kozier - chapter 17- health wellness well being

Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.

Chapter 17

Health, Wellness, and Illness

Copyright 2008 by Pearson Education, Inc.

Question 1

Which one of the following is an example of the emotional component of wellness?

1. The client chooses health foods.2. A new father decides to take parenting

classes.3. A client expresses frustration with her

partner’s substance abuse.4. A widow with no family decides to join a

bowling league.


Rationales 1

1. The client who chooses healthy foods represents the physical component.

2. Taking parenting classes enhances the intellectual component.

3. Correct. Frustration is an example of an emotion.

4. The bowling league enhances both the physical and social components.


Question 2

Which one of the following individuals appears to have “taken on” the sick role?

1. An obese client states, “I deserve to have a heart attack.”

2. A mother is ill and says, “I won’t be able to make your

3. lunch today.”4. A man with low back pain misses several

physical therapy appointments.5. An elder states, “My horoscope says I will be

well again.”


Rationales 2

1. The sick role states that persons are not answerable for their illness, contrary to the obese client’s perspective.

2. Correct. The mother has taken on the sick role by expecting to be excused from her usual role responsibilities.

3. In the sick role, the client tries to get better as opposed to the man who misses his physical therapy appointments.

4. The elder is not following the sick role expectation to rely on competent help.


Question 3

Because a client recently diagnosed with diabetes mellitus is confident that blood sugar control can be improved with diet and exercise alone, and recently went checked out a video on the management of diabetes at the HMO education center, the client’s actions are most representative of which one of the following models:

1. Health belief model2. Clinical model3. Role performance model4. Agent-host-environment model


Rationales 3

1. Correct. The behavior is most representative of health promotion, which is the central focus of the health belief model.

2. The clinical model focuses on relieving signs and symptoms of illness.

3. The role performance model emphasizes social activities such as fulfilling a particular role.

4. The agent–host–environment model focuses on predicting illness.


Question 4Because a client with human immunodeficiency virus (HIV) is scheduled to begin several medications to manage the infection, the nurse will need to provide client education. Which of the following client characteristics is most likely to predict adherence with the treatment program? Select all that apply.

1. Educational level2. A trusting relationship with the health care

provider3. An expectation that the medications will be helpful4. Being able to take the medications twice daily

instead of four times daily5. Gender


Rationales 4

1. Education has not been shown to be a predictive factor.

2. Correct. Significant evidence exists that a trusting relationship with the provider is an important predictor of adherence.

3. Correct. Effectiveness of the medication is an important predictor of adherence.

4. Correct. A less complex dosing regime is an important predictors of adherence with the medical regimen.

5. Gender has not been shown to be a predictive factor.


Question 5

Which one of the following might be the BEST way to measure adherence to a prescribed medication regime?

1. Direct observation of medication administration.2. Evidence of illness complications or

exacerbations.3. Monitoring laboratory values of element

influenced by the medication.4. Questioning the client about his or her

medication routine.


Rationales 51. Correct. Although not always practical, direct

observation is the best method to measure adherence (for example, watching heroin addicts actually take their methadone dose).

2. Since lack of adherence may be life threatening or damaging to the client as well as others, waiting until the client displays illness is not the best method.

3. Since lack of adherence may be life threatening or damaging to the client as well as others, waiting until laboratory values reflect lack of adherence is not the best methods.

4. Client report or recall is not always accurate, even if the client believes he or she is telling the truth.


Health, Wellness, Wellbeing

• Many definitions and interpretations


Health

• Presence or absence of disease• Complete physical, mental, social

well-being• Ability to maintain normal roles• Process of adaptation to physical and

social environment• Striving toward optimal wellness• Individual definitions


Wellness

• State of well-being• Basic aspects include:

– Self-responsibility – An ultimate goal– A dynamic, growing process– Daily decision-making in areas related to

health– Whole being of the individual


Well-being

• Subjective perception of vitality and feeling well

• Described objectively, experienced, measured

• Can be plotted on a continuum


Dimensions of Wellness


Physical Dimension

• Ability to carry out daily tasks• Achieve fitness

• Maintain nutrition• Avoid abuses


Social Dimension

• Interact successfully• Develop and maintain intimacy

• Develop respect and tolerance for others


Emotional Dimension

• Ability to manage stress• Ability to express emotion


Intellectual Dimension

• Ability to learn• Ability to use information effectively


Spiritual Dimension

• Belief in some force that serves to unite


Occupational Dimension

• Ability to achieve balance between work and leisure


Environmental Dimension

• Ability to promote health measure that improves– Standard of living– Quality of life


Models of Health• Clinical Model• Role Performance Model• Adaptive Model• Eudemonistic Model• Agent-Host-Environment Model• Health-Illness Continuum


Clinical Model

• Provides the narrowest interpretation of health

• People viewed as physiologic systems • Health identified by the absence of signs

and symptoms of disease or injury• State of not being “sick”• Opposite of health is disease or injury


Role Performance Model

• Ability to fulfill societal roles• Healthy even if clinically ill if roles

fulfilled• Sickness is the inability to perform

one’s role


Adaptive Model

• Creative process• Disease is a failure in adaptation or

maladaption• Extreme good health is flexible

adaptation to the environment• Focus is stability• Element of growth and change


Eudemonistic Model

• Comprehensive view of health• Condition of actualization or

realization of a person’s potential• Illness is a condition that prevents

self-actualization


Agent-Host-Environment Model

• Each factor constantly interacts with the others

• When in balance, health is maintained

• When not in balance, disease occurs


Health-Illness Continuum

• Measure person’s perceived level of wellness• Health and illness/disease opposite ends of a health

continuum• Move back and forth within this continuum day by day• Wide ranges of health or illness


Factors Affecting Health Status, Beliefs, and

Practices• Internal variables• External variables


Internal Variables

• Biologic dimension (genetic makeup, gender, age, and developmental level)

• Psychologic dimension (mind-body interactions and self-concept)

• Cognitive dimension (intellectual factors include lifestyle choices and spiritual and religious beliefs)


External Variables

• Physical environment• Standards of living• Family and cultural beliefs• Social support networks


Factors Affecting Health Care Adherence

• Client motivation• Degree of lifestyle change necessary• Perceived severity of problem• Value placed on reducing the threat

of illness• Difficulty in understanding and

performing specific behaviors• Degree of inconvenience of the

illness itself or of the regimens


Factors Affecting Health Care Adherence

• Complexity, side effects, and duration of the proposed therapy

• Specific cultural heritage that may make adherence difficult

• Degree of satisfaction and quality and type of relationship with the health care providers

• Overall cost of prescribed therapy


Illness

• A highly personal state• Person’s physical, emotional,

intellectual, social, developmental, or spiritual functioning is diminished

• Not synonymous with disease• May or may not be related to disease• Only person can say he or she is ill


Disease

• Alteration in body function • A reduction of capacities or a

shortening of the normal life span


Acute Illness

• Characterized by severe symptoms of relatively short duration

• Symptoms often appear abruptly, subside quickly

• May or may not require intervention by health care professionals

• Most people return to normal level of wellness


Chronic Illness

• Lasts for an extended period• Usually has a slow onset• Often have periods of remissions and

exacerbations• Care includes promoting

independence, sense of control, and wellness

• Learn how to live with physical limitations and discomfort


Parson’s Four Aspects of the Sick Role

• Clients are not held responsible for their condition

• Clients are not excused from certain social roles and tasks

• Clients are obligated to try to get well as quickly as possible

• Clients or their families are obligated to seek competent help


Suchman’s Stages of Illness

• Stage 1: Symptom experience– Believe something is wrong

• Stage 2: Assumption of the sick role– Accepts the sick role and seeks

confirmation

• Stage 3: Medical care contact– Seeks advice of a health professional


Suchman’s Stages of Illness

• Stage 4: Dependent client role– Becomes dependent on the professional

for help

• Stage 5: Recovery or rehabilitation– Relinquish the dependent role– Resume former roles and responsibilities


Impact of Illness

On the Client• Behavioral and

emotional changes• Loss of autonomy• Self-concept and

body image changes

• Lifestyle changes

On the Family• Depends on:

– Member of the family who is ill

– Seriousness and length of the illness

– Cultural and social customs the family follows


Impact of Illness: Family Changes

• Role changes• Task reassignments• Increased demands on time• Anxiety about outcomes• Conflict about unaccustomed

responsibilities • Financial problems• Loneliness as a result of separation and

pending loss• Change in social customs


Question 1

Which one of the following is an example of the emotional component of wellness?

1. The client chooses health foods.2. A new father decides to take parenting

classes.3. A client expresses frustration with her

partner’s substance abuse.4. A widow with no family decides to join a

bowling league.