Chapter 8
The Health Process and
Self-Care of the Nurse
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World Views of Health
• Paradigms or world views
– Basic philosophic assumptions about nature of
reality, including human beings and human–
environment relationship
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World Views of Health (cont’d)
• World views described by nursing scholars:
– Change/persistence (Hall, 1981)
– Totality/simultaneity (Parse, 1987)
– Particulate–deterministic/interactive–
integrative/unitary–transformative (Newman, 1992)
– Reaction/reciprocal interaction/simultaneous action
(Fawcett, 1993)
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The Interaction World View
• Human being usually conceptualized as whole comprised
of parts who interacts with physically separate
environment
– Persons strive to maintain balance or state of
stability
– Whenever environment changes, persons must
change
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Disease
• Medical term meaning dysfunction of body consistent
with interaction world view
• Medical intervention aimed at curing disease
• Nursing interventions support, promote medical regimen
– Administering medications
– Performing ordered treatments
– Promoting rest
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Illness
• Subjective feeling of being unhealthy that may or may
not be related to disease
• Medical interventions focus on efforts to label, treat
symptoms, cure disease
• Nursing interventions focus on
– Human response to illness
– Identification of reasons for symptoms
– Efforts to decrease symptoms
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Sickness
• Status, social entity usually associated with disease or
illness, although it may occur independent of them
• Nursing roles focus on assisting people until they can
resume
– Responsibility for decision making
– Independent functioning
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Well-Being
• Subjective perception of vitality, feeling well that is
component of health within interaction world view
• Occurs on wellness-illness continuum
– Experienced at lowest degrees, person might feel ill
– At highest levels, person would perceive maximum
satisfaction with life, understand what it means to be
in harmony with universe
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Health as Wellness
• Health
– State or condition of integrity of functioning
(functional capacity and ability), perceived well-being
(feeling well)
– As a result, person is able to
• Function adequately (can be observed objectively)
• Adapt adequately to environment
• Feel well (as assessed subjectively)
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Health as Wellness (cont’d)
• Wellness
– Integrated method of functioning that is oriented
toward maximizing potential of which individual is
capable within environment where he is functioning
– Person’s capacity to perform to best of ability
• Ability to adjust, adapt to varying situations
• Reported feeling of well-being
• Feeling that “everything is together”
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Question
• What is the focus of nursing interventions provided for a
client during illness?
A. To treat the client’s symptoms
B. To provide curative care to the client
C. To label or name the client’s disease
D. To identify reasons for the client’s symptoms
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Answer
• D. To identify reasons for the client’s symptoms
• Rationale: Nursing interventions focus on monitoring
human response to illness, identification of reasons for
symptoms, and efforts to decrease symptoms. Medical
interventions focus on efforts to label and treat the
symptoms and cure disease.
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Health as Wellness (cont’d)
• Four models of health consistent with interaction world
view:
– Clinical model
• Absence of signs, symptoms of disease or
disability as identified by medical science
– Role performance model
• If person becomes unable to perform expected
roles, inability can mean illness even if individual
appears clinically healthy
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Health as Wellness (cont’d)
• Four models of health consistent with interaction world
view:
– Adaptive model
• Health perceived as condition in which person can
engage in effective interaction with physical, social
environment
– Eudaimonistic model
• Health is condition of actualization or realization of
person’s potential
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The Integration World View
• Human being considered to be unitary, indivisible whole
• Goal for person is to develop his or her potential toward
increased diversity
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Disease and Illness as Manifestations of
Health
• Illness, health viewed as single process of ups, downs
that are manifestations of varying degrees of
organization, disorganization
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Disease and Illness as Manifestations of
Health (cont’d)
• Health is actively continuing process that involves
initiative, ability to assume responsibility for health,
value judgments, integration of total person
– Rogers’ science of unitary human beings
– Parse’s theory of human becoming
– Neuman’s theory of health as expanding
consciousness
– Leddy’s human energy model
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Health Protection and Promotion
• Health promotion
– Activities directed toward increasing level of wellbeing, actualizing health potential of people, families,
community, society
• Health protection
– Focuses on efforts for active disease or injury
avoidance, early detection or optimal functioning
within confines of illness, health promotion expands
potential for health
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Goals for Health Promotion and Protection
• United States spends more on health care than all other
nations with goal of curing, controlling illness
• Health promotion, disease prevention, health education
receive less funding
• Healthy People 2010
– Report described national objectives for health
promotion and disease prevention, including two
major goals:
• Increase quality, years of healthy life
• Eliminate health disparities
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Models for Changing Lifestyle Behavior
• Health Belief Model
– Rational model that explains how persons work
toward improving their general well-being, health
– Assumes that all persons value well-being,
differences vary according to differing perceptions in
interactions and motivation
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Models for Changing Lifestyle Behavior
(cont’d)
• Revised Pender Health Promotion Model (HPM Model)
– Original model provides framework for combining
professional nursing, behavioral science outlooks on
various determinants of health behaviors
– Revised model proposes that health-promoting
behavior is related to direct, indirect influences
among 10 determinants of individual characteristics,
experiences
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Models for Changing Lifestyle Behavior
(cont’d)
• Studies testing HPM model determine that following
factors contribute to health-promoting behaviors:
1. Perceived benefits of action
2. Perceived barriers to action
3. Perceived self-efficacy
4. Interpersonal influences
5. Situational influences
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Models for Changing Lifestyle Behavior
(cont’d)
• Transtheoretical Model
– Assumes that change requires movement through
discrete motivational stages over time, with active
use of different processes of change at different
stages
– Model provides rationale for individualizing
interventions based on client’s readiness for change
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Models for Changing Lifestyle Behavior
(cont’d)
• Transtheoretical Model
– Precontemplation: not intending to change
– Contemplation: intending to change within 6 months
– Preparation: actively planning change
– Action: overtly making changes
– Maintenance: taking steps to sustain change, resist
temptation to relapse
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Question
• Which statement best describes health promotion?
A. Care is directed toward increasing the level of wellbeing and actualizing the health potential.
B. Interventions are directed toward encouraging the client
to assume responsibility for his or her health.
C. Focus is on efforts to decrease disease or injury, and
early detection of disease.
D. Vaccinations and adequate exercise are used to prevent
illness.
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Answer
• A. Care is directed toward increasing the level of wellbeing and actualizing the health potential.
• Rationale: Activities directed toward increasing the level
of well-being and actualizing the health potential of
people, families, community, and society is known as
health promotion. Health protection focuses on efforts for
active disease or injury avoidance, and early detection or
optimal functioning within the confines of an illness,
health promotion expands potential for health.
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Lifestyle Behavior Change
• Lifestyles and health
– General way of living based on interplay between
living conditions, individual patterns of behavior as
determined by sociocultural factors, personal
characteristics
– Alternative health practices
• Habits used exclusively and that fall outside
traditional scientific-based medicine
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Lifestyle Behavior Change (cont’d)
• Lifestyles and health
– Complementary health practices
• Use of alternative practices in combination with
traditional scientific-based medicine
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Lifestyle Behavior Change (cont’d)
• Health-protecting behavior includes activities such as:
– Optimal nutrition
– Perceived self-efficacy
– Supportive relationships
– Regular exercise
– Adequate sleep
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Lifestyle Behavior Change (cont’d)
• Health strengths
– Events appraised as stressful, emotionally linked
responses occur that result in vulnerability to illness
– Social support, self-efficacy, internal locus of control
seem to decrease relationship between stress, illness
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Lifestyle Behavior Change (cont’d)
• Strategies for lifestyle behavior change
– Person assumes different activities in multiple
aspects of his or her life
– There are no miracle drugs available for helping
people change long-standing patterns of living
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Lifestyle Behavior Change (cont’d)
• Nurse can best assist in promoting, changing health
behaviors by:
– Providing education
– Facilitating changes
– Sustaining positive health behaviors
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Lifestyle Behavior Change (cont’d)
• Strategies, techniques to help clients modify their
behavior include:
– Consciousness raising
– Self-reevaluation
– Environmental reevaluation
– Self-liberation
– Social liberation
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Lifestyle Behavior Change (cont’d)
• Strategies, techniques to help clients modify their
behavior include:
– Helping relationships
– Stimulus control
– Counter conditioning
– Reinforcement management
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Health Patterning
• Models for health patterning
– Concept of vital life energy, or chi, has been part of
Eastern religion, culture
– Blockage in energy flow results in energy
imbalances, areas of body with energy deficits,
producing symptoms or disease
• Leddy’s practice theory of energy
• Martha Rogers introduced concept of person as an
energy field
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Health Patterning (cont’d)
• Health patterning modalities
– Leddy’s model identifies integrative nursing
interventions to promote health, healing
• Tai Chi, Reiki, relaxation, yoga…
– Nurse must be educated about how each
complementary intervention may affect client’s
physiologic well-being, potential adverse effects
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Implications of the Nurse’s View of Health
for Role Performance
• Integrative world view supports belief that nurses work
with people who display areas of strength, weakness in
health pattern manifestations at specific time
• Nurse must learn, use self-care strategies to promote her
or his own health
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Implications of the Nurse’s View of Health
for Role Performance (cont’d)
• Self-care of the nurse
• Stressful work environment
– Pressure put on nurses by external organizational
forces that determine work conditions
– Distress placed on nurses in this environment
becomes state of emotional exhaustion known as
burnout
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Implications of the Nurse’s View of Health
for Role Performance (cont’d)
• Stress and burnout
– Common symptoms of stress:
• Sleep disturbance, fatigue, reduced abilities to
think and concentrate, sudden mood swings
• Appetite changes: increases or loss, overeating,
increased smoking
• Frequent tardiness or absences from work
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Implications of the Nurse’s View of Health
for Role Performance (cont’d)
• Stress and burnout
– Constant exposure to situations that cause
overstress depletes nurse’s energies, can lead to
burnout
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Techniques to Enhance Well-Being
• Stress management
• Affirmations
• Refuting irrational ideas
• Social support
• Values clarification
• Taking care of oneself
• Barriers to self-care
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Summary and Significance to Practice
• Clients
– Must be encouraged to assume increased concern,
responsibility for health potential
• Nurses
– Support, facilitate, encourage those positive skills,
qualities, plans that will promote health
– Client, nurse can devise interventions collaboratively
– Need to take responsibility for self-care
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Question
• Tell whether the following statement is true or false:
• Mood swings, overeating, weight loss, and self-evaluation
are symptoms of increased stress in nurses.
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Answer
• False.
• Rationale: Common symptoms of stress include sleep
disturbance, fatigue, reduced abilities to think and
concentrate, and sudden mood swings; appetite
changes: increases or loss, overeating or increased
smoking; and frequent tardiness or absences from work.
Increased stress may lead the nurse to self-evaluation
but it is not a symptom of stress.
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