Answer :

Discuss personal, family, and cultural factors which could affect Kim-Ly’s health and her reluctance to go to the hospital? Outline why these factors might be important.

          The determinants of health such as personal, cultural and social factors can have both positive and negative health implications. The personal factor, in this case, can be loneliness. Kim-Ly is 74 years old and has been living alone for the last twenty-five years. Research indicates that loneliness and social isolation have adverse health outcomes and this affects both the mental and physical health of an individual (Leigh et al., 2017). Loneliness is found to cause chronic diseases such as blood pressure issues, depression, anxiety, weak immune system and heart diseases (Leigh et al., 2017). Kim has developed a routine of taking care of herself on her own and might have felt that she will go to the hospital on her own making her reluctant to go to the hospital. Carr and Weir (2017) state that family and marriage are characteristics of healthy and successful ageing. In this case, neither Kim married nor she has kids which have made her lonely. Hence, loneliness is among the most prevalent factor behind poor health outcomes for Kim-Ly. 

          Next, family factors also play an important role in shaping an individual’s health. Kim-Ly does not have her own children but she has her brother and his kids as her family. So in this case two-family factors are evident, genes and shared social environment. According to Suzuki et al. (2019) genes are directly related to the onset of many diseases and arthritis is among the genetically transferred diseases. Genes in combination with lifestyle factors can cause chronic diseases as in the case of Kim. Next, Kim lacks a social shared environment in her home. Family plays an important role in improving health and wellbeing and also the quality of life increases when family members are involved in care regimes (Carr and Weir, 2017). Kim migrated to Australia hence it is possible she has no relatives nearby and her brother lives on the other side of the city leading to a lack of family support.

          Kim-Ly was born in Vietnam and had been residing in Australia since she was in her mid-twenties. As a result, Kim-Ly has lived in two completely different cultures throughout her life. She was influenced by the cultural shifts to some extent, but she kept herself occupied with the restaurant work. Migrants face a variety of stresses that can affect their mental health, including the lack of cultural values, religious traditions, and social support structures, as well as cultural transition and shifts in personality and self-concept (Hashemi et al., 2020). Further, discrimination towards migrants can make them reluctant towards healthcare services (Hashemi et al., 2020). Kim's childhood views of wellbeing, illness, and care might have been different from those she had when she came to Australia. After war effects also have negative health outcome due to exposure to chemical hazards and the sudden culture change due to migration (VanLandingham & VanLandingham, 2017). 

          These factors are very important as they have huge impacts on the health outcomes mainly for the vulnerable population such as aged people. Also, while providing treatment patients environment and these factors are considered for designing care plan and for better outcomes (Leigh et al., 2017). This also enables stakeholders and policymakers to make policies that align with these factors and measures and resources are developed in place to meet the individual needs of the population. In Kim's case, her living environment should be improved and social support is keen for better health outcomes. 

Discuss structural (access to and availability of health care), social and economic factors that might influence how Kim-Ly views and seeks health care?

           Kim-Ly is not employed and living on a pension and might not have enough money to attend healthcare services. The structural factors could be the lack of accessible and affordable healthcare.  Australia is a developed country and has efficient healthcare services but equity in healthcare is not yet established. People living in disadvantaged locations have great difficulty in accessing health centres. The region where Kim-Ly lives is challenged with socioeconomic issues, as shown by the fact that her niece attempted to call for an ambulance but was unable to arrange an appointment with nearby healthcare professional. Such things might have influenced Kim-Ly’s view towards healthcare access and she does not want to visit the medical centre. The community's structural care set-up must be able to provide emergency treatment to the locals, which will aid in providing the affected people with timely medical treatment (Gorman et al., 2019). In Australia, either government is responsible for healthcare or insurance companies provide funding. Kim-Ly may be mindful that if she does not have medical insurance care and she is retired, it would be difficult for her to afford the requisite interventions to treat her health conditions. 

           Next, the social factor, in this case, will be a lack of education. The educational attainment of individual shapes their views towards healthcare. Studies show that people with high educational attainments live a healthy and long life as compared to people with low or no education (Rydland et al., 2020). Kim-Ly worked in a local restaurant which is indicative of her low education levels. People from low education status are negligible towards their health and alarming signs and symptoms which might be possible in Kim’s case. Lack of education is associated with unhealthy eating habits, poor mental health, and asthma and decrease quality of life. In contrast to this, education usually leads to better employment, more income, among several other advantages, like health insurance and, as a result, more access to high-quality health care (Rydland et al., 2020). Higher salaries will allow individuals to afford homes in healthy areas and eat better diets. Hence, to improve health outcomes for Kim-Ly health literacy is important for her. 

          The economic factors, in this case, are low income and inadequate housing. Low-income individuals are nearly twice as probable as those with higher salaries to report they have had difficulty paying medical bills (Lazar & Davenport, 2018). Low-income residents are much more prone than other people to experience non-financial barriers to health coverage, such as longer waiting times for appointments (Lazar & Davenport, 2018). Kim lives in the suburbs of the city in a government housing scheme and as evident in the case despite the critical situation, Kim's niece was unable to book an urgent appointment. Effective medical insurance comes hand in hand with a reasonable salary. Kim-Ly served in the local restaurant until she was in her late 70s, according to the case study. Working for several years indicates that her salary was below the expected limits for anyone to live a healthier life and shaping her views that she cannot afford good healthcare services.

As a nurse, what areas do you believe should be addressed to ensure Kim-Ly receives the care she needs to maintain her health?

         As a nurse, I believe that Kim should be given immediate medication care and attention. Initially, there should be a psychological assessment for the patient using theoretical models such as the biomedical model of health psychology and the sociological model (Taukeni et al., 2019). Healthcare professionals must consider human psychology and they must interact with a wide variety of ailments. Patients like Kim-Ly are not uncommon, but it is essential to understand how to communicate with them. Healthcare professionals must give the necessary care to each patient they encounter, and a knowledge of human psychology aids them in dealing with unwilling patients. 

          Positive health outcome and efficient care for Kim-Ly can be achieved through therapeutic support by a nurse, medical management and patient education. The first and most important aspect is that nurse should maintain a therapeutic relationship with the patient in order to show compassion and to provide social support. Kim lacks social and family support hence it is a necessity in this case that Kim gets emotional and therapeutic support so that she can convey her physical sufferings on admission to the hospital. Having positive support plays an important part in enhancing elderly people's social and physical well-being (Zhao et al., 2019).

         Education and counselling will assist in further understanding the nature of arthritis and coping with the difficulties. The health-care providers should collaborate to develop a long-term recovery plan, increase motivation, and address both conventional and complementary treatment alternatives. Patient education is critical as arthritis is a chronic disease and requires self-management for improving quality of life (Sweeney et al., 2021). The nurse can educate the patient about a healthy diet, medication adherence and regular physical exercise. Biofeedback (a method that helps patients to monitor certain body functions) and cognitive behavioural therapy (a type of therapy in which patients try to transform how they respond to situations) are two approaches that can be beneficial. These methods can help to relieve pain and impairment while also promoting self-esteem. Some hospitals already have these facilities. These services have been shown to help people with arthritis manage their pain, depression, and impairment, as well as gain more control of their condition. Because of the difficulty of exercising due to pain and discomfort, many people with arthritis restrict their physical activity. Lack of activity, on the other hand, will result in a lack of joint motion, soreness, and muscle strength. Weakness reduces joint mobility, which leads to increased fatigue. Exercise regularly can help to avoid and reverse these side effects (Sweeney et al., 2021).

          Moreover, Kim-Ly has serious ailments of respiratory infections including severe cough and shortness of breath. Such symptoms are a clear indication of deterioration of health. Hence, her health assessment and continuous monitoring are required to manage her conditions. This can be followed by medication management as per the assessment to eliminate the pain and suffering of the patient. A patient with a chest infection may need medicines to reduce the discomfort that arises with the infection as well as alleviate pain and stress that may be correlated with it, based on the medical examination. By addressing these issues the nurse can achieve positive health outcomes for Kim-Ly.