UNIT - I

INTRODUCTION TO HEALTH & ILLNESS

INTRODUCTION
Health is a resource for everyday life. The word health means different things to
different people depending on the situation. Health is a relative state in which one is able to
function well physically, mentally, socially and spiritually to express the full range of one's
unique potentialities within the environment in which one lives.

CONCEPT OF HEALTH: DEFINITIONS (WHO), DIMENSIONS

The meaning of health has evolved over time. Early definitions of health focused on
the theme of the body's ability to function. Health was seen as a state of normal function that
could be disrupted from time to time by disease. An example of such a definition of health is:
"a state characterized by anatomic, physiologic, and psychological integrity. Health is
difficult to define but easy to understand.

Definition:

In 1948, the World Health Organization (WHO) proposed a definition that aimed
higher. Health is a state of complete physical, mental me and social well-being and not
merely the absence of disease and/or infirmity WHO recognizes health as a fundamental
human right of an individual, family and community. Modern concepts of health recognize
health as more than the absence of disease.

Dimensions of Health:
There are three dimensions of health: Physical, mental/emotional and social. A few more
dimensions have been added.

Dimensions of Health
Physical Mental

Spritual Environmental

Intellectual
Social Occupational
Physical Wellness:

 It is the ability to maintain a healthy quality of life that allows us to get through our
daily activities without undue fatigue or physical stress.
 The individual should possess adequate body weight, height and circumference as per
age and sex with acceptable levels of vital signs, vision, hearing and movements.
 The ability to recognize that our behaviours have a significant impact on our wellness
and adopting healthful habits (routine checkups, a balanced diet, exercise, etc.) while
avoiding destructive habits (tobacco, drugs, alcohol) will lead to optimal Physical
Wellness.

Mental/Emotional Wellness:

 It is the ability to understand ourselves and cope with the normal stresses/challenges
Can bring the ability to acknowledge and share feelings of anger, fear, sadness or
stress, hope, love, joy and happiness in a productive manner contributes to our
emotional wellness.
 A mentally normal person has the ability to mix up with others, makes friendships,
behaves in a balanced manner and observes adequate personal hygiene.
 He is cheerful and happy and enjoys life with a purpose.
 He is well oriented to time, place, person and environment. He thinks positively, has
normal development and contributes to the society,

Social Wellness:

 It is the ability to relate to and connect with other people in the world. The ability to
establish and maintain positive relationships with family, friends and co-workers
contributes to our social wellness.

Spiritual Wellness:

 This dimension is considered as the ability to establish peace and harmony in our
lives. The ability to develop congruency between values and actions and to realize a
common purpose that binds creation together contributes to our Spiritual wellness.

Environmental Wellness:

 It is the ability to recognize our own Responsibility for the quality of the air, the
water and the land that surrounds us the ability to make a positive impact on the
 quality of our environment be it our homes, our communities or our planet
contributes to our Environmental Wellness,

Intellectual Wellness.

 It is the ability to open our minds to new ideas and experiences that can be applied to
personal decisions, group interaction and community betterment.
 The desire to learn new concepts, improve skills and seek challenges in pursuit of
lifelong learning contributes to our Intellectual Wellness.

Occupational Wellness:

 Occupational is the ability to get personal fulfilment from our jobs or our chosen
career fields while still maintaining balance in our lives Our desire to contribute in our
careers to make a positive impact on the organizations we work in and to society as a
whole leads to Occupational Wellness.

MASLOW'S HIERARCHY OF NEEDS

Abraham Maslow (1908-1970) was a professor in Psychology at Brandeis University.
He was the founder of Humanist Psychology. He proposed Basic Human Needs Model which
is useful for establishing priorities of care. The model of basic human needs is a foundation
for nursing care and interventions. Basic human needs are elements necessary for human
survival and health. All people share the basic human needs.

Basic human needs have the following characteristics:

 The absence of a basic human need results in illness.

 The presence of basic human needs helps to prevent illness or promote health.
 Meeting the basic human needs restores health.
 It is preferred over other satisfactions when unmet.
 A person feels something missing when need is unmet.
 He feels satisfied when needs are met

Maslow's Hierarchy of needs is a model that is used to understand the inter

relatedness of human basic needs. Certain needs are more basic than others. All people have
the same needs.
 The people generally strive to meet certain of their needs before attending to others.
Needs at the bottom of the pyramid are basic physical requirements including the need for air,
water, food, shelter, sleep, warmth and sex. Once these lower-level needs have been met,
people can move on to the next level of needs, which are for safety and security.

As people progress up the pyramid, needs become increasingly psychological and

social. Soon the need for love, belongingness, and intimacy becomes important

Further up the pyramid, the need for self-esteem and feelings of accomplishment take
priority.

Maslow emphasized the importance of self-actualization, which is a process of

growing and developing as a person in order to achieve 0 al individual potential.

Basic Human Needs:

Level 1: Physiological Needs It is the most basic in the hierarchy and needs the highest
priority. It includes the things that are vital to our survival i.e. air (oxygen), water, food,
warmth, sexuality, physical activity and rest. Usually, it can be met through self-care, but
many people who are ill require assistance. Maslow included sexual reproduction in this level
of the hierarchy of needs since it is essential to the survival and propagation of the species.
Level 2: Safety and Security- It involves both physical and emotional components. One
needs adequate shelter, safe environment, protection from violence and safe emotional
environment. People want control and order in their lives. So, this need for safety and
security contributes largely to behaviours at this level. Some of the basic security and safety
needs

 Financial security
 Health and wellness
 Safety against accidents and injury

Level 3: Love and belonging needs-These needs in Maslow's hierarchy include such things
as love, acceptance. understanding and belonging from families, pears, friends and
community. At this level, the need for emotional relationships drives human behaviour. Some
of the things that satisfy this need include:

 Friendships
 Romantic attachments
 Family
 Social groups
 Community groups
 Churches and religious organizations

In order to avoid problems such as loneliness, depression and anxiety, it is important for
people to feel loved and accepted by other people. Personal relationships with friends, family.
religious groups, sport teams etc play an important role. Include family in the care of the
patients. Establish good nurse patient relationship.

Level 4: Self-Esteem Needs - At the fourth level in Maslow's hierarchy is the need for
appreciation and respect. When the needs at the bottom three levels have been satisfied, the
esteem needs begin to play a more prominent role in motivating behaviour.

Level 5: Self-Actualization Needs -At the very peak of Maslow's hierarchy are the self-
actualization needs. "What a man can be, he must be." Maslow explained, referring to the
need people have to achieve their full potential as human beings.
 ILLNESS-WELLNESS CONTINUUM

The Illness-Wellness Continuum is a graphical illustration of a wellbeing concept. It

was first proposed by Travis in 1972. It proposes that wellbeing includes mental and
emotional health as well as the presence or absence of illness. Wellness is a process, never a
static state.

Most of us think of wellness in terms of illness; we feel that the absence of illness
means wellness. There are many degrees of wellness, just as there are many degrees of
illness.

Both health and illness are dynamic processes and each person is located on a
graduated scale or continuous spectrum (continuum) ranging from wellness and optimal
functioning in every aspect of one's life at one end, to illness culminating in death at the other
end.

FACTORS INFLUENCING HEALTH

Many factors i.e. internal and external variables, influence a client's health belief and
practices.

Health believes fluence health behaviour or health practices and can positively or
negatively affect a client's level of health.

Understanding the effect of these variables will allow the nurse to plan and deliver
individualized nursing care to the clients.
 FACTORS INFLUENCING HEALTH

Internal Variables External Variables

Developmental Intellectual Family

stage background Practices

Perception of Emotional Socio-Economic

functioning factors factors

Spiritual Cultural
factors background

a).Internal Variables:

 Internal variables that influence a client's health includes a person's developmental

stage, intellectual background, perception of functioning and emotional and spiritual
factors

Developmental stage:

 Health belief of a person change in different stages of growth and development) The
health belief of an adult is different than that of a child. The nurse must consider the
client's level of growth and development while planning for care, Sick children may
exhibit more of fear and anxiety. Concept of illness depends on the developmental
stage of a child, adolescent-or-adult.

Intellectual Background:
  A person's health belief is shaped by factors such as person's conceptions about body
functions and illness, knowledge level, educational background, past experiences etc.

Perception of functioning:
 People differ in their perception about physical functioning. While doing assessment
the nurse gathers subjective data about the way the client perceives physical
functions, such as level of fatigue, shortness of breath or pain and objective data about
the actual functioning such as blood pressure lung sound.
 This helps the nurse to successfully plan and implement individualized care.

Emotional factors:
 The client's emotions such as stress, depression or fear can influence health belief and
practices. A client, who is very calm, may have little emotional response during
illness.
 But an individual who is depressed or in stress may over react to illness.

Spiritual factors:

 Spirituality is an important aspect of health. Religious practices are one way that
people exercise spirituality.
 There are some religions that restrict the use of certain forms of medical treatment.
Nurses must understand client's spiritual levels to involve them effectively in nursing
care.

(b) External Variables:

 External variables that influence person's health believes and practices include family
practices, socio-economic factors and cultural background

Family practices:

 The health of an individual highly depends on how his family uses health care
services. Family's response to diseases and their preventive care behaviours can
influence health of its members.

Socio-Economic factors:
  Social and psychosocial factors influence health and health practices. Psycho social
variables include the person's marital or intimate relationship, life-style habits and
occupational environment.
 Economic status of the family directly or indirectly affects the health.
 Poverty leads to unhygienic environment, malnourishment and deficiency diseases.

Cultural Background:

 Cultural background of the individual influences health and health related practices.
It influences an individual's belief about causes of illness, treatment or practices to
restore health.
 The nurses should be aware of the cultural patterns of their clients so that they can
recognize and understand client's behaviours and beliefs and can provide better care

CAUSES AND RISK FACTORS FOR ILLNESS

Causes for illness

 Illness results from a disease -physiological or psychological or from an injury that

affects body functioning.
 Disease is defined as a pathological process with characteristic signs and symptoms
affecting the whole body or any of its parts.
 Most health problems have multiple causative factors.
 Causative factors, life situations and environment often come together the end result
is a serious or less serious health problem.
 No disease is ever caused by a single factor.
 Physical
Injuries

Abnorma Physiolog
Disease
l Growth ical
of biotic
of Cells causes

Chemical
Injury

Genetic
Factors

Life Psycholo
Psychotic
experienc gical
disorders
es causes

Neurotic
disorders

Physiological causes/injuries include:

Physical injuries:

 It includes those caused by mechanical trauma, heat and cold, electrical discharges,
changes in pressure and radiation

Diseases of biotic origin:

  Biotic agents include living organisms that range in size from the smallest virus
measuring approximately 20 nanometres to tapeworms having lengths of 10 meters.
These agents are commonly grouped as viruses, rickettsiae, bacteria, fungi and
parasites.

Abnormal growth of cells:

 Diseases arising from uncontrolled cell growth constitute the second most common
cause of human death. The two types of tumours -malignant or benign-are collectively
referred to as neoplasms (new growths), and their study is known as oncology.

Chemical injury:

 poisoning- A poison is any substance that can cause illness or death when ingested

Psychological causes are:

Genetic factors

 Life experiences (life style, socio-economic factors, lack of love, affection and care,
broken families etc.)
 Neurotic disorders
  Psychotic disorders

[Link] (heredity):

 Mental illnesses sometimes run in families. Susceptibility is passed on in families

through genes.
 It occurs from the interaction of multiple genes and other factors such as stress, abuse,
or a traumatic event which can influence or trigger an illness in a person who has an
inherited susceptibility to it.

2. Life experiences

 Severe psychological trauma during childhood, such as emotional, physical, or sexual

abuse
 Poor ability to related to others
 Changing jobs or schools
 Poor nutrition and exposure to toxins
 Substance abuse by the person or persons parents.

3. Neurotic disorder

 Stressors in childhood and adolescence: Research has shown that stressors in

childhood and adolescence are typically responsible for neuroticism
 High Present Stress Index. The current level of stress also plays a role in neurosis.
 Heritability. Neuroticism can be inherited. Many studies have found that children of
neurotic parents, are more likely to become neurotic as well.

[Link] disorders

The main causes of psychotic disorders are:

 It can be caused by mental illnesses such as schizophrenia, bipolar disorder etc

 Genetics: people with a family history of psychotic disorders such as schizophrenia
have a slightly increased chance of developing psychotic disorders.
 Recreational drugs: psychosis can be triggered by the use of drugs, including
cannabis. amphetamines etc.

Risk Factors of illness

  A risk factors is anything that increases the vulnerability of an individual or
community to an illness or accident.
 If a risk factor is present, it does not mean that the individual will develop disease, but
it only increases the chance for experiencing the disease.

Genetic Physiological Environment Age Life style

Factors Factors
Spiritual
Factors
Facilities
Available
Immunological RISK FACTORS OF ILLNESS
Factors
Dietary
Economic
Habits
status
Social Factors Literacy Levels Biological
Factors

Most common risk factors for developing illness include the following:
Genetic factors:
 There is genetic or hereditary predisposition for developing many diseases. E.g. An
individual with family history of diabetes/hypertension/heart disease is at greater risk
for developing the disease in future.
 We receive from our ancestors not only the colour of our hair or tendency toward
diabetes or heart diseases, but also a variety of psychological stresses, traumas and
pains also.

Physiological factors:

 It includes the physical functioning of the body e.g. being pregnant or obesity places
increased stress on the body and causes illness.

Environment:

 The environment in which an individual lives determines how he lives, eats, works so
on. Exposure to polluted air can predispose to diseases such as cancer, chronic lung
disease etc.
  The chemicals used in the industry can be a cause for many occupational diseases.
Stress, suppression, negative thoughts, fear, lack of love, lack of joy, lack of desire to
live, lack of physical activity etc increase the risk for illnesses

Age:
 Age is a major factor that determines the risk for diseases.
 The children and elderly are more at risk for contacting illnesses as compared to
adults.
 Diseases such as cancer, heart diseases increase as age advances.
 Children especially newborns and infants are more susceptible for infections.

Lifestyle:
 lifestyle practices affect the health positively or negatively. Practices which has
negative outcome are risk factors.
 The most important risk factors include lack of knowledge, poor lifestyle habits,
environmental factors, unhealthy diet, exposure to toxins, exposure to micro
organisms, parasitic animals, unpleasant life situations etc.
 Stress is a risk factor for the development of many diseases.
 It seriously affects the mental health.
Dietary habits:
 dietary habits play a major role in the development of illnesses.
 Poor dietary choices lead to either under nutrition or over nutrition.
 Diet deficient in essential nutrients is affecting biochemical processes inside our cells.
It is also affecting digestion and preventing internal natural detoxification.

ILLNESS BEHAVIOUR
Illness is a state in which the physical, social, developmental, intellectual, emotional
or spiritual functioning of the individual is diminished or impaired
  Acute illness
 Chronic illness

Acute illness

 Short duration
 Mostly severe
 Starts abruptly and subsides in relatively short period (less than 6 months)

Chronic illness

 Persist for more than six months

 May affect functioning of body in any dimension
 Up to the level of disability
 Major health problem

Illness behaviour

The way the sick person acts is called illness behaviour. – Factors • How the interpret
and view the symptoms • Use remedial measures • Utilize the health care facilities • Nature of
illness

STAGES OF ILLNESS BEHAVIOUR

Edward suchman (1972) identified stages of illness behaviour.

1. Symptoms experience

2. Assumption of the sick role

3. Medical care contact

4. Dependent patient role

5. Recovery and rehabilitation

Impact of illness on patient and family

Behaviour and emotional changes
  Illness always puts a patient under stress
 Serious illness
 Frustration and he may lose his hope for life
 Anger
 Resentment
 Anxiety
 Hopelessness
 Shock
 Denial
 Withdrawal

Impact on family roles family dynamics

 Client is bread winner of the family

 Financial problems

Role reversal Family dynamics:

 it is the process by which the family functions, makes decisions and gives support to
the individuals If the parent is ill
 Family activities
 Decision making

Nurses’ role:

 Help the family to gain maximum level of functioning

Impact on self-concept and self- esteem

• Self-concept: is that what a person views about his own strengths and weakness in all
aspects of personality

 Components
 Body image
 Role performance

• Self-esteem: is a person’s overall feeling of self-worth. It is the emotional appraisal of self-

concept

Impact on body image

 • Changes in the physical appearance

• Depending on the type of change

Short term: they will accept

Permanent: show reaction

 Shock
 Withdrawal
 Acknowledgment
 Acceptance
 Rehabilitation
 Use of prosthesis
 Change life style