Locus of Control Model

determine whether clients takes actions regarding health

o Internals health is largely self determined
o Externals health is largely controlled by outside forces
Rosenstock/Beckers Health-Belief Model
a. based on motivational theory
b. composed of three components:
o an individuals perceptions, e.g.:
1. of perceived susceptibility
2. of perceived seriousness
3. perceived threat
o modifying factors (factors that modify an individualsperceptions), e.g.:
1. demographic variables (e.g., age, gender, race, ethnicity, etc.)
2. sociopsychologic variables (e.g., personality, social class, peer andreference group
pressure, etc.)
3. structural variables (e.g., knowledge about the disease, prior contact with the
disease, etc.)
4. cues to action (e.g., mass media campaigns, advice fromothers, reminder postcard
from a physician or dentist, illness of family member or friend,newspaper or
magazine article)
o likelihood of action
1. perceived benefits of the action MINUS
2. perceived barriers to action EQUALS

Variables influencing health status, belief, and practices

Internal Variables
1. Biologic
genetic makeup
age
developmental level
race
gender
2. Psychologic or Emotional
Mind-body interaction
3. Cognitive or Intellectual
Cognitive abilities
Educational background
Past experiences
4. Spiritual
Spiritual and religious beliefs and values

5. Environmental
Housing
Sanitation
Climate
Pollution of air, food, water
6. Sociocultural
Economic levels
Lifestyle
Family
Culture

Health Care Adherence

Adherence
Extent of which an individuals behavior coincides with medical or health advice
Factors influencing Adherence
1. Client motivation to become well
2. Degree of lifestyle change necessary
3. Perceived severity of the health care problem
4. Value placed on reducing the threat of illness
5. Difficulty in understanding and performing specific behaviors
6. Degree of inconvenience of the illness itself or of the regimens
7. Beliefs that the prescribed therapy or regimen will or will not help
8. Complexity, Side effects, and duration of the proposed therapy
9. Specific Cultural heritage that may make adherence difficult
10. Degrees of satisfaction and quality and type of relationship with the health care providers
11. Overall cost of prescribed therapy
Nursing action on Non Adherence
1. Establish why the client is not following the regimen
2. Demonstrate caring
3. Encourage healthy behaviors through positive reinforcements
4. Use aids to reinforce teaching
5. Establish a therapeutic relationship of freedom, mutual understanding and mutual responsibility
with the client and support persons
Concept of Illness and Disease
Disease
pathologic change in the structure or function of the body or mind
Illness
the response a person has to a disease; it is an abnormal process in which the persons level of
functioning is changed compared with a previous level

 influenced by the following:

o self-perceptions
o others perceptions
o the effects of changes in body structure and function
o the effects of those changes on roles and relationships
o cultural and spiritual values and beliefs
Etiology
Causation of the disease
Types of illness
1. acute illness
has a rapid onset of symptoms that lasts for a limited and relatively short period of time
o e.g., typically less than six months
2. chronic illness
has a gradual onset of symptoms that lasts for anextended and relatively long period of
time
o e.g., typically six months or longer
characterized by periods of remission and exacerbation
o remission - symptoms disappear
o exacerbation - symptoms reappear
Illness Behaviors
behavior of individuals when they are ill
ways individuals describe, monitor, and interpret their symptoms, take remedial actions and use
the health care system
Parsons four aspect s of the sick role
1. Clients are not responsible for their conditions
2. Clients are excused from certain social roles andtasks
3. Clients are obliged to try to get well as quickly as possible
4. Clients or their families are obliged to seek competent help
Suchman 5 Stages of Illness
1. Symptom experiences
a. Physical
b. Cognitive
c. Emotional
2. Assumption of the sick role
3. Medical Care Contact
a. Validation of real illness
b. Explanation of the symptoms in understandable terms
c. Reassurance that they will be alright or prediction of what the outcome
will be
4. Dependent Client Role

5. Recovery or Rehabilitation
Effects of Illness
Impact on Client
Behavioral Changes
Emotional Change
Physical Changes
Lifestyle Changes
Impact on the Family
Factors:
1. Member of the family who is ill
2. The seriousness and length of the illness
3. Cultural and social customs the family follows
Changes in the family:
1. Role Changes
2. Task reassignments and increased demands on time
3. Increased stress
4. Financial problems
5. Loneliness as a result of loss and separation
6. Change in social customs