ILLNESS

ILLNESS

“Illness is a condition characterized by a deviation from a normal health state which is manifested by physical & psychological symptoms.” – Kozier.
“Illness is a state in which a person’s physical, intellectual, emotional, social or spiritual functioning is diminished or impaired in comparison with the previous experience”. Potter & Perry.

Common Cause of Disease /illness

Biologic agent- It can be virus, bacteria, protozoa or any other microorganism.
Inherited genetic defect- For example, cleft palate.
Faulty chemical/metabolic process- Inadequate insulin in diabetes.
Emotional/physical reaction to stress- Fear, anxiety.
Developmental defect- For example, imperforate anus.
Physical agents- Radiation, ultraviolet rays.
Chemical agents- Carbon monoxide, lead.
Tissue response to injury/irritation- Fever, inflammation .

Classification of Illness

Illness can be classified based on the duration-

1. Acute illness- It is for a shorter duration; usually less than 3 months. The onset of symptoms is sudden. It usually results in complete recovery, death or develops into a chronic disease.

2. Chronic illness- It is for a long term. The onset is slow. The symptoms are less severe. It results in optimizing the level of functioning and coping with the illness. It usually requires modification in the lifestyle, habits, daily activities, etc.

Stages of Illness

The way people experience illness differs. There are 5 stages that an individual usually goes through. The stages of illness are-

Stage I: Symptom experience- The person feels something is wrong, but he/she is unable to diagnose. There is awareness of physical change like pain, fever, rash, lump, etc. At the end of this stage, the person is sure that the symptoms belong an illness.
Stage II: Assumption of sick role- If the symptoms persist, the client will assume sick role. They confirm the sickness through the family members and others and are excused from performing their normal routine duties and activities.
Assumption of sick role results in emotional changes like withdrawal, depression. The person may deny or will avoid contact with health care system. Once the client accepts the persistent nature of symptoms or potential threat to life, medical assistance is sought.
Stage III: Medical care contact- The client acknowledges the illness. He seeks advice, consultation regarding the cause, duration of illness, complications, etc. Health professional determines the illness and its severity.
Stage IV: Dependent client care- Once the client accepts the diagnosis, they become dependent on health care team to get treatment. There is acceptance of care, sympathy, protection from the demands and stress of life. The client adjusts to the disruption in daily activities. This disruption may affect the client's role, occupation, family, community and lead to stress.
Stage V: Recovery/rehabilitation- In this stage, the symptoms subside. The person assumes the original health. In case of chronic illness, it results in adjustment and measures taken to prevent complications.

Factors/Variables Affecting Illness Behavior-

The two main factors that affect the illness behavior can be classified as internal and external factors/variables.

Internal Factors

These are variables that are within a person. They differ from person to person. These are-

Perception of symptoms- It is the way a person perceives the symptoms of illness that influence the illness behavior. If a person takes symptoms not too seriously and takes prompt and adequate treatment; recovery is fast. If the person takes the symptoms too seriously, whether they are or not, they may become life-threatening.
Nature of illness- In case of acute illness, client may take adequate treatment and recover fast. In chronic illness, the client will take responsibility for self, may cope and adjust or may get frustrated and not comply with the treatment.
Characteristics of person- The way the person responds to illness will depend on his personality coping ability and adjustment.

2. External Factors

These are variables that influence from outside.

Visibility of symptoms- Visibility of symptoms affect body image as well as behavior. If symptoms are visibile the chances of seeking medical help will be more.
Social group- The social support available through family, friends, relatives may assist the client to recognize the threat of illness and support the denial of potential illness.
Culture and values- They teach the client how to remain healthy and recognize the illness.
Economic variable- The socioeconomic background affects how early medical assistance is sought by the person. Economic constraint may delay treatment.
Accessibility of the health care system- The proximity of health care system influences the frequency and the interval for seeking medical advice.

Emotional Response to Illness

An emotion is a bodily state that involves feeling which may be conscious or unconscious. The way the emotions are expressed will depend on the personality of the person, perception and extent of support. The common emotional responses to illness are-

Fear- It is an emotional response characterized by expectation of harm or unpleasantness. The person may withdraw or avoid threat. The client may express fear and some may be reluctant to express it freely.
Overdependence and feeling of helplessness- The feeling of dependence and helplessness increases to the extent that it can be harmful to the client. The nurse can assist the client to reduce this feeling by assessing his capability and helping him to become independent.
Anxiety- Illness results in anxiety, especially due to lack of insight, knowledge regarding the illness, investigations, etc. Anxiety may cause insomnia, diarrhea, change in BP, fatigue, inadequate coping. It is the duty of the nurse to identify anxiety and implement interventions to reduce the same.
Hope- People hope for the best outcome of their illness and expect to resume a long and healthy life. Physical and emotional balance gets disturbed and death may result in case the person loses his will to live. Reinforcing and providing hope and encouraging the client will help in the recovery.
Anger and hostility- This is an emotion that results due to frustration in dealing with a difficult situation. Anger is seen when a person is unable to move forward in meeting his goal, objectives and self-respect gets lowered. Hostility is a desire for aggression.It is necessary that the nurses understand these emotions and assist the clients to adjust/adapt to the situation.

Impact of Illness on the Patient and the Family

While studying the impact, it is necessary to consider the patient and the family as one unit. We cannot realize the effect of illness if we consider only the patient as the patient belongs to a family and his role, functions, etc are interdependent. Illness is not a solitary event. It results in-

A. Behavioral and emotional changes- People react differently to illness. The reaction depends upon-

Nature of illness: For example, duration, intensity
Clients' attitude toward illness
Others' reactions (family) to the client's illness

B. Impact on body image- Body image has been defined as the subjective concept of physical appearance (Potter & Perry, 2014). The reaction to the body image changes with each individual. The reaction to the change depends on-

Nature and type of change
Individual's capacity of adaptation
The available support system

C. Impact on self-concept- A person's adaptation to the illness and the change in body image will determine the impact of illness it has on his self-concept. Self-concept thus will depend on the coping mechanism adopted by an individual.

D. Impact on family roles- People perform various roles in and out of the family. During illness, it has a direct impact on the roles played by a particular individual. The roles could be like breadwinner, decision maker, homemaker, parent, etc. During an illness, there is an alteration in performance of these roles.

E. Impact on family dynamics- Family dynamics involves family coping, decision-making and family support system. Illness may result in reversal of roles, new patterns of functioning, conflict resolution, etc. Thus, inclusion of family in the care of an individual is important. The nurse needs to assess the family dynamics and plan and provide interventions accordingly.