Dr. Naglaa F. A. Youssef

Lecturer

Medical Surgical Nursing Dep.

Faculty of Nursing

Cairo University

Content outlines

Definitions of terms: health, disease, illness and wellness or well-being

Concept of health

Models of health & illness

Factors affecting health belief, health status and practice

Levels of prevention

Illness classifications

Impact of illness on patients & family

Role of the nurse in promotion & maintenance of health Identify risk factors

Follow levels of prevention

Health: is a broad term, individualized to each person, and is

affected by so many factors, thus it has various definitions.

Disease: is a pathological change in structure &/or function……signs.

Illness: is the response of person to disease, which is based on the person’s perception……symptom.

Wellness (health): is a status in which individual is capable of meeting the minimum physical, psychological and social requirements of appropriate functioning.

Glossary

Self-concept (also called self-construction, self-identity, self-perspective or self-structure). It is a collection of beliefs about oneself that includes elements such as academic performance, gender roles and sexuality, and racial identity.

Glossary

Dimensions of wellness

Health and illness:

are not static conditions,

They are vital concepts,

They are subject to continuous evaluation and

change.

First definition:

In 1948, the World Health Organization

(WHO) defines health as “a state of complete

physical, mental and social well-being and

not merely the absence of infirmity and

disease”.

Definitions of Health

1. Health is a multidimensional concept that includes different interdependent and interrelated aspects, i.e.

Feeling of health can be with or without disease.

Based on the WHO definition

Mental health

Social health Well-being

Physical health

Bio-psychosocial dimensions of health

Characteristics of the WHO definition of health

1. Considers the individual as a holistic system.

2. Looks at the internal and external factors.

3. Acknowledges the individual’s role in life and his

value.

However, there is no general agreement about this

definition of health.

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”.

Characteristics of the second definition of health

Considers health as a dynamic status, which can be changed from time to time.

Acknowledges the relationship between internal and external environment and health status.

Recognizes the importance of adaptation to maintain state of health and well-being.

Models of health and illness

1. Health-illness continuum

2. Agent-host environment model

3. High-Level Wellness Model

4. Health belief model

5. Health promotion model

1. Health-illness continuum model (adapted)

Disability symptoms Signs Awareness Education Growth

Premature death

High level

wellness Treatment model

Psychosocial model Medical model

Nursing/care providers interventions

Main idea of health-illness continuum model

Health and illness are seen as relative concepts and

not as separate absolutes.

Health and illness as a graduated scale has two ends.

Health is a dynamic state that fluctuates as a person

adapts to changes in the internal and external

environments to maintain a state of well- being.

2. Agent–Host Environment Model

This model is used primarily in describing causes of illness rather than in promoting wellness.

It helps in identifying risk factors that

result from interaction of agent-host-environment.

Agent

Host

Environment

Any internal or external factor or stressor

(biological, chemical, mechanical, physical, or psychological) that by its

presence or absence (e.g. lack of essential nutrients → illness or

disease).

Person's who may be at risk of acquiring a disease.

External factors that make illness more or less likely.

Physical environment → climate, living conditions, sound (noise) levels, and economic level.

Social environment → interaction with others and life events, such as death of spouse, stress, or conflicts.

Components of this model

• When each of the agent-host-environment factors are in

balance, health is maintained and when not in balance

disease occurs (fluid, electrolytes, vitamins,…etc.

Factors affecting health belief, health status and practice

Factors

Internal factors

External factors

A. Internal Factors affecting health belief, health status and practice

A-Biological dimension

Developmental stage e.g. age,

Heredity, genetics, race, and gender

B-Psychological dimension:

Mind-body interaction

Self-concept

Emotional factors

C-Cognitive / intellectual dimension:

Life-style choices Patterns of eating and exercise, use of tobacco, abuse of drugs and alcohol.

Spiritual and religious beliefs

B. External Factors affecting health belief, health status and practice

Family practices

Socioeconomic status

Cultural background

Social support networks

Levels of Preventive Care

Tertiary prevention

Secondary prevention

Primary prevention Health promotion and protection

Early diagnosis, treatment and disability limitation

Restoration and rehabilitation

? Give example

The Illness Classifications

I. Acute illness: – Short term < three

months. – Severe symptoms

appear suddenly.

Result in:

– Complete recovery, – Death, or – Develop into a

chronic disease.

II. Chronic illness: – long term > 3 months, – Less severe symptoms,

and – Slow onset.

Result in:

– A state of optimizing patient’s levels of functioning.

– A state of optimizing patient’s ability to live with the illness (coping).

Care for patient and his family as one unit

Impact of Illness on patient and family

Illness is never an isolated life event.

Behavioral and emotional changes

Impact on body image

Impact on self concept

Impact on family roles

Impact on family dynamics

1. Behavioral and emotional changes

People react differently to illness.

Reaction to illness depends on:

Nature of illness e.g. duration, severity.

Client’s attitude toward the illness.

The others’ reaction (e.g. family) to the client’s illness.

E.g. life threatening illness can lead to more extensive emotional and behavioral changes, such as anxiety, depression, shock, denial, anger and withdrawal. Example of leg amputation…..

3. Impact on Body Image

Body image has been defined as “the subjective concepts of

physical appearance’’ (Potter and Perry 2014).

Reaction to changes differently according to:

Type and rate of changes,

Individual's capacity of adaption, and

Availability of supportive health service.

2. Impact on family roles

People have various social role in and out their families,

such as work, decision maker and parent.

When illness occurs, the client’s and family’s role may

change.

The change may be slight or huge based on the disease

duration and severity, and people ability to cope.

Nurses should involve the patient’s family in the

care plan.

5. Impact on Family Dynamics

It means the process of family coping,

making decision and giving support.

Activities & decision making delay action,

new pattern of functioning stress &

reversal of roles → stress & conflicting

responsibilities.

Each client responds uniquely to illness →

nursing assessment, diagnosis, and

interventions must be individualized.

Role of the Nurses in the Promotion & Maintenance of Health

Maintaining or improving the person’s perception about his/her health status is a central goal of nursing practice.

A nurse can determine a client’s level of health using the health-illness continuum.

Then, a nurse can help the patient/client to identify his/her position on the health-illness continuum. This can guide to set a goal for achieving optimal health.