SUGGESTIONSFOR CLASSROOM ACTIVITIES
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• Have the students develop their own definitions of health and wellness using info from Box 7.1.
• Have the students interview a school-age child, an adolescent, a middle-aged adult, and an older adult, asking each to define health and wellness. Have the students report their findings. Record the results. Have the class analyze the results, looking for patterns across the groups and within the groups. If possible, compare and contrast results given by men and women. Compare the findings to the definitions given in the textbook.
SUGGESTIONSFOR CLINICAL ACTIVITIES
• Have the students ask their clients and several different types of health-care professionals to define health and wellness. Compare and contrast definitions of the clients and the health care professionals.
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LEARNING OBJECTIVE 2
Explain the common models of health and wellness (p. 125-129, Figure 7.3, Figure 7.4).
CONCEPTS FOR LECTURE
1 Models of health include the Medical Model of Health, the Agent-Host-Environment Model, and the Health-Illness Continuum Model.
2. The Medical Model of Health has the narrowest interpretation of health and views people as physiological systems, whereby the mind and body are separated and the body is analyzed as a sum of its parts. Health is identified by the absence of signs and symptoms of disease or injury It is considered the state of not being “sick.” When the signs and symptoms of disease are no longer present, the medical practitioner considers the individual’s health restored
3 The Agent-Host-Environment Model (see Figure 7.3) is used to identify risk factors that result from the interaction of agent, host, and environment. Health is an ever changing state, and the goal is to promote and maintain health. When the variables are in balance, health is maintained; when variables are not in balance, disease occurs. The model has three dynamic, interactive elements: (1) Agent: Any environmental factor or stressor (biological, chemical, mechanical, physical, or psychosocial) that by its presence or absence (e.g., lack of essential nutrients) can lead to illness or disease. (2) Host: A person or people who may or may not be at risk of acquiring a disease. Family history, age, and lifestyle habits influence the host’s reaction to an agent. (3) Environment: Includes all factors external to the host that may or may not predispose the person to the development of the disease. The physical environment includes climate, living conditions, sound (noise) levels, and economic level. The social environment can include interactions with others and life events, such as the death of a spouse.
4. Travis’s Illness-Wellness Continuum (see Figure 7.4) ranges from high-level wellness to premature death, shown by two arrows pointing in opposite directions and joined at a neutral point. People move back and forth within the continuum Movement to the right of the neutral point indicates increasing levels of health and well-being. This improvement is achieved in three steps: (a) Awareness, (b) Education, and (c) Growth In contrast, movement to the left of the neutral point indicates decreasing levels of health. One may be physically ill and at the same time oriented toward wellness, or be physically healthy and at the same time function from an illness perspective.
5 Rosenstock’s and Becker’s Health Belief Model proposed a health belief model (HBM) to predict which individuals would or would not use such preventive measures as screening for early cancer detection. Becker (1974) modified the HBM to include three components that include individual perceptions, modifying factors, and variables affecting the likelihood of action (see Figure 7.5 ). Individual perceptions include the following: perceived susceptibility, perceived seriousness, and perceived threat. Modifying factors that modify individual perceptions include the following: demographic variables, socio-psychological variables, structural variables and cues to action. Likelihood to action includes perceived benefits of the action, and perceived barriers to action.
SUGGESTIONSFOR CLASSROOM ACTIVITIES
• Have the students classify their definitions of health and wellness into the model of health that best fits their definitions. Discuss how their definitions and models of health may affect their nursing practice.
SUGGESTIONSFOR CLINICAL ACTIVITIES
• Have students use the Agent-Host-Environment Model in clinical practise and explain the three interactive elements of the model using a patient situation
• Have students use the Health-Illness Continuum Model and identify where clients in clinical practice are in terms of the continuum of health.
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Instructor’s Manual for Fundamentals of Canadian Nursing, Third Canadian Edition
LEARNING OBJECTIVE 3
Discuss primary prevention, secondary prevention, and tertiary prevention (p. 126-127, Table 7.1).
CONCEPTS FOR LECTURE
1 Prevention refers to avoiding the development of disease and occurs in three levels: primary, secondary, and tertiary. See Table 7.1 for definitions and examples.
2 Primary prevention focuses on health promotion and protection against specific health problems or disease. Precedes disease or dysfunction and is applied to generally healthy individuals or groups. Examples of primary prevention health care activities include teaching accident and poisoning prevention, immunizations, family planning, nutrition, exercise, stress management, home and occupational safety; lifestyle and nutrition to prevent cancer or heart disease.
3 Secondary prevention focuses on early identification or detection of health problems and prompts intervention to alleviate health problems and limit future disability. Examples of secondary prevention health care activities include screening for developmental delays and hypertension;tuberculosis skin test; clinical breast examination and testicular examination; annual physical and dental examinations.
4 Tertiary prevention focuses on restoration and rehabilitation to an optimal level of functioning Begins after an illness, when a defect or disability is stabilized or determined to be irreversible. Examples of tertiary prevention health care activities include teaching foot care to diabetic clients and teaching range-of-motion exercises to patients who have suffered a cerebrovascular accident.
SUGGESTIONSFOR CLASSROOM ACTIVITIES
• Provide the students with a list of health care activities and ask them to classify the activity as primary, secondary, or tertiary prevention.
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UGGESTIONSFOR
CLINICAL ACTIVITIES
• Divide the class into three groups. Assign each group an observational experience for one of the levels of prevention to find examples for that level of prevention. Have the groups share their observations.
LEARNING OBJECTIVE 4
Differentiate illness from disease and acute illness from chronic illness (p. 129-130).
CONCEPTS FOR LECTURE
1. Illness is a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished. It is not synonymous with disease and may or may not be related to disease. Illness is highly subjective; only the individual person experiencing it can say he or she is ill.
2 Disease can be described as an alteration in bodily functions resulting in a reduction of capacities or a shortening of the normal lifespan.
3 Acute illness is typically characterized by severe symptoms of relatively short duration The symptoms appear abruptly and subside quickly and, depending upon the cause, may or may not require intervention by health-care professionals. Following an acute illness, most people return to their normal level of wellness.
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Chapter 7: Health, Wellness, and Illness
4 Chronic illness lasts for an extended period, usually 6 months or longer, and often for the person’s life. Chronic illnesses usually have a slow onset and often have periods of remissions, when symptoms disappear, and exacerbations, when the symptoms reappear. Care should focus on promoting the highest level possible of independence and sense of control. In addition, many must learn how to live with increasing physical challenges and discomfort
SUGGESTIONSFOR CLASSROOM ACTIVITIES
• Discuss the statement that illness is “not synonymous with disease and may or may not be related to disease.” Have the students provide examples to illustrate their statements.
• Provide examples of an acute illness (or disease) and a chronic illness (or disease). Ask the students to compare and contrast the onsets, durations, interventions, and recoveries.
SUGGESTIONSFOR CLINICAL ACTIVITIES
• Have the students identify clients who have an acute illness (disease) and those who have a chronic illness (disease). Compare and contrast the clients’ responses to the different types of illnesses in terms of influence on the clients’ roles, treatment, and discharge plans.
LEARNING OBJECTIVE 5
Describe the effects of illness on the roles and functions of individuals and families (p. 130-131).
CONCEPTS FOR LECTURE
1 Impact on the Client: Clients with illnesses may experience behavioural and emotional changes as well as changes in life-style, self-concept and body image. Behavioural and emotional changes associated with short-term illness are generally mild and short-lived. More Individuals with illness are also vulnerable to loss of autonomy.
2 Impact on the Family: A person’s illness affects not only the person who is ill but also the family or significant others. The kind of effect and its extent depend chiefly on three factors: the member of the family who is ill, the seriousness and length of the illness, and the cultural and social customs the family follows. The changes that can occur in the family include the following: (1)role changes,(2) task reassignments and increased demands on time, (3) increased stress due to anxiety about the outcome of the illness and conflict about new responsibilities, (4) financial problems, (5) loneliness as a result of separation and pending loss, and (6) changes in social customs.
3 Family Nursing Interventions: Nurses need to support the clients’ right to self-determination and autonomy by providing them with sufficient information to participate in decision making and maintain feelings of control. Nurses can help their clients express their thoughts and provide care to help them effectively cope with change by doing the following: (1) providing explanations about any necessary adjustments to the client and their significant others; (2) Making arrangements, wherever possible, to accommodate the client’s lifestyle; (3) actively listening to clients as they share their feelings about various changes; (4) Reinforcing and incorporating desirable changes as a permanent part of the client’s lifestyle
SUGGESTIONSFOR CLASSROOM ACTIVITIES
• Invite a guest speaker who is related to a client with a chronic condition to discuss the effects of the client’s condition on the family
• Invite someone living with a chronic illness to discuss the impact on their life and family.
SUGGESTIONSFOR CLINICAL ACTIVITIES
• During clinical conference, have students describe how an assigned client’s illness has affected the roles and functions of each of the client’s family members.
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7-5 Instructor’s Manual for Fundamentals of Canadian Nursing,
Edition
LEARNING OBJECTIVE 6
Discuss the factors that determine health (p. 131-133, Table 7.2).
CONCEPTS FOR LECTURE
1. Health: Everything in the environment and society affects the health of individuals, families, and communities. Nurses must maintain a spirit of inquiry and inquisitiveness about the world and the root causes of what determines health.
2. Social Determinants of Health: It is not lifestyle choices or medical treatments that are the primary factors shaping Canadians’ health; instead, it is their experiences within their living environments These conditions are called the social determinants of health It is individuals’ interactions with their environments that have greater impacts on their health than do individual lifestyle choices and behaviours The original 1974 list of 12 determinants of health were modified to include the following 15 social determinants of health: (1) Stress, Bodies, and Illness, (2) Income and Income Distribution, (3) Education, (4) Unemployment and Job Security, (5) Employment and Working Conditions, (6) Early Childhood Development, (7) Food Insecurity, (8) Housing, (9) Social Exclusion, (10) Social Safety Net, (11) Health Services, (12) Aboriginal Status, (13) Gender, (14) Race, and (15) Disability (see Table 7.2 ).
SUGGESTIONSFOR CLASSROOM ACTIVITIES
• Provide examples of how various factors (determinants) influence health status, health beliefs, and health practices.
• Show a video in class related to living conditions on a reserve for Native Aboriginals and discuss the implications for health
SUGGESTIONSFOR CLINICAL ACTIVITIES
• Have the students discuss current newspaper articles of situations in which health determinants had an impact on either physical, emotional, spiritual or social health
KEY TERMS
130
123
p. 129
p. 130
wheel p. 125
remission p. 130
well-being p. 124
wellness p. 124
ANSWERS AND EXPLANATIONS FOR ASSESS YOUR LEARNING QUESTIONS
1. Answer: b. Social Exclusion
Explanation: A lack of social support has been linked with increased mortality and overall levels of declining health. Canadians who are socially excluded, have reduced access to cultural, economic, and social resources, which leads to reduced health. Option (a): Mr. Smith does state that he is financially secure, so this is not the health determinant posing the greatest risk. Option (c): The client lives in an environment with adequate resources, so this would not have the most influence. Option (d): Gender roles or power differences do not currently affect his health
Nursing Competency Category: Health and Wellness
Question Type: Application
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Chapter 7: Health, Wellness, and Illness
illness
adherence
autonomy
chronic illness
disease
illness
acute
p. 130
p. 129
p 130
p. 130
p. 130 etiology p.
exacerbation
health p.
medicine
2. Answer: c. Chronic illness
Explanation: Chronic illness can last six months or longer and can alter the client’s interactions with others, ability to perform self-care, and feelings of independence. Option (a): Disability can cause some of these problems, but it is not the best match. Option (b): An alteration of bodily functions, linked to etiology or the cause of disease, is not part of social relationships. Option (d): Acute illness is characterized by severe symptoms of short duration.
Nursing Competency Category: Health and Wellness
Question Type: Knowledge/Comprehension
3. Answer: a. Perceived susceptibility
Explanation: Family genetics may make a person feel more vulnerable or at risk for developing certain illnesses. Option (b): The person is not describing the potential consequences, such as financial challenges, that may affect her health should she develop the illness. Option (c): This describes a modifying factor, such as the influence of family or friends, that can motivate a person to exhibit health-seeking behaviours.
Option (d): This is a modifying factor that cannot be changed, such as race, gender, or age.
Nursing Competency Category: Health and Wellness
Question Type: Knowledge/Comprehension
4. Answer: d. Well-being
Explanation: Well-being is the definition as described above. Option (a): Health as defined by the World Health organization is a “state of complete physical, mental and social well-being, not the mere absence of disease.” Option (b): Perception is the process of acquiring and interpreting information from the senses.
Option (c): Wellness is a state of well-being that includes self-awareness, stress management, and emotional health
Nursing Competency Category: Health and Wellness
Question Type: Knowledge/Comprehension
5. Answer: b. Education regarding self-care hygiene practices is not going to be enough to change Mr. Street’s behaviours.
Explanation: Clients living on the streets often have multiple physical, psychosocial, financial, and coping needs. Option (a): Mr. Street requires more nursing care than information, skills, or knowledge of hygiene practices. Option (c): There is no consideration for the determinants of health and underlying premises. Such a statement may produce conflict within the nurse–client relationship. Option (d): There is no consideration for the determinants of health and underlying premises.
Nursing Competency Category: Professional Practice
Question Type: Application
6. Answer: b. Secondary prevention
Explanation: Mrs. Run has a mammogram, as it is designed for early detection and treatment of breast cancer. Option (a): This would imply that Mrs. Run has taken up activities directed toward protection from or avoidance of breast cancer. Option (c): The disease would be stabilized, and the goal would be rehabilitation; however, in this case, the client does not have the disease. Option (d): Health-promotion behaviours are not linked to a specific disease or disability, and Mrs. Run has not changed her activities.
Nursing Competency Category: Health and Wellness
Question Type: Application
7. Answer: b. Early child development
Explanation: The early life experiences of supportive relationships, recreation, housing, and family income affect brain development, school readiness, and health in later life. The child’s development is at risk without a supportive relationship from the mother. Option (a): The social safety net of this family is not described. Option (c): The socially determined roles of gender and power are not described in this question. Option (d): Although this determinant is important to assess with all clients, the family’s financial situation is not described.
Nursing Competency Category: Professional Practice
Question Type: Application
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Instructor’s Manual for Fundamentals of Canadian Nursing, Third Canadian Edition
8. Answer: c. Tertiary prevention
Explanation: Mrs. Jog has had this chronic illness for some time, and since her diagnosis, she has been maintaining restorative healthy lifestyle choices. Option (a): The client already has the diagnosis and is not preventing the disease from occurring. Instead, she is trying to keep her blood pressure stabilized. Option (b): This would imply that early screening is taking place. Option (d): Mrs. Jog already has hypertension. This is not one of the levels of prevention.
Nursing Competency Category: Health and Wellness
Question Type: Application
9. Answer: b. Clinical model
Explanation: The emphasis of the clinical model is on restoring health by relieving signs and symptoms of the disease. In this scenario, the client was focusing on how diet and exercise could change his physiological responses to his diabetes. Option (a): The health belief model examines the likelihood for action based on the perception of a threat to health. Option (c) views a person’s health state as the person’s ability to fulfill his or her role performance. Option (d): Smith (1981) described several approaches around four different models of health They are all models of health and wellness but do not apply to this situation as well as option (a).
Nursing Competency Category: Alteration in Health
Question Type: Application
10. Answer: c. “Health is a state of complete physical, mental, and social well-bring.”
Explanation: Health is defined as including well-being, not just the absence of disease. Option (a): Health is influenced by many social, economic, political, developmental, physical, and cultural determinants, not just biology and genetics. Option (b): People do have their own personal beliefs about the definition of health, but this statement is not a part of the nursing definition of health Option (d): Although other areas of the health care system may define health as an absence of disease, this is not consistent with the World Health Organization’s definition of health.
Nursing Competency Category: Professional Practice
Question Type: Knowledge
ANSWERS TO CASE STUDY 7
1. How does Russel’s psychological dimension of health status differ from Rayne’s?
Russel has a positive outlook and views himself as well, while Rayne has a negative outlook and views himself as “ill.” Data indicating the psychological dimension include self-concept, mind-body interactions, and emotional response to health Speculate about how their differences in perception may affect their continuing recovery process.
2. Both Russel and Rayne have heart disease. Russel considers himself well, whereas Rayne considers himself ill. Explain this phenomenon based on Dunn’s high-level wellness grid. Russel and Rayne have different psychological outlooks on their post-cardiac recovery Russel is highly motivated to do what he can to avoid another heart attack; he takes control of his health with a goal to return to work and stay well. He implements healthy lifestyle behaviours and has a positive outlook. Russel is in the “high-level wellness in a favourable environment.” In contrast, Rayne has the knowledge to implement healthy lifestyles, and he does modify his diet and activity level. However, he does not implement adequate self-care practices. He is unable to quit smoking, he is fearful of having another heart attack, and he perceives himself as being ill. Rayne is in the “emergent high-level wellness in an unfavourable environment.”
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Chapter 7: Health, Wellness, and Illness
3. What external factors may have influenced Russel’s decision to implement positive health behaviours?
Some external factors are Russel’s beliefs in his traditional healer’s and his physician’s advice. Other factors may include colleagues from his work and cultural influences.
4. What factors may have prevented Rayne from developing the same positive outlook and taking the same actions as Russel did regarding his illness?
Rayne’s perception of his illness, and thus his ability to respond in a positive manner, may be affected by a family history of heart disease, his perception that he is at high risk, and his belief that he can do nothing to change his pattern of health. Rayne may face some perceived barriers to action: cost, time, lack of social support, and possible lack of connectedness to his cultural community. For Rayne, perhaps the benefit of assuming the sick role outweighs the benefit of recovery
5. What nursing interventions would be most beneficial to Rayne regarding his smoking problem?
Many interventions are possible, and the following are just a sample:
• Verifying that Rayne values the planned health outcome he can achieved from smoking cessation
• Verifying Rayne’s knowledge about the effects of smoking
• Providing needed information or correcting misbeliefs
• Demonstrating genuine concern for Rayne
• Positively reinforcing positive changes that he does make
• Allowing Rayne to make his own decisions, thereby demonstrating trust and respect
• Assisting to identify and encouraging connecting with traditional social supports in his community
6. What would be some cultural considerations when teaching Russel and Rayne?
Cultural considerations for teaching include the following:
• Recognizing the importance of culture and holistic health
• Respecting client choice
• Integrating the client’s preference for and belief in traditional healing and the use of plants and ceremonies to aid with healing and health
• Respecting the client’s beliefs of the interconnectedness of life and importance of mind
spirit balance
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Instructor’s Manual for Fundamentals of Canadian Nursing, Third Canadian Edition
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