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Concept of Health and Wellness



 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

 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

1. 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
2. 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
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

1. 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
 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

2. Leavell and Clark’s ecologic model (agent-host-environment model)


Agent Host
 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
 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. Dunn’s High-Level Wellness Grid

Protected poor Health High Level Wellness
Very Favorable

Environment Axis

Death Peak Wellness

Health Axis

Poor Health Emergent High level wellness

Very Unfavorable
composed of two axis’s
1. a health axes which ranges from peak wellness to
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 life-
style behaviors and has the
biopsychosocialspiritual resources to support
this life-style
2. emergent high-level wellness in an unfavorable
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
4. poor health in an unfavorable environment
1. e.g., a young child who is starving in a drought
ridden country
b. Travis’ Illness-Wellness Continuum

Wellness Model
Premature High-level
Treatment Model
Death 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:
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 life-
style 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. based on motivational theory

b. 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
developmental level

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

Pollution of air, food, water

f. Sociocultural

Economic levels
Health Care 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. 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

 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 self-perceptions
o others’ perceptions
o the effects of changes in body structure and function
o the effects of those changes on roles and relationships
o cultural and spiritual values and beliefs


 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 e.g., typically less than six months

2. 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
o remission
 symptoms disappear
o 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
3. Clients are obliged to try to get well as quickly as
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


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-
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 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

1. 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