chapter 2 health, wellness, & illnesswellness • a state of well-being • basic aspects...

Chapter 2

Health, Wellness, & Illness

0 Copyright 2012 by Pearson Education, Inc.

Health Vs Wellness


Health

Health (a basic human right):

• Presence or absence of disease

• Ability to maintain normal roles

• Florence Nightingale’s definition of health: a state of being well & using every power the individual possesses to the fullest extent.

• WHO definition: a state of complete physical, mental, & social well-being, and not merely the absence of the disease or infirmity.

• Complete person

• Environment

© Pearson Education 20122

Health

• Process of adaptation to physical & social environment

• ANA definition

○Health is “a dynamic state of being in which the developmental & behavioral potential of an individual is realized to the fullest extent possible”. (1980) → striving toward optimal functioning.

○Health is “an experience that is often expressed in terms of wellness & illness, and may occur in the presence or absence of disease or injury.” (2004)


Health

• A highly individual perception.

• An ongoing process that includes body, mind, & feelings harmoniously.

• Individual definitions (e.g.)

• Free from symptoms or pain

• Be active & to do what they want

• Be in good spirits most of the time

• Factors affecting definitions include previous experiences, expectations of self, age, socio-cultural influences,...etc.


Wellness

• A state of well-being

• Basic aspects include:

‒ Self-responsibility

‒ An ultimate goal

‒ A dynamic, growing process

‒ Daily decision-making in areas related to health

‒ Whole being of the individual


Components of wellness (fig 2-2)

1. Physical Dimension

• Ability to carry out daily tasks

• Achieve fitness

• Maintain nutrition

• Avoid drug abuse, alcohol, tobacco

2. Social Dimension

• Interact successfully

• Develop & maintain intimacy

• Develop respect & tolerance for others


Components of wellness

3. Emotional Dimension

• Ability to manage stress

• Ability to express emotion

4. Intellectual Dimension

• Ability to learn

• Ability to use information effectively

• Striving for continued growth & learning to deal with new challenges



5. Spiritual Dimension

• Belief in some force (e.g. nature, science, religion) that serves to unite

• Includes a person’s own morals (right vs. wrong), values, & ethics (behaviors)

6. Occupational Dimension

• Ability to achieve balance between work & leisure

• Beliefs about education, employment, & home influence personal satisfaction & relationships with others



7. Environmental Dimension

• Ability to promote health measures in the community that improve standard of living & quality of life

‒ Includes influences such as food, water, & air.

* The 7 components overlap.


Well-being

• A component of health.

• Subjective perception of vitality & feeling well

• Described objectively, experienced, measured

• Can be plotted on a continuum


Models of Health

• Clinical Model (people are physiologic systems, health is the

absence of disease or injury)

• Role Performance Model (the individual’s ability fo fulfill

societal roles, e.g., mother, daughter, friend )

• Adaptive Model (disease is a failure in adaptation)

• Eudemonistic Model (a comprehensive view of health;

health is a condition of actualization or realization of a person’s potential) (Eudemonistic the doctrine that the basis of moral obligations is to be found in the tendency of right actions to produce happiness.)

• Agent-Host-Environment Model (used primarily in

predicting illness)

• Health–Illness Continua © Pearson Education 201211

Clinical Model

• People viewed as physiologic systems

• Health identified by the absence of signs & symptoms of disease or injury

• A state of NOT being ‘sick’

• Opposite of health is disease or injury

• Mostly used by medical practitioners.


Role Performance Model

• Ability to fulfill societal roles

• Healthy even if clinically ill IF roles are fulfilled

• Sickness is the inability to perform one’s role


Adaptive Model

• Health is a creative process

• Disease is a failure in adaptation (or maladaption)

• Extreme good health is the flexible adaptation to the environment

• Focus is on stability, growth, & change


Eudemonistic Model

• Comprehensive view of health

• Health is a Condition of actualization or realization of a person’s potential (The apex of human needs)

• Illness is a condition that prevents self-actualization


Agent-Host-Environment Model

• The model has three dynamic interactive elements:

○ Agent: any environmental factor that by its presence or absence can lead to illness

○ Host: a person who may or may not be at risk of acquiring a disease.

○ Environment: all factors external to the host

• Each factor constantly interacts with the others.

• When in balance, health is maintained.

• When not in balance, disease occurs.


Health–Illness Continua

• Health & illness/disease can be seen as opposite ends of a health continuum

• A person moves back & forth within this continuum day by day

• No distinct boundary across which people move from health to illness or from illness back to health


Travis’s Illness – Wellness Continuum

Copyright 2012 by Pearson Education, Inc.

The 4+ Model of Wellness

• The model consists of the four domains of the inner self (physical, spiritual, emotional, & intellectual) plus the elements of the outer systems (environment, culture, nutrition, safety, and many other elements).

Copyright 2012 by Pearson Education, Inc.

Factors Affecting Health Status, Beliefs, & Practices

• Internal variables:

❑ Described as non-modifiable variables because they can’t be changed.

❑ So, regular health exams & appropriate screening for early detection of health problems are very important.

• External variables: mostly modifiable.


Internal Variables

Biologic dimension

• Genetic makeup

○ Influences biologic characteristics, innate temperament, activity level, & intellectual potentials.

○ e.g., susceptibility to diseases (e.g., DM & cancer).

• Gender

○ Influences the distribution of disease

○ e.g., osteoporosis is more common among females, stomach ulcers are more common among males.

• Age & developmental level

○ Communicable diseases as measles are common in children but rare in elders.

○ Arteriosclerotic heart diseases are common in middle age.


Internal Variables

Psychologic (emotional) dimension

• Mind–body interactions

○ It can affect health status positively or negatively (Both ways).

○ Emotional responses to stress affect body function (e.g.,

prolonged emotional distress may increase susceptibility to organic

diseases).

○ Relaxation, meditation can improve psychological functions.

• Self-concept

○ How a person feels about self (self-esteem) and perceives the physical self (body image), needs, roles, & abilities.

○ Self concept affects how people view & handle situations.

○ Such attitudes can affect health practices & responses to illness (e.g., anorexic women for wt loss).


Internal Variables

Cognitive dimension

• The intellectual factors that include lifestyle choices, and spiritual & religious beliefs.

• Lifestyle: a person’s general way of living including living conditions & individual patterns influenced by socio-cultural factors & personal characteristics.

• It may have positive or negative effects (RISK FACTORS) on health.


External Variables

Physical environment

• Geographic location determines climate, and climate affects health.

• Pollution

• Tobacco

• Radiation (X-ray, sun)

• Asbestos (carcinogenic)

• Carbon dioxide (Greenhouse)

• Pesticides & chemicals


External Variables

Standards of living

• Reflect occupation, income, & education

• Hygiene, food habit, seeking health care, following regimen???

• Low income families often define health in terms of work.

• Environmental conditions of poverty-stricken areas.

• Occupational roles predispose people to certain illnesses.


External Variables

Family & cultural beliefs

• Open communication, sharing, and love → person’s

optimum potentials.

• Cultural rules, values, beliefs give sense of stability.

• Conflicts between generations.

Social support networks

• Support network (family, friends, & confidants) and job satisfaction help people avoid illnesses.

• Provide the stimulus for an ill person to become well again


Health Care Adherence

• Def: Extent to which individual’s behavior coincides with medical/health advice.

• Ranges from total disregard to following total plan. WHY???

• To enhance adherence, nurses need to ensure that the client:

✓ Is able to perform the prescribed therapy

✓ Understands the necessary instructions

✓ Is a willing participant in establishing goals of therapy

✓ Values the planned outcomes of behavior changes.


Factors Affecting Health Care Adherence

1. Client motivation

2. Degree of lifestyle change necessary

3. Perceived severity of the problem

4. Value placed on reducing the threat of illness

5. Difficulty in understanding & performing specific behaviors

6. Degree of inconvenience of the illness itself or of the regimens


Factors Affecting Health Care Adherence (continued)

7. Complexity, side effects, & duration of the proposed therapy

8. Specific cultural heritage that may make adherence difficult

9. Degree of satisfaction, quality, & type of relationship with the healthcare providers

10. Overall cost of the prescribed therapy


Health Care Adherence

Steps to reduce client’s nonadherence:

1. Establish why the client is not following the regimen.

2. Demonstrate caring (showing concern & acceptance).

3. Encourage healthy behaviors through positive reinforcement.

4. Use aids to reinforce teaching (pamphlet, pill calendar).

5. Establish a therapeutic relationship of freedom, mutual understanding, & mutual responsibility with the client & support person (by providing knowledge &

skills).

Illness & Disease

• Illness: a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished.

• Not synonymous with disease.

• May or may not be related to a disease.

• It is highly subjective: Only the person can say if he or she is ill.

Illness & Disease

• Disease: an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span.

• Primitive people: thought forces or spirits caused disease.

• Today, multiple factors are considered to interact in causing disease.

• Etiology: the causation of a disease.

• Etiology includes description of all causal factors that act together to bring about the disease.


Classification of Illness & Disease

Acute Illnesses

• Severe symptoms of relatively short duration.

• Symptoms often appear abruptly & subside quickly.

• May or may not require intervention by healthcare professionals

• May be serious or minor.

• Most people return to normal level of wellness


Classification of Illness & Disease

Chronic Illnesses

• Lasts for an extended period, usually > 6 months.

• Often have a slow onset.

• Often have periods of remission (when symptoms

disappear) & exacerbation (when symptoms reappear).

• Care includes promoting independence, a sense of control, & wellness.

• Modify activities of daily living, social relationships, and perception of self & body image.

• Requires learning to live with physical limitations & discomfort.


Illness Behaviors

• Def: a coping mechanism involves how people describe, monitor, interpret their symptoms, take remedial actions, & use the healthcare system.

• People behave in certain ways when become ill (Highly individualized)

• Illness behavior is affected by many variables such as age, gender, occupation, socioeconomic status, religion, ethnic origin, psychological stability, personality, education, modes of coping.

• Suchman describes 5 stages of illness (not all pts go

through the 5 stages)

Suchman’s Stages of Illness

Stage 1: Symptom experience

• Believe something is wrong (felt or told).

• Has 3 aspects:

1. Physical experience of symptoms (e.g. cough, nausea).

2. The cognitive aspect (interpretation of symptoms).

3. The emotional response (e.g. fear, anxiety).

• Consults others about the symptoms or feelings.

• Try home remedies.

• If self management is ineffective, the individual enters the next stage.© Pearson Education 201236


Stage 2: Assumption of the sick role

• Accepts the sick role & seeks confirmation.

• Continues with self treatment & delay contact with healthcare professionals.

• May be excused from normal duties & role expectations.

• Emotional responses (e.g. withdrawal, anxiety, fear,...)

• When symptoms persist or increase, the person seeks professional help.


Stage 3: Medical care contact

• Seeks advice from a health professional & asks for 3 types of information:

○ Validation of a real illness.

○ Explanation of the symptoms in understandable terms.

○ Reassurance that they will be all right or prediction of what the outcome will be.

• The health professional determines that client does not have an illness OR an illness is present.

• The client may accept or deny the diagnosis.


Stage 4: Dependent client role

• Becomes dependent on the professional for help

• Most people accept their dependence on the primary care provider (Not an easy decision)

• For a client:

○ Illness may meet dependence needs → satisfaction

○ Have minimal dependence needs or

○ Try to maintain independence



Stage 5: Recovery or rehabilitation

• Relinquish the dependent role

• Resume former roles & responsibilities

• Time depends on type of illness.


Effects of Illness

• The changes (pt & family) depend on:

– The nature, severity, & duration of illness.

– Attitudes associated with the illness by the client & others.

– The financial demands

– The lifestyle changes.

– Adjustments to usual roles.


Impact of Illness on client

• Behavioral & emotional changes (according to the illness)

• Self-concept & body image changes

• Loss of autonomy (independence & self-direction)

• Lifestyle changes


Impact of Illness on family

• Depends on three factors

‒ Member of the family who is ill

‒ Seriousness & length of the illness

‒ Cultural & social customs the family follows

• Changes that can occur in family:

• Role changes

• Task reassignments.

• Increased stress due to anxiety about the outcome of illness.

• Financial problems.

• Loneliness as a result of separation & pending loss.

• Changes in social customs


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