COLLEGE OF NURSING

Visca, Baybay City, Leyte,

PHILIPPINES
Tel. no.: (053) 563-7226
Email address: nursing@vsu.edu.ph
Website: www.vsu.edu.ph

Name: Joshua D. Sy Course: NuCM 103r

Program and Year: BS in Nursing – 1 Date: 04-01-2022

Health, Illness, Wellness, and Wellbeing

According to Kozier and Erb (2018), the concepts of health, wellness and well-
being have various definitions. Moreover, nurses should be familiar with the concepts
and consider how it can be individualized for specific clients. This is because the clients
that the nurse encounters have different perceptions or views about health, illness and
wellness.

I. Health

On the other hand, health was traditionally defined in terms of the presence or
absence of disease. According to Florence Nightingale, health is “a state of being well
and using every power the individual possesses to the fullest extent.” Moreover, the
World Health Organization (WHO) (1948) views health in a holistic way which is “a state
of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity.” According to Edlin et al 2015, the WHO definition of health signifies
the interrelationship between physical, mental and social well-being which are factors
that would contribute to the overall quality of life. Furthermore, Octaviano and Balita
(2008), defines health as a holistic level of wellness that the person experiences. Given
the various definitions, it can be inferred that health is holistic.

● Health as defined by Various Nursing Theorists

On the other hand, health is one of the concepts of the metaparadigm in

nursing: person, health, environment and nursing. Each nursing theorist known
has their own interpretation of health. Going back to Nightingale, she defined
 health as “being well and using every power that the person has to the fullest
extent.”

● Jean Watson perceived health as “unity and harmony within the mind,
body and soul.”
● Hildegrad Peplau defined health as "a word symbol that implies forward
movement of personality and other ongoing human processes in the
direction of creative, constructive, productive, personal, and community
living."
● Dorothea Orem defined health as “being structurally and functionally
whole or sound.”
● Virginia Henderson believes that health was taken to mean balance in all
realms of life.
● Martha Rogers views health as an expression of life process.
● Imogene King defined health as a dynamic life experience of a human
being, which implies continuous adjustment to stressors in the internal
and external environment through optimum use of one’s resources to
achieve maximum potential for daily living.

II. Wellness and Well-being

Wellness is a state of well-being. In addition, the National Institute of Wellness

defines wellness to be “an active process through which people become aware of, and
make choices toward, a more successful existence”. Moreover, the WHO also defines
wellness as “the optimal state of health of individuals and groups.”

● Aspects of Wellness

According to Kozier and Erb (2018), the basic aspects of wellness includes:

1. self-responsibility;
2. an ultimate goal;
 3. a dynamic, growing process;
4. daily decision making in the areas of nutrition, stress management,
physical fitness, preventive health care, and emotional health; and, most
importantly, the whole being of the individual.

Components of Wellness

There are seven (7) components of wellness identified by Anspaugh, Hamrick and
Rosato (2011) which includes: environmental, social, emotional, physical, spiritual,
intellectual, and occupational. People must deal with the factors of each component
in order to optimize health and wellness.

● Environmental wellness is the ability to promote health measures that improve

the standard of living and quality of life in the community. This includes
influences such as food, water, and air.
● Social wellness is the ability to interact successfully with people and within the
environment of which each person is a part, to develop and maintain intimacy
with significant others, and to develop respect and tolerance for those with
different opinions and beliefs.
● Emotional wellness is the ability to manage stress and to express emotions
appropriately. Emotional wellness involves the ability to recognize, accept, and
express feelings and to accept one’s limitations.
● Physical wellness is the ability to carry out daily tasks, achieve fitness (e.g.,
pulmonary, cardiovascular, gastrointestinal), maintain adequate nutrition and
proper body fat, avoid abusing drugs and alcohol or using tobacco products, and
generally practice positive lifestyle habits.
● Intellectual wellness is the ability to learn and use information effectively for
personal, family, and career development. Intellectual wellness involves striving
for continued growth and learning to deal with new challenges effectively.
● Occupational wellness is the ability to achieve a balance between work and
leisure time. A person’s beliefs about education, employment, and home
influence personal satisfaction and relationships with others.
 ● Other sources also include financial wellness as a component of wellness. This
involves the process of learning how to successfully manage financial expenses.
Money plays a critical role in our lives, and it can impact your health as well as
academic performance.

Well-being

According to Hood (2010), well-being is a subjective perception of vitality and

feeling well . . .can be described objectively, experienced, and measured. . . and can
be plotted on a continuum”. It is a component of health. Moreover, well-being is a
positive outcome that is meaningful for people and for many sectors of society, because
it tells us that people perceive that their lives are going well. Good living conditions (e.g.,
housing, employment) are fundamental to well-being. Tracking these conditions is
important for public policy. However, many indicators that measure living conditions fail
to measure what people think and feel about their lives, such as the quality of their
relationships, their positive emotions and resilience, the realization of their potential, or
their overall satisfaction with life—i.e., their “well-being.” Well-being integrates mental
health (mind) and physical health (body) resulting in more holistic approaches to
disease prevention and health promotion. Well-being is a valid population outcome
measure beyond morbidity, mortality, and economic status that tells us how people
perceive their life is going from their own perspective.

III. Models of Health and Wellness

Researchers have developed different models of health because of its

complexity. This is in order to better understand the concept of health through models
and paradigms. Furthermore, this would help health professionals to identify and
provide appropriate care to meet the health and wellness of clients.
Clinical Model

People are viewed as physiological systems with related functions, and health is
identified by the absence of signs and symptoms of disease or injury. It is considered
the state of not being “sick.” In this model, the opposite of health is disease or injury.
This model focuses on the relief of signs and symptoms of disease and its pain. If these
are no longer present, the health of an individual is considered restored.

Role Performance Model

Health is defined in terms of an individual’s ability to fulfill societal roles, that is, to
perform his or her work. According to this model, people who can fulfill their roles are
healthy even if they have clinical illness. It is assumed in this model that sickness is the
inability to perform one’s work role.

Adaptive Model

In the adaptive model, health is a creative process; disease is a failure in

adaptation, or maladaptation. The aim of treatment is to restore the ability of the person
to adapt, that is, to cope. According to this model, extreme good health is flexible
adaptation to the environment and interaction with the environment to maximum
advantage. The famous Roy adaptation model of nursing (Roy, 2009) views the person
as an adaptive system. The focus of this model is stability, although there is also an
element of growth and change.

Eudaimonistic Model

The eudaimonistic model incorporates a comprehensive view of health. In this

model, health is indicated by exuberant well-being. Derived from Greek terminology, this
term indicates a model that embodies the interaction and inter-relationships among the
physical, social, psychological and spiritual aspects of life and the environment. Illness
is indicated by a denervation or languishing, a wasting away, or lack of involvement with
life.
Agent–Host–Environment Model

The agent–host–environment model of health and illness, also called the

ecologic model, originated in the community health work of Leavell and Clark (1965)
and has been expanded into a general theory of the multiple causes of disease. The
model is used primarily in predicting illness rather than in promoting wellness. The
model has three dynamic interactive elements: agent, host and environment.

1. Agent. Any environmental factor or stressor (biologic, chemical, mechanical,

physical, or psychosocial) that by its presence or absence (e.g., lack of essential
nutrients) can lead to illness or disease.
2. Host. Person(s) who may or may not be at risk of acquiring a disease. Family
history, age, and lifestyle habits influence the host's reaction.
3. Environment. All factors external to the host that may or may not predispose the
person to the development of disease. Physical environment includes climate,
living conditions, sound (noise) levels, and economic level. Social environment
includes interactions with others and life events, such as the death of a spouse.

Health–Illness Continua

Health–illness continua (grids or graduated scales) can be used to measure a

person’s perceived level of wellness. Health and illness or disease can be viewed as the
opposite ends of a health continuum. From a high level of health a person’s condition
can move through good health, normal health, poor health, and extremely poor health,
eventually to death. People move back and forth within this continuum day by day.
There is no distinct boundary across which people move from health to illness or from
illness back to health. How people perceive themselves and how others see them in
terms of health and illness will also affect their placement on the continuum. The ranges
in which people can be thought of as healthy or ill are considerable.

Dunn’s High-Level Wellness Grid

Dunn (1959) described a health grid in which a health axis and an environmental
axis intersect. The grid demonstrates the interaction of the environment with the illness–
wellness continuum. The health axis extends from peak wellness to death, and the
environmental axis extends from very favorable to very unfavorable. The intersection of
the two axes forms four quadrants of health and wellness:

1. High-level wellness in a favorable environment. An example is a person who

implements healthy lifestyle behaviors and has the biopsychosocial, spiritual, and
economic resources to support this lifestyle.
2. Emergent high-level wellness in an unfavorable environment. An example is a
woman who has the knowledge to implement healthy lifestyle 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. An example is an ill person
(e.g., one with multiple fractures or severe hypertension) 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. An example is a young child who is
starving in a drought-stricken country

Illness-Wellness Continuum

The illness–wellness continuum developed by Anspaugh, Hamrick, and Rosato

(2011) ranges from optimal health to premature death. The model illustrates arrows
pointing in opposite directions and joined at a neutral point. Movement to the right of the
neutral point indicates increasing levels of health and wellness for an individual. This is
achieved through health knowledge, disease prevention, health promotion, and positive
attitude. In contrast, movement to the left of the neutral point indicates progressively
decreasing levels of health. Some people believe that a health continuum is overly
simplistic and linear when the real concepts are more complex than the diagram
suggests.
IV. Variables Influencing Health Status, Beliefs, and Practices or Behaviors

Many variables influence a person’s health status, beliefs, and behaviors or

practices. These factors may or may not be under conscious control. People can usually
control their health behaviors and can choose healthy or unhealthy activities. In
contrast, people have little or no choice over their genetic makeup, age, sex, culture,
and sometimes their geographic environments.

According to the American Thoracic Society (2007), Health status is an

individual’s relative level of wellness and illness, taking into account the presence of
biological or physiological dysfunction, symptoms and functional impairment. Moreover,
the WHO defines it as the state of health of a person or population assessed with
reference to morbidity, impairments, anthropological measurements, mortality, and
indicators of functional status and quality of life.

A. Internal Variables

Internal variables include biologic, psychological, and cognitive dimensions. They are
often described as non-modifiable variables because they cannot be changed or
altered. However, when internal variables are linked to health problems, the nurse must
be even more diligent about working with the client to influence external variables (such
as exercise and diet) that may assist in health promotion and prevention of illness.

Biologic Dimension

Genetic makeup, sex, age, and developmental level all significantly influence a person’s
health.

● Genetic makeup influences biologic characteristics, innate temperament, activity

level, and intellectual potential. It has been related to susceptibility to specific
diseases, such as diabetes and breast cancer. Nurses are expected to
incorporate knowledge of genetics and genomics (how genetics interacts with the
environment and other personal factors in influencing health) in their care and
teaching of clients (Calzone et al., 2012).
 ● Sex influences the distribution of disease. Certain acquired and genetic diseases
are more common in one sex than in the other. Disorders more common among
females include osteoporosis and autoimmune disease such as rheumatoid
arthritis. Those more common among males are stomach ulcers, abdominal
hernias, and respiratory diseases.
● Age is also a significant factor. The distribution of disease varies with age. For
example, arteriosclerotic heart disease is common in middle-aged males but
occurs infrequently in younger people; such communicable diseases as
whooping cough and measles are common in children but rare in older adults,
who often have acquired immunity to them.
● Developmental level has a major impact on health status. For instance, infants
lack physiological and psychological maturity so their defenses against disease
are lower during the first years of life.

Psychological Dimension

Psychological (emotional) factors that influence health include mind– body interactions
and self-concept.

● Mind–body interactions can affect health status positively or negatively.

Emotional responses to stress affect body function. For example, a student who
is extremely anxious before a test may experience urinary frequency and
diarrhea. Emotional distress may influence the immune system through central
nervous system and endocrine alterations. Relaxation, meditation, and
biofeedback techniques are gaining wider recognition by individuals and health
care professionals. For example, women often use relaxation techniques to
decrease pain during childbirth.
● Self-concept is how a person feels about self (self-esteem) and perceives the
physical self (body image), needs, roles, and abilities. Self-concept affects how
people view and handle situations. Such attitudes can affect health practices,
responses to stress and illness, and the times when treatment is sought. Self-
perceptions are also associated with a person's definition of health. For example,
 a 75-year-old man who feels he should be able to move large objects just as he
did when he was younger may need to examine and redefine his concept of
health in view of his age and abilities.

Cognitive Dimension

Cognitive or intellectual factors influencing health include lifestyle choices and spiritual
and religious beliefs.

● Lifestyle refers to a person’s general way of living, including living conditions

and individual patterns of behavior that are influenced by sociocultural factors
and personal characteristics. In brief, lifestyle is often considered to be the
behaviors and activities over which people have control. Lifestyle choices may
have positive or negative effects on health. Practices that have potentially
negative effects on health are often referred to as risk factors.
● Spiritual and religious beliefs can significantly affect health behavior. For
example, Jehovah’s Witnesses oppose blood transfusions; some fundamentalists
believe that a serious illness is a punishment from God; some religious groups
are strict vegetarians; and religious Jews perform circumcision on the eighth day
of a male baby’s life.

B. External Variables

External variables affecting health include the physical environment, standards of living,
family and cultural beliefs, and social support networks.

Environment

People are becoming increasingly aware of their environment and how it affects
their health and level of wellness. Geographic location determines climate, and climate
affects health. For instance, malaria and malaria-related conditions occur more
frequently in tropical rather than temperate climates. Pollution of the water, air, and soil
affects the health of cells. Pollution can occur naturally (e.g., lightning-caused fires
produce smoke, which pollutes the air). Some man-made substances in the
environment, such as asbestos, are considered carcinogenic (i.e., they cause cancer).

Standards of Living

An individual’s standard of living (reflecting occupation, income, and education) is

related to health, morbidity, and mortality. Hygiene, food habits, and the ability to seek
health care advice and follow health regimens vary among high-income and low-income
groups. For instance, low-income families must prioritize use of their finances, often
choosing food and housing over health care.

Family and Cultural Beliefs

The family passes on patterns of daily living and lifestyles to offspring. For
example, a man who was abused during his childhood has a tendency to physically
abuse his own children. Physical or emotional abuse may cause long-term health
problems. Culture and social interactions also influence how a person perceives,
experiences, and copes with health and illness. Each culture has ideas about health,
and these are often transmitted from parents to children.

Social Support Network

Having a support network (family, friends, or a confidant) and job satisfaction

helps people avoid illness. Support persons also help the individual confirm that illness
exists. People with inadequate support networks sometimes allow themselves to
become increasingly ill before confirming the illness and seeking therapy. Support
people also provide the motivation for an ill person to become well again.
V. Illness and Disease

Illness is a highly personal state in which the person’s physical, emotional,

intellectual, social, developmental, or spiritual functioning is thought to be diminished. It
is not synonymous with disease and may or may not be related to disease. An individual
could have a disease and not feel ill. Similarly a person can feel ill, that is, feel
uncomfortable, and yet have no discernible disease. Illness is highly subjective; only the
individual person can say he or she is ill.

Additionally, there are many ways to classify illness and disease; one of the most
common is as acute or chronic. Acute illness is typically characterized by symptoms of
relatively short duration. The symptoms often appear abruptly and subside quickly and,
depending on the cause, may or may not require intervention by health care
professionals. Meanwhile, a chronic illness is one that lasts for an extended period,
usually 6 months or longer, and often for the person’s life. Chronic illnesses usually
have a slow onset and often have periods of remission, when the symptoms disappear,
and exacerbation, when the symptoms reappear.

On the other hand, disease can be described as an alteration in body functions

resulting in a reduction of capacities or a shortening of the normal life span.
Traditionally, intervention by primary care providers has the goal of eliminating or
ameliorating disease processes. Primitive people thought “forces” or spirits caused
disease. Later this belief was replaced by the single-causation theory. Today multiple
factors are considered to interact in causing disease and determining an individual's
response to treatment. The causation of a disease or condition is called its etiology. A
description of the etiology of a disease includes the identification of all causal factors
that act together to bring about the particular disease. However, there are certain
diseases by which its etiology is unknown.
VI. Aspects of Sick Role

Parsons (1979) described four aspects of the sick role.

1. Clients are not held responsible for their condition. Even if the illness was
partially caused by an individual’s behavior (e.g., lung cancer from smoking), the
individual is not capable of reversing the condition on his or her own.
2. Clients are excused from certain social roles and tasks. For example, an ill
parent would not be expected to prepare meals for the family.
3. Clients are obliged to try to get well as quickly as possible. The ill person should
follow legitimate advice regarding a specialized diet or activity restrictions that
could help with recovery.
4. Clients or their families are obliged to seek competent help. For example, the ill
person should contact the primary care provider rather than relying solely on his
or her own ideas of how to recover

VII. Effects of Illness towards Individuals, Family and Community

According to Kozier and Erb (2018), illness brings about changes in both the
involved individual and in the family. The changes vary depending on the nature,
severity, and duration of the illness, attitudes associated with the illness by the client
and others, the financial demands, the lifestyle changes incurred, adjustments to usual
roles, and so on.

Individual

Illness may cause changes in the behavior of a client. Also, emotional changes,
self-concept and body-image, and physical changes may be experienced due to illness.
The individual, for example, may become irritable and lack the energy or desire to
interact in the usual fashion with family members or friends. Ill individuals are also
vulnerable to loss of autonomy, the state of being independent and self-directed without
outside control. Family interactions may change so that clients are no longer involved in
making family decisions or even decisions about their own health care. Illness also often
necessitates a change in lifestyle. In addition to participating in treatments and taking
medications, the ill person may need to change diet, activity and exercise, and rest and
sleep patterns.

Families

A person’s illness affects not only the person who is ill but also the family or
significant others. The kind of effect and its extent depend chiefly on three factors: (1)
the member of the family who is ill, (2) the seriousness and length of the illness, and (3)
the cultural and social customs the family follows. The changes that can occur in the
family include role changes; task reassignments and increased demands on time;
increased stress due to anxiety about the outcome of the illness for the client and
conflict about unaccustomed responsibilities; financial problems; loneliness as a result
of separation and pending loss; and change in social customs.

Communities

According to a lecture of Medina (2015) in UP College of Medicine, those who

belong in the marginalized sector are most vulnerable to illness and disease. Moreover,
illness worsens the effects and impacts of baseline unfavorable health determinants.
He added that ill community members are non-productive. In result, children who are
the future of the community will fail to reach their full potential. Likewise, the adults who
are supposed to lead productive lives in order to contribute to the well-being of the
community are either too sick or too busy taking care of those who are to do so.
Furthermore, an ill community is unable to fulfill its role in health. dd
References:

Berman, A., Synder, S. J., & Frandsen, G. (2018). Health, Wellness and Illness. In
Kozier and Erb's Fundamentals of Nursing Concepts, Process and Practice (10th
ed., Vol. 1, pp. 288–299). Pearson.

Edlin, G., & Golanty, E. (2015). Health and wellness. Jones & Bartlett Publishers.

Eight Dimensions of Wellness. UC Davis. (2019, September 3). Retrieved March 30,
2022, from https://shcs.ucdavis.edu/health-and-wellness/eight-dimensions-
wellness

Health and Disease, Influence of Family and Community. Lumen Learning. (n.d.).
Retrieved March 31, 2022, from
https://courses.lumenlearning.com/diseaseprevention/chapter/lesson-1-health-
and-disease-influence-of-family-and-community/

Health Status, Health Perceptions. American Thoracic Society. (2007). Retrieved March
31, 2022, from https://qol.thoracic.org/sections/key-concepts/health-status-health-
perceptions.html

Health status. IAHPC Pallipedia. Retrieved March 31, 2022, from

https://pallipedia.org/health-status/.

Irhuma, A. E. B. (2008). Health, Illness and Disease. Sebha Medical Journal, 7(2).
https://doi.org/sebhau.edu.ly/suj/paper/Health.Amer.pdf

Medina, P. V. N. (2015, September 19). Illness and the Community. Slideshare.

Retrieved April 1, 2022, from https://www.slideshare.net/lopaoMD/illness-and-the-
community