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Health and Illness

HEALTH- is a fundamental right of every

human being. It is a state of integration of the body and mind. It is much sought after state; a highly desirable state for most people and yet at times, it remains elusive for some people

Heath and illness are highly individualized

perceptions. Meanings and descriptions of health and illness vary among people, in relation to geography and to culture.

CONCEPTS OF HEATH AND ILLNESS Health is a state of complete, mental and

social well-being, and not merely the absence of the disease or infirmity. (WHO) Health is the ability to maintain the internal milieu. Illness is the result of failure to maintain the internal environment.(Claud Bernard) Health is the ability to maintain homeostasis or dynamic equilibrium.

Homeostasis is regulated by the negative

feedback mechanism. (Walter Cannon) Health is being well and using ones power to the fullest extent. Heath is maintained through prevention of disease via environmental health factors. (Nightingale) Health is viewed in terms of the individuals ability to perform 14 components of nursing care unaided. (Henderson) Positive health symbolizes wellness. It is a value term defined by the culture or individual. (Rogers)

Health is a state and a process of being

and becoming an integrated and whole person. (Roy) Heath is a state that is characterized by soundness or wholeness of developed human structures and of bodily and mental functioning. (Orem) Health is a dynamic state in the life cycle; illness is an interference in life cycle. (King)

Wellness is the condition in which all

parts and subparts of an individual are in harmony with the whole system. (Neuman) Health is an elusive, dynamic state influenced by biologic, psychologic, and social factors . Health is reflected by the organization, interaction, interdependence and integration of the subsystems of the behavioral system. (Johnson)

Wellness and Well Being

Wellness is well-being. It involves engaging in
attitudes and behaviors that enhance quality of life and maximize personal potential. Well being is subjective perception of balance, harmony and vitality Wellness is a choice Wellness is a way of life Wellness is the integration of body, mind and spirit Wellness is the loving acceptance of ones self

MODELS OF HEALTH AND ILLNESS I. The health-Illness Continuum (Dunn) Dunns theory on health-illness continuum describes the interaction of the environment with well-being and illness.

Protected poor health In favorable environment

HLW in favorable environment



Poor Health

Poor health in
unfavorable environment

Good health High precursor Level of illness Wellness Emergent HLW in unfavorable environment

High level wellness (HLW). An integrated

method of functioning that is oriented towards maximizing ones potentialities within the limitations of his environment. This concept connotes ability to perform ADL or to perform independently.

Precursor of Illness
These are the factors which impinge on the individuals to lead towards the illness spectrum: 1. Heredity (ex. Family history for diabetes mellitus, hypertension, cancer. 2. Behavioral factors (ex. Cigarette smoking, alcohol abuse, high minimal fat intake) 3. Environmental factors (ex overcrowding poor sanitation, poor supply of potable water.

MODELS OF HEALTH AND ILLNESS II. Health Belief Model (HBM) Becker, 1975 Describes the relationship between a persons belief and behavior Individual perceptions and modifying factors may influence health beliefs and preventive health behavior.

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MODELS OF HEALTH AND ILLNESS Individual perceptions include the following: Perceived susceptibility to an illness. Ex. Family history to diabetes mellitus increases risk to develop the disease. Perceived seriousness of an illness. Ex. Diabetes mellitus is a lifelong disease. Perceived threat of an illness. Ex. Diabetes mellitus causes damage to the brain, heart, eyes, kidneys, blood vessels.

1. 2.

3. 4.

MODELS OF HEALTH AND ILLNESS Modifying factors include the following: Demographic variables (age, sex, race, etc) Sociopsychologic variables (social pressure or influence from peers, etc.) Structural variables (knowledge about the disease, and prior contact with it) Cues to action (internal: fatigue, uncomfortable symptoms; external; mass media, advice from others)


Likelihood of taking recommended preventive health action depends on: 1. Perceived benefits of preventive action. 2. Perceived barriers to preventive action. a. Preventive health behavior may include lifestyle changes, increased adherence to medical therapies, search for medical advice or treatment. b. Perceived barriers to preventive action may be due to difficulty in adhering to lifestyle changes; social pressures; physical symptoms such as fatigue, joint pains, etc; economic factors; accessibility of heath care facilities

MODELS OF HEALTH AND ILLNESS III. Smiths Model of Health 1. Clinical model: Views people as physiologic system with related functions and identifies health as the absence of signs and symptoms of disease or injury. 2. Role Performance Model. Defines health in terms of individuals ability to fulfill societal roles such as performing work.

MODELS OF HEALTH AND ILLNESS 3. Adaptive model: Focuses on adaptation. Views health as creative process; and disease as a failure in adaptation or maladaptation. This model believes that the aim of treatment is to restore the ability of the person to adapt, that is to cope. 4. Eudaemonistic Model: Conceptualizes that health is a condition of actualization or realization of a persons potential. This model avers that the highest aspiration of people is fulfillment and complete development-actualization.


IV. Leavell and Clarks Agent-Host Environment Model (Ecologic Model) Avers that there are three interactive factors affect health and illness. The three factors are as follows: 1. Agent- any factor or stressor that can lead to illness or disease. 2. Host- persons who may or may not be affected by a disease. 3. Environment-any factor external to the host that may or may not predispose the person to a certain disease.


V. Health Promotion Model (Pender 1982 1993, 1996) The health Promotion Model (Pender) describes the multi-dimensional nature of persons as they interact within the environment to pursue health. The model focuses on the following areas: 1. Individual Perceptions (clients cognitive perceptual factors). 2. Modifying Factors (demographic and social factors) 3. Participation in Health- promoting behaviors (likelihood of Action)


This model attempts to explain the

reasons why individuals engage in health activities. Pender advocates the heath promotion involves activities that are directed toward increasing the level of well-being and self-actualization. 1. Includes efforts to assist individuals in taking control of and responsibility for their health risks and ultimately improve quality of life.

MODELS OF HEALTH AND ILLNESS 2. Encompasses activities to improve the health of those who are not initially healthy as well as the healthy individuals. 3. Includes individual and community activities to promote healthful lifestyles. 4. Includes the principles of self responsibility, nutritional awareness, stress reduction and management and physical fitness..

MODELS OF HEALTH AND ILLNESS 5. Health promotion activities such as routine exercise and good nutrition, help clients maintain or enhance their present level of health. 6. Illness prevention activities such as immunization programs protect clients from actual or potential threats to health.


ILLNESS Is a personal state in which the person feels

unhealthy. Is a state in which a persons physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with previous experience. Is not synonymous with disease; although nurses must be familiar with different kinds of diseases and their treatments, they are concerned more with illness, which may include disease but also the effects on functioning and well-being in all dimensions.

DISEASE An alteration in body functions resulting in

reduction of capacities or a shortening of the normal life span.

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Common Causes of Disease Biologic agents (e.g. microorganism) Inherited genetic defects (e.g. cleft palate) Developmental defects (e.g. imperforate anus) Physical agents (e.g. hot and cold substances, radiation, ultraviolet rays) Chemical agents (e.g. lead, emissions from smoke-belching cars) Tissue response to irritation/injury (e.g. fever, inflammation) Faulty chemical/metabolic process (e.g. inadequate insulin in diabetes mellitus, inadequate iodine causing goiter) Emotional/physical reaction to stress (e.g. anxiety, fear)

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Stages of Illness Symptom experience Transition stage The person believes something is wrong Experiences some symptoms 3 aspects Physical (fever, muscle aches, malaise, headache) b. Cognitive (perception of having flu) c. Emotional (worry on consequence of Illness)

2. Assumption of Sick Role Acceptance of the illness Seeks advice, support for decision to give up some activities.

3. Medical Care Contact Seeks advice of health professionals for the following reasons: a. Validation of real illness b. Explanation of symptoms c. Reassurance or production of outcome

4. Dependent Patient Role The person becomes a client dependent on the health professional for help. Accepts/rejects health professionals suggestions. Becomes more passive and accepting May regress to an earlier behavioral stage.

5. Recovery/Rehabilitation Gives up the sick role and returns to former roles and functions.

Aspects of Sick Role 1. One is not held responsible for his condition.
The person did not cause his illness 2. One is excused from social roles. This person is allowed to rest by seeking sick leave or leave of absence. 3. One is obliged to get well as soon as possible. The person is expected to cooperate and comply with recommended therapies. 4. One is obliged to seek for competent help. The person is expected to seek help from health professionals.

Risk Factors A risk factor is any situation, habit, social,

or environmental condition, physiological or psychological condition, developmental or intellectual condition, or spiritual or other variable that increases the vulnerability of an individual or group to an illness or accident. The presence of risk factors does not mean that a disease will develop, but risk factors increase the chances that the individual will experience a particular dysfunction.

Risk Factors of a Disease 1. Genetic and Physiological Factors Heredity, or genetic predisposition to
specific illness, is a major physical risk factor. For example, a person with a family history of diabetes mellitus is a risk for developing the disease later in life.

2. Age Age increases or decreases susceptibility to certain illnesses (e.g. the risk of heart diseases increases with age for both sexes) The risk of birth defects and complications of pregnancy increase in women bearing children after age 35.

3. Environment The physical environment in which a person works or lives can increase the likelihood that certain illnesses will occur. For example, some kinds of cancer and other diseases are more likely to develop when industrial workers are exposed to certain chemicals or when people live near toxic waste disposal sites.

4. Lifestyle Many activities, habits and practices involve risk factors. Lifestyle practices and behaviors can also have positive or negative effects on health. Other habits that put a person at risk for illness include tobacco use, alcohol or drug abuse and activities involving a threat or injury, such as skydiving or mountain climbing.

Stress can be a lifestyle risk factor if it is

severe or prolonged, or if the person is unable to cope with life events adequately. Stress can threaten mental health (emotional stress), as well as physical well being (physiologic stress). The goal of risk factor identification is to merely assist clients in visualizing those areas in their life that can be modified or even eliminated to promote wellness and prevent illness.

Disease. Disturbance of structure or of
function of the body or its constituent parts.
Lack of or faulty or inadequate adaptation of the organism to his environment. Failure of the adaptive mechanism to adequately counteract the stimuli or stresses to which it is subject resulting in disturbances in function and structure of any part, organ or system of the body

Morbidity- condition of being diseased.

Morbidity rate- the proportion of disease to
health in a community.

Mortality- condition or quality of being

subject to death.

Ecology- the science of organisms as

affected by factors in their environment; deals with the relationship between the disease and geographical environment.

Epidemiology- study of the patterns of

health and disease, its occurrence and distribution in man, for the purpose of control and prevention of disease.

Susceptibility- the degree of resistance the

potential host has against the pathogen.

Etiologic agent- one that possesses the

potential for producing, injury or disease (e.g. streptococcus, staphylococcus)

Virulence- relative power or the degree of

pathogenicity of the invading microorganism, the ability to produce poisons that repel or destroy phagocytes.

Symptomatology- study of symptoms Sign- an objective symptom or objective

evidence or physical manifestation made apparent by special methods of examination or use of senses

Symptom- any disorder of appearance,

sensation or function experienced by the patient indicative of a certain phase of a disease.

Syndrome- a set of symptoms, the sum of

which constitutes a disease.
A group of symptoms which commonly occur together. A group of signs and symptoms which when considered together characterize a disease. E.g. fever, rashes , Kopliks spot in measles.

Pathology- the branch of medicine which deals

with the cause, nature, treatment and resultant structural and functional changes of disease.

Pathogenesis- method of origin and

development of a disease, including sequence of processes or events from inception to the development of characteristic lesion or disease.

Diagnosis- art or act of determining the nature of

a disease, recognition of a diseased state.

Sequela- the consequence that follows the

normal course of an illness.

Complication- a condition that occurs during or

after the course of an illness.

Prognosis- prediction of the course and end of a

disease, medical opinion as to the outcome of a disease process. Good prognosis means that there is great possibility to recover from the disease and poor prognosis means that there is great risk for morbidity or mortality.

Recovery-implies that the person has no

observable or known after effects from his illness; there is apparent restoration to the preillness state

Classification of Diseases
A. According to Etiologic Factors 1. Hereditary- due to defect in the genes of
one or other parent which is transmitted to the offspring. (e.g. diabetes mellitus, hypertension) 2. Congenital- due to a defect in the development, hereditary factors, or prenatal infection; present at birth. (e.g. cleft palate, cleft lip)

3. Metabolic- due to disturbances or abnormality in the intricate processes of metabolism (e.g. diabetes mellitus, hyperthyroidism) 4. Deficiency- results from inadequate intake or absorption of essential dietary factors (e.g. osteomalacia, which is vitamin D deficiency in adults) 5. Traumatic- due to injury. (e.g. fractures) 6. Allergic- due to abnormal response of he body to chemical or protein substances or to physical stimuli (e.g. asthma, skin allergy)

7. Neoplastic- due to abnormal or uncontrolled growth of cells. (e.g. cancer 8. Idiopathic- cause is unknown; selforiented; of spontaneous origin. (e.g. cancer) 9. Degenerative- results from the degenerative changes that occur in tissue and organs. (e.g. osteoporosis, osteoarthrtis) 10. Iatrogenic- results from the treatment of a disease. (hypothyroidism after thyroid surgery; alopecia after chemotherapy)

B. According to Duration or Onset 1. Acute illness- an acute illness usually has a short duration and is severe. The signs and symptoms appear abruptly, are intense and often subside after relatively short period. An acute illness may affect functioning in any dimension. (e.g. acute appendicitis)

2. Chronic Illness- a chronic illness persists, usually longer than 6 months, and can also affect functioning in any dimension. The client may fluctuate between maximal functioning and serious relapses that may be life threatening. (e.g. hypertension). It is characterized by remission and exacerbation.

Remission- period during which the

disease is controlled and symptoms are not obvious.

Exacerbation- the disease more active

again at a future time, with recurrence of pronounced symptoms. 3. Sub-acute- symptoms are pronounced but more prolonged than in acute disease. (e.g. sub-acute endocarditis)

C. Others. Diseases may also be described as: 1. Organic- results from changes in the normal structure, from recognizable anatomical changes in an organ or tissue of the body 2. Functional- no anatomical changes are observed to account for the symptoms present, may result from abnormal responses to stimuli (e.g. psychiatric illness)

3. Occupational- results from factors associated with the occupation engaged in by the patient (e.g. cancer among chemical factory workers) 4. Familial- occurs in several individuals of the some family. (e.g. Hypertension, cancer) 5. Venereal- usually acquired through sexual relation. (e.g. AIDS) 6. Epidemic- attacks a large number of individuals in a community at the same time (e.g. SARS)

7. Endemic- present more or less continuously or recurs in a community. (e.g. malaria, in Palawan, Goiter in Mountain Province) 8. Pandemic- an epidemic disease which is extremely widespread involving an entire country or continent. 9. Sporadic- a disease in which only occasional cases occur. (e.g. Dengue during rainy season, leptospirosis during floods)

Leavell and Clarks Three Levels of Prevention

1. Primary Prevention: to encourage
optimal heath and to increase the persons resistance to illness. Seeks to prevent a disease or condition at a prepathologic state; to stop smoking from ever happening. Health promotion Specific protection

2. Secondary Prevention: It is also known as health maintenance. Seeks to identify specific illness or conditions at an early stage with prompt intervention to prevent disability; to prevent catastrophic effects that could occur if proper attention and treatment are not provided. Early detection/diagnosis/screening Prompt treatment to limit disability

3. Tertiary Prevention: To support the clients achievement of successful adaptation to known risks, optimal reconstitution, and/ or establishment of high-level wellness. Occurs after a disease or disability has occurred and the recovery process has begun; intent is to halt the disease or injury process and assist the person in obtaining an optimal health status. Rehabilitation

Behaviors Associated with the Levels of Prevention

Primary Prevention Quit smoking Avoid/limit alcohol Exercise regularly Eat well-balanced diet Reduce fat and increases fiber in diet Take adequate fluids

Avoid exposure to sunlight Maintain ideal body weight Complete immunization program Wear hazard devices in work site.

Secondary Prevention Have annual physical examination Regular Paps test for women Monthly BSE for women who are 20 years
old and above Sputum examination for Tuberculosis Annual stool guaiac test and rectal examinaton for clients over age 50 years

Tertiary Prevention Self-monitoring of blood glucose among

diabetics Physical therapy after CVA (stroke); participation In Cardiac Rehabilitation after MI (myocardial infarction or heart attack) Attending self-management education for diabetes. Undergoing speech therapy after laryngectomy.

Types of Health Promotion Programs

1. Information Dissemination Use of variety of media to offer
information to the public about the particular lifestyle choices and personal behavior, the benefits of changing that behavior and improving the quality of life.

2. Health Appraisal and Wellness Assessment Programs Appraise individuals of their risk factors that are inherent in their lives in order to motivate them to reduce specific risk and develop positive health habits. Wellness assessment programs are focused on more positive methods of enhancement.

3. Lifestyle and Behavior Change Programs Basis for Changing health behavior Geared toward enhancing the quality of life and extending the life span.

4. Worksite Wellness Programs Include programs that serve the needs of persons in their workplace. 5. Environment Control Programs Developed to address the growing problem of environment pollution-air, land, water, etc.

Activities to Promote Health and Prevent

1. 2.
Illness Have regular (yearly) physical examination Women Regular Par test Monthly BSE (breast self examination)

3. Men: regular testicular self-examination

4. Annual dental examination and prophylaxis. 5. Regular eye exam (every 1-2 years) 6. Exercise regularly at least 3x per week for 30 minutes 7. Do not smoke: avoid second hand smoke 8. Avoid alcohol and recreational drugs 9. Reduce fat and increase fiber in diet.

10. Sleep regularly 7-8 hours/night 11. Eat breakfast 12. Eat regular meals with few snacks 13. Maintain Ideal Body Weight