Health and

Illness

Health and Illness

HEALTH

is the extent to
which an individual or group is
able to realize aspirations and
satisfy needs and change to
cope with environment.

Health and Illness

HEALTH

It is the complete
physical, mental and social well
being and not merely the
absence of disease or infirmity
(WHO, 1948)

Health and Illness

HEALTH

Is the state of being

well and using power the
individual possesses to the
fullest extent (Nightingale,
1969)

Health and Illness

WELLNESS

Is the integrated
method of functioning oriented
towards maximizing the
potential by which a person is
capable of functioning in a
given time and environment
(Halpert Dunn).

Health and Illness

ILLNESS

is the response of
the person to a disease; it is an
abnormal process in which the
persons level of functioning is
changed when compared with a
previous level.

Health and Illness

DISEASE

is a medical term,
meaning that there is a
pathologic change in the
structure or function of the body
or mind.

Factors influencing health

PRECURSORS (underpinning) OF ILLNESS

1. Heredity- family history for diabetes

mellitus; hypertension; cancer
2. Behavioral factors- cigarette smoking;
alcohol abuse; high animal fat intake
3. Environmental factors- overcrowding;
poor sanitation; poor supply of potable
water

FACTORS AFFECTING HEALTH AND

ILLNESS

1.PHYSICAL DIMENSION
Genetic

make-up, age,
developmental level, race and sex
are all part of an individuals
physical dimension and strongly
influence health status and health
practices.

2. EMOTIONAL DIMENSIONS
How the mind and body interact to
affect body function and to respond to
body conditions also influences health.
Long-term stress affects the body
systems and anxiety affects health
habits; conversely, calm acceptance
and relaxation can actually change
body responses to illness.

3. INTELLECTUAL DIMENSION

The intellectual dimension encompasses

cognitive abilities, educational background
and past experiences.
These influence a clients responses to
teaching about health and reactions to
health care during illness.
They also play a major role in health
behaviors.

4. ENVIRONMENTAL
DIMENSION
The

environment has many

influences on health and illness.
Housing, sanitation, climate,
and pollution of air, food and
water are aspects of
environmental dimension.

5. SOCIOCULTURAL DIMENSION

Health practices and beliefs are strongly

influenced by a persons economic level, life style,
family and culture.
Low-income groups are less likely to seek health
care to prevent or treat illness; high-income
groups are more prone to stress-related habits
and illness.
The family and the culture to which the person
belongs determine patterns of living and values
about health and illness that are often unalterable.

6. SPIRITUAL DIMENSION
Spiritual

and religious beliefs

and values are important
components of the way the
person behaves in health and
illness.

Health and Illness

MODELS

OF HEALTH
Clinical Model
Role Performance Model
Adaptive Model
Eudemonistic Model

Health and Illness

MODELS

OF HEALTH
Agent-Host-Environment
Model
Health-Illness Continuum

Health and Illness

CLINICAL

MODEL
Narrowest interpretation of
health; opposite of health is
disease or injury; Absence of
Disease

Health and Illness

ROLE

PERFOMANCE MODEL
Health is based on the ability
to fulfill societal roles. Sickness
is the inability to perform ones
work.

Health and Illness

ADAPTIVE

MODEL Health is
a creative process. Disease is
failure in adaptation or
maladaptation.

Health and Illness

EUDEMONISTIC

Health is
seen as a condition of
actualization or realization of a
persons potential while illness
is a condition that prevents selfactualization.

Health and Illness

AGENT-HOST-

ENVIRONMENT MODEL
A.K.A Ecological Model, when
the 3 variables (agent-hostenvironment) are in balance,
health is maintained; when
variables are not in balance,
disease occurs.

LEAVELL AND CLARK

Agent-host-environment

model

Ecologic

model
Describes the cause and illness in
other health areas
Used in predicting illness rather than
in promoting wellness

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Health and Illness

HEALTH-ILLNESS

CONTINUUM (Travis) Health

and illness can be viewed as opposite
ends of a health continuum.
composed of two arrows pointing in
opposite directions and joined at a
neutral point

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25

movement to the right on the

arrows (towards high-level
wellness) equals an increasing
level of health and well-being
achieved in three steps:

awareness
education
growth
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movement to the left on the arrows

(towards premature death) equates
a progressively decreasing state of
health
achieved in three steps:

signs
symptoms
disability
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compares a treatment model with a

wellness model

if a treatment model is used, an individual can

move right only to the neutral point

e.g., a hypertensive client who only takes his

medications without making any other life-style changes

if a wellness model is used, an individual can

move right past the neutral point

e.g., a hypertensive client who not only takes his

medications, but stops smoking, looses weight, starts
an exercise program, etc.
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HALBERT DUNNS HIGH

LEVEL WELLNESS GRID
High-level

wellness in favorable environment

(healthy lifestyles)
Emergent high-level wellness in an unfavorable
environment (healthy lifestyle not implemented
because of family, job etc)
Protected poor health in favorable environment
(ill person whose needs met by health care sy.
Has access to medication, diet, & care)
Poor health in unfavorable environment (child
starving in drought-stricken country)
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Concepts in Dunns Theory

TOTALITARITY

Biopsychosocial components
UNIQUENESS

Manner in which biopsychosocial

components are integrated

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 ENERGY

Physical energy
Psychosocial energy
Environmental elements
INNER

AND OUTER WORLD

Reflections of experiences with his past

and present inner self with the outer
world
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 SELF-INTEGRATION

Reflections of the past and present are

basis of behavior
Inability to reintegrate results to illness
and death

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Rosenstock/Beckers HealthBelief Model

based on motivational theory
composed of three components

INDIVIDUALS PERCEPTION
MODIFYING FACTORS
LIKELIHOOD OF ACTION

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an individuals perceptions, e.g.:

of perceived susceptibility
of perceived seriousness
of perceived threat

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modifying factors (factors that

modify an individuals perceptions),
e.g.:

demographic variables

e.g., age, gender, race, ethnicity, etc.

sociopsychologic variables

e.g., personality, social class, peer and

reference group pressure, etc.
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 structural variables
e.g., knowledge about the disease, prior
contact with the disease, etc.

perceived threat
cues to action
e.g., mass media campaigns, advice from
others, reminder postcard from a physician
or dentist, illness of family member or
friend, newspaper or magazine article
HEALTH AND ILLNESS

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likelihood of action

perceived benefits of the action

MINUS
perceived barriers to action EQUALS
likelihood of taking recommended
preventive health action

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PENDERS HEALTH
PROMOTION MODEL
Describes

the multidimensional nature of

persons as they interact within their
environment to pursue health
Defines health as a positive, dynamic
state nor merely the absence or disease
Directed at increasing a clients level of
well-being
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 Focuses

on the following areas

Clients cognitive perceptual factors

(individual perceptions)
Modifying factors (demographic and social)
Participation in health promoting behaviors
(likelihood of action)

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Health and Illness

ILLNESS

TYPE OF ILLNESS
Acute Illness
Chronic Illness

Health and Illness

ACUTE

ILLNESS generally,
has a rapid onset of symptoms
and lasts only a relatively short
time. (< 6 months)

Health and Illness

CHRONIC

ILLNESS is a
broad term that encompasses
many different physical and
mental alterations in health.
(> 6 months)

Health and Illness

ILLNESS

STAGES OF ILLNESS
Injury
Prodromal
Convalescent
Remission
Recovery

Health and Illness

ILLNESS

STAGES OF ILLNESS
BEHAVIOR
Symptom Experience
Assumption of the Sick
Role
Medical Care Contact

Health and Illness

ILLNESS

STAGES OF ILLNESS
BEHAVIOR
Dependent Client Role
Recovery and
Rehabilitation

Levels of prevention
PRIMARY

PREVENTION

Providing specific protection against disease to prevent

its occurrence is the most desirable form of prevention.
Primary preventive efforts spare the client the cost,
discomfort and the threat to the quality of life that
illness poses or at least delay the onset of illness.
Preventive measures consist of counseling, education
and adoption of specific health practices or changes in
life style.

SECONDARY PREVENTION
It consists of organized, direct screening efforts or
education of the public to promote early case
finding of an individual with disease so that prompt
intervention can be instituted to halt pathologic
processes and limit disability.
Early diagnosis of a health problem can decrease
the catastrophic effects that might otherwise result
for the individual and the family from advanced
illness and its many complications.

TERTIARY PREVENTION
-It begins early in the period of recovery from illness and
consists of such activities as consistent and appropriate
administration of medications to optimize therapeutic
effects, moving and positioning to prevent complications of
immobility and passive and active exercises to prevent
disability.
Continuing health supervision during rehabilitation to
restore an individual to an optimal level of functioning.
Minimizing residual disability and helping the client learn to
live productively with limitations are the goals of tertiary
prevention (Pender, 1987).

Stress
STRESS

Is the bodys nonspecific response to any

demand made upon it. (Han
Selye, Father of Modern Stress
Theory)

Stress
STRESSOR

The source of

stress
EUSTRESS Positive stress
DISTRESS Negative stress

Stress
STRESS-ADAPTATION

SYNDROME
STAGES
Alarm Reaction
Stage of Resistance
Stage of Exhaustion

Stress
STRESS-ADAPTATION

SYNDROME
ALARM REACTION.
mobilization of bodys
defenses and activation for
possible fight or flight
reaction.

Stress
ALARM

REACTION
PHYSICAL CHANGES: inc. BP,
inc. force of cardiac contraction,
inc. hormone levels, adrenals
enlargement, marked loss of BW,
irritation of gastric mucosa,
atrophy of spleen, thymus and
lymph nodes

Stress
ALARM

REACTION
PSYCHOSOCIAL
CHANGES: inc. alertness
level, inc. anxiety level (+1 to
+2 anxiety), task-oriented,
defense-oriented, inefficient
behavior

Stress
STRESS-ADAPTATION

SYNDROME
STAGE OF RESISTANCE.
Optimal adaptation to stress
within personal capability.

Stress
STAGE

OF RESISTANCE
PHYSICAL CHANGES:
adjustment of hormone levels,
reduced activity and size of
adrenal cortex, normalization
of lymph node size and BW

Stress
STAGE

OF RESISTANCE
PSYCHOSOCIAL
CHANGES: intensified use of
coping mechanisms, reliance
on defense-oriented behavior,
psychosomatic symptoms

Stress
STRESS-ADAPTATION

SYNDROME
STAGE OF EXHAUSTION.
Loss of ability to resist stress
due to depletion of body
resources: fight, flight or
immobilization occurs.

Stress
STAGE

OF EXHAUSTION
PHYSICAL CHANGES: dec.
immune response, dec. adrenal
hormone, weight loss, enlarge
lymph nodes and dysfunctional
lymphatic system [worst case:
heart failure, renal failure and
DEATH]

Stress
STAGE

OF EXHAUSTION
PSYCHOSOCIAL CHANGES:
exaggerated defense-oriented
behavior, disorganization of
thinking, illusions, delusions, and
hallucinations [worst case: stupor
and VIOLENCE]

Stress
NURSING

INTERVENTIONS

Stress Management
Promotion of healthy lifestyle
Enhancing coping strategies
Teaching relaxation techniques
Progressive muscle relaxation

Stress
NURSING

INTERVENTIONS

Guided imagery
Music therapy
Use of humor
Massage
Therapeutic Touch

DEATH AND DYING

Death and Dying

GRIEF

is an encompassing
response (physical,
psychological, cognitive and
behavioral) that a person
experiences after the loss of
significant person, object, belief
or relationship.

Death and Dying

ANTICIPATORY

GRIEF is the
characteristic pattern of
responses a person ,makes to
the impending (real or
imagined) loss.

Death and Dying

BEREAVEMENT

is the state
of desolation resulting from
loss.
MOURNING is a socially
conventional bereavement
behaviors after the death of a
significant other.

Death and Dying

GRIEF

MODELS OF GRIEF

Engels Model
Kubler-Ross Stages of
Dying
Parkes Model

Death and Dying

ENGELS

MODEL resolution
of grief takes 1 year or longer.

Death and Dying

ENGELS MODEL
1.
2.
3.
4.
5.
6.

Shock and Disbelief

Developing awareness
Restitution
Resolving the Loss
Idealization
Outcome

Death and Dying

1.

SHOCK AND DISBELIEF

survivor either refuses to accept
the loss or shows intellectual
acceptance but denies
emotional impact.

Death and Dying

2.

DEVELOPING
AWARENESS when reality
and meaning of the loss
surfaces into the
consciousness.

Death and Dying

3.

RESTITUTION involves
work of mourning that includes
rituals.
4. RESOLVING THE LOSS
focus on thoughts of the
deceased.

Death and Dying

5.

IDEALIZATION repressing
all the negative feelings toward
the deceased.
6. OUTCOME psychological
dependence on the deceased
reduces as interest in new
relationship resumes.

Death and Dying

KUBLER-ROSS

STAGE OF
DYING Pioneering work that
prompted for increased
attention to the needs of the
dying and the bereaved.

Death and Dying

KUBLER-ROSS STAGES OF
DYING
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Death and Dying

1.

DENIAL from complete

denial of the illness and
impending death to denial of the
effect that dying will have on
self and others
"I feel fine."; "This can't be
happening, not to me!,"

Death and Dying

2.

ANGER may be directed

toward fate, God, family
members, health care providers
or others.
"Why me? It's not fair!"; "How can
this happen to me!"; "Who is to
blame?"

Death and Dying

3.

BARGAINING seeks to delay

the dreaded event, bargains with
their God as promise is made to
repay for more time.
"Just let me live to see my children
graduate."; "I'll do anything for a few more
years."; "I will give my life savings if..."

Death and Dying

4.

DEPRESSION
acknowledges the reality and
inevitability of the impending
death.
"I'm so sad, why bother with
anything?"; "I'm going to die . . .
What's the point?"; "I miss my loved
one, why go on?"

Death and Dying

5.

ACCEPTANCE comes to
terms with loss and detach from
supportive people and loss
interest in worldly activities.
"It's going to be okay."; "I can
handle it with change"; "I can't fight
it, I may as well prepare for it."

Death and Dying

PARKES MODEL

(4 STAGES
OF GRIEF) Progression
through the stages of grief
normally takes 2 years or
longer.

Death and Dying

PARKES MODEL (4 STAGES

OF GRIEF)
1. Numbness
2. Yearning
3. Disorganization
4. Reorganization

Death and Dying

1.

NUMBENESS brief denial

as a psychological defense.
2. YEARNING last several
months with intense
psychological distress with
thoughts focused on the
deceased.

Death and Dying

3.

DISORGANIZATION
characterized by severe
depression, social withdrawal,
lack of interest in people and
activities.

Death and Dying

4.

REORGANIZATION
begins 6-9 months with gradual
renewal of interest in people
and activities.

Death and Dying

SIGNS OF IMPENDING DEATH
1. slow, thready and weaker
pulse
2. lowered blood pressure
3. rapid, shallow, irregular or
abnormally slow breathing
4. mottling of lower extremities

Death and Dying

INDICATION OF DEATH
1. Total lack of response to
external stimuli
2. No muscular movement
especially breathing
3. No reflexes
4. Flat ECG

Death and Dying

BODY

CHANGES AFTER
DEATH
Rigor Mortis
Algor Mortis
Livor Mortis

Death and Dying

RIGOR

MORTIS stiffening of
the body 2-4 hours after death
ALGOR MORTIS gradual
dec. of the bodys temperature
until it reaches room
temperature

Death and Dying

LIVOR

MORTIS discoloration
of the surrounding tissues due
to the release of Hgb; appears
in lowermost parts or
dependent areas of the body.

Death and Dying

NURSING

INTERVENTIONS

Care for the body

Positioning
Place dentures
Close eyes using wet/ moistened
cotton balls
Close mouth before rigor mortis
sets in

Death and Dying

NURSING

INTERVENTIONS

All equipments and supplies

must be removed from the
bedside
Identify clients religion and
comply
Apply proper identification bands

Death and Dying

NURSING

INTERVENTIONS

Make body as natural as

possible
Place small pillow or folded towel
under the head to prevent
discoloration from blood pooling

Death and Dying

NURSING

INTERVENTIONS

All valuables and disposition

must be documented in the
patients medical record
Provide emotional support to the
significant other