THE HEALTH-ILLNESS CONTINUUM a. The individual's state of health is o n e of continual change.

He moves back a n d forth from health to illness a n d back to health again. His condition is rarely constant. He may wake up feeling great, develop a headache mid-morning, a n d feel fine again by noon. The health-illness continuum (see figure 1-1) illustrates this process of change, in which t h e individual experiences various states of health a n d illness (ranging from extremely good health to death) that fluctuate throughout his life.

Figure 1-1. The health-illness continuum.

b. As we previously stated, health, just as life itself, it is a process of continual change. A n d we m u s t continually adapt to these changes in o u r lives in order to maintain good health a n d well-being. It is o u r adaptation or response to that change, rather t h a n t h e change itself, that affects o u r health. For example, t w o students just found o u t about a big test tomorrow, for which t h e y are completely unprepared. One student responds to this stressful situation (stressor) by going home, getting his books out, a n d starting to study. The other student breaks o u t into a sweat, a n d spends most of t h e evening fretting over this outrage a n d imagining what will happen to him if he doesn't pass t h e test. No doubt, this student is doing more damage to his health t h a n is his friend. And, considering t h e time a n d energy he is expending on worrying (and n o t studying), he may experience e v e n more stress when t h e y receive their grades

c. Adaptation a n d effective functioning, e v e n in t h e presence of chronic disease, c a n be considered a state of wellness. A person may be in perfect physical condition, b u t feel too tired a n d "blue" to go to work, while his co-worker, a diabetic, is at work, functioning fully a n d accomplishing his job. Which of these t w o people is at a higher level on t h e health-illness continuum? NOTE: Death occurs when adaptation fails completely, a n d there is irreversible damage to t h e body. 1-4. ADAPTING TO CHANGE The individual's state of health is determined by t h e ability to adapt to changes in t h e following dimensions: a. Developmental--changes in a person's behavior a n d ability, which are associated with increasing age. b. Psychosocial--the development of t h e personality, social attitudes, a n d skills. c. Cultural--changes in or development of beliefs a n d values held by t h e individual's family or culture. d. Physiological--changes in body function. 1-5.

POSITIVE HEALTH HABITS Regardless of one's definition of health, t h e individual who practices t h e following positive health habits on a regular basis is certainly at an advantage. a. A balanced diet with adequate caloric intake. b. Efficient elimination. c. Regular exercise. d. Adequate sleep, rest periods, a n d relaxation periods. e. Regular medical checkups. f. Regular dental checkups. g. Maintenance of good posture. h. Good grooming habits

1-6. CATEGORIES OF BASIC HUMAN NEEDS a. Physical Needs. These are closely related to body functions a n d are sometimes referred to as primary or physiological drives. Physical needs include: (1) Food. (2) Water. (3) Oxygen. (4) Elimination. (5) Clothing a n d shelter for body warmth a n d protection.

(6) Activity, or sensory a n d motor stimulation, including sex, physical exercise, a n d rest. b. Emotional Needs. Emotional needs are closely interwoven with physical needs a n d are m e t in interaction with significant others. They include: (1) Love, including approval a n d esteem. (2) Importance, including recognition a n d respect.

NOTE: This applies to t h e patient's perception of t h e nurse's feelings toward him. For example, if y o u r patient feels that you do n o t approve of or respect him, he may become v e r y demanding, or he may withdraw a n d n o t cooperate with y o u r efforts to make h i m healthy again. (3) Adequacy, including self-sufficiency a n d t h e need to be needed a n d wanted. (4) Productivity, including work a n d creative pursuits. c. Social Needs. Social needs grow o u t of t h e culture a n d society of which o n e is a member. They include: (1) Identification or belonging. (2) Education or learning. (3) Recreation or play. (4) Religion or worship. NOTE: Remember that all human behavior is aimed toward t h e satisfaction of basic human needs. 1-7.

MASLOW'S HIERARCHY OF NEEDS Psychologist Abraham Maslow defined basic human needs as a hierarchy, a progression from simple physical needs to more complex emotional needs (see figure 1-2). a. Types of Needs. (1) Physiological--food, shelter, water, sleep, oxygen. (2) Safety--security, stability, order, physical safety. (3) Love a n d belonging--affection, identification, companionship. (4) Esteem a n d recognition--self-esteem, self-respect, prestige, success,

esteem of others. (5) Self-actualization--self-fulfillment, achieving one's own capabilities. (6) Aesthetic--beauty, harmony, spiritual. b. Relationship Between Levels of Needs. (1) According to Maslow, t h e basic physiological needs related to survival (food, water, etc.) m u s t be m e t first of all. (2) These basic physiological needs h a v e a greater priority over those higher on t h e pyramid. They m u s t be m e t before t h e person c a n m o v e on to higher level needs. In other words, a person who is starving will n o t be concentrating on building his self-esteem. A patient in severe pain will n o t be concerned with improving his interpersonal relationships. (3) Generally speaking, each lower level must be achieved before t h e n e x t higher level(s) c a n be focused upon.