kozier - chapter 17- health wellness well being
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Kozier - Chapter 17- Health Wellness Well BeingTRANSCRIPT
Kozier & Erb's Fundamentals of Nursing, 8eBerman, Snyder, Kozier, ErbCopyright 2008 by Pearson Education, Inc.
Chapter 17
Health, Wellness, and Illness
Copyright 2008 by Pearson Education, Inc.
Question 1
Which one of the following is an example of the emotional component of wellness?
1. The client chooses health foods.2. A new father decides to take parenting
classes.3. A client expresses frustration with her
partner’s substance abuse.4. A widow with no family decides to join a
bowling league.
Copyright 2008 by Pearson Education, Inc.
Rationales 1
1. The client who chooses healthy foods represents the physical component.
2. Taking parenting classes enhances the intellectual component.
3. Correct. Frustration is an example of an emotion.
4. The bowling league enhances both the physical and social components.
Copyright 2008 by Pearson Education, Inc.
Question 2
Which one of the following individuals appears to have “taken on” the sick role?
1. An obese client states, “I deserve to have a heart attack.”
2. A mother is ill and says, “I won’t be able to make your
3. lunch today.”4. A man with low back pain misses several
physical therapy appointments.5. An elder states, “My horoscope says I will be
well again.”
Copyright 2008 by Pearson Education, Inc.
Rationales 2
1. The sick role states that persons are not answerable for their illness, contrary to the obese client’s perspective.
2. Correct. The mother has taken on the sick role by expecting to be excused from her usual role responsibilities.
3. In the sick role, the client tries to get better as opposed to the man who misses his physical therapy appointments.
4. The elder is not following the sick role expectation to rely on competent help.
Copyright 2008 by Pearson Education, Inc.
Question 3
Because a client recently diagnosed with diabetes mellitus is confident that blood sugar control can be improved with diet and exercise alone, and recently went checked out a video on the management of diabetes at the HMO education center, the client’s actions are most representative of which one of the following models:
1. Health belief model2. Clinical model3. Role performance model4. Agent-host-environment model
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Rationales 3
1. Correct. The behavior is most representative of health promotion, which is the central focus of the health belief model.
2. The clinical model focuses on relieving signs and symptoms of illness.
3. The role performance model emphasizes social activities such as fulfilling a particular role.
4. The agent–host–environment model focuses on predicting illness.
Copyright 2008 by Pearson Education, Inc.
Question 4Because a client with human immunodeficiency virus (HIV) is scheduled to begin several medications to manage the infection, the nurse will need to provide client education. Which of the following client characteristics is most likely to predict adherence with the treatment program? Select all that apply.
1. Educational level2. A trusting relationship with the health care
provider3. An expectation that the medications will be helpful4. Being able to take the medications twice daily
instead of four times daily5. Gender
Copyright 2008 by Pearson Education, Inc.
Rationales 4
1. Education has not been shown to be a predictive factor.
2. Correct. Significant evidence exists that a trusting relationship with the provider is an important predictor of adherence.
3. Correct. Effectiveness of the medication is an important predictor of adherence.
4. Correct. A less complex dosing regime is an important predictors of adherence with the medical regimen.
5. Gender has not been shown to be a predictive factor.
Copyright 2008 by Pearson Education, Inc.
Question 5
Which one of the following might be the BEST way to measure adherence to a prescribed medication regime?
1. Direct observation of medication administration.2. Evidence of illness complications or
exacerbations.3. Monitoring laboratory values of element
influenced by the medication.4. Questioning the client about his or her
medication routine.
Copyright 2008 by Pearson Education, Inc.
Rationales 51. Correct. Although not always practical, direct
observation is the best method to measure adherence (for example, watching heroin addicts actually take their methadone dose).
2. Since lack of adherence may be life threatening or damaging to the client as well as others, waiting until the client displays illness is not the best method.
3. Since lack of adherence may be life threatening or damaging to the client as well as others, waiting until laboratory values reflect lack of adherence is not the best methods.
4. Client report or recall is not always accurate, even if the client believes he or she is telling the truth.
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Health, Wellness, Wellbeing
• Many definitions and interpretations
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Health
• Presence or absence of disease• Complete physical, mental, social
well-being• Ability to maintain normal roles• Process of adaptation to physical and
social environment• Striving toward optimal wellness• Individual definitions
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Wellness
• State of well-being• Basic aspects include:
– Self-responsibility – An ultimate goal– A dynamic, growing process– Daily decision-making in areas related to
health– Whole being of the individual
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Well-being
• Subjective perception of vitality and feeling well
• Described objectively, experienced, measured
• Can be plotted on a continuum
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Dimensions of Wellness
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Physical Dimension
• Ability to carry out daily tasks• Achieve fitness
• Maintain nutrition• Avoid abuses
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Social Dimension
• Interact successfully• Develop and maintain intimacy
• Develop respect and tolerance for others
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Emotional Dimension
• Ability to manage stress• Ability to express emotion
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Intellectual Dimension
• Ability to learn• Ability to use information effectively
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Spiritual Dimension
• Belief in some force that serves to unite
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Occupational Dimension
• Ability to achieve balance between work and leisure
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Environmental Dimension
• Ability to promote health measure that improves– Standard of living– Quality of life
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Models of Health• Clinical Model• Role Performance Model• Adaptive Model• Eudemonistic Model• Agent-Host-Environment Model• Health-Illness Continuum
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Clinical Model
• Provides the narrowest interpretation of health
• People viewed as physiologic systems • Health identified by the absence of signs
and symptoms of disease or injury• State of not being “sick”• Opposite of health is disease or injury
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Role Performance Model
• Ability to fulfill societal roles• Healthy even if clinically ill if roles
fulfilled• Sickness is the inability to perform
one’s role
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Adaptive Model
• Creative process• Disease is a failure in adaptation or
maladaption• Extreme good health is flexible
adaptation to the environment• Focus is stability• Element of growth and change
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Eudemonistic Model
• Comprehensive view of health• Condition of actualization or
realization of a person’s potential• Illness is a condition that prevents
self-actualization
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Agent-Host-Environment Model
• Each factor constantly interacts with the others
• When in balance, health is maintained
• When not in balance, disease occurs
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Health-Illness Continuum
• Measure person’s perceived level of wellness• Health and illness/disease opposite ends of a health
continuum• Move back and forth within this continuum day by day• Wide ranges of health or illness
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Factors Affecting Health Status, Beliefs, and
Practices• Internal variables• External variables
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Internal Variables
• Biologic dimension (genetic makeup, gender, age, and developmental level)
• Psychologic dimension (mind-body interactions and self-concept)
• Cognitive dimension (intellectual factors include lifestyle choices and spiritual and religious beliefs)
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External Variables
• Physical environment• Standards of living• Family and cultural beliefs• Social support networks
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Factors Affecting Health Care Adherence
• Client motivation• Degree of lifestyle change necessary• Perceived severity of problem• Value placed on reducing the threat
of illness• Difficulty in understanding and
performing specific behaviors• Degree of inconvenience of the
illness itself or of the regimens
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Factors Affecting Health Care Adherence
• Complexity, side effects, and duration of the proposed therapy
• Specific cultural heritage that may make adherence difficult
• Degree of satisfaction and quality and type of relationship with the health care providers
• Overall cost of prescribed therapy
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Illness
• A highly personal state• Person’s physical, emotional,
intellectual, social, developmental, or spiritual functioning is diminished
• Not synonymous with disease• May or may not be related to disease• Only person can say he or she is ill
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Disease
• Alteration in body function • A reduction of capacities or a
shortening of the normal life span
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Acute Illness
• Characterized by severe symptoms of relatively short duration
• Symptoms often appear abruptly, subside quickly
• May or may not require intervention by health care professionals
• Most people return to normal level of wellness
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Chronic Illness
• Lasts for an extended period• Usually has a slow onset• Often have periods of remissions and
exacerbations• Care includes promoting
independence, sense of control, and wellness
• Learn how to live with physical limitations and discomfort
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Parson’s Four Aspects of the Sick Role
• Clients are not held responsible for their condition
• Clients are not excused from certain social roles and tasks
• Clients are obligated to try to get well as quickly as possible
• Clients or their families are obligated to seek competent help
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Suchman’s Stages of Illness
• Stage 1: Symptom experience– Believe something is wrong
• Stage 2: Assumption of the sick role– Accepts the sick role and seeks
confirmation
• Stage 3: Medical care contact– Seeks advice of a health professional
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Suchman’s Stages of Illness
• Stage 4: Dependent client role– Becomes dependent on the professional
for help
• Stage 5: Recovery or rehabilitation– Relinquish the dependent role– Resume former roles and responsibilities
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Impact of Illness
On the Client• Behavioral and
emotional changes• Loss of autonomy• Self-concept and
body image changes
• Lifestyle changes
On the Family• Depends on:
– Member of the family who is ill
– Seriousness and length of the illness
– Cultural and social customs the family follows
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Impact of Illness: Family Changes
• Role changes• Task reassignments• Increased demands on time• Anxiety about outcomes• Conflict about unaccustomed
responsibilities • Financial problems• Loneliness as a result of separation and
pending loss• Change in social customs
Copyright 2008 by Pearson Education, Inc.
Question 1
Which one of the following is an example of the emotional component of wellness?
1. The client chooses health foods.2. A new father decides to take parenting
classes.3. A client expresses frustration with her
partner’s substance abuse.4. A widow with no family decides to join a
bowling league.
Copyright 2008 by Pearson Education, Inc.
Rationales 1
1. The client who chooses healthy foods represents the physical component.
2. Taking parenting classes enhances the intellectual component.
3. Correct. Frustration is an example of an emotion.
4. The bowling league enhances both the physical and social components.
Copyright 2008 by Pearson Education, Inc.
Question 2
Which one of the following individuals appears to have “taken on” the sick role?
1. An obese client states, “I deserve to have a heart attack.”
2. A mother is ill and says, “I won’t be able to make your
3. lunch today.”4. A man with low back pain misses several
physical therapy appointments.5. An elder states, “My horoscope says I will be
well again.”
Copyright 2008 by Pearson Education, Inc.
Rationales 2
1. The sick role states that persons are not answerable for their illness, contrary to the obese client’s perspective.
2. Correct. The mother has taken on the sick role by expecting to be excused from her usual role responsibilities.
3. In the sick role, the client tries to get better as opposed to the man who misses his physical therapy appointments.
4. The elder is not following the sick role expectation to rely on competent help.
Copyright 2008 by Pearson Education, Inc.
Question 3
Because a client recently diagnosed with diabetes mellitus is confident that blood sugar control can be improved with diet and exercise alone, and recently went checked out a video on the management of diabetes at the HMO education center, the client’s actions are most representative of which one of the following models:
1. Health belief model2. Clinical model3. Role performance model4. Agent-host-environment model
Copyright 2008 by Pearson Education, Inc.
Rationales 3
1. Correct. The behavior is most representative of health promotion, which is the central focus of the health belief model.
2. The clinical model focuses on relieving signs and symptoms of illness.
3. The role performance model emphasizes social activities such as fulfilling a particular role.
4. The agent–host–environment model focuses on predicting illness.
Copyright 2008 by Pearson Education, Inc.
Question 4Because a client with human immunodeficiency virus (HIV) is scheduled to begin several medications to manage the infection, the nurse will need to provide client education. Which of the following client characteristics is most likely to predict adherence with the treatment program? Select all that apply.
1. Educational level2. A trusting relationship with the health care
provider3. An expectation that the medications will be helpful4. Being able to take the medications twice daily
instead of four times daily5. Gender
Copyright 2008 by Pearson Education, Inc.
Rationales 4
1. Education has not been shown to be a predictive factor.
2. Correct. Significant evidence exists that a trusting relationship with the provider is an important predictor of adherence.
3. Correct. Effectiveness of the medication is an important predictor of adherence.
4. Correct. A less complex dosing regime is an important predictors of adherence with the medical regimen.
5. Gender has not been shown to be a predictive factor.
Copyright 2008 by Pearson Education, Inc.
Question 5
Which one of the following might be the BEST way to measure adherence to a prescribed medication regime?
1. Direct observation of medication administration.2. Evidence of illness complications or
exacerbations.3. Monitoring laboratory values of element
influenced by the medication.4. Questioning the client about his or her
medication routine.
Copyright 2008 by Pearson Education, Inc.
Resources
• Audio Glossary• Boston College: Welcome to the Nurse Theorist Web Site
Overview of Sister Callista Roy's Adaptation Model• Personality Theories: Abraham Maslow
Informative Web site on Maslow's Hierarchy of Needs• Mental Health: A Report of the Surgeon General
The Web site relates mental health and its relationship to well-being.
• Center for Scientific Review: National Institutes of Health: Risk, Prevention and Health Behavior.This sites offers information on the biological, psychological, and social conditions that affect mental illness.
Copyright 2008 by Pearson Education, Inc.
Resources
• Health and AgeThis site offers information on and links to various health-related items and news pertaining to the latest research and variables that affect health care.
• Center for the Study of Religion/Spirituality and Health
Abstracts and references on spirituality and health care
• World Health OrganizationWHO defines health and offers related documents.