Human Responses to Illness

Faculty: Ibne Amin

INS, Khyber Medical University,
Peshawar,
 Definition of Health

Health:
It is a complete state of physical, mental, and social well
being and not merely the absence of disease or
infirmity. (WHO,1948)

Second definition of Health Potter & Perry (2014)

define health as a “ dynamic state, in which the
individual adapts to changes in internal and external
environments to maintain a state of well-being”.
 Wellness

Wellness:
It is the state in which attitudes and behaviors enhance
the quality of life and maximizing personal potentials.
OR
Wellness is an active state, oriented toward maximizing
the potential of the individual.
OR
Wellness is a status in which individual is capable of
meeting the minimum physical ,psychological and
social requirement of appropriate functioning.
Dimensions of Wellness

Copyright 2008 by Pearson Education,

4 Inc.
 Dimensions of Wellness

Physical Potential:
Able to carry out daily tasks, achieve fitness, maintain
adequate nutrition, body fat, avoid alcohol/Drug
abuse or tobacco products, practice healthy lifestyle
habits.
 Dimensions of Wellness

Social Potential:
Able to interact successfully with people in one’s
environment, to develop and maintain intimacy with
others, to develop respect and tolerance about
different opinions and believes.
 Dimensions of Wellness

Emotional Potential:
Ability to manage stress, expresses emotions
appropriately and accepts limitations.

Intellectual Potential:
Ability to learn and use information effectively for
personal development and meeting new challenges.
 Dimensions of Wellness

Environmental Potential:
Ability to promote health measures to enhance
standard of living and quality of life in community
Spiritual potential:
Belief in some forces or higher power, meaning and
purpose of life (morals, values, ethics)
 Dimensions of Wellness

Occupational Potential:
The ability to achieve a balance between work and
leisure time, A person's beliefs about education,
employment, and home influence personal
satisfaction and relationships with others.
 Concepts of illness and disease

Disease
Disease can be described as an alteration in body functions
resulting in a reduction of capacities or shortening of the
normal life span. OR
A disease is a pathological condition that impairs normal body structure and
functions. ... Illness is a broad term that is used to describe a person who is in a
poor state of health. Illness is not always due to disease.
Illness: the unique response of a person to a disease
It is an abnormal, highly personal and subjective feeling in which
individual’s physical, emotional, intellectual, social,
developmental or spiritual functioning is thought to be
diminished or impaired

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 Illness

• “Illness is a condition characterized by a deviation

from a normal health state which is manifested by
physical & psychological symptoms.” – Kozier.

• “Illness is a state in which a person’s physical,

intellectual, emotional, social or spiritual functioning
is diminished or impaired in comparison with the
previous experience”.
Potter & Perry.
 Variables Affecting Illness Behaviour

1. Internal Variables.
2. External Variables.
 Variables Affecting Illness Behaviour

INTERNAL VARIABLES
1. Perception of symptoms.
2. Nature of illness.
3. Characteristics of person
 Variables Affecting Illness Behaviour

EXTERNAL VARIABLES
1.Visibility of symptoms.
2.Social group.
3.Culture & values.
4.Economic variable.
5.Accesibility of health care system.
 Types of Illnesses
Acute Illness: Generally has a rapid onset of symptoms and
lasts only for a relatively short time
Examples: Appendicitis, Pneumonia, Diarrhea, Common Cold

Chronic Illness: A broad term that encompasses many

different physical and mental alterations.
• It is a permanent change
• It causes/is caused by irreversible alterations in normal A & P
• It requires special patient education for rehabilitation
• It requires a long period of care or support

Examples: Diabetes Mellitus, COPD, Arthritis, CRF etc

 Types of Illnesses

Acute illness
– Short duration
– Mostly severe
– Starts abruptly and subsides in relatively short period (less
than 6 months)
Chronic illness
– Persist for more than six months
– May affect functioning of body in any dimension
– Up to the level of disability
– Major health problem
 Illness Behaviour

Illness behaviour refers to “the way in which symptoms

are perceived, evaluated, and acted upon by a
person who recognizes some pain, discomfort or
other signs of organic malfunction
OR
A coping mechanism , involves ways individual
describes ,monitor ,interpret their symptoms ,take
remedial actions , and the use of health care system.
OR
The way the sick person acts is called illness behaviour
 Stages of Illness Behavior

Edward suchman (1972) identified 5 stages of illness

behavior.
When a person experience illness ,he/she generally passes
through five stages of illness behaviour.
This pattern involves how a person seeks, finds & completes
the health care.
1.Stage I : Symptom experience.
2.Stage II : Assumption of sick role.
3.Stage III : Medical care contact.
4.Stage IV : Dependent client care.
5.Stage V : Recovery & rehabilitation.
 Stages of Illness Behavior

STAGE I – SYMPTOM EXPERIENCE (manifestation /Signs)

• In the first stage, person feels that something is
wrong but he is not able to diagnose the problem.
• Perception of symptoms includes awareness of
physical change like pain, rashes, lump. At the end of
this stage , he is able to make the decision that it is a
symptom of an illness.
• Awareness of physical changes.
• Pain, rashes and lump etc
 Stages of Illness Behavior

STAGE II –ASSUMPTION OF SICK ROLE

(Disruption of normal social roles, rights, obligation)
If the symptoms persist, then the client will assume sick role & seek
confirmation from family & others that they are indeed sick.
Then he gets excuse from normal duties & role expectations.
Assumption of sick role results in emotional changes such as
withdrawal, depression, physical changes. The person may deny
& delay the contact with health care system.
• Accept sick role and seek confirmation
• Self treatment
• Excuses
• Emotional responses
• Illness persist seek professional help
 Stages of Illness Behavior

STAGE III –MEDICAL CARE CONTACT

At this stage, the client acknowledges the illness & seeks
explanation of causes, duration of illness & it’s
complications. Health professional may determine
whether the client is ill or not.
After knowing about illness some client seek medical
treatment , but sometimes, they start denying the
symptoms.
• Seek professional advice
• Accept or deny diagnosis
• Follow the treatment plan
 Stages of Illness Behavior

STAGE IV – DEPENDENT STAGE

(Increased attention and escape for work responsibilities)
After accepting the diagnosis, client becomes
dependent upon health care professionals to get
treatment.
Here, the client accepts the care, sympathy, protection
from the demands & stress of life.
• Dependent for professional help.
• Accept their dependence on the primary care provider.
 Stages of Illness Behavior

STAGE V – RECOVERY & REHABILITATION

(Varies depending on the type of illness)
This is the stage when the symptoms of illness get
subsiding. The person starts regaining original health
status.
In case of chronic illness, final stage involves an adjustment
to a prolonged reduction in health & functioning.
Relinquish the dependent role
Resume former roles and responsibilities.
Acute illness (short term) – recovery fast
Chronic illness (Long term) s– recovery difficult
 Emotional Responses To Illness

1. Fear.
2. Over dependence & feeling of helplessness.
3. Anxiety.
4. Hope.
5. Anger & hostility.
 Impact Of Illness
1.Impact of illness on client.
2.Impact of illness on client & family.
 Support During Illness

• Family Support

• Health Care Givers Support

• Complementary and Alternative Medicine

• Faith Healing

• Homeopathy
 Models of Health and Illness

• The Agent-Host-Environment Model

• The Health–Illness Continuum

• The High-Level Wellness Model

• The Health Belief model

• The Health Promotion Model

 The Agent-Host-Environment Model

Agent-Host-Environment Model (Leavell and Clark)

Agent: Agent is environmental factor or stressor,

bacteria, virus, chemical substance
Host: Host is living organism cable of being affected
by the agent
Environment: Environment is factors that are
external to host that make illness more likely i.e:
Lack of Sleep. Cold Temperature
 The Health–Illness Continuum

The Health–Illness Continuum

Measures a person’s level of health

Views health as a constantly changing state with high-
level wellness and death on opposite sides of a
continuum
Illustrates the dynamic (ever-changing) state of health
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 The High-Level Wellness Model (Dunn)
• Encourages the nurse to care for the total person
• Involves functioning to one’s maximum potential while maintaining
balance and a purposeful direction
• Regards wellness as an active state, oriented toward maximizing the
potential of the individual, regardless of his or her state of health
• Incorporates the processes of being, belonging, becoming, and
befitting

Active State: More than good health (passive) maximizes the person’s
potential. More total person focus encompasses all of the
dimensions Being: Recognizing self as separate and individual
Belonging: Being part of a whole becoming: Growing and Developing
Befitting: Making personal choices to befit the self of the future
 The High-Level Wellness Model (Dunn)

Dunn(1959) described a health grid in which a health

axis and an environmental axis intersect.The Health
axis extends from peak wellness to death, & the
environmental axis extends from very favourable to
very unfavourable.The intersection of two axis forms
four quadrants of health and wellness;
1:High level wellness in a favourable environment
2:Emergent high level wellness in an unfavorable environment
3:Protected Poor Health in a favorable environment
4:Poor health in an unfavorable environment
 The Health Belief Model (Rosenstock)
• Concerned with what people perceive to be true about
themselves in relation to their health

• Modifying factors for health include demographic,

sociopsychological, and structural variables

• Based on three components of individual perceptions of

threat of a disease
– Perceived susceptibility to a disease
– Perceived seriousness of a disease
– Perceived benefits of action
 Health Promotion Model (Pender)

Illustrates the “ multidimensional nature of persons interacting

with their environment as they pursue health”
Incorporates individual characteristics and experiences and
behavior-specific knowledge and beliefs, to motivate health -
promoting behavior
Personal, biologic, psychological, and sociocultural factors are
predicative of a certain health-related habit

Health-related behavior is the outcome of the model and is

directed toward attaining positive health outcomes and
experiences throughout the lifespan
 Health Promotion Model (Pender)

Example: Used to predict how a person is likely to

incorporate health promotion behaviors into their
lifestyle.
Smoking: If parents smoke children more likely to
smoke
Primary prevention—e.g., Diet, Exercise
 Level of prevention

• Primary prevention—e.g., Diet, Exercise,

Immunizations

• Secondary prevention—e.g., Screenings,

Mammograms, Family Counseling

• Tertiary prevention—e.g., Medications, Surgical

Treatment, Rehabilitation
 References
• Kozier & Erb’s Fundamental of Nursing Book, 8th
edition.
• Michael A Bettman FACRS “Self Esteem article” 1960.
• Thomas Fuller Ph.D/MCPR “Teaching and Learning”
1955.
• John Jackson M.D “of nursing research 6th edition.
Manual
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