NURSING FOUNDATION UNIT I FOR NURSING STUDENTS

NOTES FOR NURSING STUDENTS

1. NURSING FOUNDATION UNIT I VIJI VS ASSISTANT PROFESSOR BETHLEHEM COLLEGE OF NURSING

2. INTRODUCTION The word health means different things to different people depending on the situation. Health is a relative state in which one is able to function well physically, mentally, socially, and spiritually to express the full range of one’s unique potentialities within the environment in which one lives.

3. CONCEPT OF HEALTH There is no consensus about definition of health. Health is difficult to define, but easy to understand. The meaning of health has evolved over time. Health is a state characterized by anatomic, physiologic and psychological integrity.

4. DEFINITION OF HEALTH Traditionally health has been defined in terms of the presence or absence of diseases. (1947) WHO defined heath as: “Heath is a state of complete physical, mental and social-wellbeing and not merely the absence of disease and or infirmity.”

5. American Nurses Association defined health as : It is a dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible. Most individuals define health as : Being free of symptoms of disease and pain as much as possible Being able to be active and able to do what they want or must to

6. Illness is an abnormal process in which functioning of a person is diminished or impaired in one or more dim

7. Biomedical concept: As per this concept health means absence of disease. It is based on germs theory. The human body is considered as a machine, disease is an outcome of the damage of the machine and one of the doctors role was to repair the machine. And, also this concept minimized the role of environment, social and cultural determinants of the health.

8. Germs theory

9. Ecological concept According to this concept health is a dynamic equilibrium between man and his environment. Disease is a maladjustment of the human organism to environment. This concept to support the needs for clean air, safe water, and good atmosphere, to protect us from the exposure to unhealthy factor. If any person is able to adjust himself according to different environmental situation, then he will be considered as healthy.

10. Psycho social concept: Health is not only a biomedical concept, but one which is influenced by social, psychosocial, cultural, economic and political factors of the people concerned. These factors must be taken into consideration in defining and measuring health. Thus health is both biological and social phenomenon.

11. Holistic concept: This concept is the synthesis of all the above concepts. This concept describes the wellbeing of a person as a whole. Holistic concept describes health as multidimensional approach and it is influenced by various factors. This concept recognizes the strength of social, economic, political, and environmental influence on health.

12. Holistic concept implies that all sectors of society have an effect on health, in particular agriculture, food industry, housing, education, animal husbandry, public works, and other sectors.

13. DIMENSIONS OF HEALTH There are mainly 3 dimensions such as physical, mental/emotional and social. Other dimensions are spiritual, environmental, intellectual, occupational

14. Physical wellness: It is the ability to maintain a healthy quality of life that allows us to get through our daily activities without undue fatigue or physical stress. If an individual is having an adequate body weight, height and circumference as per age and sex with acceptable levels of vital signs, vision, hearing and movements, then he can consider as having a physical wellness.

15. Mental Wellness

16. Mental/Emotional wellness: This is the ability to understand ourselves and cope with the normal stresses/challenges life can bring. A mentally normal person has the ability to mix up with others, makes friendships, behaves in a balanced manner and observe adequate personal hygiene. Will be well oriented to time, place, person and environment. Thinks positively, has normal development and contributes to the society.

17. Able to realize his short comings, strengths and abilities.. The ability to acknowledge and share feelings of anger, fear, sadness, or stress, hope, love, joy and happiness in a productive manner contributes to our emotional wellness.

18. Social wellbeing: Ability to relate to and connect with other people in the world. Ability to establish and maintain positive relationships with family, friends, and co-workers contribute to our social wellness.

19. Spiritual wellness: This the ability to establish peace and harmony in our lives. The ability to develop congruency between values and actions and to realize a common purpose that binds creation together contributes to our spiritual wellness.

20. Environmental wellness: Ability to recognize our own responsibility for the quality of the air, the water and the land that surrounds us., The ability to make a positive impact on the quality of our environment contributes to the environmental wellness.

21. Intellectual wellness: Ability to open our minds to new ideas and experiences that can be applied to personal decisions, group interaction and community betterment. The desire to learn new concepts, improve skills and seek challenges pursuit of lifelong learning contributes to our intellectual wellness.

22. Occupational wellness: The ability to get personal fulfillment from our jobs or our chosen career fields while still maintaining balance in our lives. Our desire to contribute in our careers to make a positive impact on the organizations we work in and to society as a whole leads to occupational wellness.

23. MASLOW’S HIERARCHY OF NEEDS

24. This theory was proposed by Abraham Maslow in the year 1943. He was a professor in psychology and founder of humanist psychology. This model of basic need is a foundation for nursing care, and interventions. Basic needs are elements necessary for human survival and health.

25. Basic human needs have the following characteristics: The absence of a basic human need result in illness. The presence of basic human needs helps to prevent illness or promote health. Meeting the human needs restores health. He feels satisfaction when needs are met.

26. Once the lower level needs have been met, people can move on to the next level of needs. As the people progress up the pyramid, needs become increasingly psychological and social.

27. Physiological needs: These are physical requirement for the human survival. If these requirements are not met, the human body cannot function properly and will ultimately fail. Therefore physiological needs are thought to be the most important and they should be met first. The basic needs are the air, water, food, warmth, sexuality, physical activity and rest.

28. Safety and Security It includes both physical and emotional components. One needs adequate shelter, safe environment, protection from violence and safe emotional environment. For example, financial security, health and wellness, safety against accident, injury, violence etc. Safety and security needs involve physical and well as economic safety.

29. Love & Belongingness

30. Love and belongingness This needs include love, acceptance, understanding and belonging from families, peers, friends and community. At this level the need for emotional relationships drives human behavior. Examples are friendships, family, social groups, community groups, church and religious organizations.

31. The deficiency of these needs can adversely affect the individual’s ability to form and maintain emotionally significant relationship such as friendship, family etc. Absence of this needs will result in loneliness, depression etc. Love and belongingness is dependent on interpersonal relationship such as friendship, family etc. Personal relationship with friends, family, religious groups, sports teams etc. can play important role.

32. Self-esteem

33. Self esteem needs At the fourth level in Maslow’s hierarchy is the need for appreciation and respect. When the needs at the bottom three levels have been satisfied, the esteem needs begin to play a more prominent role in motivating behavior. Self-esteem is the person’s overall subjective, emotional evaluation of her/his own worth.

34. The person needs to feel good about self and a sense of accomplishment, respect and appreciation. People need to sense that they are valued by others, and feel that they are making a contribution to the world. Self-esteem gives confidence to the individual. Participation in professional activities, academic accomplishments, athletic or team participation and personal hobbies can all play a role in fulfilling the esteem needs.

35. Those who lack self-esteem and the respect of others can develop feelings of inferiority. Maslow noted two versions of esteem needs: lower and higher versions. Lower version of esteem is the respect from others. Eg. Need for recognition, attention, prestige etc. Higher version of esteem is the self respect.

36. Self-actualization need: At the very peak of Maslow’s hierarchy are the self-actualization needs. “what a man can be, he must be”, Maslow explained, referring to the need people have to achieve their full potential as human beings. According to Maslow, self-actualization may be described as the full use and exploitation of talents, capabilities, potentialities etc.

37. It is the highest expression of one’s individual potentials. It allows for the discovery of self. Eg. People like Mother Theresa, Gandhi etc. could go up to the highest levels of utilizing their potentials and capabilities. Another examples are one may have the desire to become athlete, others may have desires such as to shine in art, inventions etc.

38. How this Maslow’s Hierarchy theory can be applied to nursing care. To prioritizing care we can use Maslow’s hierarchy theory of basic needs. Physiological needs : oxygen, nutrition, fluids, body temperature, elimination, shelter must be ensured at all times as a basis for everything else. When prioritizing physical needs should be first.

39. Safety and security : physical safety is a core concept in nursing. Your patient’s safety should be always considered when completing nursing interventions. Love and belonging : ensuring your patients are able to communicate with their loved ones and helping to facilitates visits family when necessary. Self esteem : encouraging patients to do things for themselves while hospitalized, empowering them with the information they need to have

40. a successful discharge. Self actualization : positive conversation with your patient can help with self actualization such as when you encourage them that they are ready to go home, or remind them of how far they have come.

41. The illness wellness continuum is a graphical illustration of a well-being concept. It was first proposed by Travis in 1972. Wellness is a process, never a static state. This model views health as a constantly changing state, with high level wellness and death at opposite ends. (ranging from extremely health to death).

42. One’s condition is rarely constant. Individual may wakeup feeling great, develop a headache mid-morning, and feeling fine again by noon. This model consist of 2 arrows are pointing in opposite direction. And joint at neutral point. Movement to the right arrow(toward the wellness) has increasing level of health and well-being and achieved in three steps.

43. Awareness Education Growth Awareness: person should be aware about his health status and should not neglect any warning signs of illness. Eg : regular mild exercise like walking can prevent heart diseases in the middle ages.

44. Education: A person should be educated about the general health issues of day to day life. It can be done by various mass media method like newspaper, TV, radio etc. By gaining awareness person can improve health. Eg. Individual learns about healthy practices or lifestyles for improving overall health.

45. Growth: it includes overall aspect for growth of individual such as intellectual, mental, physical and spiritual. Movement to the left arrows shows a progressively decreasing state of health. Signs- objective in nature which can ruled out only by physician or other health care worker. They are the evidence of disease. For eg. Fever, rash etc.

46. Symptoms -they are subjective in nature which means patient can feel them but other person cannot measure or quantify it. Eg pain or fatigue Disability- it is the condition of the body or mind impairment that makes it more difficult for the person with the condition to do certain activities The treatment paradigm like drugs, surgery, psychotherapy, herbs can bring individual up to the neutral point, where the symptoms of

47. disease have been alleviated. The wellness paradigm directs beyond neutral and encourages moving as far as possible toward wellness. If the patient is ill, then the treatment is important, but don’t stop at the neutral point. Use wellness paradigm to move toward high-level wellness.

48. FACTORS INFLUENCING HEALTH Many factors like internal and external factors influence client’s health belief and practices. The common factors that affect health are hereditary or genetics, environmental factors, lifestyle, educational and economical status etc.

49. Genetics - the inheritance plays a part in determining lifespan, health and the likelihood of developing certain illness. Environmental factors- safe water, clean air, healthy workplaces, safe house, communities and roads all contributes to good health. Education - lower education levels are linked with poor health. Health services- the access and use of services that prevent and treat disease influences health of an individual.

50. Social connection- person’s marital or intimate relationship Behavioral factors- Cultural factors- cultural background of individual influences health and health related practices

51. ILLNESS An illness is the response of a person to a disease. Illness are classified as either acute or chronic Both illness have the potential to be life threatening Acute Illness: This is a rapid onset of symptom and lasts only a relatively short time Although some acute illness are life threatening, simple acute illness such as common cold, or diarrhea do not usually require medical treatment.

52. But other acute illness requires medical treatment, surgical treatment or other therapies to return to the normal functioning. For eg - an antibiotic for pneumonia, surgery appendectomy for appendicitis etc. Chronic illness: This is the one which persists, usually longer than 6 months. It is broad term that encompasses a number of different physical and mental alterations in health.

53. This usually have a slow onset and many have periods of remission(the disease is present, but the person does not experience symptoms) and exacerbation( the symptoms of the disease reappear) Characteristics of a chronic illness It is a permanent change Causes irreversible alterations in normal anatomy and physiology Requires special patent education for rehabilitation Requires long period of care or support

54. CAUSES FOR ILLNESS Causes for illness Illness results from a disease-physiological or psychosocial or from an injury that affects body functioning. Disease is defined as a pathological process with characteristics signs and symptoms affecting the whole body or any of its parts. Most health problems have multiple causative factors.

55. Physiological causes: Physical injuries -it includes those caused by mechanical trauma, heat and cold, electrical discharges, changes in pressure and radiation Disease of biotic origin -includes living organisms like virus, bacteria, fungi, parasites etc. Abnormal growth of the cell -disease occurs as a result of uncontrolled growth of cells. Chemical injury- because of poisons

56. Psychological causes: Genetic factors- mental illness sometimes run in families. Stress, abuse, or a traumatic event which can trigger illness in a person. Life experiences- severe psychological trauma during childhood, such as emotional, physical, or sexual abuse. An important loss like loss of a parent or divorce. Neglect from family members

57. Poor social or cultural expectations , for eg a society that associates beauty with thinness can be a factor in the development of eating disorders. Substance abuse has been linked to anxiety, depression etc. Poor nutrition , exposure to toxins may play a role in the development of mental illness. Certain infections have been linked to brain damage and the development of mental illness

58. Brain defects or injury to certain areas of brain also been linked to some mental illness Prenatal damage -a disruption of early fetal brain development or trauma that occurs at the time of birth may can cause certain mental illness. Neurotic disorders- stressors in childhood and adolescence Research has shown that stressors in childhood and adolescence can cause neuroticism

59. Psychotic disorders- caused by genetics or recreational drugs eg cannabis

60. RISK FACTORS OF ILLNESS A risk factor is anything that increases the vulnerability of an individual or community to an illness. If a risk factor is present it does not mean that the individual will develop disease, but it only increases the chances for getting the disease. Risk factors can be modifiable or non-modifiable

61. Non-modifiable risk factors: These risk factors cannot be changed or controlled. This includes age, gender, family history and genetic factors. Age: it’s a major factor risk factors The children and elderly are more at risk for contacting illness as compared to adult. For eg elders are more prone to get heart disease and new- borns and children can easily get infections.

62. Gender: gender is considered as an untreatable and non-modifiable risk factor. Women above 55 years of age are more prone to get disease than male. Male gender is associated with a dramatically increased risk of major infections following trauma. Family history and genetic factors: When considering risk factors for chronic diseases like diabetes and heart disease family health history is often included in the list of non-modifiable risk factors.

63. There is genetic or hereditary predisposition for developing many diseases Eg an individual with family history of diabetes/hypertension/heart disease is at greater risk for developing the disease in future. We receive from our ancestors not only the colour of our hair or tendency towards diabetes or heart disease, but also a variety of psychological stress, traumas and pain also. People can strongly suffer from emotional trauma inherited from parents who lived with hidden and unsolved rejection.

64. Modifiable risk factor Physiological factors It includes the physical functioning of the body Eg being pregnant or obesity places increased stress on the body and cause illness Environment: the environment in which an individual lives determines how he lives, eats, works so on. Exposure to polluted air can predispose to disease such as cancer, chronic lung diseases etc.

65. The chemical used in the industry can be a causefor many occupational disease Lifestyle: lifestyle practices affect the health positively or negatively. Practices which has negative outcome are risk factors The most important risk factors include poor lifestyle habits, unhealthy diets etc. Lack of exercise can leads to overweight

66. Dietary habits: Poor dietary choices have a major role in the development of illness This leads to either under nutrition or over nutrition.

67. ILLNESS BEHAVIOUR The way the sick person acts is called illness behavior Different people act different way to same type of illness. It involves how they interpret and view the symptoms, use remedial measures or utilize the health care facilities. Illness behavior are influenced by age, gender, family values, culture, mental status and education level. Edward Suchman described 5 stages of illness behavior model

68. Nursing roles throughout the stages remain constant In all stages the nurse accepts the patient as an individual, gives nursing care based on prioritized needs and facilitates recovery through physical care, emotional support and health education.

69. Stage 1-experiencing symptoms Stage 2-assuming the sick role Stage 3-assuming dependent role Stage 4-achieving recovery Stage 5-rehabilitation

70. Stage 1 : Experiences symptoms The client believes that something is wrong and he experiences physical symptoms and emotional responses. He may consult others and may try some home remedies.

71. The common symptoms include pain, rash, fever, bleeding etc If the symptoms last for a short time or relieved by self-care, the person usually takes no further action. If the symptoms continues the person enters the next stage

72. Stage 2: Assumption of the sick role He seeks confirmation from family, and friends and continue with treatment He is usually excused from normal duties and expectations He continues with treatment

73. Depending on the health beliefs and practices the person may choose to do nothing, may research symptoms on internet sources, may buy over-the- counter medications, may try alternative remedies to relieve symptoms

74. Stage 3: Medical care contact Seeks advice of medical professionals to validate real illness and to get explanation about illness in understandable terms He gets reassurance He may accept or deny diagnosis

75. Stage 4: Dependent client role The client becomes dependent on the professional for help

76. This stage is characterized by the patient’s decision to accept the diagnosis and follow the prescribed treatment plan The person may have difficulty conforming to the recommendations of the health care provider and may decide to seek a second opinion. They often require assistance in carrying out activities of daily living and need emotional support, approval and protection.

77. Stage 5:Recovery or rehabilitation This stage might begin in hospital and conclude in home In this stage he relinquishes dependent role and resumes former roles and responsibilities He needs adjustment in case of disability

78. IMPACT OF ILLNESS ON PATIENT & FAMILY Illness affects both patient and family in many ways. Behavioral and emotional changes Illness always put a patient under stress Behavioral and emotional changes depend on the nature of illness or diagnosis. Hearing the diagnosis of a serious illness eg cancer may make the

79. patient frustrated and he may lose his hope for life. He will show anger, resentment, anxiety, hopelessness, shock, denial, withdrawal etc. in the beginning The nurse should assist the client and family to cope with stress Spirituality will have lots of effects on the patient during this time. He will slowly accept the reality and will try to adjust with it. The nurse should act as a counselor, and help the patient and family to cope with the illness

80. Impact on family roles and family dynamics The illness brings additional stress if the client is the breadwinner of the family Financial problem will arise additionally Role-reversal occurs as any other member of the family assumes responsibility of the client and family -may be elder child, parent or sibling The family easily adjusts if it is a short term illness

81. But long term illnesses the families requires counselling and guidance to cope with the changes The family dynamics also changes It is the process by which the family functions, make decisions and gives support to the individuals If the parent is ill, it affects the family activities and decision making Help the family to gain maximum level of functioning

82. Impact on self concept and self-esteem Self-concept is that what a person views about his own strengths and weaknesses in all aspects of personality The components of self concepts are identity, body image and role performance Self-esteem comes from the self-concept. Self concept is important to maintain relationships with other members of family

83. The nurse should observe these changes in the client or family members and help them to overcome the change. Impact on body image Certain illness result in changes in the physical appearance of the clients Client react differently to these changes depending on the type of change If it is short term change they will accept it readily

84. But if it is long term change such as an amputation of a limb or permanent colostomy, they may show reactions in phases such as shock, withdrawal, acknowledgment, acceptance and finally rehabilitation.