MDWF112 Health Concepts Fall 2021 PDF

Unit Three: health and related concepts.  Definition of health.  Theoretical Perspectives of Health  Levels of preventive care.  Variables Influencing Health Behaviors  The impact of illness on the client and family. 1  Definit...

Unit Three: health and related concepts.  Definition of health.  Theoretical Perspectives of Health  Levels of preventive care.  Variables Influencing Health Behaviors  The impact of illness on the client and family. 1  Definition of health, Illness and Wellness.  Defining good health is difficult because each person has a personal concept of health.  Health is not an acquired piece of scientific knowledge, nor is it a thing, a part of the body, or a function of the body such as hearing, seeing, or breathing. Health is a state of being that people define in relation to their own values.  Health, the process through which a person seeks to maintain an equilibrium that promotes stability and comfort, is a dynamic process that varies according to a person’s perception of well-being. The traditional definition of health as the absence of illness is a narrow concept.  Illness is the inability of an individual’s adaptive responses to maintain physical and emotional balance that subsequently results in an impairment of functional abilities.  Wellness is the condition in which an individual functions at optimal levels.  Health is a global term because it refers to every aspect of a person’s life, including:  Physical status  Emotional well-being  Social relationships  Intellectual functioning  Spiritual condition  The World Health Organization defines health as a “state of complete physical , mental and social well-being, not merely the absence of disease or infirmity” Concept of illness and disease  Disease is a medical term, ref erring to pathologic changes in the structure or f unction of the body or mind.  An illness is the response of the person to a disease; it is an abnormal process in which the person’s level of functioning is changed when compared with a previous level. Models of Health  There are several theoretical models of health, as shown in Table 1 These models help clarify the link between the states of well-being and illness and clients’ responses to these processes.  The American Holistic Nurses’ Association (1994) describes health as a maintenance of harmony and balance among body, mind, and spirit. Balance refers to homeostasis, which is an equilibrium among psychological, physiological, sociocultural, intellectual, and spiritual needs. The process by which a person adjusts to achieve homeostasis is called adaptation.  When people describe their health status, basically three areas are considered: 1. Presence or absence of symptoms (physical and emotional) 2. How they feel (emotionally and physically) 3. What they are able to do (ability to function).  Health can be studied both in individuals and in groups (e.g., families and communities).  Health status is influenced by: o Beliefs and attitudes o Cultural factors o Lifestyle behaviors 2 Theoretical Perspectives of Health Model Theorist Assumptions Clinical model Traditional perspective  Health is absence of illness.  Individuals who are not “sick” (i.e., experiencing a disease) are healthy. Health-belief model Rosenstock  Expectations direct behaviors that lead to fulfillment of the expectations.  Group values exert influence on beliefs about health.  Beliefs may change as a person grows and develops. High-level wellness model Dunn  Health is influenced by the interaction between the individual, family, and community.  Health is viewed as an attempt toward achieving one’s fullest potential. Social learning theory Bandura  Beliefs strongly Rosenstock influence actions.  Behavior is influenced by expectations and reinforcements (or incentives). Host-agent-environment Leavell and Clark  Health depends on the model (“Ecologic” model) interaction of host, agent, and environment.  Balance among these elements results in health.  Illness occurs when there is an imbalance in one of the three 3  elements.  Model is used most often in predicting risk of illness. Health promotion model Pender  Model focuses on activities that improve wellness and prevent disabilities.  People use health- promoting activities when they: 1. Value health 2. Perceive health as being within their control 3. Can identify benefits in self- care activities 4. Have a positive perception of their own health status (Data from Bandura, A.. A social learning theory. Englewood Cliffs, NJ: Prentice Hall; Becker, M. H.. The health belief model and sick role behavior. Health Education Monogram, 2, 409–419; Dunn, H.. High-level wellness. Arlington, VA: R.W. Beatty; Edelman, C., & Mandle, C. L.. Health promotion throughout the lifespan (4th. ed.). St Louis: Mosby-Yearbook; Leavell, H., & Clark, A. E.. Preventive medicine for doctors in the community. New York: McGraw-Hill; Pender, N. J.. Health promotion in nursing practice. East Norwalk, CT: Appleton & Lange; and Rosenstock, I.. Historical origin of the health belief model. In M. H. Becker (Ed.), The health belief model and personal health behavior. Thorofare, NJ: Charles B. Slack.) Family Influences on Health Care:  Generally, families are the first to identify signals of impending illness. Also, families’ help determine the following:  Whether to seek treatment  What type of treatment is appropriate  Who should provide the treatment or care?  Where the treatment or care should be provided  Families are often the major caregivers for their relatives. Extended families and communities have traditionally acted as a buffer against excessive stress and illness.  Lack of social support from family or significant others results in psychological and spiritual isolation, which negatively impacts a person’s physiological state. 4   It is important to help clients identify, Strengthen, and use their social support systems. Sometimes, families need guidance to optimize health behaviors.  Health assessment must include the client’s (including the family’s) perspective of the most pressing problem. Illness Perspectives  Illness means different things to different people. Illness is the result of a disease (either physiological or psychological) or injury that affects functioning, and occurs when there is an inability to meet one’s needs.  There are two major classifications of illness: acute and chronic.  An acute illness is a disruption in functional ability usually characterized by a rapid onset, intense manifestations, and a relatively short duration.  Acute illnesses are usually reversible.  A chronic illness is a disruption in functional ability usually characterized by a gradual, insidious onset with lifelong changes that are usually irreversible.  An example of an acute illness is influenza. Arthritis is an example of a chronic illness. It is possible for a person to have both a chronic illness and an acute illness at the same time, for example, the person with diabetes (chronic) who also develops pneumonia (acute). Illness s Behaviors When a person becomes ill, certain illness behaviors may occur in identifiable stages (Suchman, 1965). These behaviors are how people cope with altered functioning caused by the disease. They are unique to the person and are influenced by age, gender, family values, economic status, culture, educational level, and mental status. There is no specific timetable for the stages-of -illness behaviors, which may occur rapidly or slowly. Nursing/midwifery roles throughout the stages remain constant. In all stages, the nurse/midwife accepts the patient as an individual, gives nursing/midwifery care based on prioritized needs, and facilitates recovery through physical care, emotional support, and health education STAGE 1: EXPERIENCING SYMPTOMS How do people define themselves as “sick”? The first indication of an illness usually is recognizing one or more symptoms that are incompatible with one’s personal definition of health. Although pain is the most common symptom indicating illness, other common symptoms include a rash, fever, bleeding, or a cough. If the symptoms last or a short time or are relieved by self-care, the person usually takes no further action. If the symptoms continue, however, the person enters the next stage. STAGE 2: ASSUMING THE SICK ROLE The person now self -defines as being sick, seeks validation (support) of this experience from others, gives up normal activities, and assumes a “sick role.” At this stage, most people focus on their symptoms and bodily functions. Depending on individual health beliefs and practices, the person may choose to do nothing, may research symptoms on Internet sources, may buy over-the-counter medications, may try alternative remedies to relieve symptoms, or may seek out a health care provider or diagnosis and treatment. STAGE 3: ASSUMING A DEPENDENT ROLE This stage is characterized by the patient’s decision to accept the diagnosis and follow the prescribed treatment plan. The person may initially have difficulty conforming to the recommendations of the health care provider and may decide to seek a second opinion or deny the diagnosis. The lack of independence is more troubling or some people who, based on their diagnosis, often require assistance in carrying out activities of daily living, and need emotional support through acceptance, approval, physical closeness, and protection. 5 If the disease is serious (such as a heart attack or stroke, cancer), the patient may enter the hospital for treatment. If the symptoms can be managed by the patient or family alone or with the assistance of home care providers, the patient is cared for at home. To facilitate adherence to the treatment plan, the patient needs effective relationships with caregivers, knowledge about the illness, and an individualized plan of care. STAGE 4: ACHIEVING RECOVERY AND REHABILITATION Recovery and rehabilitation might begin in the hospital and conclude at home, or may be totally concluded at a rehabilitation center or at home. Most patients complete this final stage of illness behavior at home. In this stage, the person gives up the dependent role and resumes normal activities and responsibilities. If the plan of care includes health education, the person may return to health at a higher level of functioning and health than before the illness. Wellness Perspectives  Wellness further describes health status. It allows health to be placed on a continuum from one’s optimal level (“wellness”) to a maladaptive state (“illness”).  Wellness is a dynamic process that is ever changing. The well person usually has some degree of illness and the ill person usually has some degree of wellness.  This concept of a health continuum negates the idea that wellness and illness are opposite because they may occur simultaneously in the same person in varying degrees.  According to Dunn (1961), high-level wellness means functioning to one’s maximum health potential while remaining in balance with the environment. 6 7  Levels of preventive care: 1. Primary prevention  It is true prevention; it precedes disease or dysfunction and is applied to clients considered physically and emotionally healthy.  Does not use therapeutic treatments, and does not involve symptom identification.  Primary prevention includes health education programs, immunization, or physical and nutritional fitness activities.  Primary prevention can be provided to an individual or to a general population, or it can focus on individuals at risk for developing specific diseases. 2. secondary prevention  Focuses on individuals who are experiencing health problems or illnesses and who are at risk for developing complications.Activities are directed at diagnosis and prompt intervention.  Secondary prevention includes screening techniques and treatment of early stages of disease to limit disability by averting or delaying the consequences of advanced disease. 3. Tertiary prevention  It occurs when a defect or disability is permanent and irreversible.  It involves minimizing the effects of the disease or disability by interventions directed at preventing complication and deterioration.  Activities are directed at rehabilitation rather than diagnosis and treatment. Variables Influencing Health Behaviors There are several variables that influence health including:  Lifestyle  Perceived locus of control  Perceived ease or difficulty in accomplishing a task (self-efficacy)  Health care attitudes  Self-concept Lifestyle:  Lifestyle consists of a person’s usual daily activities and routines that are acceptable practices in the person’s life. Such routines and habits influence health status. For example, consumption of large amounts of caffeine, cigarette smoking, consistent intake of high-fat foods, and a sedentary routine can adversely affect health status.  Lifestyles are developed within one’s family and one’s cultural environment. The family is the primary influence on a child’s development of health-promoting (or health-defeating) behaviors.  When lifestyle modifications are necessary to improve health, many individuals have difficulty implementing the suggested changes.  Individuals are less likely to comply with recommended lifestyle changes if there is a perception of increased inconvenience and cost. Perceived locus of control:  Locus of control refers to individuals’ sense of control over events and situations affecting their lives.  A person with an external locus of control feels like a victim with little, if any, control over life events. 8   However, a person with an internal locus of control feels able to influence significant events and occurrences affecting self, that is, they see themselves as responsible for their own lives.  Thus, those with an internal locus of control are more willing to make lifestyle changes that will lead to wellness. Perceived ease or difficulty in accomplishing a task (self-efficacy):  Self-efficacy is an individual’s perception of one’s own ability to perform a certain task. Self-efficacy has a powerful impact on initiating behavior change.  When clients are able to make informed decisions about their health behaviors and feel that they are successful in these areas, they are more likely to attempt behavior change.  Self-efficacy is a form of self-confidence that leads to successful behavior performance; it is a strong influencing factor on behavior (Borsody, Courtney, Taylor, & Jairath, 1999).  As described by Bandura (1986), self-efficacy encompasses two types of expectations: 1. Outcome expectations: Beliefs about whether behavior will produce desirable results 2. Efficacy expectations: Beliefs the person has about his or her own ability to perform the behavior  Only when individuals enter into active partnerships with their primary health care provider (nurse, physician, or other healer) will self-responsibility for health become a reality. Health care attitudes:  Health behaviors are based on beliefs. Attitudes about health and personal vulnerability (which are initially learned in the family unit) greatly influence behavior.  Socialization (which occurs within the family) influences the development of beliefs about health care. These beliefs determine the person’s willingness to participate in health care. For example, if the person believes in the use of herbs or folk healers, such nontraditional health care practices could either enhance or interfere with traditional treatment approaches.  There are some gender differences in beliefs regarding health care. Midwives must be sensitive to the fact that all clients do not share the same beliefs about health care issues. Using a nonjudgmental attitude helps the midwife to be more accepting of clients with diverse beliefs and behaviors. Self-concept:  Self-concept is an individual’s perception of self. It includes self-esteem (an individual’s perception of self worth) and body image (perception of physical self).  Self-concept influences individuals’ health behaviors in that people who think highly of themselves will tend to take care of themselves.  On the other hand, a person with a negative self-concept will engage in careless or self-destructive behaviors that endanger health. Persons with a low self-concept frequently ignore their own needs because they are perceived to be less important than the needs of other people.  Self-concept is dynamic and may change according to health status. Not only does self-concept influence health, but changes in health status may influence self concept. For example, consider the person who has lost a limb due to amputation. This person’s self-concept would be altered as a result of the physical change. Impact of illness on the client and family 9 Behavioral and Emotional Changes: People react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness, the client’s attitude toward it, the reaction of others to it, and the variables of illness behavior. These are common responses to the stress of illness.  Anxiety: is a feeling of apprehension, uneasiness, agitation, uncertainty, and fear that occurs when individuals anticipate threats. The anxiety is a fear of a possible diagnosis, particularly a diagnosis of cancer. Others may become more anxious over impending surgery and anticipated pain. Anxiety responses vary from client to client, family to family, and stage to stage in illness behavior.  Shock: response is a powerful emotional state. Some people describe themselves as “numb” or “immobilized”. People hearing that they have cancer may react with shock. They hear what has been said to them but fail to respond or respond in a totally inappropriate manner.  Denial: is a mechanism by which the client or family avoids emotional conflict and anxiety by refusing to acknowledge difficult facts. A family learning that a loved one has cancer may deny the diagnosis and attempt to continue as though nothing were wrong. Short-term denial, however, can be an effective way of coping with an illness.  Anger: the anger of family members might be directed at the client because the illness has disrupted their routine, their plans, and in some cases, their economic and emotional support. Anger also may have effects on a client’s social or spiritual dimensions.  Withdrawal: illness particularly long-term or severe illness may cause clients to withdraw. They may avoid interaction, remain in their rooms, or resort to solitary activities such as continuously watching television. Withdrawal is a symptom of depression. Impact on family roles  People have many roles in life such as wage earner, decision maker, professional, and parent.  When an illness occurs, the roles of client and family may change. Such a change may be subtle and short term or drastic and long term. An individual and family generally adjust more easily to subtle, short-term changes.  In some cases, family members may mistakenly assume that the ill person needs to be free of decisions and responsibilities. family members take over all the roles of the client, including wage earner and decision maker. Impact on body image:  Body image is the subjective concept of physical appearance. The reactions of clients and families to changes in body image depend on the following: a. The types of changes for example, loss of a limb, a special sense, or an organ. b. Their adaptive capacity. c. The rate at which changes take place. d. Supportive services available.. Impact on family dynamics:  Family dynamics is the process by which the family functions, makes decisions, gives support to individual members, and copes with every changes and challenges.  If a parent in a family becomes ill, family activities and decision making often come to a halt as the other family members wait for the illness to pass, or they delay action because they are reluctant to assume the ill person’s roles or responsibilities.  In some cases of prolonged illness, the family often has to shift to a new pattern of functioning, a change that can lead to emotional stress. Young children for example, may experience a strong sense of loss if either parent is hospitalized or unable to provide affection and a sense of security.  If a parent of an adult becomes ill and cannot carry out usual activities, the adult child often assumes many of the parent’s responsibilities and in essence becomes a parent to the parent. 10  Such a reversal of the usual situation can lead to stress, conflicting responsibilities for the adult child or direct conflict over decision making. 11