Health, Wellness, and Illness, CH> 17

Suchman's 5 Stages of Illness

1. Symptom experience: person comes to believe that something is wrong by either someone else mentioning it or symptoms such as pain, rash, cough, fever, or bleeding. Has 3 aspects: the physical aspect of symptoms, Cognitive aspect, and emotional response. Unwell person consults others about symptoms or feelings to validate if symptoms are real. Might try home remedies. 2. Assumption of the Sick Role: Individual accepts the sick role and seeks confirmation from family and friends. Often people continue to self treat and delay contact with health care professionals. When symptoms or illness gets worse person may be motivated to see professional help. 3. Medical Care Contact: Individual seek the advice of a health professional either on own or urging of significant others. Wanting 3 types of information- validation of real illness, explanation of the symptoms in laymens terms, and reassurance that they will be all right or prediction of what the outcome will be. 4. Dependent Client Role: accepting the illness and seeking treatment, client becomes dependent on the professional for help. 5. Recovery or Rehabilitation: client is expected to relinquish the dependent role and resume former roles and responsibilities.

President's Commission on Health needs of the Nation (19530

"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." ** Adaptive process rather then state. Get them back to state of health they were previously at.

Health Is:

- an evolving concept basic to nursing -more than the absence of disease -almost impossible to measure -a desired state

Most Laymen Describe Health as Being:

-Free from symptoms of disease and pain as much as possible -able to be active and to do what they want or must do (ADL'S) -in good spirit most of the time. * Health is not something that a person achieves suddenly at specific time. * It is an ongoing process- a way of life thru which a person develops and encourages every aspect of body, mind, and feelings to interrelate harmoniously.

Disease

An alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span. Something really shows up that they feel - objective.

Internal Variables Influencing Health Status, Beliefs, and Practices

Biologic dimensions: genetic make up (influences from biologic characteristics), sex ( diseases are more common in one sex then the other), age, and developmental levels ( Infant stages, toddlers learning to walk, adolescents taking risks, and older adults decline in physical and sensory perceptual abilities). Psychological dimensions: Mind body interactions like emotional responses to stress affect body function. Self- Concept is another one. Cognitive dimensions: lifestyle choices refers to general way of living for a person like their living conditions and patterns of behavior, which can be positive or negative. Spiritual and religious beliefs like that Jehovah Wittnesses oppose blood transfusions. **Internal Variables are non- modifiable because they CANNOT BE CHANGED!

Acute Illness

Characterized by severe symptoms of relatively short duration. Symptoms appear abruptly and subside quickly May or may not require health care intervention- ex. appendicitis requires surgical intervention, but colds subside without medical intervention or with help of over the counter meds.

Health -Illness Continua

Grids or graduated scales where health and illness or disease can be viewed as opposite ends of a health continuum. Dunn's High Level Wellness Grid: Health axis extends from peak wellness to death and the environment axis extends from very favorable to very unfavorable. 1. High-level wellness in a favorable environment 2. Emergent high-level wellness in an unfavorable environment. 3. Protected poor health in a favorable environment. 4. Poor health in an unfavorable environment. Travis Illness wellness continuum: Ranges from high level of wellness to premature death. Movement to the RT indicate increasing levels of health and well being for an individual. (awareness, education, and growth.) Movement to the LT indicates progressively decreasing levels of health. 4+ model of wellness: Consists of the 4 domains of the inner-self, Physical, spiritual, emotional, and intellectual-- plus elements of the outer self, environment, culture,nutrition, safety, and many others. Useful when working with individuals, families, or communities.

Health Belief Model Rosenstocks

was intended to predict which individuals would or would not use preventive measures such as screening for early detection. Individual Perceptions: Perceived susceptibility, Perceived Seriousness, and Perceived Threat. Modifying Factors: Demographic variables, Sociopsychological variables, Structural variables, and Cues to action. Likelihood Action: Perceived benefits of the action and Perceived barriers to acton.

Wellness

" A state of well-being--engaging in attitudes and behaviors that enhance quality of life and maximize personal potential."

WHO Definition of Health (1948)

"A state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity" ** not universally excepted because people in third world countries would not be as healthy cuz of culture and physical mental, and social well being is different.

ANA's updated definition

"An experience that is often expressed in terms of wellness and illness, and may occur in the presence or absence of illness or injury."

Factors Affecting One's Definition of Health

- Previous experience ( what they have done in the past) - Expectations of self - Age - Socio-cultural influences ( Different cultures influence differently) - Lifestyles -Spiritual beliefs - Economic Status ( rich or poor) - Psychological status ( mental capacity)

Illness

A highly personal state in which the person's physical, emotional, intellectual, social, developmental or spiritual functioning is thought to be diminished. Illness is highly subjective only the individual person can say he/she is ill. Not related to disease cuz a person could have a disease and not feel ill.

How people behave when they are illl depends on:

Age, Sex, Occupation, Socioeconomic Status, Religion, Ethnic origin, Psychological Stability, Education, Mode of caring.

ANA'S Definition (1980)

America Nurse's Association "A dynamic state of being in which the developemental and behavioral potential of an individual is realized to the fullest extent possible."

Eudemonistic Model

Incorporates a comprehensive view of health. Health is seen as an actualization or realization of a person's potential. In this model the highest aspiration of people is fulfillment and complete development, which is actualization. Illness is a condition that prevents self-actualization in this model.

Chronic Illness

Lasts for extended periods of time 6 months or longer and often for persons entire life. Has slow onset Periods of "remission" and "exacerbation" Often need to modify ADL'S Ex: heart and lung disease, diabetes mellitus.

Health Belief Model LOC

Locus of Control ( LOC) model: concept from social learning theory that nurses can use to determine whether clients are likely to take action regarding health, that is, whether they understand that their health is under their won or others' control. Internals- people who believe that they have a major influence on their own health status- that health is largely self-determined. Externals- people who believe that their health is largely controlled by outside forces.

Factors Influencing Adherence Compliance

Motivation to become well Lifestyle change necessary Perceived severity of the health care problem Value placed on reducing threat of illness Difficulty in performing specific behaviors/tasks Inconvenience of illness vs regimens to follow Beliefs that therapy or regimens to follow Beliefs that therapy or regimen will work Complexity, side effects and duration of therapy Cultural heritage Relationship with health care provider Cost of therapy

Models of Health and Wellness

Clinical Model Role performance model Adaptive model Eudemonistic model Leavell and Clark's model Health Illness Continua Dunn's wellness grid, Travis wellness continuum, 4+ model of wellness.

Health Belief

Concepts about health that an individual believes are true. Such beliefs may or may not be founded on fact. Some are influenced by culture like the "hot-cold" systems of some Hispanic Americans.

Nurse's Role in Assisting the Client to Adhere

Establish why the client is not following the regimen- nurse can provide info, correct misconceptions, attempt to decrease expense, or suggest counseling if psychological problems are interfering with adherence. Demonstrate caring- show sincere concern about the clients problems and decisions. Encourage healthy behaviors through positive reingorcement Use aids to reinforce teaching- like pamphlets or a pill calendar. Establish a therapeutic relationship of freedom, mutual understanding, and mutual responsibility with the client and support persons- by providing knowledge, skills, and information, the nurse gives clients control over their health.

Health Care Adherence

Extent of individuals behavior that coincides with medical or health advice. Like following diets, medical, or health advice. To ensure that client is able to perform activities, understand the necessary instructions, is a willing participant in establishing goals of therapy, and values the planned outcomes of behavior changes.

External Variable Influencing Health Status, Beliefs, and Practices.

Geography: geographic location determines climate, and climate affects health. Environmental: like radiation, chemicals used to control weeds and plant diseases, the greenhouse effect, x-ray, acid rain, ect... Standard of living: like occupation, income, and education, hygiene, food habits, and ability to seek healthcare advice. Family and Cultural Beliefs: family passes on patterns of daily living and lifestyle to offspring. Once abused as a child man might grow up and abuse his own children. Social support networks: having support from family, friends, or confidant along with job satisfaction helps people avoid illness.

Clinical Model

In this model the opposite of health is desease Medical practitioners use the clinical model in their focus on relief of signs and symptoms of disease and elimination of malfunction and pain. When s/s are no longer present they consider the individual's health restored.

Florence Nightengale (1860)

Health is a state of being well and using every power the individual posseses to the fullest extent.

Adaptive model

Health is seen as a creative process; disease is seen as a failure in adaptation or maladaptation. The treatment is to restore the ability of the person to adapt, that is to cope. Focus is stability, although there is an element of growth and change.

Role Performance Model

People have different societal roles (mother, daughter, friend) in order to perform his/her work so, People who can fulfill their roles are healthy even if they have clinical illness. It is assumed in this model that sickness is the inability to perform one's work role.

Effects of Illness

Privacy, Autonomy, Financial Burden, Changes in lifestyles. IMPACT ON THE CLIENT: Behavioral and emotional changes Self concept and body image changes Lifestyle changes ON THE FAMILY: Depends On: Member of the family who is ill Seriousness and length of the illness Cultural and social customs the family follows

Parson's Sick Role

Rights: 1. Clients are not held responsible for their condition. Ex. lung cancer from smoking 2. Clients are excused from certain social roles and tasks Ex. ill parent would not be expected to make dinner for family. Obligations: 3. Clients are obligated to try to get well as quickly as possible. 4. Clients or their families are obligated to seek competent help.

Impact on the Family

Role changes Task reassignments Increased demands on time Increased stress due to anxiety about outcomes Conflict about unaccustomed responsibilities Financial problems Loneliness as a result of separation and pending loss Change in social customs

Wellness Includes:

Self-Responsibility An Ultimate goal A dynamic growing process Daily decision making in the areas of: Nutrition Stress management Physical fitness Preventive health care Emotional health Whole being of the individual (Can be addictive)

Dimensions of Wellness

Spiritual- belief in some force Emotional- ability to manage stress and to express emotions appropriately. Intellectual- ability to learn and use information effectively for personal, family, and career development. Social- ability to interact successfully with people and within the environment. Physical- ability to carry out daily tasks, achieve fitness, adequate nutrition and no drugs or alcohol. Occupational- ability to achieve balance between work and leisure time. Environmental- measures that improve quality of life of the community.

Health status

State of health of an individual at a given time. Report may include, anxiety, depression, or acute illness and describe individual's problem in general. Can also describe specifics like vital signs.

Health Behaviors

The action people take to understand their health state, maintain an optimal state of health, prevent illness and injury, and reach their maximum physical and mental potential. Ex: eating wisely, exercising, paying attention to signs of illness, following treatment advice, not smoking, taking time fro rest and relaxation, managing time effectively. Health behavior is intended to prevent illness or disease or to provide early detection of disease.

Etiology

The causation of a disease or condition. It may be known or unknown. Ex: MS does not have an etiology cuz they don't know what it is related to. Could be the medical diagnoses

Illness Behavior

The ways individuals describe,monitor, and interpret their symptoms, take remedial actions, and use the health care systems.

Leavell and Clark's Model

Used primarily in predicting illness rather than promoting wellness. Identification risk factors that result from the interactions of agent, host, and environment are helpful in promoting and maintaining health. Agent: any environment factor or stressor ( biological, chemical, mechanical, physical, or psycosocial) Host: Person(s) who may or may not be at risk of acquiring a disease. Environment: all factors external to the host that may or may not predispose the person to the development of disease.