Illness - Wellness Continuum

HEALTH “State of complete physical, mental and social well-being not merely the absence of disease or infirmity” WHO (World Health Organization)

Characteristics of being healthy: • • • • • •

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

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 (highly subjective)

Three distinct criteria to determine illness (according to Bauman) • • •

the presence of symptoms the perception of how they feel their ability to carry out daily activities

Classification of Illness 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 (6 months or longer) • Usually has a slow onset • Often have periods of remissions (symptoms disappear) and exacerbations (symptoms reappear) • Care includes promoting independence, sense of control, and wellness • Learn how to live with physical limitations and discomfort

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Parson’s Four Aspects of the Sick Role (Parsons, 1979) • • • •

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 5 Stages of Illness (Suchman, 1979) •

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Stage 1: Symptom experiences – Cognitive aspect (believe something is wrong) – Physical experience of symptoms – Emotional response (may consult others and try home remedies) Stage 2: Assumption of the sick role – Accepts the sick role and seeks confirmation from family and friends – Continue with treatment – Excused from normal duties and expectations – Emotional responses common – Seek professional health advice Stage 3: Medical care contact – Seeks advice of a health professional to: • Validate real illness • Explain illness in understandable terms • Get reassurance (may accept or deny diagnosis) 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 – long term responsibilities and permanent disability necessitate adjustment

Impact of Illness On the Client • Behavioral and emotional changes • Loss of autonomy (autonomy is the state of being independent and self-directed without outside control) • Self-concept and body image changes • Lifestyle changes (lifestyle is a general way of living based on the interplay between living condition in the wide sense and individual pattern of behaviour as determined by socio-cultural factors and personal characteristic) • Privacy is usually affected (privacy is described as comfortable feeling reflecting a deserved degree of social retreat or freedom from authorized intrusion)

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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 Nursing interventions: 1. explanations about adjustments 2. arrangements to accommodate lifestyle 3. encourage health professionals to become aware of changes and give support 4. reinforce desirable changes in practice

DISEASE “abnormal vital function involving any structure, part, or system of an organism” “specific illness or disorder characterized by a recognizable set of manifestations, attributable to heredity, infection, diet, or environment” • •

Alteration in body function A reduction of capacities or a shortening of the normal life span

WELLNESS •

State of well-being – Subjective perception of vitality and feeling well – Described objectively, experienced, measured – Can be plotted on a continuum

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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

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Dimensions of Wellness (Anspaugh, Hamrick, Rosato)

Physical Dimension • Ability to carry out daily tasks • Achieve fitness • Maintain nutrition • Avoid abuses • Positive lifestyle habits 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 and grow • Ability to use information effectively Spiritual Dimension • Belief in some force that serves to unite • Belief in moral, values and ethics Occupational Dimension • Ability to achieve balance between work and leisure Environmental Dimension • Ability to promote health measure that improves – Standard of living (food, water, air) – Quality of life

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Models of Health  Smith model of health – discusses four models of health o 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 o 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 o 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 o 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 (Leavell and Clark’s) • •

also called ecologic agent ,used in predicting illness rather than promoting wellness has 3 dynamic interactive elements: 1. agents – stressors/environment factors that by it presence or absence can lead to illness or disease 2. host – who may or may not be at risk of acquiring the disease 3. environment – external to the host

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Each factor constantly interacts with the others When in balance, health is maintained When not in balance, disease occurs

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 Health-Illness Continuum • • • •

Dunn’s high level wellness grid Travis’s illness – wellness continuum Health Belief model Health locus of control model

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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

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illness

Dunn’s high level wellness grid 

Health axis and environmental axis intersect forming four quadrants 1. high-level wellness in favourable environment ex. Person who implement healthy lifestyle and has complete resources to support his lifestyle 2. emergent-high level wellness in unfavourable environment ex. Person who has knowledge to implement healthy lifestyle but does not implement adequate self-care because of some family responsibility 3. protected poor health in favourable environment ex. Ill person whose needs are met by the health care system 4. poor health in an unfavourable environment ex. Young child who is starving in a drought stricken country

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Travis’s Illness – wellness continuum • • • • •

compose of 2 arrows pointing in opposite direction and joined at neutral point movement to the left of neutral point indicate progressive decrease in state of health movement to the right of the neutral point indicates increasing level of health traditional treatment model > help only the individual move from left to the neutral point Wellness model > help move individual beyond the neutral point to high level of wellness

Health Belief Model •

based on motivation theory, has 3 components a) individual perception > include perceived susceptibility, perceived threat and perceived seriousness b) modifying factors > include demographic variables socio-psychologic variables, structural variables, cues to action c) likelihood of action > depend on perceived benefits of action minus the perceived barriers to the action

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Health Locus of control model Factors Affecting Health Status, Beliefs, and Practices • Internal variables (Internal LOC) • External variables (External LOC) 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

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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 • 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

COMPILED FROM VARIOUS SOURCES -

Halley

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