CONCEPTS OF

HEALTH, WELLNESS
and
ILLNESS
The primary roles of the nurse as a care
giver are to promote health, to prevent
illness, to restore health and to facilitate
coping. These activities help maximize the
health of patients of all ages, in all settings,
and in both health and illness.
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 Importance of Studying Health,
Wellness and Illness

• To give holistic care, the nurse must understand and

respect each person’s individual definition of health
• Nurses must be familiar with models of health and
illness as guides or frameworks of her nursing care
activities.
• Nurses must be familiar with factors affecting health
and illness as these will have influence over the
patients’ health behavior and health practices.
• NURSES
-play major role in helping clients implement healthy
behaviors
-help clients monitor health, supply anticipatory
guidance & impart knowledge about health
-reduce barriers to action
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HEALTH
Traditional view of Health:
Health: defined in terms of disease (the state of people
who were not sick or dying)
WHO 1947
“Health is a state of complete, physical, mental & social
well being, and not merely the absence of disease or
infirmity”
Holistic view of Health:
• individual as a total person functioning physically,
psychologically, and socially “mental processes /
attitudes
• places health in the context of the environment
• equates health with productive & creative living
President Commission on Health needs of the Nation (US)
– 1953
“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” jdelarosa,rn
• Health is the ability to maintain homeostasis (Claude
Bernard)
• Health: highly individual perception
• Most people define & describe health as…
- being free from symptoms of disease & pain as
much as possible
- being able to be active & be able to do what they
want or must
- being in good spirits most of the time
• Health: ongoing process – a way of life
• NURSES: should be aware of their own definition of
health & should appreciate that other people have
their own individual definitions as well by
understanding client’s perception of health & illness;
nurses can provide more meaningful assistance to
help clients regain or attain a state of health.

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WELLNESS
• state of well-being, with balance of the 7 inter-related
components: Physical, Emotional, Intellectual,
Spiritual, Occupational, Social and Environmental
(Kozier)
• engaging in attitudes & behaviors that enhance quality
of life & maximize personal potential
• basic concept of wellness:
- self-responsibility
- ultimate goal
- dynamic growing process
- daily decisional making: areas of nutrition, stress
management, physical fitness, preventive health care,
emotional health and others
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• Anspaugh et al (1991) : 5 Dimensions of Wellness
1. Physical – ability to carry out daily tasks, achieve
fitness; practice positive lifestyle habits.

2. Social – ability to interact successfully with people

3. Emotional – ability to manage stress, express

emotions appropriately, ability to recognize, accept, &
express emotions & accepts one’s limitation

4. Intellectual – ability to learn & use information

effectively, striving for growth for continued growth &
learning, to deal with new challenges effectively

5. Spiritual – belief in some force (nature, science,

religion)
-serve to unite human being and provide meaning and
purpose to life
-include: morals, values, ethics
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WELL-BEING
• subjective perception of balance, harmony & vitality
(Leddy and Pepper, 1983)
• A subjective perception of vitality and feeling well, can
be described objectively, experienced and measured
and can be plotted in a continuum (Kozier)

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ILLNESS
• The response of the person to a disease, an abnormal
process in which the person’s level of functioning is
changed when compared to the previous level.
• highly personal state in which the person feels
unhealthy or ill
• may or may not be related to disease
• A condition causing harm or pain (Naidoo)
• A state of diminished physical, emotional, intellectual,
social, developmental or spiritual functioning (Kozier)
• A product of disharmonious interactions between
mind, body, emotions, spirit (Craven)
• The inability of the individual’s adaptive response to
maintain physical and emotional balance (Daniels)

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DISEASE
• an alteration in body functions resulting in a reduction
of capacities or shortening of the normal life span
(Kozier)
• derived from the word “desaise” which means
uneasiness or discomfort
• A medical term which means a pathologic change in
the structure or function of the body or mind

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 CAUSES OF DISEASES
• Inherited genetic defects
• Developmental defects resulting form exposure to
such factors as virus or chemicals during pregnancy
• Biologic agents or toxins (viruses, bacteria,
rickettsia, fungi, protozoa, helminthes & toxins)
• Physical agents such as temperature, chemicals and
radiation, electricity
• Generalized tissue responses to injury or irritation
• Physiologic and emotional reactions to stress
• Excessive or insufficient productions of body
secretions like hormones, enzymes, etc.
• Chemical agents (alcohol, strong acids & bases,
drugs, heavy metals, industrial poisons)

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MODELS OF HEALTH
and ILLNESS

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 CLINICAL MODEL
• People viewed as physiologic systems with related
functions
• Health is identified by the absence of signs &
symptoms of disease or injury. It s a state of no being
sick
• Health: absence of signs and symptoms
• Disease: opposite of health
• Focus: Health is identified by absence of
manifestations and people are viewed as physiologic
system with related functions
• Limitation: Other factors are not considered such as
health beliefs, lifestyle

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 ROLE PERFORMANCE
MODEL
• individual ability to fulfill societal role (perform work)
• Health is defined in terms of individuals ability to
perform or fulfill societal roles
• Disease: inability to perform roles
• Focus: The person’s roles. In this model, an individual
who can fulfill his roles is healthy even if he appears
clinically ill

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 ADAPTIVE MODEL

• health is a creative process

• disease: failure in adaptation (maladaptation)
• Sister Calista Roy’s Adaptation model of nursing:
focus on stability with elements of growth & change
• Aim is to restore the ability to adapt or cope

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EUDAEMONISTIC MODEL
• Health: condition of actualization/realization of
person’s potential

• Highest aspiration of people: fulfillment & complete

development

• Illness: condition that prevents actualization

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 LEAVELL and CLARK’S
AGENT-HOST ENVIRONMENT MODEL
(ECOLOGIC MODEL)
• used primarily in predicting illness rather than in
promoting wellness
• Health is seen as the balanced interaction of the
agent, host and environment
• Disease is an imbalance of the 3 factors
• Focus: Views health via the three interactive
elements
• 3 Dynamic Interactive Elements
– Agent: any factor or stressor that by its presence
or absence can lead to illness
– Host: the person who may or may not be at risk
of acquiring the disease
– Environment: All factors external to the host that
may or may not predispose the person to the
development of the disease.
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 ENVIRONMENT

AGENT HOST

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 TRAVIS’S
ILLNESS-WELLNESS
CONTINUUM
• This is a model with two opposite arrows with a
neutral point.
• Wellness is achieved in 3 steps: Awareness,
Education and Growth
• This model compares traditional treatment with
wellness model
• What matters most is not the point on the
continuum the person might be identified BUT the
DIRECTION on the pathway in which the person is
facing
• Wellness interventions can be initiated at any point
of the continuum: Assess life stressors, emotional
disturbance, non-pharmacologic approach and
support groups
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jdelarosa,rn
 ROSENSTOCK’S
HEALTH BELIEF MODEL
• This is based on motivational theory and assumes that good
health is an objective common to all people
• Describes the relationship between a person’s belief and
behavior
• Components:
– Individual perceptions
– Perceived susceptibility
– Perceived seriousness
– Perceived threat
– Modifying Factors
– Demographic variables
– Sociopsychologic variables
– Structural variables
– Cues to action
– Likelihood of Action
– Perceived benefits of the preventive action
– Perceived barriers to preventive action
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 Modifying Factors Likelihood of Action
Demographic variables
(age, sex, race, ethnicity, etc) Perceived benefits
Sociopsychologic variables of preventive
(personality, social class, peer action
Individual
and reference group pressure) -minus-
Perception
Structural Variables Perceived barrier
(knowledge about disease, prior to preventive
Perceived contact with disease) action
susceptibility to
disease X Likelihood of
Perceived Perceived threat of disease X
taking
seriousness recommended
(severity) of preventive health
diseases Cues to action action
Mass media campaigns
Advise from others
Reminder postcard from physician
or dentist
Illness of family member or friend
Newspaper or magazine article
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DIMENSIONS OF WELLNESS

physical

environmental social

wellness
occupational emotional

spiritual intellectual

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 VARIABLES
INFLUENCING
HEALTH STATUS,
BELIEFS &
PRACTICES

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• Health Status
-state of health of a person at a given time

• Health Beliefs
-concepts about health than an individual
believes true

• Health Behavior
-actions people take to understand their health
state, maintain an optimal state of health prevent
illness & injury, & reach their maximum physical
& mental potential (exercising, avoidance of
smoking)

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Internal Factors/Variables
• Biologic Dimension- non-modifiable
– Genetic makeup
– Race
– Sex
– Age & developmental level
• Psychologic Dimension
– Mind-body interactions
– Self-concept
– Job satisfaction
• Cognitive Dimension
– Life-style choices
– Spiritual & religious beliefs

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External Factors/Variables
• Geography – climate
• Environment- pollution, radiation
• Standards of living- occupation, income and
education
• Family & cultural beliefs- culture and social
interactions
• Social support networks- family and friends

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ILLNESS and
DISEASE

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Classification of Illness and Disease
Acute Illness
• Illness of rapid onset and short duration, intense
manifestations
• Characterized by severe symptoms of relatively
short duration. The symptoms often appear abruptly
& subside quickly
• Depending on the cause: may or may not require
intervention by health care professional. Some are
serious (surgical intervention), some mild (subside
w/o medical intervention or by OTC drugs)

Chronic Illness
• Illness of subtle onset and extended period of more
than 6 months
• lasts for extended period of time (6 months or
longer)
• slow onset often with periods of remission &
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 FACTORS CAUSING ILLNESS
• Predisposing Factors
- Conditions characterized by a previous tendency or
susceptibility
- Family history is an example

• Contributory Factors
- Conditions that help bring about the disease
- Examples are lifestyle behaviors, smoking and
obesity

• Precipitating Factors
- Conditions that hasten a result of the disease
- Example is a stressful event

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• Risk factor

- Is any situation, habit, social or environmental

condition, physiological or psychological condition,
developmental or intellectual condition or spiritual or
other variable that increases the vulnerability of an
individual or group to an illness or accident

- The presence of risk factors does not mean that a

disease will develop, but risk factors increase the
chances that the individual will experience a particular
dysfunction.

- Risk factors of a disease include: genetic,

physiological factors, age, environment and lifestyle

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4 Aspects of Sick Role
• Clients not held responsible for their condition
• Clients are excused from certain social roles & tasks
• Clients are obliged to try to get well as quickly as
possible
• Clients or their families are obliged to seek competent
help

Illness Behaviors
• any activity undertaken by a person who feels it
• Involves ways individuals describe, monitor and
interrupt their symptoms, take remedial actions and
use their health care systems

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THE 5 STAGES OF ILLNESS
STAGE ONE : THE SYMPTOM EXPERIENCES

– The person comes to believe something is wrong

– There is the physical experience of symptoms,
interpretation of symptoms and an emotional
response
– Consultation with others, validation with spouse,
home remedies and self-management

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STAGE TWO: ASSUMPTION OF THE SICK ROLE

– The Person accepts the sick role and seeks

confirmation from significant others, delays
contact with health care professionals as long as
possible
– Self treatment is continued, patient is excused
from normal duties and role expectation

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STAGE THREE: MEDICAL CARE CONTACT

– Sick people seek the advice of a health

professional either personally or by the urging of
the significant others
– Purposes of medical care contact are validation of
real illness, explanation of the symptoms in
understandable terms and reassurance that they
will be alright

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STAGE FOUR: DEPENDENT CLIENT ROLE

– Client becomes dependent on the professional for

help. Most people accept their dependence

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STAGE FIVE: RECOVERY OR REHABILITATION

– Client relinquishes the dependent role and

resumes former roles
– Restoration of functioning to maximal self-
sufficiency

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• 3 Distinct Criteria to determine if a person is ill
(Bauman 1965)
– presence of symptoms
– perception of how they feel
– ability to carry out daily activities

• IGUN’s 11 Stages of Illness or Health Seeking:

– Symptom experience
– Self-treatment or self-medication
– Communication to others
– Assessment of symptoms
– Sick role assumption
– Concern
– Efficacy of Treatment
– Selection of Treatment
– Treatment
– Assessment of effectiveness of treatment
– Recovery & rehabilitation
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Effects of Illness
1. Privacy affected
Privacy – comfortable feeling reflecting a deserved
degree of social retreat or as a freedom from
unauthorized intrusion
-dimensions & duration controlled by the individual
seeking privacy
-Boundaries – highly individualized (personalized state)
2. Autonomy affected
Autonomy – state of being independent & self-directed
without outside control
-individualized
3. Financial burden it places on clients & family

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4. Necessitates a change in life-style
Life-style – a general way of living based on the interplay
- between living conditions in the wide sense &
individual patterns of behavior as determined by
sociocultural factors & personal characteristics

NURSES can help clients adjust their life-style by:

– providing explanations about necessary
adjustments
– making arrangements wherever possible to
accommodate the client’s life-style
– encouraging other health professionals to become
aware of the person’s life-style practices & to
support healthy aspects of that life-style
– reinforcing desirable changes in practices with a
view to making them a permanent part of the
client’s life-style

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5. Affects also family / significant others
3 Factors that determines: kind of effect & its extent
– member of the family that is ill
– seriousness & length of illness
– cultural & social customs the family follows

Changes that occur in the family:

– role changes
– tasks reassignments & increased demands on
time
– increased stress due to anxiety about the
outcome of the illness for the client & conflict
about unaccustomed responsibilities
– financial problems
– loneliness as a result of separation & pending loss
– change in social customs
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• Effects on the client
– Behavioral and emotional changes like fear, anxiety
and withdrawal
– Body image disturbances
– Loss of autonomy
– Change in lifestyles

• Effects on the family

– Depends upon the member who is ill, the seriousness
and length of illness and the cultural customs
– Role changes and role reversal
– Task re-assignment and increased demands on time
– Increased stress due to anxiety
– Financial problems. Loneliness and change in social
customs

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TRENDS IN HEALTH
AND ILLNESS

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MORTALITY
** death rates – changes that occur
Eg: Reduction in Heart disease mortality secondary to:
• Increase detection & control of high BP
• Reduction in cigarette smoking
• Increasing awareness of the role of blood cholesterol
& dietary fats

Eg: Reduction of death from stroke secondary to:

• hypertension control & smoking cessation

Eg: Decline in unintentional injuries: traffic fatalities

secondary to
• increased used of seatbelts
• lower speed limits
• decline in alcohol use
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LONGEVITY
** average life expectancy
• Increased due to reduction of deaths from infectious
diseases
• Factors Responsible: introduction of the following:
– antibiotics & vaccines
– basic hygienic measures: water purification,
efficient sewage disposal, improved food hygiene
– improved conditions in home, workplace &
general environment
– increased food supplies – better nutrition,
increased resistance to infectious diseases

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MORBIDITY
• Include rates for incidence of
– acute conditions
– restricted activity, bed disability, & absence from
work (work loss) due to acute & chronic conditions
– limitations of activities due to chronic conditions

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 PROMOTING
HEALTH & WELLNESS

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Health Promotion
• any activity undertaken for the purpose of achieving a
higher level of health & well being directed toward
improving well-being and actualizing the health
potential if individuals, families, groups & communities
• Health promotion is more than the avoidance or
prevention of disease. It includes primary prevention
activities not directed to any specific disease
• Health promotion can be offered to all clients
regardless of their health and illness status
• Health promotion programs can be found in many
setting like clinics. Community agencies, etc.
• Health promotion topics for adults may include:
adequate sleep, nutrition, dental health, drug
management , exercise, health screening,
immunization, physical fitness, preventive health
services, safety precautions, smoking cessation, stress
management and weight control
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 Types of Health Promotion
Information dissemination- this is the most basic type of
health promotion program. This method uses a
variety of media to offer information to the public
about the risk of a particular lifestyle choices and
personal behavior as well as the benefits of changing
behavior and improving quality of life

Health appraisal & wellness assessment- are used to

appraise individuals of the risk factors inherent in
their lives in order to motivate them to reduce
specific risk factors and developed positive health
habits

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Worksite wellness programs- include programs that
address work quality standards for the office,
classroom or plant. Programs are aimed t specific
population, includes accident prevention and health
enhancement programs

Environmental control programs- developed in response

to the recent growth in the number of contaminants
of human origin that has been introduced in the air

Lifestyle and Behavioral changes – requires the

participation of the individual and are geared toward
enhancing the quality of life and extending the life
span.

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Nurse’s Role in Health Promotion

1. Model healthy life-style behaviors & attitudes

2. Facilitates client involvement in the assessment,

implementation,& evaluation of health goals

3. Teach clients self-care strategies to enhance fitness,

improve nutrition, manage stress, & enhance
relationships

4. Assist individuals, families, & communities to increase

their levels of health

5. Teach clients to be effective health care consumers

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6. Assist clients, families & communities to develop &
choose health promoting options

7. Guide the clients’ development in effective problem

solving & decision making

8. Reinforce the clients’ personal & family health

promoting behaviors

9. Advocate in the community for changes that

promote a health environment

10. As promoter of health: NURSES acts as advocate,

consultant, teacher and coordinator of services

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 LEVELS OF
PREVENTION

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Primary Preventive Care
• Is directed towards promoting health and
preventing the development of illness. Health risk
assessments are an important part of primary
preventive care. Nursing activities here may focus
on individuals, families and communities

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Secondary Preventive Care
• Focuses on early detection of disease, prompt
intervention and health maintenance for patients
experiencing health problems. The goal of
secondary prevention is to reverse or reduce the
severity of the disease or to provide cure, if
possible. Nursing activities at this level are
carrying out direct nursing actins (giving
medications, providing wound care, and
exercising muscles), assessing children for
normal growth and development and encouraging
regular medical and dental screenings and care.

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Tertiary Preventive Care
• Begins after an illness is diagnosed and treated to
reduce disability and to help rehabilitate patients
to a maximum level of functioning. Nursing
Activities on this level include teaching a patient
how to recognize and prevent complications,
using physical/occupational or other therapies,
and referring patients to community/support
groups.

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Level of preventive care Activities or topics
Primary prevention Diet
Exercise
Smoking cessation
Work safety
Immunization
Environmental sanitation
Safe sex practices
Family planning and good parenting

Secondary prevention Screenings : Blood pressure, cholesterol, glaucoma,

cancer
Pap smear
Mammography
Breast self exam
Testicular exams
Medical and dental check ups
Diagnostic exams
Nursing care in the hospital and clinics

Tertiary prevention Rehabilitation

Physical therapy
Occupational therapy
Job training
Referrals
Follow-up
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