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Health

• The World Health Organization defines health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity
• Individual perceptions and definitions of health change with age and are affected by personal health beliefs
• Health involves actualization of inherent and acquired human potential through goal-directed behavior, competent self-care, and satisfying relationships with others

Models of Health and Illness

• Models explain complex subjects like health and illness, and the relationship between attitudes toward health and behavior
• Clinical judgment will help you determine which model to use
• Health beliefs are a person's ideas, convictions, and attitudes about health and illness
• Positive health behaviors maintain, attain, or regain health and prevent illness
• Negative health behaviors are harmful practices like smoking, drug or alcohol abuse, risky sexual behaviors, poor diet, and refusing medication

Health Belief Model (HBM)

• HBM addresses the relationship between a person's beliefs and behaviors and has three components:
  • The individual's perception of susceptibility to an illness
  • The individual's perception of seriousness of the illness
  • The likelihood that a person will take preventive action
• The HBM helps in understanding factors influencing patients' perceptions, beliefs, and behaviors, to plan care, help maintain/restore health, and prevent illness

Health Promotion Model (HPM)

• HPM defines health as a positive, dynamic state, not merely the absence of disease
• It describes the multidimensional nature of people as they interact within their environment to pursue health
• The model focuses on three areas:
  • Individual characteristics and experiences
  • Behavior-specific cognitions and affect
  • Behavioral outcome
• Health-promoting behaviors result in improved health, enhanced functional ability, and better quality of life at all stages of development

Maslow's Hierarchy of Needs

• Nurses use it to understand the interrelationships of basic human needs
• Certain human needs are more basic than others; some must be met first:
  • Physiological needs: breathing, food, water, shelter, clothing, sleep
  • Safety and security: health, employment, property, family and social stability
  • Love and belonging: friendship, family, intimacy, sense of connection
  • Self-esteem: confidence, achievement, respect of others, the need to be a unique individual
  • Self-actualization: morality, creativity, spontaneity, acceptance, experience purpose, meaning, and inner potential
• Self-actualization is the highest expression of individual potential, allowing for continual self-discovery

Holistic Health Model

• The relationships among body, mind, and spirit affect a person's overall health
• The Holistic Health Model promotes a patient's optimal level of health by considering the dynamic emotional, spiritual, social, cultural, and physical aspects of an individual's wellness
• Our choices powerfully affect our health
• Widely used holistic interventions include meditation, music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery

Variables Influencing Health and Health Beliefs and Practices

• Internal and external variables influence a patient's health and health beliefs and practices
  • Internal Variables: developmental stage, intellectual background, perception of functioning, emotional and spiritual factors
  • External Variables: family practices, psychosocial factors, socioeconomic factors, cultural background
• Health beliefs influence health behaviors or practices, which affect a patient's level of health (positively or negatively)

Internal Variables

• Developmental Stage: A person's perceptions of health, illness, and health behaviors change over time
• Intellectual Background: Influences how a patient thinks about health
  • Cognitive abilities also relate to a person's developmental stage
• Perception of Functioning: Perceptions of physical functioning affect people's health beliefs and practices
• Emotional Factors: A patient’s degree of stress, depression, or fear influences health beliefs and practices
• Spiritual Factors: Spirituality integrates people's lives and provides motivation for health-promoting activities

External Variables

• Family Role and Practices: Influence how each family member defines health and illness and values health practices
• Social Determinants of Health/Culture: Health is determined by a person's circumstances and environment
• Social and community context influences a patient's beliefs, values, and customs
• Cultural background influences an individual's beliefs about causes of illness and remedies or practices to restore health

Health Promotion, Wellness & Illness Prevention

• Public Health focuses on health promotion, wellness, and illness prevention
• Health promotion helps individuals maintain or enhance their present health
  • It motivates people to engage in healthy activities like routine exercise and good nutrition to reach more stable levels of health
• Health education provides information on topics such as physical awareness, stress management, and self-responsibility, to enable individuals to improve their health
• Illness prevention activities protect people from actual or potential health risks
  • Immunization programs and blood pressure screenings help avoid declines in the level of health or functional ability

Three Levels of Prevention

• Primary Prevention: True prevention to reduce the incidence of disease
  • Health education programs, nutritional programs, and physical fitness activities
• Secondary Prevention: Prevents the spread of disease, illness, or infection once it occurs
• Activities are directed at diagnosis and prompt intervention, reducing severity and enabling the patient to return to a normal level of health ASAP
• Tertiary Prevention: Occurs when a defect or disability is permanent and irreversible
• Minimizes the effects of long-term disease or disability with interventions directed at preventing complications and deterioration

Primary and Secondary Prevention (examples)

• Primary Prevention:
  • Health promotion: health education, good nutrition, adequate housing, recreation, working conditions, marriage counseling, sex education, genetic screening
  • Specific Protection: providing immunizations, attention to personal hygiene, use of environmental sanitation, protection from occupational hazards and from accidents and carcinogens
• Secondary Prevention:
  • Early Diagnosis and Prompt Treatment: individual and mass screening surveys; focused examinations to cure and prevent diseases and spread (communicable diseases); prevent complications, limit disability, and prevent death
  • Disability Limitations: Adequate treatment to stop the disease process and prevent further complications and provision of facilities to limit disability and prevent death

Risk Factors

• A risk factor attribute, quality, environmental situation, or trait that increases the vulnerability of an individual or group to an illness or accident. Example: impaired gait, reduced vision, and lower extremity weakness
• Non-Modifiable Risk Factors: Risk factors that cannot be changed, such as age, gender, genetics, and family history
• Modifiable Risk Factors: Include smoking, drinking alcohol, unhealthy diet, obesity, physical inactivity, and insufficient rest and sleep
  • These risk factors put people at risk for chronic illnesses, such as diabetes and heart disease
• Environment: The physical environment can increase the likelihood of certain illnesses

Risk Factor Identification & Changing Health Behaviors

• Health risk appraisal forms identify health threats based on various risk factors
• Appropriate and relevant health education and counseling help a person change or implement behaviors to maintain or improve health status
• To be most effective, nursing interventions should match the stage of change

Illness

• Illness and disease are different concepts
• Illness: A state in which a person's physical, emotional, intellectual, social, developmental, or spiritual functioning is diminished or impaired; a feeling of poor health
• Disease: A medical condition that causes distress for a person in the form of its symptoms
• Both acute and chronic diseases can affect many dimensions of functioning
  • Acute Disease: Usually reversible with a short duration
  • Symptoms appear abruptly and are intense then subside after short period
  • Chronic Disease: Lasts more than six months and is irreversible; affects functioning in one or more systems; patients fluctuate between maximal functioning and serious health relapses

Variables Influencing Illness and Illness Behavior

• Internal Variables: Patient's perceptions of symptoms and the nature of a disease
• External Variables: Visibility of symptoms, social group, cultural background, economic variables, accessibility of healthcare system, and social support

Impact of Illness

• Behavioral and Emotional Changes: Short term, non-life-threatening diseases require few changes in the functioning of a patient of family
• Impact on Body Image: Body image = the subjective concept of physical appearance (some diseases/illnesses result in changed in the patient's physical appearance)
• Impact on Self-Concept: Self-concept = a mental self-image of all aspects of personality; depends in part on body image and roles as well as other aspects of psychology/spirituality
• Impact on Family Roles: People have many roles in life (wage earner, decision maker, professional, child, sibling, parent); role reversal is common if family member is diagnosed or becomes ill
• Impact on Family Dynamics: The process by which a family functions, makes decisions, gives support, and copes with changes; dynamics change because of the effects of diseases/illnesses

Caring for Yourself

• To provide competent, quality, and safe care, nurses need to care for themselves, to remain healthy