Concept of Health and Wellness

Health
Definition:

State of being well and using every power the individual possesses
"Health is a state of complete physical, mental, and social well-being and not merely the absence of
disease" (WHO)
"Health is not a condition, it is an adjustment. It is not a state, but a process. The process adapts the
individual not only to our physical, but also our social, environments" (Presidents Commission)
most individuals define health as the following:

being free of symptoms of disease and pain as much as possible

being able to be active and able to do what they want or must do

being in good spirits most of the time

Wellness

an active process by which an individual progresses towards maximum potential possible, regardless of
current state of health
Components of Wellness

1.

2.

3.

physical, e.g.:
a.

ability to carry out daily tasks

b.

achieve fitness

c.

maintain nutrition and proper body fat

d.

avoid abusing drugs, alcohol, or using tobacco products

e.

generally to practice positive life-style habits

social, e.g.:
a.

ability to interact successfully with people and within the environment of which each person is a
part

b.

develop and maintain intimacy with significant others

c.

develop respect and tolerance for those with different opinions and beliefs

emotional, e.g.:

4.

5.

6.

7.

a.

ability to manage stress and express emotions appropriately

b.

ability to recognize, accept, and express feelings

c.

ability to accept ones limitations

intellectual, e.g.:
a.

ability to learn and use information effectively for personal, family, and career development

b.

striving for continued growth and learning to deal with new challenges effectively

spiritual, e.g.:
a.

belief in some force (nature, science, religion, or a "higher power") that serves to unite human
beings and provide meaning and purpose to life

b.

includes a persons morals, values, and ethics

occupational
a.

ability to achieve a balance between work and leisure time

b.

beliefs about education, employment and home influence personal satisfaction and relationships
with others

environmental
a.

ability to promote health measures that promote the standard of living and quality of life in the
community
i. influences include:
1.

food

2.

water

3.

air
Models of health and illness

1.

Smiths models of health and illness

clinical model

narrowest interpretation; medically-oriented model

o

health is seen as freedom from disease

illness is seen as the presence of disease

role performance model

health is seen as the ability to fulfill societal roles

illness is seen as the inability to fulfill societal roles

ability to adapt to the environment and interact with it to maximum advantage essential to the
model
o

health is seen as adaptation

illness is seen as a failure of adaptation, or maladaptation

eudaemonistic model

2.

adaptive model

ability to perform work, that is fulfill societal roles, essential to the model; assumption of the
model is that a persons most important role is their work role

most comprehensive, holistic, view of health; ability to become self-actualized essential to the
model
o

health is actualization or realization of ones potential

illness is seen as the failure to actualize or realize ones potential

Leavell and Clarks ecologic model (agent-host-environment model)

Environme
nt
Agent

Host

used primarily in predicting illness rather than promoting wellness

model is composed of three dynamic, interactive elements

the agent

a factor (biologic, chemical, physical, mechanical, psychosocial) that must be present

or absent for an illness to occur, e.g.:
presence of the legionella bacillus

the host
o

living beings (e.g., human or animal) capable of being infected or affected by the
agent, e.g.:
a Legionnaire at the Legionnaires Conference at the Bellevue-Stratford
Hotel in Philadelphia

environment
o

everything external to the host that makes illness more or less likely, e.g.:
presence of stagnant water in the air conditioning system at the BellevueStratford Hotel in Philadelphia

view of health and illness

health is seen when all three elements are in balance

illness is seen when one, two, or all three elements are not in balance
Health-illness continua
a.

Dunns High-Level Wellness Grid

Protected poor Health

Very
Favorable
Environment
Environment Axis

Death

Health Axis

Poor Health

Peak
Wellness

composed of two axiss

High Level Wellness

Very
Unfavorable
Environment
Emergent High level wellness

1.

a health axes which ranges from peak wellness to death

2.

a environmental axes which ranges from very favorable to very unfavorable

the two axiss form four quadrants

1.

high-level wellness in a favorable environment

1.

2.

emergent high-level wellness in an unfavorable environment

1.

3.

e.g., an ill person whose needs are met by the health care system and
who has access to appropriate medications, diet, and health care
instruction

poor health in an unfavorable environment

1.

b.

e.g., a woman who has the knowledge to implement healthy life-style

practices but does not implement adequate self-care practices because
of family responsibilities, job demands, or other factors

protected poor health in a favorable environment

1.

4.

e.g., a person who implements healthy life-style behaviors and has the
biopsychosocialspiritual resources to support this life-style

e.g., a young child who is starving in a drought ridden country

Travis Illness-Wellness Continuum

Wellness Model

Premature
Death

High-level

Treatment Model

Disability Symptoms

Signs

Awareness

Education

Growth

Wellness

Neutral Point

composed of two arrows pointing in opposite directions and joined at a neutral point
1.

movement to the right on the arrows (towards high-level wellness) equals an

increasing level of health and well-being
1.

achieved in three steps:

2.

awareness

b.

education

c.

growth

movement to the left on the arrows (towards premature death) equates a

progressively decreasing state of health
1.

a.

achieved in three steps:

a.

signs

b.

symptoms

c.

disability

most important is the direction the individual is facing on the pathway

1.

if towards high-level health, a person has a genuinely optimistic or positive

outlook despite his/her health status

2.

if towards premature death, a person has a genuinely pessimistic or negative

outlook about his/her health status

compares a treatment model with a wellness model

1.

if a treatment model is used, an individual can move right only to the neutral
point
1.

2.

e.g., a hypertensive client who only takes his medications without

making any other life-style changes

if a wellness model is used, an individual can move right past the neutral point
1.

e.g., a hypertensive client who not only takes his medications, but stops
smoking, looses weight, starts an exercise program, etc.
Locus of Control Model

determine whether clients takes actions regarding health

o

Internals health is largely self determined

Externals health is largely controlled by outside forces

Rosenstock/Beckers Health-Belief Model

a.

based on motivational theory

b.

composed of three components:

an individuals perceptions, e.g.:

1.

of perceived susceptibility

2.

of perceived seriousness

3.

perceived threat

modifying factors (factors that modify an individuals perceptions), e.g.:

1.

demographic variables
1.

2.

sociopsychologic variables
1.

3.

e.g., personality, social class, peer and reference group pressure, etc.

structural variables
1.

4.

e.g., age, gender, race, ethnicity, etc.

e.g., knowledge about the disease, prior contact with the disease, etc.

cues to action
1.

e.g., mass media campaigns, advice from others, reminder postcard

from a physician or dentist, illness of family member or friend,
newspaper or magazine article

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
a.

Biologic
genetic makeup
age
developmental level

 race
gender
b.

Psychologic or Emotional
Mind-body interaction

c.

Cognitive or Intellectual
Cognitive abilities
Educational background
Past experiences

d.

Spiritual
Spiritual and religious beliefs and values

e.

Environmental
Housing
Sanitation
Climate
Pollution of air, food, water

f.

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

others perceptions

the effects of changes in body structure and function

the effects of those changes on roles and relationships

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

2.

e.g., typically less than six months

chronic illness

has a gradual onset of symptoms that lasts for an extended and relatively long
period of time
o

e.g., typically six months or longer

characterized by periods of remission and exacerbation

o

remission

exacerbation

Illness Behaviors

symptoms disappear

symptoms reappear

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 and tasks

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

Health promotion and wellness

health promotion is any activity undertaken for the purpose of achieving a higher level of health
and well-being

Healthy People 2010

two goals
1.

help individuals of all ages increase life expectancy and improve the quality of life

particularly African-Americans
i. currently life expectancy is 74.9 years for European-Americans and 68
years for African-Americans

2.

eliminate health disparities among different segments of the population

particularly African-Americans
i. currently, years of healthy life is 63 years for European-Americans and 62
years for Hispanics, and 56 years for African-Americans

Focus areas of healthy people 2010

1.

access to quality health services

2.

arthritis, osteoporosis, and chronic back conditions

3.

cancer

4.

chronic kidney disease

5.

diabetes

6.

disability and secondary conditions

7.

educational and community-based programs

8.

environmental health

9.

family planning

10. food safety

11. health communication
12. heart disease and stroke
13. HIV
14. immunzation and infectious disease
15. injury and violence prevention
16. maternal, infant, and child health
17. medical product safety
18. mental health and mental disorders
19. nutrition and oveweight
20. occupational safety and health
21. oral health
22. physical activity and fitness
23. public health infrastructure
24. respiratory diseases
25. sexually transmitted diseases

26. substance abuse

27. tocacco use
28. vision and hearing
Levels of Health Promotion (Leavell and Clark)
1.

2.

3.

Primary Prevention

Health promotion

Protection against specific health problems

Secondary Prevention

Early identification of health problems

Prompt intervention to alleviate health problems

Tertiary Prevention

Restoration and rehabilitation

Types of health promotion programs

1.

Community Based

2.

Hospital Based

3.

Health-organization programs

4.

School Health-promotion programs

5.

Worksite programs for healthpromotion

Programs for health promotion

1.

2.

Information dissemination

health promotion programs that use a variety of media to offer information to the public about the risk
or particular lifestyle choices and personal behavior, as well as the benefits of changing that behavior
and improving the quality of life

e.g., billboards, posters, brochures, newspaper features, books, health fairs

health risk appraisal/wellness assessment programs

health promotion programs that appraise individuals of the risk factors inherent in their lifestyles in
order to motivate them to reduce specific risks factors and develop positive health habits


3.

lifestyle and behavioral change programs

4.

e.g., tools such as Health-Style: A Self-Test

health promotion programs geared toward enhancing the quality of life and extending the lifespan
through implementation of a healthy lifestyle or behavioral change in the individual

environmental control programs

health promotion programs developed in response to the recent growth in the number of contaminants
of human origin that have been introduced into our environment
The Nursing Process and Health Promotion

1.

2.

3.

4.

5.

Assessment
Health History
Physical Examination
Physical Fitness Examination
Lifestyles assessment
Spiritual Health assessment
Social support System review
Health risk assessment
Health Beliefs review
Life stress review
Validating assessment data
Diagnosis
Wellness diagnosis
Readiness for enhanced
Planning
Identify health goals related behavior change options
Identify behavior or health outcomes
Develop Behavior change plan
Reiterate benefits of change
Address environmental and interpersonal facilitators and barriers of change
Determine a time for implementation
Commit to behavior-change goals
Implementation
Supporting
Counseling
Individual
Telephone
Facilitating
Teaching
Consulting
Enhancing behavior change
Modeling
Evaluation