Kozier - Chapter 17- Health Wellness Well Being

Chapter

17

Health, Wellness, and Illness Kozier & Erb's Fundamentals of Nursing, 8e Berman, Snyder, Kozier, Erb Copyright 2008 by Pearson Education, Inc.

Question 1 Which one of the following is an example of the emotional component of wellness? 3. The client chooses health foods. 4. A new father decides to take parenting classes. 5. A client expresses frustration with her partner’s substance abuse. 6. A widow with no family decides to join a bowling league. Copyright 2008 by Pearson Education, Inc.

Rationales 1 • The client who chooses healthy foods represents the physical component. • Taking parenting classes enhances the intellectual component. • Correct. Frustration is an example of an emotion. • The bowling league enhances both the physical and social components. Copyright 2008 by Pearson Education, Inc.

Question 2 Which one of the following individuals appears to have “taken on” the sick role? 3. 4. 5. 6. 7.

An obese client states, “I deserve to have a heart attack.” A mother is ill and says, “I won’t be able to make your lunch today.” A man with low back pain misses several physical therapy appointments. An elder states, “My horoscope says I will be well again.” Copyright 2008 by Pearson Education, Inc.

Rationales 2 • • •

•

The sick role states that persons are not answerable for their illness, contrary to the obese client’s perspective. Correct. The mother has taken on the sick role by expecting to be excused from her usual role responsibilities. In the sick role, the client tries to get better as opposed to the man who misses his physical therapy appointments. The elder is not following the sick role expectation to rely on competent help. Copyright 2008 by Pearson Education, Inc.

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: 3. 4. 5. 6.

Health belief model Clinical model Role performance model Agent-host-environment model Copyright 2008 by Pearson Education, Inc.

Rationales 3 •

• • •

Correct. The behavior is most representative of health promotion, which is the central focus of the health belief model. The clinical model focuses on relieving signs and symptoms of illness. The role performance model emphasizes social activities such as fulfilling a particular role. The agent–host–environment model focuses on predicting illness. Copyright 2008 by Pearson Education, Inc.

Question 4 Because 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. 3. 4. 5. 6. 7.

Educational level A trusting relationship with the health care provider An expectation that the medications will be helpful Being able to take the medications twice daily instead of four times daily Copyright 2008 by Pearson Education, Inc. Gender

Rationales 4 • • • • •

Education has not been shown to be a predictive factor. Correct. Significant evidence exists that a trusting relationship with the provider is an important predictor of adherence. Correct. Effectiveness of the medication is an important predictor of adherence. Correct. A less complex dosing regime is an important predictors of adherence with the medical regimen. Gender has not been shown to be a predictive factor. Copyright 2008 by Pearson Education, Inc.

Question 5 Which one of the following might be the BEST way to measure adherence to a prescribed medication regime? 3. 4. 5. 6.

Direct observation of medication administration. Evidence of illness complications or exacerbations. Monitoring laboratory values of element influenced by the medication. Questioning the client about his or her medication routine.

Copyright 2008 by Pearson Education, Inc.

Rationales 5 •

•

•

•

Correct. Although not always practical, direct observation is the best method to measure adherence (for example, watching heroin addicts actually take their methadone dose). 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. 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. Client report or recall is not always accurate, even if the client believes he or she is telling the truth. Copyright 2008 by Pearson Education, Inc.

Health, Wellness, Wellbeing • Many definitions and interpretations

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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 Copyright 2008 by Pearson Education, Inc.

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 Copyright 2008 by Pearson Education, Inc.

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

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Dimensions of Wellness

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Physical Dimension • Ability to carry out daily tasks • Achieve fitness • Maintain nutrition • Avoid abuses

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Social Dimension • Interact successfully • Develop and maintain intimacy • Develop respect and tolerance for others

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Emotional Dimension • Ability to manage stress • Ability to express emotion

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Intellectual Dimension • Ability to learn • Ability to use information effectively

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Spiritual Dimension

• Belief in some force that serves to unite

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Occupational Dimension

• Ability to achieve balance between work and leisure

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

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

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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

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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

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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 Copyright 2008 by Pearson Education, Inc.

Eudemonistic Model • Comprehensive view of health • Condition of actualization or realization of a person’s potential • Illness is a condition that prevents self-actualization

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Agent-Host-Environment Model • Each factor constantly interacts with the others • When in balance, health is maintained • When not in balance, disease occurs Copyright 2008 by Pearson Education, Inc.

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

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Factors Affecting Health Status, Beliefs, and Practices

• Internal variables • External variables

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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) Copyright 2008 by Pearson Education, Inc.

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 Copyright 2008 by Pearson Education, Inc.

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 Copyright 2008 by Pearson Education, Inc.

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 Copyright 2008 by Pearson Education, Inc.

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

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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 Copyright 2008 by Pearson Education, Inc.

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

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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 Copyright 2008 by Pearson Education, Inc.

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

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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

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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

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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 Copyright 2008 by Pearson Education, Inc.

Question 1 Which one of the following is an example of the emotional component of wellness? 3. The client chooses health foods. 4. A new father decides to take parenting classes. 5. A client expresses frustration with her partner’s substance abuse. 6. A widow with no family decides to join a bowling league. Copyright 2008 by Pearson Education, Inc.

Rationales 1 • The client who chooses healthy foods represents the physical component. • Taking parenting classes enhances the intellectual component. • Correct. Frustration is an example of an emotion. • The bowling league enhances both the physical and social components. Copyright 2008 by Pearson Education, Inc.

Question 2 Which one of the following individuals appears to have “taken on” the sick role? 3. 4. 5. 6. 7.

An obese client states, “I deserve to have a heart attack.” A mother is ill and says, “I won’t be able to make your lunch today.” A man with low back pain misses several physical therapy appointments. An elder states, “My horoscope says I will be well again.” Copyright 2008 by Pearson Education, Inc.

Rationales 2 • • •

•

The sick role states that persons are not answerable for their illness, contrary to the obese client’s perspective. Correct. The mother has taken on the sick role by expecting to be excused from her usual role responsibilities. In the sick role, the client tries to get better as opposed to the man who misses his physical therapy appointments. The elder is not following the sick role expectation to rely on competent help. Copyright 2008 by Pearson Education, Inc.

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: 3. 4. 5. 6.

Health belief model Clinical model Role performance model Agent-host-environment model Copyright 2008 by Pearson Education, Inc.

Rationales 3 •

• • •

Correct. The behavior is most representative of health promotion, which is the central focus of the health belief model. The clinical model focuses on relieving signs and symptoms of illness. The role performance model emphasizes social activities such as fulfilling a particular role. The agent–host–environment model focuses on predicting illness. Copyright 2008 by Pearson Education, Inc.

Question 4 Because 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. 3. 4. 5. 6. 7.

Educational level A trusting relationship with the health care provider An expectation that the medications will be helpful Being able to take the medications twice daily instead of four times daily Copyright 2008 by Pearson Education, Inc. Gender

Rationales 4 • • • • •

Education has not been shown to be a predictive factor. Correct. Significant evidence exists that a trusting relationship with the provider is an important predictor of adherence. Correct. Effectiveness of the medication is an important predictor of adherence. Correct. A less complex dosing regime is an important predictors of adherence with the medical regimen. Gender has not been shown to be a predictive factor. Copyright 2008 by Pearson Education, Inc.

Question 5 Which one of the following might be the BEST way to measure adherence to a prescribed medication regime? 3. 4. 5. 6.

Direct observation of medication administration. Evidence of illness complications or exacerbations. Monitoring laboratory values of element influenced by the medication. Questioning the client about his or her medication routine.

Copyright 2008 by Pearson Education, Inc.

Resources

• Audio Glossary • Boston College: Welcome to the Nurse Theorist Web Site Overview of Sister Callista Roy's Adaptation Model • Personality Theories: Abraham Maslow Informative Web site on Maslow's Hierarchy of Needs • Mental Health: A Report of the Surgeon General The Web site relates mental health and its relationship to well-being. • Center for Scientific Review: National Institutes of Health: Risk, Pr Behavior. This sites offers information on the biological, psychological, and social conditions that affect mental illness.

Copyright 2008 by Pearson Education, Inc.

Resources

• Health and Age This site offers information on and links to various health-related items and news pertaining to the latest research and variables that affect health care. • Center for the Study of Religion/Spirituality and Health Abstracts and references on spirituality and health care • World Health Organization WHO defines health and offers related documents. Copyright 2008 by Pearson Education, Inc.