Republic of the Philippines

BRENT HOSPITAL & COLLEGES Inc.

COLLEGE OF NURSING
RT Lim Boulevard, Zamboanga City

NCM 103
3 units Lecture (54 Hours)
2 unit RLE Skills (102 Hours)

Course Description
This course deals with concepts,
principles, theories and techniques
basic to nursing as a profession,
science and art. It emphasizes on the
concept of man of as a holistic being
and the professional roles of the nurse
in health care setting. The learners are
expected to utilize the nursing process
LEARNING PACKET ON and the basic nursing skills as primary
tool in health promotion, diseases
FUNDAMENTALS OF NURSING prevention, restoration and
maintenance and rehabilitation.
Prepared by:

Nelia P. Magsino RN MN
Norsaada D. Sajili, RN MN
Abdulkarim O. Agga, RN MAN
Level 1 NCM 103 Instructors
 Message to the Learners
Ma’am Nur
Hello Dear Level 1 Students,
I am pleased to be partnering with you as you
participate in an exciting educational journey of discovery in
the field of nursing. Given the current circumstances, we the
faculty of the College of Nursing of Brent Hospital and Colleges
will work together to maintain health and safety standards while
sustaining the academic excellence and personalized attention
for students through distant learning. I know, you we’re quite
accustomed to frequently go online to get variety of information
on various subjects, project work or assignments and have
never relied completely to learn from e-platforms. This
challenge has evolved in you to learn varied strategies to face
the crisis.
As we get ready to embark on this journey into our
new-and-improved remote learning environment well I must
say, feeling some trepidation is understandable. Rest assured,
as one of the instructors tasked to deliver NCM 103/
Fundamentals of Nursing subject I am giving my commitment
to walk in this path in partnership with you and will be focused
on reaching a common destination: the very best foundation in
Nursing that will equip you all for the future. Inshaa Allah. This
is not to say that you are no longer beset with challenges. But
no challenge is insurmountable, for as long as you continue to
work harder in your studies and provide a mindset that you will
be future nurses and an asset in the healthcare team. I
welcome You All for the second semester for the school year
2020-2021! Together let us team up to lift the educational
ladder!
Best of Luck,
Nursaada A. Sajili-Damih, RN MN
Messenger: Nursaada Sajili
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Message to the Learners
Sir Abz
My Dear Level 1 Students,
Assalamu Alaikum Brentonian Community! It
is a great pleasure to welcome you all to this semester!
As you start your journey as novice nurses, it is my
great pleasure to become one of your mentors in this
course.
This course will serve as your foundations in
your major subjects and I’m excited to teach you
concepts that you can really use in the near future. The
only thing I ask you guys is let us help each other for
us to reached our objectives in the end, which is to
learn.
Together, let us embrace new normal and
continue to be productive student nurses, as we
embark you to the new lessons and experiences in the
nursing world. With the use of our blended learning
approach, we hope that in the end of this semester,
you shall be the cream of the crop when it comes to
the fundamentals of nursing. Let’s meet half way and
work hand in hand with me for a fun learning
experience. God bless you all.
Sincerely yours,
Abdulkarim O. Agga, RN MAN
Gmail account: brentabzpogi@gmail.com
Messenger: BrentAbz Faculty
 Message of the Learners
Ma’am Nelia
Education is said to be the passport to every
student’s future, for tomorrow belongs to those who
prepare for it today. It opens up the mind of every
individual, expands it and allows you to improve your life in
so many ways. And when we say education, this quotes
learning. As we go along with our daily lives, we get to learn
many things. One of the formal things in learning is to earn
a degree which our institution I believe can offer to you a
road to your future.
In this 2nd semester school year 2020-2021, I am
going to handle Fundamental of Nursing Practice (NCM
103). I and my team will be teaching you the basic
principles and procedures of nursing. This subject
highlights the significance of the fundamental needs of
humans and competence in fundamental skills as
prerequisites to providing extensive nursing care. These
theories are the basis of the nursing discipline and what
makes it a profession.
required to keep on top of each week. Each student must
manage their own time each week, to know when
assignments are due, and any other weekly course
obligations. This will involve regularly logging into the
online learning systems to check forums, communications,
monitor email address, and virtually interact with
classmates, team members, instructors, and course
materials. I may also be using Modular Distance Learning
Wherein It involves individualized instruction that allows
you to use self-learning materials (SLMs). Such
instructions are learning content, textbooks, schedules and
activity guides. This module will be send to you for your
self-learning and I will be taking the responsibility to
monitor your progress in learning. Should there be any
queries, you can reach me through my email account, or
chat me at my Facebook messenger which I will be posting
in the last part of my message.
Studying is an important part of gaining your
education, in my capacity as your teacher, I will do my best
to lead you to take responsibility for your learning.
Facilitate you to discover priceless lessons that will lead
you to your futures path. To my dear students, allow our
excellence launch your success. Let’s buckle down for
learning and face the challenges of the new normal.
Sincerely yours,
Ma. Nelia P. Magsino, RN, MN
Facebook account: Ma. Nelia P. Magsino
Contact No.: 0956-3351028
Email address: ailenonisgam2020@gmail.com

Due to the threat of COVID-19, our institution is

are facing decisions about how to continue teaching and
learning while keeping our faculty, staff and students safe
from a public health emergency. Despite of the crisis, I will
continue to render education through this remote learning.
This provides us an opportunity to continuously remain
connected and engage with the content while working from
home. The flow of this online set-up uses a mix of
asynchronous (not live/own time), and synchronous
(live/real time) learning activities. This course will have
regular weekly assignments due, scheduled live sessions
(via web conferencing-google meet, ZOOM), weekly text
discussions via the course discussion forum, online
assessments (Google Forms and Edmodo), as well as
readings and course materials that each of student is
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Module Instruction:

This is you learning packet for Fundamentals of Nursing, which is patterned based on ADPCN’s
outcome based learning syllabus. There will be 5 modules containing this learning packet with activities enclosed
in it. Kindly answer all the activities enclosed in every module and submit it to the email address of your respective
instructors. Also, you may contact your respective instructors anytime within 8am-5pm or upon an appointment
for any queries regarding this learning packet. It is expected that by the end of this semester, this module will be
thoroughly discussed via Google Meet/ Zoom Meeting depending on the discourse of the instructor handling
your class. God bless and enjoy learning.

PLACEMENT: 1st Year, 2nd Semester
PRE-REQUISITES: Anatomy & Physiology, NCM 100
CONTACT HOURS: 54 hours’ lecture / 102 hours’
laboratory
INSTITUTIONAL CORE VALUES
1. Christ – like Servant – A servant who is fully aware and
sensitive to the needs of others just like Jesus Christ
who came to serve and not to be served
2. Preserve the Sanctity of life – Upholds the mandate of
the Creator to preserve the sanctity of life of every
person.
3. Client centered – We continuously uphold the
challenges to be a client-centered institution by being
compassionate, caring, and emphatic in the delivery of
services
4. Quality Service-We serve with highest standard. Top
most quality service is our aim, our inspiration and
primary mission
5. Integrity and Professionalism – We operate within the
spirit of law. Always doing the right thing, honest and
hardworking
6. Synergy- We work closely as one family and
harmoniously coordinate with each other. We
recognize each and everyone’s contribution towards a
common goal
INSTITUTIONAL GOALS
1. Practice Christian-like attitude to contribute positively to
the accomplishment of goals through collaborative
processes.
2. Engage in service –learning activities for meaningful
community involvement.
3. Provide safe, ethical standards and holistic care to
individual, family, population group and community with
integrity and professionalism.
4. Communicate effectively in speaking, writing and
presenting using appropriate language.
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5. Demonstrate sound relationship with God, Self and
others by being compassionate, Caring and empathic in
the delivery of quality service.
6. Apply guidelines and principles of highest standards in
the performance of the delivery of care.
7. Produce a well-rounded Brentonian equipped with
appropriate Knowledge, Attitude and Skills who are ready
to meet the demands of the challenging society.
PROGRAM OUTCOMES
1. Apply knowledge of physical, social, natural and health
sciences and humanities in the practice of nursing.
2. Apply safe appropriate and holistic care to individuals,
families, population, groups and community utilizing
nursing process
3. Apply guidelines and principles of evidence-based
practice in the delivery of care.
4. Practice nursing in accordance with existing laws,
legal, ethical and moral principles.
5. Communicate effectively in speaking, writing and
presenting using culturally-appropriate language.
6. Work effectively in collaboration with inter-, intra- and
multidisciplinary and multicultural teams.
7. Document to include reporting up-to-date client care
accurately and comprehensively.
8. Practice beginning management and leadership skills
in the delivery of client care using a systems approach,
9. Engage in lifelong learning with a passion to keep
current with national and global developments in
general, and nursing and health developments in
particular.
10. Conduct research with an experienced researcher.
11. Demonstrate responsible citizenship and pride in
being a Filipino.
12. Apply techno-intelligent care systems and processes
in health care delivery.
13. Adopt the nursing core values in the practice of the
profession.
14. Apply entrepreneurial skills in the delivery of nursing
care.
 MODULE OUTLINE  Types (Independent, Dependent, Interdependent)
 Health Education
1. Concept of Man, Health and Illness e. Evaluation
a. Define health, wellness and illness  Types: Planned, Ongoing, Purposeful
b. Explain the dimension of wellness f. Documentation
c. Discuss the health-illness continuum  Guidelines/Protocols/Tools in documentation
d. Enumerate the stages of wellness and illness related to client care
e. Describe the three levels of prevention  Subjective Information, Objective Information,
f. Factors and Issues affecting Health and Illness Assessment, Plan, Implement and Evaluate
2. Concept of Nursing as a Profession, Science and Art. (SOAPIE).
A. Nursing as a Profession  Focus, Data, Action, Response (FDAR).
a. Criteria  Electronic Health Record (EHR).
b. Personal and professional Qualities of a nurse  Problem Oriented Medical Record (POMR).
c. Fields of Nursing  Guidelines/Protocols/ Tools in reporting
d. History of Nursing related to client care
(world and Philippines, include history of own  Identify, Situation, Background, Assessment,
nursing school) Recommendation, Read Back (ISBARR)
e. Development of Modern Nursing  Change of Shift Report
f. Overview of Professional Nursing Practice  Incident Report
1. Level of Proficiency according to Benner  Referral System
2. Roles and Responsibilities of a Professional  Healthcare Electronic Database
Nurse
3. Scope of Nursing Practice based on RA 9173 4. Concepts and Principles of Partnerships, Collaboration
B. Nursing as an Art and Teamwork
1. Caring A. Development of Teamwork and Collaboration
a. Caring Practice Model  Self-awareness
b. 6 C’s of Caring  Dyad
c. Caring for self and others
 Group
2. Communicating
 Team
a. Process and Modes
 Health Care Team
b. Therapeutic Communication
c. Helping Relationship  Multidisciplinary Team
d. Nurse Patient Interaction B. Tools for facilitating Teamwork
3. Teaching C. Roles of the Nurse
a. Health promotion 5. Concept of Leadership and Management
b. Disease prevention A. Roles of the Nurse as Leader/Manager
c. Health Restoration and Maintenance B. Positive Practice Environment
d. Rehabilitation  Elements
C. Nursing as a Science  Characteristics
3. Problem Solving Process 6. Concepts of Continuing Professional Development
A. Nursing Process A. Lifelong
a. Assessment B. Career Path/Development Map
 Subjective: Health History
 Objective: Physical Examination and Diagnostic 7. Ethico-Moral and Legal Considerations in the Practice
Tests of Nursing
b. Nursing Diagnosis A. Philippine Nursing Law of 2012: RA 9173
 NANDA Art.VI, Sec 28: Scope of Nursing Practice
B. Patients’ Bill of Rights
 NANDA Taxonomy II
C. Informed Consent
c. Planning
D. Data Privacy Law
 Types: Initial, Ongoing, Discharge
E. Code of Ethics
 Formulation of objectives, priority setting F. Philippine Professional Nursing Roadmap
 Nursing Outcomes Classification G. National Nursing Core Competency
d. Intervention Standards
 Nursing Intervention Classification
4|Page
 MODULE 1
Concept of Man, Health & Illness

Learning Objectives:
At the end of this Module, you shall be able to;
1. Identify influences on client’s definitions of health, wellness, and
well- being.
2. Describe the five components of health accurately.
3. Identify variables affecting health status, beliefs and practices
correctly.
4. Differentiate illness from diseases and acute illness from chronic
illness comprehensively.
5. Describe the effects of illness on individuals and family member’s
roles and functions.

5|Page
 Nurses’ understanding of health and
wellness largely determines the scope and
nature of nursing practice. Clients’ health beliefs
influence their health practices. Some people
think of health and wellness (or well-being) as
the same thing or, at the very least, as
accompanying one another. However, health
may not always accompany well-being: A
person who has a terminal illness may have a
sense of well-being; conversely, another person
may lack a sense of well-being yet be in a state
of good health. For many years, the concept of
disease was the yardstick by which health was
measured. In the late 19th century the “how” of
disease (pathogenesis) was the major concern
of health professionals. The 20th century
focused on finding cures for diseases. Currently
health care providers are increasing their
emphasis on promoting health and wellness in
individuals, families, and communities.
CONCEPTS OF HEALTH, WELLNESS AND
WELL-BEING
Health, wellness, and well-being have
many definitions and interpretations. The nurse
should be familiar with the most common
aspects of the concepts and consider how they
may be individualized with specific clients.
A. Health
Traditionally health was defined in terms
of the presence or absence of disease. Florence
Nightingale (1860/1969) defined health as a
state of being well and using every power the
individual possesses to the fullest extent. The
World Health Organization (WHO) (1948) takes
a more holistic view of health. Its constitution
defines health as “a state of complete physical,
mental, and social well-being, and not merely
the absence of disease or infirmity.”
This definition reflects concern for the
individual as a total person functioning
physically, psychologically, and socially. Mental
processes determine people’s relationship with
their physical and social surroundings, their
attitudes about life, and their interaction with
others. It also places health in the context of
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environment. People’s lives, and therefore their
health, are affected by everything they interact
with—not only environmental influences such as
climate and the availability of food, shelter,
clean air, and water to drink, but also other
people, including family, lovers, employers,
coworkers, friends, and associates.
Health has also been defined in terms of
role and performance. Talcott Parsons (1951),
an eminent American sociologist and creator of
the concept “sick role,” conceptualized health as
the ability to maintain normal roles. In 1953, the
U.S. President’s Commission on Health Needs
of the Nation made the following statement
about health: “Health is not a condition; it is an
adjustment. It is not a state but a process. The
process adapts the individual not only to our
physical but also our social environments”. The
American Nurses Association, in its social policy
statement (2010), states, “Health and illness are
human experiences. The presence of illness
does not preclude health, nor does optimal
health preclude illness”
B. Wellness and Well Being
Wellness is a state of well-being. Basic
aspects of wellness include self-responsibility;
an ultimate goal; a dynamic, growing process;
daily decision making in the areas of nutrition,
stress management, physical fitness, preventive
health care, and emotional health; and, most
importantly, the whole being of the individual
Anspaugh, Hamrick, and Rosato (2011)
propose seven components of wellness. To
realize optimal health and wellness, people
must deal with the factors within each
component:
“The Seven Components of
Wellness” from Wellness:
Concepts and Applications by
David Anspaugh, Michael
Hamrick and Frank Rosato.
Copyright ©2010 by McGraw-
Hill Education.
 Environmental. The ability to promote
health measures that improve the standard
of living and quality of life in the community.
This includes influences such as food, water,
and air.
 Social. The ability to interact successfully
with people and within the environment of
which each person is a part, to develop and
maintain intimacy with significant others, and
to develop respect and tolerance for those
with different opinions and beliefs.
 Emotional. The ability to manage stress and
to express emotions appropriately.
Emotional wellness involves the ability to
recognize, accept, and express feelings and
to accept one’s limitations.
 Physical. The ability to carry out daily tasks,
achieve fitness (e.g., pulmonary,
cardiovascular, gastrointestinal), maintain
adequate nutrition and proper body fat, avoid
abusing drugs and alcohol or using tobacco
products, and generally practice positive
lifestyle habits.
 Spiritual. The belief in some force (nature,
science, religion, or a higher power) that
serves to unite human beings and provide
meaning and purpose to life. It includes a
person’s own morals, values, and ethics.
 Intellectual. The ability to learn and use
information effectively for personal, family,
and career development. Intellectual
wellness involves striving for continued
growth and learning to deal with new
challenges effectively.
 Occupational. The ability to achieve a
balance between work and leisure time. A
person’s beliefs about education,
employment, and home influence personal
satisfaction and relationships with others.
The seven components overlap to some
extent, and factors in one component often
directly affect factors in another. For example, a
person who learns to control daily stress levels
from a physiological perspective is also helping
to maintain the emotional stamina needed to
cope with a crisis. Wellness involves working on
all aspects of the model.
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“Well-being is a subjective perception of vitality
and feeling well . . . can be described
objectively, experienced, and measured . . . and
can be plotted on a continuum” (Hood, 2010, p.
185). It is a component of health. Nurses need
to clarify their understanding of health, wellness,
and well-being for the following reasons:
a. Nurses’ definitions of health largely
determine the scope and nature of nursing
practice. For example, when health is
defined narrowly as a physiological
phenomenon, nurses confine themselves to
assisting clients to regain normal
physiological functioning. When health is
defined more broadly, the scope of nursing
practice enlarges correspondingly.
b. People’s health beliefs influence their health
practices. A nurse’s health values and
practices may differ from those of a client.
Nurses need to ensure that a plan of care
developed for an individual relates to the
client’s concept of health rather than the
nurse’s belief system. Otherwise the client
may fail to respond to the health care
regimen.
MODELS OF HEALTH AND WELLNESS
Because health is such a complex
concept, various researchers have developed
models or paradigms to explain health and in
some instances its relationship to illness or
injury. Models can be helpful in assisting health
professionals to meet the health and wellness
needs of individuals. Models of health include
the clinical model, the role performance model,
the adaptive model, the eudemonistic model,
the agent–host–environment model, and
health–illness continua.
a. Clinical Models
The narrowest interpretation of health occurs
in the clinical model. People are viewed as
physiological systems with related functions,
and health is identified by the absence of signs
and symptoms of disease or injury. It is
considered the state of not being “sick.” In this
model, the opposite of health is disease or
injury. Many medical practitioners have used the
clinical model in their focus on the relief of signs
and symptoms of disease and elimination of
malfunction and pain. When these signs and
symptoms are no longer present, the medical
practitioner considers the individual’s health
restored.
b. Role Performance Model
Health is defined in terms of an individual’s
ability to fulfill societal roles, that is, to perform
his or her work. People usually fulfill several
roles (e.g., mother, daughter, friend), and
certain individuals may consider nonwork roles
the most important ones in their lives. According
to this model, people who can fulfill their roles
are healthy even if they have clinical illness. For
example, a man who works all day at his job as
expected is healthy even though he is partially
deaf. It is assumed in this model that sickness is
the inability to perform one’s work role.
c. Adaptive Model
In the adaptive model, health is a creative
process; disease is a failure in adaptation, or
maladaptation. The aim of treatment is to
restore the ability of the person to adapt, that is,
to cope. According to this model, extreme good
health is flexible adaptation to the environment
and interaction with the environment to
maximum advantage. The famous Roy
adaptation model of nursing (Roy, 2009) views
the person as an adaptive system. The focus of
this model is stability, although there is also an
element of growth and change.
d. Eudaimonistic Models
The eudaimonistic model incorporates a
comprehensive view of health. Health is seen as
a condition of actualization or realization of a
person’s potential. Actualization is the apex of
the fully developed personality, described by
Abraham Maslow In this model the highest
aspiration of people is fulfillment and complete
development, which is actualization. Illness, in
this model, is a condition that prevents self-
actualization. Pender, Murdaugh, and Parsons
(2011) include stabilizing and actualizing
tendencies in their definition of health: “the
realization of human potential through goal-
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directed behavior, competent self-care, and
satisfying relationships with others while
adapting to maintain structural integrity and
harmony with the social and physical
environments”
Another model of this type is that of Margaret
Newman (2008) who states that health is the
expansion of consciousness. The basic
assumptions of this model or theory are: Health
is an evolving unitary pattern of the whole,
including patterns of disease. Consciousness is
the informational capacity of the whole and is
revealed in the evolving pattern. Pattern
identifies the human–environmental process
and is characterized by meaning.
e. Agent-Host-Environment Model
The agent–host–environment model of
health and illness, also called the ecologic
model, originated in the community health work
of Leavell and Clark (1965) and has been
expanded into a general theory of the multiple
causes of disease. The model is used primarily
in predicting illness rather than in promoting
wellness, although identification of risk factors
that result from the interactions of agent, host,
and environment are helpful in promoting and
maintaining health. The model has three
dynamic interactive elements.
The agent–host–environment
triangle.
a. Agent. Any environmental factor or stressor
(biologic, chemical, mechanical, physical, or
psychosocial) that by its presence or
 absence (e.g., lack of essential nutrients)
can lead to illness or disease.
b. Host. Person(s) who may or may not be at
risk of acquiring a disease. Family history,
age, and lifestyle habits influence the host’s
reaction.
c. Environment. All factors external to the host
that may or may not predispose the person
to the development of disease. Physical
environment includes climate, living
conditions, sound (noise) levels, and
economic level. Social environment includes
interactions with others and life events, such
as the death of a spouse.
Because each of the agent–host–
environment factors constantly interact with the
others, health is an ever-changing state. When
the variables are in balance, health is
maintained; when the variables are not in
balance, disease occurs.
HEALTH ILLNESS CONTINUUM
Health–illness continua (grids or
graduated scales) can be used to measure a
person’s perceived level of wellness. Health and
illness or disease can be viewed as the opposite
ends of a health continuum. From a high level of
health, a person’s condition can move through
good health, normal health, poor health, and
extremely poor health, eventually to death.
People move back and forth within this
continuum day by day. There is no distinct
boundary across which people move from
health to illness or from illness back to health.
How people perceive themselves and how
others see them in terms of health and illness
will also affect their placement on the
continuum. The ranges in which people can be
thought of as healthy or ill are considerable.
Dunn’s High Level Wellness Grid
Dunn (1959) described a health grid in
which a health axis and an environmental axis
intersects. The grid demonstrates the
interaction of the environment with the illness–
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wellness continuum The health axis extends
from peak wellness to death, and the
environmental axis extends from very favorable
to very unfavorable. The intersection of the two
axes forms four quadrants of health and
wellness:
Dunn’s health grid: its axes and quadrants.
From “High-Level Wellness for Man and Society,” by H. L. Dunn, 1959,
American Journal of Public Health, 49, p. 788. Reprinted with permission of
American Public Health Association.
1. High-level wellness in a favorable
environment. An example is a person who
implements healthy lifestyle behaviors and
has the biopsychosocial, spiritual, and
economic resources to support this lifestyle.
2. Emergent high-level wellness in an
unfavorable environment. An example is a
woman who has the knowledge to
implement healthy lifestyle practices but
does not implement adequate self-care
practices because of family responsibilities,
job demands, or other factors.
3. Protected poor health in a favorable
environment. An example is an ill person
(e.g., one with multiple fractures or severe
hypertension) whose needs are met by the
health care system and who has access to
appropriate medications, diet, and health
care instruction.
4. Poor health in an unfavorable environment.
An example is a young child who is starving
in a drought-stricken country.
 Illness–wellness continua.
“Illness-Wellness Continua” from Wellness: Concepts and Applications by David Anspaugh, Michael Hamrick and Frank Rosato. Copyright ©2010 by McGraw-Hill Education.
Used by permission of McGraw-Hill Education.

Family wellness enhances wellness in the real concepts are more complex than the
individuals. In a well family that offers trust, love, diagram suggests.
and support, the individual does not have to
expend energy to meet basic needs and can
move positively on the wellness continuum. By Thoughts to Ponder:
providing effective sanitation and safe water,
disposing of sewage safely, and preserving
beauty and wildlife, the community enhances Health status. State of health of an individual at
both family and individual wellness. a given time. A report of health status may
Environmental wellness is related to the include anxiety, depression, or acute illness and
premise that humans must be at peace with and thus describe the individual’s problem in
general. Health status can also describe such
guard the environment. Societal wellness is
specifics as pulse rate and body temperature.
significant because the status of the larger,
social group affects the status of smaller groups. • Health beliefs. Concepts about health that an
Dunn believes that social wellness must be individual believes are true. Such beliefs may or
considered on a worldwide basis. may not be founded on fact. Some of these are
influenced by culture, such as the “hot cold”
ILLNESS-WELLNESS CONTINUUM system of some Hispanic Americans. In this
The illness–wellness continuum system, health is viewed as a balance of hot and
developed by Anspaugh, Hamrick, and Rosato cold qualities within a person. Citrus fruits and
(2011) ranges from optimal health to premature some fowl are considered cold foods, and meats
death. The model illustrates arrows pointing in and bread are hot foods. In this context, hot and
cold do not denote temperature or spiciness but
opposite directions and joined at a neutral point.
innate qualities of the food. For example, a fever
Movement to the right of the neutral point is said to be caused by an excess of hot foods.
indicates increasing levels of health and Another example of a culturally related health
wellness for an individual. This is achieved belief is the belief that health and illness are
through health knowledge, disease prevention, closely associated with the amount and quality
health promotion, and positive attitude. In of blood in the body. For example, some
contrast, movement to the left of the neutral Southern Americans say that “high blood,”
point indicates progressively decreasing levels meaning too much blood in the body, causes
of health. Some people believe that a health headaches and dizziness. For additional
continuum is overly simplistic and linear when information about cultural views of health and
illness.
10 | P a g e
 Health behaviors. The actions people take to
understand their health state, maintain an
optimal state of health, prevent illness and
injury, and reach their maximum physical and
mental potential. Behaviors such as eating
wisely, exercising, paying attention to signs of
illness, following treatment advice, avoiding
known health hazards such as smoking, taking
time for rest and relaxation, and managing one’s
time effectively are all examples. Health
behavior is intended to prevent illness or
disease or to provide for early detection of
disease. Nurses preparing a plan of care with an
individual need to consider the person’s health
beliefs before they suggest a change in health
behaviors.
VARIABLES INFLUENCING HEALTH
STATUS, BELIEFS AND PRACTICES
Many variables influence a person’s
health status, beliefs, and behaviors or
practices. These factors may or may not be
under conscious control. People can usually
control their health behaviors and can choose
healthy or unhealthy activities. In contrast,
people have little or no choice over their genetic
makeup, age, sex, culture, and sometimes their
geographic environments differentiates health
status, beliefs, and behaviors or practices.
Internal Variables
Internal variables include biologic,
psychological, and cognitive dimensions. They
are often described as non- modifiable variables
because, for the most part, they cannot be
changed. However, when internal variables are
linked to health problems, the nurse must be
even more diligent about working with the client
to influence external variables (such as exercise
and diet) that may assist in health promotion and
prevention of illness. Regular health exams and
appropriate screening for early detection of
health problems become even more important.
a. Biologic Dimensions
Genetic makeup, sex, age, and developmental
level all significantly influence a person’s health.
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Genetic makeup influences biologic
characteristics, innate temperament, activity
level, and intellectual potential. It has been
related to susceptibility to specific disease, such
as diabetes and breast cancer. For example,
people of African heritage have a higher
incidence of sickle cell disorder and
hypertension than the general population but
may be less susceptible to malaria. Genetic
predisposition for health or illness is enhanced
when parents are from the same ethnic genetic
pool. Nurses are expected to incorporate
knowledge of genetics and genomics (how
genetics interacts with the environment and
other personal factors in influencing health) in
their care and teaching of clients.
Sex influences the distribution of disease.
Certain acquired and genetic diseases are more
common in one sex than in the other. Disorders
more common among females include
osteoporosis and autoimmune disease such as
rheumatoid arthritis. Those more common
among males are stomach ulcers, abdominal
hernias, and respiratory diseases.
Age is also a significant factor. The distribution
of disease varies with age. For example,
arteriosclerotic heart disease is common in
middle-aged males but occurs infrequently in
younger people; such communicable diseases
as whooping cough and measles are common
in children but rare in older adults, who often
have acquired immunity to them.
Developmental level has a major impact on
health status.
b. Psychological Dimension
Psychological (emotional) factors influencing
health include mind– body interactions and self-
concept.
Mind–body interactions can affect health
status positively or negatively. Emotional
responses to stress affect body function. For
example, a student who is extremely anxious
before a test may experience urinary frequency
and diarrhea. A person worried about the
outcome of surgery or about the behavior of a
teenager may chain-smoke. Prolonged
emotional distress may increase susceptibility to
organic disease or precipitate it. Emotional
distress may influence the immune system
through central nervous system and endocrine
alterations. Alterations in the immune system
are related to the incidence of infections,
cancer, and autoimmune diseases.
Emotional reactions also occur in response
to body conditions. For example, a person
diagnosed with a terminal illness may
experience fear and depression. Self-concept is
how a person feels about self (self-esteem) and
perceives the physical self (body image), needs,
roles, and abilities. Self-concept affects how
people view and handle situations. Such
attitudes can affect health practices, responses
to stress and illness, and the times when
treatment is sought. An example is a woman
with anorexia who deprives herself of needed
nutrients because she believes she is too fat
even though she is well below an acceptable
weight level.
c. Cognitive Dimension
Cognitive or intellectual factors influencing
health include lifestyle choices and spiritual and
religious beliefs.
Lifestyle refers to a person’s general way of
living, including living conditions and individual
patterns of behavior that are influenced by
sociocultural factors and personal
characteristics. In brief, lifestyle is often
considered to be the behaviors and activities
over which people have control. Lifestyle
choices may have positive or negative effects
on health. Practices that have potentially
negative effects on health is often referred to as
risk factors. For example, overeating, getting
insufficient exercise, and being overweight are
closely related to the incidence of heart disease,
arteriosclerosis, diabetes, and hypertension.
Excessive use of tobacco is clearly implicated in
lung cancer, emphysema, and cardiovascular
diseases
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External Variables
External variables affecting health
include the physical environment, standards of
living, family and cultural beliefs, and social
support networks.
a. Environment
People are becoming increasingly aware
of their environment and how it affects their
health and level of wellness. Geographic
location determines climate, and climate affects
health. For instance, malaria and malaria-
related conditions occur more frequently in
tropical rather than temperate climates.
Pollution of the water, air, and soil affects the
health of cells. Pollution can occur naturally
(e.g., lightning-caused fires produce smoke,
which pollutes the air). Some man-made
substances in the environment, such as
asbestos, are considered
carcinogenic (i.e., they cause cancer). Tobacco
is “hazardous to one’s health,” with rates of
cancer higher among both smokers themselves,
and those who live or work near people who
smoke in their environment.
b. Standards of Living
An individual’s standard of living
(reflecting occupation, income, and education)
is related to health, morbidity, and mortality.
Hygiene, food habits, and the ability to seek
health care advice and follow health regimens
vary among high-income and low-income
groups. Low-income families must prioritize use
of their finances, often choosing food and
housing over health care. They may have
difficulty obtaining time off from work and
transportation to health care facilities. Because
their present problems are so great and all
efforts are exerted toward survival, they may
lack an orientation toward actions that help
prevent illness.
c. Family and Cultural Beliefs
The family passes on patterns of daily living
and lifestyles to offspring. For example, a man
who was abused as a child may physically
abuse his own children. Physical or emotional
abuse may cause long-term health problems.
Emotional health depends on a social
environment that is free of excessive tension
and does not isolate the person from others. A
climate of open communication, sharing, and
love fosters the fulfillment of the person’s
optimum potential. Culture and social
interactions also influence how a person
perceives, experiences, and copes with health
and illness. Each culture has ideas about health,
and these are often transmitted from parents to
children. People of certain cultures may
perceive home remedies or tribal health
customs as superior to and more dependable
than the health care practices of North American
society.
d. Social Support Networks
Having a support network (family, friends, or
a confidant) and job satisfaction helps people
avoid illness. Support persons also help the
individual confirm that illness exists. People with
inadequate support networks sometimes allow
themselves to become increasingly ill before
confirming the illness and seeking therapy.
Support people also provide the motivation for
an ill person to become well again.
ILLNESS AND DISEASE
Illness is a highly personal state in which
the person’s physical, emotional, intellectual,
social, developmental, or spiritual functioning is
thought to be diminished. It is not synonymous
with disease and may or may not be related to
disease. An individual could have a disease and
not feel ill. Similarly, a person can feel ill, that is,
feel uncomfortable, and yet have no discernible
disease. Illness is highly subjective; only the
individual person can say he or she is ill.
Disease can be described as an
alteration in body functions resulting in a
reduction of capacities or a shortening of the
normal life span. Traditionally, intervention by
primary care providers has the goal of
eliminating or ameliorating disease processes.
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Primitive people thought “forces” or spirits
caused disease. Later this belief was replaced
by the single-causation theory. Today multiple
factors are considered to interact in causing
disease and determining an individual’s
response to treatment.
The causation of a disease or condition
is called its etiology. A description of the etiology
of a disease includes the identification. of all
causal factors that act together to bring about
the particular disease. For example, the tubercle
bacillus is designated as the biologic agent of
tuberculosis. However, other etiologic factors,
such as age, nutritional status, and even
occupation, are involved in the development of
tuberculosis and influence the course of
infection. There are many diseases for which the
specific cause is unknown (e.g., multiple
sclerosis). Nurses have traditionally taken a
holistic view of people and base their practice on
the multiple-causation theory of health
problems.
There are many ways to classify illness
and disease; one of the most common is as
acute or chronic.
Acute illness is typically characterized by
symptoms of relatively short duration. The
symptoms often appear abruptly and subside
quickly and, depending on the cause, may or
may not require intervention by health care
professionals. Some acute illnesses are serious
(for example, appendicitis may require surgical
intervention), but many acute illnesses, such as
colds, subside without medical intervention or
with the help of over-the counter medications.
Following an acute illness, most people return to
their normal level of wellness.
A chronic illness is one that lasts for an
extended period, usually 6 months or longer,
and often for the person’s life. Chronic illnesses
usually have a slow onset and often have
periods of remission, when the symptoms
disappear, and exacerbation, when the
symptoms reappear.
 ILLNESS BEHAVIORS
When people become ill, they behave in
certain ways that sociologists refer to as illness
behavior. Illness behavior, a coping mechanism,
involves ways individuals describe, monitor, and
interpret their symptoms, take remedial actions,
and use the health care system. How people
behave when they are ill is highly individualized
and affected by many variables, such as age,
sex, occupation, socioeconomic status, religion,
ethnic origin, psychological stability, personality,
education, and modes of coping. Parsons
(1979) described four aspects of the sick role.
Rights:
1. Clients are not held responsible for their
condition. Even if the illness was partially
caused by an individual’s behavior (e.g., lung
cancer from smoking), the individual is not
capable of reversing the condition on his or her
own.
2. Clients are excused from certain social roles
and tasks. For example, an ill parent would not
be expected to prepare meals for the family.
Obligations:
3. Clients are obliged to try to get well as quickly
as possible. The ill person should follow
legitimate advice regarding a specialized diet or
activity restrictions that could help with recovery.
4. Clients or their families are obliged to seek
competent help. For example, the ill person
should contact the primary care provider rather
than relying solely on his or her own ideas of
how to recover.
Suchman (1979) described five stages of
illness: symptom experiences, assumption of
the sick role, medical care contact, dependent
client role, and recovery or rehabilitation. Not all
clients progress through each stage. For
example, the client who experiences a sudden
heart attack is taken to the emergency
department and immediately enters stages 3
and 4, medical care contact and dependent
client role. Other clients may progress through
only the first two stages and then recover.
Details of Suchman’s five stages follow.
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In assuming the sick role for simple illnesses such as a cold, individuals
are expected to rest and treat themselves with common remedies.
Stage 1: Symptoms & Experiences
At this stage the person comes to believe
something is wrong. Either someone significant
mentions that the person looks unwell, or the
person experiences some symptoms such as
pain, rash, cough, fever, or bleeding. Stage 1
has three aspects:
• The physical experience of symptoms
• The cognitive aspect (the interpretation
of the symptoms in terms that have some
meaning to the person)
• The emotional response (e.g., fear or
anxiety).
During this stage, the unwell person usually
consults others about the symptoms or feelings,
validating with support people that the
symptoms are real. At this stage the sick person
may try home remedies. If self-management is
ineffective; the individual enters the next stage.
Stage 2: Assumption of the Sick Role
The individual now accepts the sick role
and seeks confirmation from family and friends.
Often people continue with self-treatment and
delay contact with health care professionals as
long as possible. During this stage people may
be excused from normal duties and role
expectations. Emotional responses such as
withdrawal, anxiety, fear, and depression are
not uncommon depending on the severity of the
illness, perceived degree of disability, and
anticipated duration of the illness. When
symptoms of illness persist or increase, the
person is motivated to seek professional help.
Stage 3: Medical Care Contact
Sick people seek the advice of a health
professional either on their own initiative or at
the urging of significant others. When people
seek professional advice, they are really asking
for three types of information.
• Validation of real illness
• Explanation of the symptoms in
understandable terms
• Reassurance that they will be all right or
prediction of what the outcome will be.
The health professional may determine that
the client does not have an illness or that an
illness is present and may even be life
threatening. The client may accept or deny the
diagnosis. If the diagnosis is accepted, the client
usually follows the prescribed treatment plan. If
the diagnosis is not accepted; the client may
seek the advice of other health care
professionals or quasi-practitioners who will
provide a diagnosis that fits the client’s
perceptions.
Stage 4: Dependent Client Role
After accepting the illness and seeking
treatment, the client becomes dependent on the
professional for help. People vary greatly in the
degree of ease with which they can give up their
independence, particularly in relation to life and
death. Role obligations—such as those of wage
earner, parent, student, sports team member, or
choir member— complicate the decision to give
up independence. Most people accept their
dependence on the primary care provider,
although they retain varying degrees of control
over their own lives. For example, some people
request precise information about their disease,
their treatment, and the cost of treatment, and
may delay the decision to accept treatment until
they have all this information.
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Others prefer that the primary care
provider proceed with treatment and do not
request additional information. For some clients,
illness may meet dependence needs that have
never been met and thus provide satisfaction.
Other people have minimal dependence needs
and do everything possible to return to
independent functioning. A few may even try to
maintain independence to the detriment of their
recovery.
Stage 5: Recovery or Rehabilitation
During this stage the client is expected to
relinquish the dependent role and resume
former roles and responsibilities. For people
with acute illness, the time as an ill person is
generally short and recovery is usually rapid.
Thus most find it relatively easy to return to them
former lifestyles. People who have long-term
illnesses and must adjust their lifestyles may
find recovery more difficult. For clients with a
permanent disability, this final stage may require
therapy to learn how to make major adjustments
in functioning.
EFFECTS OF ILLNESS
Illness brings about changes in both the
involved individual and in the family. The
changes vary depending on the nature, severity,
and duration of the illness, attitudes associated
with the illness by the client and others, the
financial demands, the lifestyle changes
incurred, adjustments to usual roles, and so on.
Impact on the Client
Ill clients may experience behavioral and
emotional changes, changes in self-concept
and body image, and lifestyle changes.
Behavioral and emotional changes associated
with short-term illness are generally mild and
short lived. The individual, for example, may
become irritable and lack the energy or desire to
interact in the usual fashion with family
members or friends. More acute responses are
likely with severe, life-threatening, chronic, or
disabling illness. Anxiety, fear, anger,
withdrawal, denial, a sense of hopelessness,
and feelings of powerlessness are all common
responses to severe or disabling illness. For
example, a client experiencing a heart attack
fears for his life and the financial burden it may
place on his family. Another client informed
about a diagnosis of cancer or AIDS or crippling
neurologic disease may, over time, experience
episodes of denial, anger, fear, and
hopelessness.
Impact on the Family
A person’s illness affects not only the
person who is ill but also the family or significant
others. The kind of effect and its extent depend
chiefly on three factors: (1) the member of the
family who is ill, (2) the seriousness and length
of the illness, and (3) the cultural and social
customs the family follows.
The seven dimensions of wellness are the physical, social,
emotional, intellectual, spiritual, occupational, and
environmental dimensions.
Well-being is a subjective perception of vitality and feeling
well that can be described, experienced, and measured.
Illness is usually associated with disease but may occur
independently of it. Illness is a highly personal state in
which the person feels unhealthy or ill. Disease alters body
functions and results in a reduction of capacities or a
shortened life span.
Various theorists have described stages and aspects of
illness. Parsons describes four aspects of the sick role.
Suchman outlines five stages of illness: symptom
experiences, assumption of the sick role, medical care
contact, dependent client role, and recovery or
rehabilitation.
An individual’s usual pattern of behavior changes with
illness and hospitalization, which disrupt a person’s privacy,
autonomy, lifestyle, roles, and finances.
Nurses need to be aware that the illness of one member of
a family affects all other members.

The changes that can occur in the family

include the following: SUPPLEMENTATION:
• Role changes
• Task reassignments and increased
demands on time
• Increased stress due to anxiety about the
outcome of the illness for
• the client and conflict about unaccustomed
responsibilities
• Financial problems
• Loneliness as a result of separation and
pending loss
• Change in social customs.

IN A NUTSHELL Need to understand more on health-illness? You may visit

https//: www. youtube.com/watch=XQkYIpCmTDw
As an additional reference.
Nurses need to clarify their understanding of health
because their definitions of health largely determine the
scope and nature of nursing practice. Likewise, people’s
Self-Reflection
health beliefs influence their health practices.
The perspective from which health is viewed has changed;
instead of absence of disease, health has come to mean a As a nurse, what would be your role on the
high level of wellness or the fulfillment of one’s maximum health-illness continuum of a sick persona? Explain
potential for physical, psychosocial, and spiritual briefly.
functioning.
Wellness is an active, seven-dimensional process of
becoming aware of and making choices toward a higher
level of wellbeing.

16 | P a g e Note: Please answer this on a separate sheet of paper and email it to the official emails of your NCM 103 Instructor. For further
clarifications regarding the above topics, you contact them via your Facebook group messenger or on their official emails.