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A REPORT THAT ANALYSES FACTORS INFLEUNCING MOVING
UPSTREAM AS AN Ophthalmology Nurse With Glaucoma PAT ...
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A REPORT THAT ANALYSES FACTORS INFLEUNCING MOVING
UPSTREAM AS AN Ophthalmology Nurse With Glaucoma PATIENTS
COURSE - MSc NURSING
MODULE NAME - NURSING AND PUBLIC HEALTH
MODULE CODE – 7004CPD
STUDENT ID -
WORD COUNT – 2,7 21
Academic writing exercise
This is an example assignment submitted by a student in a previo us cohort for you to review
and to use as an academic writing learning exer cise . It is not to be cop ied. It was submitted
through Turnitin and so any work that you submit that is similar or copied f rom it will be
identified in the similarity report generated. Remember , the assignme nt you submit needs
to be your own original work .
The as signment received a pas s mark but has flaws . It is suggested that as you read through
the as signment you reflect , and make notes , on its areas of strength and areas for
development . The questions , following each section , are for guidance only .
Report title :
Does the title clea rly communicate what the report is abou t? Does it reflect the
assignment ta sk?
How might the title of the r eport be im proved ?
TABLE OF CONTENTS
Cover Page……………………………………………………………………………… ... 1
Table of contents …………………………………………………………………………2
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Abstract........... ...................... ............... ..................................................... ...............3
Body ……………………………………………………………………………………… .5
Socioeconomic determinants an d gradient with the diagnosis of glaucoma…. .6
Culture as a factor impacting the health of individuals and communities…… ...7
Epidemiology and its use in health needs assessment………………………….8
Collaboration s and community partic ipation to prom ote health……………… …9
Challenges of public health nurses………………………………………………...11
Glaucoma is a public health problem which accounts for the second leading cause of
irreversible blindness. This report was done to analyse factors influencing moving
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upstream as a pub lic health nurse concerning glaucoma. Recent scientif ic evidence
supporti ng, and contrasting findings were used for evaluation and analysis. Moving
upstream in public health places more emphasis on socio -economic determ inants of
health inequalities. Result s demonstrated that both socioeconomic factors and
cu lture impact the hea lth of an individual and communities however, there was no
clear evidence on the determinants of culture. Based on the findings, collaborations,
implementing policies at governmental levels, employment for all irrespective of
socioecono mic status, and crea ting awareness about glaucoma and the need for
early detention were recommended. The knowledge and understanding of
epidemiology in moving upstrea m was also emphasised and analysed.
How informative is the abstract? Does it present objectively the main ideas that
are to be presented in the report including its conclusion and a summ ary of the
How might the abstrac t be improved?
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The holistic theory of health is attaining individual wholeness, which is dependent on
social, physical, spiritual, and mental factors thereby enabling the i ndividual to
utilise their potentia ls in the community (Svalastog et al. 2017). Keleher and
MacDougall (2016) describe health as one of the most essential parts of living and it
depends on an individual’s idea of the co ncept of health, their experiences, a ge,
gender, awareness, and educatio nal level about certain things and their medical
history. Binns and Low (2015) described public health as the protection and
prevention of diseases, promotion of healthy living of the public, and understanding
the princip les of epidemiology whi ch helps in identifying the pattern of the disease
and those at risk for it. Fisher et al. (2016) stated that the distribution and utilisation
of health services by individuals and communities are greatly influenced by social,
politi cal, cultural, and econ omic factors .
Moving upstream in public health as a nurse focuses on the social, economic, and
political determinants of health and developing policies, laws, and regulations to
reduce health pro blems and inequalities in the communi ty (Syrett 2018). In ad dition,
movi ng upstream in public health emphasises on understanding the socio -economic
determinants of health, implementing policies at a global and government level to
improve health and promote regulations for not only improving h ealth but also
preventi ng diseases and illness in the communities (Ingleby 2019). For the purpose
of this report, the importance of moving upstream as a nurse will be focused on
Glaucoma is a public h ealth issue that results in irreversi ble blindness when not
detected ear ly and the aging of the public will result in an increased burden in the
future (Kreft et al. 2019). Liang et al. (2017) also stated that glaucoma is responsible
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for 12.3% of blindness globally and a global prevalence of 64.3million people in 2 013
and will increase in 2020 to 76million emphasising that the people at the most risk
are those living in Asia and Africa. This is in line with Tham et al. (2014) who
reported a prevalence of 3. 54% of glaucoma for people aged 40 -80 with the highest
incid ence of prim ary open angle glaucoma and angle closure glaucoma in Africa and
Asia, respectively. In addition, McMonnies (2017) discussed that the risk of having
glaucoma increases with age, enviro nmental, socio -economic, and heredita ry
factors; also, women are more at risk for Angle closure glaucoma while men are
more prone to primary open angle glaucoma.
A study conducted by Kyari et al. (2013) believed that Africans are most at risk of
having gl aucoma than other ethnic groups in th e world; additionally, another risk of
going blind from glaucoma is due to inaccessibility to medical services, poor quality
of medical care to individuals, the older generation, genetic and family history and
the adher ence of treatment and follow -up plan. This essay aims to ide ntify factor s
that may influence moving upstream as an ophthalmology nurse when dealing with
Intro duction :
To what extent does the introduction ‘set the scene ’ i.e. establish t he report ’s
purpose, background and c ontext in relation to pub lic health and nursing ? Does it
communicate th e main ideas to be presented in the report?
How m ight the in troduction be improved?
Is this an appropriate ti tle for this section of the rep ort?
It is impossible not to acknowl edge the political aspects when making health
regulations as public health is a combination of both polit ics and science and its aim
and priority is establishing conditions that promote good healthy living in the
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commun ities; this aim cannot be accomplishe d if the major disparities of health are
not understood (Scutchfield and Howard 2011).
Socio -economic d eterminants and gradient with the diagnosis of glaucoma
Health inequalities are differences in the provision and distribution of healthcare
services. Bleich et al. (2012) defined health inequalities as unfairness in health which
could be d ue to access to medical services, gender, age, race, educational and
environmental status. Researchers have established that low s ocio -economic status,
educational and geographical positions increase the possibilities of getting sick,
having appropriate tr eatment, accessi bility to healthcare services, and untimely
death (Clougherty, Souza, and Cullen 2010). This is in line with Dahlg ren and
Whitehead (2007 cited in Gibs on et al. 2011) who explained that determinants of
health such as social, economic and en vironmental fac tors influence the prevention
and promotion of an individual’s health and that these factors can be intervened at
political policy makings and individu al decisions. The knowledge and understanding
of these factors enable ophthalmology nurse s to provide hol istic care for diagnosed
glaucoma patients and the community at large.
Glaucoma has been seen to be more prevalent in Asia and Africa and individuals
with low educational background and monthly income were seen to be more
susceptible to gla ucoma. Buys, Jin and Canadian Glaucoma Risk Factor Study
Group (2013) agree that individuals aged 65 years and older and those loc ated in
poor neighbourhoods with litt le or less monthly income were found to be more
diagnosed with glaucoma as they could not afford a glauco ma detection exam. In
addition, Sung et al. (2017) stated that patients with a pre -existing history of
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glaucoma an d those with low educational backgrou nd were seen to have more visual
impairment from having glaucoma as they lacked awareness about early det ection of
In order to attain health equity and reduce health inequalities of glaucoma and its
social d eterminants, the Marmot review should be considered. He emphasised the
need for employment, healthy living, and housing for al l and to strengt hen health
prevention measures. Bambra et al. (2011) support this by discussing that the
Marmot review is evidence -based and focuses on interventions t o decrease health
disparities by identifying policies and strategies at governmental leve ls.
Countries, w here health inequalities are recorded to be the highest, health promotion
and preventive strategies should be inco rporated into government policies suc h as
housing, labour, safety, and education thereby bringing about equity in health
(Barr eto 2017). To re duce disparities and improve equity in health, government,
Non -governmental organizations should recognise health inequalities and implement
regulation s, policies that could reduce social determinants in healthcare. Garthwaite
et al. (2016) share similar v iews that the reduction of health inequalities is more
effective with policy intervention that supports individual and community efforts.
Cultur e as a factor impacting the health of individuals and communities
As well as socio -economic fa ctors, culture a lso impacts the health of individuals and
communities. Duijster et al. (2018) reported that as well as behavioural and
psychological factors, culture a lso determines educational and socioeconomic
inequalities in health. However, Mansyur et al. (2009) state d that although there are
limited understanding and knowledge about the cultural determinants of health,
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culture a lso births inequalities which could b e direct or indirect relating to the monthly
income and economic improvement. In addition , Lorant and Bho pal (2011) claim that
other than socio -economic determinants, ethnicity is another important determinant
of inequa lity as it is believed that minor eth nicity is associated with low
socioeconomic status and varies between different groups. A lso, Anderson an d
Olson (2014) identified globalization, culture, and territory as other wide
determinants of health that acts on populations rather than individual le vel and that
the lack of understanding of the impact of cultural factors leads to non -adh erence of
the tr eatment plan, unwillingness to use medical services, feelings of disregard and
Epidemiology and its use in health needs assessment
Unders tanding individual health needs and differentiating it from the community is
important in public health. National Institute for Health and Care Excellence (2020)
defined health needs as identifying the health priorities of an individual and
community and f ocussing on the most important need to achieve equity in the
distribution of health servi ces and the effi cient utilization by the population. According
to Bradshaw (1972 cited in Carver, Ward, and Talbot 2008), needs ar e expressed in
different ways such as felt, expressed, normative and comparative by individuals;
while felt needs are an indiv idual’s percepti on of what might be the most important to
them at that moment, expressed needs are putting into action a felt need , normative
needs are based on a prof essional or expert opinion of what is needed and
comparative needs are compared needs to other healthcare providers or services.
Furthermore, Chader (2012) claims that the needs felt by most diagnosed glaucoma
patients are normative as it requires the know ledge and opinions of a professional
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and these needs were identified as a better understa nding of the cau ses of visual
degeneration, the relationship between the severity of glaucoma and age, gender
and individuals with low socioeconomic status and possibl e treatments for glaucoma
other than the known surgical interventions.
The use of epidemiology in identi fying the health needs of individuals and a
community is of great importance. Epidemiology is mainly a branch of m edicine that
analyses how diseases ar e distributed and identifying effective control and
management for it in communities. Wilks (2015) suppor ts that epidemiology focuses
on health issues, identification of risk factors of diseases, and how best to control
them. The understanding and applicat ion of epidemiology in moving upstream as an
ophthalmology nurse with th e prevention and treatment of gla ucoma is important as
it gives an insight of individuals who are more susceptible to glaucoma and the best
possibl e ways of reducing the risk of irreve rsible blindness. This is in line with
Haveman -Nies et al. (2011) who ag ree that epidemiology is the key factor that
strengthens public health practice as it functions in identifying the aetiology of
diseases, mortality rates, populations most affected and evaluate how successfully
implemented health policies and programs impr oves the health of the communitie s.
Collaborations and community participation to promote health
Health education and health promotion are two i nterchangeable words; health
educatio n is about providing information and awareness to populations and
indivi duals on skills to accept and pra ctice which identifies measures to prolong life
and improve wellbeing whereas health promotion is understanding he alth education
and creating policies and strategies to support it (Kumar and Preetha 2012). This is
in line w ith Sharma (2016) who discussed t hat health education is a systematic
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combination of personal knowledge which enhances the application of healthy
behaviours in individuals and populati ons without coercion while health promotion is
applying both knowledge, politics, and organisational assi stance in improving healthy
wellbeing of individuals and communities. However, Golden and Earp (2012)
reported tha t most health promotion and education al professionals have little
knowledge, training, and resources to succe ssfully implement policies. The n urse
and other professionals in the department act as a source of educating and creating
awareness to individuals and the communities about the importa nce of health
promotion and prevention skills as the nurses are usually the first point of contact
with p atients and patient relatives.
Collaboration with different partners at the governmental level in public health to
reduce socio -economic determinants of glaucoma, create awareness about
glaucoma, and provide adequate free glaucoma detention centres for t hose at risk is
important. Moyer (2013) argued that detention centres for glaucoma is lacking and
recommended that early detention helps in reducing th e rate of people who are at
risk for glaucoma and visual impairment. Thi s is in line with Nystrom et al. (2018)
who shared that to close the gap between clinical practice and scientific research,
researchers emphasise o n the need for collaboration and part nership from different
stages of healthcare to improve the promotion of health, distribution, and utilisa tion
of medical services. In addition, sharing resources, ideas, and talents and efficiently
working together to p romote creating awareness for early d etection of glaucoma and
reduce the increasing rate of irreversible blin dness of glaucoma in Africa and g lobally
leads to better health. Estacio et al. (2017) supports that partnership is known to be
more efficient as i t provides holistic steps to attain h ealth equity and promote healthy
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living; also, a partnership is more eff ective with a shared interest and working
together towards achieving a common goal thereby putting into practice policies to
Howev er, Hann (2005) stated that for colla boration to be effective and objectives
met, partners should assume equa l roles and responsibilities and give up control
over another due to adequate resources or knowledge but rather a partner should be
appointed to ta ke up a leadership role; also, emphas is should be placed on
communication between partners as these factors m akes the partnership more
success ful. Also, the participation of the communities in identifying their health needs
and involving them in decision m aking is an important factor in reduc ing health
inequalities and to improve their health. Singh et al. (2017) identified the need for
communit y and individual participation in achieving the proposed public health
objectives at an individual, community, and nationwide levels.
Challenges of p ublic health nurses
The promotion and prevention of the health of the p ublic is the sole responsibility of
everyone however, several factors act as difficulties nurses in achieving the
objectives of public health. Dahl (2018) reported that lack of underst anding of health
inequalities, social determinants, and preventive healt h measures were identified to
be a major challenge of public health to nurses as most nurses focus on the
physiological aspect of the individuals a nd treat on individual levels rather than
community and have no idea of what health prevention and promotion is for
individuals and communitie s; also, lack of resources at work to facilitate the effective
provision of healthcare services is another challen ge. In addition, Farrelly, Flaherty,
and Healy (2019) stated that another challenge of a public health nurse is the lack of
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Information and Te chnology Communications (ICT) which delays accessibility to
medical records of individuals and communities, especi ally in rural areas.
Furthermore, Ke leher and Parker (2013) argued that the nursing staff is important in
pr omoting healthy living however, n urses get inadequate training in schools and
graduate into the clinical field unprepared; therefore, nursing progr ams should
incorporate health promoti on and prevention courses in student nurses curriculum to
increase their knowledge and participation when in the field.
Main bod y of the r eport :
How satisfactorily are the module learni ng out comes (1, 2 and 3) dealt with in th is
part of th e report? Wou ld you deal with them differently? If so, how?
Are rele vant pu blic health/health promotion theoretica l conc epts and pr inciples
explained , analysed and eval uated ?
To what extent is argument created and accounted for theoret ically ?
To what extent is theor y applied to nursing practice and the health iss ue?
Doe s this main part of the report remain focused on the assignment task?
What improvements wo uld you make to th is part of the report?
Create aware ness about the risks of glaucoma and emphasis the need for
early detection especially for As ians, Africans, and the older generation who
are more susceptible to glauc oma.
More studies should be done to understand the cultural determinants of
Intro ducing health education and promotion courses into nurs ing schools’
curriculums to enable nu rses to understand its importance and apply it in
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Crea ting an environment that is fair to all, low socio -economic, low
educational i ndividuals, and those who stay in poor neighbourhoods.
Make early d etection for glaucoma cost -effective for individuals with low
monthly income and provide job opportunities to a fford it.
More studies focused on why Asians, Africans, and individuals older than 40
year s are at more risk of having glaucoma.
Providing access to medical services to improve utili sation.
Implement health education and promotion policies at governmental and
organisational levels to improve healthy living.
Recomm endat ions
What comments would you make about the above recommendations? To what exten t are
they relevant and realis tic? How might the recommendations be improved ? What
recommendations would you make based on what you have read?
In conclusion, glaucoma is a major burden in public health with about 7 6 million
people diagnosed globally. Africans, Asians, the older g eneration, and people with
limited or no access to medi cal care services were seen to be more at risk for having
glaucoma. Socio -economic determinants were identified to have an impact on th e
health equalities of glaucoma patie nts. Collaboration and partne rship were identified
to be ways of promoting health ed ucation and promotion. The health needs of
glaucoma patien ts were identified to be normative as these are needs identified by a
profess ional in relation to improving their health and wellbeing. In addi tion, the need
for epidemiology in accessing the health needs of individuals and communities was
emphasised there by determining individuals at risk for a particular disease or illness,
the o ccurrence of the disease in a geograp hical location, mortality rat e, and possible
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treatments for the disease. The importa nce of adequate communication between
partners and for the m to have responsibilities according to their practice, talents, and
level of knowledge on the problem when collab orating was analysed. The rep ort
achieved its proposed aim of evaluating factors inf luencing moving upstream as a
public health nurse. However , the influence of cultural determinants on health is not
yet understood and more studies should be done to unders tand this .
To wha t extent d oes the conclusion conclude the m ain issues presented in the
Does it contain any new informatio n or ideas?
Does the conclusion demonstrate that the report has accomplished what it se t out
How w ould you improve the conclusion?
Word allocation, s truc ture and coherence
Are there areas of the report where the w ord allocation co uld be us ed more p urposefully ?
(review the suggested w ord count for each section of the report)
Do se nte nces and paragraphs clearly convey meaning? Does the report make sense? Do
ideas and argument flow logically?
Would you make any i mprovements to the structu re of the repor t, its coherence and use
of the word a llocation ?
To what exten t does the report demonstrate critica l thinking in terms of :
o analysis - detailed examination of something e.g. concept s of hea lth
o synthesis - combining or mixing together ideas to make a whole that is differ ent or
new e.g. a new theory of he alth
o evaluation - making a judgement
Remem ber, critic al analysis does not mean ‘fin ding fault ’ but rather involves a thoughtful
examination and eva luation, for example, of an idea /s, defi nition, or an author ’s view o r
Highl ight area s in the assignment where critical analysis could be improved.
In text r eferencing
To what extent d oes the report demonstrate depth and breadth of reading and engage ment
with, and the use of, lite rature , to dev elop ideas and argument ?
Are all claims, assertions and statements suppor ted by a literary source?
Ar e refere nces cited accurately both in the text and in the reference list?
Highlight the ar eas where you think a referenc e is lacking and should be provided.
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Refere nce list
Re write the referen ces , in the refere nce list below , in the CU APA style of referenc ing .
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Labour of Sisyphus? Public Policy and Health I nequalities Research from the
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Barreto, M. L. (2017) 'Health Inequalities: A Gl obal Perspective' . Ci encia & Saude
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