Health and Illness - Chapter 4 Timby

Health and Illness: Chapter 4 (Timby)

• Learning objectives (from Page 2):

  • Describe how the World Health Organization (WHO) defines health

  • Discuss the difference between values and beliefs, and list health beliefs common among Americans

  • Explain the concept of holism

  • Identify the five levels of human needs (Nursing Judgment)

  • Define illness and terms used to describe illness (Nursing Judgment)

  • Differentiate primary, secondary, tertiary, and extended care (Nursing Judgment)

  • Name programs that help finance health care for the aged, disabled, and low-income population (Patient-Centered Care)

  • Identify national health goals targeted for the year 2030 (EBP)

  • Discuss methods that nurses use to administer client care (Professional Behavior & Teamwork Collaboration)

Health and wellness: foundational definitions

• Health (WHO definition):

  • Health is “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.”

  • ext{Health} = ext{physical} ext{ + } ext{mental} ext{ + } ext{social well-being} ext{ (not just absence of disease)}

• Beliefs and values:

  • Most Americans have specific beliefs regarding healthcare

  • A person’s behaviors are the outcomes of their values and belief systems

Wellness and holism

• Wellness: full and balanced integration of all aspects of health

  • Dimensions: physical, emotional, social, and spiritual

• Holism: the sum of physical, emotional, social, and spiritual health

• Interdependence within holism:

  • Any change in one component (positive or negative) automatically repercusses in the others

  • Implication for nursing: assess and intervene across multiple domains, not just physical symptoms

Hierarchy of human needs

• Five levels (by Maslow):

  • Self-actualization: need to be self-fulfilled, to learn, create, understand, and experience one’s potential

  • Esteem and self-esteem: need to be well thought of by oneself and by others

  • Love and belonging: need for affection, belonging, meaningful relationships

  • Safety and security: need for shelter and freedom from harm

  • Physiologic: need for air, nutrition, water, elimination, rest and sleep, thermoregulation

• Note on sexuality: sex is unnecessary for individual survival, but necessary for survival of humankind

• Practical implication: the hierarchy informs prioritization of care and interventions in nursing practice

Illness: definitions and key terms

• Illness: state of being unhealthy when disease, deterioration, or injury impairs a person’s well-being

• Common terms associated with illness (definitions to know):

  • Morbidity

  • Mortality

  • Acute

  • Chronic

  • Terminal

  • Primary

  • Secondary

  • Remission

  • Exacerbation

  • Hereditary

  • Congenital

  • Idiopathic

Morbidity vs mortality

• Morbidity: incidence of a specific disease, disorder, or injury; refers to the rate or numbers of people affected

• Mortality: incidence of deaths; the number of people who died from a particular disease or condition

Types of illness by duration and origin

• Acute illness: sudden onset and short duration

• Chronic illness: gradual onset and long duration

• Terminal illness: no potential for cure; will be fatal

• Underlying disease: the root cause that may persist and drive other conditions

• Primary illness: develops independently of other diseases

• Secondary illness: develops as a result of a preexisting condition

Illness terms: remission and exacerbation

• Remission: disappearance of signs and symptoms; resembles a cured state but relief may be temporary

• Exacerbation: reactivation of disorder; shift from chronic to acute stage or periodic flare-ups

Illness terms: hereditary, congenital, idiopathic

• Hereditary condition: acquired from genetic codes of one or both parents; symptoms may or may not be present at birth

• Congenital disorders: present at birth and result from faulty embryonic development

• Idiopathic illness: unknown cause

Health care system: levels of care

• Definition: network of available health services and institutions where people seek treatment or support for health problems

• Primary care: services provided by the first health care provider/contact (usually Family Practice MD, NP, or PA in office/clinic)

• Secondary care: services to which primary caregivers refer clients for consultation or tests (e.g., Cardiac Cath Lab, outpatient lab, x-rays, GI testing)

• Tertiary care: hospital or medical center services with complex technology and specialists

• Extended care: services meeting health needs of clients who no longer require acute hospital care (rehabilitation; skilled nursing at home or nursing facility; hospice care)

Health care system financing and access

• Health Insurance Marketplaces and access to care:

  • ACA (Affordable Care Act) established marketplace options and expanded coverage; year: 2010

  • Medicare: for ages 65+, permanent disability, ESRD

  • Medicaid: for low-income individuals/families

  • CHIP: Children’s Health Insurance Program

  • TRICARE: military health benefits

• Private health insurance and uninsured population:

  • CDC (2018) reported about 29.7 million uninsured individuals

Financing Healthcare and reimbursement models

• Prospective payment system (PPS):

  • Hospitals reimbursed at a fixed rate based on diagnostic-related groups (DRGs)

• Managed care organizations (MCOs):

  • Private insurers who plan and supervise distribution of services to reduce costs

• Financing implications:

  • Costs, access, and decision-making power shift toward insurers

• Integrated delivery systems: networks providing a full range of health care services in a coordinated, cost-effective manner

• Wellness programs, rehabilitation, long-term care (LTC), home health, hospice

Types of managed care organizations

• Health Maintenance Organizations (HMOs): preset fees; preventive services; prior authorization often required

• Preferred Provider Organizations (PPOs): network groups discount services for steady clients; higher costs outside network

• Capitation: preset fee per member paid to provider regardless of services used; provider has control over tests and services

Outcomes of structured reimbursement and delivery systems

• Shift in economic and decision-making power from hospitals/physicians to insurance companies

• Integrated delivery systems improve coordination and cost-effectiveness

• Emphasis on wellness programs, rehabilitation, LTC, home health, and hospice as part of care continuum

National Health Goals: Healthy People 2030

• Ongoing national health-promotion effort with goals to:

  • Help people achieve healthy, thriving lives

  • Eliminate health disparities

  • Create health-promoting environments

  • Promote health across the lifespan

  • Engage leaders and the public in designing health-promoting policies

• Reference: Box 4-3 (p. 55) in the source text

The Nursing Team Management patterns

• Patterns include: functional nursing, case method, team nursing, primary nursing, nurse-managed care

Functional Nursing

• Each nurse on a client unit is assigned specific tasks

• Less common nowadays; focus is on task completion rather than holistic client care

Case Method

• One nurse manages all care for a client or group for a designated period

• Used in home health, public health, and community mental health nursing

• Nurses function as case managers

Team Nursing

• Nursing staff divide clients into groups; care is completed collectively

• Directed by a team leader who assigns and supervises care

• Team leader evaluates whether patient care goals are met

Primary Nursing

• Admitting nurse takes responsibility for planning client care and evaluating progress

• Remains responsible and accountable for specific clients until discharge

Nurse Managed Care

• A nurse manager plans nursing care based on patient type or diagnosis

• Clinical pathway is used to guide care

Continuity of health care

• Definition: maintenance of health care across levels and agencies

• Ensures efficient navigation of the health care system with minimal frustration

• Goal: avoid feelings of isolation, fragmentation, or abandonment by the client

Review questions

• Question 1: The WHO defines health as "a state of complete physical, mental, and social well-being, not merely the __ of disease or infirmity."

  • Answer: absence

• Question 2: In the remission state of illness, the relief or the cured state is permanent.

  • Answer: False

Practical takeaways and implications

• A holistic view of health means treating the person, not just the disease; patient education and social supports are essential

• Understanding the continuum of care (primary → secondary → tertiary → extended) helps in coordinating referrals and care transitions

• Knowledge of financing models (DRGs, MCOs, capitation) informs nursing practice, especially around cost containment and advocacy for patients

• National health goals (Healthy People 2030) provide a framework for quality improvement, prevention strategies, and policy discussion

• Various nursing care delivery models affect workload, accountability, and patient outcomes; flexibility and adaptation to setting are key

Connections to foundational principles

• Holism aligns with patient-centered care and ethical practice by acknowledging multiple dimensions of health

• Continuity of care supports patient autonomy and reduces fragmentation, aligning with professional standards in nursing

• Evidence-based practice (EBP) guides adoption of policies and practices toward national health goals

Real-world relevance

• Health policy changes (ACA, Medicare/Medicaid expansions) directly impact access to care for vulnerable populations

• Insurance design (DRGs, MCOs) shapes hospital behavior and patient experience

• National goals push communities to address disparities and promote lifelong health behaviors