健康与疾病课件资料

1、Health and IllnessSoN, SDU1Learning objectives说明影响健康的因素列出常见的病人角色适应不良及心理原因阐述健康促进的原则和策略解释名词：健康、生存质量、健康促进能运用现代健康观和疾病观评述护士在健康保健事业中的作用23Are they healthy?4Is she healthy?5Definition of Health古代健康观（协调、阴阳）近代健康观（流行病学、社会学）现代健康观6Definition of healthHealth is a state of complete physical, mental, and social wel

2、l-being and not merely the absence of disease or infirmity. -World Health Organization, 19481989年，WHO又提出了有关健康的新概念，即“健康不仅是没有疾病，而且包括躯体健康、心理健康、社会适应良好和道德健康。” 7亚健康状态(sub-health status)亚健康状态是处于健康和疾病之间的一种状态，主观上有不适感觉，但临床检查无明显疾病，机体各系统的生理功能和代谢活力降低。表现为躯体疲劳、易感冒、稍动即累、出虚汗、食欲下降、头痛、失眠、焦虑、人际关系不协调、家庭关系不和谐、性功能障碍等。8Var

3、iables Influencing Health StatusBiological factorsPsychological factorsEnvironmental factorsLifestyleSocial factors9Variables Influencing Health Status- Biological factors生物致病因素Genetic makeup AgeRaceDevelopmental stageSex10Variables Influencing Health Status- Biological factorsGenetic makeupIt affec

4、ts biologic characteristics, innate temperament, activity level, and intellectual potential.Some susceptibility of some specific diseases such as diabetes and hypertension is related to genetic makeup. 11Variables Influencing Health Status-Biological factorsAgeDisease distribution differs with age.C

5、oronary heart disease commonly occurs in adults over the 40-year-old, but chicken pox is common in children12Variables Influencing Health Status- Biological factorsRaceSome diseases are more likely to occur in specific raceFor example: Asian have higher incidence of osteoporosis(骨质疏松) than European.

6、13Variables Influencing Health Status- Biological factorsDevelopmental stageClients level of growth and development has a major impact on their health status.Infants has lower defense against disease Toddlers are more likely to have falls and injuryAdolescents are more prone to take risky behaviorOl

7、d adults have declining body function14Variables Influencing Health Status- Biological factorsSexSex impacts the distribution of diseaseSome genetic disease commonly occur in one genderOsteoporosis and breast cancer are more common among females, stomach ulcers are more common among males15Variables

8、 Influencing Health Status- Psychological factorsMind-body interactions It may impact health status positively or negativelyEmotional responses to stress either long term or short term affect body function, for example urinary frequency before a testThe long term emotional distress may lead to disea

9、se16Variables Influencing Health Status- Psychological factorsSelf-conceptIt is how a person feels about himself, how a person perceives his physical self, his needs, his roles and his abilitiesSelf-esteemfeeling about oneselfbody imagethe perception of physical selfIt influences the manners and att

10、itudes that people view and deal with situations17Would you please give me an example?18Variables Influencing Health Status-Environmental factorsNatural environmentHousing, sanitation, climate, food, air, water, soil, sunshine and so on are the environmental factors which have many influences on hea

11、lth and illness. For example19Variables Influencing Health Status-Environmental factorsSocial environmentEconomic factors Health care system Some occupational situations Social violence and traffic accidents Peoples cultural background For example20Variables Influencing Health Status- Social factors

12、Economic factorsLow-income peopleHigh-income people21Variables Influencing Health Status- Social factorsHealth care system It determines how people can obtain care, method of therapy, the outcome of medical care, the cost and so on.22Variables Influencing Health Status- Social factorsSome occupation

13、al situations They expose workers to stressful situation. The effects of the hazards may be occurrence of mental disturbance or occupational diseases, and the effects are not always immediate and some of them have a long latency period.23Variables Influencing Health Status- Social factorsSocial viol

14、ence and traffic accidentsIt increases risk for injury or death.24Variables Influencing Health Status- Social factorsPeoples cultural backgroundPeoples cultural background determining their living way, beliefs, values, and customs influences the approach to the health care system, personal health pr

15、actices, and the relationship between clients and health care providers. 25Variables Influencing Health Status- LifestyleLifestyle involves aspects of persons behavior and surroundings that they control. The lifestyle that people choose may affect health positively or negatively 26Variables Influenc

16、ing Health Status- Lifestyle Lifestyle with positive effects on health is healthy lifestyle, for example Lifestyle with potentially negative effects on health are often defined as risk factors, such asWHO指出“影响人类健康的因素，行为与生活方式占60%，遗传占15%，社会因素占10%，医学因素仅占8%，气候因素占7%.”27Related researchSule Ecevit Alpar.

17、Et al. Change in the health promoting life style behavior of Turkish University nursing students from beginning to the end of nurse training. Nurse Education in Practice, 2008,8:382-38828Related researchIrene Coulson. Et al. Knowledge and lifestyle behaviors of healthy older adults related to modify

18、ing the onset of vascular dementia. Archives of gerontology and geriatrics, 2004,39:43-5829Related researchSmi Choi-Kwon., Jong S. Kim. Lifestyle factors and risk of stroke in Seoul, South Korea. Journal of stroke and Cerebrovascular diseases, 1998,7(6):414-42030生存质量(quality of life, QOL)WHO的定义“生存质量

19、是指个体在其所处的文化和风俗习惯的背景下，由生存的标准、理想、追求的目标所决定的对其目前社会地位及生存状况的认识和满意程度”，它包括个体生理、心理、社会功能及物质状态四个方面。31量表一般量表特殊量表糖尿病病人生存质量量表卒中特定生活质量量表老年人生存质量量表32健康促进（Health promotion） 1986年，WHO提出：“健康促进是促使人们维护和提高其自身的过程，是协调人类与环境之间的战略，规定个人与社会对健康各自所负的责任。”33健康促进的策略制定促进健康的政策营造良好的支持性环境扩大卫生服务职能充分发挥社区力量发挥个人的作用34制定促进健康的政策WHO明确指出“健康问题已经提到

20、了各个部门、各级领导的议事日程上，要让他们了解他们的决策对健康产生的后果负有责任。”健康促进的政策由多样且互补的政策、法规、财政、税收和组织改变等综合而成。35营造良好的支持性环境WHO指出“创造支持性环境与健康息息相关，两者相互依存，密不可分。创造对健康更为有利的环境，必须使自然环境、物质环境、经济环境和社会政治环境等都能有助于健康而不是有损健康。”36扩大卫生服务职能卫生管理部门和卫生工作者扩大服务职能和服务范围，以自身的资源优势，特别是人力资源优势加强健康促进中的卫生服务。37充分发挥社区力量社区发挥着重要的作用社区广大居民的权力和义务38发挥个人的作用个体的主观能动性对自己的健康负责3

21、9促进健康行为是个人或群体表现出的、客观上有利自身和他人健康的一组行为具有以下5大基本特征有利性：有益于自己、他人和社会，如不吸烟，不酗酒规律性：有恒定的规律，如定时、定量进餐和谐性：有个性但能根据整体环境随时调整一致性：行为本身具有外显性，与内心一致、无冲突适宜性：行为强度有理性控制，无明显冲动表现，且该强度是对健康有利的40健康促进行为的分类日常健康行为：合理营养、平衡膳食等戒除不良嗜好：如戒烟预警行为：通指预防事故发生和一旦发生事故后能正确处理的行为，如驾乘先系安全带，发生车祸后能自救和他救等避免有害环境行为合理利用卫生服务行为41危害健康行为 危害健康行为是个体或群体在偏离个人、他人、

22、社会的期望方向上表现的一组行为。其主要特点是： 危害性危害的稳定性和持续性后天习得，也可以改变42危害健康行为分类日常危害健康行为：如吸烟、酗酒、吸毒、性乱等致病性行为模式：导致特异性疾病发生的行为，如A型行为模式（冠心病易发性行为）和C型行为模式（肿瘤易发性行为）不良疾病行为：从感知到自己患病到疾病康复所表现出来的一系列行为，如不及时就医等。不良生活习惯：如饮食过度等。43促进健康的护理活动生理领域心理领域社会领域44健康促进措施专业 Health risk appraisal and wellness assessment Health information dissemination

23、Lifestyle and behavior modification Environmental restructuring Social support45疾病预防Motivation:trying to actively avoid illness, detect it early, and maintain functioning within constraints of disease. Goals:taking action to prevent or opposite disease process. Focus: a problem oriented approach, in

24、 which emphasis is on finding ways to modify the environment, behavior, and body defenses so that the disease processes eliminated, slowed, or changed.46It is hard to differentiate them from each other. 47三级预防 Primary prevention Secondary prevention Tertiary prevention 48一级预防病因预防 健康教育、建立良好生活方式特殊人群的重

25、点预防针对病因的特异性预防环境保护和监测重视社会、心理、行为与健康的关系 49二级预防三早预防To screen and to promote early diagnosis so that prompt and adequate treatment can be instituted. Examples50三级预防预防残障 Aims at minimizing residual disability from a permanent and irreversible defect and disability and helping the patient achieve as high l

26、evel of functioning as possible. Examples51疾病（Illness）Definition古代的疾病观（元素失衡、阴阳失调） 近代疾病观（18-19世纪，不同的学科角度不同） 现代疾病观 52现代疾病观的基本观点疾病是发生在人体一定部位、一定层次的整体反应过程，是生命现象中与健康相对立的一种特殊征象。疾病是人体正常活动的偏离或破坏，表现为功能、代谢、形态结构及其相互关系超出正常范围，以及由此而产生的机体内部各系统之间和机体与外界环境之间的协调发生障碍。53现代疾病观的基本观点（续）疾病不仅是体内的病理过程，而且是内外环境适应的失败，是内外因作用于人体并引起

27、损伤的客观过程，是人体内部功能、代谢、形态结构的异常，一般是一定内外因素作用的结果。疾病不仅是躯体上的疾病，而且也包括精神、心理方面的疾病，完整的疾病过程，常常是身心因素相互作用、相互影响的过程。54疾病行为 是患者通常采取的应对疾病导致的机体功能改变的行为. 如果认为自己患病，疾病行为可以是一种应对机制. 疾病行为高度个体化，并受许多因素的影响。55What is your behavior when you feel ill?Group discussion 56疾病行为 疾病行为有五个阶段: 症状阶段, 患者角色假设阶段, 寻求医疗帮助阶段, 依赖性患者角色, 和康复阶段. 57 症状阶

28、段个体会就自身的感觉和症状咨询他人，或者与自己的亲朋好友诉说. 如果症状继续或者通过自我管理没有改善，就进入下一个阶段.58患者角色假设阶段 放弃原来的活动，进入病人角色. 行为多样，如休息、买药治疗. 当症状不缓解的时候，建议去看医生. 59寻求医疗帮助阶段从专业人员那儿寻求诊断和治疗. 患者想确认的信息为疾病的真相、症状的解释以及预后. 患者可以接受或否定这个诊断，如果接受事实，患者就会遵从治疗计划，如果患者否认诊断，他或许会寻求其他专业人员的帮助. 60患者角色依赖阶段 完全接受诊断和治疗的患者，依赖于专业人员的帮助. 患者或许进入医院住院，而放弃其他的角色如父亲、母亲等。 多数人尽管可

29、以控制自己的生活，但是还是依赖于专业人员的帮助. 61康复阶段 the person is expected to give up the dependent role and resume former role and responsibility. The person with acute illness recovers rapidly and returns to their former life easily. On the reverse, the person with chronic illness must adjust their lifestyle, and rec

30、overs difficultly. At present, the rehabilitation often happens outside of hospital, such as at home, in the community, or at rehabilitation center. 62健康与疾病的关系wellnessdeathThe wellness continuum6364健康与疾病的关系每个人的健康状况都处在这种健康与疾病所所构成的线形谱的某一点上，而且处在不断动态变化之中。任何时期都包含着健康和疾病两种成分，哪一个成分占主导，就表现出哪一个成分的现象与特征。当个体向最佳

31、健康一端移动时，健康的程度就增加。65健康与疾病的关系（续）个体从健康到疾病康或从疾病到健康的过程中，并不存在一个明显的界线。所以健康与疾病是相对的，在生命过程中是动态变化的，并在一定条件下可以相互转化。健康与疾病可在个体身上同时并存，即一个人可能在生理、心理、社会的某方面处于低水平的健康甚至疾病状态，但在其他方面却是健康的。66角色及病人角色角色：是对某特定位置的行为期 ：待与行为要求，是个体在多层面、多方位的人际关系中的身份和地位。病人角色：免除或减轻日常生活中的其他角色及义务；病人一般不需为其患病承担责任；病人应该努力使自己康复，有接受治疗、恢复健康的义务；病人有寻求有效帮助、并在治疗中

32、积极配合医疗和护理的责任。67常见病人角色适应不良角色行为冲突：即病人角色与其他角色发生冲突。如角色行为强化：即病人因为患病而导致自信心减弱，对家庭和社会的依赖性增强；当病情好转，由病人角色向常态角色转变时，仍然安于病人角色，产生退缩和依赖心理。如角色行为缺如：指病人没有进入病人角色，不愿意承认自己是病人，这是一种心理防御的表现。如68常见病人角色适应不良（续）角色行为减退：指病人已经适应了病人角色，但由于某种原因，使其又重新承担起原来扮演的其他角色，病人往往忽视了病人角色，而偏重其他角色。如角色行为异常：角色行为异常即病人虽然知道自己患病，但受疾病折磨而出现的失落、悲观、厌倦甚至自杀等行为表现。如69疾病的影响生理心理外表经济70医疗卫生保健政策与体系全球卫生政策：WHO和各成员国共同提出的全球卫生政策如下：健康是每个人