2101 - Health and Wellness

Illness (brief)

- A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired - Acute Illness = short duration and severe - Chronic Illness = persists longer than 6 months

Illness

- At times, an experience with an illness will motivate a person to adapt positive behaviors. - It is good to remember that an illness does not always indicate that a disease is present. - Acute and chronic illnesses are two general classifications of illness used in this chapter. - An acute illness is usually short term and severe. The symptoms appear abruptly, are intense, and often subside after a relatively short period. - A chronic illness usually lasts longer than 6 months. Patients fluctuate between maximal functioning and serious health relapses that are sometimes life threatening. - A major role for you as a nurse is to provide patient education that helps patients manage their illnesses or disabilities to reduce the occurrence of symptoms and improve the tolerance of symptoms (tertiary prevention). This education enhances wellness and improves quality of life for patients living with chronic illnesses or disabilities. Use a holistic approach when helping patients who have chronic illnesses better manage their care.

Healthy People 2020 Goals

- Attain high-quality, longer lives - Achieve health equality Create social and physical environments that promote good health - Promote quality of life across all life stages The document comprises four areas: (1) attain high-quality, longer lives, (2) achieve health equality, (3) create social and physical environments that promote good health and (4) promote quality of life across all life states. - The goal is to achieve or make improvements for each objective by the year 2020

Impact of Illness: Client

- Behavioral and emotional changes - Loss of autonomy - Self-concept and body image changes - Lifestyle changes Illness brings about changes in both the involved individual and in the family. The changes vary depending on the nature, severity, and duration of the illness, attitudes associated with the illness by the client and others, the financial demands, the lifestyle changes incurred, adjustments to usual roles, and so on.

Manually Healing Methods

- Chiropractic - Massage - Acupuncture/acupressure reflexology **Manual healing methods include chiropractic, massage, and other acupuncture/acupressure/reflexology. All three approaches could be simply defined as the use of the hands on or near the body with the intention to help or to heal. The goals are to accelerate the person's own healing process and to facilitate healing at all levels of body, mind, emotions, and spirit.

Internal Variables

- Developmental Stage - Intellectual Background - Emotional Factors - Spiritual Factors

Spiritual Therapy

- Faith - Prayer **Health care sciences have begun to demonstrate that spirituality, faith, and religious commitment may play a role in promoting health and reducing illness.

External Variables

- Family Practices - Socioeconomic Factors - Cultural Background

Risk Factors (4)

- Genetic and physiological factors - Age - Environment - Lifestyle

Models of Health and Illness

- Health Belief Model - Health Promotion Model - Basic Human Needs Model - Holistic Health Model **A model is a theoretical way of understanding a concept or an idea. ** Because health and illness are complex concepts, you use models to help you understand the relationship between health and illness and your patients' attitudes toward health and health practices.

Definition of Health

- Health is more than the absence of disease! - A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity (WHO, 1947) - A state of being that people define in relation to their own values, personality, and lifestyle

Types of health promotion activities

- Health promotion - Wellness education - Illness prevention

Healthy People Documents

- Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, 1979 - Healthy People 2000: National Health Promotion and Disease Prevention Objectives - Healthy People 2010: Understanding and Improving Health Healthy People 2020 **Since the 1970s there has been a nationally focused initiative toward better health for the American people. *The Healthy People documents, published by the U.S. Department of Health and Human Services (USDHHS), provide evidenced-based objectives to achieve increased quality and years of healthy life and eliminate health disparities. *These objectives are updated every 10 years to meet a wide range of health needs, encourage collaboration in communities, help individuals make informed health decisions, and measure the impact of prevention activities. *Listed on the power point slide are the four documents with national goals for improving the physical health of Americans

Botanical Healing

- Herbal Medicine - Aromatherapy **Botanical (plant) healings are used by 80% of the world's population.

Impact of Illness: Family

- Influencing Factors - Family Changes

Illness Behavior (brief)

- Involves how people monitor their bodies and define and interpret their symptoms - Internal variables = perception of illness and nature of illness - External variables = visibility of symptoms, social group, cultural background, economics, and accessibility to health care

Impact of Illness: Family Influencing Factors

- Member of the family who is ill - Cultural and social customs the family follows

Miscellaneous Therapies

- Music therapy - Humor/ laughter - Animal-Assisted therapy - Horticultural therapy

Family Forms

- Nuclear Family - Extended Family - Blended Family - Alternative Patterns of Relationship

Illness Behavior

- People who are ill generally adopt illness behaviors. These behaviors affect how people monitor their bodies, define and interpret their symptoms, take remedial actions, and use the health care system. Personal history, social situations, social norms, and the opportunities and limits of community institutions all affect illness behaviors. - If people think of themselves as ill, illness behaviors act as coping mechanisms. Illness behavior can often result in patients being released from roles, social expectations, or responsibilities. - Just as internal and external variables affect health behavior, they affect illness behavior as well. You individualize care to assist patients in coping with their illnesses at various stages

Stages of Behavior Change

- Precontemplation - Contemplation - Preparation - Action - Maintenance **Current research shows that change involves movement through a series of five stages of behavior, ranging from precontemplation, when a person has no intention to change, to the maintenance stage, when a person maintains a changed behavior. Most people acting on their own do not get through all the stages on their first attempt.

Three Levels of Prevention

- Primary - Secondary - Tertiary **Nursing care directed at health promotion, wellness, and illness prevention can be understood in terms of health activities on primary, secondary, and tertiary levels

Risk Factors

- Risk factors are variables that increase the vulnerability of an individual or a group to an illness or accident. - Risk factors threaten health, influence health practices, and are important considerations in illness prevention activities. - A risk factor can be a situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, spiritual condition, or other variable

Impact of Illness: Family Family Changes

- Role changes/ task reassignments - Increased demands on time - Anxiety about outcomes - Conflict about unaccustomed responsibilities - Financial problems - Loneliness as a result of separation and pending loss - Change in social customs

Variables Influencing Health and Health Beliefs and Practices

- Variables influence how a person thinks and acts. - Health beliefs can negatively or positively influence health behavior or health practices. - Health beliefs and practices are influenced by internal and external variables and should be considered when planning care.

Mind Body Therapies

- Yoga/Pilates - Meditation - Hypnotherapy - Guided imagery **In mind-body therapies, individuals focus on realigning or creating balance in mental processes to bring about healing. These therapies include yoga, meditation, hypnotherapy, guided imagery, biofeedback, qigong, t'ai chi, and Pilates

Maslow's Hierarchy of Needs as adapted by Kalish

1. Self-Actualization 2. Esteem, Self-Esteem 3. Love, Belonging, Closeness 4. Safety, Security, Protection 5. Sex, Activity, Exploration, Manipulation, Novelty 6. Food, Air, Water, Temperature, Elimination, Rest, Pain Avoidance

Maslow's Hierarchy Of Needs (5)

1. Self-Actualization 2. Self-Esteem 3. Love and Belonging 4. Safety and Security 5. Physiologic

Faith

A belief in a supreme being who listens and responds to people and who cares about their well-being. Also defined as the power to accept the nature of life as it is and live in the present moment

Prayer

A form of communication and fellowship with the deity or creator. Can be a self-care strategy. Can provide comfort, increase hope, and promote healing and psychological well-being

Meditation

A general term for a wide range of practices that involve relaxing the body and easing the mind. Can help an individual calm themselves, cope with stress, and feel as one with God or the universe

Pilates

A method of physical movement and exercise designed to stretch, strengthen, and balance the body with a particular emphasis on the core or center (abdominal range)

Intellectual Background

A person's beliefs about health are partially shaped by knowledge, education, and past experiences

Developmental Stage

A person's concept of illness depends on the person's developmental stage.

Emotional Factors

A person's degree of anxiety or stress influences health beliefs and practices

Guided Imagery

A state of focused attention that encourages changes in attitudes, behavior, and physiologic reactions. Helps stop troublesome thoughts and focus on images that help a person relax and decrease negative impact of stressors.

Health Promotion, Wellness, and Illness Prevention

Active vs passive activities Types of health promotion activities - Health promotion - Wellness education - Illness prevention

Action:

Actively engaged in strategies to change behavior. This stage sometimes lasts up to 6 months. It requires commitment of time and energy.

Health Belief Model

Addresses the relationship between a person's beliefs and behaviors - sanitizing

Horticultural therapy

Also called gardening or a healing garden is an adjunct therapy to occupational and physical therapy. People may view nature, visit a healing or wander garden, or actually participate in gardening. Stimulates the five senses. Improves range of motion and mobility. Can help with socialization.

Holistic Health Model

Also known as complementary or alternative medicine. It is based on a comprehensive view of the person as a biopsychosocial and spiritual being. Holistic health models of nursing promote optimal health by incorporating active participation of patients in improving their health state.

Hypnotherapy

Application of hypnosis in a wide variety of medical and psychological disorders. Helps people gain self-control, improve self-esteem, and become more autonomous.

Holistic Health Model (brief)

Attempts to create conditions that promote optimal health - looks as pt as a whole - active participation from client

Basic Human Needs Model (brief)

Attempts to meet the patient's basic needs

Contemplation:

Considering a change within the next 6 months. Patient says that he or she is seriously considering a change

Health Promotion Model

Directed at increasing a patient's level of well-being - Gym - check up - dentist

Secondary

Focuses on those who have a disease or are at risk to develop a disease - is provided in the home, health care facility, or skilled nursing facility. It includes screening techniques and treating early stages of disease to limit disability by delaying the consequences of advanced disease

Preparation:

Has tried to make changes, but without success. Patient intends to take action within the next moth

Health promotion activities are either

Health promotion activities are either passive or active. With passive strategies of health promotion, individuals gain from the activities of others without acting themselves. With active strategies of health promotion, individuals adopt specific health programs.

Humor/ laughter

Helping the client "to perceive, appreciate, and express what is funny, amusing, or ludicrous in order to establish relationships, relieve tension, release anger, facilitate learning, or cope with painful feelings

Basic Human Needs Model

Helps you understand the needs of patients and families, their behaviors, and their readiness to take part in health promotion activities. Basic human needs are the elements necessary for survival and health. Needs are greater or lesser for different persons. Therefore a thorough and individualized assessment of needs is an important aspect of patient care. One way to understand an individual's motivation to achieve optimal health is to review Abraham Maslow's hierarchy of needs. [See next slide for more information on Maslow's hierarchy of needs.]

Risk Factor Identification

Identification - Help patients understand areas that must be changed to promote wellness and prevent illness Modification and changing health behaviors - Implement health education programs to help patients change risky health behaviors

Maslow's Hierarchy Of Needs

Maslow's model describes human needs using a pyramid divided into five levels. As people meet the needs of one level, they move up to the next level. In this theory, individuals have to meet lower-level needs before they are able to satisfy higher-level needs. Unsatisfied needs motivate human behavior. *The lowest level of needs on the hierarchy consists of very basic physiological needs, such as oxygen, water, food, sleep, and sex. When these needs are not met, the affected person feels sick or irritated or complains of pain or discomfort. Those feelings motivate the individual to satisfy the need. *The second level on the hierarchy of needs consists of safety needs, which include establishing stability and consistency. *The third level on the hierarchy is love and belongingness, which is a desire to belong to groups. *The fourth level deals with the need for self-esteem. Self-esteem results from mastery of a task and also includes the recognition gained from others. *The highest level of needs on the hierarchy is self-actualization, which is the desire to become everything that one is capable of becoming. Individuals at this level are concerned with maximizing their potential. - An understanding of Maslow's hierarchy of needs provides you with a framework to meet patient needs and prioritize care for your patients. Realize that unless a patient's basic needs have been met, higher levels in the pyramid are not relevant and that patients of different generations approach life differently. See Figure 2-3, Maslow's hierarchy of needs, in the text book for a more detailed image

Yoga

Mental and physical exercised aimed at producing spiritual enlightenment. Can be more fitness oriented with a goal of managing stress, learning to relax and increasing vitality and well-being.

Tertiary

Occurs when a defect or disability is permanent or irreversible - aims to help patients achieve as high a level of functioning as possible. This level of care is called preventive care because it involves preventing further disability or reduced functioning

Precontemplation:

Precontemplation: Does not intent to make changes within the next 6 months. Patient is unaware of the problem or underestimates it.

Chiropractic

Spinal adjustment and use of muscles and ligaments strengthened by spinal rehabilitative exercises; Outcomes: reduce or eliminate pain, correct spinal dysfunction, and preventive maintenance to ensure the problem does not recur

Spiritual Factors

Spirituality is reflected in how a person lives his or her life, including values, beliefs, personal relationships, and the ability to find hope and meaning in life. Spiritual health often provides motivation during times of change in health status

Massage

Strong sustained touch with the outcomes of physical benefits, satisfying the need for caring and nurturing touch, increased feeling of wellbeing, decreases depression, and enhances self-image. Physical benefits: relieve muscle tension, reduce muscle spasm, improve joint flexibility, improve posture, lower blood pressure, promote deeper and easier breathing, improve health of skin, and reeducate anxiety

Maintenance:

Sustained change over time. This stage begins 6 months after action has started and continues indefinitely. It is important to avoid relapse

The World Health Organization (WHO) defines health as a

The World Health Organization (WHO) defines health as a "state of complete physical, mental and social well-being, not merely the absence of disease or infirmity"

Aromatherapy

Therapeutic use of oils of plants in which fragrance plays an important part. - Chemicals found in essential oils are absorbed into the body resulting in physiologic or psychological benefits. - Different oils can calm, stimulate, or boost the immune system - Ex. Chamomile, Eucalyptus, Ginger, Jasmine, Lavender

Acupuncture/acupressure reflexology

To apply pressure or stimulate specific body points to relieve pain, cure certain diseases, and promote wellness.; acupuncture uses needles; acupressure uses finger pressure; reflexology is acupressure performed on the feet primarily but my include manipulation of the hands or ears

Primary

True prevention that lowers the chances that a disease will develop - includes health promotion, wellness education programs, immunizations, hearing protection in occupational settings, training to develop good body mechanics, and health screening for prostate, breast, and colon cancer

Herbal Medicine

Use of plant and their derivatives for treating disease. - Many of medications originated from herbs and plants but not all plant life is beneficial - Need to consider herbal supplements - Ex. aminio acids, enzymes, fish oils, vitamins, minerals - Be aware that some herbal supplements can be a problem when interacting with prescribed medications. - There are no regulations to controlling dosage, purity, safety of these supplements. - Many are costly and have no proven efficacy. - ALWAYS ask patients being admitted to the hospital if they take herbals, what kind and how much.

Animal-Assisted therapy

Use of specifically selected animals as a treatment modality in health and human service settings. Ex. throwing object for a dog to receive → increased upper extremity ROM; Ambulating with dog → improves mobility; Recalling animal's name → helps with memory

Music therapy

Using music to improve health by recognizing the balance or harmony of body, mind, and spirit. Quiet smoothing music can induce relaxation. Music recordings can help relax and distract clients

Healthy People 2020

Vision Statement: A society in which all people live long, healthy lives - The most recent of these documents, Healthy People 2020 , includes 600 objectives covering 42 topics. - It provides direction for health care efforts on an individual, community, and national level. New topic areas include adolescent health, health care-associated infections, and social determinates of health

Health promotion

You need to emphasize __________________________, wellness strategies, and illness prevention activities as important forms of health care because they help patients maintain and improve health. Health promotion activities, such as routine exercise and good nutrition, help patients maintain or enhance their present levels of health and reduce their risks for developing certain diseases

Illness prevention

activities, such as immunization programs, protect patients from actual or potential threats to health

Family Practices

can be passed down, in both positive and negative forms. If, as a child, you had immunizations, well-child checkups, and regular dental and eye examinations, chances are you will continue to do so in your adult years

Socioeconomic Factors

can greatly influence a person's ability to make hard decisions. If I am healthy, I need to buy food, pay bills, or buy clothes for the children.

Behavioral and emotional changes

changes associated with short-term illness are generally mild and short-lived ranging from irritability to lack of energy or desire to interact. More acute responses are likely with severe, life-threatening, chronic, or disabling illness.

Nuclear family:

consists of husband and wife and perhaps one or more children

Lifestyle

contains those factors that have positive or negative effects on health, such as smoking, drinking, and using drugs

Self-concept and body image changes

depends on the illness but may include feelings of loss of body parts and function, pain, disfigurement, dependence on others, inability to participate in social functions, strained relationships, and spiritual distress

Blended family:

formed when parents bring unrelated children from prior or foster parenting relationships into a new joint living situation

Alternative patterns of relationships:

include multiadult household, "skip-generation" families (grandparents caring for grandchildren which commonly results from legal interventions such as when a parent is convicted of a crime or dies and there is no other parent available), communal groups with children, "nonfamilies" (adults living alone), and cohabitating partners

Environment

includes cleanliness, heat, cold, overcrowding, and air quality

Extended family:

includes relatives (aunts, uncles, grandparents, and cousins) in addition to the nuclear family

Age

increases susceptibility to certain diseases. Review Box 2-2 for more information on the importance of health promotion in older adults

Internal variables

influence the way patients behave when they are ill. These are the patient's perceptions of symptoms and the nature of the illness. If patients believe that the symptoms of their illnesses disrupt their normal routine, they are more likely to seek health care assistance than if they do not perceive the symptoms as disruptive

Cultural Background

influences beliefs, values, and customs. As health care providers, we need to be aware of diverse cultures and to plan care accordingly if we expect patients to be compliant

External variables

influencing a patient's illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. The visibility of the symptoms of an illness affects body image and illness behavior. A patient with a visible symptom is more likely to seek assistance than a patient who does not have visible symptoms.

The goal of risk factor identification

is to help patients understand those areas in their lives that they need to modify or even eliminate to promote wellness and prevent illness. You will perform health risk appraisals, using health risk appraisal forms, to estimate health threats based on risk factors. You need to link findings from a health risk appraisal with educational programs and other community resources available to patients to provide a way for them to make necessary lifestyle changes and risk reduction. - Once you identify risk factors, implement health education programs that help a person to change a risky health behavior. This is called risk factor modification. Aim your attempts to change a patient's behavior at stopping a health-damaging behavior or adopting a healthy behavior.

The third level on the hierarchy is

love and belongingness, which is a desire to belong to groups.

Lifestyle changes

may include change in diet, activity and exercise, and rest and sleep patterns

Internal variables =

perception of illness and nature of illness

Chronic Illness =

persists longer than 6 months

The second level on the hierarchy of needs consists of

safety needs, which include establishing stability and consistency.

The highest level of needs on the hierarchy is

self-actualization, which is the desire to become everything that one is capable of becoming. Individuals at this level are concerned with maximizing their potential.

Acute Illness =

short duration and severe

Genetic and physiological factors

such as being overweight, affect physical functioning of the body.

Wellness education

teaches people how to care for themselves in a healthy way and includes topics such as physical awareness, stress management, and self-responsibility.

The fourth level deals with

the need for self-esteem. Self-esteem results from mastery of a task and also includes the recognition gained from others.

Loss of autonomy

the state of being independent and self-directed without outside control. Family interactions may change so that clients may no longer be involved in making family decisions or even decisions about their own healthcare

The lowest level of needs on the hierarchy consists of

very basic physiological needs, such as oxygen, water, food, sleep, and sex. When these needs are not met, the affected person feels sick or irritated or complains of pain or discomfort. Those feelings motivate the individual to satisfy the need.

External variables =

visibility of symptoms, social group, cultural background, economics, and accessibility to health care