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HUMAN RESPONSE TO ILLNESS

CHAP 8

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Definition of Health

Health:

It is a complete state of physical, mental, and social well being and not merely the absence of disease or infirmity. (WHO,1948)

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Second definition of Health Potter & Perry (2014) define health as a “ dynamic state, in which the individual adapts to changes in internal and external environments to maintain a state of well-being”.

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Wellness

Wellness:

It is the state in which attitudes and behaviors enhance the quality of life and maximizing personal potentials. OR

Wellness is an active state, oriented toward maximizing the potential of the individual.

OR

Wellness is a status in which individual is capable of meeting the minimum physical ,psychological and social requirement of appropriate functioning.

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Dimensions of Wellness

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Copyright 2008 by Pearson Education, Inc.

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Dimensions of Wellness

Physical Potential:

Able to carry out daily tasks, achieve fitness, maintain adequate nutrition, body fat, avoid alcohol/Drug abuse or tobacco products, practice healthy lifestyle habits.

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Dimensions of Wellness

Social Potential:

Able to interact successfully with people in one’s environment, to develop and maintain intimacy with others, to develop respect and tolerance about different opinions and believes.

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Dimensions of Wellness

Emotional Potential:

Ability to manage stress, expresses emotions appropriately and accepts limitations.

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Intellectual Potential:

Ability to learn and use information effectively for personal development and meeting new challenges.

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Dimensions of Wellness

Environmental Potential:

Ability to promote health measures to enhance standard of living and quality of life in community

Spiritual potential:

Belief in some forces or higher power, meaning and purpose of life (morals, values, ethics)

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Dimensions of Wellness

Occupational Potential:

The ability to achieve a balance between work and leisure time, A person's beliefs about education, employment, and home influence personal satisfaction and relationships with others.

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Concepts of illness and disease

Disease

Disease can be described as an alteration in body functions resulting in a reduction of capacities or shortening of the normal life span. OR

A disease is a pathological condition that impairs normal body structure and functions. ... Illness is a broad term that is used to describe a person who is in a poor state of health. Illness is not always due to disease.

Illness: the unique response of a person to a disease

It is an abnormal, highly personal and subjective feeling in which individual’s physical, emotional, intellectual, social, developmental or spiritual functioning is thought to be diminished or impaired

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Illness

• “Illness is a condition characterized by a deviation from a normal health state which is manifested by physical & psychological symptoms.” – Kozier.

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• “Illness is a state in which a person’s physical, intellectual, emotional, social or spiritual functioning is diminished or impaired in comparison with the previous experience”.

Potter & Perry.

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Variables Affecting Illness Behaviour

1. Internal Variables.

2. External Variables.

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Variables Affecting Illness Behaviour

INTERNAL VARIABLES

1. Perception of symptoms.

2. Nature of illness.

3. Characteristics of person

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Variables Affecting Illness Behaviour

EXTERNAL VARIABLES

1.Visibility of symptoms.

2.Social group.

3.Culture & values.

4.Economic variable.

5.Accesibility of health care system.

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Types of Illnesses

Acute Illness: Generally has a rapid onset of symptoms and lasts only for a relatively short time

Examples: Appendicitis, Pneumonia, Diarrhea, Common Cold

Chronic Illness: A broad term that encompasses many different physical and mental alterations.

    • It is a permanent change
    • It causes/is caused by irreversible alterations in normal A & P
    • It requires special patient education for rehabilitation
    • It requires a long period of care or support

Examples: Diabetes Mellitus, COPD, Arthritis, CRF etc

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Types of Illnesses

Acute illness

– Short duration

– Mostly severe

– Starts abruptly and subsides in relatively short period (less than 6 months)

Chronic illness

– Persist for more than six months

– May affect functioning of body in any dimension

– Up to the level of disability

– Major health problem

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Illness Behaviour

Illness behaviour refers to “the way in which symptoms are perceived, evaluated, and acted upon by a person who recognizes some pain, discomfort or other signs of organic malfunction

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A coping mechanism , involves ways individual describes ,monitor ,interpret their symptoms ,take remedial actions , and the use of health care system.

OR

The way the sick person acts is called illness behaviour

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Stages of Illness Behavior

Edward suchman (1972) identified 5 stages of illness behavior.

When a person experience illness ,he/she generally passes through five stages of illness behaviour.

This pattern involves how a person seeks, finds & completes the health care.

1.Stage I : Symptom experience.

2.Stage II : Assumption of sick role.

3.Stage III : Medical care contact.

4.Stage IV : Dependent client care.

5.Stage V : Recovery & rehabilitation.

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Stages of Illness Behavior

STAGE I – SYMPTOM EXPERIENCE (manifestation /Signs)

  • In the first stage, person feels that something is wrong but he is not able to diagnose the problem.
  • Perception of symptoms includes awareness of physical change like pain, rashes, lump. At the end of this stage , he is able to make the decision that it is a symptom of an illness.
            • Awareness of physical changes.
            • Pain, rashes and lump etc

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Stages of Illness Behavior

STAGE II –ASSUMPTION OF SICK ROLE

(Disruption of normal social roles, rights, obligation)

If the symptoms persist, then the client will assume sick role & seek confirmation from family & others that they are indeed sick. Then he gets excuse from normal duties & role expectations.

Assumption of sick role results in emotional changes such as withdrawal, depression, physical changes. The person may deny & delay the contact with health care system.

  • Accept sick role and seek confirmation
  • Self treatment
  • Excuses
  • Emotional responses
  • Illness persist seek professional help

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Stages of Illness Behavior

STAGE III –MEDICAL CARE CONTACT

At this stage, the client acknowledges the illness & seeks explanation of causes, duration of illness & it’s complications. Health professional may determine whether the client is ill or not.

After knowing about illness some client seek medical treatment , but sometimes, they start denying the symptoms.

  • Seek professional advice
  • Accept or deny diagnosis
  • Follow the treatment plan

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Stages of Illness Behavior

STAGE IV – DEPENDENT STAGE

(Increased attention and escape for work responsibilities)

After accepting the diagnosis, client becomes dependent upon health care professionals to get treatment.

Here, the client accepts the care, sympathy, protection from the demands & stress of life.

  • Dependent for professional help.
  • Accept their dependence on the primary care provider.

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Stages of Illness Behavior

STAGE V – RECOVERY & REHABILITATION

(Varies depending on the type of illness)

This is the stage when the symptoms of illness get subsiding. The person starts regaining original health status.

In case of chronic illness, final stage involves an adjustment to a prolonged reduction in health & functioning.

Relinquish the dependent role

Resume former roles and responsibilities.

Acute illness (short term) – recovery fast

Chronic illness (Long term) s– recovery difficult

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Emotional Responses To Illness

  1. Fear.
  2. Over dependence & feeling of helplessness.
  3. Anxiety.
  4. Hope.
  5. Anger & hostility.

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Impact Of Illness

1.Impact of illness on client.

2.Impact of illness on client & family.

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Support During Illness

  • Family Support

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  • Health Care Givers Support

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  • Complementary and Alternative Medicine

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  • Faith Healing

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  • Homeopathy

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Models of Health and Illness

  • The Agent-Host-Environment Model

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  • The Health–Illness Continuum

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  • The High-Level Wellness Model

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  • The Health Belief model

  • The Health Promotion Model

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�The Agent-Host-Environment Model �

Agent-Host-Environment Model (Leavell and Clark)

Agent: Agent is environmental factor or stressor, bacteria, virus, chemical substance

Host: Host is living organism cable of being affected by the agent

Environment: Environment is factors that are external to host that make illness more likely i.e: Lack of Sleep. Cold Temperature

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The Health–Illness Continuum

The Health–Illness Continuum

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

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The High-Level Wellness Model (Dunn)

  • 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

Active State: More than good health (passive) maximizes the person’s potential. More total person focus encompasses all of the dimensions Being: Recognizing self as separate and individual Belonging: Being part of a whole becoming: Growing and Developing Befitting: Making personal choices to befit the self of the future

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The High-Level Wellness Model (Dunn)

Dunn(1959) described a health grid in which a health axis and an environmental axis intersect.The Health axis extends from peak wellness to death, & the environmental axis extends from very favourable to very unfavourable.The intersection of two axis forms four quadrants of health and wellness;

1:High level wellness in a favourable 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

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The Health Belief Model (Rosenstock)

  • Concerned with what people perceive to be true about themselves in relation to their health

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  • Modifying factors for health include demographic, sociopsychological, and structural variables

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  • Based on three components of individual perceptions of threat of a disease
        • Perceived susceptibility to a disease
        • Perceived seriousness of a disease
        • Perceived benefits of action

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Health Promotion Model (Pender)

Illustrates the “ multidimensional nature of persons interacting with their environment as they pursue health”

Incorporates individual characteristics and experiences and behavior-specific knowledge and beliefs, to motivate health - promoting behavior

Personal, biologic, psychological, and sociocultural factors are predicative of a certain health-related habit

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Health-related behavior is the outcome of the model and is directed toward attaining positive health outcomes and experiences throughout the lifespan

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Health Promotion Model (Pender)

Example: Used to predict how a person is likely to incorporate health promotion behaviors into their lifestyle.

Smoking: If parents smoke children more likely to smoke

Primary prevention—e.g., Diet, Exercise

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Level of prevention

  • Primary prevention—e.g., Diet, Exercise, Immunizations

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  • Secondary prevention—e.g., Screenings, Mammograms, Family Counseling

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  • Tertiary prevention—e.g., Medications, Surgical Treatment, Rehabilitation

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References

  • Kozier & Erb’s Fundamental of Nursing Book, 8th edition.
  • Michael A Bettman FACRS “Self Esteem article” 1960.
  • Thomas Fuller Ph.D/MCPR “Teaching and Learning” 1955.
  • John Jackson M.D “of nursing research 6th edition. Manual

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