Introduction to Health and Illness: Complete Nursing Notes and Important Questions

Introduction to Health and Illness: Before we learn how to care for a sick person, we must first understand two basic ideas: what is health and what is illness. These two ideas are the foundation of all nursing. In this unit we study the meaning and dimensions of health, Maslow’s hierarchy of needs, the health-illness continuum, the models used to explain health and illness, the factors that influence health, the causes and risk factors of illness, illness behaviour, and the impact of illness on the patient and the family.

Learning objectives: define health (WHO) and its dimensions; explain Maslow’s hierarchy of needs; describe the health-illness continuum; list factors influencing health; explain causes and risk factors for illness; describe types of illness and illness behaviour; and explain the impact of illness on the patient and family.

1. Important Terminology

Medical terminology: quick reference

Common medical terms and abbreviations

2. Meaning and Concepts of Health

Many people think of health as the opposite of illness. For some it means a well-developed, well-nourished body that can do various activities and withstand stress. All communities have their own concept of health as part of their culture, and many cultures share the idea of health as balance and harmony.

WHO definition: “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity, and the ability to lead a socially and economically productive life.” (Some versions add spiritual well-being.)
Operational definition: “A condition or quality of the human organism expressing the adequate functioning of the organism in given conditions, genetic or environmental.”

An individual’s health is never static. It is in dynamic equilibrium with the environment. Physical well-being can be measured, but standards of mental and social well-being differ from culture to culture. In its broadest sense, health is a dynamic state in which a person adapts to changes in the internal environment (genetic and psychological variables, intellectual and spiritual dimensions, disease processes) and the external environment (physical environment, social relationships, economic variables) to maintain well-being.

Changing concepts of health

New philosophy of health

• Health is a fundamental human right.
• Health is the essence of productive life.
• Health is inter-sectoral and an integral part of development.
• Health is central to the concept of quality of life.
• Health involves individual, state and international responsibility.
• Health and its maintenance is a major social investment and a worldwide social goal.

Wellness and holistic health

• Wellness: a state of high-level health, achieved by balancing the various dimensions of health.
• Holistic health: all aspects of wellness are interrelated. Lifestyle choices, like what to eat and when to exercise, affect health physically, mentally, emotionally, socially and spiritually.

Concept of well-being

The WHO definition introduces “well-being”, which has subjective and objective components.

3. Dimensions of Health

Other models of dimensions

• Dimensions model of health (six): biophysical, psychological and emotional, behavioral, sociocultural, physical environment, and health systems dimensions. (Details in Section 8.)
• Holistic wellness (eight pillars): physical, nutritional, emotional, social, spiritual, intellectual, financial and environmental.

Multiple facets of health (WHO Constitution)

4. Maslow’s Hierarchy of Needs

Maslow’s hierarchy of needs is a motivational theory in psychology with a five-tier model shown as a pyramid. The basic needs at the bottom must be satisfied before a person can move to higher needs. A person who struggles to survive does not think much about self-actualization. The theory was fully expressed in Maslow’s 1954 book Motivation and Personality.

The esteem and social levels together form the psychological needs of the hierarchy.

Maslow’s hierarchy and basic human needs

Characteristics of self-actualized people

1. Efficient perception of reality.
2. Comfortable acceptance of self, others and nature.
3. Reliant on own experiences and judgement.
4. Spontaneous and natural.
5. Task centring.
6. Autonomy.
7. Continued freshness of appreciation.
8. Profound interpersonal relationships.

Key terms: Peak experience is an awe-inspiring emotional experience with a sense of timelessness, unity and wonder. Transcendence needs go beyond self-actualization and involve a higher purpose and concern for the community. Self-esteem is a sense of competence, achievement and self-respect; Maslow felt genuine accomplishment is its most stable source.

Limitations: the theory cannot be verified empirically, because there is no proper method to measure how satisfied one level must be before the next becomes active; and Maslow considered only a narrow segment of the human population.

Nursing use: When you prioritize a patient’s needs, start from the bottom: airway, breathing, food and fluid first; then safety; then emotional needs. This is why a patient in severe pain cannot focus on health teaching.

5. Health-Illness Continuum

The health-illness continuum is a graphic illustration of well-being, first proposed by John W. Travis in 1972. It shows that well-being is more than the absence of illness and includes mental and emotional health. Travis felt the usual medical approach (a person is well if there are no signs or symptoms) is not enough. It is made of two arrows pointing in opposite directions joined at a neutral point.

• Movement to the right (toward high-level wellness) is achieved in three steps: awareness, education, growth.
• Movement to the left (toward premature death) is a decreasing state of health through signs, symptoms and disability.
• Neuman (1990): health on a continuum is the degree of client wellness at any point in time, ranging from optimal wellness (maximum energy) to death (total energy depletion).
• Health is a dynamic state that keeps changing as a person adapts to the internal and external environment. Responses can be adaptive or maladaptive, and the direction of change may be reversible.

Goal of preventive health care: maintain equilibrium between health and illness, with balance in favour of maximum wellness. The treatment paradigm only takes patients to the neutral (non-illness) point; the wellness paradigm goes beyond it. A nurse should move patients beyond the neutral point toward an optimal level of health.

6. Models of Health and Illness

A. Health Belief Model (HBM)

Developed by Rosenstock and Becker (Rosenstock 1974; Becker and Maiman 1975). It explains the relationship between a person’s beliefs and behaviour, and predicts whether a person will take part in immunization, screening tests or other health actions. (The PDF prints Rosenstock’s year as 1794, a typing error.) The model rests on two ideas: the desire to avoid illness or get well, and the belief that a specific action will prevent or cure illness.

Limitations of HBM: it ignores attitudes and other individual determinants; ignores habitual behaviours (such as smoking) and behaviours done for non-health reasons (social acceptability); ignores environmental and economic factors; assumes everyone has equal information and that cues to action are common and health is the main goal.

B. Health Promotion Model (Pender, 1996)

Emphasizes the relationship between the client’s motivation and commitment and goal-directed behaviour. It was designed as a complementary counterpart to models of health protection, and explains why individuals engage in health activities. It is not designed for families or communities. It focuses on three areas:

Eight behavior-specific beliefs: (1) perceived benefits of action, (2) perceived barriers to action, (3) perceived self-efficacy, (4) activity-related affect, (5) interpersonal influences (norms, modelling, social support), (6) situational influences, (7) commitment to a plan of action, (8) immediate competing demands and preferences.

Assumptions: individuals actively regulate their own behaviour; they interact with and transform the environment over time; health professionals are part of the interpersonal environment; self-initiated change in person-environment patterns is essential for behaviour change.

C. Agent-Host-Environment Model (Leavell and Clark)

Describes disease as a result of the dynamic interaction between agent, host and environment. It helps understand disease, but is not helpful for health and health promotion.

Epidemiologic triad: the simplest model of disease causation, the traditional model for infectious disease. It is not enough for cardiovascular disease and cancer, which have multiple contributing causes.

D. Neuman’s Systems Model

The human being is an open system with natural boundaries that protect against stressors: flexible lines of defense, normal lines of defense and lines of resistance. Health promotion means the nurse strengthens these lines of defense. When the lines are penetrated (illness), the nurse with the health team gives care to reorganize and reconstitute the system. Client system variables: physiological, sociocultural, developmental, spiritual and psychological.

E. Dimensions Model of Health (six dimensions)

F. Holistic models

Based on the WHO holistic definition: the biopsychosocial-spiritual person is in constant dynamic interaction with the environment. Wellness is sustained by eight pillars: physical, nutritional, emotional, social, spiritual, intellectual, financial and environmental.

G. Adaptation models: Roy’s Adaptation Model (1976)

Health is how well the client can adapt and cope with change. Illness occurs when the person is maladapting; health is promoted when the person copes successfully. Developed by Sister Callista Roy (1976) with the goal of nursing being to promote adaptation.

• Four key concepts: person, health, environment and nursing. The person is a biopsychosocial being in constant interaction with a changing environment and uses innate and acquired mechanisms to adapt.
• Environment stimuli: focal (immediately confronts the person), contextual (all other stimuli present), residual (unclear effects).
• Subsystems: cognator (cognitive-emotive coping: perception and information processing, learning, judgement, emotion) and regulator (automatic neural, chemical and endocrine coping).
• Six-step nursing process: first-level assessment (behaviour), second-level assessment (stimuli), diagnosis, goal setting, intervention, evaluation.

H. Role performance model

A person is healthy when able to fulfil multiple roles without disruption and ill when unable to fulfil roles and responsibilities. A client who continues to work and parent while managing diabetes is considered healthy, not ill.

I. High Level Wellness Model (Halbert Dunn)

Oriented toward maximizing the health potential of an individual: a continuum of balance and purposeful direction within the environment, progressing toward higher functioning and living to the fullest potential. Unlike the continuum, it has two axes (horizontal and vertical) that form four quadrants. (The PDF gives the year as 1997; Dunn’s work is much older, so cite only the name.)

7. Biopsychosocial Aspects of Health and Illness

Physical, social, cultural and psychological factors interact dynamically and strongly influence patient care needs. There are human needs common to everyone. When these are not met, tension and anxiety arise, which can delay recovery if not relieved.

Developmental needs

Social determinants of health (summary)

Cultural and religious influences

• Culture is the total way of life of a people, the social legacy a person gets from the group. Folkways are accustomed, time-honoured ways of doing things (social habits done without thinking); mores are stronger customs.
• The patient’s cultural background shapes how the relationship with the doctor or nurse is seen and may help or block communication.
• Religion relates the person to God and gives group and family support. It strengthens the belief that recovery is possible. The nurse should understand the patient’s spiritual needs and how organized religion meets them.

Biopsychosocial model (George L. Engel)

Health and illness are determined by a dynamic interaction between biological, psychological and social factors. No one factor alone is enough; it is their interplay that decides the cause, manifestation and outcome of wellness and disease.

Application: health promotion must address all three factors, because health status, perception of health and sociocultural barriers together decide whether a patient takes medicines, eats properly and exercises.

8. Determinants of Health

Many factors combine to affect health. Whether a person is healthy is decided by circumstances and environment. Where we live, the state of the environment, genetics, income, education and relationships have a large impact, while access to health services has comparatively less.

9. Factors Influencing Health

10. Concept of Disease and Illness

Disease is more than a deviation from health. Each disease is a distinct entity with its own pathological process, clinical picture and characteristic pattern in time, place and person. Between “optimal health” and “serious disease” lie various grades; the milder the disease, the harder it is to tell from health.

Difference between illness and disease

Types of diseases

Stages and course of illness

Extent of illness: localized (one part, such as athlete’s foot or eye infection), disseminated (spread to other parts; metastatic in cancer) and systemic (affects the entire body, such as influenza or hypertension).

Acute and chronic illness

• Acute: severe symptoms, relatively short, sudden onset, progresses steadily and subsides; may not need medical care; may lead to chronic illness (MI to CHF).
• Chronic: develops gradually, needs ongoing medical attention, may last for life, caused by permanent changes with residual disability. Remission is when symptoms subside; exacerbation is when symptoms reappear or worsen.

11. Cultural Factors in Health and Disease

Members of a society unconsciously agree on a common pattern of living, called culture. Behaviour patterns are not biologically inherited but socially learned.

12. Causes and Risk Factors for Developing Illness

Illness is the person’s response to disease, an abnormal process in which the level of functioning changes compared with a previous level. Risk factors that raise the chance of illness are:

Factors affecting a patient’s health status: smoking, nutrition, alcohol use, habituating drug use, driving (safety), exercise, sexuality and contraceptive use, family relationships, risk factor modification, and coping and adaptation.

13. Health Behavior, Illness Behavior and Sick-Role Behavior

Illness is not merely the presence of disease. It is a state in which physical, emotional, intellectual, social, developmental or spiritual functioning is diminished or impaired compared with previous experience. Illness behavior is how persons monitor their bodies, define and interpret symptoms, take remedial action and use the health care system.

Factors affecting illness behavior: Internal: perception of symptoms and the nature of the illness (acute or chronic). External: visibility of symptoms, social groups, cultural background, economic variables, accessibility of the health care system and social support. The significance of symptoms depends on danger value, visibility, ambiguity, fear of the unknown, expectations of those from whom help is sought, feelings about dependence, fear of loss of control and past experience of illness.

Abnormal illness behavior: the conviction of being sick and overuse of medical care without objective signs of disease. Sickness behavior: the adaptive reorganization of priorities during infection, shown by decreased activity (immobility, sleepiness, reduced food and water intake), which conserves energy.

Stages of illness behavior

14. Impact of Illness on the Patient and Family

Impact on the patient

Physical changes may affect appearance and turn a positive self-image into a poor one. Depression and anxiety are common in chronic illness but are treatable. Illness can reduce the ability to work and cause financial problems; prolonged stress leads to frustration, anger, hopelessness and sometimes depression.

Emotional responses to illness

Specific impacts

Withdrawal is an adaptive coping mechanism that can help the client make adjustments.

Impact of illness on the family

Illness of one member disrupts the whole family, because each member has a role in everyday functioning. Examples: when the person who cooks is ill, others must take over; if the main earner has a heart attack, the wife may have to work or become the breadwinner; adults may have to care for aging parents.

• Role changes, task reassignments, increased demands on time.
• Anxiety about outcomes; conflict about unaccustomed responsibilities.
• Financial problems; change in social customs.
• Loneliness due to separation and pending loss; family members may withdraw from each other or be unsure how to relate to the sick person.

Extent of disruption depends on the seriousness of illness, the family’s level of functioning before illness, socioeconomic conditions and how far other members can take over the sick person’s role. At different life stages the strain differs: a sick young child strains siblings’ needs; illness in mid-life family stage adds to adolescent and mid-life turmoil; illness in later age affects grown children and the older couple.

Family adaptation to chronic illness

Nursing implications: include the family in the teaching plan (for example if the wife cooks, include her in diet teaching); notice patterns of relationships and family attitudes; remember that anxiety of family members may look like lack of interest; mobilize family resources; and give counselling to help with role changes.

Conclusion

Health is a fundamental human right. WHO defines it as a state of complete physical, psychological and social well-being, not merely absence of disease or infirmity. Health is linked to the environment and to the ability to adapt. Normality needs to be seen in context of gender, geographical origin and living conditions (what is normal for a young person may differ from an older person). A disease is a physical or mental disturbance with symptoms, dysfunction or tissue damage, while illness (sickness) is a subjective concept related to the personal experience of disease.

Quick Revision Points

• WHO health definition; four concepts: biomedical, ecological, psychosocial, holistic.
• 5 dimensions: physical, mental, emotional, spiritual, social.
• Maslow: physiological, safety, love and belonging, esteem, self-actualization.
• Travis (1972) continuum: awareness, education, growth versus signs, symptoms, disability.
• HBM: 6 constructs. Pender HPM: 3 areas and 8 beliefs. Agent-Host-Environment: Leavell and Clark. Roy (1976): 4 modes.
• Disease = objective; illness = personal feeling; sickness = social role.
• 5 stages of illness behavior: symptom experience, sick role, medical care contact, dependent client care, recovery and rehabilitation.
• Body image phases: shock, withdrawal, acknowledgment, acceptance, rehabilitation.

Practice MCQs (tap a question to see the answer)

Q1. WHO defines health as:

1. Absence of disease
2. State of complete physical, mental and social well-being, not merely absence of disease or infirmity
3. Ability to work only
4. Absence of pain

Answer: B. The concept of positive wholeness.

Q2. The biomedical concept of health is based on:

1. Germ theory of disease
2. Social theory
3. Ecological balance
4. Yoga

Answer: A. Health means absence of disease.

Q3. Which concept views health as a dynamic equilibrium between man and environment?

1. Biomedical
2. Ecological
3. Psychosocial
4. Holistic

Answer: B. Disease is a maladjustment to the environment.

Q4. Which concept is a synthesis of all other concepts of health?

1. Biomedical
2. Ecological
3. Psychosocial
4. Holistic

Answer: D. Recognizes social, economic, political and environmental influences.

Q5. How many dimensions of health are described in the first model?

1. 3
2. 4
3. 5
4. 6

Answer: C. Physical, mental, emotional, spiritual and social.

Q6. The dimension of health related to the sense of purpose in life is:

1. Physical
2. Emotional
3. Spiritual
4. Social

Answer: C. It may come from a belief or faith system.

Q7. The dimension related to the ability to make and maintain meaningful relationships is:

1. Social
2. Mental
3. Physical
4. Spiritual

Answer: A. The family is the basic social unit.

Q8. Quality of life is a:

1. Subjective component of well-being
2. Objective component only
3. Disease
4. Treatment

Answer: A. Level of living is objective.

Q9. The ‘level of living’ consists of how many components?

1. 5
2. 7
3. 9
4. 11

Answer: C. Health, food, education, occupation, housing, social security, clothing, recreation, human rights.

Q10. Maslow’s hierarchy has how many levels?

1. 3
2. 4
3. 5
4. 6

Answer: C. Physiological, safety, love and belonging, esteem, self-actualization.

Q11. The first and most basic level of Maslow’s hierarchy is:

1. Safety
2. Physiological needs
3. Esteem
4. Belonging

Answer: B. Air, food, water, sleep, shelter.

Q12. Self-actualization means:

1. Realizing one’s full potential
2. Getting food
3. Getting a job
4. Avoiding disease

Answer: A. It is at the top of the pyramid.

Q13. Maslow’s idea was fully expressed in his book published in:

1. 1934
2. 1954
3. 1974
4. 1994

Answer: B. Motivation and Personality.

Q14. The health-illness continuum was first proposed by:

1. John W Travis in 1972
2. Roy in 1976
3. Pender in 1996
4. Engel in 1977

Answer: A. Wellness is more than absence of illness.

Q15. Movement toward high-level wellness is achieved through:

1. Awareness, education and growth
2. Signs, symptoms and disability
3. Rest only
4. Medicines only

Answer: A. Movement to the left is signs, symptoms, disability.

Q16. The Health Belief Model was developed by:

1. Rosenstock and Becker
2. Pender
3. Neuman
4. Roy

Answer: A. It predicts health behaviour from beliefs.

Q17. How many constructs does the Health Belief Model have?

1. 4
2. 5
3. 6
4. 8

Answer: C. Susceptibility, severity, benefits, barriers, cue to action, self-efficacy.

Q18. The stimulus that triggers a person to act on health advice is:

1. Cue to action
2. Perceived barrier
3. Perceived benefit
4. Self-efficacy

Answer: A. Can be internal (chest pain) or external (advice).

Q19. Self-efficacy in HBM means:

1. Confidence in ability to perform a behaviour
2. Fear of disease
3. Cost of treatment
4. Severity of illness

Answer: A. Added in the 1980s.

Q20. Pender’s Health Promotion Model was proposed in:

1. 1976
2. 1986
3. 1996
4. 2006

Answer: C. It complements models of health protection.

Q21. Pender’s model has how many behavior-specific beliefs?

1. 4
2. 6
3. 8
4. 10

Answer: C. Benefits, barriers, self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment, competing demands.

Q22. The Agent-Host-Environment model was developed by:

1. Leavell and Clark
2. Neuman
3. Roy
4. Dunn

Answer: A. Also called the epidemiologic triad.

Q23. In the epidemiologic triad, bacteria is an example of:

1. Agent
2. Host
3. Environment
4. Cue

Answer: A. The agent causes the disease.

Q24. Which model has ‘lines of resistance’ and ‘flexible lines of defense’?

1. Neuman’s systems model
2. Roy’s model
3. HBM
4. Dunn’s model

Answer: A. Nurses fortify the lines of defense.

Q25. Roy’s Adaptation Model was developed in:

1. 1966
2. 1976
3. 1986
4. 1996

Answer: B. By Sister Callista Roy.

Q26. Which is NOT a mode of adaptation in Roy’s model?

1. Physiologic needs
2. Self-concept
3. Role function
4. Nutritional status

Answer: D. The fourth mode is interdependence.

Q27. Halbert Dunn’s model has how many quadrants?

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

Answer: C. Formed by two axes.

Q28. The biopsychosocial model was developed by:

1. George L Engel
2. Maslow
3. Travis
4. Pender

Answer: A. Biology, psychology and social factors interact.

Q29. Folkways and mores are:

1. Customs and group habits
2. Diseases
3. Drugs
4. Vaccines

Answer: A. Social habits performed without thinking.

Q30. An objective, observable pathological process is called:

1. Disease
2. Illness
3. Sickness
4. Wellness

Answer: A. Illness is the personal experience; sickness is the social role.

Q31. A disease caused by medical intervention is:

1. Iatrogenic
2. Idiopathic
3. Congenital
4. Hereditary

Answer: A. Side effect of treatment.

Q32. A disease of unknown cause is:

1. Iatrogenic
2. Idiopathic
3. Primary
4. Terminal

Answer: B. Idiopathic.

Q33. A chronic disease usually lasts at least:

1. 1 week
2. 1 month
3. 6 months
4. 5 years

Answer: C. It may also last for life.

Q34. Return of symptoms or onset of more severe symptoms is a:

1. Remission
2. Flare-up
3. Cure
4. Terminal phase

Answer: B. Remission is the disappearance of symptoms.

Q35. Another name for subclinical disease is:

1. Silent disease
2. Acute disease
3. Terminal disease
4. Systemic disease

Answer: A. Symptoms are not yet noted.

Q36. A disease affecting the entire body, such as influenza, is:

1. Localized
2. Disseminated
3. Systemic
4. Subclinical

Answer: C. Localized affects one part only.

Q37. How many stages of illness behavior are there?

1. 3
2. 4
3. 5
4. 6

Answer: C. Symptom experience to recovery and rehabilitation.

Q38. In which stage does the person assume the sick role?

1. Stage I
2. Stage II
3. Stage III
4. Stage V

Answer: B. Emotional changes such as withdrawal may appear.

Q39. Activities a person does when feeling well to prevent disease is:

1. Health behavior
2. Illness behavior
3. Sick-role behavior
4. Sickness behavior

Answer: A. Illness behavior is when feeling ill.

Q40. Which is an emotional response to illness?

1. Fear
2. Cure
3. Vaccination
4. Diagnosis

Answer: A. Others: anxiety, anger, hostility, over-dependence, hope.

Q41. Phases of adjustment to body image change (amputation) begin with:

1. Shock
2. Acceptance
3. Rehabilitation
4. Anger

Answer: A. Shock, withdrawal, acknowledgment, acceptance, rehabilitation.

Introduction to Health and Illness Questions

Long answer questions (10 to 15 marks)

1. Define health. Explain the determinants of health.
2. Define illness. Describe the factors affecting illness behaviour and the stages of illness behaviour.
3. Describe the health-illness continuum with a diagram.
4. Explain Maslow’s hierarchy of needs and its importance in nursing.
5. Explain the Health Belief Model and Pender’s Health Promotion Model.
6. Describe the impact of illness on the patient and the family.
7. Define health promotion and discuss the levels of prevention of disease. (This question is in your PDF’s review questions, but its content is not in this PDF.)

Short answer questions (5 marks)

1. Concepts of health
2. Dimensions of health
3. Differences between disease, illness and sickness
4. Agent-Host-Environment model
5. Roy’s Adaptation Model
6. Biopsychosocial model
7. Types of diseases
8. Emotional responses to illness
9. Impact of illness on family
10. Cultural factors in health and disease

Very short answer questions (2 marks)

1. Define health (WHO).
2. Define wellness.
3. Define quality of life.
4. Name the levels of Maslow’s hierarchy.
5. What is a cue to action?
6. Define iatrogenic disease.
7. Define chronic illness.
8. What is sick-role behaviour?
9. List four emotional responses to illness.
10. Define self-concept.

FAQs

Also read:
CHAPTER 1: Introduction to Health and Illness, Nursing Foundation Unit 1 Notes PDF
CHAPTER 2: Health Care Delivery System, Nursing Foundation Unit 2 BSc Nursing Notes
Chapter 3: Nursing as a Profession and History of Nursing in India: BSc Nursing 1st Semester Notes (Nursing Foundation)
CHAPTER 4: Hospital Admission and Discharge: Complete BSc Nursing Notes | 1st Semester Notes (Nursing Foundation)
CHAPTER 5: Communication and Nurse Patient Relationship: Complete Notes | BSc Nursing 1st Semester Notes (Nursing Foundation)
Chapter 6: Patient Education in Nursing: Notes for BSc Nursing 1st Semester, Nursing Foundation Notes with MCQs & Important Questions
Chapter 7: The Nursing Process: Complete Notes for BSc Nursing, 1st Semester, Nursing Foundation
Chapter 8: Documentation and Reporting: Notes with MCQs and Important Questions for BSc Nursing 1st Year, Nursing Foundation Notes

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