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Chapter 4
Health and Illness
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Definitions of Health States
• Health: a state of complete physical, mental, and social
well being, not merely the absence of disease
• Illness: the unique response of a person to a disease
• Wellness: an active state, oriented toward maximizing
the potential of the individual
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Dimensions of Health
• Physical
• Intellectual
• Emotional
• Sociocultural
• Spiritual
• Environmental aspects
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Human Dimensions Composing the
Whole Person
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Acute Illness
• Generally has a rapid onset of symptoms and lasts only a
relatively short time
• Examples: appendicitis, pneumonia, diarrhea, common
cold
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chronic Illness
• A broad term that encompasses many different physical
and mental alterations
• Examples: diabetes mellitus, lung disease, arthritis, lupus
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Characteristics of a Chronic Illness
• It is a permanent change
• It causes, or is caused by, irreversible alterations in
normal anatomy and physiology
• It requires special patient education for rehabilitation
• It requires a long period of care or support
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stages of Illness Behavior
• Experiencing symptoms
• Assuming the sick role
• Assuming a dependent role
• Achieving recovery and rehabilitation
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Agent-Host-Environment Model (Leavell
and Clark)
• Examines the causes of disease in an individual
• Agent, host, and environment interact in ways that
create risk factors
• Understanding the risk factors is important for the
promotion and maintenance of health
• The host reaction is influenced by family history, age,
and health habits
• The environment includes physical, social, biologic, and
cultural factors
• Each of the agent-host-environment factors affects and is
affected by the others
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Agent-Host-Environment Triangle
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Health–Illness Continuum
• Measures a person’s level of health
• Views health as a constantly changing state with highlevel wellness and death on opposite sides of a
continuum
• Illustrates the dynamic (ever-changing) state of health
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Health–Illness Continuum
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The 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
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Factors Affecting Health Status, Beliefs,
and Practices
• Risk factors for illness
• Factors in the human dimensions that influence health–
illness status
• Beliefs and practice
• Basic human needs
• Self-concept
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Human Dimensions
• Physical dimension—genetic inheritance, age,
developmental level, race, and gender
• Emotional dimension—how the mind affects body
function and responds to body conditions
• Intellectual dimension—cognitive abilities, educational
background, and past experiences
• Environmental dimension—housing, sanitation, climate,
pollution of air, food, and water
• Sociocultural dimension—economic level, lifestyle, family,
and culture
• Spiritual dimension—spiritual beliefs and values
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Basic Human Needs
• Physiological needs
• Safety and security needs
• Love and belonging needs
• Self-esteem needs
• Self-actualization needs
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Factors That Influence a
Person’s Self-Concept
• Past experiences
• Interpersonal interactions
• Physical and cultural influences
• Education
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Levels of Preventive Care
• Primary prevention—e.g., diet, exercise, immunizations
• Secondary prevention—e.g., screenings, mammograms,
family counseling
• Tertiary prevention—e.g., medications, surgical
treatment, rehabilitation
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following is an example of an acute illness?
A. Diabetes
B. Rheumatoid arthritis
C. Pneumonia
D. Osteoporosis
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: C. Pneumonia
Rationale:
Pneumonia is an acute illness that has a rapid onset of
symptoms and lasts only a relatively short time.
Diabetes, rheumatoid arthritis, and osteoporosis are
chronic illnesses that cause a permanent change, require
special patient education for rehabilitation, and require a
long period of care or support.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
A person who is experiencing a productive cough and
fever takes a sick day to recuperate and decide whether
to make an appointment with the doctor. This person is
said to be in stage 3 of illness behavior: assuming a
dependent role.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
A person who defines himself as sick and self-medicates
or visits a doctor is said to be in stage 2 of illness
behavior: assuming the sick role.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following models of health and illness views
health as a constantly changing state, with high-level
wellness and death being on opposite ends of a
graduated scale?
A. Agent-host-environment model
B. Health-illness continuum
C. High-level wellness model
D. Health belief model
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. Health-illness continuum
Rationale:
The health-illness continuum measures a person’s level
of health on a graduated scale.
The agent-host-environment model refers to the
interaction of the agent, host, and environment creating
risk factors that must be examined.
The high-level wellness model involves functioning to
maximum potential with balance and direction.
The health belief model is concerned with what people
believe to be true about their health.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
A person who keeps in touch with neighbors in an
attempt to foster a “community feeling” is promoting his
or her emotional human dimension.
A. True
B. False
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which of the following is an example of a nursing activity
that promotes secondary prevention as a level of
preventive care?
A. Conducting a smoking cessation class
B. Performing a blood pressure screening at a local mall
C. Performing range-of-motion exercises on a bedridden
patient
D. Promoting safe sex practices in school settings
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. Performing a blood pressure screening at a
local mall
Rationale:
Secondary preventive care focuses on early detection of
disease, such as the heart disease in this example.
Primary preventive care is directed toward promoting
health and preventing diseases.
Tertiary care begins after an illness is diagnosed to
reduce disability and rehabilitate patients.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
Answer: B. False
A person who keeps in touch with neighbors in an
attempt to foster a “community feeling” is promoting his
or her sociocultural human dimension.
Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins