Date of Learning: 22/09/2023

Time: 09:30-16:30

Learning Activity 1: Social Determinants of Health and Cultural Influences Epidemiology and Demographics

In today’s session, we covered the demographics and epidemiology in planning appropriate services within health promotion and public health. The learning outcomes for this session are to gain knowledge of the importance of epidemiology and demographics, identify and discuss the social factors influencing health and the mechanisms by which they do so, understand the association between social classes and health, gender and health, ethnicity and health, and how this applies to specific groups, and to understand the theories of the social determinants of health.

The class session started by looking at an example of a health promotion poster related to our module assignment.  A good poster must be detailed, informative, and educational. The students had an opportunity to discuss both posters and we were able to gain more understanding of the assignment. We then moved on to today’s class session.

Demography is the study of statistics to determine the causes of health and diseases. The study of demography is the study of the human population concerning their size, structure and dynamics. It is looked at by the office for health improvement and disparities. A population is all the inhabitants of a particular place, such as residents in the same area. It is structured and refers to age, sex, ethnicity, and individual characteristics e.g., LGBTQI. Decisions on how and where resources can be allocated will be made based on these characteristics.

Epidemiology is the study of the determinants, occurrence, and distribution of health and disease in a defined population. We discussed an example of epidemiology in class, and we talked about COVID-19 and the rising number of HIV. Epidemiology can inform the health of the population, morbidity and mortality which can provide information about trends. It can help target delivering healthcare for diverse groups. The ethnic demography of an area will increase the possibility of certain genetic conditions being prevalent. The use of statistics, probability and the R-value assess the ability of a disease to spread. Statistics that are monitored are morbidity, mortality, life expectancy at birth, health-adjusted life expectancy, and studies that are often explored as ‘casual factors’ e.g., smoking.

Disease surveillance is an information-based activity involving the collection, analysis and interpretation of large volumes of data originating from a variety of sources. It is the core function of Public Health England (PHE) which is now known as The Office for Health Improvement and Disparities, they ensure that they have the right information available to inform public health decisions and actions. Good surveillance is significant because they must respond quickly and effectively to public health threats. It improves interoperability between systems and uses new technologies to improve outcomes. When gathering information, surveillance should have recognised goals and objectives. The data collected defines the target population as high quality, accessible, and contains interpretation and recommendations. To give a clearer interpretation about the topic we looked at disease surveillance in COVID-19 and tuberculosis (TB).

Social determinants of health are the non-medical factors that influence health outcomes. These are economic and social factors that have a profound effect on health. Conditions in which people are born, grow, and work. We gave some examples of what we think are social determinants of health which can influence health equity in positive and negative ways. These social determinants are income, social protection, education, unemployment, job security, working life conditions, food security, housing etc. Health inequalities are unavoidable and unfair differences in health between groups of people who are united by their shared socio-economic status or gender rather than by any health-related attributes.

We looked at and discussed some reports on health inequalities during this learning activity. The Marmot Review Report is an evidence-based report which proposes a strategy to address the social determinants of health, the conditions in which people are born, grow, live, work and age which can lead to health inequalities. There were a few reports we can look at to support and gain more knowledge about the topic. These reports are made by the Institute of Health and Equality, King’s Fund, World Health Organisation, NICE guidelines and Anti-social Behaviour.

The module was a great learning experience in which I enjoyed the topic and group activities. The class delivery was interactive, I gained more confidence in presenting since we presented our findings and research about the Marmot report. We looked at factors why it is worse to live in the Northeast of England than in deprived areas in London. We were able to gain relevant, evidence-based information. I also had an opportunity to remind myself how referencing should be and how it should support any literature included. I like how the module provides a clear understanding of each lecture which always relates to the assignment.

Learning Activity 2: Respiratory Care, Peak Flows and Oxygen Therapy

In this learning activity, I was introduced to oxygen therapy. The learning outcomes for this session are to identify different methods of administering oxygen therapy, discuss the use of oxygen therapy in practice including indications and cautions, and to become familiar with the equipment used for delivering oxygen.

The class started with a theoretical approach before going to the clinical simulation centre where I practised clinical skills on oxygen therapy. Administering oxygen has a different delivery system it will depend on the patient’s condition. It was discussed that oxygen treats hypoxaemia not breathlessness. Oxygen therapy aims to maintain the patient’s oxygen saturation within the range that is appropriate for them. The general respiratory assessment was discussed, some factors need to be assessed such as what physical position is the patient in – sitting or standing? Assessing any abnormalities by looking and listening to the patient. These could be the use of accessory muscles, intercostal recession, wheezing, coughing, nasal flaring, level of consciousness or any other noises.  Oxygen levels can be assessed by using a pulse oximeter, or blood gas analysis, and in some situations, it may not be appropriate to continue monitoring e.g., palliative care.

Oxygen administration should only be administered by trained staff. Oxygen is a medicine; therefore, it should be prescribed before administrating. Oxygen therapy can be administered only during an emergency, it should be given without any delay and the oxygen given should be documented as per local policy. In the prescription, it should indicate target saturation, percentage or flow rate as well as delivery device.

The target oxygen saturation for most people who are not at risk of carbon dioxide retention also known as the hypercapnia target of 94%-98%. People who are at risk of hypercapnia will need a lower target of 88%-92%. This includes patients who suffer lung conditions such as chronic obstructive pulmonary disorder (COPD), cystic fibrosis, bronchiectasis or chronic asthma. Some patients may have a lower target range such as 85%-90% which will be specified on the prescription.

There are different oxygen delivery devices such as nasal cannulae, Hudson masks, venturi masks, and non-breather masks. A nasal cannulae is a device that delivers extra oxygen through a tube and into your nose. It does not deliver a consistent concentration of oxygen 24%-30%. It is useful when low to moderate oxygen therapy is required usually up to 4 litres. Some patients may swap their oxygen mask with nasal cannulae when eating, drinking or receiving nebuliser. It is important to remind patients to breathe through their nose and out through their mouth. The tubing must fit over the nose and bring the tubes together under the chin. Nasal cannulae can irritate the skin therefore it is important that the comfort of the patient is ensured, and skin is protected.

Hudson mask is a simple face mask where the oxygen source attaches to the mask and exhalation ports allow the carbon dioxide to escape. The Hudson mask can be used for higher-concentration delivery of oxygen. The flow must be at least 5 L/min to avoid CO2 build-up.

The venturi mask is an oxygen device to delivers a known oxygen concentration to patients on controlled oxygen therapy. The oxygen flow through the venturi barrel which sucks in the room air through the small holes in the barrel which mixes with the oxygen and dilutes its concentration.

Non-rebreathe mask allows high flow rates of oxygen. It is usually used in patients who are critically ill, and it can only be used for short-term therapy. The oxygen must be turned on at the flow meter and the reservoir bag must be inflated before applying it to the patient. It is also important that the oxygen is at the desired level using the flow meter. The standard flow rate is 15L/min, minimum delivery of 10L/min to ensure that the oxygen reservoir bag does not collapse during inspiration.

The oxygen flow meter regulates the flow of the oxygen. When looking at a flow meter with a bobbin, the flow rate is read from its top. However, in flow meters with a ball, the rate is read from the centre of the ball.

It is important to explain to the patient the procedure of oxygen therapy and emphasise the need to keep the mask on their face and to make sure that they breathe normally. The patient must be seated upright unless it is not possible. The patient can hold it so that they can cover their mouth and nose if it is possible to do so. When the mask feels comfortable the elastic strap can help hold the mask in position.

There are few cautions when using oxygen therapy. The oxygen tank or machine should not be near an open flame, static electricity, newly applied alcohol gel, certain oils, greases and recently moisturised skin. If the patient has pressure sores a preventative dressing may be required. Oxygen therapy can also dehydrate membranes in the respiratory tract.

Oxygen can be humidified to reduce sensations of dryness in the upper airways. It can be added to moisten the gas and it is not normally required for short-term delivery of oxygen. Humidification can be used if they require high-flow oxygen for over 24 hours. It can also help loosen secretions for some patients. Humidification should always be used in patients who have tracheostomies when receiving oxygen therapy.

After covering the theoretical session of the topic, we then moved to the clinical simulation centre where Luke (one of the lecturers) set up different cases of mimic patients who are receiving oxygen therapy. Each student had an opportunity to explore and learn about different cases of the mimic patients. I was also able to see what a prescribed oxygen would look like and explored the different types of oxygen devices. I gained new knowledge and clinical skills during this learning activity which I can use in my future as a nursing associate.

KSB ADDRESSED:

Knowledge:

Skills:

Behaviour: