6/15/2016

Chapter

17

Health, Wellness, and

Illness

Question 1
Which one of the following is an example of the emotional component
of wellness?
1.
2.
3.
4.

The client chooses health foods.

A new father decides to take parenting classes.
A client expresses frustration with her partners substance abuse.
A widow with no family decides to join a bowling league.

Copyright 2008 by Pearson Education, Inc.

Rationales 1

Question 2

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.

Which one of the following individuals appears to have taken on the sick role?

1.

1.
2.
3.
4.
5.

An obese client states, I deserve to have a heart attack.

A mother is ill and says, I wont be able to make your
lunch today.
A man with low back pain misses several physical therapy appointments.
An elder states, My horoscope says I will be well again.

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Rationales 2
1.
2.

3.
4.

Question 3

The sick role states that persons are not answerable for their illness,
contrary to the obese clients perspective.
Correct. The mother has taken on the sick role by expecting to be
excused from her usual role responsibilities.
In the sick role, the client tries to get better as opposed to the man
who misses his physical therapy appointments.
The elder is not following the sick role expectation to rely on
competent help.

Copyright 2008 by Pearson Education, Inc.

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
clients actions are most representative of which one of the following models:
1.
2.
3.
4.

Health belief model

Clinical model
Role performance model
Agent-host-environment model

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6/15/2016

Rationales 3
1.

2.
3.
4.

Question 4

Correct. The behavior is most representative of health promotion,

which is the central focus of the health belief model.
The clinical model focuses on relieving signs and symptoms of illness.
The role performance model emphasizes social activities such as
fulfilling a particular role.
The agenthostenvironment model focuses on predicting illness.

Because 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.
2.
3.
4.
5.

Educational level
A trusting relationship with the health care provider
An expectation that the medications will be helpful
Being able to take the medications twice daily instead of four times daily
Gender

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Rationales 4
1.
2.
3.
4.

5.

Question 5

Education has not been shown to be a predictive factor.

Correct. Significant evidence exists that a trusting relationship with the provider is
an important predictor of adherence.
Correct. Effectiveness of the medication is an important predictor of adherence.
Correct. A less complex dosing regime is an important predictors of adherence
with the medical regimen.
Gender has not been shown to be a predictive factor.

Which one of the following might be the BEST way to measure adherence to a
prescribed medication regime?
1.
2.
3.
4.

Direct observation of medication administration.

Evidence of illness complications or exacerbations.
Monitoring laboratory values of element influenced by the medication.
Questioning the client about his or her medication routine.

Copyright 2008 by Pearson Education, Inc.

Rationales 5
1.
2.

3.
4.

Copyright 2008 by Pearson Education, Inc.

Health, Wellness, Wellbeing

Correct. Although not always practical, direct observation is the best method to
measure adherence (for example, watching heroin addicts actually take their
methadone dose).
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.
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.
Client report or recall is not always accurate, even if the client believes he or she
is telling the truth.

Copyright 2008 by Pearson Education, Inc.

Many definitions and interpretations

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6/15/2016

Health

Wellness

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

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

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Dimensions of Wellness

Well-being
Subjective perception of vitality and feeling well
Described objectively, experienced, measured
Can be plotted on a continuum

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Physical Dimension

Social Dimension

Ability to carry out daily tasks

Achieve fitness
Maintain nutrition
Avoid abuses

Interact successfully
Develop and maintain intimacy
Develop respect and tolerance for others

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Copyright 2008 by Pearson Education, Inc.

6/15/2016

Emotional Dimension

Intellectual Dimension
Ability to learn
Ability to use information effectively

Ability to manage stress

Ability to express emotion

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Spiritual Dimension

Occupational Dimension

Belief in some force that serves to unite

Ability to achieve balance between work and leisure

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Copyright 2008 by Pearson Education, Inc.

Environmental Dimension

Models of Health

Ability to promote health measure that improves

Standard of living
Quality of life

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Clinical Model
Role Performance Model
Adaptive Model
Eudemonistic Model
Agent-Host-Environment Model
Health-Illness Continuum

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6/15/2016

Clinical Model

Role Performance 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

Ability to fulfill societal roles

Healthy even if clinically ill if roles fulfilled
Sickness is the inability to perform ones role

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Adaptive Model

Eudemonistic 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

Comprehensive view of health

Condition of actualization or realization of a persons potential
Illness is a condition that prevents self-actualization

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Health-Illness Continuum

Agent-Host-Environment Model

Each factor constantly interacts

with the others
When in balance, health is
maintained
When not in balance, disease
occurs

Copyright 2008 by Pearson Education, Inc.

Measure persons 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

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)

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

External Variables

Factors Affecting Health Care Adherence

Physical environment
Standards of living
Family and cultural beliefs
Social support networks

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

Copyright 2008 by Pearson Education, Inc.

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

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Illness
A highly personal state
Persons 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

Acute Illness

Alteration in body function

A reduction of capacities or a shortening of the normal life span

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

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Parsons Four Aspects

of the Sick Role

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

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

Copyright 2008 by Pearson Education, Inc.

Suchmans Stages of
Illness

Copyright 2008 by Pearson Education, Inc.

Suchmans Stages of
Illness

Stage 1: Symptom experience

Stage 4: Dependent client role

Believe something is wrong

Becomes dependent on the professional for help

Stage 2: Assumption of the sick role

Stage 5: Recovery or rehabilitation

Accepts the sick role and seeks confirmation

Relinquish the dependent role

Resume former roles and responsibilities

Stage 3: Medical care contact

Seeks advice of a health professional

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

6/15/2016

Impact of Illness
On the Client
Behavioral and emotional changes
Loss of autonomy
Self-concept and body image
changes
Lifestyle changes

Impact of Illness: Family 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

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.

Copyright 2008 by Pearson Education, Inc.

Question 1

Rationales 1

Which one of the following is an example of the emotional component

of wellness?
1.
2.
3.
4.

The client chooses health foods.

A new father decides to take parenting classes.
A client expresses frustration with her partners substance abuse.
A widow with no family decides to join a bowling league.

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.

Copyright 2008 by Pearson Education, Inc.

Question 2
1.
2.
3.
4.
5.

Rationales 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.

A mother is ill and says, I wont be able to make your
lunch today.
A man with low back pain misses several physical therapy appointments.
An elder states, My horoscope says I will be well again.

2.

Copyright 2008 by Pearson Education, Inc.

3.
4.

The sick role states that persons are not answerable for their illness,
contrary to the obese clients perspective.
Correct. The mother has taken on the sick role by expecting to be
excused from her usual role responsibilities.
In the sick role, the client tries to get better as opposed to the man
who misses his physical therapy appointments.
The elder is not following the sick role expectation to rely on
competent help.

Copyright 2008 by Pearson Education, Inc.

6/15/2016

Question 3

Rationales 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
clients actions are most representative of which one of the following models:
1.
2.
3.
4.

Health belief model

Clinical model
Role performance model
Agent-host-environment model

1.

2.
3.
4.

Correct. The behavior is most representative of health promotion,

which is the central focus of the health belief model.
The clinical model focuses on relieving signs and symptoms of illness.
The role performance model emphasizes social activities such as
fulfilling a particular role.
The agenthostenvironment model focuses on predicting illness.

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Question 4

Rationales 4

Because 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.
2.
3.
4.
5.

Educational level
A trusting relationship with the health care provider
An expectation that the medications will be helpful
Being able to take the medications twice daily instead of four times daily
Gender

1.
2.
3.
4.

5.

Education has not been shown to be a predictive factor.

Correct. Significant evidence exists that a trusting relationship with the provider is
an important predictor of adherence.
Correct. Effectiveness of the medication is an important predictor of adherence.
Correct. A less complex dosing regime is an important predictors of adherence
with the medical regimen.
Gender has not been shown to be a predictive factor.

Copyright 2008 by Pearson Education, Inc.

Copyright 2008 by Pearson Education, Inc.

Question 5

1.
2.
3.
4.

Resources

Which one of the following might be the BEST way to measure adherence to a
prescribed medication regime?

Direct observation of medication administration.

Evidence of illness complications or exacerbations.
Monitoring laboratory values of element influenced by the medication.
Questioning the client about his or her medication routine.

Copyright 2008 by Pearson Education, Inc.

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.

6/15/2016

Resources
Health and Age
This 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 Organization
WHO defines health and offers related documents.

Copyright 2008 by Pearson Education, Inc.

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