Wellness, Health and

Illness
Ns. Heni Dwi Windarwati,
M.Kep.Sp.Kep.J

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 wellbeing 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" (Presidents
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

Wellness
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.:
ability to carry out daily tasks
achieve fitness
maintain nutrition and proper body fat
avoid abusing drugs, alcohol, or using tobacco products
generally to practice positive life-style habits

2.social, e.g.:
ability to interact successfully with people and within the
environment of which each person is a part
develop and maintain intimacy with significant others
develop respect and tolerance for those with different
opinions and beliefs

3. emotional, e.g.:
ability to manage stress and express emotions
appropriately
ability to recognize, accept, and express feelings
ability to accept ones limitations
4.intellectual, e.g.:
ability to learn and use information effectively for
personal, family, and career development
striving for continued growth and learning to deal
with new challenges effectively
5.spiritual, e.g.:
belief in some force (nature, science, religion, or a
"higher power") that serves to unite human beings
and provide meaning and purpose to life
includes a persons morals, values, and ethics

6. occupational
ability to achieve a balance between work and
leisure time
beliefs about education, employment and
home influence personal satisfaction and
relationships with others
7. environmental
ability to promote health measures that
promote the standard of living and quality of
life in the community
influences include:
Food
Water
air

MODELS OF HEALTH AND

ILLNESS

Smiths models
of health and illness

clinical model
narrowest interpretation; medically-oriented model
health is seen as freedom from disease
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 persons
most important role is their work role
health is seen as the ability to fulfill societal roles
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
health is seen as adaptation
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
health is actualization or realization of ones potential
illness is seen as the failure to actualize or realize ones
potential

Leavell and Clarks ecologic model (agent-hostenvironment model)

environme
nt

agent

Host

 used primarily in predicting illness rather than promoting

wellness

model is composed of three dynamic, interactive elements

the agent
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
living beings (e.g., human or animal) capable of being infected or
affected by the agent, e.g.:
Legionnaire at the Legionnaires Conference at the BellevueStratford Hotel in Philadelphia
environment
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 Philadelphi

 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

Dunns High-Level Wellness Grid

Protected poor Health

Very Favorable
Environment

High Level Wellness

Environment Axis
Death

Poor Health

Peak Welness

Health Axis
Very
Unfavorable
Emergent High level wellnes
Environment

 composed of two axiss

A health axes which ranges from peak
wellness to death
A environmental axes which ranges from
very favorable to very unfavorable

the two axiss form four quadrants

high-level wellness in a favorable environment
e.g., a person who implements healthy life- style behaviors and has
the biopsychosocialspiritual resources to support
this life-style
emergent high-level wellness in an unfavorable environment
e.g., 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
protected poor health in a favorable environment
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
poor health in an unfavorable environment
e.g., a young child who is starving in a drought ridden country

Travis Illness-Wellness Continuum

Premature

High-level

Treatment Model

Death Disability
SymptomsSigns

GrowthWellness
Education
Awareness

Neutral Point

 composed of two arrows pointing in opposite directions and

joined at a neutral point
movement to the right on the arrows (towards high- level
wellness) equals an increasing level of health and wellbeing
achieved in three steps:
Awareness
Education
growth
movement to the left on the arrows (towards premature
death) equates a progressively decreasing state of health
achieved in three steps:
Signs
Symptoms
disability

 most important is the direction the individual is facing on the

pathway
if towards high-level health, a person has a genuinely optimistic
or positive outlook despite his/her health status
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
if a treatment model is used, an individual can move right only to
the neutral point
e.g., a hypertensive client who only takes his medications
without making any other life- style changes
if a wellness model is used, an individual can move right past the
neutral point
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
Internals health is largely self
determined
Externals health is largely controlled
by outside forces

Rosenstock/Beckers Health-Belief Model

based on motivational theory

composed of three components:
an individuals perceptions, e.g.:
of perceived susceptibility
of perceived seriousness
perceived threat
modifying factors (factors that modify an individuals perceptions), e.g.:
.demographic variables
e.g., age, gender, race, ethnicity, etc.
sociopsychologic variables
e.g., personality, social class, peer and reference group pressure, etc.
structural variables
e.g., knowledge about the disease, prior contact with the disease, etc.
cues to action
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
perceived benefits of the action MINUS
perceived barriers to action EQUALS

Variables influencing health status, belief,

and practices
Variables influencing health status, belief, and practices
Internal Variables
Biologic
genetic makeup
Age
developmental level
race
gender
Psychologic or Emotional
Mind-body interaction
Cognitive or Intellectual
Cognitive abilities
Educational background
Past experiences

 Spiritual
Spiritual and religious beliefs and values

Environmental

Housing
Sanitation
Climate
Pollution of air, food, water

Sociocultural

Economic levels
Lifestyle
Family
Culture

Health Care Adherence

Adherence
Extent of which an individuals behavior
coincides with medical or health advice

 Factors influencing Adherence

Client motivation to become well
Degree of lifestyle change necessary
Perceived severity of the health care problem
Value placed on reducing the threat of illness
Difficulty in understanding and performing specific behaviors
Degree of inconvenience of the illness itself or of the regimens
Beliefs that the prescribed therapy or regimen will or will not
help
Complexity, Side effects, and duration of the proposed therapy
Specific Cultural heritage that may make adherence difficult
Degrees of satisfaction and quality and type of relationship with
the health care providers
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

Disease
pathologic change in the structure or function of the body or mind
Illness
the response a person has to a disease; it is an abnormal process in
which the persons level of functioning is changed compared with a
previous level
influenced by the following:
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
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
e.g., typically six months or longer
characterized by periods of remission and exacerbation
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 Change
Emotional Change
Physical Changes
Lifestyle Changes

 Impact on the Family

Factors:
Member of the family who is ill
The seriousness and length of the illness
Cultural and social customs the family follows
Changes in the family:
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
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 EuropeanAmericans and 68 years for African- Americans
eliminate health disparities among different segments of the
population
particularly African-Americans
currently, years of healthy life is 63 years for EuropeanAmericans and 62 years for Hispanics, and 56 years for
African-Americans

Focus areas of healthy people 2010

access to quality health services

arthritis, osteoporosis, and chronic back conditions
Cancer
chronic kidney disease
Diabetes
disability and secondary conditions
educational and community-based programs
environmental health
family planning
food safety
health communication
heart disease and stroke
HIV
immunzation and infectious disease

injury and violence prevention

maternal, infant, and child health
medical product safety
mental health and mental disorders
nutrition and oveweight
occupational safety and health
oral health
physical activity and fitness
public health infrastructure
respiratory diseases
sexually transmitted diseases
substance abuse
tocacco use
vision and hearing

Levels of Health Promotion

(Leavell and Clark)

Primary Prevention
Health promotion
Protection against specific health problems

Secondary Prevention
Early identification of health problems
Prompt intervention to alleviate health
problems

Tertiary Prevention
Restoration and rehabilitation

Types of health promotion programs

1.
2.
3.
4.
5.

Community Based
Hospital Based
Health-organization programs
School Health-promotion programs
Worksite programs for health
promotion

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
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
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
environmental control programs
health promotion programs developed in response to the
recent growth in the number of contaminants of human origin

The Nursing Process and Health Promotion

Assessment
1. Health History
2. Physical Examination
3. Physical Fitness Examination
4. Lifestyles assessment
5. Spiritual Health assessment
6. Social support System review
7. Health risk assessment
8. Health Beliefs review
9. Life stress review
10.Validating assessment data

 Diagnosis
Wellness diagnosis
Readiness for enhanced

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

 Implementation
Supporting
Counseling
Individual
Telephone

Facilitating
Teaching
Consulting
Enhancing behavior change
Modeling

Evaluation