1. Concepts of Health, Illness, Stress, and Health Promotion
Chapter 2
Concepts of Health, Illness, Stress, and Health Promotion
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

2. Chapter 2
Lesson 2.1
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3. Learning Objectives Theory
Compare traditional and current views of the meanings of health and illness.
Describe what the word “health” means to you.
Define what “sickness” means to you.
Discuss why nurses need to be aware of any cultural, educational, and social differences that might exist between themselves and their patients.
Compare cultural/racial differences in disease predisposition and communication between the main cultures and different races.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

4. Learning Objectives Clinical Practice
Observe patients during the data-gathering process and interview process and determine their views on health and illness.
Recognize cultural differences in health care concepts and behaviors in the clinical setting and be able to share those observations with fellow students.
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5. Health and Illness Health means different things to people
Absence of disease
Optimum functioning on every level
Miller-Keane dictionary defines health as:
“A relative state in which one is able to function well physically, mentally, socially, and spiritually in order to express the full range of one’s unique potentialities within the environment in which one is living”
It is important to define what you believe health and illness to mean because your perception of these terms influences what you say and do when caring for patients.
What may influence a person’s idea of what the meaning of health is to him or her?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

6. Traditional Views of Health and Illness
Chronic illness
Develops slowly over a long period and lasts throughout life
Acute illness
Develops suddenly and resolves in a short time
Terminal illness
No cure available; ends in death
Who influenced the traditional view of health in Western culture?
For many years an acceptable definition of health was simply “the absence of disease.”
In 1946, the World Health Organization redefined health as “the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

7. Traditional Views of Health and Illness (cont’d)
Primary illness
Develops without being caused by another health problem
Secondary illness
Results from or is caused by a primary illness
Peripheral vascular disease resulting from diabetes is an example of a secondary illness.
Some diseases are inherited (genetic) or congenital (present at birth). Sickle cell anemia is an inherited disease.
What is an idiopathic illness?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

8. Stages of Illness Transition stage Acceptance stage
May deny feeling ill, but recognize symptoms of illness are present
Acceptance stage
Acknowledge illness and take measures to become well
Convalescence stage
Recovering after the illness and regaining health
When experiencing illness, people act in ways called illness behaviors.
Fear of what the problem may be and of undergoing examination and diagnostic procedures often causes anxiety.
During convalescence from a chronic illness, total recovery is replaced by either adaptation (adjustment in structure or habits) or maladaptation (lack of adjustment).
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

9. Current Views of Health and Illness
Health evaluated on a graduated scale or continuous spectrum
Ranges from obvious disease through absence of disease to a state of optimum functioning in every aspect of life
In general, being healthy means being able to function well physically and mentally and to express the full range of one’s potential within one’s environment.
Who is René Dubos, and who is Halbert Dunn?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

10. Implications of Current Views
Value of nursing as caring profession reinforced
Although nurse is involved in curing the ill or injured, goal is primarily under the control of physician
Nurses seek to help patients use coping skills
A common theme in all of nursing theory is that nursing is concerned with helping people cope with adverse physiologic, psychosocial, and spiritual responses to illness, rather than with treating the illness itself.
Since Florence Nightingale, nurses have encouraged a wholesome environment in the home, hospital, and community.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

11. Health and Illness Behavior
Health behavior
Any action taken to promote health, prevent disease, or detect disease in early, asymptomatic (without symptoms) stage
Illness behavior
Any activity a person takes to determine her actual state of health and seek a suitable remedy for a health problem
Health and illness behaviors are based on what a person knows and believes about health and illness.
What are some examples of health behavior? Illness behavior?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

12. Cultural Influences on Concepts of Health and Illness
Racial and ethnic differences apparent in attitudes and practices related to:
Birth, death, and general health care
Susceptibility to specific diseases
Responses to pain and suffering
Personal hygiene and sense of privacy
Adjustment to life changes
Great cultural diversity in the United States brings many differences between the values and practices of various ethnic and minority groups.
Many cultural health beliefs are based on folk medicine passed down through the generations within a culture.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

13. Question  1  
Illness occurs in three stages. All of the following are stages of illness except the:
transition stage.
acceptance stage.
convalescence stage.
terminal stage.
Answer: 4
Rationale: There are three stages of illness: a transition stage (onset), an acceptance stage (sick role), and a convalescence stage (recovery).
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

14. Question 2
Jane has hypertension and has recently suffered a mild stroke. This diagnosis is an example of a/an:
primary illness.
secondary illness.
idiopathic illness.
terminal illness.
Answer: 2
Rationale: A secondary illness (such as a stroke) results from or is caused by a primary illness (such as hypertension). An idiopathic illness is one in which there is no known cause. A terminal illness is incurable and results in death.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

15. Chapter 2
Lesson 2.2
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16. Learning Objectives Theory Clinical Practice
List the components of holistic health care.
Identify the four areas of human needs and give an example within each level of need.
Identify ways in which the body adapts to maintain homeostasis.
Clinical Practice
Determine a patient’s status on Maslow’s hierarchy during a clinical experience.
Describe alterations in homeostasis as observed in the clinical setting.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

17. The Holistic Approach
Nurses take holistic approach to caring for the sick and promoting wellness
Considers biologic, psychological, sociologic, and spiritual needs
Acupuncture, acupressure, biofeedback, meditation, and various relaxation techniques
The current focus on holism was stimulated by Jan Smuts, a noted South African who formulated a philosophical theory of holism.
In the holistic approach to healing, the person is the central focus, not the illness or injury.
What influences our basic beliefs about other humans and our relationships with them?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

18. Maslow’s Theory of Basic Needs
Hierarchy of human needs as an explanation for the things that motivate human behavior
Basic physical needs—food, air, water, rest—must be satisfied before emotional needs
Used to determine priorities of nursing care
Maslow’s hierarchy takes into account the social needs and personal needs of the individual.
In acute illness, which needs are most often compromised? (physiologic)
In chronic illness, which needs are affected? (All of them may be affected.)
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19. Maslow’s Theory of Basic Needs (cont’d)
Physiologic needs
Fundamental physical needs essential to maintain life
Security and belonging
Security for patients depends on reassurance that their physiologic and safety needs will be met
Each person needs to feel that she belongs or is attached to others
Protection from physical harm, from a nursing standpoint, is often equivalent in importance to physical needs.
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20. Maslow’s Theory of Basic Needs (cont’d)
Self-esteem and love and belonging
Interrelated, because one cannot truly love others until one first loves or accepts oneself
Self-actualization
Occurs when individuals are comfortable with themselves and are certain of their beliefs and values
How does self-esteem develop?
Nursing actions that facilitate self-actualization are pertinent mainly during rehabilitation periods, when the nurse assists the patient to strive to achieve full potential.
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21. Homeostasis
Biologic systems maintain stability of internal environment by continually adjusting to changes necessary for survival
Wellness maintained or regained when one is able to keep a sense of balance while adapting to factors that can upset that balance
Stress disturbs homeostasis and causes the body to attempt to adapt
In order to enjoy some degree of health and sense of well-being, one must adapt to factors in the external environment.
What is maladaptation?
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22. Adaptation A response to change
Body’s systems have self-regulatory mechanisms to maintain homeostasis
Requires pathway of communication between the brain and various body systems
Coordination of the central nervous system, the autonomic nervous system, and the endocrine system is required for the body to adjust, adapt, and maintain equilibrium.
What comprises the central nervous system?
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23. Central nervous system structures
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24. The General Adaptation Syndrome
Occurs in response to long-term exposure to stress
Stages
Alarm stage
Stage of resistance
Stage of exhaustion
In 1950, Hans Selye, a Canadian physician, published his research-based theories on stress.
Selye concluded that stress plays a role in every disease process because of faulty adaptation (maladaptation) by the body.
What did Selye believe would happen if the body overreacts in defending itself?
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25. Question 3
A teenage drug addict who has lost numerous jobs states, “I do not have a problem with drugs. Everyone uses them as much as I do. I can quit anytime.” This is an example of which coping mechanism?
Denial
Repression
Rationalization
Displacement
Answer: 1
Rationale: Denial is a more serious form of repression. The person lives as though an unwanted piece of information or reality does not exist.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

26. Chapter 2
Lesson 2.3
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

27. Learning Objectives Theory
Explain why a particular stressor may be experienced differently by two people.
List the common signs and symptoms of stress.
Identify four ways in which a nurse can help decrease stress and anxiety for patients.
Clinical Practice
Document observations about stress-reduction techniques used by staff or patients during a clinical experience.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

28. The Effects of Stress
A stressor can be helpful or harmful depending on the person’s:
Perception of the stressor
Degree of health and fitness
Previous life experiences and personality
Available social support system
Personal coping mechanisms
What may cause a very mild reaction in one person may cause a much stronger reaction in someone else.
What are some common patient stressors?
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29. Coping with Stress Coping—adjusting to or solving challenges
Three types of coping responses:
Actions or thoughts that change the situation so it is no longer stressful
Alteration of thoughts to control the meaning of the situation before it triggers a stress response
Control of thoughts and actions to stop a stress reaction
Coping mechanisms help us to resist and master stressors.
Ways to achieve coping responses are:
Seeking information
Taking direct action
Stopping an unhelpful reaction
Discussing the situation with someone from your social support system
Using defense mechanisms to perceive the situation differently
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30. Defense Mechanisms Strategies that protect us from increasing anxiety
Reduce anxiety and the secretion of stress hormones
Used to maintain and improve our self-esteem
Can be overused in a maladaptive way
Unconsciously using defense mechanisms gives us time to solve the problem and adapt in a positive manner.
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31. Stress Reduction Techniques
Progressive relaxation
Imagery
Massage
Biofeedback
Yoga
Meditation
Regular physical exercise
How does exercise promote a feeling of well-being and tranquility?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

32. Health Promotion and Illness Prevention
Healthy People 2010 : Understanding and Improving Health
Created by scientists: a comprehensive set of objectives for disease prevention and health promotion for the nation
Goals
Increase the quality and years of healthy life
Eliminate health disparities  
Every nurse has a responsibility to patients to promote better health through teaching about illness prevention, periodic diagnostic testing for cancer and diabetes, and safe health practices.
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33. Health Promotion and Illness Prevention (cont’d)
Primary prevention
Avoid or delay occurrence of a disease or disorder
Secondary prevention
Follow screening guidelines for easily treated diseases if found early or detecting disease return
Tertiary prevention
Rehabilitation measures after disease/disorder has stabilized
What are some examples of each type of prevention?
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

34. Question 4
A nurse should minimize stress for a patient whenever possible. A common measure to reduce stress is:
explaining all procedures.
listening carefully and answering all questions.
providing privacy.
All of the above
Answer: 4
Rationale: Explaining procedures, listening carefully to the patient, answering questions, and providing privacy reduce stress by meeting basic security needs as identified by Maslow. In addition, these measures provide respect and dignity to the patient.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.

35. Question 5
A charge nurse is reviewing a student’s charting. Which descriptive term might be considered inappropriate when charting an assessment?
Agitated
Nauseated
Fatigued
Noncompliant
Answer: 4
Rationale: Assessment must be done without criticism, with an open mind, and with active listening. Judgmental terms such as noncompliant, uncooperative, ignorant, lazy, or unmotivated should not be used to describe another person’s health or behavior.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.