NCM 102NCM 102 - Curative and - Curative and RehabilitativeRehabilitativeIllness and DiseaseIllness and Disease

Health and WellnessHealth and Wellness

Traditional view of Traditional view of HealthHealth: Defined in : Defined in terms of diseaseterms of disease

(The state of people who not sick or (The state of people who not sick or dying)dying)

WHO 1947WHO 1947 ““Health is a state of complete, Health is a state of complete,

physical, mental & social well being and physical, mental & social well being and not merely the absence of disease or not merely the absence of disease or infirmity”infirmity”

HealthHealth

Derived from old English for “heal” Derived from old English for “heal” which means whole.which means whole.

A dynamic change in the person who is A dynamic change in the person who is constantly adapting to changes in the constantly adapting to changes in the internal and external environment internal and external environment (Craven)(Craven)

The process through which a person The process through which a person seeks to maintain equilibrium that seeks to maintain equilibrium that promotes stability and comfort (Daniels)promotes stability and comfort (Daniels)

HealthHealth

Holistic view of Health:Holistic view of Health: -Individual is viewed as a total person -Individual is viewed as a total person

functioning physically, psychologically, and functioning physically, psychologically, and socially with mental processes and socially with mental processes and attitudesattitudes

-This view places health in the context of -This view places health in the context of the environment and equates health with the environment and equates health with productive & creative livingproductive & creative living

HealthHealth: highly individual perception.: highly individual perception.   Most people define & describe Most people define & describe

health as…health as… Being free from symptoms of disease Being free from symptoms of disease

& pain as much as possible& pain as much as possible Being able to be active & be able to do Being able to be active & be able to do

what they want or must what they want or must Being in good spirits most of the timeBeing in good spirits most of the time

Wellness and Well-beingWellness and Well-being WELLNESSWELLNESS

State of well-beingState of well-being Engaging in attitudes & behaviors that Engaging in attitudes & behaviors that

enhance quality of life & maximize personal enhance quality of life & maximize personal potentialpotential

Basic Concept:Basic Concept: Self-responsibilitySelf-responsibility Ultimate goal Ultimate goal Dynamic growing processDynamic growing process Daily decisional making: areas of nutrition, Daily decisional making: areas of nutrition,

stress management, physical fitness, preventive stress management, physical fitness, preventive health care, emotional health, & othershealth care, emotional health, & others

Whole being of the individualWhole being of the individual

WellnessWellness

Leddy and Pepper 1993Leddy and Pepper 1993 Well-being: subjective perception of Well-being: subjective perception of

balance, harmony & vitality balance, harmony & vitality Travis & Ryan 1991Travis & Ryan 1991 Wellness is a choice; a way of life; a Wellness is a choice; a way of life; a

process; efficient handling of energy; process; efficient handling of energy; integration of body, mind & spirit; & integration of body, mind & spirit; & loving acceptance of selfloving acceptance of self

5 Dimensions of Wellness5 Dimensions of Wellness Physical Dimension: Respiratory; CVS; Physical Dimension: Respiratory; CVS;

GIT; Nutrition, life styles and habitGIT; Nutrition, life styles and habit Social Dimension: interaction; Social Dimension: interaction;

intimacy; respect & toleranceintimacy; respect & tolerance Emotional Dimension: manage; Emotional Dimension: manage;

recognize; accept & express (one’s recognize; accept & express (one’s limitation)limitation)

Intellectual Dimension: learn; use; Intellectual Dimension: learn; use; striving & to deal w/ new challengesstriving & to deal w/ new challenges

Spiritual Dimension: belief; morals; Spiritual Dimension: belief; morals; values & ethicsvalues & ethics

WellnessWellness

A state of well-being, with balance of the A state of well-being, with balance of the 7 interrelated components- Physical, 7 interrelated components- Physical, Emotional, Intellectual, Spiritual, Emotional, Intellectual, Spiritual, Occupational and Environmental (Kozier)Occupational and Environmental (Kozier)

A balance of the all aspects of a person’s A balance of the all aspects of a person’s life-physical, spiritual, psychological, life-physical, spiritual, psychological, emotional and social aspects (Craven)emotional and social aspects (Craven)

A condition in which an individual A condition in which an individual functions at optimum levels (Daniels)functions at optimum levels (Daniels)

Well- beingWell- being

A subjective perception of vitality A subjective perception of vitality and feeling well, can be and feeling well, can be described objectively, described objectively, experienced and measures and experienced and measures and can be plotted in a continuum can be plotted in a continuum (Kozier)(Kozier)

MODELS OF HEALTH AND MODELS OF HEALTH AND WELLNESSWELLNESS

Models or paradigms have been Models or paradigms have been developed to explain health and its developed to explain health and its relationship to illness. The reason relationship to illness. The reason why we study these models is to why we study these models is to help assist health professionals to help assist health professionals to meet the health needs of the meet the health needs of the individual patient in any health care individual patient in any health care settings.settings.

The CLINICAL MODEL- The CLINICAL MODEL- Smith’s Models of Smith’s Models of

healthhealth People viewed as physiologic systems with People viewed as physiologic systems with

related functions.related functions. Health is identified by the absence of signs Health is identified by the absence of signs

& symptoms of disease or injury. It is a & symptoms of disease or injury. It is a state of not being sick.state of not being sick. Health: Absence of signs and symptoms of Health: Absence of signs and symptoms of

disease or injurydisease or injury Disease: Opposite of healthDisease: Opposite of health Focus: Health is identified by absence of signs Focus: Health is identified by absence of signs

and symptoms and people are viewed as and symptoms and people are viewed as physiologic systems with related functionsphysiologic systems with related functions

Limitation: Other factors are not considered Limitation: Other factors are not considered such as health beliefs, lifestyles, etc…such as health beliefs, lifestyles, etc…

The ROLE The ROLE PERFORMANCE MODELPERFORMANCE MODEL

Health is a creative processHealth is a creative process Disease: failure in adaptation (Maladaptation)Disease: failure in adaptation (Maladaptation) Aim of treatment is to restore the ability to Aim of treatment is to restore the ability to

adapt/ to cope.adapt/ to cope. Sister Calista Roy’s Adaptation Model of Sister Calista Roy’s Adaptation Model of

NursingNursing focus on stability with elements of growth focus on stability with elements of growth and changeand change

Health: Defined in terms of individual’s ability to Health: Defined in terms of individual’s ability to fulfill societal rolesfulfill societal roles

Disease: Inability to perform the rolesDisease: Inability to perform the roles Focus: The person’s roles. In this model, an Focus: The person’s roles. In this model, an

individual who can fulfill his roles is healthy even if individual who can fulfill his roles is healthy even if he appears clinically ill.he appears clinically ill.

The ADAPTIVE MODELThe ADAPTIVE MODEL

Health: Health is a creative process Health: Health is a creative process of adaptationof adaptation

Disease: Failure in adaptationDisease: Failure in adaptation

The EUDEMONISTIC The EUDEMONISTIC MODELMODEL

Health: A condition of Health: A condition of actualization or realization of a actualization or realization of a person’s potentialperson’s potential

Disease: Failure to attain the Disease: Failure to attain the highest potential of functioninghighest potential of functioning

The ECOLOGIC MODELThe ECOLOGIC MODEL Health is seen as the balanced interaction Health is seen as the balanced interaction

of the agent, host and environmentof the agent, host and environment Disease: An imbalance in the 3 factorsDisease: An imbalance in the 3 factors Focus: Views health via the interactive Focus: Views health via the interactive

elements:elements: The AGENTThe AGENT- any factor or stressor that by its - any factor or stressor that by its

presence or absence can lead to illnesspresence or absence can lead to illness The HOSTThe HOST- person who may or may not be at - person who may or may not be at

risk of acquiring diseaserisk of acquiring disease The ENVIRONMENTThe ENVIRONMENT-all factors external to the -all factors external to the

host that may or may not predispose the host that may or may not predispose the person to the development of diseaseperson to the development of disease

THE DIMENSIONS OF THE DIMENSIONS OF HEALTHHEALTH

PHYSICAL HEALTH-PHYSICAL HEALTH- concerns with the fitness concerns with the fitness of the bodyof the body

MENTAL HEALTH-MENTAL HEALTH- refers to positive sense of refers to positive sense of purpose and belief in one’s worthpurpose and belief in one’s worth

EMOTIONAL HEALTHEMOTIONAL HEALTH- concerns with the ability - concerns with the ability to express feelings and relationshipsto express feelings and relationships

SOCIAL HEALTH-SOCIAL HEALTH- concerns with the sense of concerns with the sense of having support available from family and friendshaving support available from family and friends

SPIRITUAL HEALTH-SPIRITUAL HEALTH- is the recognition and is the recognition and ability to put into practice moral or religious ability to put into practice moral or religious beliefsbeliefs

SEXUAL HEALTH-SEXUAL HEALTH- is the acceptance and ability is the acceptance and ability to achieve satisfactory expression of one’s to achieve satisfactory expression of one’s sexuality.sexuality.

HEALTH AND ILLNESS HEALTH AND ILLNESS CONTINUACONTINUA

This is a visual comparison of high-This is a visual comparison of high-level wellness and traditional level wellness and traditional medicine’s view of wellness. This is medicine’s view of wellness. This is used to measure a person’s perceived used to measure a person’s perceived level of wellnesslevel of wellness

DUNN’S HIGH LEVEL DUNN’S HIGH LEVEL WELLNESS GRIDWELLNESS GRID

This grid demonstrates the interaction of This grid demonstrates the interaction of the environment with the Illness-Wellness the environment with the Illness-Wellness continuum.continuum.

High level wellness in a favorable High level wellness in a favorable environmentenvironment

Emergent High level wellness in an Emergent High level wellness in an unfavorable environmentunfavorable environment

Protected Poor health in a favorable Protected Poor health in a favorable environmentenvironment

Poor health in an unfavorable environmentPoor health in an unfavorable environment

TRAVIS ILLNESS-TRAVIS ILLNESS-WELLNESS WELLNESS

CONTINUUMCONTINUUM This is a model with 2 opposite arrows with a This is a model with 2 opposite arrows with a neutral point.neutral point.

Wellness is achieved in 3 steps- awareness, Wellness is achieved in 3 steps- awareness, education and growtheducation and growth

This model compares traditional treatment with This model compares traditional treatment with wellness modelwellness model What matter most is What matter most is NOT NOT the point on the continuum the point on the continuum

the person might identify the person might identify BUT BUT the direction on the the direction on the pathway in which the person is facing…pathway in which the person is facing…

Wellness intervention can be initiated at Wellness intervention can be initiated at ANY ANY POINT POINT of the continuumof the continuum Assess life stressors & emotional disturbancesAssess life stressors & emotional disturbances Non-pharmacological approach- (education)Non-pharmacological approach- (education) Join support groups to control weight, smoking and Join support groups to control weight, smoking and

stress etc. stress etc.

FACTORS OR VARIABLES FACTORS OR VARIABLES INFLUENCING HEALTH INFLUENCING HEALTH STATUS, BELIEFS AND STATUS, BELIEFS AND

HEALTH PRACTICESHEALTH PRACTICES INTERNAL VARIABLESINTERNAL VARIABLES BIOLOGIC FACTORSBIOLOGIC FACTORS

Non-modifiableNon-modifiable Genetic make-up, Sex, Age, Developmental levelGenetic make-up, Sex, Age, Developmental level Race ( Sickle cell anemia; DM; etc.)Race ( Sickle cell anemia; DM; etc.) Sex (female: osteoporosis, rheumatoid arthritis, SLE /male: Sex (female: osteoporosis, rheumatoid arthritis, SLE /male:

ulcer, hernias, PTB)ulcer, hernias, PTB) Age and developmental level (adult: ASHD; children: Age and developmental level (adult: ASHD; children:

measles)measles)   PSYCHOLOGIC FACTORSPSYCHOLOGIC FACTORS

Mind and body interaction, Self-conceptMind and body interaction, Self-concept Self-concept (anorexia nervosa)Self-concept (anorexia nervosa) Job satisfactionJob satisfaction

   COGNITIVE FACTORSCOGNITIVE FACTORS

Lifestyle choices, Spiritual beliefs and Religious practicesLifestyle choices, Spiritual beliefs and Religious practices

EXTERNAL VARIABLESEXTERNAL VARIABLES ENVIRONMENTENVIRONMENT Geographic location, pollution and radiationGeographic location, pollution and radiation

   STANDARDS OF LIVINGSTANDARDS OF LIVING Occupation, income and educationOccupation, income and education

   FAMILY AND CULTURAL BELIEFSFAMILY AND CULTURAL BELIEFS Culture and Social InteractionsCulture and Social Interactions

   SOCIAL SUPPORT NETWORKSOCIAL SUPPORT NETWORK Family and friendsFamily and friends

   GEOGRAPHYGEOGRAPHY

ILLNESS AND DISEASEILLNESS AND DISEASE

DISEASEDISEASE Derived from the word “desaise’ which Derived from the word “desaise’ which

means uneasiness or discomfortmeans uneasiness or discomfort An Alteration in body functions resulting An Alteration in body functions resulting

in a reduction of capacities or a in a reduction of capacities or a shortening of normal life span (Kozier)shortening of normal life span (Kozier)

A state of disharmony of mind, body, A state of disharmony of mind, body, emotion and spirit (Craven)emotion and spirit (Craven)

An alteration in body functions resulting An alteration in body functions resulting in a reduction of capacities or shortening in a reduction of capacities or shortening of the normal life spanof the normal life span

Illness and DiseaseIllness and Disease

ILLNESSILLNESS A condition causing harm or pain (Naidoo)A condition causing harm or pain (Naidoo) A state of diminished physical, emotional, A state of diminished physical, emotional,

intellectual, social, developmental or spiritual intellectual, social, developmental or spiritual functioning (Kozier)functioning (Kozier)

A product of disharmonious interactions A product of disharmonious interactions between mind, body, emotions and spirit; between mind, body, emotions and spirit; deviation from normal state (Craven)deviation from normal state (Craven)

The inability of an individual’s adaptive response The inability of an individual’s adaptive response to maintain physical and emotional balance to maintain physical and emotional balance (Daniels) (Daniels)

This is a highly personal state in which the This is a highly personal state in which the person feels unhealthy or illperson feels unhealthy or ill

ILLNESS BEHAVIORILLNESS BEHAVIOR Involves ways individuals describe, Involves ways individuals describe,

monitor and interrupt their monitor and interrupt their symptoms, take remedial actions symptoms, take remedial actions and use their health care systems.and use their health care systems.

Common Causes of Common Causes of Diseases:Diseases:

Biologic agents: (viruses, bacteria, rickettsia, Biologic agents: (viruses, bacteria, rickettsia, fungi, protozoa, helminthes, & toxins)fungi, protozoa, helminthes, & toxins)

Inherited genetic defectsInherited genetic defects Developmental defects from exposure to Developmental defects from exposure to

environmental elements (viruses, chemicals)environmental elements (viruses, chemicals) Physical agents (temperature extremes, Physical agents (temperature extremes,

radiation and electricity)radiation and electricity) Chemical agents (alcohol, strong acids and Chemical agents (alcohol, strong acids and

bases, drugs, heavy metals, industrial bases, drugs, heavy metals, industrial poisons)poisons)

Tissue responses to irritation or injuryTissue responses to irritation or injury Faulty chemical or metabolic processesFaulty chemical or metabolic processes Emotional and physical reaction to stressEmotional and physical reaction to stress

Classification of IllnessClassification of Illness

Acute IllnessAcute Illness Characteristics: severe symptoms of Characteristics: severe symptoms of

relatively short durationrelatively short duration Symptoms often appear abruptly and Symptoms often appear abruptly and

subside quickly, depending on the cause: subside quickly, depending on the cause: may or may not require intervention by may or may not require intervention by health care professional. Some are health care professional. Some are serious (surgical intervention) or Mild serious (surgical intervention) or Mild (subside w/o medical intervention or by (subside w/o medical intervention or by OTC drugs)OTC drugs)

Classification of IllnessClassification of Illness

Chronic IllnessChronic Illness This lasts for extended period of time This lasts for extended period of time

(6 months or longer)(6 months or longer) It has a slow onset often with periods It has a slow onset often with periods

of remission and exacerbationof remission and exacerbation

ILLNESS BEHAVIORSILLNESS BEHAVIORS

TheseThese are activities undertaken are activities undertaken by a person who feels ill, to by a person who feels ill, to define the state of his health & to define the state of his health & to discover suitable remedydiscover suitable remedy

4 Aspects of Sick role: 4 Aspects of Sick role: (Parson 1972)(Parson 1972)

Clients not held responsible for Clients not held responsible for their conditiontheir condition

Clients are excused from certain Clients are excused from certain social roles and taskssocial roles and tasks

Clients are obliged to try to get well Clients are obliged to try to get well as quickly as possibleas quickly as possible

Clients or their families are obliged Clients or their families are obliged to seek competent helpto seek competent help

IGUN’s 11 Stages of Illness IGUN’s 11 Stages of Illness of Health Seeking:of Health Seeking:

1.Symptoms experience1.Symptoms experience 7. Efficacy of 7. Efficacy of treatmenttreatment

2.Self-treatment or self-medicatio2.Self-treatment or self-medicatio 8. Selection 8. Selection of treatmentof treatment

3.Communication to others3.Communication to others 9. Treatment9. Treatment

4.Assessment of symptoms4.Assessment of symptoms 10. 10. Assessment of effectiveness ofAssessment of effectiveness of 5.Sick 5.Sick role assumptionrole assumption treatmenttreatment

6.Concern6.Concern 11. Recovery and 11. Recovery and rehabilitationrehabilitation

3 Distinct Criteria to 3 Distinct Criteria to determine if a person is ill determine if a person is ill

(Bauman 1965)(Bauman 1965) Presence of symptoms (ex. Presence of symptoms (ex.

Elevated temp.)Elevated temp.) Perception of how they feel (ex. Perception of how they feel (ex.

Well, tired, sick)Well, tired, sick) Ability to carry out daily activities Ability to carry out daily activities

(ex. Work, school work)(ex. Work, school work)

THE EFFECTS OF ILLNESSTHE EFFECTS OF ILLNESS EFFECTS ON THE CLIENTEFFECTS ON THE CLIENT

Behavioral and emotional changes like fear, anxiety, Behavioral and emotional changes like fear, anxiety, and withdrawaland withdrawal

Body image disturbanceBody image disturbance Loss of autonomyLoss of autonomy Change in lifestyleChange in lifestyle

EFFECTS ON THE FAMILYEFFECTS ON THE FAMILY Depends upon the member who is ill, the Depends upon the member who is ill, the

seriousness and length of illness and the cultural seriousness and length of illness and the cultural customscustoms

Role changes and role reversalRole changes and role reversal Task reassignment and increased demands on Task reassignment and increased demands on

timetime Increased stress due to anxietyIncreased stress due to anxiety Financial problems, loneliness and change in Financial problems, loneliness and change in

social customssocial customs

Privacy affectedPrivacy affected PrivacyPrivacy—comfortable feeling reflecting a —comfortable feeling reflecting a

deserved degree of social retreat or as a deserved degree of social retreat or as a freedom from unauthorized intrusionfreedom from unauthorized intrusion

Dimensions & duration controlled by the Dimensions & duration controlled by the individual seeking privacyindividual seeking privacy

Boundaries—highly individualized Boundaries—highly individualized (personalized state)(personalized state)

Autonomy affectedAutonomy affected AutonomyAutonomy—state of being independent & —state of being independent &

self-directed without outside controlself-directed without outside control Financial burden it places on clients Financial burden it places on clients

& family& family Referral to social workerReferral to social worker

Necessitates a change in life-styleNecessitates a change in life-style Life-styleLife-style—a general way of living based on —a general way of living based on

the interplay between living conditions in the the interplay between living conditions in the wide sense & individual patterns of behavior wide sense & individual patterns of behavior as determined by socio-cultural factors & as determined by socio-cultural factors & personal characteristicspersonal characteristics

Nurses can help Nurses can help clients adjust their clients adjust their

life-style by:life-style by: Providing explanations about necessary Providing explanations about necessary

adjustmentsadjustments Making arrangements wherever possible to Making arrangements wherever possible to

accommodate the client’s life-styleaccommodate the client’s life-style Encouraging other health professionals to Encouraging other health professionals to

become aware of the person’s life-style become aware of the person’s life-style practices & to support healthy aspects of practices & to support healthy aspects of that life-style that life-style

Reinforcing desirable changes in practices Reinforcing desirable changes in practices with a view to making them a permanent with a view to making them a permanent part of the client’s life-stylespart of the client’s life-styles

FACTORS CAUSING FACTORS CAUSING ILLNESSILLNESS

PREDISPOSING FACTORSPREDISPOSING FACTORS Conditions characterized by a previous tendency Conditions characterized by a previous tendency

or susceptibilityor susceptibility Example is Family HistoryExample is Family History

   CONTRIBUTORY FACTORSCONTRIBUTORY FACTORS

Are conditions that help bring about the diseaseAre conditions that help bring about the disease Examples are lifestyle behaviors, smoking and Examples are lifestyle behaviors, smoking and

obesityobesity

PRECIPITATING FACTORSPRECIPITATING FACTORS Are conditions that hasten a result of the diseaseAre conditions that hasten a result of the disease Example is a stressful eventExample is a stressful event

THE FIVE STAGES OF THE FIVE STAGES OF ILLNESSILLNESS

STAGE ONE: THE SYMPTOM STAGE ONE: THE SYMPTOM EXPERIENCESEXPERIENCES The person comes to believe The person comes to believe

something is wrongsomething is wrong There is the physical experience of There is the physical experience of

symptoms, interpretation of symptoms, interpretation of symptoms and an emotional response symptoms and an emotional response

Consultation with others, validation Consultation with others, validation with spouse, home remedies and self-with spouse, home remedies and self-managementmanagement

STAGE TWO: ASSUMPTION OF STAGE TWO: ASSUMPTION OF THE SICK ROLETHE SICK ROLE

The Person accepts the sick role and The Person accepts the sick role and seeks confirmation from significant seeks confirmation from significant others, delays contact with health others, delays contact with health care professionals as long as possiblecare professionals as long as possible

Self treatment is continued, patient Self treatment is continued, patient is excused from normal duties and is excused from normal duties and role expectationrole expectation

STAGE THREE: MEDICAL CARE STAGE THREE: MEDICAL CARE CONTACTCONTACT

Sick people seek the advice of a health Sick people seek the advice of a health professional either personally or by the professional either personally or by the urging of the significant othersurging of the significant others

Purposes of medical care contact are Purposes of medical care contact are validation of real illness, explanation of validation of real illness, explanation of the symptoms in understandable terms the symptoms in understandable terms and reassurance that they will be and reassurance that they will be alrightalright

STAGE FOUR: DEPENDENT CLIENT STAGE FOUR: DEPENDENT CLIENT ROLEROLE

Client becomes dependent on the Client becomes dependent on the professional for help. Most people professional for help. Most people accept their dependenceaccept their dependence

STAGE FIVE: RECOVERY OR STAGE FIVE: RECOVERY OR REHABILITATIONREHABILITATION

Client relinquishes the dependent Client relinquishes the dependent role and resumes former rolesrole and resumes former roles

Restoration of functioning to maximal Restoration of functioning to maximal self-sufficiencyself-sufficiency

STRESSSTRESSCLAUDE BERDARD, 1867:CLAUDE BERDARD, 1867: First physiologist to recognize the First physiologist to recognize the

consequences of stress proposed, “Change in the consequences of stress proposed, “Change in the internal and external environment disrupted the internal and external environment disrupted the functioning of an organism.”functioning of an organism.”

It is essential for an organism to adapt to a It is essential for an organism to adapt to a stressor to survive stressor to survive

WALTER CANNON, 1920:WALTER CANNON, 1920: Studied physiological responses to emotional Studied physiological responses to emotional

arousal and emphasized the adaptive functions of arousal and emphasized the adaptive functions of the “Fight or Flight” reaction. (the “Fight or Flight” reaction. (HomeostasisHomeostasis))

Responses were results of the influence of the Responses were results of the influence of the emotional state on the body and that the emotional state on the body and that the subsequent responses were adaptive and subsequent responses were adaptive and physiologicalphysiological

STRESSSTRESS

RENE JULES DUBOS, 1965:RENE JULES DUBOS, 1965: ““Absolute constancy is only a concept of Absolute constancy is only a concept of

the ideal”. Homeostasis & adaptation the ideal”. Homeostasis & adaptation were both necessary to survival in a were both necessary to survival in a changing world.changing world.

LYON & WERNER, 1987:LYON & WERNER, 1987: Stress defined as a response, disruption Stress defined as a response, disruption

caused by noxious stimulus or stressors.caused by noxious stimulus or stressors.

STRESSSTRESS

SCHAFER, 1992:SCHAFER, 1992: ““Arousal of mind and body in Arousal of mind and body in

response to demand made upon response to demand made upon them”them”

HANS SELYE, 1946:HANS SELYE, 1946: “ “The nonspecific response of The nonspecific response of

the body to any kind of demand the body to any kind of demand made upon it.”made upon it.”

General Idea on StressGeneral Idea on Stress -It is a universal phenomenon. Every -It is a universal phenomenon. Every

person experiences stress one way or person experiences stress one way or anotheranother

-Any factor or situation that requires a -Any factor or situation that requires a response.response.

-Provides stimulus for growth and change. -Provides stimulus for growth and change. It may be positive which effects growth or It may be positive which effects growth or negative that effects change.negative that effects change.

-Affects all dimension of life. Too much -Affects all dimension of life. Too much stress threatens a person’s perception of stress threatens a person’s perception of reality, ability to make decisions, his health reality, ability to make decisions, his health status, and outlook in life. State produced status, and outlook in life. State produced by a change in the environment that is by a change in the environment that is perceived as challenging, threatening or perceived as challenging, threatening or damaging to the individual’s homeostasis.damaging to the individual’s homeostasis.

Dimensions of StressDimensions of Stress PhysicalPhysical- affects physiologic homeostasis- affects physiologic homeostasis Homeostasis:Homeostasis: state of balance or state of balance or

equilibriumequilibrium EmotionalEmotional- affects feeling towards self - affects feeling towards self IntellectualIntellectual- influences perception and - influences perception and

problem solving abilitiesproblem solving abilities Perception: ability to interpret the Perception: ability to interpret the

environment through one’s sensesenvironment through one’s senses SocialSocial – can alter relationships with – can alter relationships with

othersothers SpiritualSpiritual- affects one’s beliefs and values- affects one’s beliefs and values  

ILLNESSES LINKED TO ILLNESSES LINKED TO STRESSSTRESS

Metabolic disorders:Metabolic disorders: hyper/hypothyroidism. hyper/hypothyroidism. Diabetes CancerDiabetes Cancer

Accident proneness:Accident proneness: Skin disorders:Skin disorders: eczema, pruritus, urticaria, psoriasis eczema, pruritus, urticaria, psoriasis Respiratory disorders: Respiratory disorders: asthma, hay fever, asthma, hay fever,

tuberculosistuberculosis Cardiovascular disease:Cardiovascular disease: CAD, essential CAD, essential

hypertension, CHFhypertension, CHF Gastrointestinal disorders:Gastrointestinal disorders: constipation, diarrhea, constipation, diarrhea,

duodenal ulcer, anorexia nervosa, obesity, ulcerative duodenal ulcer, anorexia nervosa, obesity, ulcerative colitiscolitis

Menstrual irregularities:Menstrual irregularities: Musculoskeletal disorders:Musculoskeletal disorders: RA, LBP, migraine, RA, LBP, migraine,

headache, muscle tensionheadache, muscle tension

STRESS AS A STRESS AS A STIMULUSSTIMULUS Life events or circumstances causing a disrupted Life events or circumstances causing a disrupted

response on an individualresponse on an individual Holmes and Rahe 1976:Holmes and Rahe 1976: social readjustment scale social readjustment scale

(43 life events), which measures the effects of major (43 life events), which measures the effects of major life events on illness. The scale of stressful life events life events on illness. The scale of stressful life events is used to document a person’s relatively recent is used to document a person’s relatively recent experiences (failed marriage, miscarriages, broken experiences (failed marriage, miscarriages, broken family)family)

Focus:Focus: disturbing events within the environment disturbing events within the environment People with high level of stress are more prone to People with high level of stress are more prone to

illness and have lowered ability to cope with illness illness and have lowered ability to cope with illness and other stresses that may comeand other stresses that may come

Advantage:Advantage: the scale identifies events stressful for the scale identifies events stressful for most peoplemost people

Disadvantage:Disadvantage: does not provide individual does not provide individual differences in perception and response to stressors; differences in perception and response to stressors; the degree of stress of a life event varies from one the degree of stress of a life event varies from one person to anotherperson to another

STRESS AS A STRESS AS A RESPONSERESPONSE Disruptions caused by harmful stimulus or Disruptions caused by harmful stimulus or

stressorsstressors Specifies particular response or pattern of Specifies particular response or pattern of

responses that may indicate a stressorresponses that may indicate a stressor Selye (1976):Selye (1976): developed models of stress, that developed models of stress, that

defines stress as a non-specific response of the defines stress as a non-specific response of the body to any demand made on itbody to any demand made on it

Focus:Focus: reactions reactions Schafer (1992)Schafer (1992) “ arousal of the mind and body in “ arousal of the mind and body in

response to demands made upon them” response to demands made upon them” Hans Selye (1976)Hans Selye (1976) “ non-specific response of the “ non-specific response of the

bony to any kind of demand made upon it” bony to any kind of demand made upon it” Advantage :Advantage : response to stress is purely response to stress is purely

physiologic; determines physiological response to physiologic; determines physiological response to stressstress

Disadvantage: Disadvantage: does not consider individual does not consider individual differences in response patterndifferences in response pattern

GAS: GENERAL ADAPTATION GAS: GENERAL ADAPTATION SYNDROMESYNDROME

Physiologic response of the whole Physiologic response of the whole body to stressbody to stress

LAS: LOCAL ADAPTATION LAS: LOCAL ADAPTATION SYNDROMESYNDROME Localized responses to Localized responses to stress; does not involve the entire stress; does not involve the entire bodybody

STRESS AS A STRESS AS A TRANSACTIONTRANSACTION

Views the person and environment in a Views the person and environment in a dynamic, reciprocal and interactive dynamic, reciprocal and interactive relationshipsrelationships

Lazarus, 1966Lazarus, 1966 “people differ in sensitivity “people differ in sensitivity and vulnerability to stress” and vulnerability to stress”

Mental and physiologic (adaptive and Mental and physiologic (adaptive and affective) responses to stressaffective) responses to stress

The transactional stress theory includes The transactional stress theory includes cognitive, affective, and adaptive responses cognitive, affective, and adaptive responses from person and environment interaction. from person and environment interaction. The person responds to perceived The person responds to perceived environmental changes by coping environmental changes by coping mechanisms.mechanisms.

DEFINITION OF DEFINITION OF STRESSORS:STRESSORS:

Stimuli causing or precipitating changeStimuli causing or precipitating change Represents an unmet need… Stressors may be:Represents an unmet need… Stressors may be:   Physiological:Physiological: ex. Drugs, poison, alcohol ex. Drugs, poison, alcohol

(chemical agents),(chemical agents), Heat, cold, trauma, radiation (physical agents); Heat, cold, trauma, radiation (physical agents);

infectioninfection Psychosocial:Psychosocial: ex. Airplane- crash survivors, ex. Airplane- crash survivors,

prisoners of war, death of a friend, slavery, prisoners of war, death of a friend, slavery, poverty, oppression, life crises.poverty, oppression, life crises.

EnvironmentalEnvironmental DevelopmentalDevelopmental Spiritual Spiritual CulturalCultural

CLASSIFICATIONS OF CLASSIFICATIONS OF STRESSORS:STRESSORS:

INTERNALINTERNAL- originate inside the - originate inside the person (fever, pregnancy, guilt)person (fever, pregnancy, guilt)

EXTERNALEXTERNAL- originates outside the - originates outside the person (peer pressure)person (peer pressure)

FACTORS FACTORS INFLUENCING INFLUENCING RESPONSE TO RESPONSE TO STRESSORSSTRESSORS Physiological functioningPhysiological functioning

Personality:Personality: the outward expression of oneself; the outward expression of oneself; the totality of a personthe totality of a person

Behavioral CharacteristicsBehavioral Characteristics   Level of personal control:Level of personal control: Availability of support system:Availability of support system: people ready people ready

to give emotional and moral support, offer help to give emotional and moral support, offer help and adviceand advice

Feelings of competence:Feelings of competence: confidence that a confidence that a person can cope to stress successfullyperson can cope to stress successfully

Cognitive appraisal:Cognitive appraisal: evaluating and evaluating and determining the extent of a particular stress determining the extent of a particular stress between the person and the environmentbetween the person and the environment

Nature of stressorNature of stressor Intensity:Intensity:

MinimumMinimum ModerateModerate SevereSevere

Scope:Scope: LimitedLimited MediumMedium ExtensiveExtensive

Duration of exposure to stressor:Duration of exposure to stressor: ex. Being ill for ex. Being ill for several weeksseveral weeks

PredictabilityPredictability Previous experiences with a comparable stress:Previous experiences with a comparable stress:

ex.ex. A person who has successfully adjusted from death of a A person who has successfully adjusted from death of a friend will more likely to do the same next time compared to friend will more likely to do the same next time compared to someone who experiences it for the first timesomeone who experiences it for the first time

Age of individual:Age of individual: infants have more difficulty recovering infants have more difficulty recovering from cough, colds, fever than a middle aged woman who from cough, colds, fever than a middle aged woman who can take care of herselfcan take care of herself

LAS (LOCAL ADAPTATIONS SYNDROME):LAS (LOCAL ADAPTATIONS SYNDROME): Localized responses to stress; does not involve the Localized responses to stress; does not involve the

entire body. Ex.entire body. Ex. Wound healing, blood clotting, vision, Wound healing, blood clotting, vision, response to pressureresponse to pressure

Adaptive:Adaptive: a stressor is necessary to stimulate it a stressor is necessary to stimulate it short- term:short- term: ex. Wound healing ex. Wound healing Restorative:Restorative: assist in homeostasis assist in homeostasis

Reflex Pain response:Reflex Pain response: Localized response of the CNS to painLocalized response of the CNS to pain Adaptive response and protects tissue from further Adaptive response and protects tissue from further

damage damage Involves a sensory receptor, a sensory serve to the spinal Involves a sensory receptor, a sensory serve to the spinal

cord, a connector neuron, motor nerve, effectors' musclescord, a connector neuron, motor nerve, effectors' muscles Ex.Ex.: unconscious removal of hand from a hot surface, : unconscious removal of hand from a hot surface,

sneezing, etc. sneezing, etc.    Inflammatory Response:Inflammatory Response: Stimulated by trauma or infection, thus preventing it to Stimulated by trauma or infection, thus preventing it to

spread; also promotes healingspread; also promotes healing Pain, heat, redness, swellingPain, heat, redness, swelling

GAS (GENERAL ADAPTATION GAS (GENERAL ADAPTATION SYNDROME):SYNDROME):

Physiologic response of the whole body Physiologic response of the whole body to stressto stress

Involves the Involves the Autonomous Nervous Autonomous Nervous System, and Endocrine SystemSystem, and Endocrine System

Occurs with the release of adaptive Occurs with the release of adaptive hormones and subsequent changes in hormones and subsequent changes in the bodythe body

Three Stages of GASThree Stages of GAS ALARM REACTION:ALARM REACTION: Initial reaction of the body; Initial reaction of the body; “ fight and flight”“ fight and flight” responses responses Mobilizing of the defense mechanisms of the body and mind to Mobilizing of the defense mechanisms of the body and mind to

cope with stressors.cope with stressors. SHOCK PHASE-SHOCK PHASE- the autonomic nervous system reacts; release of the autonomic nervous system reacts; release of

Epinephrine and CortisoneEpinephrine and Cortisone COUNTERSHOCK PHASE- COUNTERSHOCK PHASE- reversal of the changes produced in reversal of the changes produced in

the shock phasethe shock phase   II. STAGE OF RESISTANCE:II. STAGE OF RESISTANCE: The stabilizes, hormonal levels return to normal, heart rate, blood The stabilizes, hormonal levels return to normal, heart rate, blood

pressure and cardiac output return to normalpressure and cardiac output return to normal 2 things may occur:2 things may occur: Either the person successfully adapts to the stressors and returns Either the person successfully adapts to the stressors and returns

to normal, thus resolving and repairing body damage; orto normal, thus resolving and repairing body damage; or The stressor remains present, and adaptation fails (ex. Long-term The stressor remains present, and adaptation fails (ex. Long-term

terminal illness, mental illness, and continuous blood loss)terminal illness, mental illness, and continuous blood loss)   III. STAGE OF EXHAUSTION:III. STAGE OF EXHAUSTION: Occurs when the body can no longer resist stress and body energy Occurs when the body can no longer resist stress and body energy

is depleted. The body’s energy level is compromised and is depleted. The body’s energy level is compromised and adaptation diminishes. Body may not be able to defend self that adaptation diminishes. Body may not be able to defend self that may end to death.may end to death.

Physiologic Manifestations of Stress:Physiologic Manifestations of Stress: Elevated blood pressureElevated blood pressure Increased muscle tension in neck, shoulders, backIncreased muscle tension in neck, shoulders, back Elevated pulse and increased respirationElevated pulse and increased respiration Sweaty palms (diaphoresis)Sweaty palms (diaphoresis) Cold hands and feetCold hands and feet Slumped postureSlumped posture FatigueFatigue Tension headacheTension headache Upset stomachUpset stomach Higher pitched voiceHigher pitched voice Nausea, vomiting, diarrheaNausea, vomiting, diarrhea Change in appetiteChange in appetite Change in weightChange in weight Abnormal laboratory findings; elevated ACTH, Abnormal laboratory findings; elevated ACTH,

cortisol,cortisol, Catecholamine levels and hyperglycemiaCatecholamine levels and hyperglycemia Restlessness: difficulty falling asleep/frequent Restlessness: difficulty falling asleep/frequent

awakeningawakening Dilated pupilsDilated pupils

PHYCHOLOGICAL MANIFESTATIONSPHYCHOLOGICAL MANIFESTATIONSAcquired through Acquired through learninglearning and and experienceexperience as a as a person identifies acceptable and successful person identifies acceptable and successful behaviors behaviors

a. Constructive behavior:a. Constructive behavior:Accepts challenges to resolve conflictsAccepts challenges to resolve conflicts

b. Destructive behavior:b. Destructive behavior:Do not help a person cope with stressorDo not help a person cope with stressor

TASK ORIENTED BEHAVIORTASK ORIENTED BEHAVIOR Uses cognitive abilities to reduce stress, solve Uses cognitive abilities to reduce stress, solve

problems and resolve conflictsproblems and resolve conflicts Use of direct problem solving techniques to cope Use of direct problem solving techniques to cope

with threatswith threats Example:Example: attack behavior, withdrawal behavior, attack behavior, withdrawal behavior,

and compromiseand compromise

ANXIETY:ANXIETY: state of mental uneasiness, state of mental uneasiness, apprehension, or helplessness, related apprehension, or helplessness, related to anticipated unidentified stress.to anticipated unidentified stress.

ANXIETY FEAR

Not identifiable identifiable

Related to future Related to present

Vague definite

Psychological/emotional conflict Discrete physical/psycho

4 Levels of Anxiety:4 Levels of Anxiety: Mild-Mild- increased alertness, motivation increased alertness, motivation

and attentiveness (Enhances perception, and attentiveness (Enhances perception, learning and productive learning and productive abilities)abilities)

Moderate-Moderate- perception narrowed, perception narrowed, selective inattention, physical discomfort selective inattention, physical discomfort (express feeling of tension)(express feeling of tension)

Severe-Severe- behaviors becomes automatic behaviors becomes automatic details are not seen, senses are drastically details are not seen, senses are drastically reduced (consumes most of the person’s reduced (consumes most of the person’s energies and require intervention)energies and require intervention)

Panic-Panic- overwhelmed, unable to function overwhelmed, unable to function or communicate, possible bodily harm to or communicate, possible bodily harm to self and others, loss of strong displeasureself and others, loss of strong displeasure

FEAR:FEAR: mild to severe apprehension about mild to severe apprehension about some perceived threat (Schafer 1992)some perceived threat (Schafer 1992)

ANGER:ANGER: Subjective feeling of strong Subjective feeling of strong displeasuredispleasure Verbal expression of angerVerbal expression of anger HostilityHostility- over antagonism and - over antagonism and

harmful/destructive behaviorharmful/destructive behavior AggressionAggression-unprovoked attack injurious/ -unprovoked attack injurious/

destructive actiondestructive action ViolenceViolence- use of physical force to injure/abuse- use of physical force to injure/abuse

Constructive expressions of anger have Constructive expressions of anger have 3 elements:3 elements:

AlertingAlerting DescribingDescribing IdentifyingIdentifying

DEPRESSION:DEPRESSION: common reactions to common reactions to events that are negative or overwhelmingevents that are negative or overwhelming Buckwalter & Babich(1990):Buckwalter & Babich(1990): state that state that 10% to 15%- suffer from major depressive 10% to 15%- suffer from major depressive

episodeepisode 20% to30% - experience significant depressive 20% to30% - experience significant depressive

symptomssymptoms Emotional symptoms:Emotional symptoms:(tiredness, (tiredness,

sadness, emptiness or numbness)sadness, emptiness or numbness) Behavioral signs:Behavioral signs:( irritability, inability to ( irritability, inability to

concentrate, difficulty in making decisions, concentrate, difficulty in making decisions, loss of sexual desire, crying, sleep loss of sexual desire, crying, sleep disturbances, and social withdrawal.disturbances, and social withdrawal.

Physical signs:Physical signs:(loss of appetite, weight (loss of appetite, weight loss, constipation, headache, and dizziness) loss, constipation, headache, and dizziness)

COGNITIVE MANIFESTATIONSCOGNITIVE MANIFESTATIONS Thinking responses of the individual toward stressThinking responses of the individual toward stress

1.1. PROBLEM SOLVING:PROBLEM SOLVING: Use of specific steps to Use of specific steps to arrive at a solution: like the nursing processarrive at a solution: like the nursing process

2.2. STRUCTURING:STRUCTURING: manipulation of a situation so manipulation of a situation so that threatening events do not occur (open/close that threatening events do not occur (open/close question)question)

3.3. SELF CONTROL / DISCIPLE:SELF CONTROL / DISCIPLE: assuming a sense assuming a sense of being in control or in charge of whatever of being in control or in charge of whatever situationsituation

4.4. SUPPRESSION:SUPPRESSION: willfully putting a thought / willfully putting a thought / feeling out of one’s mindfeeling out of one’s mind

5.5. FANTASY / DAYDREAMING:FANTASY / DAYDREAMING: “ make believe” “ make believe”6.6. PRAYER:PRAYER: identification, description of the identification, description of the

problem, suggestion of solution, then reaching problem, suggestion of solution, then reaching out for help or supportout for help or support

VERBAL / MOTOR MANIFESTATIONS:VERBAL / MOTOR MANIFESTATIONS: First hand responses to stressFirst hand responses to stress

1.1.CRYING:CRYING: feelings of pain, joy, sadness are feelings of pain, joy, sadness are releasedreleased

2.2.VERBAL ABUSE:VERBAL ABUSE: release mechanism release mechanism toward non living objects, and stress toward non living objects, and stress producing eventsproducing events

3.3.LAUGHING:LAUGHING: anxiety reducing response anxiety reducing response4.4.SCREAMING:SCREAMING: response to fear or intense response to fear or intense

frustration and angerfrustration and anger5.5.HITTING AND KICKING:HITTING AND KICKING: spontaneous spontaneous

response to physical threats or frustrationsresponse to physical threats or frustrations6.6.HOLDING AND TOUCHING:HOLDING AND TOUCHING: responses to responses to

joyful, painful or sad eventsjoyful, painful or sad events