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Explore the range of potential circumstances and factors, i.e. determinants of health, that may have impacted on Jake’s current experience of health and well-being.

Fundamentals of Behavioural Sciences

HS182- 4 – AP (Adult Nursing & Mental Health Nursing)

Assessment – STUDENT SUMMATIVE ANSWERS FOR SUBMISSION

Module Code: HS182- 4 – AP (Adult Nursing & Mental Health Nursing)

Cohort: 2024

Student Number:

Answer both questions to each scenario. Total word count is a maximum of 2000 words. Anything beyond 2000 words will not be marked. Word count excludes the reference list.

Scenario 1

Jake, 25, began working at a local gym 3 years ago following completion of his degree in Sport and Exercise. Work was going well, and he was taking on more responsibility until the Covid-19 pandemic enforced lockdown and the owners of the gym, like other businesses, applied for and placed the workforce on the furlough scheme. The loss of a proportion of his income is compensated by a saving on travel costs.

Jake lives alone in a bedsit and his family live some distance away in the midlands. He has friends whom he stayed in touch with via social media and began spending a lot of time in online gaming. At first, he enjoys the time away from work and not having to wake early to get himself ready and make the journey to the gym. There is a supermarket a fifteen-minute walk from home and, as permitted, he shops, observing social distancing rules.

As the weeks passed Jake became more preoccupied with gaming, lost the inclination to walk to the supermarket, opting instead to use the local shop three minutes away, and has generally adopted a more sedentary routine with little exercise and less healthy eating habits. Jake has become increasingly frustrated with lockdown and the inability to meet with friends and family.

When the gym reopens Jake’s manager notices his weight gain and more slovenly appearance. He is warned that this affects the image and good reputation of the gym and he must address this with immediate effect, otherwise his position is under threat. Jake arranges a telephone consultation with the practice nurse at his local GP practice for advice.

Essay Questions 1 (total 500 words)

  1. Explore the range of potential circumstances and factors, i.e. determinants of health, that may have impacted on Jake’s current experience of health and well-being.

  2. What are likely to be the main concerns as far as the practice nurse is concerned, and how may she support Jake in making the necessary changes?

(Write your answer below here)

Scenario 2

Gerry is 15 and currently living with his father and elderly grandmother. His grandmother has started to become muddled at times and Gerry feels increasingly stressed about her safety when on her own. His parents are separated following many years of a troubled relationship and his mother has returned to her family in the Philippines.

Gerry always remembers there being rows and, especially when his dad had been drinking, it was always safer to hide in his room before the physical fighting started and he learned it was best to keep out of the way. Gerry’s mum was very timid and had been kept under control herself by a very strict father, so she had taken a back seat in Gerry’s upbringing and had left him to his own devices. She would often stay in bed all day.

At school, concerns have been raised with the School Nurse about Gerry’s attendance and he is reluctant to communicate with staff or other students. There is evidence that Gerry is being bullied and taunted because of his shabby appearance, and he has begun to get involved in fighting. Gerry is also refusing to eat with others or get involved in sports at school, is wearing increasingly baggy clothes, and keeps his arms and legs covered at all times.

Essay Questions 2 (total 500 words)

  • Describe the behaviours that suggest Gerry has experienced traumatic events in his life and explain what these events have been.

  • Identify the principles of care in safeguarding Gerry as a vulnerable person and supporting his family.

(Write your answer below here)

Scenario 3

Yasmin is a 19-year-old woman who, until seven months ago, was living in the family home. She had a major falling out with her parents over her choice of partner (same sex relationship) and then moved in with her. This relationship has since ended; however, Yasmin has been unable to reconcile with her parents and had been ‘sofa surfing’ with a friend for two months but eventually felt that she had outstayed her welcome, leading her to sleep rough.

About six weeks ago Yasmin was approached by a man who seemed pleasant, gave her money for food and invited her to an abandoned property where others also lived. Shortly after moving in the same man began providing her with cocaine, unconditionally at first but after a while he sought sexual favours from her. Yasmin was uncomfortable with this and resisted initially but submitted soon after owing to her longing for the drug.

In the last two weeks the man has pressured Yasmin to have sex with other men, suggesting that he will provide her with money (as well as the drug). He adds that they will pay more if they do not have to wear a condom. Yasmin is again uncomfortable with this but also gives this consideration with the promise of money in her pocket.

During a visit to a food bank Yasmin was upset, and a visiting primary health care worker sat with her and listened sensitively whilst Yasmin confided in her about the events of the past seven months.

Essay Questions 2 (total 500 words)

  1. Discuss the determinants that affected Yasmin on her journey from the beginning to the close of the scenario, and the factors that increased her vulnerability on the way, including the health risks.

  2. How might Yasmin be supported in addressing possible health risks and concerns in a way that empowers her to act on this?

(Write your answer below here)

Scenario 4

Frank has been living alone with Alzheimer’s for many years, but his condition has deteriorated significantly enough over recent months, following a period in hospital after a fall, that his family decided that it would be safer and best for him to move to a nursing home for care. Before the move, Frank was visited daily by his granddaughter who used to help him get up and ready for the day and make sure he was able to get to the day centre twice a week.

Since the move, Frank has started to get out of bed as many as ten times during the night to visit the toilet and has started wetting his pyjamas on some nights. He ends up wandering, losing his way and pacing up and down the care home corridors. He spends much of his time during the day napping in his chair.

Frank’s family have noticed when they visit that he seems increasingly confused and distressed, especially in the evening and at night. He is sometimes verbally abusive to them and repeats the same phrases over and over. The care staff have reported that he has become very irritable for most of the time and has also started to lash out when approached and has refused care and help from the female staff.

Essay Questions 4 (total 500 words)

  • What factors might explain Frank’s increasing agitation?

  • What strategies might be useful in calming Frank and maintaining feelings of comfort and safety?

(Write your answer below here) 

REFERENCE LIST

 

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Sample Answer

Scenario 1 – Jake

Determinants Affecting Jake’s Health and Well-Being

Jake’s health has been influenced by multiple determinants. Biological factors include his age (25) and general physical health, which may have been compromised by a sedentary lifestyle and weight gain during lockdown (Marmot et al., 2020). Psychological determinants include stress, frustration, and potential anxiety due to isolation, loss of routine, and uncertainty surrounding employment. Social determinants are significant: living alone, being distant from family, and reduced social interaction increased his social isolation (WHO, 2021). Economic factors also impacted Jake; reduced income combined with furlough led to changes in behaviour, such as reliance on convenience stores and reduced activity. Environmental determinants include limited access to exercise opportunities due to lockdown and closure of the gym. Health behaviours were affected by increased gaming, reduced physical activity, and unhealthy dietary choices, all contributing to weight gain.

Practice Nurse Concerns and Support

The practice nurse would be concerned about Jake’s physical health, including weight gain, reduced fitness, and potential dietary deficiencies. Mental health concerns include stress, low mood, and social isolation. Behavioural risk factors include sedentary habits and poor diet, which increase long-term cardiovascular and metabolic risks (NICE, 2019).

Support strategies could include:

  • Motivational interviewing to explore Jake’s readiness to change and encourage realistic goal setting for diet and activity.

  • Behavioural interventions such as structured exercise programmes or gym sessions to gradually rebuild activity levels.

  • Dietary guidance using evidence-based resources to encourage balanced meals, portion control, and meal planning.

  • Social support facilitation, such as virtual group fitness or reconnecting with friends safely, to reduce isolation.

  • Regular follow-ups to monitor progress and adapt goals, promoting accountability and sustained lifestyle change.

Integrating these interventions underpins holistic care, addressing physical, psychological, and social health determinants, while supporting Jake in making sustainable behavioural changes that align with both his personal and professional life.

References:
Marmot, M., Allen, J., Goldblatt, P., Herd, E., & Morrison, J. (2020). Build Back Fairer: The COVID-19 Marmot Review. Institute of Health Equity.
NICE. (2019). Obesity: Identification, Assessment and Management. National Institute for Health and Care Excellence.
WHO. (2021). Social Determinants of Health. World Health Organization.

Scenario 2 – Gerry

Behavioural Evidence of Trauma

Gerry demonstrates behaviours consistent with exposure to trauma. Social withdrawal, reluctance to communicate, refusal to eat with peers, covering arms and legs, and involvement in fighting are indicative of post-traumatic stress and hypervigilance (van der Kolk, 2014). Shabby appearance, anxiety about safety, and difficulty trusting others are further signs of emotional neglect and chronic stress. The traumatic events include exposure to domestic violence, parental separation, maternal absence, and bullying at school. Early experiences of instability and fear during parental conflict contribute to insecure attachment, emotional dysregulation, and maladaptive coping mechanisms.

Safeguarding Principles and Family Support

Safeguarding principles emphasise protection from harm, promoting welfare, and ensuring safe environments (Department of Health, 2018). For Gerry, these include:

  • Early intervention: Coordinating with school and social services to provide counselling and safe spaces.

  • Risk assessment: Evaluating ongoing exposure to harm or neglect at home or school.

  • Supportive relationships: Building trust with the school nurse and mental health professionals to foster resilience.

  • Family engagement: Working with his father to provide guidance, stress management support, and education on safeguarding, while recognising his grandmother’s vulnerabilities.

Support strategies could include trauma-informed care, mentoring, and psychoeducation for both Gerry and his family. Interventions must be tailored to his developmental stage and focus on rebuilding confidence, social skills, and emotional regulation, while ensuring immediate protection from harm.