HEALTH & ILLNESS AND LEVELS OF CARE
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Compare the different global definitions of Health
and Illness
Health
 Traditional definition – absence of disease
 Florence Nightingale – state of being well
and using the power of an individual to its
fullest extent
 WHO – complete state of physical, mental
and social well-being, and not merely the
absence of disease and infirmity
Wellness
 WHO – optimal state of health of
individual or groups; two focal concerns:
o realization of fullest potential of an
individual physically, mentally,
socially, spiritually and
economically, and the
o fulfillment of one’s role and
expectations in the family,
community, place of worship and
other settings
 WHO (2010) – subjective perception of
vitality and feeling well. It can be
described objectively, experienced,
measured, and can be plotted in a
continuum. It is a component of health.
Illness
 Webster Dictionary – unhealthy condition
of body or mind
 Likencult’s Fundamentals Nursing Book –
response of a person to a disease.
Abnormal process in which a person’s
level of functioning is changed as
compared to a previous level.
Disease
 Bermann & Snyder’s Fundamental
Nursing Book – alteration in body
functions resulting in the reduction of
capacities or shortening of the normal life
 Britannica – any normal variation in the
structural or functional state of an
organism. Generally associated with
certain signs and symptoms, and
deferring in a nature from a physical
injury
Identify your future client as an individual and as
part of a family
 Nurses assess and plan health care for
the three types of clients:
o Individual
o Family
o Community
 Man as an individual – do we care for
patients or clients?
o Patients
 Comes from the Latin word,
patior, which means “to
suffer”
 Defined as “one who
suffers”
o Client
 Comes from the Latin word
“clinare”, which means “to
learn”
 Defined as “one who is the
recipient of a professional
service”
o Patient indicates a chorological
relationship, and client signifies a
more collaborative relationship
o Terms used simultaneously or
interchangeably
 Family – basic unit of society. It consists
of those individuals, male or female,
youth or adult, legally or not legally
related, genetically or not genetically
related, who are considered by the others
to represent their significant people

Family-centered nursing – nursing that
considers the health of the family as a
unit in addition to the health of individual
family members
Types of Families:
1. Nuclear
 Family structure of parents and
their offspring
2. Extended
 Relatives of nuclear families
(grandparents, aunts, uncles)
3. Traditional
 Independent unit in which
parents reside in the home
with their children, mom-
nurturing role, father-economic
role
4. Two-career
 Both parents are employed,
they may or may not have
children
5. Single parent
 Single-parent household due to
death, separation, divorce,
death of a child to an
unmarried woman, adoption
by a single mom/dad
6. Adolescent
 Young parents are often
developmentally, physically,
emotionally and financially ill
prepared to undertake
responsibility of parenthood
7. Foster
 Children placement in Foster
homes that has legally agreed
to include them temporarily
due to social issues, legal
preparation before return to
original birth parents or be
legally adopted by other
parents
8. Blended or step
 Existing family units who join
together form new families
9. Intragenerational
 More than 2 generations may
live together, children continue
to live with parents or
grandparents may live in
children’s own families
10. Cohabiting
 Consists of unrelated
individuals of families who live
under 1 roof
11. Gay and lesbian
 Homosexual adults from gay
and lesbian families based on
the same goals of caring and
commitment seen in
heterosexual relationships
12. Single-adults living alone
 Singles include young self-
supporting adults who have
recently left the nuclear family
as well as older adults living
alone
Applying Theoretical Frameworks to
Families
 Theoretical frameworks provide
the nurse with a context or
structure from which to view
health and promotion for families
across the life span
 Family systems theory
o Murray Bowen
o Theory of human behavior
that defines the family unit
as a complex social system
in which members interact
 to influence each one’s  Includes influences such as food,
behaviors. water and air
o Family members 2. Social
interconnect, making it  Ability to interact successfully with
appropriate to view it as a people and within the
whole rather than environment of which each person
individual elements is a part to develop and maintain
o Any change in one intimacy with significant others,
individual is likely to and to develop respect and
influence the entire system tolerance to those with different
or change another opinions and beliefs
o Using this will allow the 3. Emotional
nurse to see how each  Ability to manage stress and
element influences the express emotion appropriately
other 4. Physical
 Structural-functional theory  Ability to carry out daily tasks,
o Focuses on family structure achieve fitness, maintain adequate
and function nutrition and proper body fat,
o Structural component avoid abusing drugs or alcohol, or
addresses the membership using tobacco products
of the family and the  Practice positive lifestyle habits
relationship among 5. Spiritual
members  Belief in some force, nature,
o Functional aspect examines religion or a higher power that
the effect of intra-family serves to unite human beings or to
relationship in the family provide meaning and purpose to
system as well as its effect life
on other systems 6. Intellectual
o The nurse will facilitate a  Ability to learn and use
care plan that includes information effectively for
diagnosis and problems personal, family or career
from the perspective of development
stabilizing or enhancing the 7. Occupational or vocational
family structure and  Ability to achieve a balance
function during the episode between work and leisure time
of disruption 8. Financial
 Satisfaction with current and
Compare and contrast the different dimensions of future financial situation
wellness
1. Environmental  The diagram reflects the 8 dimensions of
 Ability to promote health wellness from the Hodge model that was
measures that improve the created by Brian Hodge, senior lecture-
standard of living and quality of life retired in the mid-1980’s at Manchester
in the community Metropolitan University
Understand the Health-Illness Continuum
 Health-illness continua (grids or
graduated scales) can be used to measure
an individual’s perceived level of wellness
 Health and illness or disease can be
viewed as the opposite ends of a health
continuum
o Individuals move back and forth in
the continuum
o Examples include Dunn’s high-level
performance grid, and Travis’s
illness-wellness continuum
 Dunn’s high-level wellness grid
o Consists of four levels of wellness
grid
 High levels of wellness in a
favorable environment
 Emergent high wellness in
an unfavorable
environment
 Protected poor health in a
favorable environment
 Poor health in an
unfavorable environment
 Travis’s illness-wellness continuum
o Arrows pointing at opposite
directions, and joined at a neutral
point
 Illness-wellness continua
o Individual’s state of health is one
of continual change where it
moves back and forth from
wellness and illness
o Condition is rarely constant
 Health is a process of continual change,
and there is a need to adapt to maintain
good health and well-being
 The adaptation or response to the change
affects our health
Differentiate illness from disease and acute illness
from chronic illness
 Illness
o Highly personal state in which an
individual’s physical, emotional,
intellectual, social, developmental
or spiritual functioning is thought
to be diminished
 Disease
o Alteration in the body function
resulting in the reduction of
capacities or shortening of normal
life span
 Acute illness
o Characterized by severe symptoms
of relatively short duration
o Symptoms appear abruptly and
subside quickly
o Depending on the cause, it may or
may not require intervention from
the health care provider
 Chronic illness
o Longer period, 6 months or longer
o Slow onset and periods of
remission
o Care needs to be focused on
promoting the highest level
possible of independence, sense of
control and wellness
Identify Parson’s four aspects of the sick role and
explain Suchman’s stages of illness
 Parsons (1979) described four aspects of
the sick role
o Clients are not held responsible for
their condition
o Clients are excused from certain
social roles and tasks
 o Clients are obligated to try to get
well as quickly as possible
o Clients or their families are
obligated to seek competent help
 Suchman (1979) described five stages of
illness. Not all clients progress through
each stage. Others may progress through
only the first two stages and then recover:
o Stage 1 – symptom experience
 Individual comes to believe
that something is wrong
o Stage 2 – assumption of the sick
role
 Individual accepts sick role
and seeks confirmation
from family and friends
o Stage 3 – medical care contact
 Individuals seek advice
from a health care
professional either on
his/her initiative or urging
of a significant other
o Stage 4 – dependent client role
 Client becomes dependent
on the professional for help
o Stage 5 – recovery or rehabilitation
 Client is expected to
relinquish the dependent
role and resume former
roles and responsibilities
Describe effects of illness on individuals’ and family
members’ roles and functions
 Ill clients may experience behavioral and
emotional changes, changes in self-
concept and body image, and lifestyle
changes
o Behavioral and emotional changes
associated with short-term illness
are generally mild and short-lived
o Acute responses are likely severe,
life-threatening, chronic or
disabling illness
o Ill clients are vulnerable to loss of
autonomy
o Family interactions may change so
client can no longer be involved in
decision-making
 An individual’s illness affects not only the
individual who is ill but also the family or
significant others. The kind of effect and
its extent depend chiefly on three factors:
o The member of the family who is ill
o The seriousness and length of the
illness
o The cultural and social customs
the family follows
 Changes that may occur in the family
o Role changes
o Task reassignments
o Increased demand on time
o Increased stress due to anxiety
about the outcome of illness
o Conflict on unaccustomed
responsibilities
o Financial problems
o Loneliness as a result of
separation or impending loss
o Change in social customs
Identify and explain the levels of care and
prevention
 There are 2 levels of primary health
workers
o Intermediate health workers
 Trained community health
workers, health auxiliary
volunteers provide support
to the frontline health
workers in terms of
supervision, training,
services through linkages
with another sector
o Village/barangay health workers
 General practioners or their
assistants, public health
 nurses, rural sanitary
inspectors, midwifes
 First contact of community
 Health care delivery system
o Primary health care
 Devout to cities and POSTMORTEM CARE
municipalities
 first contact between Post mortem care
community people and  Caring for a person’s deceased body with
different levels of health sensitivity, and consistent on their cultural
facility and religious beliefs
 includes
 sub-centre Assessment & preparation
 primary health 1. Check vital
centre
 community health
centre
o Secondary health care
 Rendered by physicians
with basic health training in
district, provincial and city
hospitals
 Capable of basic surgery
procedures and simple
laboratory examinations
 Referral center of primary
health facilities
 Includes
 District hospital
o Tertiary health care
 Rendered by specialized in
medical centers, regional
hospitals, specialty
hospitals
 Referral center of
secondary health facilities
 Health promotion focuses
on the prevention of health
risk factors toward healthy
individuals, family and
environment
 Includes
 Sub-specialty
 Medical institute