1. Dr. Naglaa F. A. Youssef
Lecturer
Medical Surgical Nursing Dep.
Faculty of Nursing
Cairo University

3. Content outlines
 Definitions of terms: health, disease, illness and
wellness or well-being
 Concept of health
 Models of health & illness
 Factors affecting health belief, health status and
practice
 Levels of prevention
 Illness classifications
 Impact of illness on patients & family
 Role of the nurse in promotion & maintenance of
health
 Identify risk factors
 Follow levels of prevention

4.  Health: is a broad term, individualized to each person, and is
affected by so many factors, thus it has various definitions.
 Disease: is a pathological change in structure &/or
function……signs.
 Illness: is the response of person to disease, which is based
on the person’s perception……symptom.
 Wellness (health): is a status in which individual is capable of
meeting the minimum physical, psychological and social
requirements of appropriate functioning.
Glossary

5.  Self-concept (also called self-construction, self-identity, self-
perspective or self-structure). It is a collection of beliefs about
oneself that includes elements such as academic performance,
gender roles and sexuality, and racial identity.
Glossary

6. Dimensions of wellness

7.  Health and illness:
 are not static conditions,
 They are vital concepts,
 They are subject to continuous evaluation and
change.

8.  First definition:
 In 1948, the World Health Organization
(WHO) defines health as “a state of complete
physical, mental and social well-being and
not merely the absence of infirmity and
disease”.
Definitions of Health

9. 1. Health is a multidimensional concept that includes different
interdependent and interrelated aspects, i.e.
Feeling of health can be with or without disease.
Based on the WHO definition
Mental health
Social health
Well-being
Physical health

10. Bio-psychosocial dimensions of health

11. Characteristics of the WHO definition of health
1. Considers the individual as a holistic system.
2. Looks at the internal and external factors.
3. Acknowledges the individual’s role in life and his
value.
However, there is no general agreement about this
definition of health.

12. 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”.

13. Characteristics of the second
definition of health
 Considers health as a dynamic status, which
can be changed from time to time.
 Acknowledges the relationship between
internal and external environment and health
status.
 Recognizes the importance of adaptation to
maintain state of health and well-being.

14. Models of health and illness
1. Health-illness continuum
2. Agent-host environment model
3. High-Level Wellness Model
4. Health belief model
5. Health promotion model

15. 1. Health-illness continuum
model (adapted)
Disability symptoms Signs Awareness Education Growth
Premature
death
High
level
wellness
Treatment model
Psychosocial model
Medical
model
Nursing/care providers
interventions

16. Main idea of health-
illness continuum model
 Health and illness are seen as relative concepts and
not as separate absolutes.
 Health and illness as a graduated scale has two ends.
 Health is a dynamic state that fluctuates as a person
adapts to changes in the internal and external
environments to maintain a state of well- being.

17. 2. Agent–Host Environment
Model
 This model is used primarily in
describing causes of illness rather than
in promoting wellness.
 It helps in identifying risk factors that
result from interaction of agent-host-
environment.

18. Agent Host
Environment
Any internal or external
factor or stressor
(biological, chemical,
mechanical, physical, or
psychological) that by its
presence or absence
(e.g. lack of essential
nutrients → illness or
disease).
Person's who may be at
risk of acquiring a disease.
External factors that make
illness more or less likely.
Physical environment →
climate, living conditions,
sound (noise) levels, and
economic level.
Social environment →
interaction with others and
life events, such as death of
spouse, stress, or conflicts.
Components of this model

19. • When each of the agent-host-environment factors are in
balance, health is maintained and when not in balance
disease occurs (fluid, electrolytes, vitamins,…etc.

20. Factors affecting health belief, health
status and practice
Factors
Internal
factors
External
factors

21. A. Internal Factors affecting health belief,
health status and practice
 A-Biological dimension
 Developmental stage e.g. age,
 Heredity, genetics, race, and gender
 B-Psychological dimension:
 Mind-body interaction
 Self-concept
 Emotional factors
 C-Cognitive / intellectual dimension:
 Life-style choices
 Patterns of eating and exercise, use of tobacco, abuse of drugs and alcohol.
 Spiritual and religious beliefs

22. B. External Factors affecting health belief,
health status and practice
 Family practices
 Socioeconomic status
 Cultural background
 Social support networks

23. Levels of Preventive Care
Tertiary
prevention
Secondary
prevention
Primary preventionHealth promotion and
protection
Early diagnosis, treatment and
disability limitation
Restoration and rehabilitation
?
Give example

24. The Illness Classifications
I. Acute illness:
– Short term < three
months.
– Severe symptoms
appear suddenly.
Result in:
– Complete recovery,
– Death, or
– Develop into a
chronic disease.
II. Chronic illness:
– long term > 3 months,
– Less severe symptoms,
and
– Slow onset.
Result in:
– A state of optimizing
patient’s levels of
functioning.
– A state of optimizing
patient’s ability to live
with the illness
(coping).

25. Care for patient and his family as one unit

26. Impact of Illness on patient and
family
 Illness is never an isolated life event.
 Behavioral and emotional changes
 Impact on body image
 Impact on self concept
 Impact on family roles
 Impact on family dynamics

27. 1. Behavioral and emotional changes
 People react differently to illness.
 Reaction to illness depends on:
 Nature of illness e.g. duration, severity.
 Client’s attitude toward the illness.
 The others’ reaction (e.g. family) to the client’s
illness.
E.g. life threatening illness can lead to more extensive
emotional and behavioral changes, such as anxiety,
depression, shock, denial, anger and withdrawal.
Example of leg amputation…..

28. 3. Impact on Body Image
Body image has been defined as “the subjective concepts of
physical appearance’’ (Potter and Perry 2014).
Reaction to changes differently according to:
 Type and rate of changes,
 Individual's capacity of adaption, and
 Availability of supportive health service.

29. 2. Impact on family roles
 People have various social role in and out their families,
such as work, decision maker and parent.
 When illness occurs, the client’s and family’s role may
change.
 The change may be slight or huge based on the disease
duration and severity, and people ability to cope.
 Nurses should involve the patient’s family in the
care plan.

30. 5. Impact on Family Dynamics
 It means the process of family coping,
making decision and giving support.
 Activities & decision making delay action,
new pattern of functioning stress &
reversal of roles → stress & conflicting
responsibilities.
 Each client responds uniquely to illness →
nursing assessment, diagnosis, and
interventions must be individualized.

31. Role of the Nurses in the Promotion &
Maintenance of Health

32.  Maintaining or improving the person’s perception
about his/her health status is a central goal of
nursing practice.
 A nurse can determine a client’s level of health
using the health-illness continuum.
 Then, a nurse can help the patient/client to
identify his/her position on the health-illness
continuum. This can guide to set a goal for
achieving optimal health.