PRINCE SULTAN MILITARY COLLEGE OF HEALTH SCIENCES Nursing Diploma Department PSMCHS, Dhahran

C OURSE C ODE : N URS 112

T ITLE : FUNDAMENTALS D ESCRIPTION

OF

OF

NURSING

D ATE D EVISED : DEC 2003 D ATE R EVISED : MAY 2004 N.

O

T OPIC : C ONTEMPORARY H EALTH C ARE : H EALTH , W ELLNESS

AND

L ECTURE N OTES N. NURS112.006

I LLNESS

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P AGES :

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OBJECTIVES
At the completion of this lecture, the trainee shall be able to: 1. 2. Define the terms: health, wellness and illness. Discuss examples of models of health and illness including: - The Health Illness Continuum - Maslows Hierarchy of Needs - Agent-Host-Environment Triangle - Holistic Health Model - The Human Dimensions Discuss variables that influence health beliefs and a client's perception of health, wellness and illness. Discuss health, wellness and disease prevention strategies. Identify and discuss the three (3) levels of preventative care. Outline five (5) risk factors that influence health. 7. 8. 9. Discuss risk factor modification and identify four (4) health behaviours. Identify internal and external variables that influence illness behaviour. Briefly discuss the impact of illness on the client and their family.

3. 4. 5. 6.

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HEALTH
The World Health Organization (WHO) defines health as a state of complete physical, mutual and social well-being, not merely the absence of disease or infirmity (WHO, 1947). People define health in relation to their own values, personality, experience and lifestyle, and will vary among: age groups, gender, race and culture.

WELLNESS
Wellness can be thought of as a dynamic balance among the physical, emotional, social and spiritual aspects of a persons life - wellness behaviors promote healthy functioning and help prevent illness.

ILLNESS
Illness is a state in which a persons physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with the persons previous experience. Illness could also be seen as a product of the disharmonious interaction between mind and body.

DISEASE
Disease is a pathological change in the structure or function of the body, mind, emotions and spirit.

MODELS OF HEALTH AND ILLNESS

1. HEALTH ILLNESS CONTINUUM MODEL
A person adapts to changes in the internal and external environments to maintain a state of physical, emotional, intellectual, social, developmental and spiritual well-being over a lifetime.

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Health

High level wellness

Risk factors to functionin g in all dimension s

Severe Illness

Illness

The Health Illness Continuum

2.

BASIC HUMAN NEEDS MODEL

Basic human needs are elements that are necessary for human survival and health, e.g., food, water, safety and love and are shared by all people.

Maslows Hierarchy of Human Needs could be used to understand the interrelationships of basic human needs:
Survival needs: Security needs: without these nothing else matters; e.g., food, water shelter safety from danger and safety in numbers - this covers everything from having a big group of friends, to having a parent looking out for you, to having a system of law and order in a society. association with a group with which you identify - a family, a social group, some likeminded peers (i.e., the need not to be an outcast). love for ones family and friends - the need to have people around you that care deeply and to care in return.
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Belonging needs:

Love needs:

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Self esteem needs:

need to achieve a level of competence or status that one feels is useful and deserving of respect in society. the need to control and create within ones environment freedom to express individuality that will not collide with the needs for belonging and esteem. the need for people to pursue intellectual avenues and probe the reaches of human understanding. connecting with the power of God, Allah or the development of a consistent and nourishing philosophy (because one needs a reason to live).

Self expression needs:

Intellectual needs:

Spiritual needs:

SELF ACTUALIZATION Pursue inner talent, Creativity, Fulfillment SELF ESTEEM Achievement, Mastery, Recognition, Respect BELONGING LOVE Friends, Family, Spouse, Lover SAFETY Security, Stability, Freedom from fear PHYSIOLOGICAL Foodl, Water, Shelter, Warmth

Maslows Hierarchy of Needs

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3.

HEALTH BELIEF MODEL (ROSENTOCHS 1974)

o The health belief model is concerned with what people believe to be true about themselves in relation to their health.

It is based on three (3) components of a disease:

1. This involves the individual awareness of their ability to be ill or to recognize the familial link of a disease. 2. The individuals view of the seriousness of an illness is also related to how much the person knows about the disease, advice from friends and family, mass media etc. 3. This is how effective the individual believes preventive measures will be in preventing illness - preventive action could be lifestyle changes, increased awareness of medical therapies or a search for medical advice or treatment. INDIVIDUAL PERCEPTIONS MODIFYING FACTORS Demographic variables (age, sex, race, ethnicity, etc.) Socio-psychologic variables (personality, social class, peer and reference-group pressure, etc.) Structural variables (knowledge about the disease, prior contact with the disease, etc.). LIKELIHOOD OF ACTION Perceived benefits of preventive action minus Perceived barriers to preventive action.

Perceived susceptibility to disease X versus Perceived seriousness (severity) of disease.X

Perceived Threat of Disease X

Likelihood of taking recommended preventive health action.

Cues to action Mass media campaigns Advice from others Reminder postcard from physician or dentist Illness of family member or friend Newspaper or magazine article

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The health-belief model helps nurses to understand factors influencing clients perceptions, beliefs and behavior.

4.

HOST-AGENT-ENVIRONMENT MODEL (LEAVELL AND CLARK 1965)

This model is useful for examining the causes of diseases in an individual. Host: Agent: Environment: A person who may be at risk to an illness influenced by the persons family history, age and health habits. Any factor (internal or external) that can lead to illness by its presence or absence. Physical, social, economic, emotional, cultural, or spiritual factors that creates the possibility for the person to develop a disease.

Health and Illness depend on the interaction of these three factors in this model.

Environment

Agent

Host

5.

HOLISTIC HEALTH MODEL

In the holistic approach, the interaction of a persons mind, body and spirit is acknowledged. Holism is based on the belief that people cannot be fully understood if not examined individually and in pieces apart from their environment. Holism sees people as ever changing systems of energy. Holistic nursing interventions can be used such as music therapy, relaxation therapy, therapeutic touch, and massage therapy.

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Most holistic therapies are easily learned and can be applied to almost any nursing setting and in all stages of health and illness.

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6.

BASIC HUMAN NEEDS THE HUMAN DIMENSIONS MODEL

Physiological Needs (Physical Dimension): Involve breathing, intake and output of food and fluids, temperature, circulation and movement. Safety and Security Needs (Environmental Dimension): Related to physical surroundings as they affect safety and security including housing, neighbourhood and climate. Love and Belonging Needs (Socio- cultural dimension): related to a persons relationships and communications with family, friends and a group. Self-esteem Needs (Emotional dimension): involve the feelings of a person, such as fear, happiness, sadness, loneliness and feeling good about oneself. Self-actualization Needs (Intellectual and Spiritual Dimension): focuses on processes such as thinking, learning, problem solving and decision-making. Also relate to experience of love, joy, peace and fulfilment.

Environmental

Sociocultural

Intellectual

WELLNESS

Emotional

Spiritual

Physical

The Human Dimensions

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VARIABLES INFLUENCING HEALTH BELIEFS AND PRACTICES

1. Internal Variables
Include a persons developmental stage, intellectual background, perception of functioning, emotional and spiritual factors. Developmental Stage: A persons thought and behavior patterns change throughout life. A client's level of growth and development should be considered (child or adult). Good communication through provision of age-appropriate explanations to increase the clients understanding and knowledge is necessary. Emotional development may also influence personal beliefs about health-related matters.

Intellectual Background: A persons belief about health is shaped in part by the persons knowledge about the body and illness, educational background and past-experiences. Cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness.

Perception of Functioning: The way people see their physical functioning, affects health beliefs and practices. Subjective data Objective Data : : The way a client recognizes physical functioning, such as level of fatigue, pain, etc. Blood pressure, height measurements, lung sounds, etc.

Emotional Factors: The clients degree of calmness or stress can influence health beliefs and can actually change body responses to illness.

Spiritual Factors: Spirituality is reflected in how a person live his or her life, including the value and beliefs exercised, relationships established with family and friends and the ability to find hope and meaning in life. Religious practices are the way that people exercise spirituality.

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2.

External Variables
Family Practices: The way that clients families use health care services generally affects their health practices. Their view of the seriousness of diseases and their history of preventive care behaviors can influence how clients think about health.

Socioeconomic Factors: Psychosocial variables include the stability of the persons marital or intimate relationship, lifestyle habits and learning environment. A person generally seeks approval and support from social networks, neighbours, equals, co-workers. The desire for approval and support affects health beliefs and practices. Social flexibility partly determine how the health care system provides medical care how clients obtain care, treatment method, economic cost and potential refunding to the health care agency or client. Economic variables may affect a clients levels of health by increasing the risk for disease and influencing how or at what point the client enters the health care system. It also affects a persons cooperation with the treatment that is designed to maintain or improve health.

Cultural Background: Cultural background influences beliefs, values and customs. It influences the approach to the health care system, personal health practice and the nurse-client relationship. May also influence an individuals beliefs about causes of illness as well as remedies or practices to restore health. Cultural differences can affect the progression of health care.

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HEALTH PROMOTION, WELLNESS AND ILLNESS PREVENTION

Health promotion activities help clients maintain or enhance their present levels of health such as routine exercise and good nutrition. Wellness education teaches people how to care for themselves in a healthy way and include topics such as physical awareness, stress management and self-responsibility. Illness prevention activities such as immunization programs protect clients form actual or potential health threats. The goal of a total health program is to improve a clients level of well-being on all levels, not just physical health.

Health can be influenced by:

Individual Practices: Physical Stressors: Hereditary and Psychological Stressors: poor eating habits and little or no exercise poor living environment, exposure to air pollutants, unsafe environment emotional, intellectual, social, developmental and spiritual factors

Health programs are directed at individuals changing their lifestyle by developing habits that can improve their level of health. An individual takes responsibility for health and wellness by making appropriate lifestyle choices that will affect a persons quality of life. Prevention of illness can reduce anxiety, stress, pain and suffering. It also enables the ongoing attainment of life goals and has an economic impact in that it decreases health care costs.

LEVELS OF PREVENTIVE CARE

1.

Primary Prevention
Primary prevention precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy. It is aimed at health promotion including health education programs, immunization and physical fitness activities. Primary prevention also includes all health promotion efforts, as well as wellness activities that focus on maintaining or improving the general health of individuals, families and communities.

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2.

Secondary Prevention
Secondary prevention focuses on individuals who are experiencing health problems or illness. Activities are directed at diagnosis and immediate action to reduce severity. Secondary prevention also includes screening techniques and treating early stages of disease to limit disability by delaying the consequences of advanced disease.

3.

Tertiary Prevention
Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effects of long-term disease by interventions directed at preventing complications and deterioration. Activities are directed at rehabilitation and aims to help clients achieve the highest level of functioning possible, despite limitations caused by illness or impairment.

RISK FACTORS
The presence of risk factors does not mean that a disease will develop but increase the chances that an individual will experience a particular disease or dysfunction.

1.

Physiological Factors
Certain physical conditions, such as pregnancy or overweight, place increased stress on physiological systems. (e.g., circulatory system)

2.

Genetic Factors
Heredity to a specific illness e.g. diabetes mellitus, is at risk for developing the disease later in life. (Cancer, heart disease, kidney disease, mental illness).

3.

Age
Age increases susceptibility to certain illness.

4.

Environment
The physical environment in which a person work or lives can increase the susceptibility towards some diseases e.g. cancer, industrial related illnesses, chemicals. Living under poor conditions could increase the likelihood of infections and other diseases.

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5.

Lifestyle
Many activities, habits and practices involve risk factors. Practices with potential negative effects are risk factors, e.g. overeating, poor nutrition, insufficient rest and sleep and poor personal hygiene. Other habits that put a person at risk include tobacco, alcohol, drug abuse and activities such as skydiving and mountain climbing. Skin cancer - because of excessive sunbathing or cardiovascular disease - because of overweight also represents huge impact on the economics of health care systems. Events that increase stress may cause accidents or illness, e.g. divorce, retirement.

RISK FACTOR MODIFICATION AND CHANGING HEALTH BEHAVIOR

Identifying risk factors is the first step in health promotion, wellness education and illness prevention activities. Attempts to change may be aimed at the termination of a health-damaging behavior or at the adoption of a healthy behavior. It is believed that change involves movement through a series of stage. identified the five stages of change. Conn (1994) has

STAGES OF HEALTH BEHAVIOR CHANGE

Definition Nursing Implications Client will not be interested in information about the behavior and may be defensive when confronted with the information A feeling of uncertainty may be present, but clients will more likely accept information as they are developing more belief in the value of change Clients belief advantages outweigh disadvantages of behavior change. They may need assistance in planning for the change Be aware of previous habits that may prevent action on new behaviors. Identify barriers of change. Changes need to be integrated into the clients lifestyle

Pre-contemplation (Pre-consideration)

Not intending to make changes within the next 6 months. Considering a change within the next 6 months.

Contemplation (Consideration)

Preparation

Make small changes in preparation for change in the next month. Actively engaged in strategies to change behavior. This stage may last up to 6 months. Sustained change over time. This stage begins 6 months after action has started and continues indefinitely.

Action

Maintenance Stage

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Pre-contemplation

Contemplation

Preparation

Relapse

Action

Maintenance

Permanent Change

Stages of Health Behavior Change

Acute Illness is usually severe but of short duration - symptoms appear suddenly, are intense and often go away after a relatively short period. People act in a certain way when they are ill. This involves how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care systems. If people belief themselves to be ill, illness behaviors can be coping mechanisms in that they are released from roles. However, it could also be added stress to the client in a normal working day. Illness behavior may become abnormal when it is disproportionate to the present problem and the client persists in the sick role.

Certain illness behaviors may occur when a person become ill and has four (4) stages as described by Suchmon (1965):

Stage I:

Experiencing Symptoms

Although pain is the most prominent symptom indicating illness, other common symptoms include a rash, fever, bleeding or a cough.

Stage 2:

Assuming a Sick Role

The person defines himself as being sick, seeks support of this experience from others, gives up normal activities, and takes on a sick role.

Stage 3:

Assuming a Dependent Role

This stage is characterized by the clients decision to accept the diagnosis and follow the prescribed treatment plan.
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The person conforms to the opinions of others, often requires assistance in carrying out activities of daily living, and needs emotional support through acceptance, approval, physical closeness, and protection.

Stage 4:

Achieving Recovery and Rehabilitation

Most clients complete this final stage of illness behavior at home. In this stage, the person gives up the dependent role and start normal activities and responsibilities.

VARIABLES INFLUENCING ILLNESS BEHAVIOR 1. Internal Variables

Internal variables are the clients perceptions of symptoms and the nature of the illness e.g. if a client believes the symptoms are serious, they will probably be motivated to seek assistance or deny that the illness is serious and not seek medical assistance. The nature of the illness, either acute or chronic, can also affect a clients illness behavior. A client is likely to comply readily with therapy with an acute illness. Where a client with a chronic illness may not be motivated to go along with a therapy plan because the symptoms are not cured.

2.

External Variables
External variables includes the:
Visibility of symptoms Social group Cultural background Circumstances Economic variables : : : : : more likely to seek help/assistance the group may assist the client in recognizing the threats of an illness effects of disease and its interpretation vary to cultural it affects how a person is taught to be healthy, or how to recognize illness economic restraints may delay treatment. physical proximity could be complex or confusing to clients social support

Accessibility of Health Care Treatment:

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IMPACT OF ILLNESS ON THE CLIENT AND FAMILY

Each client responds different to illness and should be treated individually

The following behaviors are commonly experienced:

1.

Behavioral and Emotional Changes

People react differently to illness or the threat of the illness. Individual and emotional reactions depend on the nature of the illness, the clients attitude toward it, the reactions of others and the variables of illness behavior. Short-term, non-life-threatening illness involve few behavioral changes where severe illness can lead to more extensive emotional behavioral changes such as anxiety, shock, denial, anger and withdrawal.

2.

Impact on Body Image

Body image is the subjective concept of physical appearance. Reactions of the client and family to changes in body image depend on the type of change, their adaptive capacity, the rate at which changes take place and the support services available. The client usually adjusts in phases to body image change. Phases include: Shock, withdrawal, acknowledgement, acceptance and rehabilitation.

3.

Impact on Self-Concept
Self-concept is a mental self-image of strengths and weaknesses in all aspects of personality. Self-concept is important in relationships with other family members. A client whose selfconcept changes because of illness may no longer meet family expectations and will lead to tension or conflict. As a result, family members may change their interactions with the client.

4.

Impact on Family Roles

Roles such as wage earner, decision maker, professional, child, sibling or parent could change because of illness. Parents and children have to adapt to major changes resulting from a family member illness. An individual and family generally adjust more easily to subtle short-term changes. Longterm changes require an adjustment process similar to the grief process. The client and family often require specific counselling and guidance to assist them in coping with the changes.

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5.

Impact on Family Dynamics

Family dynamics is the process by which the family functions, make decisions, give support to individual members and cope with everyday changes and challenges. Because of the effects of illness, family dynamics often change.

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