Chapter 2 Health and illness

Current issues in Healthcare

 Aging population - with Chronic illnesses. LTC underfunded and shortage of HC workers.
 Mental Health – The leading cause of disability in Canada (Addiction) 1 in 5 Canadians
will experience some type of mental illness in his or her lifetime. Lower income families
and younger Canadians are affected.
 Addiction- Opioid-related overdoses and deaths. Ex : Tranquilizers, benzodiazepines,
oxycodone, codeine, morphine, Percocet . Most deaths involve Fentanyl. Narcan
(naloxone) antidote for OD.
 Physician Assistance in dying or Medical Assistance In Dying - To be eligible for MAID,
a person must have a valid Canadian health card, be 18 years of age or older, and have a
serious, irreversible disease, illness, or disability wherein death is expected.
 The person must be experiencing “unbearable” physical or mental
suffering from the infirmity or state of decline that cannot be relieved (e.g., with
pain management)
  A person must also be deemed mentally competent both at the time he or she applies
for MAID and at the time the procedure is performed ( Right to Autonomy)
 Antibiotic-resistant bacteria “Super bugs” - It poses a threat globally, including to the
health of Canadians (children, elderly, immunocompromised)
 MRSA -(methicillin-resistant Staphylococcus aureus) -Nares of the “carrier” .
Bacteria is transmitted to patient’s open tissue.
 VRE (vancomycin-resistant enterococci) – Bacteria found in the intestines (UTI,
bloodstream) Contaminated equipment or other surfaces. Poor infection control.
 C. difficile (Clostridium difficile)- Resistant to treatment and spore former.
 Access to care and wait times – Shortage of specialists, primary care physicians across
the country. Canadians also experience significant waiting times for various diagnostic
tests.

Leading cause of Morbidity and Mortality in Canada

 Cancer - 2 in 5 Canadians in their lifetime. 1 in 4 of those would die of Cancer.

  Lung, breast, colorectal, and prostate cancer.
 Cardiovascular disease (CVD) - can result to heart attack, CHF, HPN.
 CVA (stroke)
 Respiratory diseases.

Behavioural responses to illness depends on :

Individual’s health beliefs, religion, culture, experience with illness, the health care system, and the
individual’s locus of control (Internal or external) and personality types (Optimist/Pessimist)

Health-illness continuum - How a person views his or her health can be measured on a sliding
scale. A continuum of health–illness illustrates how a person’s health status is constantly
changing. Slide 12 PP / Fig 2.2 pg 53
Poor health (or the person’s perception of poor health) moves a person towards one end (pessimistic) ,
while optimal health is at the other end (Optimistic)

Compensation—Most of us move between optimal health and compensation. Still coping independently
well.

Optimal or good health, to the righthand side of this continuum, is defined as the height of physical,
emotional, spiritual, and intellectual health and wellness. Positive outlook

Death is adaptive – Older person dies – Acceptance

Younger person dies (premature death) not adaptive.

STAGE OF ILLNESS RESPONSE

1. Preliminary phase: The appearance of clinical signs (Keep to yourself) Rationalize.

2. Acknowledgement phase: Sustained clinical signs and symptoms (Concerned) Share it
to other people to validate. Denial stage. Self- medicate first with OTC. Wait and See.
3. Action phase: Seeking medical intervention (Visit the doctor for a check-up)
Acknowledge that you need help.
4. Transitional phase: Diagnosis and treatment (Follow doctor’s advice) Response varies.
Acceptance may be delayed depending on the diagnosis.
5. Resolution phase: Recovery/rehabilitation or death. Response varies (Acceptance vs
Denial )

People assume social roles in life: positions that carry expectations of responsibilities and of appropriate
behaviour. We have obligations to fulfill, and people who rely on us.

Sick role

A particular social role that an ill person adopts, which involves giving up normal responsibilities and
accepting care. May sometimes involve uncharacteristically passive behaviour.
Health professionals must be careful not to cultivate patient dependence and should encourage
patients to be actively involved in disease prevention, health maintenance, and the treatment of their
own illnesses.

Always be sensitive to patients’ responses to illness. Recognize that they may need support and
encouragement. Slide 19 PP slide

Effect of illness to others = Family members, friends, work because of sick role (Chain-reaction).

Effects on the family may include

 Changes in a person’s duties and responsibilities,

 Increased stress because of anxiety related to the illness.

 Conflict over unaccustomed responsibilities.

 Financial problems.

 Change in social patterns.

 Loneliness (if the family member is hospitalized)

 Pending loss (if the illness is serious).

It is important to recognize that the whole family is affected when one family member becomes
ill. Understanding what they are going through will help you put any unpleasant behaviour in
perspective and maintain your calm and empathetic manner.
Patients you Rarely See : Slide 21 PP
The effects of Hospitalization
Hospitalization is a major source of stress to the patient and family members, particularly now that
hospital stays are reserved for the very ill.

You need to keep communication clear, accurate, and professional, while at the same time being
supportive, understanding, and empathetic.

It takes skill and patience to read the mood of the patient.

Do not take it personally; it can help you stay calm and deal effectively with these individuals if you
realize that most of them would not behave this way under less stressful circumstances.
Health status of patient
If you are allowed to give information, make sure it is up to date—an individual’s health status
can change from moment to moment. Pg . 62

CRITICAL: The patient is hanging in the balance between life and death and is receiving active,
intense intervention. ICU, CCU or Recovery room.
POOR: The patient is near death but not receiving active intervention.
GUARDED: The patient has moved from critical towards the wellness end of the continuum—
but only just. The patient’s condition is still volatile and easily subject to change.
STABLE: This term is used once a patient’s condition has steadied, typically after being
considered critical. It is usually considered an improvement.
SATISFACTORY: The patient continues to improve and, usually, is out of danger. Although the
position is optimistic, fluctuation or regression is still possible.
GOOD: The patient is believed to be on a firm footing and is expected to recover.