MODELS OF HEALTH AND WELLNES: 1.
Agent = any factor or stressor that can
A. SMITH’S MODEL OF HEALTH
1. Clinical Model
 Views people as a physiologic system
with related functions
 Identifies health as the absence of signs
and symptoms of disease or injury
 The state of not being sick
 The opposite of health is disease or
injury
 When these signs and symptoms are no
longer present the physician considers
the individuals health restored
2. Role Performance Model
 Defines health in terms of individual’s
ability to fulfil societal roles such as
performing work
 People who can fulfil their roles are
healthy even if they have clinical illness
 Sickness is the ability to perform one’s
work role
Ex: A man who works all day in his job is
healthy even though he is deaf
3. Adaptive Model
 Focuses on adaptation
 Views health as creative process and
disease as a failure in adaptation or
mal-adaptation
 Aim of treatment is to restore the
ability of the person to adapt or to cope
with the environment
4. Eudaimonistic Model
 Health is seen as a condition of
actualization or realization of a person’s
potential
 Actualization is the apex of the fully
developed personality (Maslows)
 Highest aspiration of people is
fulfilment and complete development
B. LEAVELL AND CLARK’S AGENT-HOST-
ENVIRONMENT MODEL
(ECOLOGIC MODEL)
 Used primarily in predicting illness
 Identification of risk factors that results
from the interaction of agent, host and
environment are important in
promoting and maintaining health
lead to illness or disease
Ex: lack of nutrient leads to illness or
disease
2. Host = person’s who may not be at risk
of acquiring a disease
Ex: family history, age, lifestyle habits
3. Environment = all factors external to
the host that may or may not
predispose the person to the
development of disease
Ex: living conditions, climate, economic
level etc.
C. HEALTH PROMOTION MODEL
(PENDER)
 Defines health as a positive, dynamic
state
 Describes multidimensional nature of
persons as they interact within their
environment
 This model explains why individuals
engage in health activities
 Result: improved health, enhanced
functional ability, better quality of life,
healthy lifestyle
VARIABLES THAT INFLUENCE BELIEFS AND
PRACTICIES
INTERNAL
 Developmental stage
 Intellectual background
 Perception of functioning
 Emotional factors
 Spiritual factors
EXTERNAL
 Family practices
 Socioeconomic factors
 Cultural background
NURSES PROVIDE CARE FOR 3 TYPES OF
CLIENTS:
 Individual
 Family
 Community
4 AREAS OF NURSING PRACTICE
 Health Promotion
 Disease Prevention
 Health Maintenance
 Curative/ Rehabilitative

I. HEALTH PROMOTION
 Enabling people to increase control
over and to improve their health (WHO)
 Helping people change their lifestyle
 Nurse must identify clients strength to
help them reach maximum functioning
and quality of life
DETERMINANTS OF HEALTH
Income and social status
 Higher income and social status are
linked to better health
Education
 Low education levels are linked with
poor health, more stress and lower self-
confidence
Physical environment
 Safe water and clean air, healthy
workplaces, safe houses, communities
and roads all contribute to good health
Employment and working conditions
 People in employment are healthier,
particularly those who have more
control over their working conditions
Social support networks
 Greater support from families, friends
and communities is linked to better
health
Culture
 Customs and traditions, and the beliefs
of the family and community all affect
health
Genetics
 Inheritance plays a part in determining
lifespan, healthiness and the likelihood
of developing certain illnesses
Personal behaviour and coping skills
 Balanced eating, keeping active,
smoking, drinking and how we deal with
life’s stresses all affect health
Health services
 Access and use of services that prevent
and treat disease influences health
Gender
 Men and women suffer from different
types of diseases at different ages
TYPES OF PROGRAMS OF HEALTH
PROMOTION
a. Information dissemination
 Uses a variety of media to offer
information to the public
b. Health risk appraisal and wellness
assessment
 Appraise individuals of their risk factors
that are inherent in their lives in order
to motivate them to reduce risk and
develop healthy habits
c. Lifestyle and behaviour change
program
 Basis for changing health behaviors
 Geared towards extending the life span
d. Worksite wellness programs
 Includes programs that serve the needs
of persons in their workplace
e. Environmental control programs
 Developed to address the growing
problem of environment pollution = air,
land, water etc.
NURSES ROLE IN HEALTH PROMOTION
 Model healthy lifestyle
 Facilitate client involvement
 Teach clients self-care strategies to
enhance fitness, improve nutrition,
manage stress and enhance
relationships (build rapport)
 Educate clients to be effective health
care consumers
 Assist clients, families and communities
in choosing health promotion options
 Be an advocate in the community for
changes that promote a healthy
environment
II. HEALTH MAINTENANCE
 The active process of achieving health
and remaining healthy
Elements used for health maintenance
A. NUTRITION
 Studies food and dietary supplements
that improve health, and cure or
prevent disease
 Food or food components that cause
disease or deteriorate health
B. EXERCISE
 The performance of movements in
order to develop or maintain physical
fitness
 Frequent and regular physical exercise
prevents some disease such as cancer,
cardiovascular disease, type 2 diabetes,
obesity and back pain
C. HYGIENE
 The practice of keeping the body clean
to prevent infection and illness, and
avoidance of contact with infectious
agents
 D. STRESS MANAGEMENT
 Prolonged stress may negatively impact
health, such as by weakening of the
immune system
 Relaxation techniques are physical
methods used to relieve stress
E. HEALTH CARE
 The prevention, treatment and
management of illness through the
services offered by the medical, nursing
and allied health professionals
F. WORKPLACE WELLNESS
PROGRAMS
 Recognized by companies for their
value in improving the health and well-
being of their employees, and for
increasing morale, loyalty and
productivity
III. DISEASE PREVENTION
 The goal of illness prevention program
is to maintain optimal health by
preventing disease
 Actions aimed at minimizing or
eliminating the impact of disease or
disability
 Hippocrates – “prevention is better
than cure”
 Nursing activities that prevent illness
includes: immunization, pre-natal and
infant care, prevention of STD’s
3 LEVELS OF PREVENTION
A. PRIMARY PREVENTION
 Defined as action taken prior to the
onset of disease, which removes the
possibility that a disease will ever occur
 Encourage optimal health
 Increase the person’s resistance to
illness
 Health promotion
EXAMPLES:
 Quit smoking
 Avoid/limit alcohol intake
 Exercise regularly
 Eat well-balanced diet
 Take adequate fluids
 Reduce fat and increase fiber in the diet
 Maintain ideal body weight
 Avoid exposure to sunlight
 Complete immunization
 Wear hazard devices in work site
 Handwashing program
 HEALTH EDUCATION
 ENVIRONMENTAL MODIFICATION
 NUTRITIONAL INTERVENTION
 LIFESTYLE AND BEHAVIORAL CHANGES
B. SECONDARY PREVENTION
 The action that halts the progress of a
disease
 Also known as health maintenance
 Early detection/screening
 Prompt treatment to limit disability
EXAMPLES:
 Having annual physical examination
 Regular pap smear test for women who
are 20 yrs old and above
 Sputum examination for TB
 Annual stool guiac test and rectal
examination for clients over age 50 yrs
C. TERTIARY PREVENTION
 Occurs after a disease or disability has
occurred and the recovery process has
begun
 Minimizing disability and helping the
client learn to live productively with
limitations
 Rehabilitation
EXAMPLES:
 Self-monitoring of blood glucose among
diabetics and attending self-
management education
 Physical therapy after CVA (Stroke),
participation in Cardiac Rehabilitation
after MI or Heart Attack
 Undergoing speech therapy after
laryngectomy
IV. RESTORING HEALTH
(CURATIVE/REHABILITATIVE
CARE)
 Focuses on the ill client and extends
from early detection of disease through
helping the client during the recovery
period
Nursing activities:
 Baths
 Assessment procedures
 Collaborating with other health care
professionals about clients problem
COMMUNICATION IN NURSING
Communication
 An exchange of information, ideas, and
feelings
 Nurses communicate clients
information effectively
 Through discussion, reports, and
records
MODES OF COMMUNICATION
Verbal communication
 Uses spoken or written words
Nonverbal communication
 Uses gestures, facial expression,
posture, body movement, eye contact,
tone of voice
CHARACTERISTICS OF
COMMUNICATION
Simplicity
 Use of commonly understood words,
direct and complete
Clarity
 Saying exactly what is meant, speak
slowly and pronounce well
Timing and Relevance
 Right time, consider client’s interest and
concerns
Adaptability
 Nurse adjust on what to say depending
on mood of client
Credibility
 Provide accurate information
COMPONENTS OF COMMUNICATION
Sender (encoder)
 The person who encodes and delivers
the message
Message
 The content of the communication
Channel
 Means of conveying and receiving
messages, visual, auditory and tactile
Receiver (decoder)
 The person who receives and decodes
the message
Response (feedback)
 The message returned by the receiver
CRITERIA FOR EFFECTIVE VERBAL
COMMUNICATION
Vocabulary
 Sender and receiver should be able to
translate each other’s words (medical
jargons)
Denovative and connovative meaning
 Denovative – real meaning of a
particular word
 Connotative – interpretation of a
word’s meaning by feelings/ ideas
people have about the word
Pacing
 Nurses should speak slowly and to
pronounce clearly
Intonation
 Tone of voice often provides the
emotional state or energy level
Clarity and Brevity
 Clarity – speaking slowly, pronounce
clearly, and using examples to be easily
understood
 Brevity – direct to the point
Timing and Relevance
 Even though a message is clear, poor
timing can make it ineffective
GUIDELINES FOR ACTIVE AND
EFFECTIVE LISTENING
 Be attentive to what the client is saying
verbally and nonverbally
 Trust communicates acceptance and
respect for the client
S – stand/sit facing the client
O – observe an open posture
L – lean towards client
E – establish and maintain eye contact
R – relax
GUIDELINES FOR USE OF TOUCH
 Touch is one form of communication
 Many messages (e.g. affection,
empathy) are conveyed through touch
 Be sensitive to other’s reactions to
touch
 Consider cultural factors
 Touch should be as gentle or as form as
needed and delivered in a comforting,
non-threatening manner
 There are times when touch should be
withheld (mentally unstable)
ZONES OF PERSONAL SPACE
 INTIMATE ZONE (0-18 INCHES)
 SOCIAL ZONE (4-12 FEET)
 PERSONAL ZONE (18 INCH TO 4 FEET)
 PUBLIC ZONE (12 FEET AND GREATER)
ZONES OF TOUCH
 SOCIAL ZONE (permission not needed)
 VULNERABLE ZONE (special care
needed)
 CONSENT FORM (permission needed)
 INTIMATE ZONE (great sensitivity
needed)
DEVELOPMENTAL CONSIDERATIONS IN
COMMUNICATIONS
1. OLDER ADULTS WITH
COMMUNICATION NEEDS
a. Check hearing aid
b. Amplify voice if necessary
c. Minimize visual and auditory
distractions
d. Provide visual aids
e. Summarize important points of
the conversation
f. Give clients plenty of time to
ask/answer
g. Stick to one topic at a time
2. INFANTS
a. Use firm and gentle physical
contact such as cuddling,
patting, or rocking
b. Hold infant so he or she can see
the parents
c. Talk softly to the infant
3. TOODLERS AND PRESCHOOLERS
a. Interact with parents before
talking to child
b. Position at child’s eye level
c. Allow children to touch objects
that will come in contact with
them
d. Use simple words and short
sentences
e. Communicate through
transition objects (e.g. dolls,
stuffed animals)
c. Be courteous, calm and open-
minded
d. Respect their privacy and views
e. Avoid judging or criticizing
f. Praise good points and tolerate
differences
g. Encourage expressions of ideas
and feelings
COMMUNICATION TECHNIQUES
 Therapeutic – the face to face process
of interaction that focuses on advancing
the physical and emotional well-being
of a patient
 Non-therapeutic – asking personal
questions that are not relevant to the
situation is not professional or
appropriate
BASIC HUMAN NEEDS
 Oxygen
 Water and fluids
 Food and nutrients
 Elimination of waste products
 Sleep and rest
 Activity and exercise
 Sexual gratification
 Temperature regulation
 Security and safety needs
 Freedom from harm
 hygiene

4. SCHOOL AGE CHILDREN

a. Avoid sudden advances, broad
smiles, staring, or other
threatening gestures
b. Talk to parent if child is initially
shy
c. Give opportunity to discuss
concerns without parents
present (allow to express
concerns/fears)
d. Be honest and let child know
what to expect (ex: how
equipment work)
e. Use variety of techniques such
as drawing or play

5. ADOLESCENTS
a. Give undivided attention
b. Listen