Name: Cyrus Josher DC.

Mayoyo
Section: BSN 1-B
HEALTH, WELNESS, AND ILLNESS
Concepts of Health, Wellness, and Well-Being
Health, wellness, and well-being have many definitions and interpretations.
The nurse should be familiar with the most common aspects of the concepts
and consider how they may be individualized with specific clients.
Health

 Traditionally health was defined in terms of the presence or absence of

disease. Florence Nightingale defined health as a state of being well
and using every power the individual possesses to the fullest extent
(Nightingale, 1860/1969).
 Health as “a state of complete physical, mental, and social well-being,
and not merely the absence of disease or infirmity” (WHO, 1948).
 Health as the ability to maintain normal roles (Talcott Parsons, 1951)
 “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” (United States President’s Commission
on Health Needs of the Nation, 1953)
 Health and illness are human experiences. The presence of illness does
not preclude health, nor does optimal health preclude illness (American
Nurses Association, 2010).
Personal Definition of Health

 Being free from symptoms of disease and pain as much as possible

 Being able to be active and to do what they want or must
 Being in good spirits most of the time.
Wellness and Well-Being
Wellness is a state of well-being. Basic aspects of wellness include self-
responsibility; an ultimate goal; a dynamic, growing process; 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.

Seven Components of Wellness

  Environmental- The ability to promote health measures thatimprove
the standard of living and quality of life in the community. This
includes influences such as food, water, and air.
 Social- 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- 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- 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.
 Spiritual- The belief in some force (nature, science, religion, or a
higher power) that serves to unite human beings and provide meaning
and purpose to life. It includes a person’s own morals, values, and
ethics.
 Intellectual- 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- 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.
“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” (Hood, 2009).
Nurses need to clarify their understanding of health, wellness, and
well-being for the following reasons:
 Nurses’ definitions of health largely determine the scope and
nature of nursing practice.
 People’s health beliefs influence their health practices. A nurse’s
health values and practices may differ from those of a client.
Models of Health and Wellness
Models can be helpful in assisting health professionals to meet the
health
and wellness needs of individuals.
 1.) Clinical Model
The narrowest interpretation of health occurs in the 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.
2.) Role Performance Model
Health is defined in terms of the individual’s ability to fulfill
societal roles, that is, to perform his or her work. People usually fulfill
several roles (e.g., mother, daughter, friend), and certain individuals
may consider nonwork roles paramount in their lives. According to this
model, people who can fulfill their roles are healthy even if they have
clinical illness.
3.) 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.
4.) Eudaimonistic Model
The eudemonistic model incorporates a comprehensive view of
health. Health is seen as a condition of actualization or realization of a
person’s potential. Actualization is the apex of the fully developed
personality, described by Abraham Maslow
5.) 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, although
identification of risk factors that result from the interactions of agent,
host, and environment are helpful in promoting and maintaining
health.
Three Dynamic Interactive Elements
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.
6.) 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
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.
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
It was 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.

VARIABLES INFLUENCING HEALTH STATUS, BELIEFS, AND

PRACTICIES
INTERNAL VARIABLES
Internal variables include biologic, psychological, and cognitive
dimensions. They are often described as nonmodifiable variables because,
for the most part, they cannot be changed.
BIOLOGIC DIMENSION
 Genetic makeup influences biologic characteristics, innate
temperament, activity level, and intellectual potential.
 Sex influences the distribution of disease. Certain acquired and
genetic diseases are more common in one sex than in the other.
 Age is also a significant factor. The distribution of disease varies with
age.
 Developmental level has a major impact on health status.
PSYCHOLOGICAL DIMENSION
 Mind–body interactions can affect health status positively or
negatively.
 Self-concept- Self-perceptions are also associated with a person’s
definition of health.
COGNITIVE DIMENSION
 Lifestyle choices may have positive or negative effects on health.
 Spiritual and religious beliefs can significantly affect health
behavior.
EXTERNAL VARIABLES
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.
STANDARD OF LIVING
An individual’s standard of living (reflecting occupation, income, and
education) is related to health, morbidity, and mortality.
FAMILY AND CULTURAL BELIEFS
The family passes on patterns of daily living and lifestyles to offspring.
SOCIAL SUPORT NETWORKS
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.

HEALTH BELIEF MODELS

HEALTH LOCUS OF CONTROL MODEL
Locus of control (LOC) is a concept from social learning theory that
nurses can use to determine whether clients are likely to take action
regarding health, that is, whether clients believe that their health status is
under their own or others’ control.
ROSENSTOCK AND BECKER’S HEALTH BELIEF MODELS
Base on assumption that health related action depends on the
simultaneous occurrence of 3 factors: Sufficient motivation, belief that one is
vulnerable and belief that one is beneficial.
INDIVIDUAL PERCEPTIONS
 Perceived susceptibility
 Perceived seriousness
 Perceived threat
MODIFYING FACTORS
 Demographic variables
 Sociopsychological variables
 Structural Variables
 Cues to action
LIKELIHOOD OF ACTION
 Perceived benefits of the action
 Perceived barriers to action
HEALTH CARE ADHERANCE
Adherence is the extent to which an individual’s behavior.
When a nurse identifies nonadherence, it is important to take the following
steps:
 Establish why the client is not following the regimen.
 Demonstrate caring.
  Encourage healthy behaviors through positive reinforcement.
 Use aids to reinforce teaching.
 Establish a therapeutic relationship of freedom, mutual understanding,
and mutual responsibility with the client and support persons.
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.
 Disease can be described as an alteration in body functions resulting
in a reduction of capacities or a shortening of the normal life span.
 The causation of a disease or condition is called its etiology.
 Acute illness is typically characterized by symptoms of relatively
short duration.
 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.
ILLNESS BEHAVIORS
Illness behavior, a coping mechanism, involves ways individuals
describe, monitor, and interpret their symptoms, take remedial actions, and
use the health care system.
Parsons (1979) described four aspects of the sick role.
Rights:
1. Clients are not held responsible for their condition. Even if the illness was
partially caused by the person’s behavior (e.g., lung cancer from smoking),
the person is not capable of reversing the condition on their 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.
Obligations:
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 them recover.
4. Clients or their families are obliged to seek competent help. For example,
the ill person should contact their primary care provider rather than relying
solely on their own ideas of how to recover.
Details of Suchman’s five stages
Stage 1: Symptom Experiences
At this stage the person comes to believe something is wrong. Either
someone significant mentions that the person looks unwell, or the person
experiences some symptoms such as pain, rash, cough, fever, or bleeding.
Stage 1 has three aspects:
■ The physical experience of symptoms
■ The cognitive aspect (the interpretation of the symptoms in terms that
have some meaning to the person)
■ The emotional response (e.g., fear or anxiety).
Stage 2: Assumption of the Sick Role
The individual now accepts the sick role and seeks confirmation
from family and friends. During this stage people may be excused from
normal duties and role expectations.
Stage 3: Medical Care Contact
Sick people seek the advice of a health professional either on their own
initiative or at the urging of significant others. When people seek
professional advice they are really asking for three types of information:
-Validation of real illness
-Explanation of the symptoms in understandable terms
-Reassurance that they will be all right or prediction of what the outcome will
be.
Stage 4: Dependent Client Role
After accepting the illness and seeking treatment, the client becomes
dependent on the professional for help.
Stage 5: Recovery or Rehabilitation
During this stage the client is expected to relinquish the dependent role and
resume former roles and responsibilities.
EFFECTS OF ILLNESS
Illness brings about changes in both the involved individual and in the family.
Impact on the Client
Ill clients may experience behavioral and emotional changes, changes in self-
concept and body image, and lifestyle changes.
Nurses can help clients adjust their lifestyles by these means:
 Providing explanations about necessary adjustments
 Making arrangements wherever possible to accommodate the client’s
lifestyle
 Encouraging other health professionals to become aware of the
person’s lifestyle practices and to support healthy aspects of that
lifestyle
 Reinforcing desirable changes in practices with a view to making them
a permanent part of the client’s lifestyle.

Impact on the Family

A person’s illness affects not only the person who is ill but also the family or
significant others.
The changes that can occur in the family include the following:
 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
 Change in social customs.