Introduction to health & illness book of FON bsc nursing

Rangoli Dosi, Tutor
Unit 1
Introduction to
Health & Illness
B.Sc Nursing 1st Year

Terminology
• Nursing: Nursing encompasses autonomous and collaborative care
of individuals of all ages, families, groups and communities, sick or
well and in all settings.
• Health: Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.
• Disease: A disease is a particular abnormal condition that negatively
affects the structure or function of all or part of an organism, and that
is not immediately due to any external injury.
• Illness: a disease or period of sickness affecting the body or mind.
• Wellness: Wellness is the act of practicing healthy habits on a daily
basis to attain better physical and mental health outcomes, so that
instead of just surviving, you're thriving.

Terminology
• Etiology: Identification of the cause of the problem. The cause may
be direct or contributing factor in the development of client problem or
need.
• Profession: any type of work that needs special training or a
particular skill, often one that is respected because it involves a high
level of education.
• Health Care Team: It refer to all of the personal in all of the
department in a health care facility who provide health care services
• Comprehensive Health Care: Is a combined curative, preventive,
promotive and restorative care made available to the people without
distinction of cast and status from birth to death.
• Community: Group of inhabitants laving together in a somewhat
localized area under the same general regualtions and having
common interest, function, needs and organization.

Definitions of Health States
• Health: a state of complete physical, mental, and social well being, not
merely the absence of disease
• Illness: the unique response of a person to a disease
• Wellness: an active state, oriented toward maximizing the potential of
the individual

Acute Illness
• Generally has a rapid onset of symptoms and lasts only a relatively
short time
• Examples: appendicitis, pneumonia, diarrhea, common cold

Chronic Illness
• A broad term that encompasses many different physical and mental
alterations
• Examples: diabetes mellitus, lung disease, arthritis, lupus

Characteristics of a Chronic Illness
• 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

Human Dimensions of Health
• Physical
• Intellectual
• Emotional
• Sociocultural
• Spiritual
• Environmental aspects

Spiritual Health
• Spiritual health allows you to develop a set of values that help
you seek meaning and purpose
• Spirituality can be represented in many ways, for example,
through relaxation or religion
• But being spiritually well means knowing which resources to
use to cope with issues that come up in everyday life
• Meditations, prayers or spiritual gathering are organized to
maintained spiritual health.

Emotional Dimension
• Emotional health is closely related to the health and is considered
as an important element of health
• Mental and emotional aspect of health are now viewed as two
separate entities of human life
• Cognition is related to the mental health whereas emotional health
is related to the feeling of a person
• Emotional health includes:
• An emotional healthy person has a positive thinking and is capable of
coping and adjusting self
• An emotionally healthy person participates in all the activities which are
related to personal growth and his self esteem
• Emotionally well people have the ability to express feeling freely and
manage feeling effectively
• They are also aware of and accept a wide range of feeling in themselves and
others.

Vocational Dimension
• The choice of profession, job satisfaction, career ambitions
and personal performance are all important components of
this dimension
• To be occupationally well, a person is ultimately doing exactly
with what they want to do in life and are comfortably with their
future plans.
• Vocational dimension of health can be assessed by:
• Assessing the satisfaction level at job
• Facilities attached to the job
• Behaviour of the management and administrator and of colleagues at
job.

Socio-Cultural Dimension
• Health practices and beliefs are strongly influenced by a
person’s economic level, lifestyle, family and culture. Low-
income groups are less likely to seek health care to prevent or
treat illness; high-income groups are more prone to stress-
related habits and illness. The family and the culture to which
the person belongs determine patterns of livings and values,
about health and illness that are often unalterable.
• Examples:
• The adolescent who sees nothing wrong with smoking or drinking
because his parents smoke and drink.

Types of Illness
ACUTE CHRONIC
• Sudden onset of symptoms
• Symptoms progress quickly from mild to severe
• Gradual onset of symptoms
• Symptoms may be mild or vague; once illness is
resolved may have remissions and exacerbations
• Patient usually returns to former level of
functioning
• Changes often not permanent but may progress
to chronic illness
• Illness continues through the life span
• Changes are permanent and progressive
• Does not usually require long-term behavioral
change/treatment
• Requires long-term behavioral change/treatment
• May represent a life crisis • Often represents a life crisis

Stages of Illness Behavior
• Stage1: Experiencing symptoms
• Stage 2: Assuming the sick role
• Stage 3: Medical Care Contact
• Stage 4: Assuming a dependent role
• Stage 5: Achieving recovery and rehabilitation

Stage 1: Experiencing symptoms
• The person is aware that something is wrong. A person usually
recognizes a physical sensation or a limitation in functioning but does
not suspect a specific diagnosis.

Stage 2: Assuming the sick role
• If symptom persist and become severe, clients assume the sick role.
At this point, the illness becomes a social phenomenon, and sick
people seek confirmation from their families and social groups that
they are indeed ill and that they be excused from normal duties and
role expectations.

Stage 3: Medical Care Contact
• If symptoms persist despite the home remedies, become severe or
require emergency care, the person is motivated to seek professional
health services. In this stage the client seeks expert
acknowledgement of the illness as well as the treatment.

Stage 4: Assuming a dependent role
• The client depends on health care professionals for the relief of
symptoms. The client accepts care, sympathy and protection from the
demands and stresses of life. A client can adopt the dependent role in
a health care institution, at home, or in a community setting. The client
must also adjust to the disruption of a daily schedule.

Stage 5: Achieving recovery and
rehabilitation
• This stage can arrive suddenly, such as when the symptoms
appeared. In the case of chronic illness, the final stage may involve in
an adjustment to a prolong reduction in health and functioning.

Impact of illness on the client/patient
• Behavior and emotional changes
• People react differently to illness. Individual behavioral and emotional reaction
depends on the nature of illness, the client attitude towards it, the reactions of
other to it.
• Severe illness, particularly one that is life threatening, can lead to more
extensive emotional and behavioral change such as anxiety, shock, anger,
withdrawal.
• Impact on family role
• When an illness occurs, the roles of client and family may change. Such a
change may be short term or long term.
• An individual and family generally adjust more easily to short term changes
• Long term changes require an adjustment process similar to grief process.
The client and family often require specific counseling and guidance to assist
them in coping with role changes.

Human Dimensions of Health
• Physical
• Intellectual/ Mental
• Social
• Spiritual
• Emotional
• Vocational

Other Dimension
• A few other dimension also suggested such as:
• Culture dimension
• Socio-economic dimension
• Environmental dimension
• Educational dimension
• Nutritional dimension
• Preventive dimension

The Human Dimensions Composing the
Whole Person

The Human Health Dimensions
• Physical dimension—genetic inheritance, age, developmental level,
race, and gender
• Emotional dimension—how the mind affects body function and
responds to body conditions
• Intellectual dimension—cognitive abilities, educational background,
and past experiences
• Environmental dimension—housing, sanitation, climate, pollution of
air, food, and water
• Sociocultural dimension—economic level, lifestyle, family, and culture
• Spiritual dimension—spiritual beliefs and values

Physical Health
• Physical health relates to maintaining a healthy body and
seeking care when needed
• Physical health is attained through exercise, eating well, getting
enough sleep and paying attention to the signs of illness and
getting help when needed

Sign of Physical Health
• A good complexion
• A clean skin
• Bright eyes
• Not too fatty
• A sweet breath
• A good appetite
• Sound sleep
• Regular activities of bowels and bladder
• Smooth, easy and coordinated bodily movements.

Evaluation of Physical Health
• Self assessment of overall health
• Inquiry about ill health and risk factors
• Inquiry in to medications
• Standardized questionnaire for cardiovascular and respiratory
diseases
• Clinical examination
• Nutritional and dietary history
• Biochemistry and laboratory investigations.

Mental Health
• Mental health is a state of balance between body and
mind. Earlier the body and mind were consider two
separate entities.
• But this is interrelated as physical illness can result
mental illness and vice versa.
Mental illness
Depression
Poor Nutrition
intake
Poor Hygienic
Decreased
Immune system
Prone to
infection
Physical
Illness

Characteristic of Mentally Health Person
• Mentally health person will be capable of making personal and
social adjustment
• Mentally health person is free from internal conflicts
• He faces problems and tries to solve them intelligently
• He has good self control balance rationally and emotionally
• He knows him self his needs problems and goal
• He has strong sense of self esteem
• He searches for identity
• He lives a well balanced life means able to maintain the
balance between work rest and recreation.

Social Wellness
• Social wellness helps you perform social roles effectively and
comfortably, and create a support network
• This dimension of wellness allows you to not only develop
encouraging relationships with peers, but also intimate
relationships with romantic partners

Social Wellness
• Social wellness helps you perform social roles effectively and
comfortably, and create a support network
• This dimension of wellness allows you to not only develop
encouraging relationships with peers, but also intimate
relationships with romantic partners
• The social dimension of health include:
• Communication
• Intimacy
• Respect
• Equality
• Social Functioning

Concepts Of Health
• biomedical concept
• ecological concept
• psychosocial concept
• holistic concept

Biomedical Concepts
• traditionally health has been viewed as absence of disease
• base of this concept is germ theory of disease (germs cause disease)
• human body is considered as a machine and disease as a
consequence of the breakdown of the machine and the doctors task is
repair of the machine
• this concept minimized the role of environmental , social ,
psychological and cultural determinants of health
• it is inadequate to solve some of the major health problems of
mankind eg. malnutrition, accidents, drug abuse etc.

Ecological Concept
• health as a dynamic equilibrium between man and his environment
and disease is a maladjustment of the human organism to
environment
• this concept raises two issues ie imperfect man and imperfect
environment
• human adaptation to his natural environment can lead to longer life
expectancies and a better quality of life

Psychosocial Concept
• Health is not only a biomedical phenomenon but one which is
influenced by social, psychological, cultural, economical, and political
factors of the people
• Health is a biological and social phenomenon

Holistic Concept
• Synthesis of all the above concepts
• Health implies a sound mind in a sound body in a sound family in
sound environment
• All sectors of the society have an effect on health in particular
agriculture, animal husbandry, food, industry, education, housing,
communication etc.
• It emphasize on the promotion and protection of health

Factors Affecting Health Status, Beliefs, and
Practices
• Risk factors for illness
• Factors in the human dimensions that influence health–illness status
• Beliefs and practice
• Basic human needs
• Self-concept

Factors That Influence a Person’s Self-
Concept
• Past experiences
• Interpersonal interactions
• Physical and cultural influences
• Education

Models of Health and Illness
• The agent-host-environment model
• The health–illness continuum
• The high-level wellness model
• The health belief model
• The health promotion model

Agent-Host-Environment Model (Leavell and
Clark)
• Examines the causes of disease in an individual
• Agent, host, and environment interact in ways that create risk factors
• Understanding the risk factors is important for the promotion and
maintenance of health
• The host reaction is influenced by family history, age, and health
habits
• The environment includes physical, social, biologic, and cultural
factors
• Each of the agent-host-environment factors affects and is affected by
the others

The Agent-Host-Environment Triangle

Agents
• Substance living or non living whose presence or absence which may
initiate a disease process.
• Cause of Disease:
• Biologic Agents: Virus, bacteria, fungi and protozoa
• Nutritive Agent: Protein, fat, carbohydrates, vitamins and minerals
• Physical Agent: Heat, Cold, Pressure, radiation, electricity and sound
• Chemical Agent:
• Endogenous - produce inside the body example uric acid, serum, bilirubin.
• Exogenous – Arising outside the body example dust, fumes, gas, etc.
• Mechanical Agent: force like crushing and friction
• Social Agent: poverty, smoking, alcohol, drugs abuse.

Host
• Person that harbors the disease
• Demographic Characteristics: Age, Sex, Ethnicity
• Biological Characteristics: Genetic Makeup, immunity
• Social Characteristics: Socioeconomics status, occupation
• Lifestyle Factor: Fitness, Nutritional habits, physical exercise,
behavior pattern

Environment
• Surrounding that allow disease transmission
• All that which is external to the individual host, living, non-living with
which he is in constant interactions
• Physical Environment: Air, water, soil, radiation
• Biological Environment: Microbial agents, animals, plants
• Psychological Environment: Culture, customs beliefs.

The Health–Illness Continuum
• Dr. John W Travis developed the illness-wellness continuum in 1972
• He observed that doctors that nurses usually treat illness, disabilities,
and symtoms, which brings a patient to the neutral zone.
• However, Dr. Travis did not believe the neutral zone should be the end
goal
• Instead, he thought wellness is a process and that nurses and doctors
should educate and help their patients move further down the
continuum towards high-level wellness.
• Measures a person’s level of health
• Views health as a constantly changing state with high-level wellness
and death on opposite sides of a continuum
• Illustrates the dynamic (ever-changing) state of health

• A health continuum definition is not complete without an image shown
of the continuum
• The diagram shows a connection between the treatment and wellness
paradigms, which meet in the middle at the neutral point

The Health–Wellness Continuum

• A health continuum shows patients the path to a better, healthier
lifestyle
• The far left end of the continuum, in the treatment paradigm, is
premature death
• As patients move to the right, they reach the neutral point, leaving the
treatment paradigm solely in the wellness paradigm
• Finally at the far right of the continuum is high-level wellness.

• One of the health continuum benefits is that it is visual tool patients
can use to see and plan their journey to better health
• It is a roadmap leading to a healthier lifestyle and optimal wherever a
patients begins

Compares Treatment model with a wellness
model
• If the treatment model is used, an individual can move right only to the
neutral point. Eg. A hypertensive client which only takes his
medication without making any other life style changes
• If wellness model is used, an individual can move right past the
neutral point. Eg. Hypertensive client not only takes medications but
stop smoking, losses weight, starts an exercise programme etc.

model
• Movement to the left to the arrows (towards premature death) equates
a progressively decreasing state of health. Achieved in three steps,
• Signs
• Symptoms
• Disability
• It is generally composed of two arrow pointing in opposite direction
and joined at a neutral point.
• Movement to the right to the arrow (toward the high level of wellness)
equals an increase in level of health and wellbeing achieved in three
steps,
• Awareness
• Education
• Growth

model
• Most important is the direction of the individual facing on the pathway
• A) If towards high level of health, a person has genuinely optimistic or
positive out look about his/ her health status
• B) If toward premature death a person had a genuinely pessimistic or
negative out look about his/ her health status.

The High-Level Wellness Model
• Encourages the nurse to care for the total person
• Involves functioning to one’s maximum potential while maintaining
balance and a purposeful direction
• Regards wellness as an active state, oriented toward maximizing the
potential of the individual, regardless of his or her state of health
• Incorporates the processes of being, belonging, becoming, and
befitting

• High level wellness in a favorable environment: a person who has
lifestyle in a healthy way and various resources like social, culture,
economic, to support the lifestyle
• Emergent High level wellness in a unfavorable environment: A
woman, who knows about the healthy lifestyle practice but do not
implement it because of family circumstances, etc.

• Protected poor health in a favorable environment: An ill person
(having fracture and hypertension) whose needs are met by the health
care system and medications, diet and health-care instructions
• Poor health in an unfavorable environment: A young child who is
starving in a drought occurring country

The Health Belief Model
• Introduction
• This model was given by Rosenstock in 1974.
• It is a physiological model that attempts to explain and predict health behavior
by focusing on the attitude and belief of the individual.
• It is a first model related to health.

• Component
• Perceived susceptibility to disease
• Perceived seriousness to disease
• Perceived benefits of action
• Perceived barrier
• Self efficacy
• Cues to action

• Perceived susceptibility to disease
• It is belief that one either will or will not contact a disease. It range from being
afraid of developing a disease to completely denying that certain behaviour
may cause illness.
• For Example: one person who smokes may believe that it can cause cancer
and stops; and another person believe it does not cause cancer and
continues.

• Perceived seriousness to disease
• It concern the person’s perception of the threat disease poses to health and its
effect on the person’s lifestyle
• Perceived seriousness depends on how much person know about disease
and can result in change in health behaviour.

• Perceived benefits of action
• It is person belief about how effectively measures will prevent
illness
• It is influenced by the patient conviction that carrying out a
recommended action will prevent or modify the disease and by
the person perception of cost and unpleasant effects of
performing the health behaviour.
• For Example: the person belief that stopping smoking will
prevent future breathing problems and that initial withdrawal
symptoms can be overcome, the person may stop smoking.

• Perceived Barrier
• It concerns that the new behaviour will take too much time.
• Their belief can be actual or imagined.

• Self efficacy
• It is one’s own belief in the ability to reach goal and complete task, in a strong
influence on a person choices particularly regarding health behaviour.

• Cues To Action
• It refer to factors which causes you to change or want to change.
• Event’s or strategies that increase one’s motivation.

Modifying Factors
• Demographic variables (Age, gender)
• Socio psychological variables (personality and peer group pressure)
• Structure variable (knowledge and prior contact with disease)
• Other advice
• Mass media campaigns
• Literature
• Illness of significant other

Strengths
• Can be used alone or conjunction with other models
• Understanding what beliefs and attitude motivates behaviour
• Good for cessation and acquisition of beahivour
• Enhances self control

Weakness
• Not good for long term behaviour change.
• Lacks predictive power
• Difficult to be tested
• Self fulfilling pridiction

Basics of the Maslow Hierarchy of Needs
Theory
• Maslow's Hierarchy of Needs is a theory in psychology proposed by
Abraham Maslow in 1943.
• Maslow’s theory proposes that as humans meet “basic needs”, we
look to satisfy “higher needs” that occupy a our mind set.
• Maslow’s theory is depicted as a pyramid in four levels: the first three
are deficiency needs (lack of), and the top level is growth needs.
• When each level of need is accomplished, the next level of need
becomes dominate. Therefore, no need is ever satisfied, motivation
excels individuals to feel satisfied.

Maslow's Hierarchy of Needs Pyramid

Physiological Needs
Bottom Level of the pyramid, the physiology needs of the human organism,
consist of:
• the need to breathe
• the need to drink water
• the need to interact
• the need to eat
• the need to dispose bodily waste

Safety Needs
Second Level of the pyramid, the safety needs of the human organism, consist of:
• Physical safety (safety from aggression, violence)
• Security of employment
• Security of resources
• Mind & Moral security
• Family security
• Health security
• Security of personal property against social indifferences such as crime

Love/ Belonging Needs
Third Level of the pyramid, involving emotional-based relationships, the
love/belonging needs of the human organism, consist of:
• Friendship
• Sexual intimacy
• Support and Communication with family

Esteem Needs
Forth Level of the pyramid, the esteem needs of the human organism, consist
of:
• Self-esteem
• Confidence
• Personal Achievement
• Respect of others
• Attaining respect by others

Self-actualization
Fifth Level of the pyramid, the Growth needs category, the self-actualization.
Self-actualization people are the following:
• Acknowledge the facts and realities of the world instead of rejecting or denying
them
• Reactive to ideas and actions
• Creative
• Interest in solving problems, usually the problems of others
• Feel closeness of others, and appreciates life
• Conforms to rules; independent from outside authority
• Objective to surrounds (are receptive of others instead of prejudice)
“Self Actualization is the intrinsic growth of what is already in the organism, or
more accurately, of what the organism is.”
-(Psychological Review, 1949)

Levels of Preventive Care
• Primary prevention—e.g., diet, exercise, immunizations
• Secondary prevention—e.g., screenings, mammograms, family
counseling
• Tertiary prevention—e.g., medications, surgical treatment,
rehabilitation

Introduction to health & illness book of FON bsc nursing

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