HEALTH AND ILLNESS

1. Concepts of Man as an Individual and as a Member of the Family

(Review)

The nursing profession is a field that deals to a great extent with human
beings. The nurse is in direct contact with the varied dimensions of human lives.
Practicing the nursing profession lacks meaning if it does not focus on humanity of
clients. A nurse should take this as his/her primary motivation in nursing practice,
while her factors should be considered the secondary (for example money,
prestige etc.)

a. MAN AS A BIOLOGICAL BEING

➢ Man normally responds as a unified whole but not a series of integral

parts.
➢ Man as a whole is different from & more than the sum of his
component parts.
➢ Man is both an open and closed system.
- As an open system, man is composed of subsystems that act as
a unified whole. What affects one subsystem easily affects
the one subsystem(s) within the set.
➢ Man is a closed system. He is self-sufficient. He uses up his energy
reserves. In doing so, he eventually fails to function and
disintegrates.
➢ Man is an energy unit. His energy is not limitless. It must be
continuously replenished as soon as it is utilized.
➢ The interrelatedness & interdependence of man’s subsystems
facilitate the energy-matter exchange.

b. MAN, AS A PSYCHO-SOCIAL BEING

➢ Man is a “unique irreplaceable individual; a one-time being in this
world”
➢ Man is capable of rational, logical thinking most of the time but
can become irrational & illogical when provoked.
➢ “Man is capable of relating with others, endowed w/ capacity to
know, to like, to love, & to responds & appreciate the uniqueness
of others.” (Travelbee)

c. MAN, AS A SPIRITUAL BEING

The unity of man in body, mind & spirit
Intellect – allows man to look for the truth
- gives him the ability to perceived his surroundings or the
forces within or outside him or to understand the meaning of
events.
Will – expresses man’s own wishes, desire or longing to do what
he has set his mind to do.
-gives him the power of conscious & deliberate action or
self-control in initiating, sustaining or terminating
human activity

d. MAN, as a Human Being with NEEDS

➢ A “need” is something that is essential to the emotional &
physiologic health & survival of human.
➢ People strive to meet basic needs at any given time an individual’s
needs may be met, partially met, or unmet.

Maslow’s Hierarchy of Needs

Something is a basic need if:
1. Its absence results to illness
2. Its presence signals or prevents health
3. Meeting an unmet need restores health
 Physiologic Needs
• Physical needs inherent in all human beings
• Basic needs
• Must be met at least minimally for life to continue.
• Need such as air, food, shelter, rest, sleep, activity, and
temperature maintenance are crucial for survival.

Safety & Security Needs

• Physiological safety – safe physical environment; shelter
• Psychological safety – regular contact with people we trust &
feel close to. Avoidance of external dangers, stability.
Love & Belongingness
• The security we gain from love ang belonging enhances the
feeling of safety.
• Need for mutual, meaningful relationship with other people
• To feel accepted affiliate with others
• To be given love, affection, care, attention, and emotional
support by another person.

Self-esteem Needs
• Derived from the feeling that we are valued by those around
us.
• Feeling good about ourselves when the people who are
important to us expresses acceptance & approval.
• Example feeling of independence, competence, and self -
respect)

Self – Actualization
• the need to reach one’s potential through development of
one’s unique capabilities.
• The need for self – esteem is satisfied the individual strives
for self – actualization, the innate need to develop one’s
maximum potential and realizes one’s abilities and
qualities.

The following are the qualities that indicate achievement of one’s

potential:
1. Acceptance of self & others as they are
2. Focus of interest on problems outside self
3. Ability to be objective
4. Feelings of happiness & affection for others
5. Ability to discriminate between good & evil
6. Creativity as a guideline for solving problems & carrying out
interests.

CONCEPTS OF HEALTH & ILLNESS

HEALTH

➢ Health (World Health Organization – 1940) is a state of physical, mental and

social well being and not merely the absence of disease or infirmity.

➢ This definition implies that there is interaction between self & environment,
preservation of structure & function, and maintenance of adaptive potential.
 ➢ Health (Brill & Kilts – 1980) is a dynamic process, which continually changes
as the interactions between individuals and their internal & external
environments change.

➢ These mean that an individual state of health changes when there are
changes in his environments, both internal & external.
➢ Health (Hardinge & Shyrock – 1991) is every organ working properly

➢ You must have health, if every function of your body perform its appointed
task efficiency and in harmony will all of your body activities. Your heart
must beat, your lungs must breathe, your eyes must see, your ears hear
and your mind must intelligently comprehend all that is happening.

➢ Health is a continuous balancing of the physical, emotional, social,

intellectual and spiritual components of an individual in such a fashion as to
produce happiness and higher quality of existence.

➢ This definition indicates that health is not static and that the potential for
change is always present.

➢ Different definitions of health by some Nursing theorists (REVIEW) :

• being well and using every power (resource) to the fullest extent
in living life - Nightingale
• Maintenance of health is through prevention of disease via
environmental control and social responsibility. – Nightingale
(Environmental Theory)
• “a state of physical, mental and social well being and not merely
the absence of disease or infirmity” plus the following three
elements: a high level of overall physical, mental and social
functioning; a general adaptive-maintenance level of daily
functioning; the absence of illness (or the presence of efforts that
leads its absence) - Jean Watson (Theory of Human Caring)
• viewed in terms of the patient's ability to independently perform
the 14 basic needs which comprise the components of nursing
care – Virginia Henderson (14 Fundamental Needs)
• a state and a process of being and becoming an integrated whole
human being – Sr. Callista Roy (Adaptation Model)
• an elusive state that is determined by psychological, social,
biological, and physiological factors – Dorothy Johnson
(Behavioral System Model)
• the goal of conservation; the ability to function in a reasonably
normal manner; “a wholeness and successful adaptation” – Myra
Estrin Levine (The Conservation Principles: A Model for Health)
• the condition or degree of system stability and is viewed as a
continuum from wellness to illness – Betty Neuman (Systems
Model)
• “a word symbol that implies forward movement of personality and
other ongoing human processes in the direction of creative,
constructive, productive, personal, and community living” –
Hildegard Peplau (Interpersonal Relation in Nursing)
• universal across cultures but defined within each culture in a
manner that reflects the beliefs, values and practices of a
particular culture – Madeleine Leininger (Theory of Culture Care
Diversity and Universality)

WELLNESS

➢ Wellness (Halbert Dunn – 1959) is an integrated method of functioning,

which is oriented toward maximizing the potential of which the individual is
capable, within the environment where he is functioning.
 ➢ This definition implies that wellness is functioning to the maximal possible
level of one’s ability within one’s environment.

➢ Wellness means engaging in attitudes and behaviors that enhance the

quality of life and maximize personal potential.

➢ Wellness emphasize the need to take responsibility for engaging in

behaviors that develop optimal health.

➢ Wellness (Bill Hettler – 1979) is an active process of becoming aware of

and making choices toward a higher level of well being.

➢ Individual’s self-concept, culture, and environment influence these choices.

➢ Wellness (Clark – 1986) is a process of moving toward greater awareness

of oneself and the environment; it is unique to the individual and purposeful
in direction.

➢ The wellness process can be pursued to prevent illness, to assist in

rehabilitation, to enhance the quality of life, or to maximize one’s potential
(Murray & Zentner – 1989)

➢ Wellness include self - responsibility , an ultimate goal, a dynamic , growing

process, daily decision making in the areas of nutrition, stress management
, physical fitness, preventive healthcare and emotional health.

DIMENSIONS/ COMPONENTS OF WELLNESS

Achieving a high level wellness requires the individuals to constantly

balance and maintain the following components:

1. Physical Dimension

The ability to carry out daily task, develop cardiovascular fitness, maintain
adequate nutrition and proper body fat, avoid abusing drugs and alcohol or using
tobacco products, and generally invest in positive lifestyle habits.

It encourages regular physical activity, cardiovascular flexibility and

strength, knowledge about food and nutrition, medical self-care, and appropriate
use of the medical system, while discourage excessive use of tobacco, drugs and
alcohol.

Genetic make-up, age, developmental level, race, and sex are all part of an
individual’s physical dimensions and strongly influence health status and practices.
Example:
1. - The toddler just learning to walk is prone to fall and injure
2. The young woman, who has a family history of breast cancer and diabetes
therefore, is a higher risk to develop these conditions.)

3. Down syndrome, hemophilia, cystic fibrosis )

2. Emotional Dimension

➢ The ability to control stress and to express emotions appropriately and

comfortably.
➢ Emotional health is the ability to recognize and accept feelings and express
them appropriately and not to be defeated by set backs and failures.
➢ It focuses on the degree to which a person feels positive about self and
enthusiastic about life.

It emphasizes:
a. awareness and acceptance of one’s feeling
b. the capacity to manage one’s feeling
 c. the ability to cope effectively with stress
d. the ability to maintain satisfying relationships with others
e. the assessments and acceptance of one’s limitations.

How the mind and body interact to affect body function and to respond to
body conditions also influence health. Long term stress affects the body systems
and anxiety affects health habits; conversely, calm acceptance and relaxation can
actually change responses to illness.

i.e., 1. Prior to a test a student always has diarrhea

2. Extremely nervous about a surgery, a man experiences severe pain
following his operation.
3. Using relaxation techniques, a pregnant woman reduces her pain
during delivery of her baby.

3. Intellectual Dimension

➢ The ability to learn and use information effectively for personal, family,
and career development. Intellectual wellness means striving for
continued growth and being able to learn to deal with new challenges
effectively.

➢ It encourages stimulating and creative mental activities and the use of

available community resources to expand one’s knowledge and
increased the potential for sharing with others.

➢ The intellectual dimensions encompass cognitive abilities. Educational

background and past experience. These influence client’s response to
teaching about health and reactions to heath care during illness. They
also play a major role in health behaviors.

i.e., 1. An elderly woman, who has only a third-grade education who needs
teaching about complicated diagnostic tests.
2. A young college student with diabetes who follows a diabetic diet
but continues to drink beer and eat pizza with friends several times
a week.

4. Social Dimension

➢ The ability to interact successfully with people and within the environment
of which each person is a part. It is the ability to develop and maintain
intimacy with significant others and to develop respect and tolerance for
those with different opinions and beliefs.

5. Occupational Dimension

➢ The ability to achieve a balance between work and leisure time. A person’s
beliefs about education, employment, and home influence personal
satisfaction and relationships with others.

6. Spiritual Dimension

➢ The belief in some force (nature, science, religion, or a higher power) that
serves to unite human beings and provide meaning and purpose to life. It
includes a person’s own morals, values and ethics.

➢ It is the ability to discover, articulate, and act on his basic purpose in life. It
involves seeking meaning and purpose in human life.

➢ These are important components of the way the person behaves in health
& illness.
 i.e. Some religions require baptism for both live births and stillbirths.
Other religion opposed blood donation & transfusion.

7. Environmental Dimension

➢ The ability to promote health measures that improve the standard of

living and quality of life in the community. It includes influences such
as food, water and air.

***Each component of wellness overlaps to certain extent, and the factors

in one component often directly affect factors in another. Some of the
factors in one component are under the individual’s direct control, and
some are not.

MODELS OF HEALTH

1. Medical Model (M.B. Belloc & L. Breslow – 1972)

Health is the stage of being free of signs & symptoms of disease.

Illness is the presence of signs & symptoms of disease.

➢ When every functional unit is working efficient, each within its own
physiological range, and is adequate supported and appropriated and
appropriately guided, you have health and your body is able to resist
disease.

➢ But when the biological range is exceeded, that is, either in excess or
deficiency in particular area, the result is imbalance, and you become
susceptible to disease.

i.e., blood pressure, body temperance, & blood sugar

2. Role-performance Model (Parson – 1958)

Health is the ability to perform all those roles form which one has been
socialized.

➢ This mean that an individual is healthy if he/she is balked to do his/her duties

& responsibilities given to him/her in a particular field form which he/she
belongs.
➢ People who can fulfill their roles are healthy even if they have clinical illness
➢ (e.g., A man who works all day at his job as expected is healthy even though
an x-ray of his lung indicates a tumor)

3. Adaptive Model
➢ In the adaptive model, health is a creative process; disease is a
failure in adaptation, or maladaptation.
➢ Aim of treatment: restore ability of the person to adapt or cope
➢ Extreme good health is flexible adaptation to the environment and
interaction with the environment to maximum advantage.
➢ Focus of this model: stability with an element of growth and
change

4. Eudemonistic Model
➢ Health is a condition of actualization (apex of fully developed
personality) or realization of a person’s potential.
➢ Illness is a condition that prevents self-actualization.
5. AGENT – HOST-ENVIRONMENT MODEL (also called the ecologic model)

This model is used primarily in predicting illness rather than in promoting

wellness, although identification of risk factors that result from interactions of
agent, host and environment are helpful in promoting and maintaining health. ‘

Three dynamic interactive element:

1. Agent - any environmental factor or stressor (biologic, chemical,

mechanical, physical, or psychosocial) that by its presence or absence (e.g.
lack of essential nutrients) can lead to illness or disease.
2. Host – are physical or psychological situations or conditions putting people
at risk for illness
Person(s) who may or may not be at risk of acquiring a disease. Family
history, age, lifestyle, habits influence the host reaction’s.
3. Environment- all factors external to the host that may or may not
predispose the person to the development of the disease. Physical
environment include climate, living conditions, sound (noise) levels, and
economic level. Social environment includes interactions with others and
life events, such as death of a spouse.

➢ Agent- host- environment factors constantly interact with the others; health
is ever changing state. When the variables are in balance, health is
maintained; when variables are not in balance, disease occurs.

6. Health – Illness Continua (McCann/Flynn & Heffron – 1984; Travis &Ryan –

1988)

Dunn and Travis

Health is a constantly changing state, with high level wellness and death
being on opposite ends of graduated scale or continuum.

➢ High level wellness is a term, which has been devised to make the person
who uses it, think about well being in degrees or levels.

➢ HLW is defines as an integrated method of functioning which is oriented

toward maximizing then potential of which the individual is capable, within
the environment where he is functioning.

➢ It requires the individual to maintain a continuum of balance and purposeful

direction within his environment.

➢ The H-I Continuum illustrates the relationships between the traditional

medical model and the wellness model, which is based on SELF-
RESPONSIBILITY.

➢ Moving from the center (neutral point) to the left shows progressive
worsening state of health; form occurrence of signs, symptoms to
developing disability and ultimately if no treatment is done, leads to
premature death.

➢ Moving to the rights indicates increasing levels of health & well being which
involves the (3) steps of wellness: awareness, education, & growth.

THREE STEPS OF WELLNESS

1. Awareness

➢ Seeing how you are presently conducting your life.

 ➢ Take charge of your own life and health by taking calculated risks or
recognition that you have a choice and carries with it the
consequences of those choices.
➢ Taking responsibility for choices which results in illness does not
mean taking on blame. With blame, you berate yourself for not
learning a lesson or burden yourself with guilt which created more
stress. With responsibility, you accept that you engineered your life
situations, and that you can change it as well. You open yourself to
learn the valuable lessons which consequences offer.
➢ Asserting your rights as consumer in the medical company, asking
questions, seeking other opinions, and accepting that you know
better than anyone else.

2. Education

➢ Exploring options; looking within and receiving others.

➢ “You don’t trust what you don’t know.” You can’t give what you
don’t have.”

24-hours a day throughout your entire life you can make use of your
body’s built-in feedback system. Self-trust means learning about how your
body works, and at the same time loving and respecting it for the
magnificent and powerful creation it is. It means at turning to the signs and
signals, both internal & external. It also includes listening to yourself to
discover what you want to change. Most imputably, it involves a new way
of thinking based in the knowledge that the only true healer is the one inside
the skin, and the realization that patience and compassion are the keywords
in the3 process.

If we are to be well, we need to start listening to every cell in the body,

then provide it the best conditions possible so that it can continue healing
itself. Only the body heals itself.

3. Growth

➢ Trying out some options.

The journey toward higher levels of wellness poses a similar challenge

and requires similar preparations. The equipment is less tangible, so it may
be easy to neglect what is most essential. In remembering knowledge, self-
trust, and perseverance, you might forget love & compassion. Yet, these
form the “knapsack” that carries all your resources.

All the things in the universe are connected. All the things in the body are
connected as well. There is simply no place where body start and the mind
stops; no place in the universe starts and the individual stops.

➢ Treatment can bring the state of health back to neutral point where
the signs & symptoms have been alleviated. If you are ill, treatment
is important, but do not stop there, move as far to the right as
possible.

(Example: A man who takes an antihypertensive medication to reduce

high blood pressure and relieve any associated symptoms moves to neutral
point.)

7. Health Belief Model

HEALTH BELIEF MODEL is used to predict health behavior.

= predict perceived susceptibility, serious, benefits or barriers to taking
action.
ILLNESS BEHAVIOR – state in which a person monitors, defines, interprets
symptoms of the body of the body and how he acts towards these perceptions.

➢ Health belief model addresses the relationships between a person’s belief

and behavior. It is way of understanding and predicting how clients will
behave in relation to their health and how they will comply with health care
therapies. Use of the model is based on a person’s perception of the
susceptibility to taking action to prevent the illness.

➢ This model helps health care provides to understand factors influencing

client’s perceptions, beliefs and behavior and to plan the most effective
care.

8. Yin and Yang

➢ The Chinese define health as a flow of energy called Yin and Yang

YIN YANG
= negative = positive
= dark = light
= cold (contraction) = warm (expansion)
= female (feminine principle) = male (masculine principles)
= outside of the body surface = inside of the body
= font of the body = back of the body
= receptive female = creative male

Yin Yang
Compassion + knowledge = wholeness
Harmony will of “TAO”

Any imbalance between Yin and Yang = disease

“T ai chi” ------ “Tao”

supreme ultimate

➢ Chinese seek health through ACCUPUNCTURE, MASSAGE, SPIRITUAL

HEALING, HERBS, MEDICATION, AND PHILOSOPHY

❖ Blood tests are prohibited because blood is thought to provide

strength and it is irreplaceable.

9. Iceberg Model

The individual’s current state of health – is it one of disease or vitality – is

just like the tip of an iceberg.

➢ This is the apparent part – what shows; your present health condition,
whether you are fat or slim, or whatever.

➢ If you do not like it, you can attempt to change it. But whenever you
knock some off, more of the same comes up to takes its place.

➢ Underneath this tip is the remaining parts of the iceberg, which are not
seen above the water. Similarly with individual’s state of health, to be to
understand all that creates and supports the health status of the
individual, you have to look underwater, to see the other levels.

➢ The first level is the Lifestyle /Behavioral level – this includes the
following:
 a. What food you eat
b. How you use and exercise your body
c. How you relax & let go of stress
d. How you safeguard yourself form the different hazards around
you.

➢ Many of us allow lifestyles that we know are destructive to us & to our

environment. Yet, we may feel powerless to control or change them. To
understand why, we must look deeper, to the next level is – the
Psychological / Motivational Level which indicates the following:

a. What moves us to lead the lifestyle we have chosen?

b. What payoffs we get from being overweight, smoking, reckless
driving, or eating well, being considerate to others, getting regular
exercise.

➢ The deepest level is the Spiritual/Being/Meaning Level. This may

transpersonal, philosophical or metaphysical aspects of an individual. It
may be called a REALM because it has no clear boundaries. It also includes
the following:

a. Mystical & mysterious and everything else in the unconscious

b. mind,
c. Concerns such issues as your reason for being.
d. The real meaning of your life,
e. Your place in the universe.
➢ Ultimately, this realm determines whether the tip iceberg, representing your
state of health, is one of diseases or wellness.

ILLNESS
➢ a state in which someone's needs are not sufficiency met you to allow the
individual to have a sense of physical & psychological well being

➢ Response of the person to a disease; it is an abnormal process in which

the person’s level of functioning is changed.

➢ Highly personal state in which the person’s physical, emotional

intellectual, social, developmental or spiritual functioning is thought to be
diminished.

STAGES OF ILLNESS

➢ Illness is a state in which someone’s needs are not sufficiency met you to
allow the individual to have a sense pf physical and psychological well
being.

➢ Illness behavior is an activity undertaken by a person who feels ill, to define

the state of his health and to discover a suitable remedy (Igun-1979).

➢ How people behave when they are ill is affected by many variables such as
age sex occupation, socioeconomic statues, religion, ethic origin,
psychological stability, personality, education and the modes of coping.

ILLNESS BEHAVIOR

➢ an activity undertaken by a person who feels ill, to define the state of his
health & to discover a suitable remedy.
DISEASE

➢ An alteration in body function resulting in reduction of capacities or a

shortening of the normal life span.

➢ Medical term meaning there is a pathologic change in the structure or

function of the body and mind.

Suchman (1972) describes the (5) stages of illness:

1. Symptom Experience

It is transition stage during which people come to believe that something is

wrong. Either significant person mentions that they look ill or people experience
some symptoms, which can appear insidiously.

It has (3) aspects:

1. Physical experience of symptoms

2. Cognitive aspects – interpretation of symptoms/evaluation of changes
3. Emotional response ( e.g. fear of anxiety )

The person is ware that something is wrong, usually recognizes a physical

sensation or limitation in functioning, but does not suspect a specific diagnosis.

During this stage, illness persons usually consult others close to them about their
symptoms or feeling. They try home remedies for possible relief of symptom.

2. Assumption of the Sick Role

It signals the acceptance of the illness. They decide that the symptoms or
concerns are sufficiency severe to suggest that they are sick.

If the symptoms persist and become severe, they assume the sick role. Sick
people seek confirmation form the family and social groups that they are indeed ill
and that they be excused form normal duties and responsibilities.

Some seek professional help quickly; other continues self-treatment, often

following the suggestions of family and friends.

They are usually afraid but they now accept that they are ill even though
they may not be able to accept possible reasons.

At the end, they experience one of two outcomes. They may find the
symptoms have changed and that they feel better, If the family member supports
the perceptions of such persons, they are no longer considered or consider
themselves sick. Then, they will resume normal obligations.

3. Medical Care Contact

If, however, the symptoms persist or increase and if lack of improvement is

validated by the family or significant others, then they know they should seek some
treatment.

Sick people seek the advice of a health professional either on their own
initiative or advice of significant others.
They ask for (3) types of information.
1. Validation of real illness
2. Explanation of the symptoms in understandable terms.
3. Reassurance that they be all right or prediction of what the outcome will be.

4. Dependent Patient Role

 When a health professional has validated that the person is ill, the individual
becomes a client, dependent on the professional for help.

They may or may not be reluctant to accept a professional’s

recommendations, or alternately suggestions.

They become more passive and accepting. They accept care, sympathy,
and protection from the demands and stresses in life. They can adopt the
dependent role in a hospital, at home or in a community setting. They must also
adjust to the disruptions of daily schedule.

Some regress to an earlier behavioral stage in their development.

Dependence needs vary with individuals; some may meet needs that never been
met, others have a minimal needs and do everything possible to return to
independent functioning and few may even try to maintain independence.

5. Recovery or Rehabilitation

They learn to give up the sick and returns to former roles and functions.
Readiness for social functioning may not coincide with physical readiness.
This stage can arrive suddenly, such as when the symptoms disappeared.
However, in the case of chronic illness, the final stage may involve an adjustment
to a prolonged in health and functioning.

References:

1. Basic Nursing Essentials for Practice 6th Edition , Potter& Perry 2007
2. Fundamentals of Nursing the Art and Science in Nursing Care . Taylor,
Lillis, Lemone 5th Edition 2005
3. Fundamentals of Nursing 8th Edition Kozier & Erb 2007