Health Wellness and Illness
disease: pathologic change in the structure or function of the body or mind
exacerbation: period in chronic illness when the symptoms of the disease reappear
morbidity: frequency that a disease occurs
mortality: number of deaths
social determinants of health: conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks wellness: an active process in which an individual progresses toward the maximum possible potential, regardless of current state of health
vulnerable population: disadvantaged subsegment of a community requiring utmost care, specific ancillary considerations, and augmented protection in research; includes those living in poverty, women, children, older adults, rural and inner-city residents, new immigrants, the homeless, mentally ill patients, and people with disabilities and special health care needs
-Health of the public is measured by morbidity (how frequently a disease occurs) and mortality (number of deaths). -Wellness is an active state that is facilitated by living a lifestyle that promotes good physical, mental, and emotional health. -Disease is a pathologic change in the structure or function of the body or mind; illness is the response of the person to a disease. -People's racial/ethnic group, poverty, biological sex, age, mental health, educational level, disabilities, sexual orientation, health insurance, and access to health care can lead to health disparities. -Basic human needs and human dimensions influence a person's behaviors in health and illness.
-Health promotion refers to a person's behaviors motivated by a personal desire to increase well-being and health potential. -Examples of models of health promotion and illness prevention include the health belief model, the health promotion model, the health-illness continuum, and the agent-host-environment model. -Many nurse-led initiatives are helping underserved populations deal with illnesses.
CONCEPTS OF ILLNESS AND DISEASE Disease is a medical term, referring to pathologic changes in the structure or function of the body or mind. An illness is the response of the person to a disease; it is a process in which the person's level of functioning is changed when compared with a previous level. This response is unique for each person and is influenced by self-perceptions, others' perceptions, the effects of changes in body structure and function, the effects of those changes on roles and relationships, and cultural and spiritual values and beliefs.
A disease is traditionally diagnosed and treatment is prescribed by a health care provider or advanced practice nurse, whereas nurses focus on the person with an illness. Terms disease and illness are often used interchangeably. It is important for nurses to remember that a person may have an illness or injury but still achieve maximum functioning and quality of life, and consider himself or herself to be healthy.
A revised health promotion model includes three additional variables: activity-related affect, a commitment to a plan of action, and immediate competing demands and preferences. Behaviors may induce either a positive or negative subjective response or affect. If the activity initiates a positive reaction, the behavior will likely be repeated; if the emotional reaction is negative, the person will likely avoid that behavior.
A person initiates a health-related behavior by committing to a plan of action, accompanied by developing associated strategies to perform the valued behavior. Failure to sustain the behavior may result from competing demands. For example, a person may begin a low-fat diet but "give in" to the convenience of fast foods. Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan.
Social Determinants Across the Life Stages From infancy through old age, the conditions in the social and physical environments in which people are born, live, work, and age can have a significant influence on health outcomes. Children Early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong health, learning, and well-being. A history of exposure to adverse experiences in childhood, including exposure to violence and maltreatment, is associated with health-risk behaviors such as smoking, alcohol and drug use, and risky sexual behavior, as well as health problems such as obesity, diabetes, heart disease, sexually transmitted diseases, and attempted suicide. Features of the built environment, such as exposure to lead-based paint hazards and pests, negatively affect the health and development of young children.
Adolescents Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental influences. Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people's health and well-being. Addressing young people's positive development facilitates their adoption of healthy behaviors and helps to ensure a healthy and productive future adult population. Adolescents who grow up in neighborhoods characterized by poverty are more likely to be victims of violence; use tobacco, alcohol, and other substances; become obese; and engage in risky sexual behavior.
To give person-centered holistic health care—care that addresses the many dimensions that comprise the whole person—the nurse must understand and respect each person's own definition of health and responses to illness, and should be familiar with models of health and illness. The nurse's knowledge of health and illness is even more important because of today's focus on health promotion and advocacy, the continuing trend toward care being provided in the home and community, the increasing numbers of older adults, the growing incidence of chronic illnesses, and the ongoing efforts to maximize health care outcomes for all populations.
Americans fare worse in nine key health areas: infant mortality and low birth weight, injuries and homicides, teenage pregnancies and sexually transmitted infections, prevalence of HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability.
Chronic Illness Chronic illness is a broad term that encompasses a number of different physical and mental alterations in health, each having one or more of the following characteristics: -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.
Chronic illnesses usually have a slow onset and many have periods of remission (the disease is present, but the person does not experience symptoms) and exacerbation (the symptoms of the disease reappear).
Precontemplation. In this stage, people are not even thinking about trying to change their behavior. DiClemente lists as reasons the four R's: reluctance, rebellion, resignation, and rationalization. Counselors can validate the lack of readiness to change and encourage self-exploration. Contemplation. People ambivalently consider the need to change the problematic behavior. Counselors can help by focusing on educating about the pros and cons of the behavior and change, and clarify that the decision to change is one that only the individual can make.
Determination: Commitment to Action. Now the decision is made to move forward and preparation ensues. Counselors are most helpful in this stage by helping people make realistic plans, with small steps that anticipate difficulties, and by identifying creative strategies to address the difficulties. It is helpful to affirm that the individual has the ability to change behaviors. Action: Implementing the Plan. When someone publicly begins to implement the plan and begins to achieve success, it reinforces the decision to change behavior. If family, friends, and co-workers understand that the person has decided to eat differently or stop drinking, they can become supporters. Counselors can bolster the person's ability to change by reiterating long-term benefits. Maintenance, Relapse, and Recycling. During this stage, people focus on sustaining the new behavior in a stage that can last from 6 months to 5 years. Counselors can be helpful by exploring strategies to support the new behaviors and by continuing support during relapse.
Wellness—a term often used interchangeably with health—is an active state of being healthy, including living a lifestyle that promotes good physical, mental, and emotional health. Dunn (1977) described his model of high-level wellness as functioning to one's maximum potential while maintaining balance and a purposeful direction in the environment. Dunn differentiated "wellness" from "good health," believing that good health is a passive state simply denoting that the person is not ill at this time. Wellness is a more active state, regardless of one's level of health.
Dunn also defined processes that help people know who and what they are. These processes, which are a part of each person's perception of his or her own wellness state, are being (recognizing oneself as separate and individual), belonging (being part of a whole), becoming (growing and developing), and befitting (making personal choices to befit oneself for the future). Dunn's model encourages the nurse to care for the total person, with regard for all factors affecting the person's state of being while striving to reach maximum potential.
Patient-centered assessment method (PCAM) is a tool nurses can use to assess patient complexity using the social determinants of health that often explain why some patients engage and respond well in managing their health while others with similar health conditions do not experience the same outcomes . You are best able to recognize factors affecting peoples' ability to manage their health care if you pay attention to their health and wellbeing (lifestyle behaviors, impact of their physical health on their mental health, and their ability to enjoy daily activities), their social environment (status of employment, housing, transportation, and social networks), and their health literacy and communication skills (understanding of their symptoms and risk factors, language and cultural differences, and learning difficulties).
During primary prevention, teaching is an important activity. However, before teaching can be initiated, it is essential that the nurse engage the patient in a discussion about their health risks and the implications of these risks. Then once the risks are identified, the nurse can develop a patient-specific teaching strategy to help the patient address the risks.
health is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity. The health of the public is measured globally by morbidity (how frequently a disease occurs) and mortality (the numbers of deaths resulting from a disease). On a personal level, however, most people define health according to how they feel ("I feel really sick"), the absence or presence of symptoms of illness ("I have a terrible pain in my stomach"), or their ability to carry out activities of daily living ("I felt so much better that I got up and cooked supper").
Each person defines health in terms of his or her own values and beliefs. The person's family, culture, community, and society also influence this personal perception of health. Health integrates all the human dimensions—the physical, intellectual, emotional, sociocultural, spiritual, and environmental aspects of the whole person. The nurse giving holistic care must equally consider all these interrelated dimensions of the whole person
National trends in efforts to prevent health disparities focus on vulnerable populations, such as racial and ethnic minorities, those living in poverty, women, children, older adults, rural and inner-city residents, and people with disabilities and special health care needs.
Emphasis is given to disparities in access to care, quality of care, health insurance status, specific sources of ongoing care, and quality and access to care for people with limited English proficiency. It is critical that nurses recognize that disparities exist and plan specific and individualized interventions for patients who are most at risk.
Secondary Health Promotion and Illness Prevention Secondary health promotion and illness prevention focus on screening for early detection of disease with prompt diagnosis and treatment of any found. The goals of secondary preventive care are to identify an illness, reverse or reduce its severity or provide a cure, and thereby return the person to maximum health as quickly as possible. The Patient Protection and Affordable Care Act (ACA) of 2010, which broadens the scope of preventive care, also helps reduce health disparities so that underserved groups can reach their full health potential.
Examples of nursing activities: assessing children for normal growth and development and encouraging regular medical, dental, and vision examinations. Other activities include screenings (e.g., blood pressure, cholesterol, skin cancer), recommending gynecologic examinations and mammograms for women at appropriate ages, and teaching testicular self-examination to men. Direct nursing care interventions at the secondary level include administering medications and caring for wounds. Screenings are a major activity involved in secondary health promotion.
The Health Promotion Model The health promotion model was developed to illustrate how people interact with their environment as they pursue health. The model incorporates individual characteristics and experiences, as well as behavior-specific knowledge and beliefs, to motivate health-promoting behavior. Nurses can use the components of the model to design and provide interventions to promote health for people, families, and communities. Individual characteristics and experiences can be useful to predict if a person will incorporate and use health-related behaviors. If a behavior has been used before and becomes a habit, it is more likely to be used again. Personal biologic, psychological, and sociocultural factors—including age, biological sex, strength, self-esteem, perceived health status, definition of health, acculturation, and socioeconomic status—all help predict a given health-related habit.
For example, the person who has high self-esteem, defines self as healthy, and has an adequate income is less likely to use alcohol or tobacco and more likely to follow a healthy diet and take part in regular exercise. Conversely, a person with low self-esteem, a fatalistic attitude toward health, and low socioeconomic status is more likely to have poor nutrition, not exercise, and use addictive substances. Behavior-specific knowledge, beliefs, and relationships are considered major motivators for health-promoting behaviors. These include the knowledge that that there will be a positive outcome from a specific health behavior, the belief that one has the skill and competence to engage in health behaviors, and the influences of others (especially family, peers, and health care providers). Situational influences, such as no-smoking policies, also influence health behaviors. Barriers to action, which include perceptions of unavailability, inconvenience, expense, difficulty, or time, usually result in avoidance of a behavior.
Risk Factors for Illness or Injury A risk factor is something that increases a person's chances for illness or injury. Like other components of health and illness, risk factors are often interrelated. Risk factors may be further defined as modifiable (things a person can change, such as quitting smoking) or nonmodifiable (things that cannot be changed, such as a family history of cancer). As a person's number of risk factors increases, so does the possibility of illness. For example, an overweight executive under pressure to increase sales may smoke and drink alcohol in excess. These factors, combined with a family history of heart disease, place this person at higher risk for illness.
HEALTH PROMOTION AND ILLNESS PREVENTION Health promotion is the behavior of a person who is motivated by a personal desire to increase well-being and health potential. In contrast, illness/disease prevention, also called health protection, is behavior motivated by a desire to avoid or detect disease or to maintain functioning within the constraints of an illness or disability. Health promotion and illness prevention activities are traditionally described as occurring on primary, secondary, and tertiary levels.
Major Areas of Risk Factors Age School-aged children are at high risk for communicable diseases. After menopause, women are more likely to develop cardiovascular disease. Genetic factors A family history of cancer or diabetes predisposes a person to developing the disease. Physiologic factors Obesity increases the possibility of heart disease. Pregnancy places increased risk on both the mother and the developing fetus.
Health habits Smoking increases the probability of lung cancer. Poor nutrition can lead to a variety of health problems. Lifestyle Multiple sexual relationships increase the risk for sexually transmitted infections (gonorrhea or AIDS). Events that increase stress (divorce, retirement, work-related pressure) may precipitate accidents or illness. Environment Working and living environments (such as hazardous materials and poor sanitation) may contribute to disease.
Primary objectives of the nurse as caregiver: - TO PROMOTE HEALTH - TO PREVENT ILLNESS - TO RESTORE HEALTH - TO FACILITATE COPING WITH ILLNESS, DISABILITY, OR DEATH objectives focus care on: -maximizing the health of patients of all ages and in all populations, in all settings, and in both health and illness.
Health is more than just the absence of illness; it is an active process in which a person moves toward his or her maximum potential. Each person has a different definition of health
Primary Health Promotion and Illness Prevention Primary health promotion and illness prevention are directed toward promoting health and preventing the development of disease processes or injury. Nursing activities at the primary level may focus on people or groups. Examples of primary-level activities are immunization clinics, family planning services, providing poison-control information, and accident-prevention education. Other nursing interventions include teaching about a healthy diet, the importance of regular exercise, safety in industry and farms, using seat belts, and safer sex practices.
Health-risk assessments are an important part of primary health promotion and preventive care. A health-risk assessment is an assessment of the total person. The resulting "picture" of the person indicates areas of risk for disease or injury as well as areas that support health. A variety of formats are used to perform this assessment, but all take a broad approach to health, focusing on lifestyle and behaviors. As you work with patients in both hospital and community settings to provide care, use this self-test to help your patients assess their state of health and health risks, and learn a new health style through recommended lifestyle practices that support health.
Healthy People 2020 defines health equity as the attainment of the highest level of health for all people. Although health care is increasingly focused on the promotion of health and the prevention of illness, there continue to be disparities that lead to different health outcomes among different populations of people. A health disparity is defined by Healthy People 2020 as a "particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage". Health disparities are influenced by many different factors, including race and ethnicity, poverty, biological sex, age, mental health, educational level, disabilities, sexual orientation, health insurance, and access to health care.
Healthy People 2020 defines social determinants of health as the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks.
Acute Illness An acute illness usually has a rapid onset of symptoms and lasts only a relatively short time. Although some acute illnesses are life threatening, simple acute illnesses, such as the common cold or diarrhea, do not usually require medical treatment.
If medical care is required, a specific treatment with medication (an antibiotic for pneumonia), surgical procedures (an appendectomy for appendicitis), or another medical treatment usually return the person to normal functioning.
If a person who smokes knows that lung cancer can cause physical disability or death and therefore affect his or her ability to work and care for the family, the person is more likely to stop smoking. The perceived benefits of action are the person's beliefs about how effectively measures will prevent illness. This factor is influenced by the person's conviction that carrying out a recommended action will prevent or modify the disease and by the person's perception of the cost and unpleasant effects of performing the health behavior (compared with not taking any action). For example, the person may believe that stopping smoking will prevent future breathing problems and that the initial withdrawal symptoms can be overcome; therefore, the person may stop smoking.
In addition to these three components, a person's health beliefs are affected by modifying factors including demographic variables (such as age and biological sex), sociopsychological variables (such as personality and peer group pressure), and structural variables (such as knowledge and prior contact with the disease). These factors interact to influence the perceived benefits of preventive action minus the perceived barriers to preventive action. Another modifying factor is cues to action, including activities such as others' advice, mass-media campaigns, literature, appointment-reminder telephone calls or postcards, and the illness of a significant other. The likelihood of taking a recommended preventive health action is thus a composite of individual perceptions and modifying factors.
Emotional Dimension How the mind affects body functions and responds to body conditions also influences health. Long-term stress affects body systems, and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change the body's responses to illness. As examples of the negative effects of emotions, a student may always have diarrhea before examinations and an adolescent with poor self-esteem may begin to experiment with drugs. The positive effects of emotions include reducing surgical pain with relaxation techniques and reducing blood pressure with biofeedback skills.
Intellectual Dimension The intellectual dimension encompasses cognitive abilities, educational background, and past experiences. Whether or not someone can understand the causes of disease and the importance of healthy lifestyle behaviors can have a huge impact on health and wellness. These influence the person's responses to teaching about health and reactions to nursing care during illness. They also play a major role in health behaviors. Examples involving this dimension include a young college student with diabetes who follows a diabetic diet but drinks beer and eats pizza with friends several times a week, and a middle-aged man who quits taking his high blood pressure medication after developing unpleasant side effects.
NURSING CARE TO PROMOTE HEALTH AND PREVENT ILLNESS The current focus on health promotion and illness prevention at local, state, national, and global levels is important to nursing. Nurses must take care of their own health to be able to give effective nursing care to others. Good personal health enables nurses not only to practice more efficiently but also to serve as role models for patients and families.
Nurses can help patients acquire new health behaviors by modeling the very behaviors they are trying to promote. It is difficult for nurses to be sincerely attentive to the needs of patients when their own needs are not being met. Because no one is perfectly healthy all of the time, nurses who are preparing for professional practice should spend time getting to know themselves. From this self-knowledge should come a commitment to actively pursue holistic health. Primary role is not the same as primary prevention. Primary role is individually directed; primary prevention focuses on activities that foster health for individuals, groups, and communities.
To successfully adapt to a chronic illness, the person must learn to live as normally as possible and maintain a positive self-concept and sense of hope, despite symptoms and treatments that may make the person feel different from others. Activities of daily living, relationships, and self-care activities must often be modified, and it is important that the person maintain a feeling of being in control of his or her own life and the prescribed treatments.
Nurses care for people of all ages with chronic illnesses, providing that care in all types of settings, including homes, hospitals, clinics, long-term care facilities, and other institutions. Regardless of the age of the patient or the effects and demands of the illness or the setting, the nurse must make every effort to promote health for patients with chronic illness, with a focus of care that emphasizes what is possible rather than what can no longer be.
Tertiary Health Promotion and Illness Prevention Tertiary health promotion and illness prevention begins after an illness is diagnosed and treated, with the goal of reducing disability and helping rehabilitate patients to a maximum level of functioning. Nursing activities on a tertiary level include teaching a patient with diabetes how to recognize and prevent complications, using physical therapy to prevent contractures in a patient who has had a stroke or spinal cord injury, and referring a woman to a support group after removal of a breast because of cancer.
Nurses play an important role in monitoring the responses of the patient to the prescribed therapy and in providing services to facilitate the patient's recovery or improve quality of life while living with the effects of an illness or injury.
Cultural Considerations and Sensitivity Each person is a unique individual. Nurses must consider patients within the context of family, culture, and community. Nurses and other health care professionals need to provide health care services in a sensitive, knowledgeable, and nonjudgmental manner with respect for people's health beliefs and practices when they are different than those of the care provider. Nurses should be familiar with the general health beliefs and variances of various groups to improve the effectiveness of health care services and provide care within a cultural context.
Nurses should know risk factors for alterations in health that are based on racial inheritance and ethnic backgrounds, as well as normal variations that occur within races. In addition, it is important to consider how religion and spirituality may impact health. Chapter 5 provides information about cultural diversity and the importance of providing culturally sensitive nursing care. All patients, regardless of their race or culture, have the same basic human needs. However, the nurse needs to keep in mind any cultural influences or factors affecting anatomy and physiology, health beliefs, and alterations in health.
Adults Access to and availability of healthier foods can help adults follow healthful diets. For example, better access to retail venues that sell healthier options may have a positive impact on a person's diet. These venues may be less available in low-income or rural neighborhoods. Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace and are increasingly affecting the health and lives of U.S. adults. Research has shown that workers experiencing these stressors are at higher risk of injuries, heart disease, and digestive disorders.
Older Adults Availability of community-based resources and transportation options for older adults can positively affect health status. Studies have shown that increased levels of social support are associated with a lower risk for physical disease, mental illness, and death
Disparities in health outcomes are especially common in racial and ethnic minorities, in whom higher rates of obesity, cancer, diabetes mellitus, and AIDS are seen. See the U.S. Department of Health and Human Services Office of Minority Health for Specifics (USDHHS, 2016). The Health Equity Institute urges the following measures to eliminate avoidable health inequities and health disparities (Health Equity Institute): Attention to the root causes of health inequities and health disparities—specifically, health determinants, a principal focus of Healthy People 2020.
Particular attention to groups that have experienced major obstacles to health associated with socioeconomic disadvantages and historical and contemporary injustices. Promotion of equal opportunities for all people to be healthy and to seek the highest level of health possible. Distribution of socioeconomic resources needed to be healthy in a manner that progressively reduces health disparities and improves health for all. Continuous efforts to maintain a desired state of equity after avoidable health inequities and health disparities are eliminated.
To help to meet the chronic disease burden, the CDC uses four cross-cutting strategies: (1) epidemiology and surveillance to monitor trends and inform programs; (2) environmental approaches that promote health and support healthy behaviors; (3) health system interventions to improve the effective use of clinical and other preventive services; and (4) community resources linked to clinical services that sustain improved management of chronic conditions. This approach is based on the assumption that establishment of community conditions to support healthy behaviors and promote effective management of chronic conditions will deliver healthier students to schools, healthier workers to employers and businesses, and a healthier population to the health care system
People with a chronic illness often grieve over losses or changes in physical structure and function; worry about their finances, status, roles, and dignity; and face the possibility of an earlier death.
The Health Belief Model Free or low-cost screens and health information are available in most areas to help detect disease early and to educate people about healthy living. Why, then, don't more people take advantage of these services or change their lifestyles? This question can be answered with the widely used health belief model, which describes health behaviors. The health belief model (Rosenstock, 1974) focuses on what people perceive or believe to be true about themselves in relation to their health. This model is based on three components of individual perceptions of threat of a disease: (1) perceived susceptibility to a disease, (2) perceived seriousness of a disease, and (3) perceived benefits of action.
Perceived susceptibility to a disease is the belief that one either will or will not contract a disease. It ranges from being afraid of developing a disease to completely denying that certain behaviors may cause illness. For example, one person who smokes cigarettes may believe he or she is at danger for lung cancer and may stop smoking, while another person may believe smoking poses no serious threat and continues to smoke. Perceived seriousness of a disease concerns the person's perception of the threat that disease poses to health and its effects on the person's lifestyle. Perceived seriousness depends on how much the person knows about the disease and can result in a change in health behavior.
FACTORS AFFECTING HEALTH AND ILLNESS Many factors influence a person's health status, health beliefs, and health practices. These factors may be internal or external and may or may not be under the person's conscious control. To plan and provide holistic care, the nurse must understand how these factors influence behavior in both healthy and ill patients.
Physical Dimension The physical dimension includes genetic inheritance, age, developmental level, race, and biological sex. These components strongly influence the person's health status and health practices. For example, inherited genetic disorders include Down syndrome, hemophilia, cystic fibrosis, and color blindness. Toddlers are at greater risk for drowning, and adolescents and young adult males are at greater risk for automobile crashes from excessive speed. There are specific racial traits for disease, including sickle cell anemia, hypertension, and stroke. A young woman whose mother and grandmother had breast cancer is more likely to have an annual clinical breast examination and mammogram.
STAGE 1: EXPERIENCING SYMPTOMS How do people define themselves as "sick"? The first indication of an illness usually is recognizing one or more symptoms that are incompatible with one's personal definition of health. Although pain is the most common symptom indicating illness, other common symptoms include a rash, fever, bleeding, or a cough. If the symptoms last for a short time or are relieved by self-care, the person usually takes no further action. If the symptoms continue, however, the person enters the next stage.
STAGE 2: ASSUMING THE SICK ROLE The person now self-defines as being sick, seeks validation of this experience from others, gives up normal activities, and assumes a "sick role." At this stage, most people focus on their symptoms and bodily functions. Depending on individual health beliefs and practices, the person may choose to do nothing, may research symptoms on Internet sources, may buy over-the-counter medications, may try alternative remedies to relieve symptoms, or may seek out a health care provider for diagnosis and treatment. In our society, an illness becomes "legitimate" when a health care provider diagnoses it and prescribes treatment. After seeking help from the health care provider, the person becomes a patient and enters the next stage.
STAGE 3: ASSUMING A DEPENDENT ROLE This stage is characterized by the patient's decision to accept the diagnosis and follow the prescribed treatment plan. The person may initially have difficulty conforming to the recommendations of the health care provider and may decide to seek a second opinion or deny the diagnosis. The lack of independence is more troubling for some people who, based on their diagnosis, often require assistance in carrying out activities of daily living, and need emotional support through acceptance, approval, physical closeness, and protection. If the disease is serious (such as a heart attack or stroke), the patient may enter the hospital for treatment. If the symptoms can be managed by the patient or family alone or with the assistance of home care providers, the patient is cared for at home. To facilitate adherence to the treatment plan, the patient needs effective relationships with caregivers, knowledge about the illness, and an individualized care plan. The patient's responses to care depend on a variety of factors, including the seriousness of the illness, the patient's degree of fear about the disease, the loss of roles, the support of others, and previous experiences with illness care. The optimal outcome expected by both caregivers and family is to get well and resume normal roles.
STAGE 4: ACHIEVING RECOVERY AND REHABILITATION Recovery and rehabilitation might begin in the hospital and conclude at home, or may be totally concluded at a rehabilitation center or at home. Most patients complete this final stage of illness behavior at home. In this stage, the person gives up the dependent role and resumes normal activities and responsibilities. If the care plan includes health education, the person may return to health at a higher level of functioning and health than before the illness.
Examples of Nursing Activities by Level of Health Promotion and Preventive Care Primary Weight loss Diet Exercise Smoking cessation Reduced alcohol consumption Avoidance of illicit drugs Farm safety Seat belts and child safety seats Immunizations Water treatment Safer sex practices Effective parenting
Secondary Screenings (blood pressure, cholesterol, glaucoma, HIV, skin cancer) Pap smears Mammograms Testicular examinations Family counseling Tertiary Medication Medical therapy Surgical treatment Rehabilitation Physical therapy Occupational therapy Job training
Spiritual Dimension Spiritual beliefs and values are important components of a person's health and illness behaviors. It is important that nurses respect these values and understand their importance for the individual patient. Examples of the influences of the spiritual dimension on health care include the Roman Catholic requirement of baptism for both live births and stillborn babies; kosher dietary laws, prohibiting the intake of pork and shellfish, practiced by Orthodox and Conservative Jews; and opposition to blood transfusion, common to Jehovah's Witnesses.
Self-Concept Another variable influencing health and illness is people's self-concept, which incorporates both how they feel about themselves (self-esteem) and the way they perceive their physical self (body image). Self-concept has both physical and emotional aspects and is an important factor in the way a person reacts to stress and illness, follows self-care health practices, and relates to others. A person's self-concept results from a variety of past experiences, interpersonal interactions, physical and cultural influences, and education. It includes perceptions of one's own strengths and weaknesses. Illness can alter a person's self-concept as it affects roles, independence, and relationships with important others.
Environmental Dimension The environment has many influences on health and illness. Housing, sanitation, climate, and pollution of air, food, and water are elements in the environmental dimension. Examples of environmental causes of illness include deaths in older adults from inadequate heating and cooling, an increased incidence of asthma and respiratory problems in large cities with smog, and an increased incidence of skin cancer in people who live in hot, sunny areas of the world.
Sociocultural Dimension Health practices and beliefs are strongly influenced by a person's economic level, lifestyle, family, and culture. In general, low-income groups, racial and ethnic minorities, and other underserved populations are less likely to seek medical care to prevent illness and have fewer treatment options, while high-income groups are more prone to stress-related habits and illness. The family and the culture to which a person belongs influence the person's patterns of living and values about health and illness; such patterns are often unalterable. All of these factors are involved in personal care, patterns of eating, lifestyle habits, and emotional stability. Examples of other sociocultural situations that influence health and illness are an adolescent who sees nothing wrong with smoking or drinking because her parents smoke and drink; parents of a sick infant who do not seek medical care because they have no health insurance; a single parent (abused as a child) who in turn physically abuses her own small son; and a person of Asian descent who uses herbal remedies and acupuncture to treat an illness.
The Health-Illness Continuum The health-illness continuum is one way to conceptualize a person's level of health. This model views health as a constantly changing state, with high-level wellness and death at opposite ends of a graduated scale, or continuum. This continuum illustrates the ever-changing state of health as a person adapts to changes in internal and external environments to maintain a state of well-being. For example, patients with cancer may view themselves at different points on the continuum at any given time, depending on how well they believe they are functioning with the illness.
The Agent-Host-Environment Model The agent-host-environment model of health and illness, developed by Leavell and Clark, views the interaction between an external agent, a susceptible host, and the environment as causes of disease in a person. It is a traditional model that explains how certain factors place some people at risk for an infectious disease—a model that is currently helpful in addressing the Zika virus. These factors are constantly interacting, and a combination of factors may increase the risk of illness. The use of this model is limited when dealing with noninfectious diseases, and other models have proved more useful.
Common Causes of Diseases -Inherited genetic defects -Developmental defects resulting from exposure to such factors as viruses or chemicals during pregnancy -Biologic agents or toxins -Physical agents such as temperature, chemicals, and radiation -Generalized tissue responses to injury or irritation -Physiologic and emotional reactions to stress -Excessive or insufficient production of body secretions (hormones, enzymes, and so forth)
The Centers for Disease Control and Prevention (CDC) reports that chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, disabling and preventable of all health problems
Recent research indicates that self-efficacy should be added as another component of the health belief model. Self-efficacy, one's own belief in the ability to reach goals and complete tasks, is a strong influence on a person's choices, particularly regarding health behaviors.
The health belief model is useful when teaching about health and illness. You can assess the patient's related beliefs and together structure goals to help realistically meet health needs. Teaching and health promotion activities are ineffective, however, unless the patient believes that they are important and necessary.
Effects of Illness on the Family Most nursing care is given to patients with some form of support system, usually family members. When an illness occurs, daily life changes for both the patient and the family. For example, a chronic illness creates stress for the patient and family because of possible lifelong alterations in roles or lifestyle, frequent hospitalizations, economic problems, and decreased social interactions among family members.
The responses of family members to an illness are also individualized. Some family members want to be with the patient all the time, while others might avoid visiting. Parents of a sick child often react with blame, overprotection, and severe anxiety, and family members of patients requiring intensive care often feel alone and frightened. In both cases, they might also feel guilty and imagine the worst possible outcome.
Illness Behaviors When a person becomes ill, certain illness behaviors may occur in identifiable stages. These behaviors are how people cope with altered functioning caused by the disease. They are unique to the person and are influenced by age, biological sex, family values, economic status, culture, educational level, and mental status.
There is no specific timetable for the stages-of-illness behaviors, which may occur rapidly or slowly. Nursing roles throughout the stages remain constant. In all stages, the nurse accepts the patient as an individual, gives nursing care based on prioritized needs, and facilitates recovery through physical care, emotional support, and health education.
MODELS OF HEALTH PROMOTION AND ILLNESS PREVENTION Models of why and how people behave in ways to promote health and prevent illness help health care providers understand health-related behaviors and adapt care to people from diverse economic and cultural backgrounds.
This knowledge can be used to overcome barriers to health from disparities in care resulting from such factors as the increasing number of people without health insurance, a predicted increase in minority populations, and a lack of accessible and essential health care services for low-income and rural populations.
acute illness: rapidly occurring illness that runs its course, allowing a person to return to one's previous level of functioning
chronic illness: irreversible illness that causes permanent physical impairment and requires long-term health care
health: state of optimal functioning or well-being health disparity: a specific difference that is closely linked to social, economic, and/or environmental disadvantage
health equity: attainment of the highest level of health for all people health promotion: behavior of an individual motivated by a personal desire to increase well-being and health potential
holistic health care: health care that takes into account the whole person interacting in the environment
illness: abnormal process in which any aspect of the person's functioning is altered (in comparison to the previous condition of health)
remission: period in a chronic illness when the disease is present, but the person does not experience symptoms of the disease
risk factor: something that increases a person's chance for illness or injury
