Introduction
This essay presents a case study of an individual encountered during my clinical placement as a nursing student, focusing on the social factors influencing their health and wellbeing, a critical evaluation of the nursing care provided, and how their identified needs were addressed. The patient, referred to as Mr. Smith (a pseudonym to maintain confidentiality as per the Nursing and Midwifery Council (NMC) Code, 2018), was a 68-year-old man with chronic obstructive pulmonary disease (COPD). This piece aims to explore the broader determinants of his condition, assess the care delivered by the multidisciplinary team, and discuss the interventions implemented to meet his needs. By critically analysing these elements, this essay will demonstrate the interplay between social circumstances and health outcomes, alongside the importance of holistic nursing practice.
Social Factors Influencing Health and Wellbeing
Mr. Smith’s health and wellbeing were significantly shaped by various social factors, which are critical to understanding the wider context of his condition. Living alone in a deprived urban area, he faced social isolation, a recognised determinant of poor health outcomes, particularly for older adults with chronic conditions (Holt-Lunstad et al., 2015). His limited social support network exacerbated feelings of loneliness, likely contributing to his reported low mood, which can worsen COPD symptoms through stress-related pathways (Yohannes and Alexopoulos, 2014). Furthermore, financial constraints restricted his access to nutritious food and adequate heating, both essential for managing his respiratory condition. These socioeconomic challenges reflect broader structural inequalities often linked to poorer health, as highlighted by Marmot (2010), who argues that social gradients in health stem from disparities in living conditions. Therefore, Mr. Smith’s situation illustrates how social determinants, beyond purely medical factors, play a pivotal role in shaping individual wellbeing, necessitating a comprehensive approach to care.
Critical Evaluation of Nursing Care Provided
The nursing care provided to Mr. Smith during my placement demonstrated strengths but also areas for improvement. Initially, the nursing team conducted a thorough assessment of his physical symptoms, including oxygen saturation monitoring and medication reviews, aligning with National Institute for Health and Care Excellence (NICE) guidelines for COPD management (NICE, 2018). However, the focus on biomedical needs arguably overshadowed psychosocial concerns, such as his social isolation, which received limited attention during ward rounds. While regular observations were meticulously recorded, there was minimal evidence of tailored emotional support, despite research indicating its importance for chronic illness management (Yohannes and Alexopoulos, 2014). Creatively, the team could have integrated brief therapeutic conversations or mindfulness techniques to address his anxiety, which I observed during interactions. Indeed, a more holistic approach—combining physical and emotional care—might have enhanced his overall experience, highlighting a gap in person-centred practice that is central to nursing philosophy (NMC, 2018).
Addressing Identified Needs and Collaborative Care
Mr. Smith’s needs were addressed through a multidisciplinary approach, though coordination could have been more seamless. His respiratory needs were managed by the nursing staff, who ensured adherence to inhaler therapy, and a respiratory specialist who adjusted his treatment plan. Social services were involved to assess his home situation, eventually arranging a community support worker to visit weekly, mitigating his isolation. Additionally, a dietitian provided guidance on affordable nutrition, addressing his financial barriers to healthy eating. However, delays in social service referrals meant that support was not immediate, leaving Mr. Smith vulnerable post-discharge. The involvement of various professionals underlines the complexity of meeting holistic needs, yet it also reveals the necessity for better inter-agency communication to ensure timely intervention, as advocated by the Department of Health (2012). My role as a student nurse included providing basic emotional support through active listening during care interactions, though I lacked the authority to initiate broader referrals, highlighting the importance of team collaboration.
Conclusion
In summary, this case study of Mr. Smith underscores the profound impact of social factors, such as isolation and socioeconomic deprivation, on health and wellbeing, particularly for those with chronic conditions like COPD. The nursing care provided was competent in addressing physical needs but lacked sufficient emphasis on psychosocial support, indicating a need for more holistic, person-centred practice. While his needs were ultimately addressed through multidisciplinary collaboration, delays in social support highlight systemic challenges in healthcare delivery. This analysis suggests that nurses must advocate for comprehensive care that considers social determinants, ensuring timely and integrated interventions. Reflecting on this experience, I recognise the importance of developing skills in emotional support and interprofessional coordination to better serve future patients, contributing to improved health outcomes in diverse clinical contexts.
References
- Department of Health. (2012) Liberating the NHS: No Decision About Me, Without Me. UK Government.
- Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T. and Stephenson, D. (2015) Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science, 10(2), pp. 227-237.
- Marmot, M. (2010) Fair Society, Healthy Lives: The Marmot Review. Institute of Health Equity.
- National Institute for Health and Care Excellence (NICE). (2018) Chronic Obstructive Pulmonary Disease in Over 16s: Diagnosis and Management. NICE.
- Nursing and Midwifery Council (NMC). (2018) The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. NMC.
- Yohannes, A.M. and Alexopoulos, G.S. (2014) Depression and Anxiety in Patients with COPD. European Respiratory Review, 23(133), pp. 345-349.
