The concept of health to each individual is a very personal thing. To some individuals it can be the absence of disease but to another it can be getting from day to day adequately caring for themselves’ without assistance. The governments’ policies rule health matters a great deal but this leads to problems when their concept of health differs from that of the individual. One of the major problems in health care is the money available for resources. This essay will look at some different ideas of health and will examine some of the influences that health care and carers depend on which could also influence the process of care in the way of interviews with trained staff and patients.
There are many definitions of “Health”, the most common one being from the World Health Authority (W.H.O.) in 1947: “Health is the state of complete physical, mental and social well being and not merely the absence of disease or infirmity” (Hinchcliffe 1947).
This definition, in later years, seemed too broad so the W.H.O. in 1984 added on: “The extent to which an individual or group is able, on one hand to realise aspirations or satisfy needs and on the other hand, to change or cope with the environment”
(Elves and Simnett 1992).
This indicates that the concept of health is continuously changing with the forever-changing quality of the environment around us. Aggleton (1990) argues that it is too complex to define health and fitness, as some people may be healthy according to some criteria but not according to others. Seedhouse (1986) argues that health is made up of a number of factors that help people to achieve their maximum personal potential. Acheson (1995) states that inequalities in health are still widening and that a recent report demonstrates the shorter expectation of life for people who face multiple disadvantages. On August the 29th 1980 the Department of Health published a report entitled “Inequalities in Health”, more commonly known as the Black report. It claimed that despite thirty years of the National Health Service, manual workers and their families tended to die younger than professional people. This report states that there is a need for government action and a joint approach to health policies at a local level is essential.
There are many types of illness, disease and infirmity. Most individuals’ will experience illness in their lives at one time or another, but how they cope with it depends entirely on themselves, their environment and their background. Concepts of health are instilled in us from a very early age usually by our own experiences and the experiences of our peers. These concepts are also apt to change due to media influences and the fact that as a person ages their outlook on life often changes.
Environment and social class can influence our first concepts of health. Something as broad as air and water pollution may affect the whole population but some social factors such as low income, unemployment or poor housing will affect some groups of people more than others (Kenworthy et al 1996). Epidemiological data, such as morbidity and mortality statistics, suggest health problems of a target population. Statistics may show problems such as alcoholism, communicable and chronic diseases, infant mortality and child abuse (Edelman and Mandle 1998). Some behaviours can influence the risk of disease, for example smoking can increase the risk of heart disease and cancer. There are some nonbehavioural causes of health problems which cannot be altered such as age, gender or ethnic origin. These cannot be altered by the individual changing their behaviour but if it is due to the influence of environmental factors then there is often the need for a change in legislation (Edelman and Mandle 1998).
According to Orem, a person is a functional, integrated whole with a motivation to achieve Self-Care (Aggleton and Chalmers 1990). However, when disease or infirmity affects an individual it unbalances this equation, thus making the ability to self-care debatable. Looking at the holistic concept of the human being together with individualistic, goal-directed nursing care through a process approach, allows the consideration of patient education in care planning (Carter 1990). It is important here to consider the fact that not only the patient, but the whole family needs educating. Price (1984) suggests that some individuals need to control their own situation during illness and resent being dependent on others. If education is provided the patient will have a balanced understanding of the situation and will be more motivated to learn to self-care with his/her disabilities.
To plan effective nursing care it is important to obtain and assess the individual’s needs. To do this information is needed on all aspects of functioning; physically, psychologically and socially (McFarlane and Castledine 1982). The nurse must look at the whole picture, which the patient gives to her in order for her to construct a care plan. For example it would be of no use to recommend regular bathing for a patient who could not get in and out of the bath safely. Physical, social, psychological and spiritual goals for each individual cannot be met by isolating the goals and assigning responsibility to a specific discipline. The whole is greater than the sum of it’s parts, emphasising the need for integrating the efforts of team members in a holistic manner (Trice 1993).
Most hospital wards follow a health model. The ward from which the following studies were undertaken follows the Ropers model. Newton (1993) states that :
“Roper, Logan and Tierney believe that it can only be defined in relation to the individual… they see no clear boundary between health and illness”
Newton (1993) also believes that the Roper model is concerned with the individual way in which activities are performed and the way in which they are educated and socialised, not just meeting the needs of basic day-to-day living. It is seen as a systems model, which organises nursing intervention in a fairly traditional way, enabling staff and patients to identify with its implementation and aims (Chew and Williams 1998).
The ward being observed is a rehabilitation ward where the patients varied from stroke victims, of different degrees, Multiple Sclerosis (MS) respite care and various brain trauma injuries at different stages of recovery. Some patients had been diagnosed as “Persistent Vegetative State” (PVS) and could not be interviewed. Various nurses including Clinical Support Workers were also talked to. For confidentiality the subjects and nurses will be termed 1 and 2 or A and B, only their gender will be revealed.
Patient A – MS Respite Care. This gentleman was at quite a severe stage of MS. He couldn’t move the lower part of the body and is wheelchair bound. When he was asked about “Health” he replied that he still had a good life because of his lovely family and friends. He said that he could still laugh and enjoy himself and felt that it was only occasionally that he felt the need to put a brave face on things. The gentleman felt he was unlucky to have MS and did in fact see it as a disease but not an illness. To be completely healthy he said that he would need to walk and therefore gain more independence. He recognised the fact that this was impossible so he said that while he could he would like to remain as independent as possible.
Nurse 1 The personal view of nurse 1 was very different from patient A. Health was perceived in a more physical nature. He considered eating unhealthily not an issue as long as the body had plenty of exercise to burn off unnecessary calories and fats. When asked how his views would influence his attitude of care towards patient A and he said that he would encourage as many activities as possible i.e. washing, shaving etc. to strengthen the able parts of the patients body. However, he did say that even if patient A was not keen on independence he would still have tried to encourage him.
Patient B This patient was a female in her mid thirties, who had her left leg amputated just above the knee about eleven days previous to this interview due to a thrombosis. She was still very shocked and traumatised by her situation and this may have altered her outlook on health slightly. Although in a wheelchair at the moment she visits the amputee clinic for physiotherapy and to be fitted for an artificial limb. She considers health to be more important now than before her amputation, although previously she had been a keen runner who worked out regularly. Reflecting on her situation she considers it to be a terrible one that will affect her whole life both physically, sexually and socially. She thought she would find things not so easily accessible, in the house living a normal day to day life or at work.
Already she had begun to think about how her style of dress would have to alter from short skirts to trousers to hide her artificial limb and she said that even getting out of bed in the morning would become a chore with having to think about attaching her limb first. She even spoke about the relationship between herself and her husband – she doesn’t feel like a woman anymore, just someone with a leg missing. She even thought her roles would change within her family, as she considered herself to be a doer, always the one to instigate activities, i.e. fetch the children from school and do the shopping etc.
Now she thought that her husband would have to take over these roles and that she would become less independent. Diet is also on her list of priorities, she claimed that she always tried to eat sensibly before but would now be inclined to be a little underweight rather than her usual weight, as body image is now a major issue. Olson et al (1991) believe that to overcome and adjust to a change in body image, a person must go through a period of mourning and that until grieving is complete, the individual will be unable to accept the disability.