Health

&
illness
 DEFINITION
• HEALTH
“A state of complete physical, mental and
social well being and not merely absence of
disease or infirmity”
WHO ,1947
Health is not a condition; it is an adjustment.
It is not a state but a process. The process
adapts the individual not only to our physical
but also our social environment
- US Presidents Commission on health needs of
the nation ,1953
A dynamic state of being in which the
development and behavioral potential of an
individual is realized to the fullest extent
possible
ANA,1980

An experience that is often experienced in

term of wellness and illness
ANA,2004
 DEFINITION
• ILLNESS
 An illness is the response of the person to a
disease
It is an abnormal process in which the
persons level of functioning is changed when
compared with a previous level
HEALTH ILLNESS
CONTINUM
ILLNESS WELLNESS
CONTINUUM
DUNN’S HIGH LEVEL-
WELLNESS GRID
THE 4+ Model Of wellness
Factors influencing
health status

Internal variables

External variables
 Psychological
dimensions

Biological Cognitive
dimensions dimensions

Internal
variables
 PHYSICAL STANDARD OF
ENVIORNMENT LIVING

EXTERNAL
VARIABLES

FAMILY AND SOCIAL

CULTURAL SUPPORT
BELIEFS NETWORKS
 Concept Of Health
• An understanding of health is the basis of all
the health care.
• Health is not perceived the same way by all
the members of a community including
various professional groups (like biomedical
scientists, social scientists, health
administrators, ecologists) giving rise to
confusion about the concept of health.
• Health has evolved over the centuries from the
concept of individual concern to a worldwide
social goal.
• The various changing concepts of health as
follows:
1. Biomedical concept
2. Ecological concept
3. Psychosocial concept
4. Holistic concept
 1. Biomedical concept
• Traditionally health has been considered as an
absence of the diseases and if someone was
free from disease, then that person was
considered healthy.
• This concept is known as biomedical concept,
and it is based on the “germ theory of the
disease.”
• Health means “absence of disease.”
• The medical profession viewed the human body
as a machine and disease is an outcome of the
breakdown of the machine, and one of the
doctor’s tasks was to repair the machine.
• This concept has minimized the role of the
environment, social and cultural determinants of
the health.
• Developments in medical and social sciences
led to the conclusion that the biomedical
concept of health was inadequate
 2. Ecological Concept
• Deficiencies in the biomedical concept gave rise
to other concepts.
• The ecologists put forward the concept of
ecological concept.
• Ecologists viewed health as a dynamic equilibrium
between man and his environment, and the
disease as a maladjustment of the human
organism to environment.
 3. Psychosocial Concept
•Advances in social sciences showed that health is
not only a biomedical phenomenon, but one which
is influenced by social, psychological, cultural,
economic and political factors of the people
concerned.
•These factors must be taken into consideration in
defining and measuring health.
•Thus health is both a biological and social
phenomenon
 4. Holistic Concept
• The holistic model is a synthesis of all the above
concepts.
•Holistic concept recognizes the strength of
social, economic, political and environmental
influences on health.
•It has been variously described as
multidimensional process involving the wellbeing
of the person as a whole.
•The emphasis is on the promotion and
protection of health.
• The holistic approach implies that all sectors
of the society have an effect on health, in
particular, agriculture, animal husbandry,
food, industry, education, housing, public
works and other sectors.
Disease.
• Disturbance of structure or of function of the body or
its constituent parts.
• Lack of or inadequate adaptation of the organism to his
environment.
• Failure of the adaptive mechanism to adequately
counteract the stimuli or stresses to which it is subject
resulting in disturbances in function and structure of any
part, organ or system of the body.
 ETIOLOGY
 The causation of a disease or condition is
called etiology
 A description of the etiology of a disease
includes the identification of all casual factors
that act together to bring about a praticular
disease
 RISK FACTORS
• A risk factor is any situation, habit,social or
enviornment condition,physiological or
psychological condition,developmental or
intellectual condition or spritual or other
variable that increases the vulnerability of an
individual or group to an illness or accident
• Symptom.
Any disorder of appearance, sensation or
function experienced by the patient indicative of a
certain phase of a disease. Manifestation of perceptible
changes in the body which indicate the presence of a
disease or disorder.
• Sign.
An objective symptom or objective evidence or
physical manifestation made apparent by special
methods of examination or use of sense
• Syndrome. A set of symptom, the sum of
which constituents a disease.
• A group of symptoms which commonly occurs
together
• A group of signs and symptoms which when
considered together characterize a disease
 CAUSES OF DISEASE
• Inherited genetic defects
• Developmental defects
• Biological agents or toxins
• Physical agents
• Physiological and emotional reaction to stress
• Excessive or insufficient production of body
secretion
• Generalized tissue response to injury or irritation
 RISK FACTORS
• Genetic and physiological factors
• Age
• Environment
• Lifestyle
 ILLNESS
• Illness is a state in which a persons physical,
emotional, intellectual, social, developmental
or spiritual functioning is impaired or
diminished
Classification of illness

Acute

Chronic
 Illness behaviour
• It is a coping mechanism ,that involves ways
an individuals describe, monitor and interpret
their symptoms ,take remedial actions and use
health care system
PARSONS FOUR ASPECTS OF
SICK ROLE
• RIGHTS
Clients are not held responsible for their
condition
Clients are excused from certain roles and
tasks
• OBLIGATIONS
Clients are obliged to try to get well as quickly
as possible
Clients or their families are obliged to seek
competent help
 Stages of illness
Stage 1
Symptom experiences
Stage2
Assumption of sick role
Stage 3
Medical care contact
Stage 4
Dependent client role
Stage 5
Recovery or rehabilitation
Variables affecting illness
behaviour

• Internal variables
• External variables
 Internal variables

•Perception of
symptoms
•Nature of illness
•Characterstics of
person
 External variables
• Visibility of symptoms
• Social group
• Culture and values
• Ecnomic variables
• Accesability to health care
system
 Distinction between Disease,
Illness and Sickness
• The term disease literally means “without
ease” (uneasiness), when something is wrong
with bodily function.
• Illness refers to the presence of a specific
disease, and also to the individual’s
perceptions and behavior in response to the
disease, as well as the impact of that disease
on the psychosocial environment.
• Sickness refers to a state of social dysfunction.
• Disease is a physiological/psychological
dysfunction.
• Illness is a subjective state of the person who
feels aware of not being well.
• Sickness is a state of social dysfunction i.e. a
role that the individual assumes when ill
(sickness role).
 CONCEPT OF ILLNESS
• Illness shows a positive and negative
behaviour
• It can make a person feel helpless and
defenseless
• The person who is not healthy has expects
and deserves competent care may choose to
assume the sick role
 CONCEPT OF DISEASE
• Webster defines disease as “a condition
in which body health is impaired, a
departure from a state of health, an
alteration of the human body
interrupting the performance of vital
functions”.
• The oxford English Dictionary
defines disease as “ a condition of
the body or some part or organ of
the body in which its functions are
disturbed or deranged”.
• Ecological point of view disease is
defined as “a maladjustment of the
human organism to the
environment.”
• The simplest definition is that
disease is just the opposite of health:
i.e. any deviation from normal
functioning or state of complete
physical or mental well-being.
THEORIES OF DISEASES CAUSATION

1. Supernatural theory of disease

 Disease is due to super power e.g.
gods, evil spirits.
2. Tridosha theory of disease
 The doshas or humors are: Vaata
(Wind), Pitta (gall), and Kapha
(mucus).
 Perfect balance of tridosha is
healthy
Disturbance in balance is disease
3. Theory of Contagion
Spreading of disease by being close
to or touching other people.
4. Miasmatic theory of disease
causation
Disease is due to noxious air and
vapors
 These concepts were prevailing
before Louis Pasteur (1822-1895).
5. Germ Theory of disease
 In 1860, Louis Pasteur demonstrated the
presence of bacteria in air.
This theory emphasized that the sole cause of
disease is microbes.
The theory generally referred to as one-to-
one relationship between disease agent and
disease.
Disease agent Man Disease
6.Theroy of epidemological triad
 7.MULTI-FACTORIAL ETIOLOGY
• The germ theory of disease or single
cause of disease is always not true.
• The germ theory of disease was
overshadowed by multi-factorial cause
theory in 19th century.
• As a result of advancement in public health,
communicable diseases began to decline and
are replaced by new type of diseases so called
modern disease of civilization.
• Example: Lung cancer, CHD, Mental illness etc.
The disease could not be explained on the
basis of germ theory of disease and can not be
controlled or prevented on that basis.
 MULTI-FACTORIAL ETIOLOGY
• The realization began that multiple factors are
responsible for disease causation where there
is no clear single agent.
• The purpose of knowing multiple factors of
disease is to quantify and arrange them in
priority sequence for modification to prevent
particular disease.
 8.WEB OF CAUSATION
• This model of disease causation was
suggested by Mac Mohan and Pugh.
• This model is ideally suited in the study of
chronic disease where the disease agent is
often not known, but is the outcome of
interaction of multiple factors.
• The web of causation considers all the
predisposing factors of any type and their
complex interaction with each other.
• The basic tenets of epidemiology are to study
the clusters of causes and combinations of
efforts and how they relate to each other.
• The web of causation does not imply that
the disease can not be controlled unless all
the multiple causes or chain of causation or
at least a number of them are appropriately
controlled.
• Sometimes, removal of one link may be
sufficient to control disease.
 9. Dever’s Epidemiologic Model
• This model provides another approach to
conceptualize interaction of various factors
involved in the development of a particular
condition.
• This model is composed of four major
categories of factors such as human biology,
life style, environment and health care system.
 Impact on client and
family
Behavioral and emotional
changes
Body image
Family roles
Family dynamics
 Health care services
• It can be defined as ‘a multitude of services
rendered to individual, families or
communities by agents of health care
personnel or professionals for the purpose of
promoting ,maintaining, monitoring or
restoring health’
 Principles of heath care
services
• Services should make adequate
provision for curative and preventive
and for active promotion of positive
health
• Health services should provide
consultant, laboratory and institutional
facilities
• Health services should be placed as
close to people as possible in order
to ensure their maximum use by the
community
• The health organization should
provide for the widest possible for
cooperation between the health
personnel and people
• Special provision is required for
mother, children and mentally
deficient children
• Health services should pay emphasis
on the creation and maintenance of
healthy enviornment as far as
possible
 Characteristics of health
care services
• Relevance
• Comprehensiveness
• Adequacy
• Availability
• Accessibility
• Affordability
• Feasibility
• Integrated
• Continuity
• Up-to-date
• Holistic
 Types of health care
agencies and services

• Public health
• Physicians offices
• Ambulatory care centers
• Occupational health clinics
• Hospitals
• Sub acute care facilities
• Extended care facilities
• Retirement and assisted living centers
• Rehabilitation centers
• Home health care agencies
• Day care centers
• Rural care
• Hospice services
• Crisis centers
• Mutual support and self help groups
 HOSPITAL
Hospital is an integral part of a social and
medical organization, the function of which is
to provide for the population ,the complete
health care, both curative and preventive and
whose out patient services reach out to ,the
family and its home environment .The hospital
is a centre for the training of health workers
and for bio- social research
WHO
• Hospital is an institution for the care, cure and
treatment f the sick and wounded ,for the study
of the diseases and for the training of the
doctors and nurses
Steadman’s Medical Dictionary
 FUNCTIONS OF
HOSPITALS
PATIENT CARE

DIAGNOSIS AND TREATMENT OF DISEASE

PREVENTIONOF DISEASE AND PROMOTION OF

HEALTH
REHABLITATIVE SERVICES

MEDICAL EDUCATION AND TRAINING

MEDICAL AND NURSING RESEARCH

OUTPATIENT SERVICES

IN PATIENT SERVICES
CLASSIFICATION OF HOSPITALS

LENGTH OF STAY OF PATIENT

• Long term care hospitals
• Short term care hospitals
• Day care hospitals
 ACCORDING TO CLINICAL BASIS
ACCORDING TO OWNERSHIP/
CONTROL
• Government or public hospitals
• Non governmental hospitals
Voluntary hospitals
Charitable hospitals
Private nursing homes/ hospitals
Corporate hospitals
ACCORDING TO OBJECTIVES
• Teaching cum research hospitals
• General hospitals
• Specialized hospitals
• Isolation hospitals
• Rural hospitals
ACCORDING TO SIZE/BED
CAPACITY
• Small hospital
• Medium hospital
• Large hospital
Teaching hospital/referral hospital
District hospital
Taluk hospital
Community health centre
Primary health center
ACCORDING TO MANAGEMENT
• Union government
• State government
• Local bodies
• Autonomous bodies
• Private organizations
• Voluntary agencies
ACCORDING TO SYSTEM Of
MEDICINE
• Allopathic hospitals
• Ayurveda hospitals
• Homeopathic hospitals
• Unani
 LEVELS OF HOSPITAL
• First level
• Second level
• Third level
 Essentials components of a hospital
Trained and competent professionals in
adequate numbers, paramedical staff and
other ancillary staff to render efficient services
to clients
The entire necessary infrastructure to
facilitate smooth functioning of the hospital
• An efficient organization so that each member
of the hospital is able to extent the best
services to the client and family
• A holistic approach where patients and family
are taken care of
 Organisation of hospitals
• The governing body of the hospital is called
the board of trustees
• Under the governing body there is head of the
hospital who is the administrator or director
 GOVERNING BOARD/BOARD OF
TRUSTEES

ADMINISTRATOR/DIRECTOR

PROFESSIONAL MANAGEMENT BUSINESS MANAGEMENT

MEDICAL SPECIALITY ACCOUNTING HOUSE KEEPING

DEPARTMENT
NURSING

PARAMEDICAL
PURCHASING MAINTENANCE
 TRADITIONAL
ORGANISATION OF
HOSPITAL
 HOSPITAL MANAGEMENT BOARD

HOSPITAL ADMINISTRATION

INFORMATION THERAPEUTIC DIAGNOSTIC SUPPORTIVE

SERVICES SERVICES SERVICES SERVICES

•MEDICAL CARE •MEDICAL LAB

•SURGICAL CARE •CENTRAL SUPPLY
•ADMISSION •IMAGING •DIETARY
•MATERNITY CARE &RADIOLOGY
•BILLING&COLLECTION •PHARMACY
•PEDIATRIC CARE LAB
•HEALTH EDUCATION •BIOMEDICAL
•OTHER SUPER •CARDIOLOGY
•MEDICAL RECORD TECHNOLOGY
SPECIALITY CARE LAB
•INFORMATION •HOUSE KEEPING
•PHYSIOTHERAPY •NEUROLOGY
SYSTEM •MAINTENANCE
•CLINICAL LAB
•HUMAN RESOURCES •TRANSPORTATION
PSYCHHOLOGY
•NURSING
Hospital departments
• OPD
• IP
• Medical department
• Nursing department
• Paramedical department
• Non professional services
 MEDICAL DEPARTMENT
• Medicine • Orthopedics
• Surgery • Neurology
• Gynecology • Cardiology
• Obstetrics • Psychiatry
• Pediatrics • Skin
• Ophthalmology • Plastic surgery
• ENT • Nuclear medicine
• Dental • Infectious diseases
 PARAMEDICAL
DEPARTMENT
• Pathology department
• Physical medicine &
rehablitation department
• OT complex
• Pharmacy
• Radiology department
• Dietary department
 NON PROFESSIONAL
SERVICES
• Admitting department
• Administration
• Purchasing department
• Accounts
• House keeping
• Laundary
• Mechanical department
• Maintanence department
• Central supply department
• Social service
• Pastoral care
• Hospital waste management
• Central sterile supply department
• Medical record department
• Personnel department
 Providers of health care
• Physician
• Nurses
• Emergency medical personnel
• Dentist
• Alternative care provider
• Case manager
• Dietician or Nutritionist
• Occupational therapist
• Paramedical technologist
• Pharmacist
• Physical therapist
• Physician Assistant
• Respiratory therapist
• Social worker
• Spiritual support personnel
• Unlicensed assistive personnel