Experiencing Health & Illness (FOUNDATIONS)

• Overview of how real people experience health, wellness, & illness

• How do we understand the key concept of Health?

  • 🠶A person’s image of health: The body as “beautiful” and what should look like?

    • 🠶That image may be very different person to person & defined differently

    • 🠶The “Perfect Body” image would deny anyone in a Wheelchair, with a prosthetic device, eye-glasses, & hearing aids as “imperfect”

    • 🠶Not having illness? No physical impairments?

    • 🠶Is health something we buy? 

    • 🠶Health does not come from within; instead, it is “out there” & available if you have enough money / insurance

• 🠶Is health:

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• 🠶Ideal mental & physical well-being? 

• 🠶Ideal state striving towards but never attain health as an end goal?

• 🠶Ability to cope? 

• 🠶True health is strength to live, to suffer, & strength to die. 

• 🠶Health is not a condition of body but power of the soul to cope with varying conditions of the body 

Understanding Health & Illness: An Individual Experience

• 🠶Nurses understand it as an individual experience based on a patient’s unique response

• 🠶The patient does not see it as a “diagnosis” but rather “how they feel”

• 🠶Nurses need to understand a patient’s state of being

• 🠶Patient’s may strive to maintain optimal health in light of coping with chronic / terminal disease

• 🠶A way of life oriented toward optimal health & well-being where body, mind, & spirit are integrated more fully in the “community”

• 🠶Health-Illness Continuum (many theorists):

  • 🠶Health & illness:

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• 🠶a graduated spectrum that cannot be divided into parts

• 🠶A person’s position moves back & forth with physiological changes, lifestyle choices, & result of various therapies 

• 🠶Move up & down this continuum over a lifetime

Conceptual Models of Health & Illness: Dunn’s Health Grid: (Dunn 1959)

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• 🠶Health & illness plotted against environmental conditions

• 🠶Predicts likelihood of health changes

  • 🠶Positive outlook

  • 🠶Supportive friends / family

  • 🠶Positive environment 

• Protects patients from harm & provides quality of life

Conceptual Models of Health & Illness: Neuman’s Continuum (Nursing Theorist Betty Neuman 2002)

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• 🠶Health: an expression of living energy available to a person in a continuum that may be one end as high energy (wellness) & low end (illness)

• 🠶Varying levels of energy at various stages of life

• 🠶Engagement & activity may counterbalance physical frailty

Social Determinants of Health: ecnomic stability

  Employment

■   Food insecurity

■   Housing instability

■   Poverty

Social Determinants of Health: Education Access and Quality

■  Early childhood education & development

■   Enrollment in higher education

■   High school graduation

■   Language & literacy

Social Determinants of Health: Social & Community Context

  Civic participation

■   Discrimination

■   Incarceration

■   Social cohesion

Social Determinants of Health: Healthcare Access & Quality

■  Access to healthcare / primary care

■   Health literacy

Social Determinants of Health: Neighborhood & Environment

  Access to healthy food / eating patterns

■   Crime & violence

■   Environmental conditions

■   Quality of housing

Factors in Health & Wellness: biological

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• Genetic Makeup: Can heighten risk for cancers (breast, Colon), heart disease, diabetes,  etc.

• Gender & Trends: 

  • 🠶Rheumatoid arthritis, breast cancer, osteoporosis (common in women)

  • 🠶Ulcers, Color blindness, bladder cancer (common in men)

• Age & Developmental Stage: 

  • 🠶Breast cancer in women age 50 and >

  • 🠶Coping ability & Influence on perceptions (may vary on stage of life from childhood to older adults)

• Nutrition: Undeniable link between diet & health to chronic diseases; diabetes & heart disease  

  • 🠶“You are what you eat” more science unveils the correlation between nutrition, disease & wellness

Factors in Health & Wellness

• Physical Activity:

  • Regular, moderate physical activity reduces risk of chronic disease & promotes longevity

    • 🠶Weight training increases bone density in women >40 years

    • 🠶Aerobic activity (walking) reduces risk heart disease 

• Sleep and Rest:

  • Sleep & rest aid tissue regeneration, synthesis of bones, & formation of RBCs. 

  • Sleep deprivation: common in students, mothers of infants / young children, perimenopausal women and people in pain 

• Meaningful Work (include Hobbies):

  • Dimension of wellness & means to cope with stressors

Factors in Health & Wellness: lifestyle choices

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• Smoking: Nicotine raises BP & Heart rate, increases risk of cancer, heart, lung diseases

• Alcohol: Excessive alcohol damages brain, liver, pancreas, intestine, neurological system leading to malnutrition & Fetal alcohol syndrome in infants. 

  • 🠶Implicated in half of all motor vehicle accidents, falls, & other injuries

• Other substances: abuse of Illicit drugs & prescribed medications increases risk factors in many diseases & injuries

• Personal Relationships:

  • Family relationships is a dimension of wellness

  • A support system of family, friends, coworkers, etc. is crucial in illness 

  • Knowing support is available & willing to accept help can affect a person’s response to illness

Factors in Health & Wellness: culture, religion, enviormental factors

• Culture: Affects experience of illness by influencing:

  • Health decisions, behaviors, perceptions & view of oneself as well or ill

  • Response to illness as a punishment from God? A lesson we give ourselves?

• Religion & Spirituality:

  • Healthcare choices are closely tied to culture 

  • Mind-body connection promotes wellness & healing

  • Spiritual reserves are activated in terminal illnesses to view “wellness”

• Environmental Factors:

  • Pollutants cause illness (carbon monoxide, radon, mold, chemicals)

  • Interventions to create a sense of wellness, special place for photos, a walk, any diversional activity

Factors in Health & Wellness: finances

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• 🠶Money doesn't buy happiness

  • 🠶Money can buy healthy choices & access to health promoting wellness

• 🠶Access to health care may be a matter of geographic location, finances &  service availability

Factors that Disrupt Health

• Physical Disease:

  • Reduces ability to perform life roles effectively

  • May bring shock if a chronic or life-threatening disease, causing fear, anxiety, anger & grief

  • May cause a question of meaning & purpose to a life

• Injury: 

  • A sudden injury will have great impact & cause disruption 

• Mental illness: 

  • Affects work, loss of income, & altered relationships 

  • Stigma of mental illness is diminishing but highly visible to those who suffer effects

  • Can disrupt  health of a family who live in constant fear their loved one may hurt themselves or others

Factors that Disrupt Health: pain (acute/chronic)

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• 🠶Disrupts lives, changes personalities, effects coping skills

• 🠶Interferes with healthy communication & attention span

• 🠶All encompassing pain permeates an entire existence

• 🠶Can be physical or psychological (or both)

• 🠶Nursing interventions can cause different levels of pain:

  • 🠶Procedures (injections)

  • 🠶Post operative interventions: turning, deep-breathing, coughing

  • 🠶Fear of pain / unknown (may avoid healthcare for this reason)

Factors that Disrupt Health : death

• 🠶Loss:

  • 🠶Loss of a person, relationship, or job can be devastating

  • 🠶Loss of one-self (described as “indignities) suffered in some way (abuse, lack of privacy, lack of respect, etc.) Nurses interact with patients at all levels. 

    • 🠶Important to remember always preserve dignity & privacy

  • 🠶Permanent Loss of a loved one, a body system, growing old 

    • 🠶Impairment of a sense (vision, speech, hearing), function (unable to walk), body part (amputation)

• 🠶Impending Death

  • Death becomes more real with a limited future in aging persons

  • A patient (and family) will be confronted with real or potential loss of life. 

  • An array of reactions may appear; denial, ignore it, or fight to the end.  

Factors that Disrupt Health: competing demands

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• Even in illness: Responsibilities remain (children, aging parents, bills to pay, &  job) 

• People may ignore health issues because of being busy to make a healthcare appointment, S&S may go away. Ignoring it may be more problematic later

• In acute illness (fractured bone, surgery), stress may be more bearable & manageable

• In chronic illness, competing demands will create heavy burdens

• Understand the complete situation rather than assume or being critical 

• What to do? Provide support, link with needed resources, mobilize the team to provide input

Factors that Disrupt Health: unknown, imbalence, isolation

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• The unknown:

  • Normal life changes: reality sets in when out of a healthcare system (bringing a recovery family member home)

  • Anticipated life changes: Time to prepare for recovery of a family member or friend

  • Unexpected / sudden life changes: an abrupt injury or illness with no chance to prepare (cancer dx., stroke, heart attack)

• 🠶Imbalance: 

  • A major tragic life event (loss of a parent /child)

  • Treatment failure

  • Cynicism about life events

• 🠶Isolation:

  • Lack of understanding from family / friends / coworkers who have no idea what a patient is experiencing

  • Social isolation when a patient has no one to provide support, comfort, & advocacy

Stages of Illness Behavior

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• Experiencing symptoms: May be something benign or more serious. If the S&S are familiar (runny nose, common cold) versus something unusual / severe will be more concerning & progresses to the next stage 

• Sick Role Behavior: 

  • 🠶A sick person is relieved of immediate responsibilities to get well. Western biomedical culture believes a sick person is not responsible for their illness?

  • 🠶Severity of illness & symptoms will determine progression to next stage

• Seeking Professional Care for: 

  • 🠶Seek validation, explanation of illness, remedies, & anticipated length of illness 

  • 🠶Healthcare professionals may defer this stage by relying on themselves to identify & treat their own problem

• Dependency on Others: Personal characteristics & values will determine response 

  • 🠶Severity of illness & treatment will determine level of dependance needed 

  • 🠶Non-hospital illness may be an appointment or follow-up prescriptions / treatments

  • 🠶Hospitalized patients are dependent on nursing & other clinical staff 

• Recovery:

  • 🠶Final stage: person gradually resumes independence & returns to normal role & function

  • 🠶Minor illness: returns to status quo

  • 🠶Major illness: may require a redefinition of optimal function

Nature of Illness: acute

• Occurs suddenly, limited duration, & expected to recover (cold, flu, gallbladder or kidney infection)

nature of illness: chronic

• Long period, > 6 months & could last a lifetime. Will require life changes, regular medical visits, daily medications (injections) & modifications (diet, activity). 

  • Remission:  S&S are minimal to none

  • Exacerbation: S&S intensify

nature of illness: hardiness

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• Will to Live: A strong positive force to live & enjoy the challenge

• Adapting to change: Draws on internal resources or others to break old patterns

• Hardy people seek out information & make changes necessary to deal with certain situations

nature of illness: burnout

• Dealing with cumulative effect of illness can break down coping skills (healthcare professionals during Covid) 

Psychosocial Health & Illness

• What patients think & feel is equally important to their healing process

• A healthy self-concept has a positive perception self

• What is Self-Concept? How someone sees themselves:

  • Appearance / Gender

  • Intellect

  • Success (at home & work)

  • Friendship & approval from others

  • Problem-solving & coping abilities

  • Unique talents

Components of Self-Concept

• Body Image

  • Mental & physical image of oneself

• Appearance & Function

  • Is there some level of physical disability

• Role Performance

  • Meeting expectations of the role a person has chosen

• Personal Identity

  • View of self that develops over time

Self-Esteem

• A healthy self-concept exhibits a positive perception of these evaluations of self

• Levels of Anxiety

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• Mild

  • Normal anxiety of day-to-day living.

  • Heightens perception, sharpens senses

  • Enhances learning, enables optimal level of function

• Moderate

  • As anxiety increases, perceptual field narrow

  • Person focus on self & need to relieve their discomfort

• Severe

  • Perceptual field is narrow: Can only focus on one particular detail or may shift focus to many extraneous details

  • Focus is totally on self & to relieve anxiety

• Panic Anxiety

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• Becomes unreasonable & irrational

• Unable to focus on one detail 

• May misperceive environmental cues

• May lose contact with reality (e.g., experience hallucinations or delusions)

• Coping with Anxiety

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• Mild anxiety: Exercise, diversional activities, engaging with others

• Severe Anxiety: May require professional assistance 

• Depression

• Described as “feeling sad”

  • Depressive disorders occur more in women than men 

  • Defined as maladaptive emotional response

  • Low socioeconomic circumstances & isolation correlate with depression

  • Can have devastating consequences if left untreated (up to and including suicide)

Substance Use Disorder & Mental Illness

• An epidemic in the US today

• Persons diagnosed with substance use disorders are roughly twice as likely to suffer from mood & anxiety disorders

Substance Use Disorder & Mental Illness: 🠶Promote Psychosocial Health

• Be prepared to recognize & care for patients with psychosocial problems in all practice settings

• Psychosocial problems involve nearly all areas of patient functioning

• Nursing assessments/ focused  assessments key in care planning to incorporate all aspects of psychosocial functioning  

Nursing Process: assesment

• Be an effective communicator

  • 🠶Create a climate, maximum attention, accept the person, enjoy the experience

  • 🠶Take time to communicate (even in a busy environment) use every opportunity to assess & update

  • 🠶Identify primary concern through inquiry

  • 🠶Develop observation skills: patient response, presence of others (family/friends), identify any special religious or cultural expressions

Nursing Process: Nursing Diagnosis:

• (examples from this chapter on illness / health)

  • 🠶i.e. Anxiety, knowledge deficit, 

  • 🠶i.e. Spiritual distress due to impending death

  • 🠶i.e. Caregiver role strain due to care of spouse with chronic illness

Nursing Process: interventions

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• 🠶Draw on strengths & support systems available to utilize options available 

Nursing Process: Outcomes adn Evaluation

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• 🠶Be realistic & valued by the patient & family

• 🠶Assist patient & family to envision acceptable outcomes & timeframes

• 🠶Talk through the process; may spark creative resolutions

Nursing Effectiveness:favorite

Presence & Trust

Healing Presence

Cultivate a healing presence with patient & family (verbally & non-verbally).

Establish Trust

Establish trust at your first contact & ongoing.

Nursing Effectiveness:wb_sunny

Uncertainty

Promote Wellness

Examine life’s uncertainties & be prepared to promote health & wellness even when the future is unknown.

Face Dilemmas

As a nurse, you will face many uncertainties & dilemmas. You will be a part of & witness more joy than pain.

Nursing Effectiveness: self_improvement

Support & Care

Transition Support

Provide support in transition: Hospital to home / or another facility.

Self-Care

Maintain own health & wellness in order to support others.