According to the recent survey that was carried by the Office for National Statistics (ONS), Newham which is one of the inner London boroughs has an estimated population of 307,984 people which is the highest figure that exists in each of the inner London boroughs(Abbott et al., pp.251). The report also indicated that respiratory diseases, cancer and cardiovascular disease are the leading causes of death in Newham with cardiovascular disease taking the leading position at 33%, followed by cancer at 29% and lastly respiratory illness at 18% (Abbott et al., pp.251). Although the gap is slowly narrowing, these percentages have remained higher than the averages for both London and England where cardiovascular accounts for 30% deaths, cancer at 25% and respiratory disease at 16% (Abbott et al., pp.252). Moreover, in Joint Strategic Needs Assessment (JSNA) 2017 report, Newham had the lowest survival rate of patients suffering from cardiovascular disease particularly those between 15 and 78 years of age by the end of 2014 thus standing at 64.7% when compared to the national average survival rate of cardiovascular patients in the same age bracket which stood at 70.4%(Gopee and Galloway, 2017, pp.47). These statistics are clear indicators of the numerous health and social care needs of the patients affected by long term conditions such as cardiovascular in Newham.

Health needs (Role of Nurses)

The nurses are also responsible for facilitating the quick recovery of patients suffering from long term conditions particularly cardiovascular in Newham. Though using a comprehensive recovery strategy, nurses in Newham can manage to restore the good health and enhance the quality of living of the individuals who have been diagnosed with cardiovascular disease(Salmond and Echevarria, 2017, pp.23). One of the ways of promoting the quick recovery of cardiovascular patients is through teaching them various lifestyle modification strategies that can help in improving their health(Salmond and Echevarria, 2017, pp.25). For instance, it is the duty of the nurse to educate the cardiovascular patients on the importance of dropping various negative lifestyle habits such as smoking, taking alcohol and wearing inappropriate clothing at different seasons especially wearing light clothes during winter and instead adopt positive lifestyles such as taking balanced diet and regularly engaging in various physical exercises(Salmond and Echevarria, 2017, pp.26). Additionally, in the effort of promoting holistic care, the holistic nurses should be actively engaged in providing physical therapy among other medical activities to those cardiovascular patients who are admitted in rehabilitation centres(Salmond and Echevarria, 2017, pp.29). The holistic nurses should always uniquely position themselves to serve as interdisciplinary leaders and patient advocates during the delivery of comprehensive recovery care and rehabilitation of cardiovascular patients.

Barriers to Communication

According to the Department of Health and Social Care in the United Kingdom, patient safety becomes at risk whenever the multidisciplinary team within a health care setting is not communicating well due to various reasons such as unclear orders while passing the information and misinterpretation of information (Krachler and Greer, 2015, pp.217). The Department of Health and Social Care claims that there various barriers to communication that are facing most of the clinical organisation in England and across the globe. One of such obstacles is gender differences whereby both men and women professionals within a care setting have been found to have different styles of communicating (Krachler and Greer, 2015, pp.218). Moreover, the presence of hierarchies has also significantly contributed to communication barriers within the healthcare setting with bottom-up communication being most affected.

Additionally, since most of the countries such as United Kingdom, United States and Australia among others in the world are ethnically and culturally diverse, the different cultural backgrounds of the clinicians in such nations has been acting as a critical barrier to communication within the health care setting(Krachler and Greer, 2015, pp.217). For instance, in 2002, Kaiser Permanente Health Organization faced numerous communication barriers across most of its clinical settings. Most of these communication failures were based on cultural differences of the clinicians present across multiple Kaiser Permanente inpatient settings(Stewart, 2016, pp.63). However, these Kaiser Permanente inpatient settings are now institutingSituation-Background-Assessment-Recommendation(SBAR) communication along with other communication techniques in the effort of managing and eradicating this communication barrier (Stewart, 2016, pp.65). The SBAR is acting as an excellent way of conveying relevant information both efficiently and effectively. Most of the health care organisations in the United Kingdom and other countries have also started adopting SBAR which is now enhancing patient care and providing a framework for shared communication across interdisciplinary teams in health settings (Stewart, 2016, pp.66).

Barriers to Health

Critical evaluation of integrated care using marmot indicators

According to most of the government-commissioned reviews, there exists a high level of inequalities in England(Goldblatt, 2016, pp.29633). The findings of a recent Marmot review indicate that high cases of variation in the United Kingdom have resulted in rapid increase ill-health among the citizens and poor health service performance. One of the strategies that have been proposed by the National Health Service is the use of integrated care as a way of eradicating the current health disparities that exist in the country. Integrated health care has been proposed as one of the best strategies of responding to the fragmented delivery of health care and social services hence facilitating a unison improvement in healthcare status of all the citizens across all social and economic situation (Thompson et al. 2015, pp.973). The 2015 Marmot review states that low level of education and literacy are also crucial social determinants of health care in England and they have significantly inhibited the ability of most of the citizens in the United Kingdom to access high-quality health care services (Goldblatt, 2016, pp.29633). According to the 2015 Marmot review, lack of clear expectations of the care providers in most of the hospitals in England has contributed to the emergence of fragmented care (Goldblatt, 2016, pp.29633). The current costs of healthcare in England can be attributed to high fragmentation of health care that has seen continued deterioration in coordination among multidisciplinary teams during care delivery(Tsai, Orav and Jha, 2015, pp.62). Inefficient allocation of resources by the government to the healthcare sector in England has also played a crucial role in fragmenting care within the country thus limiting the ability of the citizens to access better healthcare(Tsai, Orav and Jha, 2015, pp.64).

Health Determinants and Interventions on CVD

The physical and mental health of most of the people in England is highly influenced by the broader determinants of health which include different economic, social and environmental factors. Some of the economic factors include the level of income and employment opportunities that are available to most people (StanojevićJerkovićet al., pp.74). For instance, in the period between 2013 and 2014, the proportion of individuals in England who fell below the Minimum Income Standard increased from 21.6% to 26.4%(StanojevićJerković et al., pp.75). This was due to the lack of job opportunities for most of the middle and lower class citizens who were forced to struggle while seeking medical services. Moreover, according to the National Health Services, the quality of health for most of the people in England is significantly affected by the quality of the natural environment such as housing, air and green spaces(StanojevićJerković et al., pp.77).

Interventions on CVD

One of the most significant interventions to cardiovascular disease is the use of community-based counselling program that involves increasing the awareness of the locals about those behaviours that tend to increase the risk of an individual suffering from cardiovascular disease such as smoking(Ojaet al., 2018, pp.771). Moreover, introducing physical activity programs for community members who have been diagnosed with CVD is also an essential lifestyle intervention that can promote health care improvement in patients suffering from cardiovascular disease (Oja et al., 2018, pp.771).

Co-Creating Health

In the past one decade, the National Health Service has faced a lot of pressure from the public to deduce ways which can result to reduced health care costs(French, Teal and Raman, 2016, pp.2966). It has been discovered that by the introduction of a co-creating health program in the health sector of the United Kingdom is likely to result in improved health care outcomes especially for patients with complex health care needs. Co-creating health involves equipping the people and the clinicians with all the resources that they require to collaborate towards achieving better outcomes and embedding self-management support within the mainstream health services across the country(French, Teal and Raman, 2016, pp.2968). Co-creating health also involves encouraging and facilitating self-management of health amongst people and equipping patients with terminal illness and complex care needs with the much-required support, confidence and skills to self-manage themselves (French, Teal and Raman, 2016, pp.2972).

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