Unit 1Introduction Prepared by:Christian RavinaM.Sc.(N),2nd year M.T.I.N.Changa

Health illness continuum Wellness is a process, never a static

state. The Illness-Wellness Continuum is a

graphic illustration of a wellbeing concept first proposed by John W. Travis in 1972. 

It describes how wellbeing is more than simply an absence of illness, but also incorporates the individual's mental and emotionalhealth.

Travis believed that the standard approach to medicine, which assumes a person is well when there are no signs or symptoms of disease, was insufficient. 

This led to his development of the Continuum. The right side of the Continuum reflects degrees of wellness, while the left indicates degrees of illness.

The Illness-Wellness Continuum has been used to highlight how, even in the absence of physical disease, an individual can suffer from depression, anxiety or other conditions indicating a lack of wellness.

While traditionally medicine typically treats injuries, disabilities, and symptoms, to bring the individual to a "neutral point" where no illness is present, the Wellness Paradigm seeks to move the individual’s state of wellbeing further along the continuum towards optimal emotional and mental states.

The concept is premised on the idea that wellbeing is a dynamic rather than a static process.

The Illness-Wellness Continuum proposes that individuals can move further to the right, towards health and wellbeing, through awareness, education, and growth.

Conversely, worsening states of health are reflected by signs, symptoms, and disability. In addition, a person's outlook plays a major role in moving along the Continuum in either direction.

A positive outlook will enhance the individual’s health and wellbeing, while a negative outlook will hinder it, independent of present health status.

For example, a person who demonstrates no symptoms of disease, but is constantly complaining, would be facing the left side of the Continuum, toward an early death.

However, a person having a disability, but still maintaining a positive outlook, will be facing to the right, toward a high level of wellness. It is less important where a person is on the continuum than which direction they are facing.

The Illness-Wellness Continuum has been praised for promoting preventive treatment—improving wellbeing before an individual presents with signs or symptoms of illness, as well as educating people to be aware of, and consequently avoiding risk factors, protecting against pathology and an early death.

Factors influencing health 1) Biological factors:

(a)Pathogenic microorganism

(b) Biologic-heredity factor(c) Other factors: age, sex,

growth and development

Factors influencing health 2) Environmental factors

(a) Natural environment: air pollution, climate, water pollution, soil pollution, radiation, noise.

(b) Social environment: a) political and economic

system in the societyb) social and cultural system

Factors influencing health 3) Life style: 4) Psychological factors

Psychological factors→emotion, feelings → Physiological function

Factors influencing health THE DETERMINANTS OF HEALTH

The determinants of health include:The social and economic

environment,The physical environment, andThe person’s individual

characteristics and behaviors.

Factors influencing health Income and social status - higher

income and social status are linked to better health. The greater the gap between the richest and poorest people, the greater the differences in health.

Education – low education levels are linked with poor health, more stress and lower self-confidence.

Factors influencing health Physical environment – safe water and clean

air, healthy workplaces, safe houses, communities and roads all contribute to good health. Employment and working conditions people in employment are healthier, particularly those who have more control over their working conditions

Social support networks – greater support from families, friends and communities is linked to better health. Culture - customs and traditions, and the beliefs of the family and community all affect health.

Factors influencing health Genetics - inheritance plays a part in

determining lifespan, healthiness and the likelihood of developing certain illnesses. Personal behavior and coping skills – balanced eating, keeping active, smoking, drinking, and how we deal with life’s stresses and challenges all affect health.

Health services - access and use of services that prevent and treat disease influences health

Gender - Men and women suffer from different types of diseases at different ages.

Illness A disease or period of sickness affecting

the body or mind. A specific condition that prevents your

body or mind from working normally : a sickness or disease.

A condition of being unhealthy in your body or mind.

Illness behavior It is any behavior undertaken

by an individual who feels ill to relieve that experience or to better define the meaning of the illness experience.

Illness behavior Illness is a social state. It is not just a disturbance of body and

has social meanings and impact i.e. it is partially the result of disease but is

also determined by social and cultural factors

Sometimes a distinction is made between disease (medical definition) and illness (lay person’s perception) Can be sick but no symptoms Can feel ill but no disease/condition

Sick role Two Rights

Sick people are exempt from performing their normal social roles

Sick people are exempt from responsibility for their own state

Two Obligations To get better as soon as possible To consult and co-operate with medical experts

whenever severity of condition warrants it

Component of sick role Promotes individual health Social control of occupancy of status ‘sick’

Doctor as gatekeeper (legitimates illness and occupancy of sick role)

Privileges dependent on duties Promotes health of society

Controls number of people opting out of normal roles & responsibilities

Returns sick people to health

Stages of illness experience Edward Suchman (1965) devised an orderly

approach for studying illness behavior with his elaboration of the five key stages of illness experience:   (1) symptom experience; (2) assumption of the sick role; (3) medical care contact; (4) dependent patient role; and (5) recovery and rehabilitation

Each stage involves major decisions that must be made by the individual that determine whether the sequence of stages continue or the process is discontinued.   

Impact of illness on patient and family Impact of illness on patient Short – term and minor illnesses awoke

few behavioural changes in the functioning of the patient or family. Severe illness can lead to more extensive emotional and behavioral changes such as anxiety, shock, denial, anger and withdrawal.

Impact of illness on patient and family Impact on family roles When an illness occurs, the role of

patients and family may change. This change may be subtle and short term or drastic and long term. The patient and family require specific counseling and guidance to assist them in coping with the role changes during illness.

Impact of illness on patient and family When serious illness or disability strikes a person, the

family as a whole is affected by the disease process and by the entire health care experience.

Patients and families have different needs for education and counseling. Because each person in a family plays a specific role that is part of the family’s everyday functioning, the illness of one family member disrupts the whole family. When a family member becomes ill, other family members must alter their lifestyle and take on some of the role functions of the ill person, which in turn affects their own normal role functioning.

Impact of illness on patient and family Illness may cause additional strain as the result of

economic problems and interruptions in career development. If the patient is a young child, there may be additional strain to the family if there are siblings whose needs must also be met. 

Illness in the middle stage of family life, when adolescents are trying to break away from family ties and parents are going through their own mid-life transitions, may put further strain on what is already a time of potential family turmoil. 

Impact of illness on patient and family Illness in later age may have an impact not only

on grown children but also on the older couple who had anticipated a time of enjoyment together and are less able to care for each other because of their own physical limitations associated with aging.

The extent of family disruption depends on the seriousness of the illness, the family’s level of functioning before the illness, socioeconomic considerations, and the extent to which other family members can absorb the role of the person who is ill.

Impact of illness on patient and family In some instances, a major illness brings a

family closer together; in others, even a minor illness causes significant strain.

It is important to identify what the illness means, not only to the individual but also to the family.

Asking them what they consider major problems and how they plan to handle specific situations can help you assess the meaning of the patient’s illness to the family.

Impact of illness on patient and family To achieve effective patient teaching outcomes,

you should make the family part of your teaching plan.

For example, if your patient’s wife does all the cooking in the home, it is vital to include her in diet teaching. Involving family members may be an important future source of support for the patient as he or she works at behavioral change.

Obviously it will be difficult for a husband to be supportive of his wife’s blood pressure treatment program if he does not understand the reasons for the recommendations and the consequences of not carrying them out.

Impact of illness on patient and family Long-term illness, even in the most stable

and supportive families, brings changes in family relationships. Illness produces disequilibrium in the family structure until adjustments can occur.

 When teaching the patient and family, it is important to identify patterns of relationships and to be alert to attitudes of family members. 

Illness in a family member tends to raise the anxiety of all those close to the patient. 

Health promotion and prevention Health promotion: Activities to

improve health & well-being Health prevention : The Management

Of Those Factors That Could Lead To Disease So As To Prevent The Occurrence Of the Disease.

- Mosby dictionary

Health promotion Health promotion is about achieving the best possible

health for everyone. It is difficult to improve an individual’s health if the economic, environmental and social conditions are bad. Interventions are changes made to individual and social circumstances to maximise opportunities to achieve good health.

WHO defines health promotion as the process of “enabling people to increase control over, and to improve, their health”. (1986)

Health promotion is based around the saying “Prevention is better than cure” and it aims at preventing morbidity and mortality.

Individual role in health promotion Individual’s play a key role in promoting their

health, because personal behavior is the major determining factor of health status.

For health promotion to be effective, individuals’ need to be empowered. This refers to an individual’s ability to make decisions about, or have personal control over their life.

Individuals working in health-related areas are able to assist people to gain control over their health.

eg general practitioners, counselors, dentists, health workers, community nurses. Other individuals who are involved in improving health also include health educators, social workers, community workers and environmental health officers.

Community groups and school role in health promotion Community groups and schools are

important settings for health promotion, after all these are the places where we live, work and play.

Communities should be able to contribute to discussion and participate in the setting of health policies. Our schools also need to places that promote health among our young people.

Role of NGOs in health promotion Non-government Organizations are non-profit making

organizations that operate at local, national or international levels. They are funded from a variety of sources including government grants, public donations and fundraising.

Non-government organizations (NGO's) play a crucial role in the health of Australians. For example, many organizations such as universities conduct health research into the prevention, detection, and treatment of disease.

While other NGO's contribute in various ways, including raising funds for research, running educational and health promotion programs, providing support services and coordinating voluntary care.

Role of state and local government in health promotion State Governments are also

responsible for campaigns that target specific health promotion and disease prevention programs.

Local Governments support the state government in implementing health promotion

Levels of prevention Primordial prevention Primary prevention Secondary prevention Tertiary prevention

Primordial prevention Definition: It is the prevention of

emergence of risk factors in populations, in which they have not yet appeared.

INTERVENTIONS: The main intervention in primordial prevention is through individual and mass health education.

Primary prevention Definition: Primary

prevention can be defined as action taken prior to the onset of disease, which removes the possibility that a disease will ever occur.

Primary prevention Population (mass) Strategy: It is

directed at the whole population irrespective of an individual risk levels.

High- risk Strategy: It aims to bring preventive care to individuals at special risk. This requires detection of individuals or high risk by the optimum use of clinical methods.

Primary prevention General Health promotion

Health education Environmental modifications Nutritional interventions Lifestyle and behavioral changes.

Health education to improve healthy habits and health consciousness in the community.

Improvement in nutritional standards of the community.

Healthful physical environment (Housing, water supply, excreta disposal, etc.)

Good working condition Marriage Counseling Periodic Selective examination of risk population.

Primary prevention Specific protection: Use of Specific immunization (BCG, DPT,MMR

vaccines) Chemoprophylaxis (tetracycline for Cholera,

dapsone for Leprosy, Chloroquine for malaria,etc.,)

Use of specific nutrients (vitamin A for Children, iron folic acid tablets for Pregnant mothers)

Protection against accidents (Use of helmet, seat belt,etc.,)

Protection against occupational hazards. Avoidance of allergens.

Protection from air pollution.

Secondary prevention Definition:The action which halts the progress of a disease at its incipient stage and prevents complications”.

Secondary prevention Objectives of secondary prevention: Complete cure and prevent the

progression of disease process. To prevent the spreads of disease by

curing all the known cases. To prevent the complications and sequel

of disease. To shorten the period of disability.

Secondary prevention INTERVENTIONS: Individual and mass case-finding

measures. Screening surveys(urine examination for

diabetes, etc.,) Selective examination

Tertiary prevention Definition:All measures available to reduce

or limit impairments and disabilities, minimize suffering caused by existing departures from good health and to promote the patient’s adjustment to irremediable conditions

Tertiary prevention Modes of intervention :

i) Disability limitation ii)Rehabilitation

Tertiary prevention Disability limitation:

Disease

Impairment

Disability

Handicap

Tertiary prevention Rehabilitation : Medical rehabilitation: (restoration of

Bodily Function). Vocational rehabilitation:( restoration of

the capacity to earn a livelihood) Social rehabilitation: (restoration of family

and social relationship). Psychological rehabilitation: (Restoration

of personal dignity and confidence)

Hospital Hospitals are institutions, which are

mainly designed to care for the sick, injured and the well. The later are usually admitted for physical check up and investigations which cannot be done elsewhere.

Hospital The word hospital is derived from the

word "hopes“ which means a guest. This is quite true for a patient leaves his home and comes to the hospital as a guest for brief periods of stay.

Even more than a guest he is worried and sick as such he needs more care and attention than a guest would receive.

Hospital In the hospital the variety of people of all

ages, caste and creed with varying degrees of illness are treated. Besides the patients there are the workers like doctors, nurses, technicians, fourth class servants and other members of the health team.

It is important that the nurse understands the peculiar nature of the patient's stay in the hospital and make the physical, mental and social environment conducive to recovery.

Types of hospitals Government hospital including medical

college, district and Taluk hospitals Railway hospital Military hospital Private company hospital Christian(Mission) hospital

Functions of hospital The main aim of a hospital is patient care and

comfort and the nurse has much to contribute in not only doing her functions, but also in co-ordinating the activities of the health team.

Besides the basic functions of a hospital such as care of the sick and injured, diagnosis, treatment and rehabilitative services, many undertake education of doctors, nurses, technicians etc., as an added function. Some hospitals do research work.

Functions of hospital There are various departments in a hospital like

medical, nursing, pharmacy, and dietary. Every hospital and its departments have own policies and rules, which govern their various activities.

The nurse should acquaint herself with the policies and interpret those connected with the patient's admission, treatment and discharge to the patient's relatives in a simple language.

They must be careful and get the guidance of seniors when dealing with accident patients and other patients with legal implications (medico-legal).