CHAPTER 3 HEALTH WELLNESS AND HEALTH DISPARITIES Fundamental

CHAPTER 3 HEALTH, WELLNESS, AND HEALTH DISPARITIES Fundamental of Nursing The Art and Science of Person-Centered Care Ninth Edition Carol Taylor, Pamela Lynn, Jennifer L. Barlett

Primary objectives of the nurse as a caregiver…. . ■ Promote Health ■ Prevent Illness ■ Restore Health ■ Facilitate coping with illness, disability, or death.

Learning Objectives: 1. Describe concepts and models of health, wellness, disease, and illness. 2. Compare and contrast acute illness and chronic illness. 3. Discuss the factors that play a role in health equity and health disparities. 4. Explain how the human dimensions, basic human needs, and self-concept influence health and illness. 5. Summarize the role of the nurse in promoting health, preventing illness, and addressing disparities in health care. 6. Explain the levels of preventive care.

Health- what is it? ■ Health is more than the absence of illness – Active process in which a person moves toward their maximum potential ■ Each person has a different definition of health ■ Nurses must understand respect each person’s own definition of health and response to illness ■ Health definition: “Health is a state of complete physical, mental, and social well-being, NOT the absence of disease or infirmity” (World Health Organization 1974) ■ Personal level definition of health, “ health is according to how they feel or their ability to carry out activities of daily living” – Each person defines health in terms of their own values and beliefs ■ WHAT IS YOUR DEFINITION OF HEALTH? ? ?

WELLNESS ■ Wellness is a term that is used interchangeably with health ■ Wellness is defined: “…is an active state of being healthy, including living a lifestyle that promotes good physical, mental, and emotional health. ” ■ Dunn (1977) describes his model of high wellness “…as functioning to one’s maximum potential while maintaining balance and purposeful direction in the environment. ” ■ Dunn also said, “…Wellness is a more active state, regardless of one’s level of health. ”

Disease ■ Disease is a medical term, referring to pathologic changes in the structure or function of the body or mind. ■ Common Causes of Diseases – Inherited genetic defects – Developmental defects resulting from exposure to such factors as viruses or chemicals during pregnancy – Biologic agents or toxins – Physical agents such as temperature, chemicals, and radiation – Generalized tissue responses to injury or irritation – Physiologic and emotional reactions to stress – Excessive or insufficient production of body secretions (hormones, enzymes, etc. )

Illness ■ Illness is the response of the person to a disease. ■ Classifications of illness: – ACUTE ILLNESS has a rapid onset of symptoms and last only a short time. Some acute illnesses are life threatening, requiring medical treatment. Simple illnesses such as common cold, diarrhea do not require medical attention – CHRONIC ILLNESS broad term that covers a number of different physical and mental alterations in health through these characteristics: ■ ■ It is a permanent change ■ ■ It requires special patient education for rehabilitation It causes, or is caused by, irreversible alterations in normal anatomy and physiology It requires a long period of care or support. ■ Chronic illnesses have a slow onset and may have periods of remission (not experiencing symptoms) and exacerbation (the symptoms reappear)

Illness behaviors ■ Stage 1: EXPERIENCING SYMPTOMS ■ Stage 2: ASSUMING THE SICK ROLE ■ Stage 3: ASSUMING A DEPENDENT ROLE ■ Stage 4: ACHIEVING RECOVERY AND REHABILITATION How does illness effect families?

Health Equity / Health Disparities ■ Health equity is the attainment of the highest level of health for all people ■ Health disparity is a “Particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage” (Healthy People 2020, Disparities).

Health Disparity factors ■ Influences: race, ethnicity, poverty, biological sex, age, mental health, education level, disabilities, sexual orientations, health insurance, access to health care. ■ Social determinants of health: conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functionating, quality of life outcomes and risks. ■ Disparities in health care outcomes common in racial and ethnic minorities with a higher rate of obesity, cancer, diabetes mellitus, and AIDS.

Health Equity Institute Recommendations: ■ Attention to the root causes of health inequities and health disparities—specifically, health determinants. ■ Particular attention to groups that have experienced major obstacles to health associated with socioeconomic disadvantages and historical and contemporary injustices. ■ Promotion of equal opportunities for all people to be healthy and seek the highest level of health possible. ■ Distribution of socioeconomic resources needed to be healthy in a manner that progressively reduces health disparities and improves health for all. ■ Continuous efforts to maintain a desired state of equity after avoidable health inequities and health disparities are eliminated.

Vulnerable populations: ■ National trends in effort to prevent health disparities in vulnerable populations. ■ Vulnerable populations: – Racial and ethnic minorities – Poverty – Women – Children – Older adults – Rural and inner-city residents – People with disabilities – People with special health needs

Factors Affecting Health and ■ Basic Human needs- something essential that must be met for emotional and Illness physiologic health and survival ■ Human dimensions- factors that influence a person’s health-illness status – Age – Genetic factors – Physiologic factors – Health habits – Lifestyle – Environment ■ Self concept- How a person feels about themselves (self-esteem) and the way they perceive their physical self (body image)

Basic Human Needs ■ Human needs is something essential that must be met for emotional and physiologic health and survival. ■ A healthy person is someone who basic needs are met. ■ Unhealthy person who has one or more unmet needs is at an increased risk for illness.

Human Dimensions ■ Each dimension inter-relates with each of the others, influencing behaviors in health and illness. ■ Human dimension areas of risk factors: – Age : school age kids high risk for communicable diseases, Women after menopause likely to develop cardiac disease – Genetic factors : Family history cancer, diabetes predisposes development of these diseases – Physiologic factors : Obesity- heart disease, Pregnancy increases risks for both mom and baby – Health habits : Smoking, poor nutrition – Lifestyle : Sexually transmitted infections (multiple partners) Stress events (divorce, retirement, work-related pressure) can precipitate accidents or illness – Environment : Working and living environments (hazardous materials, poor sanitation) may contribute to disease

Self-Concept ■ Self-concept has physical and emotional aspects ■ Self-concept is an important factor in the way a person reacts to stress and illness, follows self-care practices, and relates to others ■ Self-concept is a result of a variety of past experiences, interpersonal interactions, physical and cultural influences and education ■ Illness can alter self-concept because it affects roles, independence, and relationships

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Health Promotion / Illness ■ Health Promotion : is the behavior of a person who is motivated Prevention by a personal desire to increase well-being and health potential – Activities are described as occurring on primary, secondary, and tertiary levels ■ Illness Prevention : is behavior motivated by a desire to avoid or detect disease or to maintain functioning within the constraints of an illness or disability (Pender, Murdaugh, & Parsons, 2014) – Activities are described as occurring on primary, secondary, and tertiary levels

Primary Health Promotion and Illness Prevention ■ Directed toward promoting health and preventing the development of disease processes or injury. ■ Examples: – Immunization programs, Child care seat education , Nutrition, fitness activities, Health education in schools (ati Nursing education page 84) ■ NURSING ACTIVITES: – Immunization clinics, family planning services, providing poison-control information, accident-prevention education. – Teaching about healthy diet, regular exercise, safety in industry and farms, use of seat belts, safe sex practices. – Health-risk assessments are important part of primary health promotion and preventive care.

Secondary Health Promotion and Illness Prevention ■ Focus on screening for early detection of disease with prompt diagnosis and treatment of any found. ■ Goals of secondary preventive care to identify an illness, reverse or reduce its severity or provide a cure, returning the person to maximum health. ■ Examples: Communicable disease screening, case finding, Early detection, treatment of diabetes mellitus, Exercise programs for older adults that are frail (ati Nursing education page 84) ■ NURSING ACTIVITIES– Assessing children for growth and development, encouraging regular medical, dental, vision exams. – Screenings (blood pressure, cholesterol, skin cancer) recommendations of gynecologic exams, mammograms, teaching testicular self-examination to men – Direct nursing interventions at secondary level include medication administration and wound care

Tertiary Health Promotion and Illness Prevention ■ Tertiary care begins after an illness is diagnosed and treated. The goal is reducing disability and helping rehabilitate patients to maximum level of functioning. ■ Examples: Begins after an injury or illness, Prevention of pressure ulcers after spinal cord injury, Promoting independence after traumatic brain injury, Referrals to support groups, Rehabilitation center (ati Nursing education page 84) ■ NURSING ACTIVITIES– Teaching a diabetic patient how to recognize and prevent complications – Use of physical therapy to prevent contractions for a patient with a stroke or spinal cord injury – Referring a woman to support group after a mastectomy because of cancer ■ Nurses play an important role in monitoring responses of the patient to prescribed therapy, and in providing services to help the patient’s recovery or improve quality of life living with effects of illness and injury.

Models of Health Promotion and Illness prevention ■ Health Belief Model : Focuses on what people perceive or believe to be true about themselves in relation to their health. – Useful when teaching about health and illness. Assess the patient’s beliefs and together structure goals the help meet the health needs ■ Health Promotion Model : Illustrates how people interact with their environment as they pursue health. – Use of the components of this model to design and provide interventions to promote health for people, families, and communities ■ Health-Illness Continuum : Views health as a constantly changing state, with high-level wellness and death at opposite ends of the scale, or continuum. – Continuum: High-level wellness– Good health– Normal health– Illness– Death

Models of Health Promotion and Illness prevention (cont. ) ■ Agent-Host-Environment Model : Interaction between an external agent, a susceptible host, and the environment as causes of disease in a person ■ Stages of Change Model : Developed while trying to help people with addictions, used by counselors addressing a broad range of behaviors (injury prevention, drug and alcohol addictions, weight loss) Divided in stages (Page 61 -62 lists explanation of these stages) – – – Precontemplation Contemplation Determination: Commitment to action Action: Implementing the plan Maintenance, Relapse, Recycling

Nursing Care to Promote Health and Prevent Illness ■ Focus on Health promotion and illness prevention at local, state and global levels ■ Nurses must take care of their own health to practice efficiently but also serve as a role model for patients ■ Nurse-led interventions reduce disparities, and provide access to quality health care – Examples: ■ Nurse-led clinic in urban Milwaukee established to treat low-income, uninsured patients with hypertension and diabetes ■ Nurse-led post discharge clinic in San Francisco helps patients transition from inpatient to outpatient settings ■ Nurse led health centers in Philadelphia for impoverished communities provide immediate and long-term health care coordinated by RNs and APRNs

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