_ L NURSING SCIENCE Health Introduction The key concepts of nursing science are people, health, environme nt and nursing actions. These concepts will be the focus of this co urse The widely accepted definition of health as given by the World Hea Ith Organization (WHO) in 1948, states “Health is a state of comple te physical, mental and social well-being and not merely an absen ce of disease or infirmity”. Health is being well and using to the fullest extent every power we have. Lifestyle and living conditions are two important factors in health as a broad concept. Lifestyle includes health behaviors and habits such as diet, exercis , substance use and sexual behavior. Individuals often have an inf luence over their own lifestyle choices. Living conditions refers to the settings where people live and work as well and how the surrounding environment and society impact an individual's life. Living conditions can be difficult but not impos sible to change “]| Lifestyle and living conditions are interconnected. For example, livi ng in a safe neighborhood, where there are places for children to pl ay outside increases the likelihood that the children will get enoug h physical activity. Nursing as a profession aims at promoting health, preventing dis ease and providing holistic nursing care to patients where their p hysical, social and spiritual needs are to be taken into considerati on. Concept; The manner in which an idea, (a happening), or structure (core component) of a thing is looked at, for proper understanding. Component; The description of part of a whole structure or entity and how it affects the whole positively as well as negatively. Model; A theoretical way or method, of describing (breaking dow n), an idea or concept into understandable units. They can represe nt complex ways of approaching complex issues We will be using these terms interchangeably as we proceed in thi s course hence it is important that you become versed with them L_ L DEFINITIONS OF HEALTH 1. The World Health Organization (WHO) Defines Health as a “state of complete physical, mental, and social well-bei ng, not merely the absence of disease or infirmity” (WHO 1947) 2. Pender, Murdaugh and Parsons (2002) define health as the actu alization of inherent and acquired human potential through goal-dir ected behavior, competent self-care, and satisfying relationships wi th others, while adjustments are made as needed to maintain struc tural integrity. 3. Presidents commission 1953 (U.S.A) “Health is an adjustment; it is not a state nor condition but a proce ss. The process adapts the individual not only to the physical but a Iso the social environments” only with the environment. 4. According to Jean Watson 1979. Health is defined as : Ahigh level of overall physical, mental, and social functioning with a general adaptive, maintenance level of daily functioning, and the absence of illness and or the presence of efforts that will lead to it s absence. 5. American Nurses Association 1980 A dynamic state of being, in which the developmental and behavior al potential of an individual is realized to the fullest extent possib! “] -6. Florence Nightingale (1969) Health here is described as the prevention of disease through the use of fresh air, use of pure water, prevention of disease, effective drainage, cleanliness and light. HEALTHCARE CONSIDERATIONS IN DEALING WITH THE CONCEP T OF HEALTH - Individual's views of health can vary among different age-groups, gender, race and culture. All people free of disease are not equally healthy. Views of health have broadened to include mental, social, and spiritual well-being as we focus on health at the family and co mmunity levels. - To help clients identify and reach health goals, the nurse must dis cover and use information about their concepts of health. Accordi ng to Pender, “for many people conditions of life rather than pathol ogical states are what define health.” Life conditions can have posi tive or negative effects on health before an illness is evident. - Life conditions may include socioeconomic variables such as env ironment, diet and lifestyle practices or choices, as well as many ot her physiological and psychological variables “]_ L - Nurse's attitudes toward health and illness should consider the to tal person, as well as the environment in which the person lives, to individualize nursing care and enhance meaningfulness of the clie nt's future health status. - To the layman, health implies a sound mind, in sound body, in as ound family, and in a sound environment. 1. THE CONCEPT OF HEALTH Aconcept is the manner in which an idea, a phenomenon, (a happe ning) or structure of a thing is looked at, for proper understanding. Let us consider the following structures of the concept of health b elow: a. Biomedical concept: Traditionally, health has been considered as an absence of disease and if one was free from disease, then the person was considered healthy this concept is known as ‘Biomedical concept’. The medic al profession viewed the human body as a machine, disease as ac onsequence of the breakdown of the machine and one of the doct or's tasks is repair of the machine. The basis of this theory is the germ theory of disease._ L “] b. Ecological concept: This concept was put forth by ecologists who viewed health as ad ynamic balance between man and his environment, and disease as a failure of the human organisms to adjust to the environment. Environmental and cultural adaptations determine not only the oc currence of disease but also the availability of food and the popula tion explosion of humans. The concept supports the need for clea n air, safe water, ozonic layer in the atmosphere, etc. to protect us f rom exposure to unhealthy factors. c. Psychosocial concept: Health is not only a biomedical phenomenon, but one which is infl uenced by social, psychological, cultural, economic and political fa ctors of the people concerned that factors must be taken into cons ideration in defining and measuring health. Health in this concept i s linked to the psychological development of the human being in st ages with corresponding behavior. A failure to grow or develop foll owing the various stages may greatly affect the individual. We will | ater see this in the growth and development theories. Thus health i s both a biological and psychological phenomenon. d. Holistic concept: Holism means viewing a person's health as ab -| alance of body, mind, and spirit. Treating only the body will not nec essarily restore optimal health. In addition to physical needs, healt h care providers must also consider clients’ psychological, sociocu Itural, developmental, and spiritual needs. THE CONCEPT OF WELLNESS Definition: It is defined by the global wellness institute as “the acti ve pursuit of activities, choices and lifestyle that leads to a state of holistic health”. Wellness is characterized by two important aspects in the definitio n above First it is not a static state but rather an active ongoing process as sociated with a person's intentions, choices and actions as they w ork towards an optimal state of health and wellbeing. This process usually includes self-responsibility, and ultimate goal, a dynamic an d growing process, daily decision making with regards to aspects of the whole being of the individuals. Second aspect is that wellness is linked to the holistic concept of health and extends beyond the physical and includes many differe nt dimensions we are going to see later in this lesson. The models of wellness PHYSICAL COMPONENT: Here the goal is to generally for an indivi| dual to practice positive life-style habits by the ability to carry out d aily tasks, achieve fitness, maintain nutrition and proper body fat, a void abusing drugs, alcohol, or using tobacco products. SOCIAL COMPONENT: Involves the ability to interact successfully with people, and within the environment of which each person is a part of. The ability to develop and maintain intimacy with significan tothers. the ability to develop respect and tolerance for those with different opinions and beliefs EMOTIONAL COMPONENT: Involves the ability to manage stress a nd express emotions appropriately, ability to recognize, accept, and express feelings, ability to accept one's limitations without any co moplex. INTELLECTUAL COMPONENT: involves the ability to learn and use information effectively for personal, family, and career developmen t. striving for continued growth and learning to deal with new chall enges effectively SPIRITUAL: The belief in some force (nature, science, religion, or a “higher power’) that serves to unite human beings and provide me aning and purpose to life. also includes a person's morals, values, a nd ethics OCCUPATIONAL: involves the ability to acpphieve a balance betwe en work and leisure time. an individual's beliefs about education, e mployment and home influence personal satisfaction and relations hips with others. ENVIRONMENTAL involves the ability to promote health measures “]_ L that promote the standard of living and quality of life in the commu nity. Influences include: food, water and air._ L ii. THE CONCEPT OF ILLNESS AND DISEASE Definitions A disease is an abnormal condition that affects the structure or fu nction of part or all of the body and is usually associated with spec ific signs and symptoms. Or A Disease can be described as an alteration in body functions resu Iting in a reduction of capacities or a shortening of the normal life span. the goal of the physician becomes focused on eliminating or ameliorating the disease process. While an illness is when your body or mind is not working properly, and you feel unwell or sick. It's like having a car that's not running smoothly, and you need to fix it to get it back on the road! a. Classification of illness Acute illness and chronic illness are two general classifications of i IIness. Both acute and chronic illnesses have the potential to be lif e-threatening. Acute illness:. Usually has a short duration and is severe. The sym ptoms appear abruptly, are intense, and often subside after a relati “]_ L vely short period. An acute illness may affect functioning in any di mension. Chronic illness: Persists, usually longer than 6 months, and can af fect functioning in any dimension. The client may fluctuate betwee n maximal functioning and serious health relapses that may be life- threatening. A person with a chronic illness is similar to a person with a disability in that both have limitations (of varying degrees) in function resulting from either a pathological processes or an injur y. b. Illness behavior Illness behavior refers to the ways in which individuals respond to and manage their illness or symptoms. It includes: 1. Recognition: Acknowledging and identifying symptoms “d rT| 2. Assessment: Evaluating the severity and impact of symptoms 3. Coping: Using strategies to manage and alleviate symptoms 4. Adherence: Following treatment plans and medical advice 5. Communication: Sharing concerns and needs with healthcare pr oviders 6. Help-seeking: Pursuing medical attention and support 7. Self-care: Engaging in activities to promote recovery and well-bei ng Understanding illness behavior is essential for: 1. Effective healthcare delivery 2. Patient-centered care 3. Health education and promotion 4. Research and policy development C. Stages of Illness Behavior - Symptom experience - Assumption of the sick role “]a - Medical care contact - Dependent client role - Recovery and rehabilitation. 1. Symptoms Experience During initial stage, a person is aware that something is wrong. Ap erson usually recognizes a physical sensation or limitation in funct ioning but does not suspect specific diagnosis. The person's perc eption of a symptom include awareness of a physical change muc has pain, rash or a lump evaluation of this change and decision th at itis a symptoms of an illness . For example, a 38-year-old woma n detects a lump during monthly breast examination—due to horm onal changes, not cancer. ii. Assumption of the Sick Role If symptoms persists and become severe, client assumes the sick role. The assumption of the sick role refers to the process by whic “]_ L han individual adopts the role of a patient or a person with an illne ss. At this sick people seek confirmation from their families and social groups that they are indeed ill and that they should be excused fro m normal duties and role expectations. The assumption of the sick role results in emotional changes such as withdrawal or depression and physical changes. Emotional cha nges may be simple or complex, depending on the severity of the ill ness, the degree of disability, and anticipated length of the illness. iii, Medical Care Contact If symptoms persist despite the home remedies or require emerge ncy care, the person is motivated to seek professional health servi ces. iv. Dependent Client Role After accepting the illness and seeking treatment, the client enters this stage. Here the client depends on health care professional, for the relief of symptoms. The client accepts care, sympathy, and prot “d rT_ L ection from the demands and stresses of life. A client adopts the d ependent role in a health care institution, at home or in a communit y settings. The client also adjusts to the disruption of a daily schedule occupa tion family, and community. v. Recovery Aclientis said to be recovering from his illness when his symptom s of his disease are diminishing and his general condition is impro ving. On the health-illness continuum he/she is moving towards th e side of high level of wellness. Rehabilitation Itis a dynamic, health oriented process that assists an ill or disable d individual to achieve the greatest possible level of physical, ment al, spiritual, social and economic functioning. The rehabilitation process helps the person to achieve and accept able quality of life with dignity, self-respect and independence. Rehabilitation can address various needs, such as: 1. Physical rehabilitation (e.g., after stroke, spinal cord injury, or sur gery) “d rT_ L “] 2. Occupational rehabilitation (e. g., returning to work or daily activit ies) 3. Speech and language therapy 4. Psychological rehabilitation (e.g., addressing mental health con ditions) ILLNESS BEHAVIOUR A major role for nursing is to provide client education aimed at helping clients manage their illness or disability. The goal managing a chronic illness is to red uce the occurrence of symptoms or to improve the tolerance of symptoms. By enhancing wellness, nurses may help improve the quality of life for clients livin g with chronic illnesses or disabilities. The Stages of Illness or the IlIness behavior When people become ill, they behave in certain ways that sociologists refer to as illness behavior. IlIness behavior is a coping mechanism involving ways in which an individual describes, monitor, interpret their symptoms, take remedia lactions and use the health care system. The nurse must note that how people behave when they are ill is highly i ndividualized and affected by variables as we have seen in previous topics Parsons (1979) described four aspects of the sick Roles as follows; (i)Clients are not held responsible for their condition (ii) Clients are excused from certain social roles and tasks (iii)Clients are obliged to try to get well as quickly as possible“] {iv)Clients or their families are obliged to seek competent help. Suchman still in 1979 described five stages of illness which we are goin Factors Affecting Health and Illness Physiological factors and genetic factors: Physiological changes, e.g. pregnan cy and certain genetic factors—cause increased susceptibility to illness. Age: As age increases, there is increased susceptibility to certain illnesses for example a toddler is more prone to injury than a neonate. Age also puts peopl e at risk of debilitating diseases by reason of maturation and exposure. For ex ample Alzheimer's disease is more prone in the older adult than in teens. Environment: The physical environment in which a person works or lives cani ncrease the likelihood of certain illness. the environment includes the physical environment which is made up the climate, topography, housing, availability of water, proper refuse disposal and many others, Lifestyle factors: Lifestyle practices, habits, activities, behaviors have a positiv € or negative effect on health. Variables Influencing Illness and Illness Behavior Just as health and health behavior are affected by internal and external variab les, so are illness and illness behavior. Based on an understanding of these var iable and behavior, nurses can plan individualized care to assist clients in copi ng with their illness at various stages of illness. The goal of nursing is to prom ote optimal functioning in all dimensions throughout an illness Internal Variables Client's perception of symptoms: If clients believe that the systems of their illn ess disturb their normal routine, they are more likely to seek health care assist -_ L ance than if they9 do not perceive the symptoms to disruptive. If clients believ e that the symptoms are serious or perhaps life-threatening, they are also mor e likely to seek assistance however, such a perception can also have the oppo site effects. Individual may fear serious illness, react by denying it, and not se ek medical assistance. The nature of illness: The nature of illness, either acute or chronic, can also aff ect a client's illness behavior. Clients with acute illness are likely to seek healt h care and comply readily with therapy on the other hand, a client with a chron ic illness, in which the symptoms may be cured, but only partially relieved, ma y be motivated to comply with the therapy plan. Chronically ill clients may bec ome less actively involved in their care, may experience greater frustration, an dmay comply less readily with care. Because nurses generally spend more ti me than other health care professionals with chronically ill clients, they are int he unique position of being able to assist these clients in overcoming problem s related to illness behavior. Clients coping skills as well as his or her focus of control, are other external variables that affect the way the client behaves wh enill External Variables External variables influencing a client's illness behavior include: Visibility of symptoms Social group Cultural background Economic variables Accessibility of the health care system Social support. The visibility of the symptoms of an illness can affect body image and illness behavior. A client with a visible symptom may be more likely to seek assistanc “]_ L e than a client without such a visible symptom. Client's social groups may assist them in recognizing the threat of illness or su pport the denial of potential illness. Families, friends, and coworkers all may in fluence client's illness behavior. Client's often react positively to social support while practicing positive health behaviors. A person's culture and ethnic backg round teaches the person how to be healthy, how to recognize illness, and ho w to be ill. The effects of disease and its interpretation vary according to cultur al circumstances. Ethnic differences can influence decisions about health care and the use of diagnostic and health care services. Dietary practice among et hnic groups, occupations help by the certain cultural groups, and cultural belief sare other factors that contribute to illness and the distribution of disease. Economic variables influence the way a client reacts to illness. Because of ec onomic constraints, a client may delay treatment and in many cases may cont inue to carry out daily activities. Client's access to the health care systems is a socioeconomic system that client's, entry into the system is complex or confu sing, and some client's may seek no emergency medical care in an emergence y department because they do not know how otherwise to obtain health care agency often influences how soon they enter the system after deciding to see k care. IMPACT OF ILLNESS ON THE PATIENT AND FAMILY lliness is never an isolated life event. The client and family must deal with cha Ages resulting from illness and treatment. Each client responds uniquely to illn ess, and therefore nursing intervention must be individual. Behavior and Emotional Changes “d rT_ L People react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness, the client's attitud e towards it, the reaction of others to it, and the variables of illness behavior. Short-term, nonlife-threatening illness evokes few behavioral changes in the f unctioning of the client or family. Severe illness, particularly one that is life-threatening, can lead to more extens ive emotional and behavioral changes, such as anxiety, shock, denial, anger, a nd withdrawal. These are common responses to the stress of illness. The nurs e can develop interventions to assist the client and the family in coping with a nd adapting to this stress because the stressor itself cannot usually be chang ed. Impact on Body Image Body image is the subjective concept of physical appearance. Some illness re sult in changes in physical appearance, and client's and families react different ly to these changes. Reactions of clients and families to changes in body imag e depend on the type of changes, their adaptive capacity the rate at which cha nges takes place, and the support services available. When a change in body image occurs, such as results from a leg amputation, t he clients generally adjust in the following phases: shock, withdrawal, acknowl edgment, acceptance, and rehabilitation. Impact on Self-concept Self-concept is a mental self-image of strength and weakness in all aspects of personality. Self-concept depends in part on body image and roles but also inc ludes other aspects of psychology and spirituality. The impact of illness on the “d rT| self-concepts of clients and family members may be more complex and less r eadily observed than role changes. Self-conce pt is important in relationship with other family members. A client w hose self-concept changes because of illness may no longer meet family expe ctations, leading to tension or conflict. As a result, family members may chang e their interactions with the client. In the course of providing care, a nurse is a ble to observe changes in the client's self-concept (or in the self-concepts of fa mily members) and develop a care plan to help them adjust to the changes re sulting from the illness. Impact on Family Roles People have many roles in life, such as wage earner, decision maker, professio nal, child, sibling, or parent. When an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness. Role reversa lis common. If a parent of an adult becomes ill and cannot carry out usual acti vities, the adult child often assumes many of the parent's responsibilities and i n essence becomes a parent to the parent. Such a reversal of the usual situati on can lead to stress, conflicting responsibilities for the adult child, or direct co nflict over decision-making. Such a change may be subtle and short-term or drastic and long-term. An indi vidual and family generally adjust more easily to subtle, short-term changes. | n most cases, they know that the role change is only temporary and will not re quire prolonged adjustment process similar to the grief process. The client an d family often require specific counseling and guidance to assist them coping with the role changes Impact on Family Dynamics Because of the effects of illness on the client and family, family dynamics ofte “] L_ L “] n change. Family dynamics is the process by which the family functions, make s decisions, gives support to individual members, and copes with everyday ch anges and challenges. If a parent in a family becomes ill, family activities and decision-making often come to a halt as the other family members wait for th ¢ illness to pass, or they delay action because they are reluctant to assume th e ill person's roles or responsibilities. Because of the effects of illness, family d ynamics often change. The nurse must view the whole family as a client unde r stress, planning care to help the family regain the maximal level of functionin g and welkbeing. Causes and risk factors associated with illness Arisk factor is any situation, habit, social or environmental condition, physiolo gical or psychological condition, developmental or intellectual condition, or spir itual or other variable that increase the vulnerability of an individual or group to an illness or accident. The presence of risk factors does not mean that a disease will develop, but ris k factor increase the chances that the individual will experience a particular di sease or dysfunction. Risk Factors Itcan be placedin the following interrelated categories: genetic and physiologi cal factors, age, physical environment, and lifestyle. a) Genetic and Physiological Risk Factors Physiological risk factors involve the physical functioning of the body. Certain physical conditions, such as being pregnant or overweight, place increased str ess on physiological systems (e.g. the circulatory system), increasing suscepti bility to illness in these areas. Heredity, or genetic predisposition to specific illn -| ess, is a major physical risk factor. For example, a person with a family history of diabetes mellitus is at risk for developing the disease later in life. Other doc umented genetic risk factors include family history of cancer, heart disease, ki dney disease, or mental illness. i) Age: Age increases or decreases susceptibility to certain illness. Age ris k factors are often closely associated with other risk factors such as family his tory and personal habits. Nurses need to educate their clients about the impor tance of regularly scheduled check-ups for their age group. ii) Environment Where we live and the condition of that area (its air, water, and soil) determine how we live, what we eat, the disease agents to which we are exposed, our st ate of health, and our ability to adapt. The physical environment in which a per son works or lives can increase the likelihood that certain illness will occur. Nu rsing assessments extend from the individual to the family and the communit y in which they live iii) Lifestyle Many activities, habits, and practices involve risk factors. Lifestyle practices a nd behaviors can have positive or negative effects on health. Practices with p otential negative effects are risk factors; these include sedentary lifestyle, ove reating or poor nutrition, insufficient rest and sleep, and poor personal hygien e. Other habits that put a person at risk for illness include tobacco use, alcohol or drug abuse, unsafe sex, multiple sex partner, and activities involving a threa tof injury, such as sky diving or mountain climbing. Some habits are risk factor s for specific diseases. Nurses can educate their clients and the public on well ness-prom oting lifestyle behaviors. Care must be taken however, not to blame clients for their illness. Stress can be a lifestyle risk factor if it is severe or prol onged, or if the person is unable to cope with life events adequately. Stress ca n threaten mental health (emotional stress), as well as physical well-being (ph “] La ysiological stress). Stress may also interfere with health promotion activities a nd the ability to implement needed lifestyle modifications. Emotional stressors may result from life event such as divorce, pregnancy, death of a spouse or fa mily members, and financial instabilities. Job-related stressors, for example, may overtax a person's cognitive skills and decision-making ability, leading to ‘mental overload’ or ‘burnout’. The goal of risk factor identification is to merely assist clients in visualizing tho se areas in their life that can be modified or even eliminated to promote welln ess and prevent illness.