Defining Health and Illness

The ability of the soul to cope

Theologian Jürgen Moltmann (1983) described health in a different way: “True health is the strength to live, the strength to suffer, and the strength to die. Health is not a condition of my body; it is the power of my soul to cope with the varying condition of that body”

Define Illness

Pathology affecting an organ or body system

How do nurses understand health and illness?

• Nurses understand health and illness as individual experiences, emerging from each patient’s unique responses. The person with an illness rarely perceives the experience as a medical diagnosis. Instead, people describe their illness in terms of how it makes them feel. In short, nurses honor the client’s understanding of his or her state of being.
• An illness is a disruption of health.
• “A way of life oriented toward optimal health and well-being in which body, mind, and spirit are integrated by the individual to live more fully within the human and natural community” (Myers, Sweeney, & Witmer, 2000, p. 252). This perspective acknowledges the influence of attitude and lifestyle choices on the client’s state of being. It also implies that nursing interventions in support of wellness are important for clients who are illness free, but also for those who are experiencing disease, or even facing death.

The client with multiple sclerosis can no longer walk or urinate on her own. She spends her day sewing quilts, reading, and communicating via e-mail with a support organization. This client is

a.Healthy

b.Ill

c.In poor health

d.Well

D. Well

Health-Illness Continuum

A person’s position moves back and forth on the continuum with physiological changes, lifestyle choices, and the results of various therapies.

Think of it as a scale from 1-10. One is gravely ill and 10 is excellent health. The continuum is personal and dynamic: Health changes over the course of time.

Various Ways People Experience Health and Illness:

Biological Factors (non-modifiable)

A healthy genetic makeup and freedom from debilitating age-related changes are certainly desired states, and they tip the scale toward the wellness end of the health–illness continuum.

EX: Gender (non-modifiable- can't be changed): Rheumatoid arthritis, osteoporosis, and breast cancer are more common in women, whereas, ulcers, color blindness and bladder cancer are more common in men

Various Ways People Experience Health and Illness:

Nutrition (Modifiable)

Many chronic diseases, such as type 2 diabetes mellitus and heart disease, are influenced by our diets, and nutrition appears to play at least a moderate role in a variety of other diseases, such as osteoporosis and some forms of cancer.

Nutrient-deficiency diseases, such as scurvy and night blindness, as unknown in people who consume a nutritious diet.

Various Ways People Experience Health and Illness:

Physical Activity (Modifiable)

Healthy people are usually active people. Studies support the benefit of moderate physical activity in reducing the risk of chronic disease and promoting longevity. As little as 30 min of gardening or 15 min of jogging on most days of the week can lead to these benefits.

Ex: weight training has been shown to increase bone density and reduce the risk of osteoporosis in women older than 40, and aerobic activity, such as walking decreases the risk of heart disease.

Various Ways People Experience Health and Illness:

Sleep and Rest (Modifiable)

Sleep nourishes health. Most of the body’s growth hormone, which assists in tissue regeneration, synthesis of bone, and formation of red blood cells, is released during sleep. Sleep is also important to mental health because it provides time for the mind to slow down and rejuvenate.

Various Ways People Experience Health and Illness:

Meaningful Work (Modifiable)

:Many people find that work is a healthy way to cope with stressors. Psychologist Victor Frankl, who survived internment in a Nazi concentration camp, observed in Man’s Search for Meaning (1959, 1962, 1984, 2004) that engaging in meaningful work promotes health and, even in the midst of horrific stressors, can defend against physical and mental breakdown. People also experience meaningful work as a dimension of wellness. For many people, volunteering, pursuing hobbies, and engaging in pleasurable activities can be forms of meaningful work.

Various Ways People Experience Health and Illness:

Lifestyle Choices (Modifiable)

People who consider themselves healthy are usually those who make healthy lifestyle choices. They are aware of the threats to health created by cigarette smoking, alcohol consumption, drug abuse, unprotected sex, and other risky behaviors. Tobacco use increases recovery time from illness, injury, and surgery, and it increases risk of diabetes, infertility, low birth weight and perinatal death. A glass of red wine each day can reduce the risk of heart disease and slow bone loss; excessive consumption damages the brain, liver, pancreas, intestines and neuro system.

**Excessive alcohol consumption is implicated in about half of all motor vehicle accidents and other injuries.

Various Ways People Experience Health and Illness:

Family Relationships

When illness occurs, some people prefer to be totally independent, priding themselves on never asking for or accepting help. But the reality is that during times of disruption, support from others (e.g., family, friends, coworkers, pastors, counselors) is crucial, even for rugged individualists.

Various Ways People Experience Health and Illness:

Culture

Culture affects the experience of illness in the following ways:

• It influences health decisions, behaviors, perceptions, and view of self as well or ill.
• It influences responses to illness. Our response to illness is also partly determined by our culture.

Various Ways People Experience Health and Illness:

Religion and Spirituality

Religion and spirituality are closely tied to culture, and clients’ religious beliefs and practices can influence their healthcare choices. For example, some people believe that spiritual beliefs influence the mind-body connection to promote wellness and healing.

Various Ways People Experience Health and Illness:

Environmental Factors

They can nourish wellness or can be a source of pollutants such as carbon monoxide , lead poisoning, mold, radon, or chemicals (e.g., insecticides) that can cause serious disease. For institutionalized patients, a little corner of the room that is uniquely "theirs" with pics and other mementos, can be healing.

Various Ways People Experience Health and Illness:

Finances

Money does buy access to healthcare and healthcare choices and thus nourishes wellness. In the United States, health insurance is often tied to employment or income level, and health insurance dictates which providers you have access to and what services are available to you. Even in countries with national health programs, such as Canada and some European countries, the standard care available may not include all the services or meds a person needs/desires. A patient's apparent lack of concern or lack of compliance to a treatment regimen may be, in reality, a problem of access to healthcare.

What is the goal of using a client history assessment tool to gather data about nutrition, exercise, leisure activities, spirituality, and home environment?

a.To gather data required by insurers and regulatory agencies

b.To assist the physician in developing a medical diagnosis

c.To gather data about the causes of the client’s illness

d.To increase the client’s awareness of lifestyle choices and his or her role in wellness

d.To increase the client’s awareness of lifestyle choices and his or her role in wellness

Factors that Disrupt Health:

Physical Disease

:Disease disrupts our lives in so many ways. It may reduce our ability to perform our life roles effectively or to engage in activities we enjoyed before the illness. The diagnosis of a chronic or life-threatening disease may bring shock, fear, anxiety, anger, or grief. It may also cause clients to question the meaning and purpose of their lives, to become more inwardly focused, or to embrace life even more fully.

Factors that Disrupt Health:

Injury

Injury can cause the same symptoms and emotions as disease, but perhaps its most disruptive aspect is its suddenness.

Factors that Disrupt Health:

Mental Illness

Mental illness carries with it a stigma that may be diminishing slowly but is highly visible to those who suffer from its effects. This stigmatization can also disrupt the health of family members. Families must adjust to a major upheaval in their lives, as they experience the pain associated with the loss of a once-promising child or relative to the spiral of mental illness. Family members may also live in constant fear that their loved one will hurt himself or herself or even commit suicide.

Factors that Disrupt Health:

Loss

Loss is a disruption that cuts to the core of who we are—whether the loss of a job; the end of a romantic relationship; the death of a loved one; or the loss of youth, beauty, functioning, or identity. When such a loss occurs, the resulting period of significant disintegration may continue until the person either finds a way to cope with the loss or succeeds in reinterpreting the loss in a meaningful way.

Factors that Disrupt Health:

Impending Death

Caring for dying clients makes us painfully aware of our own frailty and is one of the most difficult experiences you will face as a nurse.

Factors that Disrupt Health:

Pain

Pain disrupts the smooth operation of our lives; it can change personality, erode coping skills, and interfere with healthy communication. Even some of our nursing interventions cause pain. It is a challenge to be a comforting, healing presence when we have to do things that cause discomfort.

Factors that Disrupt Health:

Competing Demands

When an illness is chronic, the competing demands can take a heavy toll. Sometimes people ignore health issues because the competing demands are too great. Symptoms may even go unnoticed because attention is scattered in so many directions, and there is not enough time and energy to research one’s symptoms, schedule a doctor’s appointment, or follow through with treatments.

Factors that Disrupt Health:

The Unknown

Injuries and illnesses can happen abruptly, with no chance to prepare ourselves for new realities.

Factors that Disrupt Health:

Imbalance

Our sense of justice tells us that when we are good, good things should happen. When we are bad, bad things should happen. Thus, when we perceive that life has violated this rule, we experience that as a disruption, as in such examples as death of a child or treatment failure.

Factors that Disrupt Health:

Isolation

The sense of aloneness reported by seriously ill clients is related in part to their actual physical separation from loved ones during treatments, hospitalizations, or clinic visits. It also stems from their feeling that there is no one who is really “in their world.”

Name the 5 stages of illness behavior

1. Experiencing Symptoms
2. Sick Role Behavior
3. Seeking Professional Care
4. Dependence on Others
5. Recovery

5 stages of illness behavior:

Experiencing Symptoms

Symptoms are a signal that illness has begun. However, if the symptoms are unusual, severe, or overwhelming, you may progress to the next stage.

If symptoms are recognizable such as runny nose, sneezing, you may id the problem as a common cold and turn to previously used remedies. Common probs rarely progress beyond this stage.

5 stages of illness behavior:

Sick Role Behavior

When you've identified yourself as ill, you assume the sick role. The sick role relieves you from normal duties, such as work, school, or tasks at home. The severity of the symptoms and anticipated length of illness determine whether you will progress farther along the stages of illness.

5 stages of illness behavior:

Seeking Professional Care

To reach this stage, you must determine that you are ill and that professional care is required to treat the illness. Persons who seek professional care are asking for validation of their illness, explanations for their symptoms, appropriate treatment, and information about the anticipated length of illness.

5 stages of illness behavior:

Dependence on Others

The severity of the illness and the type of treatment determine the extent of dependence. This may be limited to listening to the provider’s instructions, filling the prescription, and following directions given in the office. However, illness that requires hospitalization is often associated with dependence on nursing staff and hospital personnel for activities of daily living, medications, and treatments.

5 stages of illness behavior:

Recovery

The final stage of illness is called recovery.The person gradually resumes independence and returns to normal roles and functioning. Severe illnesses may require a newly defined level of optimum function. The greater the change, the more difficult this transition will be.

The client has received a prescription for a metered-dose inhaler from the care provider. Before the client leaves the clinic, the nurse instructs the client on how to use the inhaler. The nurse is tending to the client’s need in which stage of illness behavior?

a.Dependence on others

b.Sick role behavior

c.Seeking professional care

d.Recovery

a.Dependence on others

Factors that Influence Illness Behavior?

• Age
• Family Patterns
• Culture
• Nature of the illness
• Hardiness
• Intensity, duration, and multiplicity of the disruption

Factors that Influence Illness Behavior:

Nature of the illness: Acute Illness

Occurs suddenly and lasts for a limited time. EX: cold, flu, or viral infection, may be minor and require no formal healthcare. Some acute illnesses, such as strep throat, may require a visit to a healthcare provider for treatment or even hospitalization or surgery, as in cholecystitis or pyelonephritis. In acute illness, there is an end in sight and relief is expected

Factors that Influence Illness Behavior:

Nature of the illness: Chronic Illness

lasts for a long period of time, usually 6 months or more, and often for a lifetime. Chronic illness requires the person to make life changes. Because of the lengthy period of illness, people with chronic disease often experience periods of remission or exacerbation.

Factors that Influence Illness Behavior:

Nature of the illness: Remission/Exacerbation

A remission occurs when symptoms are minimal to none. An exacerbation (“flare-up”) occurs when symptoms intensify. Clients with chronic illness often complain about the unrelenting nature of their health problems.

Factors that Influence Illness Behavior:

Hardiness

This has been described as developing a very strong positive force to live and enjoying the ride. Another aspect of hardiness is the willingness to draw on resources within oneself or from others to break out of old patterns of living when life situations change. Hardy individuals are willing to seek out information and take initiative in dealing with life situations rather than sitting back and letting someone else control their lives. Ironically, some people survive and thrive during times of adversity. Those who see themselves as hardy tend to approach changes with an “I can deal with this” attitude.

Factors that Influence Illness Behavior:

Intensity, duration and multiplicity of the disruption

For healthcare providers, too many demands over too long a period of time can lead to “burnout,” a feeling of being overwhelmed and demoralized. For clients and their families, dealing with the cumulative effect of illness and other life disruptions can break down what might otherwise be excellent coping skills. Therefore, their responses may not be typical of what they usually have demonstrated.

Using the Nursing Process to Promote Health:

Obtaining data about the psychosocial, emotional, and spiritual aspects of health requires a level of communication that goes beyond a neat list of skills, Communicating genuine care, concern, and sensitivity comes from who you are as a person, not from assuming a professinal persona (putting on your "nurse's hat").

Attuning

Being maximally attentive is another key factor in facilitating communication. Most people are hungry for someone to listen to them. So often, listeners are so busy thinking about what they want to say that they fail to really listen. Try to focus on what the patient or family has to say instead of thinking ahead to what you want to ask next.

Using the Nursing Process to Promote Health:

Accepting

Another vital aspect of communicating is acceptance—acceptance of appearance, lifestyles, ways of coping, and values. You can accept people as valued, creative, unique individuals, despite their differences from your own ways of being.

Using the Nursing Process to Promote Health:

Respecting

In your role as a caregiver, you must convey an attitude of accepting the intrinsic value of life—in whatever form that life takes.

Using the Nursing Process to Promote Health:

Enjoying

A challenge for you is to broaden the repertoire of people you enjoy: to see and enjoy commonalities among individuals seemingly so different and to recognize and appreciate the pathos of suffering in the unique experience of each person.

Using the Nursing Process to Promote Health:

Planning outcomes/evaluation:

As a nurse, your role is to help the patient (or family member) envision acceptable outcomes and to set smaller, realistic goals so that the patient recognizes progress. In the stress of illness, patients and families may not recognize the strengths and creative abilities that they bring to a situation.

Using the Nursing Process to Promote Health:

Planning interventions/implementation

Envision strengths and potential in clients and families who are too overwhelmed to identify their own.

Nursing Diagnosis: as defined in handbook

Anxiety

Vague uneasy feeling of discomfort or dread accompanied by an autonomic response (the source is often nonspecific or unknown to the individual); a feeling of apprehension caused by anticipation of danger. It is an alerting sign that warns of impending danger and enables the individual to take measures to deal with that threat.

Nursing Diagnosis: as defined in handbook

Caregiver Role Strain

Difficulty in performing family/significant other caregiver role.

Nursing Diagnosis: as defined in handbook

Deficient Knowledge

Absence or deficiency of cognitive information related to a specific topic

Nursing Diagnosis: as defined in handbook

Spiritual Distress

A state of suffering related to the impaired ability to experience and integrate meaning in life through connections with self, others, the world, or a superior being.

How Can I Honor Each Client’s Unique Health/Illness Experience?

Examine life's uncertainties

As a nurse, you will face many uncertainties and dilemmas. You will certainly face new experiences and challenges, situations you thought you never would have to deal with. You will observe pain, suffering, and death. You may never understand the apparent unfairness of it all. But often life brings new meaning when it takes a different direction from the one planned. For example, a couple formerly embittered over their third miscarriage found joy in adopting two children with disabilities.

How Can I Honor Each Client’s Unique Health/Illness Experience?

Envision wellness for your clients and yourself

Use flexible envisioning, adjusting your goals and dreams to each new reality. Health does not mean always getting your first choice. Part of health is being able to dream a new dream, starting over if you need to, but always envisioning that there is something worth striving for.

How Can I Honor Each Client’s Unique Health/Illness Experience?

Establish trust at your first client contact and through transfers and discharge

The relationship and trust you establish in your first contact with patients can go a long way toward relieving their anxiety and preserving the energy needed for healing. Take time to get to know your client. Try to set a tone of caring, respect, and understanding.

How Can I Honor Each Client’s Unique Health/Illness Experience?

Provide a healing presence

Your healing presence may be the most important aspect of care that you have to offer.

A 28-year-old client underwent surgery for testicular cancer. Which factor might increase the client's recovery time?

1) Drinking a glass of red wine daily

2) The client's developmental stage

3) Exercising three times a week

4) History of tobacco use

Answer:

4) History of tobacco use

Rationale:

A history of tobacco use increases recovery time from other illnesses, injury, and surgery. Drinking a glass of red wine each day can reduce the risk of heart disease and slow bone loss. Studies support the benefit of moderate physical activity in reducing the risk of chronic disease. Because this client is young, his developmental stage would not be a factor in increasing recovery time; advanced age might be a factor.

When do people typically begin to increase awareness of the compelling reality of death? Select all that apply.

1) Adolescence

2) Young adulthood

3) Middle age

4) Older adulthood

Answer:

3) Middle age

Rationale:

During middle age, even without a life-threatening illness, people typically become more aware of the reality of death—that one's life is limited.

Which health conditions would be considered acute illness? A patient with:

1) Diabetes mellitus

2) AIDS

3) Appendicitis

4) Multiple sclerosis

Answer:

3) Appendicitis

Rationale:

Appendicitis is an acute illness; diabetes mellitus, AIDS, and multiple sclerosis are chronic illnesses. An acute illness occurs suddenly and lasts for a limited amount of time. Chronic illness lasts for a long period of time, usually 6 months or more, often for a lifetime.

What is the most important reason for a nurse to remain calm, greet the patient by name, and introduce herself to a new patient, even when the nurse is upset by something else that has happened?

1) The nurse will work more efficiently if she is not upset.

2) These actions help to establish a trusting relationship.

3) Hospital policies prohibit nurses from showing emotion in a patient's presence.

4) If the nurse is upset, she may not recall all the assessments she needs to make.

Answer:

2) These actions help to establish a trusting relationship.

Rationale:

Greeting the patient by name and introducing yourself helps to build a trusting relationship at the first patient contact. The disruptions of illness and transition to the hospital are stressful for patients. A trusting relationship helps relieve their anxiety and preserve the energy needed for healing. The nurse might work more efficiently if she is not upset, but that is not the most important reason. It is not likely a policy would prohibit nurses from appropriately showing emotions to a patient, although it would be inappropriate to do so in the situation described in this question. However, even if there were such a policy, that is not the most important reason. It is true that if the nurse is upset, she might not recall the contents of an admission assessment; however, there is almost always a structured data collection form for admission assessments, so recall is not an issue.

A nurse is admitting a 75-year-old patient to the nursing unit, accompanied by his son. Using a life span approach to care, which of the following is essential for the nurse to do?

1) Increase the room temperature.

2) Speak slowly and use short sentences.

3) Direct admission questions to the patient's son.

4) Ask the patient whether he has had any falls in the past year.

Answer:

4) Ask the patient whether he has had any falls in the past year.

Rationale:

Falls are a major source of morbidity in hospitalized patients. On admission, nurse should ask all older adults (age 65 and older) whether they have had any falls in the past year. Although it is true that some older adults may like a warm temperature, this is not universally true; it would need to be assessed for each individual. Speaking slowly and using short sentences is recommended for patients with learning or hearing disabilities; however, the nurse cannot assume that all older adults have either of these. The best assessment data usually are obtained from the patient. The nurse should interview other family members only if the patient is not communicating clearly; the nurse has not yet assessed that in this scenario.

The nurse is responsible for setting up special equipment (e.g., oxygen, suction). Aside from that, which of the following procedures can the nurse delegate in its entirety to nursing assistive personnel (NAP)?

1) Preparing a room for a newly admitted patient

2) Admitting a patient to a hospital unit

3) Transferring a patient to a long-term care facility

4) Discharging a patient to home

Answer:

1) Preparing a room for a newly admitted patient

Rationale:

As a general rule, the nurse can delegate to a NAP the tasks of setting up a room for a patient being admitted to the unit, except for setting up and regulating special equipment such as oxygen and suction. Admissions, transfers, and discharges all involve patient assessment, teaching, and interdisciplinary communication that the NAP cannot do.

In an effort to promote health, the home health nurse opens the client's bedroom windows to let in fresh air and sunlight, washes her hands often, and teaches the patient and family about the importance of hygiene and cleanliness. This most closely illustrates the ideas of which of the following people?

1) Jean Watson

2) Jurgen Moltmann

3) Florence Nightingale

4) Robert Louis Stevenson

Answer:

3) Florence Nightingale

Rationale:

Florence Nightingale believed that health was prevention of disease through the use of fresh air, pure water, efficient drainage, cleanliness, and light. Jean Watson believes that health has three elements: a high level of overall physical, mental, and social functioning; a general adaptive-maintenance level of daily functioning; and the absence of illness (or the presence of efforts that lead to its absence). Jurgen Moltmann believes that true health is the strength to live, the strength to suffer, and the strength to die. He also stated that health is not a condition of the body; it is the power of the soul to cope with the varying condition of that body. Robert Louis Stevenson wrote that health is not a matter of holding good cards; it is playing a poor hand well.

Which of the following is known to be a healthy strategy for coping with stress?

1) Performing meaningful work

2) Consuming simple carbohydrates

3) Drinking three glasses of red wine each day

4) Weight training

Answer:

1) Performing meaningful work

Rationale:

Many individuals find that meaningful work is a healthy way to cope with stressors. Consuming simple carbohydrates is not a healthy way to cope with stress. Drinking more than one glass of red wine each day is considered unhealthy. Weight training has been shown to increase bone density and reduce the risk of osteoporosis and heart disease but not necessarily to reduce stress

Which family would most likely be helpful in encouraging the client to experience a high level of wellness? A family who:

1) Controls feelings in order to avoid conflict

2) Teaches negotiation skills and independence

3) Encourages risk-taking and adventure

4) Views themselves as helpless victims

Answer:

2) Teaches negotiation skills and independence

Rationale:

Families who promote independence and teach good negotiation skills enable family members to experience a high level of wellness by thinking for themselves. In contrast, families who tend to squelch personal feelings to avoid conflict may not allow a high level of wellness. Families who emphasize caution in new situations are more beneficial than those who encourage risk-taking. Families who view themselves as capable and successful are more advantageous than those who view themselves as helpless victims.

When developing goals, which guideline should the nurse keep in mind? Goals should be:

1) Realistic so that progress is recognized by the patient

2) Developed solely by the healthcare team

3) Developed without family input, to maintain confidentiality

4) Valued by the multidisciplinary care providers

Answer:

1) Realistic so that progress is recognized by the patient

Rationale:

Goals should be realistic so that progress is recognized by the patient. They should be valued by both the patient and family. The nurse should develop goals with input from the patient and his family.

Which one of the following important nursing actions is a hospitalized patient likely to experience on an emotional level and remember long after this hospitalization has ended?

1) Administering her medications according to schedule

2) Allowing flexible visitation by her family and friends

3) Explaining treatment options in terms she can understand

4) Providing a healing presence by listening and being attentive

Answer:

4) Providing a healing presence by listening and being attentive

Rationale:

The nurse can contribute meaningfully to the patient's hospitalization by providing a healing presence. The nurse can do this by listening to the patient and being attentive. Administering medications according to schedule, allowing flexible visitation, and explaining treatment options are important contributions that the nurse can make, but they will not be most meaningful to the patient. Patients may be impressed, even amazed, by the healthcare technology used to diagnose and treat their illness. However, often what they remember, perhaps through the rest of their lives, is the person who connected with them in a personal way.

Which statement best describes the health–illness continuum?

1) Health is the absence of disease; illness is the presence of disease.

2) Health and illness are along a continuum that cannot be divided.

3) Health is remission of disease; illness is exacerbation of disease.

4) Health is not having illness, and illness is not having health

Answer:

2) Health and illness are along a continuum that cannot be divided.

Rationale:

The health–illness continuum is best described as a graduated spectrum that cannot be divided.

Which of the following views of health would be most appropriate for you as a nurse to have when working with clients?

1) Health is not having an illness.

2) Health is a state of ideal physical and mental well-being.

3) Health is the ability of the soul to cope.

4) Health is an individual experience emerging from each patient's unique response.

4

Correct!

Nurses understand health and illness as individual experiences, emerging from each patient's unique responses. The person with an illness rarely perceives the experience as a medical diagnosis. Instead, people describe their illness in terms of how it makes them feel.

A client you are interviewing says that she is "healthy as a horse." When you look at her health history, though, you see that she has diabetes and hypertension and that she has had breast cancer twice. When you ask her what health means to her, she says, "Having a lot of energy to do whatever I want to do." Which of the following conceptual models of health and illness would best express this client's view?

1) Moltmann's definition

2) Health–illness continuum

3) Dunn's health grid

4) Neuman's continuum

4

Correct!

Nursing theorist Betty Neuman (2002) views health as an expression of living energy available to an individual. The energy is displayed as a continuum with high energy (wellness) at one end and low energy (illness) at the opposite end. When more energy is generated than expended, there is wellness.

A 50-year-old man you are treating for minor injuries related to an automobile accident seems somber and thoughtful. When you ask him how he's doing, he says the accident has made him realize how fragile life is and how little of it he has left before him. Which of the following disruptions to health is this client primarily experiencing?

1) Competing demands

2) Impending death

3) The unknown

4) Imbalance

2

Correct!

Lifton and Olson (1974) state that during middle age, even without the presence of life-threatening illness, people tend to become more aware of the compelling reality of death: "One's life is suddenly felt to be limited. . . . It also becomes apparent that . . . there will not be time for all one's projects" (p. 63).

Which of the following is the World Health Organization's definition of health?

1) Prevention of disease through the use of fresh air, pure water, efficient drainage, cleanliness, and light

2) The trinity of body, mind, and spiritual awareness

3) A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity

4) A high level of overall physical, mental, and social functioning.

3

Correct!

The World Health Organization's definition of health is as follows: "A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."

You are preparing for first contact with a patient recently admitted to the hospital. Which of the following should you do to help establish trust during this encounter?

SELECT ALL THAT APPLY.

1) Make sure the patient's bed is made properly ahead of time.

2) Review the patient's name, diagnosis, and anticipated length of stay before he or she arrives.

3) Speak confidently and keep the fact that you are a nursing student concealed.

4) Show the client how to use the bed and call light.

5) Avoid spending too much time talking with the client.

6) Ask about the client's expectations and concerns when taking the health history.

1 2 4 6

Correct!

Feedback 1: Preparing the room, such as making sure the bed is made properly, is a way to help establish trust with the patient.

Feedback 2: Gathering basic information ahead of time, such as name, diagnosis, and anticipated length of stay, allows you to greet the patient more effectively.

Feedback 3: When introducing yourself, don't be afraid to tell a client that you are a nursing student. Many clients are aware that students have more time to spend with them, and you are more likely to establish an atmosphere of trust by being forthcoming regarding your level of experience.

Feedback 4: Orient the patient to the room by making sure the patient knows how to use the bed, the call light, and any equipment as needed.

Feedback 5: Establish a relationship with the client by taking time to get to know him or her. Try to set a tone of caring, respect, and understanding.

Feedback 6: Be sure to include in your health history the client's expectations and concerns.

You notice that a client seems much calmer and happier than usual. When you ask him about the change, he says, "I bought this little cabin out by the lake and I go there every weekend now. It's a huge stress reliever for me." Which of the following factors is helping to contribute to this client's health?

1) Meaningful work

2) Culture

3) Environment

4) Religion and spirituality

3

Correct!

The environment can nourish wellness. Spending time in a place where the client feels harmony and peace and draws strength can promote the client's health.

Which of the following is an example of an acute illness?

1) Appendicitis

2) Diabetes mellitus

3) Hypertension

4) Rheumatoid arthritis

1

Correct!

An acute illness occurs suddenly and lasts for a limited amount of time. Although hospitalization and surgery may be required and may be traumatic, the person is expected to recover, as in appendicitis.

You work with an 83-year-old client, Hilary, who always has a lot to say. Although this behavior annoyed you at first, you have since learned that if you just sit with Hilary for 5 minutes at the end of her visit and listen to her attentively, making good eye contact and not interrupting, she leaves with a much calmer demeanor. Which aspect of high-level communicating are you using?

1) Settling in

2) Attuning

3) Acceptance

4) Enjoying

2

Correct!

Attuning, or being maximally attentive, is a key factor in facilitating communication. Most people are hungry for someone to listen to them.

You stop by your friend's apartment one morning and find that she is still in bed. You ask whether she is going to work today, and she says, "No—I think I'm coming down with something." Which stage of illness behavior is your friend exhibiting?

1) Experiencing symptoms

2) Sick role behavior

3) Seeking professional care

4) Dependence on others

2

Correct!

When you have identified yourself as ill, you assume the sick role. The sick role relieves you of normal duties, such as work, school, or tasks at home.

Your patient has just arrived, and you ask him, ""What is the biggest concern you are dealing with today?" You are in which phase of the nursing process?

1) Assessment

2) Analysis/nursing diagnosis

3) Planning outcomes/evaluation

4) Planning interventions/implementation

1

Correct!

One way to approach assessment, whether in outpatient care, acute care, long-term care, or home settings, is to ask the patient, "What is the biggest concern you are dealing with today?"

Below are the five stages of illness behavior. Put them in the correct order.

• Seeking professional care
• Sick role behavior
• Recovery
• Experiencing symptoms
• Dependence on others

Correct!

The five stages of illness behavior are as follows: 1. experiencing symptoms, 2. sick role behavior, 3. seeking professional care, 4. dependence on others, and 5. recovery.

You are counseling a client about ways to reduce his total cholesterol level, which is elevated. He responds by saying, "There's no use fighting it. I'm just not a healthy person." When you ask him what he means, he explains, "It's in my genes. Everybody in my family has high cholesterol and heart problems." This client is defining health primarily by which of the following factors?

1) Biological

2) Nutrition

3) Lifestyle choices

4) Culture

1

Correct!

Biological factors include genetic makeup, gender, and age and developmental state.

You are caring for a military veteran who is now a quadriplegic as a result of sustaining a spinal cord injury while serving overseas. You notice that he tenses up when you begin to give him a sponge bath. He says that being bathed makes him feel like a helpless child. Which of the following is the primary disruption of health this client is describing?

1) Loss of a sense of self

2) Injury

3) Mental illness

4) Pain

1

Correct!

Being naked and feeling like a child in the hospital setting are indignities that threaten a person's sense of self.

You are working with two clients, both of whom are receiving treatment for breast cancer. The first client, Colleen, has had breast cancer twice before and has been undergoing treatment—including surgery, radiation therapy, and now chemotherapy—for nearly 6 months. Despite all of this, Colleen remains cheerful and determined. She says, "I've beat this before and I'll beat it again." The second client, Muriel, was diagnosed a few weeks ago, has undergone surgery, and is now receiving adjuvant radiation therapy. Next she will have chemotherapy. Unlike Colleen, Muriel is devastated by her diagnosis and full of despair. Which of the following would best explain the difference between these two women's reactions to their disease?

1) Intensity of illness

2) Duration of disruption

3) Hardiness of client

4) Multiplicity of disease

3

Correct!

Hardiness—having a strong, positive force or will to live—seems to be the difference between these two clients. Colleen has a stronger will to live than does Muriel.

You are caring for a client who is the primary caregiver for her 82-year-old father, who has Alzheimer's disease. You can tell that your client is exhausted and under great strain as a result of her role as caregiver. Which of the following would be the ideal approach when planning an intervention to address this client's problem?

1) Offer to come and sit with the client's father on occasion to give her a break.

2) Ask the client's provider to prescribe an anti-anxiety medication for the client.

3) Suggest that the client hire a home health nurse to help care for her father.

4) Recommend that she recruit help from other family members in caring for her father.

4

Correct!

The ideal approach to planning interventions is to draw on patient and family strengths to help achieve the desired outcomes, in this case recruiting help from other family members in caring for the father.