VIVEKANADA COLLEGE OF NURSING

LUCKNOW

SUBJECT: ADVANCE NURSING PRACTICE

ASSIGNMENT ON: CONCEPT OF SELF HEALTH CARE

SUBMITTED TO SUMITTED BY

MS. SUTHA R. MS. GRACE YOUTHAM

PROFESSOR MSC.[N] Ist YEAR

DATE-16/01/2020
 CONCEPT OF SELF HEALTH CARE

Introduction:-

Health is considered to be one of most important values. Health should be protected

and enhanced as much as possible. Health is a nation primarily applicable to a human being as
whole.

Definition of Health:-

Health is individually defined by each person. On a personal level, individuals define

health according to - How they feel - Absence or presence of symptoms of illness - And ability to
carry out activities

“Health is a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity.” -WHO

Health as balance:-

Health is constituted by bodily and mentally balance. The Yajurveda tradition in

India declares that there are three humour’s acting in the body the breaths (Vata), the
bile(Pitta) and the phlegm (Kapha). The proportions of the three humours vary from person to
person and their actions vary according to the season, the environment, the life style of the
individual, and his or her diet.

HEALTH AS WELL BEING:-

It is an important aspect of health that the body and mind are well, both in order and functions.
When a person feels well, then he or she is healthy.
Well-being or absence if ill being is an important trait in health, most modern positive
characterization of health’s have focused on other traits. One such trait is health as a condition
for action. Health is a common theme in almost all countries.

Absence of disease Health=Harmony=Being in peace. Health is the presence of a positive

capacity to lead energetic satisfying and productive life. Health is a state of optimal physical,
mental and social adaptation to one’s environment.

Disease is the result of their imbalance:-

In homeostasis various physiological functions of the body control each other and interact in
feedback. -Walter Cannon

Balance is a concept pertaining to the relationship between a person’s abilities and his goals. The
healthy person is the person who can realize his goals as thus retain a balance between abilities
and goals. –Ingmarporn.

A healthy body is one where the primary properties (wet, dry, cold, hot) of the body balance each
other. - Hippocrates and Galen

CONCEPT OF SELF HEALTH CARE

WHO defines self-care as “the ability of individuals, families and communities to promote
health, prevent disease, maintain health, and to cope with illness and disability with or
without the support of a healthcare provider”.
The scope of self-care as described in this definition includes -health promotion; disease
prevention and control; self-medication; providing care to dependent persons; seeking
hospital/specialist care if necessary; and rehabilitation including palliative care.
Inherent in the concept is the recognition that whatever factors and processes may
determine behaviour, and whether or not self-care is effective and interfaces appropriately
with professional care, it is the individual person who acts (or does not act) to preserve health
or respond to symptoms.
Self-care is broad concept which also encompasses hygiene (general and
personal); nutrition (type and quality of food eaten); lifestyle (sporting activities, leisure,
etc.); environmental factors (living conditions, social habits, etc.); socioeconomic factors
(income level, cultural beliefs, etc.); and self-medication. Core principles: Fundamental
principles for self-care include aspects of the individual (e.g. self-reliance, empowerment,
autonomy, personal responsibility, self-efficacy) as well as the greater community (e.g.
community participation, community involvement, community empowerment).
Supporting self-care interventions has the potential to
 Strengthen national institutions to maximize efficient use of domestic resources for
health;
 Create health sector innovations, including by catalyzing digital and mhealth approaches;
 And improve access to medicines and interventions through optimal interfacing between
health systems and sites of health care delivery.
 Self-care interventions for health
Self-care is a concept frequently referred to in both the theory and the clinical practice of
nursing. This article presents an overview of self-care theory as described by “Henderson, Hall,
and Orem.”

Self-care theory operates on the assumption that all individuals have a need to care for
themselves. While this premise may be true, it poses difficult questions for the nurse who must
intervene with patients who refuse to achieve their maximum level of independence.

When a disease process occurs that alters self-image, some patients (particularly elderly
females who have cared for others most of their adult lives) may consciously opt to become the
ones cared for. This choice gives them a temporary sense of control over a situation in which
they feel helpless. When nursing care is directed toward returning control of the situation to the
patient, the process of self-care and healing can begin.

Definition of self care:-

Self-care is any activity that we do deliberately in order to take care of our mental,
emotional, and physical health. Although it’s a simple concept in theory, it’s something we very
often overlook. Good self-care is the key to improved mood and reduced anxiety. It’s also the
key to a good relationship with oneself and others.

 Knowing what self-care is not might be even more important. It is not something that we
force ourselves to do, or something we don’t enjoy doing.
 As Agnes Wainman explained, self-care is “something that refuels us, rather than takes
from us.”
 Self-care isn’t a selfish act either. It is not only about considering our needs; it is rather
about knowing what we need to do in order to take care of ourselves, being subsequently,
able to take care of others as well.
e.g. That is, if I don’t take enough care of myself, I won’t be in the place to give to my
loved ones either.
 Self-care Concepts

CONCEPTS OF SELF-HEALTH

• Biomedical Concept- Health is the absence of disease (Germ Theory), normal functioning
ability, activities that leads to the survival of the species.

• Ecological Concept- Health is a dynamic equilibrium between man and his environment.
Imbalance results disease. Adaptation of man to his environment leads to better health and longer
life expectancy even in the absence of modern health services.

Psychological Concept- Health is not only a biomedical phenomenon, but one which is in
influenced by social psychological, cultural, economic and political factors of the people
concerned. Mental and emotional fulfilment self-actualization, Absence of neurosis and
psychosis.

Holistic Concept- It emphasizes on promotion and protection of health. It includes all the
factorjn s of the other concepts in addition to all human activities such education,
communication, agriculture, industry, housing, recreation, etc. It also implies that, all sectors of
society have effect on health.

Spiritual concept- Profound awareness, appreciation of truth and a sense of bliss.

Communication with the higher power Enlightenment.

Biomedical + Ecological + Psychosocial + Holistic + Spiritual Concept = Concept of Self-Health

In the self care concept the physical health is very important as well as we have needed to
manage the stress and psychological health so we have need to use the :
Protective practices:-

 Help compartmentalize work from the rest of life – identify ways to leave the job behind
 Clarify and support staff in establishing professional boundaries
 Promote emotional and physical health, and
 Include regular self-care techniques for managing stress.
Protective skills in dealing with complex interactions can:

 Support providers who are dealing with complicated or emotionally challenging

situations
 Reduce conflict over goals of care
 Reduce conflict within the multidisciplinary team, and use humor.

Protective arrangements by health services can:

 Have a process to actively manage distress and dysfunction of their staff members
 Create opportunities for debriefing
 Focus on effective teamwork
 Promote areas of work autonomy for staff, and recognize achievements
 Promote a workplace culture which supports a balance between home and work life, and
actively encourage staff to set appropriate limits on expectations, and
 Provide access to confidential supportive services including counseling.

Self-care Plans
The concept of an individualized self-care plan for palliative care providers focuses on four self-
care domains:

 Physical
 Emotional / cognitive
 Relational, and
 Spiritual.
 

The plan encourages a systematic approach to identifying warning signs of stress and burnout in
each area, and the development of protective practices. This process has not yet been formally
validated, but has the potential to be used by individuals, or incorporated into mentoring and
supervision relationships within palliative care teams.

Developing self-awareness is an important step in self-care. It assists you to identify your

strengths and weaknesses as well as to understand why you react the way you do in certain
situations. Being self-aware can assist you to manage your emotions rather than being
overwhelmed by them. Develop your self-awareness by reflecting on how you respond in
stressful situations and why you respond this way. Questions to consider in relation to your work
include:

 Physical: What is happening to my state of health and well-being?

 Emotional: How do I feel during and after I finish work?
 Perceptions: How do I make sense of my experiences at work?
 Activities: How well do I balance my work and personal life?
 Relationships: How has work impacted on my relationships (family, friends)?
 Expertise: What am I learning in my work role?
 Spiritual: How have my faith and personal meanings changed?
SELF-CARE IS THE KEY TO LIVING A BALANCED LIFE

1. Stick to the basics. Over time you will find your own rhythm and routine. You
will be able to implement more and identify more particular forms of self-care
that work for you.Self-care needs to be something you actively plan, rather than
something that just happens. It is an active choice and you must treat it as such.
Add certain activities to your calendar, announce your plans to others in order to
increase your commitment, and actively look for opportunities to practice self-
care.

E,g. Create a “no” list, with things you know you don’t like or you no longer want to do.
Examples might include: Not checking emails at night, not attending gatherings you don’t like,
not answering your phone during lunch/dinner.

2. Promote a nutritious, healthy diet:-

3. Get enough sleep. Adults usually need 7-8 hours of sleep each night.
4. Exercise:- In contrast to what many people think, exercise is as good for our
emotional health as it is for our physical health. It increases serotonin levels,
leading to improved mood and energy. In line with the self-care conditions,
what’s important is that you choose a form of exercise that you like!
5. Follow-up with medical care it is not unusual to put off checkups or visits to the
doctor.
6. Spend enough time with your loved ones.Do at least one relaxing activity every
day, whether it’s taking a walk or spending 30 minutes unwinding.

e.g:-Do at least one pleasurable activity every day; from going to the cinema, to cooking or
meeting with friends.Look for opportunities to laugh!

Activities of Daily Living(ADL’s) :- ADLs are used as a measurement of a person’s

functional status.

 First proposed in 1950 by Sidney Katz, who developed the first evaluation tool
called the Katz ADL scale.
 ADLs consist of Basic ADLs and Instrumental ADLs
  Basics ADLs are more essential for survival than IADLs
 Instrumental ADLs (IADLs) are not necessary for fundamental functioning, but
they let an individual live independently in a community

Basic Activities of Daily Living :-(ADLs) Activities of daily living (ADLs) are basic tasks
that must be accomplished every day for an individual to thrive. Generally, ADLs can be broken
down into the following categories:

o Personal hygiene bathing, grooming, oral, nail and hair care.

o Continence management A person’s mental and physical ability to properly use
the bathroom.
o Dressing A person’s ability to select and wear the proper clothes for different
occasions.
o Feeding whether a person can feed themselves or needs assistance.
 Ambulating the extent of a person’s ability to change from one position to the other and
to walk independently.
 Instrumental Activities of Daily living (IADLs) Instrumental activities of daily living
(IADLs) are somewhat more complex but nevertheless also reflect on a person’s ability
to live independently.
E,g,Managing a person’s household Cleaning, tidying up, removing trash and clutter, and
doing laundry and folding clothes.
o Managing medications how much help may be needed in getting prescriptions
filled, keeping medications up to date and taking meds on time and in the right
dosages.
o Communicating with others managing the household’s phones and mail and
generally making the home hospitable and welcoming for visitors.
o Managing finances How much assistance a person may need in managing bank
balances and check books and paying bills on time.

CHECKLIST OF ADL’S ADL’S MEASUREMENT IN RELATION WITH HEALTH

STATUS: -

a) Requires No Assistance- Person is independent i.e., healthy.

b) Some Assistance Needed- Partially dependent.

c) Complete Assistance Needed- Dependent on other for work i.e., Unhealthy.

New Philosophy of Health

 Fundamental right
 Intersectoral
 Integral part of development
 Central to quality of life
 Social investment
 Worldwide social goal
 Involves individuals, families, communities, local, national and international
responsibilities.

CONCEPT OF DISEASE

 A disease is an abnormal condition affecting the body of an organism.

 Disease refers to any condition that impairs normal function.
 Illness and sickness occasionally used to refer specifically to the patient’s
personal experience of their disease.
 Disease is being, an exterior potency remain attaching the man, penetrating into
him, fighting with him, dominating and killing him.
 Hippocrates stated the opinion that the disease was due to natural causes and not
to any demon.

HEALTH – ILLNES CONTINUUM/ ILLNESS-WELLNESS CONTINUUM

 The continuum was first envisioned by Dr Travis in 1972.

 The continuum is a scale to show how life style choices can move a person
between high level wellness and premature death.
 Health and illness/disease can be viewed as the opposite ends of a health
continuum.
 Move back and forth within this continuum day by day wide ranges of health or
illness.
  From high level of health a person’s condition can move through good health –
normal health – poor health --extremely poor health --to death.
 People move back and forth within this continuum day by day.
 How people perceive themselves and how others see them in terms of health and
illness will also affect their placement on the continuum.

1. Movement to the right on the arrows (towards high level wellness) equals an increasing level
of health and well-being. Achieved in three steps:

i. Awareness
ii. Education
iii. Growth

2. Movement to the left on the arrows (towards premature death) equates a progressively
decreasing state of health. Achieved in three steps:

i. Signs
ii. Symptoms
iii. Disability

3. Most important is the direction the individual is facing on the pathway

If towards high-level health, a person has a genuinely optimistic or positive outlook despite
his/her health status.

If towards premature death, a person has a genuinely pessimistic or negative outlook about his,
her health status.

4. Compares a treatment model with a Wellness model: a) If a treatment model is used, an

individual can move right only to the neutral point.

E.g.: a hypertensive client who only takes his medications without making any other life-style
changes.

b) If a wellness model is used, an individual can move right past the neutral point
E.g.: a hypertensive client who not only takes his medications, but stops smoking, looses weight,
starts an exercise program, etc.

Illness-Wellness Model:-

The Health, Illness - Wellness Continuum

Health
Absence of symptoms of illness and ability to carryout activities.

Illness
A state in which the person fills unhealthy may or maynot related to disease.

Wellness
A state of optimal health or optimal functioning.

Wellness is a process, never a static state.

Most of us think of wellness in terms of illness; we assume that the absence of illness indicates
wellness. There are actually many degrees of wellness, just as there are many degrees of illness.

The illness wellness continuum, illustrate the process of change, in which the individual
experiences various states of health and illness (ranging from extremely good health to death that
fluctuate throughout life. People move back and forth with in this continuum day by day) the
illness wellness continuum composed of two arrows pointing in opposite direction and joined at
neutral point.

1. Movement to the right on the arrows (towards high level wellness) equals and increasing
level of health and wellbeing.
Achieved in three stages.
a Awarness
b Education
c Growth
2. Movement to the left on the arrows (towards pre matured death ) equals a progressively
decreasing state of health.
Achieved in three stages.
a Signs
b Symptoms
c Disability
3. Most important is the direction the individual is facing on the pathway.
a If towards high level heath, a person has a positive outlook despite is/her health status.
b If towards premature death, a person has negative outlook about is/her health status.
4. Compares treatment model with wellness model
a If treatment model is used and individual can move right only to the neutral point. (eg.) client
with hypertension takes only medication without making any other life style changes.
b If a wellness model is used, and individual can move right past the neutral point. (eg) client
with hypertension not only takes his medication but stops smoking, loose weight etc.

Wellness is an approach to recognize the risk factors of different diseases and to reduce them in
preventing diseases. Therefore, wellness implies a constant and deliberate effort to stay healthy
with positive lifestyle habits to :-Improve health and quality of life , Prolong life ,Achieve total
well-being

“Big Five” Risk Factors

o Leading risk factors are related to lifestyle choices

o Smoking
o High blood pressure
o Overweight and obesity
o Physical inactivity
o High blood glucose

The Illness-Wellness Continuum is a graphical illustration of a wellbeing concept first proposed

by Travis in 1972. It proposes that wellbeing includes mental and emotional health, as well as the
presence or absence of illness.

Concept
Travis believed that a medical approach that relied on the presence or absence of symptoms of
disease to demonstrate wellness was insufficient. As shown in the Continuum. The right side
reflects degrees of wellness, while the left indicates degrees of illness. The model has been used
to describe how, in the absence of physical disease, an individual can suffer from depression,
anxiety or other conditions

He contends that medicine typically treats injuries, disabilities, and symptoms, to bring the
individual to a "neutral point" where there is no longer any visible illness. However, the
Wellness Paradigm requires moving the state of wellbeing further along the continuum towards
optimal emotional and mental states. The concept assumes that wellbeing is a dynamic rather
than a static process.

The Illness-Wellness Continuum proposes that individuals can move farther to the right, towards
greater health and wellbeing, passing through the stages of awareness, education, and
growth. Worsening states of health are reflected by signs, symptoms and disability.

In addition, a person's outlook can affect wellness. According to the concept, a positive outlook
will enhance health and wellbeing, while a negative outlook will hinder it, independent of the
current health status. For example, a person who demonstrates no symptoms of disease, but is
constantly complaining, will be facing the left side of the Continuum and away from a state of
high-level wellness. Conversely, a person with a disability, but who maintains a positive outlook,
will be facing to the right, toward a high level of wellness. It is less important where a
person is on the Continuum than the direction they are facing.

The Illness-Wellness Continuum has been viewed as promoting preventive treatment, which
improves wellbeing before an individual presents with signs or symptoms of illness, as well as
educating people to be aware of and avoid risk factors, in order to protect against pathology and
premature death.

NURSES RESPONSIBILITIES :-

 To help the client to identify their place on the health-continuum.

 To assist the clients to adopt some measures in order to reach a well state of health.
 To explain and educate them the importance of balance diet.
 To assist the beings in doing exercises for staying healthy.
 To explain about the non-therapeutic techniques for relaxation of the body e.g.,
meditation, yoga etc.
 To help them to know about their vocational hazards and what safety measures should a
person take.
 To let them know the importance of regular health check-ups, so that early detection can
help to know the medical diagnosis of early stage of disease.
 Most important to explain and take care of vulnerable group members.
e.g., new-born’s, older etc. Never take OTC drugs without any physician’s prescription
because they can show adverse reactions e.g., over dose of PCM can cause liver
disorders.
 To explain them about model of an healthy lifestyle, behavior and attitude.
 Facilitate client involvement in the assessment, implementation, and evaluation of health
goals Teach client’s self-care strategies to enhance fitness, improve nutrition, manage
stress, and enhance relationships.
 Assist individuals, families, and communities to increase their levels of health.
 Assist clients, families, and communities to develop and choose health-promoting
options. Guide clients’ development in effective problem solving and decision making.
 Reinforce clients’ personal and family health-promoting behavior’s.
 Advocate in the community for changes that promote a healthy environment.
SUMMARY:-

General idea/Concept regarding self-health is that health status of an individual depends on

various aspects of life sessions related to health i.e starting from neutral point on the health
illness continuum which proceeds towards high level wellness if a person is aware, educated, and
growing healthy status and is called as wellness.

 If an individual shows sign and symptoms of any kind of disease, disability and is also at
risk of developing the disability and require disease management and proper care of their
self health.
 The treatment paradigm can bring the individual to the neutral point, where the
symptoms of disease have been alleviated.
 If an individual is not treated properly then he can move towards premature death and
this leads to bad/death health status of the person.
 Wellness is not a static state.
 High level wellness involves giving good care physically, using mind constructively,
expressing emotions effectively being creativity involved with those around us and being
concerned about physical, psychological and spiritual environments. It is less important
where client are on the continuum, it is more important which direction he/she is facing-
toward illness or wellness.
Bibliography:-

Bibliography –

Book references-
1. “Kumari Neelam”, text book of Advance nursing practice, edition-Ist, Published by
S.Vikas and company, pageno.122-127.
2. “P.Basheer shebeer & Khan S Yasean ” A Concise text book Advance nursing
practice, edition 1st Published by EMMESS ,page no. 65-68.
3. “Joan M.Stanley” text book of Advanced practice Nursing, edition-3rd ,
Published by F.A. Davis Company .philadelphia , page no.123.

Net reference

i. https://www.who.int/reproductivehealth/self-care-interventions/definitions/en/
ii. https://www.caresearch.com.au/caresearch/tabid/2180/Default.aspx
iii. www.asma.org
iv. https//:www.ncbl.nlm.gov
v. https://nurse.org