nurse. In Mental Health, his antipsychotic medication could
also affect his erectile function, so it is important that there is that discussion
to inform John of the risks.
w15003082 NS0500 Francesca Grainger Comparison Area Y Newcastle
Community Profile
Hospital stays for alcohol related harm 218.80% 154.90%
In this part of my presentation we are going to examine John grew up in a Deaths from respiratory diseases, all ages (rate) 184.70% 115%
epidemiology and demographic data in relation to Johns area so single-parent Deaths from circulatory disease (under 75 years) 164.40% 124.50%
we can look at the health inequalities that John will be facing. I household, his
Deaths from cancer, (under 75 years rate) 158.60% 127.00%
am using the area of Byker Newcastle, which will now be known Mother is still alive
as Area Y. however she is Long-term health problem or disability that limits day-to-day
activity 25.01% 18.80%
Firstly, I am going to talk to you about the related terminology. nearing 90 and his
Well start with epidemiology, the World Health Organisation Figure 3 Charts on Area Y statistics from
sister has moved Comparison
defines epidemiology is the study of the distribution and away which means Consensus 2011 and Health Profiles.
250.00%
determinants of health-related states or events (including he doesnt have
200.00%
disease), and the application of this study to the control of links.
diseases and other health problems.
Area Y has a total population of 150.00%
Hence, this means that epidemiology enables us to determine 100.00%
12,206 and 5,835 households in the
where diseases originate, how and the why they can move
ward. 6,589 are working age adults50.00%
through populations, and research into how we prevent them.
like John. The amount of people
Demography is the study of the structure and trends of the 0.00%
employed in Byker is near double the
population, incorporating births and deaths, employment and Hospital stays for Deaths from Deaths from Deaths from Long-term healt
national average. alcohol related respiratory circulatory cancer, (under 75 problem or
health (Tiran 2003). This is essential when we are looking at harm diseases, all ages disease (under 75 yrs rate) disability that
Area Y: 8.6%
health determinants as it helps us to identify negative trends in (rate) yrs) limits day-to-da
Newcastle: 5.0%
health. activity
National: 4.4%
A community profile can be defined as a comprehensive Area Y Newcastle
description which sets out the needs of a population which Byker has mental health wellbeing services, mental health matters were
Lone parent households with
looks at itself as a community. (Hawtin & Percy Smith, 2007 ) awarded funding to run community wellbeing programmes. Idealistically,
dependent children:
The role and contribution of mental health services in Byker are these would be suitable for John when he physically recovers.
717 households
vital within the community, through a holistic and patient-centred Northumberland, Tyne and Wear Services are the main trust to look after
Area Y: 12.3%
approach. It is very important that mental health nurses had a the mental health services. Area Y has transport services and is near
Newcastle: 7.6%
good understanding of social, cultural and context differences so Eldon Square shopping centres.
National: 7.1%
that they can respond to the mental health needs, physical
needs and understanding a person holistically in a variety of From the residents survey 2012, 31% of Area Y do use libraries and
61.7% looking for work in Area Y.
care settings This is attained by an integrated mental health 10% use museums and/or galleries. However, in reality the figure will be
(Census, 2011)
service being part of an expert multidisciplinary team in Johns way lower as the resident survey uses a sample.
case he needs the support of his CPN, his social worker and the
Children under the age of 16 living
ward staff which puts him on the road to recovery (Fraser &
in poverty: In Byker Ward life expectancy for working age males is 71.8 years (Wellbeing For Life,
Cooper 2009, p. 7).
Area Y: 54.1% 2012). Premature death: people with schizophrenia and bipolar disorder die on average
Newcastle: 29.9% 20 years earlier than the general population, largely owing to physical health problems.
National: 21.1% (Royal College of Psychiatrists, 2010)
In this part of my presentation I am going to discuss the relevance of health promotion models and how they can apply to tackle Johns
alcohol misuse.
There are many different models of health promotion but the most
commonly used is Beattie (1991). Beattie sets out 4 main strategies Alcohol is an increasing problem throughout the
for health promotion:
Health Persuasion
Health Persuasion will involve interventions that are directed at
individuals and led by in the mental health setting a Community
Psychiatric Nurse (CPN), Support Worker or another a healthcare social, environmental and economic determinants will
professional. This is the technique I would ultimately work on first
with John.
Personal Counselling
Interventions that are client led and encourage individuals to make alcohol and improving the alcohol intake of middle-
their own choices. (Beattie, 1991). Personal counselling in this
instance would help John to gain confidence, increase his internal
control (Ogden, 2004) surrounding alcohol and ultimately empower
him.
Community Development
Interventions that take place within a defined community to identify
local health issues and working with local people to take action on
those concerns. As Johns nurse, I advocate for him to make the
most of support groups and weekly meetings. (Warwick-Booth,
2012)
Legislative Action
Interventions that are led by professionals or experts but are
intended to protect the health of the community they serve. This
includes the number of units
United Kingdom. You can apply the Beattie Model in
this particular instance when creating a public health
policy. Warwick-Booth et al demonstrate that when
models are applied likely that a greater range of
be addressed.
Here I am going to attempt it in a public health
promotion which tackles the issue surrounding
aged men in deprived areas such as Area Y.
Transtheoretical Model to framework behaviour
change towards alcohol and amphetamines. In
the first and second stages of the
transtheroetical model by following health
promotion methods which comes from the
Jakarta Conference by The World Health
Organisation: Health Communication the use
of therapeutic communication techniques and
technologies to which positively influence the
health of individuals, populations and
organizations and health education. (WHO,
1997) This will help me to develop structured
opportunities for helping John to be fully
debriefed about facts surrounding his public
health issues.
Messages on improving health are drowned
out by the unfettered advertising and
promotion of junk food and alcohol.
(Wallaston, 2016)
Figure 4/5- Beatties Model & Transtheoretical Model
w15003082 NS0500 Francesca Grainger
Health messages that I have communicated
with John through the use of health education
approach.
Risks from alcohol: Alcohol puts him at more of
risk from pancreatitis, liver cancer, depression
and anxiety, cancer of the oesophagus and the
mouth. (Public Health England, 2016).
Risks from amphetamines: Regular usage of
amphetamines can cause delusions, panic
attacks, paranoia, a feeling of being wired and
hallucinations may also follow and some users
experience violent mood swings. (Drug Wise,
2016)
The concurrent use of alcohol and
amphetamines means that John is more at risk
from cardiovascular disease and can possibly
kill him. I communicated to John while
accompanying him on therapeutic activities
such as cooking, sports when he was physically
able to do so and while doing physical
observations.
 Reflection & Mental Health Nursing Contribution w15003082 NS0500 Francesca Grainger
Fulfilling societys interest in assuring conditions in which people can be healthy. (Institute of Medicine, 2003)
Promote, prevent, protect. (RCNS Public Health Reflection Toolkit, 2016)
It is of great concern that mental health frequently is overlooked as a part of health The new system for public health is more complex following the changes
promotion. If we look historically there has always been a major emphasis on made by the Health and Social Care Act, and fragmentation has caused
physical health ( Royal College of Psychiatrists, 2011.) difficulties in a number of areas. Any system will have boundaries but
further large scale restructuring would not, in our view, be advisable.
Upon reflection, public health is vital for mental health services because it helps There is a need to address the system boundary issues that have
mental health nurses be holistic and patient centred as we do neglect physical negative consequences and make sure that they are addressed in the
health and the screenings, this has caused the government to create Actions for best interests of patients. (Parliament, 2016,). Therefore we can
Mental Health Nurses Document, this came to attention in May 2016. The conclude that the government is suggesting that public health services
government focused on smoking, obesity, alcohol and substance misuse, activity are fractured, to achieve perfect integrated services we need an
levels, dental health etc. (Department of Health, 2016). Completing this physical experienced multidisciplinary team where partnerships benefit each
health module has made consider physical health and I am now going to advocate other. (Royal College of Psychiatrists, 2014) So this is potentially
giving people information alongside advocating going to activities such as cooking damaging because public health is about the collective unlike mental
and sports because it promotes their mental well-being, encourages healthier health services which can be individualistic focused. (Kappler, 2009)
support networks and prompts therapeutic communication.
The NHS
also has a
new legal
duty to
improve
health
inequalities.
(The Kings
Fund, 2012)

Inequalities
of health
2016
 w15003082 NS0500 Francesca Grainger
Reference List
Beattie, A. (1991) Knowledge and control in health promotion: a test case for social policy..In Calnan M, Gabe J, Bury M (Eds) The Sociology of the Health
Service. London, Routledge

Black Report. (1980) Inequalities in Health Report of a Research Working Group London, DHSS

Cambers, W. (2016) Exploring the merits of the recovery model for mental health nursing in Scotland, Mental Health Practice, 20(1), pp. 2731. doi:
10.7748/mhp.2016.e1103.

CDC (2016) What are the benefits of flu vaccination? How can I protect myself against flu? Available at: https://www.cdc.gov/flu/pdf/freeresources/general/flu-
vaccine-benefits.pdf (Accessed: 4 January 2017).

Department of Health (1998). Independent Inquiry into Inequalities in Health report (Acheson Report). London: The Stationary Office

Department of Health (2011) A summary of the health harms of drugs. Available at: http://www.nta.nhs.uk/uploads/healthharmsfinal-v1.pdf (Accessed: 2 January
2017).

Department of Health (2016) NHS outcomes framework: At-a-glance list of outcomes and indicators in the NHS outcomes framework for 2016-17. Available at:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/51315
7/NHSOF_at_a_glance.pdf (Accessed: 3 January 2017)
.
Drug Wise - (2016) Amphetamines. Available at: http://www.drugwise.org.uk/amphetamines/ (Accessed: 3 January 2017).

Ette, L. (2016) The importance of public health in the nursing curriculum. Available at: http://blogs.bmj.com/ebn/2016/12/12/the-importance-of-public-health-in-the-
nursing-curriculum/ (Accessed: 21 December 2016).

Hardy, S. (2016) Physical health in severe mental illness. Available at: http://physicalsmi.webeden.co.uk/ (Accessed: 3 January 2017).

Health Profiles (2012a) Byker ward know your community part of the Newcastle future needs assessment number. Available at:
https://www.wellbeingforlife.org.uk/sites/default/files/Know%20Your%20Community%20-%20Byker%20ward.pdf (Accessed: 3 January 2017).

Kappler, F. (2009) Defining mental illness. Available at: http://www.sonoma.edu/programs/healthcrisis/pdf/Defining_Mental_Illness_1.pdf (Accessed: 4 January
2017).
British Medical Journal (2016) What is epidemiology? Available at: http://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated/1-what-
epidemiology (Accessed: 3 January 2017). w15003082 NS0500
Francesca Grainger
McDowell, I. (2015) Definitions of public health. Available at: https://www.med.uottawa.ca/sim/data/Public_Health_Definitions_e.htm (Accessed: 3 January 2017).

Muir, T. (2015) Slide 1. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417894/At_a_glance_acc.pdf (Accessed: 3 January

2017).

Parliament UK (2016) The Health Service UK. Available at: http://www.legislation.gov.uk/ukpga/2012/7/contents/enacted (Accessed: 2 January 2017)
.
Prochaska, J.O., Redding, C.A., & Evers, K. (2002). The Transtheoretical Model and Stages of Change. In K. Glanz, B.K. Rimer & F.M. Lewis, (Eds.) Health Behavior
and Health Education: Theory, Research, and Practice (3rd Ed.). San Francisco, CA: Jossey-Bass, Inc.

Psychiatrists, R.C. of (2010) No health without public mental health: The case for action parliamentary briefing. Available at:
http://www.rcpsych.ac.uk/PDF/Final%20PS4%20briefing_for%20website%20A4.pdf (Accessed: 3 January 2017).

Public Health England (2014) Alcohol and drugs prevention, treatment and recovery: Why invest? Available at: http://www.nta.nhs.uk/uploads/why-invest-2014-alcohol-
and-drugs.pdf (Accessed: 2 January 2017).

Royal College of Nursing (2015) Public health nursing practice | royal college of nursing. Available at: https://www.rcn.org.uk/professional-development/publications/pub-
005587 (Accessed: 3 January 2017).

Royal College of Psychiatrists (2010) No health without public mental health. Available at: http://www.rcpsych.ac.uk/pdf/position%20statement%204%20website.pdf
(Accessed: 4 January 2017).

Royal College of Psychiatrists (2013) Physical health: What carers, friends and families need to know what support should people be getting? Available at:
http://www.rcpsych.ac.uk/pdf/Rethink%20physical%20health%20factsheet.pdf (Accessed: 3 January 2017).

Scotland NHS (2016 ) Introducing the wider determinants of health. Available at: http://www.bridgingthegap.scot.nhs.uk/understanding-health-inequalities/introducing-
the-wider-determinants-of-health.aspx (Accessed: 2 January 2017).

Sheps, C.G. and Chairman (1976) Higher education for public health: A report of the Milbank memorial fund commission Cecil New York: Published for the Milbank
Memorial Fund by PRODIST.

The Samaritans (2012b) MEN, SUICIDE AND SOCIETY why disadvantaged men in mid-life die by suicide research report. Available at:
http://www.samaritans.org/sites/default/files/kcfinder/files/press/Men%20Suicide%20and%20Society%20Research%20Report%20151112.pdf (Accessed: 3 January
2017).
 w15003082 NS0500 Francesca Grainger
Whitehead, M. and Dahlgren, G. (1991) What can be done about inequalities in health?, The Lancet, 338(8774), pp. 10591063. doi: 10.1016/0140-6736(91)91911-d.

WHO (1986) OTTAWA CHARTER FOR HEALTH PROMOTION, Health Promotion International, 1(4), pp. 405405. doi: 10.1093/heapro/1.4.405.

WHO (2010) Jakarta declaration on leading health promotion into the 21st century. Available at:
http://www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/ (Accessed: 2 January 2017)

Wollaston, S. (2016) Public health is in crisis and Theresa May is failing to act. Available at: https://www.theguardian.com/commentisfree/2016/sep/01/public-health-
crisis-government-theresa-may-childhood-obesity (Accessed: 3 January 2017).