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Coordinating Health Care F09
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  2. 2. DEFINITIONS OF HEALTH • World Health Object 5 Organization – Health is the state of complete physical, mental, social (totality) well-being and not merely the absence of disease or infirmity
  3. 3. DEFINITIONS OF HEALTH • Health is individually defined by each person • On a personal level, individuals define health according to – how they feel – absence or presence of symptoms of illness – and ability to carry out activities
  4. 4. Wellness • An integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. • It requires that the individual maintain a continuum of balance and purposeful direction within the environment where he is functioning. (Halbert Dunn)
  5. 5. DISEASE • Objective pathologic process • Pathologic change in the structure or function of the mind and body
  6. 6. DISEASE • Acute – Rapid onset of symptoms – Some are life threatening – Many do not require medical treatment
  7. 7. DISEASE • Chronic – Broad term that encompasses many different physical and mental alterations in health • It is a permanent change • Requires special patient education for rehabilitation • Requires long term of care and support
  8. 8. Illness • A highly personal state in which the person feels unhealthy, may or may not related to disease.
  9. 9. ILLNESS • Highly subjective feeling of being sick or ill • How the person feels towards sickness • Concerns the Nurse
  10. 10. ELEVEN STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN • 1. Symptom Experience – Client realizes there is a problem – Client responds emotionally • 2. Sick Role Assumption – Self-medication / Self-treatment – Communication to others
  11. 11. ELEVEN STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN • 3. Assuming a Dependent Role – Accepts the diagnosis – Follows prescribed treatment • 4. Achieving recovery and rehabilitation – Gives up the dependent role and assumes normal activities and responsibilities
  12. 12. Well-being • A subjective perception of balance, harmony and vitality
  13. 13. Dimensions of Wellness
  14. 14. Physical Dimension • Genetic make up, age, developmental level, race and sex are all part of an individual’s physical dimension and strongly influence health status and health practice. – Examples • The toddler just learning to walk is prone to tall and injure himself. • The young woman who has a family history of breast cancer and diabetes is at a higher risk to develop these conditions.
  15. 15. Emotional Dimensions • Refers to feelings, affect and person’s ability to express these; • includes belief in one’s worth. • long-term stress affects the body systems and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change body responses to illness.
  16. 16. Intellectual Dimension • encompasses cognitive abilities, educational background and past experiences; positive sense of purpose. • These influence a client’s response to teaching about health and reactions to health care during illness.
  17. 17. Environmental Dimension • The ability to promote health measures that improve the standard of living and quality of life in the community. • includes influences such as food, water, and air.
  18. 18. Socio-cultural Dimensions • Concerns the sense of having support available from family and friends; practices, values and beliefs that determine health.
  19. 19. Spiritual Dimensions • Refers to the recognition and ability to practice moral or religious principles or beliefs; recognition and maintenance of a harmonious relationship with a Supreme Being.
  20. 20. Health-Illness Continuum
  21. 21. Health-Illness Continuum • Health and illness can be viewed as the opposite ends of a health continuum • From high level of health a person’s condition can move through good health -- normal health -- poor health -- extremely poor health -- to death. • People move back and forth within this continuum day by day. • How people perceive themselves and how others see them in terms of health and illness will also affect their placement on the continuum.
  22. 22. Characteristics of Health-Illness Continuum Model • At any time any person’s health status holds a place on certain point between two ends of health-illness continuum. • Any point on the health-illness continuum is a synthetically representation of various aspects of individual in physiology, psychology and society.
  23. 23. • Nurses Responsibilities – To help the client to identify their place on the health-continuum. – To assist the clients to adopt some measures in order to reach a well state of health.
  25. 25. DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL • X-axis is HEALTH – ranges from peak wellness to death • Y-axis is ENVIRONMENT – ranges from very favorable to very unfavorable
  26. 26. DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL Quadrant 1 Quadrant 2 - High Level Wellness - Protected Poor Health in a favorable in a favorable environment environment Quadrant 3 Quadrant 4 - Poor health in an - Emergent High Level unfavorable Wellness in an environment unfavorable environment
  27. 27. Travis’ Illness-Wellness Continuum • Composed of two arrows pointing in opposite directions and joined at a neutral point
  28. 28. 1.Movement to the right on the arrows (towards high-level wellness) equals an increasing level of health and well-being – Achieved in Three Steps: a. Awareness b. Education c. Growth
  29. 29. 2. Movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health – Achieved in Three Steps: a. Signs b. Symptoms c. Disability
  30. 30. 3. Most important is the direction the individual is facing on the pathway a. If towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status b. If towards premature death, a person has a genuinely pessimistic or negative outlook about his/her health status
  31. 31. 4. Compares a treatment model with a wellness model a. If a treatment model is used, an individual can move right only to the neutral point Example: a hypertensive client who only takes his medications without making any other life-style changes a. If a wellness model is used, an individual can move right past the neutral point Example: a hypertensive client who not only takes his medications, but stops smoking, looses weight, starts an exercise program, etc.
  32. 32. HEALTH BELIEF MODEL BY ROSENTOCK • Concerned with what people perceive about themselves in relation to their health • Consider perceptions (influences individuals motivation toward results) – Perceived susceptibility – Perceived seriousness – Perceived benefit out of the action
  33. 33. Scope of Nursing Practice
  34. 34. Scope of Nursing Practice Nurses provide care for 3 types of clients: • a. Individuals • b. Families • c. Communities 4 Areas of Nursing Practice 1. PROMOTING HEALTH & WELLNESS (HEALTH PROMOTION) -Wellness is a state of well-being. It means engaging in attitudes and behavior that enhance the quality of life and maximize personal potential. -Health promotion is a behavior motivated by the desire to increase well-being and actualize human health potential.
  35. 35. Scope of Nursing Practice The Nurse’s Role in Health Promotion: – 1. Model healthy lifestyle behaviors and attitudes. – 2. Facilitate client involvement in the assessment, implementation and evaluation of health goals. – 3. Teach clients self-care strategies to enhance fitness, improve nutrition, manage stress and enhance relationships. – 4. Assist individuals, families and communities to increase their level of health. – 5. Educate clients to be effective health care consumers. – 6. Assist clients, families and communities to develop and choose heal h promotion options. – 7. Guide client’s development in effective problem solving and decision-making. – 8. Reinforce client’s personal and family health promoting behaviors. – 9. Advocate in the community for changes that promote a healthy environment.
  36. 36. Scope of Nursing Practice client… no matter how acutely or chronically ill, has Strength. The Nurse must identify the use of these strengths to help client reach maximum function & quality of life or meet death with dignity. Programs or Health Promotion • 1. Information dissemination • 2. Health risk appraisal and wellness assessment • 3. Lifestyle and behavior change • 4. Environmental control programs.
  37. 37. Scope of Nursing Practice H E A L T H P R O M O T IO N T O P IC S INFANTS • -Infant- parent attachment/ bonding • - Breastfeeding • - Sleep patterns • - Playful activity to stimulate development • - Immunizations • - Safety promotion and injury control. CHILDREN • Nutrition • Dental check-ups • Rest and exercise • Immunizations • Safety promotion and injury control
  38. 38. Scope of Nursing Practice ADOLESCENTS • Communicating with the teen. • Hormonal changes • Nutrition • Exercise and rest • Peer group influences • Self concept and body image • Sexuality • Safety promotion and accident prevention ELDERS • Adequate sleep - Drug Management • Exercise - Appropriate use of alcohol • -Dental/ oral health - Foot health
  39. 39. Health Maintenance • goes hand in hand with health promotion and disease promotion. • The active process of achieving health and remaining healthy.
  40. 40. Elements Included in the Strategies Used for Health Maintenance: • Nutrition – The science that studies how the kind of food people eat affects their health and performance – foods or food components that cause disease or deteriorate health. – studies foods and dietary supplements that improve performance, promote health, and cure or prevent disease. • Exercise – The performance of movements in order to develop or maintain physical fitness and overall health. – Frequent and regular physical exercise is to prevention of some diseases such as cancer, cardiovascular disease, Type 2 diabetes, obesity and back pain.
  41. 41. • Hygiene – The practice of keeping the body clean to prevent infection and illness, and avoidance of contact with infectious agents. – include bathing • brushing and flossing teeth • washing hands especially before eating • washing food before it is eaten • cleaning food preparation utensils and surfaces before and after preparing meals • help prevent infection and illness.
  42. 42. • Stress Management – The application of methods either to reduce stress or increase tolerance to stress since prolonged psychological stress may negatively impact health, such as by weakening the immune system. – Relaxation techniques are physical methods used to relieve stress, – While psychological methods (cognitive therapy, meditation, positive thinking) work by reducing response to stress.
  43. 43. • Health Care – The prevention, treatment, and management of illness and the preservation of mental and physical well being through the services offered by the medical, nursing and allied health professionals. • Workplace Wellness Programs – Recognized by an increasingly large number of companies for their value in improving the health and well-being of their employees, and for increasing morale, loyalty and productivity. – Workplace wellness programs may include: • onsite fitness centers • health presentations • wellness newsletters • access to health coaching • tobacco cessation programs and • training related to nutrition, • weight and stress management.
  44. 44. Scope of Nursing Practice • Health screening recommendations • Hearing aid use - Safety precautions • Immunizations - Smoking cessation • Medication instruction - Weight control • Mental health - Nutrition • Preventive health services - Physical fitness 2. PREVENTING ILLNESS (DISEASE PREVENTION) > The GOAL of illness prevention programs is to maintain optimal health by preventing disease.
  45. 45. Scope of Nursing Practice • Nursing activities that prevent illness includes: > Immunizations > Pre-natal and Infant care > Prevention of STDs. The objective of illness prevention activities are: - to reduce the risk of illness - to promote health habits - to maintain the individual’s optimal functioning
  46. 46. Scope of Nursing Practice Activities for Illness Prevention – 1. Hospital educational programs in areas such as prenatal care for pregnant women, smoking-cessation programs and & reduction seminars. – 2. Community programs & resources that encourage healthy lifestyles including aerobic exercise classes, swimnastics & physical fitness programs. – 3. Literature & TV information on diet, exercise & the importance of good health habits. – 4. Health assessments in institutions, clinics & community settings that identify areas of strength & potential for illness. Levels of Prevention: 1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention
  47. 47. 1. Primary- is true prevention - it precedes disease or dysfunction and its applied to clients considered to be physically & emotionally healthy. - includes all health promotion efforts as well as wellness activities that focus on maintaining & improving the general health of individuals, families & communities. Health Promotion includes: • Health education programs • Immunization • Physical & Nutritional fitness activities
  48. 48. Primary Prevention • By measures designed to promote positive general health: – development of good health habits and hygiene; – proper nutrition, – proper attitude towards sickness, – proper and prompt utilization of available health and medical facilities.
  49. 49. • Specific protection – By the use of measures against specific disease agents like protection of the individual, or – The establishment of barriers against agents in the environment. may include: – Control of means of spread of vector such as control, sanitation of food, milk, water, and air, proper sewerage disposal, proper disposal and or disinfect ion of soiled articles or clothing, eradication or animal reservoir. – Increasing resistance of the individual by specific immunization. – Hand washing observed strictly.
  50. 50. Scope of Nursing Practice 2. Secondary - Focuses on individuals who are experiencing health problems or illness & who are @ risk for developing complications or worsening condition. - Activities are directed at diagnosis and prompt intervention thereby reducing the severity & enabling the client to return to a normal level of health as early as possible. - Includes screening techniques & treating early stages of disease to limit disability.
  51. 51. Secondary Prevention • Consists of early diagnosis and prompt treatment of the disease in order to arrest the disease / problem and to prevent its spread to other people.
  52. 52. • Examples of secondary prevention include: – Public education to promote breast self-examination – use of home kits for detection of occult blood in the stool specimens – Screening programs for hypertension, diabetes, uterine cancer (Pap Smear), breast cancer, glaucoma and sexually transmitted diseases
  53. 53. Scope of Nursing Practice 3. Tertiary - occurs when the defect or disability is permanent & irreversible. It involves minimizing the effects of long term disease or disability by interventions directed at preventing complications & deterioration. - activities are directed at rehabilitation rather than diagnosis and treatment. - care @ this level aims to help clients achieve as high a level of functioning as possible, despite the limitations caused by illness or impairment. It I Involves preventing further disability or reduced functioning.
  54. 54. Tertiary Prevention • Begins early in the period of recovery from illness • consists of such activities as – consistent and appropriate administration of medications to optimize therapeutic effects – moving and positioning to prevent complications of immobility and active and passive exercises to prevent disability. – minimizing residual disability and helping the client learn to live productively with limitations
  55. 55. Scope of Nursing Practice 3. Restoring Health (Curative/ Rehabilitative Care) > Focuses on the ill client and extends from early detection of disease through helping the client during the recovery period. Nursing activities include the following: 1. providing direct care to the ill person, such as administering medications, baths, and specific procedures and treatments. 2. performing diagnostic and assessment procedures such as measuring BP and examining feces for occult blood. 3. consulting with other health care professionals about client problems. 4. teaching clients about recovery activities such as exercise that will accelerate recovery after a stroke. 5.rehabilitating clients to their optimal functional level following physical or mental illness, injury or chemical addiction.
  56. 56. Scope of Nursing Practice 4. Care of the Dying • Involves comforting and caring for people of all ages who are dying. • It includes helping as comfortably as possible until death and supporting persons to cope with death. • Nurses’ carrying out these activities work in homes, hospitals and extended care facilities. • Some agencies called hospices are specifically designed for this purpose.
  57. 57. Scope of Nursing Practice On Facilitating coping – Nurses facilitate client & family coping with altered functions, life, crisis, & death. – Nurses provide care to both clients & SO during the terminal illness – Nurses are becoming, more active in hospice programs which are developed to assist individuals & their families in preparing for death & living as comfortably as possible until death occurs. Institutions: Hospice Long term nursing facilities Nursing Homes
  58. 58. BASIC INTERVENTIONS USING NURSING PROCESS TO MAINTAIN HEALTHY LIFESTYLE Lifestyle the values and behaviors adopted by a person in daily life
  59. 59. • Assessment – Health History and Physical Examination – Utilize Gordon’s 11 functional health patterns to elicit health history. – For the physical assessment, start at the head and proceed in a systematic manner downward (head-to-toe).
  60. 60. • Lifestyle Assessment • Focus on the personal lifestyle and habits of the client as how • they affect his/her health. Categories of lifestyle generally • assessed are physical activity, nutritional practices, stress • management, and such habits as smoking, alcohol • consumption and drug use