Chapter 4 Health and Illness

Definitions of Health States Health: a state of complete physical, mental, and social well being, not merely the absence of disease Illness: the unique response of a person to a disease Wellness: an active state, oriented toward maximizing the potential of the individual Review “through the eyes of a student” discuss is Carrie healthy. Disease a pathological change in structure and function of the body. Where does mind vs body come into play. Can you be ill with out a disease? (mental illness) Students to define Health. Reflective practice. What would you do? Why?

Human Dimensions of Health Physical Intellectual Emotional Sociocultural Spiritual Environmental aspects See picture next page. How do these interrelate? Ask students for examples of each.

The Human Dimensions Composing the Whole Person

Acute Illness Generally has a rapid onset of symptoms and lasts only a relatively short time Examples: appendicitis, pneumonia, diarrhea, common cold Stages of acute illness: Experienceing symptoms Assuming sick role: ask students what do they want when sick. Mom, ginger ale, crushed ice curl up in bed with TV and tea. Assume dependent role: agree to be cared for by others, nurses in hospital, mom, spouse, Achieve recovery and rehabilitation : give up dependence and reassume normal activities and responsibilities.

Chronic Illness A broad term that encompasses many different physical and mental alterations Examples: diabetes mellitus, lung disease, arthritis, lupus Permanent change Irreversible alteration to anatomy or function Education for rehab and to learn to live with condition Long term care and support Slow onset, remission and exacerbation more common as population ages.

Characteristics of a Chronic Illness It is a permanent change It causes, or is caused by, irreversible alterations in normal anatomy and physiology It requires special patient education for rehabilitation It requires a long period of care or support

Stages of Illness Behavior Experiencing symptoms Assuming the sick role Assuming a dependent role Achieving recovery and rehabilitation

Models of Health and Illness The agent-host-environment model The health–illness continuum The high-level wellness model The health belief model The health promotion model

Agent-Host-Environment Model (Leavell and Clark) Examines the causes of disease in an individual Agent, host, and environment interact in ways that create risk factors Understanding the risk factors is important for the promotion and maintenance of health The host reaction is influenced by family history, age, and health habits The environment includes physical, social, biologic, and cultural factors Each of the agent-host-environment factors affects and is affected by the others Agent is environmental factor or stressor, bacteria, virus, chemical substance Host is living organism cable of being affected by the agent Environment is factors that are external to host that make illness more likely ie: lack of sleep. Cold temperature,

The Agent-Host-Environment Triangle

The Health–Illness Continuum Measures a person’s level of health Views health as a constantly changing state with high- level wellness and death on opposite sides of a continuum Illustrates the dynamic (ever-changing) state of health

The Health–Illness Continuum Individual can view themselves at varying places along the continuum depending on how they feel at any given moment.

The High-Level Wellness Model (Dunn) Encourages the nurse to care for the total person Involves functioning to one’s maximum potential while maintaining balance and a purposeful direction Regards wellness as an active state, oriented toward maximizing the potential of the individual, regardless of his or her state of health Incorporates the processes of being, belonging, becoming, and befitting Active state. More than good health (passive) maximizes the person’s potential. More total person focus incompasses all of the dimensions Being: recognizing self as separate and individual Belonging” being part of a whole: becoming: growing and developing Befitting: making personal choices to befit the self of the future

The Health Belief Model (Rosenstock) Concerned with what people perceive to be true about themselves in relation to their health Modifying factors for health include demographic, sociopsychological, and structural variables Based on three components of individual perceptions of threat of a disease Perceived susceptibility to a disease Perceived seriousness of a disease Perceived benefits of action Example: smoking cessation classes and programs. Does smoker percieve it to be a health problem? Do they believe it will lead to cancer? Are the lifestyle changes worth the effort. Social network?

The Health Promotion Model (Pender) Illustrates the “multidimensional nature of persons interacting with their environment as they pursue health” Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate health-promoting behavior Personal, biologic, psychological, and sociocultural factors are predicative of a certain health-related habit Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan Used to design and provide nursing interventions Used to predict how a person is likely to incorporate health promotion behaviors into their lifestyle. Smoking. If parents smoke children more likely to smoke.

Factors Affecting Health Status, Beliefs, and Practices Risk factors for illness Factors in the human dimensions that influence health– illness status Beliefs and practice Basic human needs Self-concept Internal or external behaviors; Alcoholics, social activity. All friends drink. If give up may need to give up friends. Smokers, light up after a meal. How to change and incorporate. Table 4-1 pg 71 age Genetics Physiolgic ( obesity, chronic disease), Habits Lifestyle Environment

The Human Dimensions Physical dimension—genetic inheritance, age, developmental level, race, and gender Emotional dimension—how the mind affects body function and responds to body conditions Intellectual dimension—cognitive abilities, educational background, and past experiences Environmental dimension—housing, sanitation, climate, pollution of air, food, and water Sociocultural dimension—economic level, lifestyle, family, and culture Spiritual dimension—spiritual beliefs and values

Basic Human Needs Physiological needs Safety and security needs Love and belonging needs Self-esteem needs Self-actualization needs Need essential to emotional and physical health and survival. Part of all dimensions. Relate to Maslow. WWMD vs WWJD? Refer to table 4-2 page 73

Factors That Influence a Person’s Self-Concept Past experiences Interpersonal interactions Physical and cultural influences Education How a person perceives themselves, believes is perceived by others. Impacts response to stress and illness. Example: diffences in perception of how to survive is boat capsized in puget sound.

Levels of Preventive Care Primary prevention—e.g., diet, exercise, immunizations Secondary prevention—e.g., screenings, mammograms, family counseling Tertiary prevention—e.g., medications, surgical treatment, rehabilitation Table 4-3 pg 73 Promote health and prevent development of disease process. Assess risk, health promotion activities, exercise, diet, attitude. Secondary; mamograms, identify and detect disease, health maintenance plans for patients. Allergy testing. Dental care Tertiary: used to achieve maximum functioning for chronic illness, support groups, PT,

Question Which of the following is an example of an acute illness? A. Diabetes B. Rheumatoid arthritis C. Pneumonia D. Osteoporosis

Answer Answer: C. Pneumonia Rationale: Pneumonia is an acute illness that has a rapid onset of symptoms and lasts only a relatively short time. Diabetes, rheumatoid arthritis, and osteoporosis are chronic illnesses that cause a permanent change, require special patient education for rehabilitation, and require a long period of care or support.

Question Tell whether the following statement is true or false. A person who is experiencing a productive cough and fever takes a sick day to recuperate and decide whether to make an appointment with the doctor. This person is said to be in stage 3 of illness behavior: assuming a dependent role. A. True B. False

Answer Answer: B. False A person who defines himself as sick and self-medicates or visits a doctor is said to be in stage 2 of illness behavior: assuming the sick role.

Question Which of the following models of health and illness views health as a constantly changing state, with high-level wellness and death being on opposite ends of a graduated scale? A. Agent-host-environment model B. Health-illness continuum C. High-level wellness model D. Health belief model

Answer Answer: B. Health-illness continuum Rationale: The health-illness continuum measures a person’s level of health on a graduated scale. The agent-host-environment model refers to the interaction of the agent, host, and environment creating risk factors that must be examined. The high-level wellness model involves functioning to maximum potential with balance and direction. The health belief model is concerned with what people believe to be true about their health.

Question Tell whether the following statement is true or false. A person who keeps in touch with neighbors in an attempt to foster a “community feeling” is promoting his or her emotional human dimension. A. True B. False

Question Which of the following is an example of a nursing activity that promotes secondary prevention as a level of preventive care? A. Conducting a smoking cessation class B. Performing a blood pressure screening at a local mall C. Performing range-of-motion exercises on a bedridden patient D. Promoting safe sex practices in school settings

Answer Answer: B. Performing a blood pressure screening at a local mall Rationale: Secondary preventive care focuses on early detection of disease, such as the heart disease in this example. Primary preventive care is directed toward promoting health and preventing diseases. Tertiary care begins after an illness is diagnosed to reduce disability and rehabilitate patients.

Answer Answer: B. False A person who keeps in touch with neighbors in an attempt to foster a “community feeling” is promoting his or her sociocultural human dimension.