Health, Illness,
&
Nursing
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Health
What does health mean to be healthy?
Has your perception of the meaning of health
changed since you began nursing?
Can health and illness co-exist?
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Health Model
• Clinical Model:
– Health = absence of S/S of disease/disability
– Medically orientated
• Role Performance Model:
– Health viewed in terms of performance of social roles
– Health = effective performance of roles
• Adaptive Model:
– Health = maintaining flexible adaptation to environment and
interacting with it to maximum advantage
• Eudaimonistic model:
– Health seen as exuberant well-being
– Healthy person is self-actualized and fulfilled.
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Health defined
• WHO
– Complete physical, mental, social well-being; not merely
absence of disease/infirmity
• Pender
– The actualization of inherent and acquired human potential
through goal-directed behavior, competent self-care, and
satisfying relationships with others, while adjustments are
made as needed to maintain structural integrity and
harmony with relevant environments
• Bevis
– The ability to set goals and to mobilize the energy and
resources needed to meet these goals while feeling good
and caring about self and others and helping others feel
good about themselves
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Health defined
• U of W
– A dynamic process whereby client is able to realize
aspirations, satisfy needs, and change/cope with
environment
– A resource for everyday life
– A positive concept emphasizing social and personal
resources as well as physical capacity
– The goal of all nursing behaviors
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Alterations in Health
• Acute/Episodic Illness
– Rapid onset, short duration
– Self-limiting or responds to Rx
• Long term/Chronic Illness
– Permanent
– Irreversible pathologic conditions
– Residual disability
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Disease versus Illness
• Disease:
– Objective state of ill health manifested by
pathology detectable by medicine
• Illness:
– subjective experience of loss of health
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Impact of Long Term Illness
• Physiologic/Somatic
• Psychologic
• Sexual
• Social
• Occupational
• Financial
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Coping with Chronic Illness
• Nursing role: Facilitate achievement of
coping tasks
• Coping Tasks:
– Maintaining sense of normalcy
– Modifying daily routine, adjusting lifestyle
– Obtaining knowledge and skill for self care
– Maintaining positive self-concept
– Adjusting to altered social relationships
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Coping with Chronic Illness
• Coping Tasks (cont)
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Grieving over losses associated with chronic illness
Dealing with role change
Handling physical discomfort
Confronting inevitability of death (make most of life)
Dealing with social stigma of illness/disability
Maintaining sense of being in control
Maintaining hope despite uncertain or downward
course of health
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Family Caregivers
• Family Caregivers
– 21% of caregivers are > 75 yrs
– Caregivers of elderly with long-term illness
usually:
•
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•
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Spouses
Children (usually daughters, daughters-in-law)
Other family members
Outside sources (when needs exceed family
resources)
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Types of Caregivers
• Care Providers
– perform direct care
• Care Managers
– manage/arrange services to provided by
others
– Often have own careers
– Often provide psychosocial support,
transportation, visiting, etc.
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Impact of Long Term Illness on
Families
• Burden
– Decreased social, recreational involvement,
financial difficulties, depression, declining
personal health
– May lead to nursing home placement
• Problems related to home care
– Financial
– Competing demands
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Impact of Long Term Illness on
Families
• Physical Strain
– Lifting, 24/7 physical care, sleep deprivation,
chronic fatigue
• Emotional Strain
– High incidence of stress-related disorders
(HTN, heart disease)
– Manifested as anxiety, anger, guilt, loss of self
– Could lead to elder abuse
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Impact of Long Term Illness on
Families
• Role Changes Associated with Caregiving
– Pre-existing relationships change
– Take on new duties
– Role Ambiguity
• Taking on of new roles (e;g. roles traditionally
fulfilled by spouse)
– Role Reversal
• Children caring for parents
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Nursing Interventions for Family
Caregivers
• Encourage verbalization and acceptance of
negative emotions
• Facilitate Realistic expectations re
– client’s illness and expected course
– Own limitations
– Common feelings
• Encourage to accept assistance from others
• Info about resources (support groups, respite
services)
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Lazarus’ Theory of Stress and
Coping
Pschological
Stress
Cognitive
Appraisal
Coping
Health
Outcome
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Lazarus’ Theory of Stress and
Coping
• Stress
– Relationship b/w person and environment
that is appraised by the person as
• Taxing or exceeding his/her resources
• Endangering his/her well-being
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Lazarus’ Theory of Stress and
Coping
• Cognitive Appraisal
– Process through which person evaluates
whether a particular encounter with the
environment is relevant to his/her well-being
and if so, in what way(s)
– i.e., evaluation of the significance or meaning
of an event to the individual
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Lazarus’ Theory of Stress and
Coping
• Two Types of Cognitive Appraisal
– Primary Appraisal
• Person evaluates whether he/she has anything at
stake (i.e., is there potential harm or benefit?).
• Evaluates significance of the “event” with respect
to well-being
• Types of appraisal:
– Stressful – harm, loss, threat
– Challenge – opportunity for growth, gain or mastery
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Lazarus’ Theory of Stress and
Coping
– Secondary Appraisal
• Evaluates what if anything can be done to
overcome or prevent harm or to improve the
prospects of benefit (ie., evaluates coping
resources and options)
• Various coping options (e.g., altering the situation,
accepting it, seeking information) are evaluated
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Lazarus’ Theory of Stress and
Coping
• Coping
– Person’s constantly changing cognitive and
behavioral efforts to manage specific external
and/or internal demand that are appraised as
taxing or exceeding the person’s resources
– i.e., efforts to master the demands
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Lazarus’ Theory of Stress and
Coping
• Two major types of coping strategies
– Emotion-focused coping
• Used to control distressing emotions, sometimes by altering
the meaning of an outcome
• Likely to be used in situations that are perceived not be not
amenable to change
– Problem-focused coping
• Used to control the troubles person-environment relationship
through problem-solving, decision-making and/or direct
action
• More likely to be used in situations perceived as changeable
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Alterations in Health: Role of the Nurse
(Bevis)
• Nursing
– A process
– Purpose - promote optimal health; facilitate
maturation and adaptation in clients (individuals
[intrapersonal], groups [interpersonal] &
community)
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Nursing System (Bevis)
• Input
– Needs, goals problems & desires of clients
– Includes assessment data
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Nursing System (Bevis)
• Throughput
– Theories, concepts, processes used
– Tools used
• Problems-solving/decision-making (critical
thinking)
• Caring
• Teaching/Learning (Educator)
• Communication
• Management/change (change agent)
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Nursing System (Bevis)
• Output
– Behaviors, services, roles, functions of nurses
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Life Tasks (Bevis)
• Stress
– Forces that press in upon or noxiously stimulate the
individual. e.g. health problems, medical diagnoses, social
problems
• Strain
– Expresses itself in symptoms, signs or behaviors that signal
response to stress. E.g., S/S of an illness; physical assessment
findings, behaviors (crying)
• Maturation
– Process of human development
• Adaptation/Maladaptation
– Coping patterns or ways of behaving that can head to an
interruption or maintenance of health
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Review of Nursing Process
Assessment
– Data collection
• Sources
– Client
– Family/significant others
– Records
– Collaboration (other health professionals)
– Formulate nursing judgements
Data clustering: organize into meaningful clusters
(e.g., physiological systems, Gordon’s functional health
patterns)
•
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Review of Nursing Process
• Analysis
– Analyze and interpret data: draw conclusions
re health risks/problems
– Nursing Diagnosis
• A clinical judgement about a response to actual
potential health problems/life processes
• Nurse is accountable/responsible for developing
and treating
– Collaborative Problem – potential problem for
which nurse monitors; requires collaboration with
MDs
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Review of Nursing Process
• Planning
– Sets priorities
– Establishes outcomes/goals (collaborate with client)
• client-centered
• Realistic
• specific and measurable
– Select nursing interventions - individualized for the client
• Implementation
– Carry out the plan of care
• Evaluation
– Determine the degree to which expected outcomes were met
– Essentially a re-assessment of the client in relation to the goals
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