Current views of health and illness recognize health as more than the absence of disease. Realizing that humans are dynamic beings whose state of health can change from day to day or even from hour to hour, leaders in the health field suggest that it is better to think of each person as being located on a graduated scale or continuous spectrum (continuum) ranging from obvious dire illness through the absence of discernible disease to a state of optimal functioning in every aspect of one’s life. High-level wellness is described as a dynamic process in which the individual is actively engaged in moving toward fulfillment of his or her potential.
2. See Window on Health Education.
Person and environment are defined as co-extensive, open energy fields. The two evolve together and move toward increasing complexity and diversity, manifested in patterns of interaction that occur along continua of time and space. Person is also defined as a specific pattern of consciousness.
Health is a process of expanding consciousness that synthesizes disease and non-disease and is recognized by patterns of person-environment interaction. An understanding of pattern is basic to an understanding of health, and involves the movement from looking at parts to looking at the whole. Pattern is defined as information that depicts the whole, and gives an understanding of the meaning of relationships.
Nursing is an integrative force within the new paradigm of health seen as the undivided wholeness of the person in interaction and as a process of evolving consciousness. The nursing process is modified by Newman and encompasses nursing diagnosis/intervention based on the unique configuration of each person-environment interaction. Intervention is broadly intepreted as the recognition and augmentation of person-environment patterns, where the nurse and the client evolve together toward expanding consciousness.
In the United States, the spectrum of health care has been defined by the Department of Health and Human Services as encompassing six levels of health care. The first level of care is preventive care, which is primarily provided by school health education courses and community and public health services.
Primary care is the usual point at which an individual enters the health care system. Its major task is the early detection and prevention of disease and the maintenance of health. This level of care also encompasses the routine care of individuals with common health problems and chronic illnesses that can be managed in the home or through periodic visits to an outpatient facility. Providers of care at the primary level include family members as well as the professionals and paraprofessionals who staff community and neighborhood health centers, hospital outpatient departments, physicians’ offices, industrial health units, and school and college health units.
Secondary or acute care is concerned with emergency treatment and critical care involving intense and elaborate measures for the diagnosis and treatment of a specified range of illness or pathology. Entry into the system at this level is either by direct admission to a health care facility or by referral. Provider groups for secondary care include both acute- and long-term care hospitals and their staffs.
Tertiary care includes highly technical services for the treatment of individuals and families with complex or complicated health needs. Providers of tertiary care are health professionals who are specialists in a particular clinical area and are competent to work in such specialty agencies as psychiatric hospitals and clinics, chronic disease centers, and the highly specialized units of general hospitals; for example, a coronary care unit. Entry into the health care system at this level is gained by referral from either the primary or secondary level.
Respite care is that provided by an agency or institution for long-term care patients on a short-term basis to give the primary caretaker(s) at home a period of relief.
Restorative care comprises routine follow-up care and rehabilitation in such facilities as nursing homes, halfway houses, inpatient facilities for alcohol and drug abusers, and in the homes of patients served by home health care units of hospitals or community-based agencies.
Continuing care is provided on an ongoing basis to support those persons who are physically or mentally handicapped, elderly and suffering from a chronic and incapacitating illness, mentally retarded, or otherwise unable to cope unassisted with daily living. Such care is available in personal care homes, domiciliary homes, inpatient health facilities, nursing homes, geriatric day care centers, and various other types of facilities. See also home health care.
holistic health a system of preventive care that takes into account the whole individual, one’s own responsibility for one’s well-being, and the total influences—social, psychological, environmental—that affect health, including nutrition, exercise, and mental relaxation.
health Insurance Portability and Accountability Act an act of Congress, passed in 1996, that affords certain protections to persons covered by health care plans, including continuity of coverage when changing jobs, standards for electronic health care transactions, and privacy safeguards for individually identifiable patient information.
health maintenance organization (HMO) any of a variety of health care delivery systems with structures ranging from group practice through independent practice models or independent practice associations (IPAs). They provide alternatives to the fee-for-service private practice of medicine and other allied health professions. Although the type of organizational pattern, membership, and ownership of the organization may vary among HMOs, all have the major goal of allowing for investment in and incentives to use a prepaid, organized, comprehensive health care system that serves a defined population. The enrolled population enters into a contract with the organization, agreeing to pay, or have paid on their behalf, a fixed sum, in return for which the HMO makes available the health care personnel, facilities, and services that the population may require. The services are available on a 24-hour-a-day, 7-day-a- week basis. Some HMOs may provide directly the entire range of health services, including rehabilitation, dental, and mental health care. Others may agree to provide directly or arrange to pay only for physicians’ services, in-hospital care, and outpatient emergency and preventive medical services. The kinds of services available are stipulated in the contract between the organization and its enrolled population. The emphasis of a health maintenance organization is on preventive rather than crisis-oriented medical care.
health seeking behaviors a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which a person in stable health is actively seeking ways to alter his or her personal habits or environment in order to move toward a higher level of health. “Stable health” is defined as the achieving of age-appropriate illness prevention measures, with reporting of good or excellent health, and signs or symptoms of disease, when present, being controlled.