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AS 90710 (3.3) Explain a range of health practices currently used in New Zealand Exemplars of student work The following student work is intended to exemplify the grade boundaries between Achievement, Merit and Excellence for this Achievement Standard. See also: Clarification of Standards 2008 National Moderator’s Report Achievement Criteria Achievement Achievement with Merit Achievement with Excellence Explain a range of health practices currently used in New Zealand. Explain, in-depth, a range of health practices currently used in New Zealand. Explain the advantages and disadvantages of these health practices. Compare the advantages and disadvantages of these health practices. Explain, comprehensively, a range of health practices currently used in New Zealand. Compare, perceptively, the advantages and disadvantages of these health practices. Student # 1 Grade boundary and grade: Not Achieved – Achievement Commentary: Note that the student also explained in general terms the philosophies behind Western Scientific Medicine and CAM/TM. This evidence is not reproduced. Criterion one: The philosophy of each health practice is accurately dealt with in some detail, with reference to the health condition (depression) and supported by evidence from a number of resources. The procedures involved for antidepressants are explained, although information about the duration of the course of medication would be useful. For green prescription, the procedures are adequate, although more specific information could be given about the nature of the “30 minutes (of) physical activity”. Some general procedures for acupuncture are given, but no reference is made to how acupuncture is used to treat depression, for example, duration and frequency of treatment. Dimensions of hauora attended to is attempted for antidepressants, but no specific information is given in the response. For green prescription, some valid information is included, although many of the references to hauora would be more suitably placed in the response for criterion two. The response for acupuncture does not contain information about the dimensions of hauora attended to. This student’s work for criterion one lies on the NA – A grade boundary due to the fact that although parts of the response are of very high quality (for example philosophies), other required aspects are omitted or too briefly dealt with. EN 9 of the AS stipulates that the explanation of each health practice must include the philosophy, procedures and dimensions of hauora attended to. For the latter in particular, more information is needed (and it is missing completely from the response for acupuncture). For this reason, criterion one is Not Achieved. Criterion two: Advantages of each health practice are explained and supported by evidence. Meaningful references to how well-being can be enhanced by use of the practices are made. Disadvantages of each health practice are attempted, but are not developed sufficiently, hence the reason for this student’s work sitting on the NA – A grade boundary. The student has explained a number of disadvantages for antidepressants (with use of supporting evidence and with reference to negative impacts on well-being). For green prescription, no disadvantages are given. The overall comparison states that “there (are) not really any negative things…” For acupuncture, disadvantages are only briefly referred to. Some perceptive and informed comparisons are made between the three health practices. Overall, criterion two is Not Achieved due to a lack of explanation of disadvantages for green prescription and acupuncture. Student # 2 Grade boundary and grade: Merit – Excellence Commentary: Note that the student also explained in general terms the philosophies behind Western Scientific Medicine and CAM/TM. This evidence is not reproduced. Criterion one: The philosophy of each health practice is accurately dealt with in some detail, with reference to the health condition (depression) and supported by evidence from resources. Each philosophy is also linked back to the general discussion (see note above), which provides evidence for a well-connected expression of ideas, which is required for Excellence. The procedures involved for antidepressants are explained, although information about the duration of the course of medication would be useful as would how long it takes for the medication to have an effect. For green prescription, some specific detail is given about how a health practitioner prescribes the treatment and provides on-going support. More specific detail could be given as to the nature of the physical activity (the response refers only to an “at home routine” and “gentle exercise”). For St John’s Wort, the key procedures are explained. The response provides excess information about the plant itself. Dimensions of hauora attended to are referred to meaningfully throughout the responses for each health practice. This evidence sits on the M – E grade boundary. Although all required aspects are included and responses are supported by accurate and detailed evidence, there is some variability in the detail provided for each health practice. The response for St John’s Wort contains some unnecessary detail about the plant, and more specific details could be provided for antidepressants and green prescription. Overall, criterion one is Achieved with Merit. Criterion two: Advantages of each health practice are explained and supported by evidence. Meaningful references to how well-being can be enhanced by use of the practices are made. Disadvantages of each health practice are also explained and supported by evidence. For green prescription, the only disadvantage mentioned is possible injury – it would be useful for further disadvantages to be explored. The overall comparison between health practices is sound and well-justified. In terms of evidence towards a perceptive comparison, a link is made to health promotion (SPARC) as well as society’s attitudes towards antidepressants and hypericum. Understanding of the underlying concept of hauora is also evident throughout the response. Criterion two is Achieved with Merit. For the step up to Excellence, more detail is needed (for example further disadvantages for green prescription) and more reference to the underlying concepts is needed (including socio-ecological perspective – effects not only on individual well-being but on relationships and on society as a whole). ACHIEVEMENT CRITERIA TWO Question two: •Explain advantages and disadvantages of each health practice when used to treat or manage the condition you named. •Compare perceptively , these advantages and disadvantages. (a) Explain advantages and disadvantages of each health practice when used to treat or manage the condition you named. Health practice one: Antidepressants When depression is severe, antidepressants can be helpful - even life-saving, such as relieving symptoms such as suicidal thoughts or attempts (1). A study showed that less than 50% of people become symptom-free on antidepressants from trying two types. However, antidepressants don't work for everyone and people who do respond to medication can slip back into major depression within a short while despite continuing with their medication (4). When on antidepressants, patience is the key as it is a trial and error process. The process normally takes about 4 - 6 weeks for antidepressants to reach their full therapeutic effect. A psychiatrist named Petros Mackou says that "strong evidence from the use of antidepressants are more effective than any other treatment for adults with severe depression". While antidepressants make people feel better physically as well as mentally and emotionally by relieving feelings of hopelessness and lack of energy, people can rely on them for a "quick fix" (5). Yes, this doesn't solve the problem. Certain types of antidepressants work best for certain kinds of depression eg. people who are agitated and depressed work best by taking antidepressants. This relates to physical well-being as the anti-depressant can calm a person down and relieve the symptom for being agitated. With the use of anti-depressants a person can have a full recovery if they are used correctly. A person can feel positive, with a good outlook on life and gain the support from others. If antidepressants are used incorrectly, a variety of short or long-term effects can occur such as addiction. Antidepressants have a range of side effects, most common are headaches, nausea, tiredness, restlessness and dry mouth. There are some cases of suicidal thoughts and attempts. To be able to use anti-depressants, four or more symptoms for more than two weeks should have occurred with the person. Depending on how severe the depression is, psychological treatments are usually the first choice for children and adolescents. In society, scientific medicine is one term accepted by physicians as it "has a strong tradition of basic laboratory science" (3). Antidepressants are also accepted by more and more people in society than they were in the past. Researchers agree that when depression is severe, medication can be helpful (4). Health practice two: Green prescription With green prescription there are a lot of advantages and benefits which relate to well-being. The use of green prescription to treat depression by doing exercise has the main focus of changing the chemical imbalance and allows support from others. A person's social well-being has benefitted by the use of green prescription as they have gained interaction with others, made more friends, are closer to family and this also increases mental and emotional well-being as focus on other things which are positive in their life and confidence has been boosted. They also may feel a sense of achievement from the exercise - this will also increase a person's physical well-being by giving a routine, increasing fitness, improved cardiovascular. This can help a person with depression have self-belief, self esteem and a goal in life. However, injury can occur if equipment or stretching is used incorrectly. Green prescription is an easy, simple programme that can "improve a patient's quality of life over 12 months with no evidence of adverse effects" (7). A 16 week research study of three groups (all with depression) using three different treatment methods was done - as a result of exercise, 60.4% were no longer classified as being depressed (7). People have the right to choose green prescription as most health professionals try to give a range of options to treat depression. Green prescription is available nationwide due to the funding from SPARC and Ministry of Health (7). Green prescription is a smart and costeffective way to help people to stay healthy. Health practice three: St Johns Wort Hypericum, also known as St Johns wort, suits a range of people, young to elderly. In modern herbal medicine, hypericum is used first and foremost to treat depression (9). Almost every herbalist would invariably recommend hypericum first as it is safer than aspirin (9). It costs considerably less and is available without a prescription. It is available in most health stores/chemists and maybe in supermarkets in a weaker dosage. Hypericum has a long history of folk use and is not only used for depression, but other illnesses and medical reasons as well. Hypericum is a great advantage to a person as it responds to most things. It can make a person feel refreshed, relaxed and have a positive frame of mind. It can also help a person feel more energised and want to get out more. Hypericum is now the most extensively researched herbal antidepressant known (9). It reduces symptoms significantly. However, it does take at least six weeks for full benefit. It has now become better known and accepted across society and may become the first line of treatment. With the use of hypericum, there is rarely any side effects. There have been cases reported of susceptibility to sunlight, irritations, restlessness, tiredness and allergic reactions. These side effects can effect a person's health even more, and may make the depression symptoms worse. This can put a strain on their physical and mental and emotional well-being as a person will have a lack of movement and will feel worthless and helpless. This is a disadvantage, however the side effects are reversible. (b) Compare perceptively , these advantages and disadvantages. My opinion on the three health practices I have studied, depending on how severe the depression is, is that green prescription would work best for mild to moderate depression. I feel that this three month process will work gradually but most effective as the main focus is on making the person concentrate on other things and it encourages exercise and fitness, as well as support. This programme benefits a person's well-being in all dimensions of hauora by making a person feel included and good about themselves and has the least amount of side effects, injury being the major drawback. The support enables a person to develop a daily routine of exercise and can enhance a person's motivation in life and goal-setting. However, I also feel that if a person's depression is severe, that a combination of antidepressants and exercise would be more beneficial. This will reduce symptoms of helplessness and anxiety and encourage the patient to be motivated. This method will cost more, due to doctor visits and prescription fees, but will work to full potential within 4 - 6 weeks. It does concern me on the amount of short and longterm side effects, but these are only possibilities. I feel that hypericum may also be effective, however not as great as a combination of the other two.