HEALTH is defined by World Health Organization as a “state of complete

physical, mental, and social well-being, and not merely the absence of disease or
infirmity”.
The National Wellness Institute defines WELLNESS as a “conscious, self-
directed and evolving process of achieving full potential.” Wellness, like wellbeing, is
centered around mental health, but instead is focused on our individual journey to
happiness.

VARIOUS MODELS OF HEALTH AND WELLNESS

1. SMITH MODEL OF HEALTH

Smith (1981), in a seminal publication, presented four models of health consistent

with the interaction world view that ‘‘can be viewed as forming a scale—a progressive
expansion of the idea of health’’

1.1. CLINICAL MODEL

A. The narrowest interpretation of health occurs in the clinical model

B. People are viewed as physiological systems with related functions ,and
health is identified by the absence of signs and symptoms of disease or injury
C. To laypeople it is considered the state of not being sick
D. In this model the opposite of health is disease or injury. Many medical
practitioners use the clinical model in their focus on the relief of signs and symptoms
of disease and elimination of malfunction and pain

1.2. ROLE PERFORMANCE MODEL

A. Health is defined in terms of the individual's ability to fulfil social roles,

that is, to perform work.
B. According to this model, People who can fulfil their roles are healthy even if
they appear clinically ill.
C. It is assumed in this model that sickness is the inability to perform
one's work
 1.3. ADAPTIVE MODEL

A. The focus of the adaptive model is adaptation.

B. In the adaptive model, health is a creative process; disease is a failure
in adaptation, or maladaption.
C. The aim of treatment is to restore the ability of the person to adapt, that
is, to cope.
D. According to this model, extreme good health is flexible adaptation to the
environment and interaction with the environment to maximum advantage.

1.4. EUDEMONISTIC MODEL

A. Eudemonism is a system of ethics that evaluates actions in terms of their

capacity to produce happiness.
B. The eudemonistic model incorporates a comprehensive view of health.
C. In this model the highest aspiration of people is fulfillment and complete
development, which is actualization

2. LEAVELL AND CLARK AGENT-HOST-ENVIRONMENT MODEL (ECOLOGIC

MODEL)

A. The Agent – Host – Environment Model, developed by Leavell and Clark,

describes disease and illness as a function of the dynamic interactions and
interrelationships among the agent, the host and the environment. The
Agent – Host – Environment Model is helpful for getting a fuller
understanding of diseases and illnesses; however, it is not helpful in terms
of health and health promotion.

B. The model has three dynamic interactive elements:

1. AGENT: Any environmental factor or stressor (biological,

chemical, mechanical, physical or psycho-social) 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

3. DUNN’S HIGH LEVEL WELLNESS GRID

A. Dunn (1959) describes a health grid in which a health axis and an

environmental axis intersect.
B. The health axis extends from peak wellness to death, and the
environmental axis extends from very favorable to very unfavorable.
C. The intersection of the two axes forms four quadrants of health and
wellness:

1. High-level wellness in a favorable environment.

2. Emergent high-level wellness in an unfavorable
environment
3. Protected poor health in favorable environment
4. Poor health in an unfavorable environment

4. TRAVIS’ ILLNESS-WELLNESS CONTINUUM

A. The illness-wellness continuum developed by Travis ranges from high-level

wellness to premature death.
B. The model illustrates two arrows pointing in opposite directions and joined at
a neutral point.
C. This is achieved in three steps:
1. Awareness
2. Education
3. Growth
5. ROSENTOCK HEALTH BELIEF MODEL
The Health Belief Model is a theoretical model that can be used to guide health
promotion and disease prevention programs. It is used to explain and predict individual
changes in health behaviors. It is one of the most widely used models for
understanding health behaviors.
Key elements of the Health Belief Model focus on individual beliefs about health
conditions, which predict individual health-related behaviors. The model defines the
key factors that influence health behaviors as an individual's perceived threat to
sickness or disease (perceived susceptibility), belief of consequence (perceived
severity), potential positive benefits of action (perceived benefits), perceived barriers
to action, exposure to factors that prompt action (cues to action), and confidence in
ability to succeed (self-efficacy).

WELL-BEING is the experience of health, happiness, and prosperity. It includes

having good mental health, high life satisfaction, a sense of meaning or purpose, and
ability to manage stress. More generally, well-being is just feeling well.

FIVE DIMENSIONS OF WELL-BEING

1. PHYSICAL
- recognizes the need for regular physical activity
2. SOCIAL
- a sense of connectedness and belonging
3. EMOTIONAL
- an ability to cope effectively with life and build satisfying relationships with
others
4. INTELLECTUAL
- you recognize your unique talents to be creative and you seek out ways to
use your knowledge and skills
5. SPIRITUAL
- related to your values and beliefs that help you find meaning and purpose in
your life
VARIABLES INFLUENCING HEALTH STATUS, BELIEFS, AND PRACTICES
Many variables influence a person’s health status, beliefs, and behaviors or
practices. These factors may or may not be under conscious control. People can
usually control their health behaviors and can choose healthy or unhealthy activities.
In contrast, people have little or no choice over their genetic makeup, age, sex, culture,
and sometimes their geographic environment.

1. INTERNAL VARIABLES
Internal variables include biologic, psychological, and cognitive dimensions. They
are often described as non-modifiable variables because, for the most part, they
cannot be changed. However, when internal variables are linked to health problems,
the nurse must be even more diligent about working with the client to influence external
variables (such as exercise and diet) that may assist in health promotion and
prevention of illness. Regular health exams and appropriate screening for early
detection of health problems become even more important.

BIOLOGIC DIMENSION
Diseases more common in females include osteoporosis and autoimmune
disease such as rheumatoid arthritis. Those more common among males are
stomach ulcers, abdominal hernias, and respiratory diseases. Age is also a
significant factor; heart disease is common in middle-aged males but rare in
younger people.

PSYCHOLOGICAL DIMENSION
Psychological (emotional) factors influencing health include mind– body
interactions and self-concept. Relaxation, meditation, and biofeedback techniques
are gaining wider recognition. Alterations in the immune system are related to the
incidence of infections, cancer, and autoimmune diseases.
.
COGNITIVE DIMENSION
Cognitive or intellectual factors influencing health include lifestyle choices
and spiritual and religious beliefs. Lifestyle refers to a person's general way of living,
including living conditions and individual patterns of behavior. Practices that have
potentially negative effects on health are often referred to as risk factors.
 2. EXTERNAL VARIABLES
External variables affecting health include the physical environment, standards
of living, family and cultural beliefs, and social support networks.

ENVIRONMENT
Climate determines climate, and climate affects health. Pollution of the
water, air, and soil affects the health of cells. Some man-made substances in the
environment, such as asbestos, are considered carcinogenic (i.e., they cause
cancer). Tobacco is "hazardous to one's health," with rates of cancer higher among
smokers.

STANDARDS OF LIVING
An individual's standard of living is related to health, morbidity, and mortality.
Hygiene, food habits, and the ability to seek health care vary among high-income
and low-income groups. Low-income families must prioritize use of their finances,
often choosing food and housing over health care.

FAMILY AND CULTURAL BELIEFS

The family passes on patterns of daily living and lifestyles to offspring.
Culture and social interactions also influence how a person perceives, experiences,
copes with health and illness. People of certain cultures may perceive home
remedies or tribal health customs as superior to North American society's practices.

SOCIAL SUPPORT 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. People with inadequate support networks sometimes allow
themselves to become increasingly ill before confirming the illness and seeking
therapy. Support people also provide the motivation for an ill person to become well
again.

ILLNESS is suffering from something that makes one sick. Illnesses span
during a precise period of time, meaning they have a beginning and an end. In
layman’s terms, an illness is basically termed as an unwell or unhealthy state of mind
or body.
DISEASE falls under an entirely different classification. A disease is defined as
suffering from a malfunctioning organism or function within the body itself. A disease
is not something that can occur from an incidence, event, or from an external element
or behavior.
ACUTE illnesses generally develop suddenly and last a short time, often only
a few days or weeks. Acute conditions are often caused by a virus or infection, but can
also be caused by an injury resulting from a fall or an accident. Sometimes, an acute
illness, such as the common cold, will just go away on its own.
CHRONIC conditions are slower to develop, may progress over time, and may
have any number of warning signs. Common chronic conditions are arthritis,
Alzheimer's disease, diabetes, heart disease, high blood pressure, and chronic kidney
disease. Unlike acute conditions, chronic health conditions cannot be cured, only
controlled.

EXAMPLES OF ACUTE AND CHRONIC MEDICAL

CONDITIONS

Acute medical conditions Alzheimer's disease

Broken bone Arthritis
Burn Chronic Obstructive pulmonary disease
(COPD)
COVID-19
Depression
Common cold
Diabetes
Flu
Heart disease

ILLNESS BEHAVIOR refers to any actions or reactions of an individual who

feels unwell for the purpose of defining their state of health and obtaining physical or
emotional relief from perceived or actual illness.

STAGES OF ILLNESS BEHAVIOR

1. SYMPTOMS EXPERIENCE
- awareness of physical change
- pain rashes, lump, etc.
- this stage has three aspects:

1. physical experience of the symptoms

2. the cognitive aspect or the interpretation of the
symptoms in terms that have some meaning
3. the emotional response like fear or anxiety
 2. ASSUMPTION OF SICK ROLE
- accept sick role and seek information
- self treatment
- excuses
- emotional responses

3. MEDIAL CARE CONTACT

- seek professional advice
- accept or deny diagnosis
- follow the treatment plan

4. DEPENDENT CLIENT ROLE

- dependent for professional help
- accept and follow the prescribed treatment

5. RECOVERY AND REHABILITATION

- relinquish the patient role
- resume former roles and responsibilities
- acute illness (short term) -fast recovery
- chronic illness (long term) -difficult recovery

TALCOTT PARSON’S SICK ROLE THEORY

A way of explaining the particular rights and responsibilities of those who

are ill (Parsons, 1951)

1. DEVIANCE
- going against societal expectations, because an ill person has
different patterns of behavior than the norm.
-
2. POSITIVELY SANCTIONED
- approved by the community or authority figures
 3. LEGITIMIZATION
- a proof that the person is truly sick and in need of a more lenient set
of expectations

RIGHTS AND RESPONSIBILITIES OF AN ILL PERSON

FIRST RIGHT: A person has a right not to be blamed for his/her illness

SECOND RIGHT: A person has a right to be given some leeway by others

in regard to normal obligations

FIRST RESPONSIBILITY: A person has the responsibility to make getting

well a priority

SECOND RESPONSIBILITY: A person has the responsibility to seek

appropriate treatment for his or her condition

HOSPITALIZATION
- An important resource in an adult’s care, and it is part of the health
care network
- Hospitalizations, especially if repeated and prolonged, may produce
negative consequences to the patient’s health, such as decreased
functional disability and lower quality of life.

ADVANTAGES OF BEING HOSPITALIZED

Proper treatment for disease
Prevention of spread of disease
Promotion of health
Promotion of psychological help
Promotion of socialization
 EFFECTS OF HOSPITALIZATION
Normal patterns of behavior generally change with illness;
with hospitalization, the change can be even greater.

EFFECTS OF HOSPITALIZATION ON THE PATIENT

Loss of privacy
Altered autonomy
Altered lifestyle
Financial burden
Anxiety
Pain
Disturbance in body image
Disappointment
Restlessness
Irritability
Depression
Nosocomial infection

CARE OF SICK AND INJURED

- Adults become dependent on their caregivers either through injury,
illness, or because of a biological limitation.
- Sometimes, individuals are excluded from a full range of benefits.
- The attitude of the society towards the kind of illness is important.
- The family acts like the cushion and gives the front-line care for such
individuals.

IMPACT OF ILLNESS ON THE FAMILY

- When serious illness or disability strikes a person, the family as a
whole is affected by the disease process and by the entire health
care experience.
ROLE FUNCTIONING
- When a family member becomes ill, other family members must alter
their lifestyle and take on some of the role functions of the ill person,
which in turn affects their own normal role functioning.

ADDITIONAL STRAIN
- Illness may cause additional strain as a result of economic problems
and interruptions in career development.

EXTENT OF FAMILY DISRUPTION

- The extent of the family disruption depends on the seriousness of the
illness, the family’s level of functioning before the illness,
socioeconomic considerations, and the extent to which other family
members can absorb the role of the person who is ill.

LONG TERM ILLNESS

- Long-term illness, even in the most stable and supportive families,
brings changes in family relationships.

ROLE OF FAMILY IN HEALTH AND ILLNESS

- Maintaining of health supporting physical and psychosocial home
environment
- Providing adequate resources for maintenance of personal hygiene
- Providing adequate and wholesome food
- Making provisions for meeting spiritual health needs
- Recognizing developmental deviations and health disruptions
- Making decisions for seeking health care
- Dealing with health crisis situations
- Providing nursing care to sick, disabled, and dependent members
- Providing rehabilitation care
- Participating in community health and welfare activities

SIX STAGES TO UNDERSTAND THE FAMILY’S ROLE IN HEALTH CARE

1. Prevention
2. Diagnosis
3. Treatment
 4. Support
5. Recuperation
6. Recovery
7. Rehabilitation and Terminal Care

HEALTH PROMOTION is a behavioral social science that draws from the

biological, environmental, psychological, physical and medical sciences to promote
health and prevent disease, disability and premature death through education-driven
voluntary behavior change activities. It is the development of individual, group,
institutional, community and systemic strategies to improve health knowledge,
attitudes, skills and behavior. It also involves providing information to others which will
help to improve their Health and Well-Being.

FIVE MAIN APPROACHES TO HEALTH PROMOTION

1. MEDICAL APPROACH
The medical or preventive approach aims to reduce premature death by
targeting the whole population or groups who are at higher risk of developing
disease. This approach can operate at three levels (Naidoo and Wills, 2009):

1. Primary prevention – preventing the onset of disease

2. Secondary prevention – attempting to prevent disease progressing
3. Tertiary prevention level – seeking to mitigate harm in people who have already
developed disease

2. BEHAVIORAL APPROACH
The behavioral approach, also known as the behavior change approach,
makes the fundamental assumption that healthy lifestyles are crucial to
maintaining good health. Some behavior change attempts have been targeted
at the whole population.
Healthcare professionals who adopt the behavioral approach in their
practice seek to provide individual patients with information concerning their
unhealthy lifestyle behaviors and motivate them to change.
3. EDUCATIONAL APPROACH
The educational approach to health promotion assumes that increasing
people’s knowledge about their health will lead to healthier behaviour. Nurses
who adopt an educational approach provide people with knowledge and
information about their health.
The focus of the educational approach is on learning and comprises
three aspects (Bloom et al.,1956).

1. Cognitive - addresses people’s understanding concerning a health

topic.
2. Affective - considers an individual’s feelings and attitudes towards a
health topic.
3. Behavioral - concerned with people’s skills, for example, their ability to
cook.

4. EMPOWERMENT APPROACH
Within the context of health promotion, empowerment can be
understood as “a process through which people gain greater control over
decisions and actions affecting their health” (WHO, 1998, p. 6).
An empowerment approach seeks to enable individuals and social
groups to express their health-related needs and have greater involvement in
decision-making regarding their health. It can be used when working directly
with individual patients or whole communities.

5. SOCIAL CHANGE APPROACH

The social change approach focuses on making changes to the physical,
social and economic environment to increase their health promoting capacity.
This approach assumes that if the healthier choice is made the easier choice,
it will become increasingly realistic for individuals to make decisions to improve
their health and wellbeing.
Therefore, health promotion is therefore ‘a social and political process’
(Nutbeam, 1998, pp. 1-2), that regards health as a human right and considers
the maintenance of population health to be a prerequisite for social progress
TYPES OF HEALTH PROMOTION

Primary Health Promotion- Primary health promotion means preventing ill

health occurring at all
Secondary Health Promotion- Secondary health promotion involves detecting
illness in early stages through screening or medical examination and giving treatment
to correct any abnormality
Tertiary Health Promotion- Tertiary health promotion involves preventing an
existing condition from worsening

WHY IS HEALTH PROMOTION IMPORTANT?

1. Health promotion improves the health status of individuals, families,
communities, states, and the nation.
2. Health promotion enhances the quality of life for all people.
3. Health promotion reduces premature deaths.
4. By focusing on prevention, health promotion reduces the costs (both
financial and human) that individuals, employers, families, insurance
companies, medical facilities, communities, the state and the nation would
spend on medical treatment.

VARIOUS TYPES OF HEALTH PROMOTION PROGRAM

1. INFORMATION DISSEMINATION
Use of variety of media to offer information to the public about the particular
lifestyle choices and personal behavior, the benefits of changing that behavior and
improving the quality of life

2. HEALTH APPRAISAL AND WELLNESS ASSESSMENT PROGRAMS

Appraise individuals of their rise factors that are inherent in their lives in
order to motivate them to reduce specific risk and develop positive health habits.
Wellness assessment programs are focused on more positive methods of
enhancement.
 3. LIFESTYLE AND BEHAVIOR CHANGE PROGRAMS
Basis for changing health behavior. Geared toward enhancing the quality of
life and extending the life span.

4. WORKSITE WELLNESS PROGRAMS

Include programs that serve the needs of persons in their workplace.

5. ENVIRONMENT CONTROL PROGRAMS

Developed to address the growing problem of environment pollution- air,
land, water, etc.

NURSES ROLE IN HEALTH PROMOTION PROGRAM

1. Model health lifestyle behaviors and attitudes

2. Facilitate client involvement in the assessment, implementation, and
evaluation health goals
3. Teach clients self-care strategies to enhance fitness, improve nutrition,
manage stress, and enhance relationships
4. Assist individuals, families, and communities to increase their levels of health
5. Educate clients to be effective health care consumers
6. Assist clients, families, and communities to develop and choose health-
promoting options
7. Guide clients’ development in effective problem solving and decision making
8. Reinforce client’s personal and family health-promoting behaviors
9. Advocate in the community for changes that promote a healthy environment

STEPS IN PLANNING HEALTH PROMOTION

1. Manage the planning process

2. Identify goals, population of interest, outcomes, and outcome objectives
3. Conduct situational assessment
4. Identify strategies, activities, outputs, process objectives, and resources
5. Review the program plan
6. Develop indicators
NURSING PROCESS AND HEALTH PRMOTION

1. ASSESSMENT
- Involves critical thinking skills; subjective or objective
- Has eight (8) components, namely:

health history and physical examination

physical fitness assessment
lifestyle assessment
spiritual health assessment
social support systems review
health risk assessment
health beliefs review, and
life-stress review

GOALS OF LIFESTYLE ASSESSMENT

1. An opportunity for clients to assess the impact of their present lifestyle on

their health
2. A basis for decisions related to desired behavior and lifestyle changes

QUESTIONS TO ASK IN SOCIAL SUPPORT SYSTEM REVIEW

1. List of individuals who provide personal support

2. Indicate the relationship of each person
3. Identify which individuals have been a source of support for five (5) or more
years

THINGS TO CONSIDER IN VALIDATING ASSESSMENT DATA

1. Spirituality
2. Sources of life stress and ability to handle stress
3. Social support systems
4. Information needed to enhance health care practices
2.5.DIAGNOSING
Client strengths
 Describes human responses to levels of wellness in an individual, family,
or community that have a readiness for enhancement “ - NANDA in wellness
diagnosing
Wellness diagnosis examples:

Readiness for Enhanced Spiritual Well-Being

Readiness for Enhanced Coping
Readiness for Enhanced Nutrition
Readiness for Enhanced Knowledge
Readiness for Enhanced Parenting
Readiness for Enhanced Self-Concept
Readiness for Enhanced Immunization Status
Readiness for Enhanced Self-Health Management

3. PLANNING

STEPS IN PLANNING:
Review and summarize data from assessment
Reinforce strengths and competencies of the client
Identify health goals and related behavior-change options
Identify behavioral or health outcomes
Develop a behavior-change plan
Reiterate benefits of change
Address environmental and interpersonal facilitators and barriers to change
Determine a time frame for implementation
Formalize commitment to behavior-change plan
 4. EVALUATION
During evaluation, the client may decide to continue with the plan, reorder
priorities, change strategies, or revise the health promotion prevention contract.

NURSING STRATEGIES FOR ENHANCING BEHAVIOR CHANGE

1. Establish rapport
2. Set agenda
3. Assess importance, confidence, and readiness
4. Exchange information and reduce resistance

REFERENCES:
https://docs.google.com/presentation/d/1K7QWF4VzIYom4F0u6Et2D3W5_9Lqw0q1
/edit#slide=id.gfa8010906c_0_255