Health, Wellness, Well- being and
Illness
Concepts of Health, wellness,
well-being
 Many definitions and
interpretations
 Be familiar with common
aspects of concepts
 Consider how to
individualize with specific
clients
Health
 Presence or absence of
disease
 Complete physical, mental,
and social well–being
 Ability to maintain normal
roles
 Developmental and
behavioral potential is
realized to the fullest
extent possible
 Striving toward optimal
functioning
 Ongoing process
 Personal perception
Wellness and well-being
WELLNESS
 State of well–being
 A dynamic, growing
process
 Daily decision–making
regarding nutrition, stress
management, physical
fitness, preventive health
care, and emotional health
 The whole being of the
individual
basic components
11Environmental
 Ability to promote health
measure that improves
▪ Standard of living
▪ Quality of life
 Influences such as food,
water, and air
Social
 Interact successfully
 Develop and maintain
intimacy
 Develop respect and
tolerance for others
Emotional
 Ability to manage stress
 Ability to express
emotions
Physical
 Carry out daily task
 Achieve Fitness
 Maintain nutrition
 Avoid abusing substances
 Practice positive lifestyle
habits

Spiritual
 Belief in some force that
gives life meaning and
purpose
 Person’s own morals,
values, and ethics
Intellectual
 Ability to learn
 Ability to use information
effectively
 Showing for contributed
growth
 Learning to deal with new
challenges
Occupational
 Ability to achieve balance
between work and leisure
WELL-BEING
 Subjective perception of
vitality and feeling well
 Can be described
objectively, experienced,
measured
 Can be plotted on a
continuum
Model of Health and Wellness
CLINICAL MODEL
 Provides the narrowest
interpretation of health
 People viewed as
physiologic systems
 health identified by the
absence of disease or
injury
 state of not being “sick”
 opposite of health
▪ Disease or injury
ROLE PERFORMANCE
MODEL
 Able to fulfill societal roles
 Viewed as healthy even if
clinically ill, if still able to
fulfill roles
 Sickness
▪ Inability to perform
one’s role
ADAPTIVE MODEL
 Creative Process
 Disease
▪ A failure in
adaptation or
maladaptation
 Extreme good health
▪ Flexible adaptation
to the environment
 Focus is stability, with the
ability to grow and change.
AGENT – HOST –
ENVIRONMENT MODEL
 Each factor constantly
interacts with the others.
 When in balance, health is
maintained.
  When not in balance,
disease occurs.
HEALTH – ILLNESS
CONTINUA
 Dunn’s high-level wellness
grid
 Illness – wellness
continuum
ENVIROME
AGENT HOST
 Measures a person’s
perceived level of wellness
 Health and illness/disease
opposite ends of a health
continuum
 Move back and forth
within this continuum day
by day
 How people perceive
themselves and how others
see them affects
placements.
Dunn’s high–level wellness
grid
 High–level wellness in a
favorable environment
 Emergent high–level
wellness in an unfavorable
environment
 Protected poor health in a
favorable environment
 Poor health in an
unfavorable environment.
Illness–wellness continuum
 Arrows pointing in
opposite directions and
jointed at a neutral point
 Some feel real concepts are
more complex than on a
continuum
Variables Influencing Health
Status, Beliefs, and Practices
 Internal and external
variables
 People can usually choose
between healthy or
unhealthy activities
 People have little or no
choice over genetic
makeup, age, sex, culture,
and sometimes geographic
environment
Health Belief Models
 Help determine whether an
individual is likely to
participate in disease
prevention and health
promotion activities
Health Care Adherence
Adherence
 The extent to which an
individual’s behavior
coincides with medical or
health advice
Upon recognizing
nonadherence
 Establish why the client is
not following the regimen
 Demonstrate caring
 Encourage health
behaviors through positive
reinforcement
 Use aids to reinforce
teaching
 Establish a therapeutic
relationship of freedom,
and mutual responsibility
with the client and support
persons
Illness and disease
Illness
 A highly personal state
 A person’s physical,
emotional, intellectual,
social, developmental, or
spiritual functioning is
diminished
 Not synonymous with
disease
 May or may not be related
to disease
 Only a person can say he
or she is ill.
Disease
 Alteration in body function
 Reduction of capacities or
shortening of normal life
span
 Etiology
▪ Causation of
disease
Acute illness
 Characterized by
symptoms of relatively
short duration
 Symptoms appear abruptly,
subside quickly
  May or may not require ▪ Obligation to try to
intervention by healthcare get well as quickly
professionals as possible
 Most people return to ▪ Obligation to seek
normal levels of wellness competent help

Chronic illness
 Usually, slow onset and Effects of Illness
lasts for 6 months or  Impact on the client
longer ▪ Behavioral and
 Often has periods of emotional changes
remission (symptoms ▪ Self–concept and
disappear) and body image
exacerbation changes
(symptoms reappear) ▪ Loss of autonomy
 Care includes
▪ Life changes
promoting
independence, a sense  Impact on the family
of control, and ▪ Depends on:
wellness.  Which
 The client must learn family
how to live with member is
physical limitations ill
and discomfort.  Seriousness
and length
Illness Behaviors of illness
 Cultural and
 Coping mechanism
social
 Parson’s 4 aspects of customs of
sick role family
▪ Right to not be held ▪ Role changes
responsible for ▪ Task reassignments
their conditions ▪ Increased demands
▪ Right to be excused on time
from certain social ▪ Stress due to
roles and tasks anxiety about
outcomes
 ▪ Conflict about
unaccustomed
Relationship of implementing to
responsibilities
other nursing process phases
▪ Financial problems
▪ Loneliness as a  The first three phases
result of separation (assessing, diagnosing,
or loss planning) provide a basis
▪ Change in social for nursing actions
customs performed
 Doing and documenting
IMPLEMENTING AND specific nursing activities
EVALUATION and resulting client
Nursing Process responses
 Results examined during
Action-oriented evaluating phase
Client-centered
Outcome directed Implementing—the fourth phase
of the nursing process. In this
phase the nurse implements the
Client and support persons are nursing interventions and
encouraged to participate as much documents the care provided.
as possible.
Implementing Skills
Implementing
• Cognitive (intellectual) skills
Doing and documenting the • Problem-solving
activities that are the specific • Decision making
nursing actions needed to carry • Critical thinking
out interventions • Creativity
Intellectual skills
• Verbal and nonverbal
Fifth standard of the ANA • Effectiveness depends
standards of practice largely on the ability to
communicate.
 Coordination of care • Therapeutic
 health teaching and communication necessary
promotion for caring, comforting,
 consultation
 advocating, referring,
counseling, and supporting
• Includes conveying
knowledge, attitudes,
feelings, interest
• Appreciation of the client's
values and lifestyle
Technical skills
• Purposeful "hands-on"
skills
• Often called tasks,
procedures, or
psychomotor skills
• Psychomotor
▪ Physical actions
that are controlled
by the mind, not by
reflexes
• Require knowledge and
often require manual
dexterity
Process of
Implementing
 Reassessing the client
 Determining nurse's need
for assistance
 Implementing nursing
interventions
 Supervising delegated care
 Documenting nursing
activities
1. Reassessing the client
 Reassess to make sure the
intervention is needed
 The client's condition may
have changed.
2. Determining nurse's need for
assistance
 Inability to implement the
nursing activity safely
 Assistance will reduce
stress on the client.
 Nurse tacks knowledge or
skills to implement a
particular nursing activity.
3. Implementing nursing
interventions
 Base actions on scientific
knowledge
 Clearly understand
interventions
 Adapt activities to
individual client
 Implement safe care
 Provide teaching, support,
and comfort
 Be holistic
 Respect the dignity of the
client and enhance self-
esteem
 Encourage active client
participation
4. Supervising delegated care
 Nurse responsible for
client's care
 Must validate and respond
to any adverse findings or
client responses
5. Documenting nursing
activities
 Record nursing
interventions and client
responses
 Do not record in advance
Evaluating
 Judgment and appraisal
 Planned, ongoing,
purposeful
 Determines dienes
progress, effectiveness of
care plan
 Continuous process
 Demonstrates nursing
responsibility and
accountability for their
actions
Evaluating—the final phase of the
nursing process. in this phase the
nurse determines the clients
progress toward goal achievement
and the effectiveness of the
nursing care plan. The plan may
be continued, modified, or
terminated.
Relationship of evaluating to other
nursing process phases
 Depends on the
effectiveness of the
preceding steps
 Assessment data must be
accurate and complete.
 Desired outcome must be
stated concretely in
behavioral terms to be
useful for evaluating
 Without
implementation/interventio
ns, there would be nothing
to evaluate.
 Evaluating and assessing
overlap.
Process of Evaluating
Client Responses
Collecting data
 Some may require
interpretation
Comparing data with desired
outcomes
 Conclusions
▪ Goal was met
▪ Goal was partially
met.
▪ Goal was not met.
Comparing data with desired
outcomes
 Evaluation statement
▪ Conclusion
▪ Supporting data
Relating nursing activities to Evaluating the Quality
outcomes
of Nursing Care
▪ Determine whether nursing
activities had any relation Quality improvement
to the outcome without
 The Joint Commission
assuming that the activity
Mission
was the cause or only
▪ "To continuously
factor in meeting a goal
improve the safety
and quality of care
provided to the
public the provision
of health care
accreditation and
related services that
Drawing conclusions about the support
problem status performance
improvement in
 The actual problem has healthcare
been resolved or the organizations".
potential problem's risk
factors no longer exist
 Potential problems are
being prevented but risk
factors still exist.
 The actual problem still
exists even though some
goals are being met
 When goals are partially
met or not met:
▪ Care plan may need
to be revised
▪ The client merely
needs more time to
▪ achieve previously
established goals
Grassroots of Nursing: Five Processes of
N-U-R-S-I-N-G- L-E-A-D-E-R-S Caring:
Florence Nightingale – first 1) Knowing
nursing scientist] theorist for her 2) Being with
work Notes on Nursing: What It 3) Doing for
Is. and What It Is Not (1860/1969)' 4) Enabling
5) Maintaining Belief
Clara Barton – organized the
American Red Cross Caring includes the
Lilian Wald – founder of Public
following factors:
Health Nursing. Providing presence - "eye
Henry Street Settlement and contact"'
Visiting Nurse Service
Comforting – “touch”
Lavinia Dock – Nursing leader,
protested for women's rights Listening – “attention”
Margaret Sanger – Nurse activist, Knowing the client –
founder of Planned Parenthood “uniqueness”
Common Themes in the Definition
Spiritual caring –
of Nursing
“transpersonally”
 Nursing is caring.
 Nursing is an art. Family care – “participants”
("SKILLS")
Is Nursing a vocation or a
 Nursing is a science.
profession?
("THEORIES")
 Nursing is client-centered. Characteristics of a
Nursing is holistic. Profession
 Nursing is adaptive.
 Nursing is a helping 1. Education
profession. 2. Theory
 Nursing is concerned with 3. Service
health promotion, disease 4. Autonomy
prevention, and health 5. Code of Ethics
restoration. 6. Caring – the most unique
characteristic of nursing
Nursing as a caring profession

"The Nurse is basically a good
person".
Four virtues from the
Practice of Charity
Definition of Terms
MAN – is a biopsychosocial and
spiritual being who is in constant
contact with the environment.
(Roy)

1. Justice – being righteous LEVELS OF CLIENTELE

2. Prudence – cautious I. Individuals
3. Fortitude – support II. Families
4. Temperance – sacrifice III. Social Group
Nursing Care Delivery Models IV. Communities

total Patient Care – RN is HEALTH – a complete state of

responsible for all aspects of care
to one or more clients.
Functional Nursing – Division of
tasks, one nurse assumes a
responsibility apart from others'
task.
physical, mental, emotional and
social being of a person and not
just merely the absence of disease
or infirmity. (World Health
Organization, 1947)
A simple paradigm

Team Nursing - RN is the leader MAN NURSING PROCESS

together with nursing assistants HEALTH
and health aides.
Primary Nursing – To develop
BEDSIDE NURSING and
improve professional relationships INDIVIDUALS ADPIE END
b/n staff. GOAL

Case management – Coordinates FAMILIES

and links health care services to SOCIAL GROUPS
clients and their families
COMMUNITIES
 1. Primary – health
promotion and protection
2. Secondary – early
detection, diagnosis,
screening
3. Tertiary – rehabilitation
and adaptation

Identify the following according to

Maslow's Hierarch of Needs:
1. Self-respect
2. The need to be fulfilled
3. Rest and sleep
4. Elimination
5. The need for shelter
6. The need to care and be
cared for
7. Self-worth
8. Psychological safety
9. Oxygen
10. Spiritual fulfillment
According to Duration or Onset
1. Acute Illness – short
duration
2. Chronic Illness – longer
than 6 months
*Remission –
asymptomatic but with dse.
*Exacerbation becomes
active again with
pronounced s/sx

Three level of prevention