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" (President’s 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


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



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

develop respect and tolerance for those with different opinions and beliefs 3. emotional, e.g.: a. ability to manage stress and express emotions appropriately b. ability to recognize, accept, and express feelings c. ability to accept one’s limitations 4. 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 5. 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 person’s morals, values, and ethics 6. 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 7. 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

Smith’s models of health and illness

clinical model • narrowest interpretation; medically-oriented model o health is seen as freedom from disease o illness is seen as the presence of disease role performance model • ability to perform work, that is fulfill societal roles, essential to the model; assumption of the model is that a person’s most important role is their work role o health is seen as the ability to fulfill societal roles o illness is seen as the inability to fulfill societal roles adaptive model • ability to adapt to the environment and interact with it to maximum advantage essential to the model o health is seen as adaptation o illness is seen as a failure of adaptation, or maladaptation eudaemonistic model • most comprehensive, holistic, view of health; ability to become self-actualized essential to the model o health is actualization or realization of one’s potential o illness is seen as the failure to actualize or realize one’s potential


Leavell and Clark’s ecologic model (agent-host-environment model)
Enviro nment



 

used primarily in predicting illness rather than promoting wellness model is composed of three dynamic, interactive elements • the agent o 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 Legionnaire’s 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 Bellevue-Stratford 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

Dunn’s High-Level Wellness Grid
Very Favorable Environment
High Level Wellness

Protected poor Health

Environment Axis Death Health Axis
Poor Health Emergent High level wellness

Peak Wellness

Very Unfavorable Environment


composed of two axis’s 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 axis’s form four quadrants 1. high-level wellness in a favorable environment 1. e.g., a person who implements healthy lifestyle behaviors and has the biopsychosocialspiritual resources to support this life-style 2. emergent high-level wellness in an unfavorable environment 1. 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 3. protected poor health in a favorable environment 1. 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 4. poor health in an unfavorable environment 1. e.g., a young child who is starving in a drought ridden country Travis’ Illness-Wellness Continuum

Wellness Model

Premature Death Disability

Treatment Model

High-level 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 highlevel wellness) equals an increasing level of health and well-being 1. achieved in three steps: a. awareness b. education c. growth 2. movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health 1. 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. e.g., a hypertensive client who only takes his medications without making any other lifestyle changes 2. 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 o Externals – health is largely controlled by outside forces Rosenstock/Becker’s Health-Belief Model
a. b.

based on motivational theory composed of three components:  an individual’s perceptions, e.g.: 1. of perceived susceptibility 2. of perceived seriousness 3. perceived threat  modifying factors (factors that modify an individual’s perceptions), e.g.: 1. demographic variables 1. e.g., age, gender, race, ethnicity, etc. 2. sociopsychologic variables 1. e.g., personality, social class, peer and reference group pressure, etc. 3. structural variables 1. e.g., knowledge about the disease, prior contact with the disease, etc. 4. 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 c.


Cognitive or Intellectual
Cognitive abilities Educational background Past experiences



and religious beliefs and values


Housing Sanitation Climate Pollution of

air, food, water


Economic Lifestyle Family Culture


Health Care Adherence Adherence  Extent of which an individual’s 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. 2. 3. 4. 5. Establish why the client is not following the regimen Demonstrate caring Encourage healthy behaviors through positive reinforcements Use aids to reinforce teaching Establish a therapeutic relationship of freedom, mutual understanding and mutual responsibility with the client and support persons

Concept of Illness and Disease

pathologic change in the structure or function of the body or mind


the response a person has to a disease; it is an abnormal process in which the person’s level of functioning is changed compared with a previous level influenced by the following:
o o o o 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

acute illness

has a rapid onset of symptoms that lasts for a limited and relatively short period of time o 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  symptoms disappear


exacerbation  symptoms reappear

Illness Behaviors  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. 2. 3. 4. 5. 6. Role Changes Task reassignments and increased demands on time Increased stress Financial problems Loneliness as a result of loss and separation 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


currently life expectancy is 74.9 years for European-Americans and 68 years for AfricanAmericans eliminate health disparities among different segments of the population

particularly African-Americans


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 and hearing Levels of Health Promotion(Leavell and Clark) 1. Primary Prevention  Health promotion  Protection against specific health problems

2. Secondary Prevention  Early identification of health problems  Prompt intervention to alleviate health problems

3. 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 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 2. 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  e.g., tools such as Health-Style: A Self-Test 3. lifestyle and behavioral change programs  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 4. 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. 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 2. Diagnosis  Wellness diagnosis  “Readiness for enhanced” 3. 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 4. Implementation  Supporting  Counseling  Individual  Telephone  Facilitating  Teaching  Consulting  Enhancing behavior change  Modeling 5. Evaluation