HEALTH / ILLNESS / DISEASE

1. HEALTH / ILLNESS / DISEASE

2. OBJECTIVES • After the class the students will be able to: • Define health • Define illness • Describe the philosophy of health • Describe the concept of health/Illness • List ICD classification of diseases • Enumerate models of health/wellness • Describe the illness behavior • List the various models of disease causation

3. INTRODUCTION Nurses understanding of health and wellness largely determines the scope and nature of nursing practice. For many years the concept of disease was the yardstick by which health was measured

4. HEALTH A STATE OF BEING WELL AND USING EVERY POWER THE INDIVIDUAL POSSESSES TO THE FULLEST EXTENT. - NIGHTINGALE, 1860/1969 A STATE OF COMPLETE PHYSICAL MENTAL AND SOCIAL WELLBEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY. - WHO, 1948

5. NEW PHILOSOPHY OF HEALTH • Health is a fundamental human right. • Health is essence of productive life. • Health is inter- sectoral. • Health is integral part of development. • Health is central to quality of life. • Health involves individuals, state and international responsibility. • Health and its maintenance is major social investment. • Health is world-wide social goal.

6. CONCEPTS OF HEALTH • BIOLOGICAL CONCEPT ABSENCE OF DISEASE • ECOLOGICAL CONCEPT EQUILIBRIUM BETWEEN MAN AND ENVIRONMENT • PSYCHOLOGICAL CONCEPT NOT ONLY BIOMEDICAL ASPECT HEALTH HAS POLITICAL SOCIAL PSYCHOLOGICAL CULTURAL ECONOMICAL FACTORS. • HOLISTIC CONCEPT

7. WELLNESS WELLNESS IS A STATE OF WELLBEING COMPONENTS OF WELLNESS • SOCIAL(INTERACTION WITH OTHER AND ENVT) • PHYSICAL(ABILITY TO DO ADLs) • SPIRITUAL(BELIEF WHICH UNITESHUMANBEING) • EMOTIONAL(STRESS MANAGEMENT) • INTELLECTUAL(LEARNING AND USING INFORMATION) • OCCUPATIONAL(BALANCE BETWEEN WORK AND LIESURE TIME) • ENVIRONMENTAL(HEALTH MEASURES TO IMPROVE QOL AND LIVING)

8. MODELS OF WELLNESS AGENT HOST ENVIRONMENTAL MODEL TRAVIS ILLNESS WELLNESS CONTINUUM PREMATURE DEATH----HIGH LEVEL WELLNESS HEALTH ILLNESS CONTINUA

9. DUNN’S HIGH LEVEL WELLNESS GRID

10. ILLNESS AND DISEASE ILLNESS 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 TO DISEASE OR EVEN MAYNOT BE RELATED. A TUMOR IN STOMACH (DISEASE) AND NOT FEEL ILL. ILLNESS IS HIGHLY SUBJECTIVE

11. CAUSES OF ILLNESS • Biological causes • Nutritional causes • Physical causes • Chemical causes • Mechanical causes • Genetic and immunity • Social factors

12. Risk factors • Genetic and physiological factors • Age • Environment • lifestyle

13. DISEASE • AN ALTERATIONS IN BODY FUNCTIONS RESULTING IN A REDUCTION OF CAPACITIES OR A SHORTENING OF NORMAL LIFE SPAN. • THE CAUSATION OF A DISEASE IS CALLED ETIOLOGY. • ETIOLOGY INCLUDES THE IDENTIFICATION OF ALL THE CAUSAL FACTORS THAT ACT TOGETHER TO BRING ABOUT THE PARTICULAR DISEASE

14. Webster defines disease as “a condition in which body health is impaired, a departure from a state of health, an alteration of the human body interrupting the performance of vital functions”. The oxford English Dictionary defines disease as “ a condition of the body or some part or organ of the body in which its functions are disturbed or deranged”.

15. Distinction between Disease, Illness and Sickness • The term disease literally means “without ease” (uneasiness), when something is wrong with bodily function. • Illness refers to the presence of a specific disease, and also to the individual’s perceptions and behavior in response to the disease, as well as the impact of that disease on the psychosocial environment. • Sickness refers to a state of social dysfunction. • Disease is a physiological/psychological dysfunction. • Illness is a subjective state of the person who feels aware of not being well. • Sickness is a state of social dysfunction i.e. a role that the individual assumes when ill (sickness role).

17. TYPES • Acute illness Typically characterised by severe symptoms of relatively short duration. Often appear abruptly and subside quickly. And depending on the cause may or maynot require treatment. • Chronic illness One that lasts for an extended period usually 6 months or longer. Usually slow onset and often has periods of remissions when sypmtoms disappear and exacerbation when the symptoms reappear. Terminal illness Active and malignant disease that cannot be cured.

18. ILLNESS BEHAVIOUR • A COPING MECHANISM INVOLVES WAYS INDIVIDUALS DESCRIBE MONITOR AND ITERPRET THEIR SYMPTOMS THAKE REMIDIAL ACTIONS AND USE THE HEALTH CARE SYSTEM. • SUCHMAN (1979) DESCIBED 5 STAGE OF ILLNESS. • NOT ALL CLIENTS PRORESS THROUGH EACH STAGE.

19. SUCHMAN ILLNESS BEHAVIOUR STAGE 1 – SYPTOM EXPERIENCE The person is aware that something is wrong. A person usually recognizes a physical sensation or a limitation in functioning but does not suspect a specific diagnosis. • Three aspects: – Physical (Fever, Muscle Aches, Malaise, Headache) – Cognitive (Perception of “having flu”) – Emotional (Worry on consequence of illness)

20. STAGE 2 – ASSUMPTION OF THE SICK ROLE If symptom persist and become severe, clients assume the sick role. At this point, the illness becomes a social phenomenon, and sick people seek confirmation from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations.

21. STAGE 3 – MEDICAL CARE CONTACT If symptoms persist despite the home remedies, become severe or require emergency care, the person is motivated to seek professional health services. In this stage the client seeks expert acknowledgement of the illness as well as the treatment. Validation of real illness; Explanation of symptoms; Reassurance or prediction of outcome

22. STAGE 4 – DEPENDENT CLIENT ROLE The client depends on health care professionals for the relief of symptoms. The client accepts care, sympathy and protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule. Accepts/rejects health professional’s suggestions; becomes more passive and accepting; may regress to an earlier behavioral stag

23. STAGE 5 – RECOVERY OR REHABILITATION This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage may involve in an adjustment to a prolong reduction in health and functioning. Gives up the sick role and returns to former roles and function

24. IMPACT 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

25. IMPACT ON THE FAMILY • 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

27. T H E O R I E S O F D I S E A S E C A U S A T I O N • A.Oldtheories • B.Germ theory of disease • C.Biomedical model • D.Theory of multifactorial causation • E.Epidemiologicaltraid • F.Lazaru’s theories of stress response • G.Wolff’s theory of stress, organ maladaptation and disease • H.Holmes and Rahe’s theory of life change and onset of illness.

28. A. Old theories Till the end of 18th century, various theories were in vogue, e.g. supernatural theory of disease (e.g. curse of God; an evil eye). The Ayurveda considers that the disease is due to imbalance of the ‘tridosha’. These are vata(air), pitta(bile), and kapha(mucus). The Chinese medicine believes that the disease is caused due to imbalance of male principle(yang)and female principle(yin).

29. GERM THEORY • The discoveries in microbiology at the turn of 18th century became a turning point in the etiological concept of disease. • Louis Pasteur (1860) demonstrated the presence of bacteria in the air. • Robert Koch (1877) showed that anthrax was caused by bacteria Robert Koch

30. These theories of pasture and Koch confirmed the germ theory of disease. Thus, the emphasis has shifted from empirical causes (like bad air as a cause in malaria) of the old theories to microbes of Germ theory. But now it is recognized that a disease is rarely caused by a single agent alone, but depends upon a number of contributory factors.

31. The Biomedical model This model explains the disease as a result of malfunctioning organs or cells, e.g. diabetes is caused by malfunctioning of pancreas. But the drawback with it is focuses on cause and effect relationships, and ends to ignore the psychosocial component of the disease.

32. Theory of multifactorial causation Now it is recognized that a disease is not caused by an organism but also predisposed by many factors contributing to its occurrence, specially ‘modern diseases’ of civilization like lung cancer, diabetes, coronary heart disease, mental illness etc. These predisposing factors are social, economic, cultural, genetic psychological factors, etc. (including poverty, illiteracy, ignorance and poor living conditions). This theory of multifactorial causation was put forth by Pettenkofer Munich (1819-1901). This theory de-emphasizes the “Germ theory” (or single cause idea)

33. Epidemiological Triad : The Germ theory of disease has many limitations. For example, it is well known that not everyone exposed to tuberculosis develops tuberculosis. The same exposure, however in an undernourished or otherwise susceptible person, may result in clinical disease. Similarly, not everyone to beta-hemolytic streptococci develops acute rheumatic environment, which are equally important to determine whether or not disease will occur in the exposed host. This demanded a broader concept of disease that synthesized the basic factors of agent, host and environment.

35. Lazaru’stheories of stress response According to him, in the process of coping, the individual shapes as well as responds to a demand or stress, which can have an impact on the client’s resistance to disease.

36. Wolff’s theory of stress, organ maladaptation and disease He studied people’s response to chronic stressors, like a frustrating job or an unhappy home life. He believed that a person’s total life situation profoundly affects a person’s susceptibility to disease.

37. Holmes and rahe’s theory of life changes and the onset of illness They explored the relationship between the amount of change in a person’s life and subsequent illness. They discovered that the higher a person’s life changes score, the greater is the like hood that an illness would develop.

38. WEB OF CAUSATION • This model of disease causation was suggested by Mac Mohan and Pugh. • This model is ideally suited in the study of chronic disease where the disease agent is often not known, but is the outcome of interaction of multiple factors. • The web of causation considers all the predisposing factors of any type and their complex interaction with each other. • The basic tenets of epidemiology are to study the clusters of causes and combinations of efforts and how they relate to each other. • The web of causation does not imply that the disease can not be controlled unless all the multiple causes or chain of causation or at least a number of them are appropriately controlled. • Sometimes, removal of one link may be sufficient to control disease.

40. PATHOGENESIS OF DISEASE It means the evolution of a disease process in an individual, from its early stage to final stage of recovery or death, in the absence of any intervention such as prevention or treatment. This differs from disease and from person to person. The natural history of an infectious disease occurs in two phases - prepathogenesisand pathogenesis.

41. Pre-Pathogenesis Phase This phase refers to the period before the onset of disease. During this phase, interaction is taking place among the three components of epidemiological triad namely Agent, Host, and Environment, each I.AgentFactors A disease ‘agent’ is defined as a substance, living or nonliving or a force, the excessive presence or relative lack of which initiates the disease process. The disease agents are broadly classified into the following groups

42. P h y s i c a l a g e n t s : Heat, cold, radiation, noise, atmospheric pressure, humidity, etc. Chemical agents : Endogenous: Urea, uric acid, bilirubin, ketones, calcium oxalate, etc. Exogenous : Dust, das, fumes, metals, allergens, etc. Biological agents : viruses, rickettsia, bacteria, fungi, protozoa, helminthes, etc. M e c h a n i c a l a g e n t s : friction, force, injury, sprain, accidents, etc. N u t r i t i o n a l a g e n t s : proteins, fats

43. HOST FACTORS • Age : certain disease is peculiar in certain age-group. • Sex : certain disease like lung cancer and coronary heart disease are common among men and rheumatoid arthritis, diabetes, and obesity are common among women. • Ethnicity : Sickle cell anemia is more frequent among the negroes. • Occupation : This not only determines the income but also the health hazards arising out of the occupation, e.g. pneumoconiosis • L i t e r a c y l e v e l : The higher the literacy level, the lower is the incidence of the disease.

44. Income : This is the ‘key’ factors determining the standard of living and influences the development of the disease. Lower socioeconomic status predisposes for infectious disease and higher status for non-communicable disease. • Marital status : cancer of cervix is common among the married women than the unmarried women. • Nutritional status : poor nutritional status makes a person more vulnerable to infectious disease. • Life-style factors : Like smoking, alcoholism, drugabuse, lack of exercise, multiple sexual partnership, etc. favor the development of disease.

45. Environmental factors These are classified into physical, biological, and sociological environment. •Physical environment : Air, water, soil, food, etc. •Biological environment : Plants, animals, insects, rodents, microbes, etc. •sociological environment : death, divorce of parents, desertion, loss of employment, birth of a handicapped child, etc.

46. Pathogenesis Phases The pathogenesis phase begins with the entry of the disease ‘agent’ in the susceptible human host. The further events in the pathogenesis phase are clear cut in infectious disease, i.e. the disease agent multiple and induces tissue and physiological changes, the disease progresses through a period of incubation and later through early and late pathogenesis. The final outcome of disease may be recovery, disability, or death. The pathogenesis phase may be modified by intervention measures such as immunization and chemotherapy.

47. The infection may be clinical or sub-clinical, and when it is subclinical, the person will not have recognizable signs and symptoms but may spread the disease agent to others, acting as a ‘carrier’, as in typhoid and diphtheria. When the person develops clinical signs and symptoms, he is called a ‘clinical case’.

48. NATURALHISTORYOF DISEASE Stage of susceptibility Asymptomatic Stage of prepathogenesis Symptomatic Symptomatic Stage of clinical disease

49. ICEBERG PHENOMENON OF DISEASE According to this concept, the disease in the community is compared to an iceberg. When a piece of ice is allowed to float on water, a small portion is visible and a major portion is submerged in the water. The visible tip of ice is compared to clinical cases, which the physician sees in the community.

50. The major submerged portion of ice corresponds to the hidden mass of unrecognized disease such as latent cases, in apparent, carriers, asymptomatic, and undiagnosed cases in the community, which are all responsible for the constant prevalence of the disease in the community.