Health , Wellness, And Illness

Liezel A. CastilloLiezel A. Castillo 11

Health, wellness and Health, wellness and health promotion health promotion

By: By: JULIE C. YU-SANTOS, M.D.JULIE C. YU-SANTOS, M.D.


HealthHealth WHOWHO

““state of complete physical, mental and social well-being not state of complete physical, mental and social well-being not merely the absence of disease or infirmity”merely the absence of disease or infirmity”

Nightingale Nightingale

““state of being well and nursing every power the individual state of being well and nursing every power the individual possesses to the full extent”possesses to the full extent”

American Nurses AssociationAmerican Nurses Association - “A dynamic state of being in which the - “A dynamic state of being in which the

developmental developmental and behavioral potentials of an and behavioral potentials of an individual, is realized individual, is realized in the fullest extent in the fullest extent possible.”possible.”

- striving toward optimal functioning- striving toward optimal functioning


DiseaseDisease “ “ abnormal vital function involving any structure, part, or abnormal vital function involving any structure, part, or

system of an organism”system of an organism” “ specific illness or disorder characterized by a “ specific illness or disorder characterized by a recognizable set of manifestations, attributable to heredity, recognizable set of manifestations, attributable to heredity, infection, diet, or environment”infection, diet, or environment”


What is your definition of Health?What is your definition of Health?

a.a. Being free of symptoms of disease and Being free of symptoms of disease and pain as much as possiblepain as much as possible

b.b. Being able to be active and to do what Being able to be active and to do what you want or mustyou want or must

c.c. Being in good spirits most of the timeBeing in good spirits most of the time


Wellness ,and well-being Wellness ,and well-being WellnessWellness - state of well- state of well

beingbeing

Well-beingWell-being - (Hood and Leddy 2002) - (Hood and Leddy 2002) - - component of health component of health - subjective perception of - subjective perception of vitality and feeling well vitality and feeling well …described objectively, …described objectively, experienced and experienced and measured …plotted on a measured …plotted on a continuum continuum


7 Components of Wellness 7 Components of Wellness (Anspaugh, (Anspaugh, Hamrick, Rosato)Hamrick, Rosato)

**To realize optimal health **To realize optimal health and wellness, deal with and wellness, deal with the factors within each the factors within each component.component.

Physical Physical – positive – positive lifestyle habitslifestyle habits

SocialSocial – interaction, – interaction, respect, tolerancerespect, tolerance

EmotionalEmotional – stress – stress managementmanagement


7 Components of Wellness7 Components of Wellness

IntellectualIntellectual – growth and – growth and learninglearning

SpiritualSpiritual – morals, values, – morals, values, ethicsethics

OccupationalOccupational – balance in – balance in work work and leisureand leisure

EnvironmentalEnvironmental (food, water, (food, water, air) – standard of livingair) – standard of living


Model of health and illnessModel of health and illness Model > is a theoretical way of Model > is a theoretical way of

understanding a concept or ideaunderstanding a concept or idea

>Assist health professionals to meet health and wellness needs of

individuals

* Nurses’ broad definition of health increases scope of nursing practice

* People’s health beliefs influence

their health practices


Models:Models:

1. 1. smith model of healthsmith model of health – discuss 4 model of health – discuss 4 model of health

a. a. clinical modelclinical model – presence of sign and symptoms – presence of sign and symptoms

of diseaseof disease

- narrowest interpretation of health- narrowest interpretation of health

use mainly by medical practitioneruse mainly by medical practitioner

b. b. role performance modelrole performance model –health is defined in –health is defined in terms terms individual ability to fulfill societal individual ability to fulfill societal role role

cc. adaptive role-. adaptive role- adaptation to environment adaptation to environment

d. d. eudaemonistic model-eudaemonistic model- most comprehensive model most comprehensive model

health views as condition of health views as condition of actualization or realization of a actualization or realization of a

person potential person potential

- highest aspiration is fulfillment- highest aspiration is fulfillment


2. 2. agent-host –environment modelagent-host –environment model( leavell and ( leavell and clark’s)clark’s)

> also called > also called ecologic agentecologic agent ,used in ,used in predicting illness rather than predicting illness rather than

promoting promoting wellnesswellness has 3 dynamic interactive elements: has 3 dynamic interactive elements:

1. agents- stressors/environment factors that 1. agents- stressors/environment factors that by it presence or absence can lead to by it presence or absence can lead to

illness or disease illness or disease

2. host –who may or may not be at risk of 2. host –who may or may not be at risk of acquiring the diseaseacquiring the disease

3. environment –external to the host 3. environment –external to the host


Agent-host-environment modelAgent-host-environment model

environment

agent host


3. Health illness continua :used of grid cylinder3. Health illness continua :used of grid cylinder

a) a) Dunn’s high level wellness gridDunn’s high level wellness grid –– described a health described a health

axis and environment axis intersectaxis and environment axis intersect 1) 1) high-level wellness in favorable environmenthigh-level wellness in favorable environment

ex. Person who implement healthy lifestyle ex. Person who implement healthy lifestyle and has complete resources to support and has complete resources to support his lifestyle his lifestyle 2) 2) emergent-high level wellness in unfavorableemergent-high level wellness in unfavorable environment- ex. Person who has knowledge environment- ex. Person who has knowledge

to implement healthy lifestyle but does to implement healthy lifestyle but does not not implement adequate self-care bec. Of implement adequate self-care bec. Of some some family responsibility family responsibility


3) 3) protected poor health in favorable protected poor health in favorable environmentenvironment

ex. Ill person whose needs are met by the ex. Ill person whose needs are met by the health care system health care system

4) 4) poor health in an unfavorable poor health in an unfavorable environmentenvironment

ex. Young child who is starving in a drought ex. Young child who is starving in a drought stricken country stricken country


Very favorable environment

Very unfavorableenvironment

death peak wellness

High level wellness

Emergent high level wellness

Protected poor health

Poor health

environment

axis

health Axis


b) b) Travis-illness –wellness Travis-illness –wellness continuumcontinuum

> compose of 2 arrows pointing in > compose of 2 arrows pointing in opposite direction and joined at neutral point opposite direction and joined at neutral point

> movement to the left of neutral > movement to the left of neutral point indicate progressive decrease in state of point indicate progressive decrease in state of health health

>movement to the right of the >movement to the right of the neutral point indicates increasing level of health neutral point indicates increasing level of health


traditional treatment model > help only the individual move from traditional treatment model > help only the individual move from left to the neutral point left to the neutral point

Wellness model > help move individual beyond the neutral point Wellness model > help move individual beyond the neutral point to high level of wellness to high level of wellness

Disease symptoms sign awareness education growthHigh level wellness

Wellness model

Treatment model

Neutral point

No discernible illness or dse.


4. 4. Health belief model – based on motivation theory, Health belief model – based on motivation theory, has has 3 components3 components

a) a) individual perceptionindividual perception >include perceived >include perceived susceptibility, perceived threat susceptibility, perceived threat

and perceived seriousnessand perceived seriousness b) b) modifying factorsmodifying factors > include demographic > include demographic

variables variables sociopsychologic variables, sociopsychologic variables, structural ariables, cues to action structural ariables, cues to action

c) c) likelihood of actionlikelihood of action > depend on perceived > depend on perceived

benefits of action minus the benefits of action minus the perceived barriers to the action perceived barriers to the action


Individual perception modifying factors likelihood of actionIndividual perception modifying factors likelihood of action

Perceived threat of disease

Perceived susceptibilityTo diseasePerceived seriousness of disease

Demographic variables (age, raceSex, ethnicity)Sociopsychologic variables(peer pressure ,personality)Structural variables (knowledge about the disease)

Cues to action mass media campaignAdvice from othersIllness of family membersNewspaper or magazine articles

Likelihood of taking Recommended preventive Health action

Perceived benefits ofPreventive action minusPerceived barriers to Preventive action


Health locus of control modelHealth locus of control model Belief that health is under own or others’ Belief that health is under own or others’

controlcontrolINTERNALSINTERNALS – health is self determined – health is self determined

- take initiative in health - take initiative in health carecare

- knowledgeable about own - knowledgeable about own health health

- adhere to health care - adhere to health care regimensregimens

EXTERNALSEXTERNALS – health controlled by outside – health controlled by outside forcesforces


IInternal Variables nternal Variables

1. Biologic Dimension:1. Biologic Dimension:Genetic makeup – Genetic makeup – temperament, activity level, temperament, activity level,

intellectual level, susceptibility to intellectual level, susceptibility to specific diseasespecific disease

Sex - Sex - Male: Stomach Ulcers, Respiratory DiseasesMale: Stomach Ulcers, Respiratory Diseases Female: Rheumatoid Arthritis, Osteoporosis Female: Rheumatoid Arthritis, Osteoporosis

Age - Age - Arteriosclerosis common in middle ageArteriosclerosis common in middle age Whooping Cough and Measles are common Whooping Cough and Measles are common in children but rare in elders in children but rare in elders

Developmental Level - Developmental Level - Infants: lack physiologic Infants: lack physiologic and psychologic maturity; defenses are and psychologic maturity; defenses are lower lower


2. Psychologic Dimension:2. Psychologic Dimension:- - mind-body interactions and self mind-body interactions and self

concept affect health statusconcept affect health status

- Emotional responses affects - Emotional responses affects body function. body function.

Example:Example: A student who is extremely anxious A student who is extremely anxious

during exam may experience urinary during exam may experience urinary frequency and diarrheafrequency and diarrhea. .


3. Cognitive Dimension:3. Cognitive Dimension:Lifestyle choicesLifestyle choices – way of – way of living, behavior influenced by living, behavior influenced by sociocultural factors and sociocultural factors and personal characteristicspersonal characteristics

Example:Example: smoking, over smoking, over eating, lack of exercise, eating, lack of exercise, alcoholismalcoholism

Spiritual and religious beliefs Spiritual and religious beliefs Example:Example:Jehovah’s Witnesses oppose Jehovah’s Witnesses oppose blood transfusionblood transfusion


External variablesExternal variables

1. Environment1. Environment

Climate:Climate: Malaria - tropical countries Malaria - tropical countries

Pollution:Pollution: Air – Respiratory Air – Respiratory

Water – DiarrheaWater – Diarrhea

Noise – Hearing LossNoise – Hearing Loss

Pesticides and Chemical use: Pesticides and Chemical use: ingested by ingested by people; harmful to health people; harmful to health


Radiation: Radiation: Sun - Cancer of the skin Sun - Cancer of the skin (Caucasians)(Caucasians)

Chemicals - Asbestos – CancerChemicals - Asbestos – CancerAcid Rain – Sulfur Dioxide, Acid Rain – Sulfur Dioxide,

Nitrogen Nitrogen OxideOxideEmissions produced by Ore Emissions produced by Ore SmeltersSmelters

Green House Effect: Green House Effect: Entrapment of carbon Entrapment of carbon dioxide in the earth’s surface due to air dioxide in the earth’s surface due to air pollution leading to global warming.pollution leading to global warming.


2. Standards of Living2. Standards of Living- Related to Health, Morbidity and Mortality- Related to Health, Morbidity and Mortality- Hygiene, food habits and the propensity to seek - Hygiene, food habits and the propensity to seek health care advice and follow health regimens vary health care advice and follow health regimens vary among high income and low income groups.among high income and low income groups.

Low Income Families Low Income Families -- “if people can work, they are healthy”“if people can work, they are healthy”

-- fatalistic and believe that illness is not fatalistic and believe that illness is not preventable.preventable.


Poverty Stricken Areas Poverty Stricken Areas -- slum neighborhood - slum neighborhood -

overcrowding thus overcrowding thus poor sanitationpoor sanitation

Occupational Roles Occupational Roles -- Industrial Workers – Industrial Workers –

exposed to exposed to carcinogenic carcinogenic agentsagents- Affluent People – - Affluent People – predisposed to predisposed to stressful stressful social and social and occupational roleoccupational role


33. Family and Cultural Beliefs. Family and Cultural Beliefs- - Family passes on patterns of daily living and Family passes on patterns of daily living and lifestyle to offspring i.e. A man who was abused as a lifestyle to offspring i.e. A man who was abused as a child may physically abuse his small sonchild may physically abuse his small son- certain cultural practices affect perception of home - certain cultural practices affect perception of home remedies vsremedies vs medical practicesmedical practices

4. Social Support Networks4. Social Support Networks- - Support network of family, friends and confidant Support network of family, friends and confidant and job satisfaction helps people avoid illness.and job satisfaction helps people avoid illness.


Variables influencing Health Variables influencing Health Status, Beliefs and PracticesStatus, Beliefs and Practices

Health StatusHealth Status – i.e. anxiety, depression, or – i.e. anxiety, depression, or acute illness; pulse rate and temperatureacute illness; pulse rate and temperature

Health BeliefsHealth Beliefs – concepts about health that – concepts about health that an individual believes truean individual believes true

Health BehaviorsHealth Behaviors – actions people take to – actions people take to understand health state i.e. maintaining understand health state i.e. maintaining proper nutritionproper nutrition


HEALTH HEALTH BELIEFS/BEHAVIORSBELIEFS/BEHAVIORS

HealthHealth beliefsbeliefs > are person's ideas, convictions > are person's ideas, convictions and attitudes about health and and attitudes about health and illnessillness

> have positively or negatively > have positively or negatively effect client healtheffect client health

Health behaviorsHealth behaviors positive health behaviors:positive health behaviors:

1. immunization1. immunization2. proper sleep pattern2. proper sleep pattern3. adequate exercises3. adequate exercises

negative health behaviorsnegative health behaviors1. smoking1. smoking2. drug or alcohol abuse 2. drug or alcohol abuse 3. poor diet 3. poor diet


Health care adherenceHealth care adherenceAdherence – extent to which individual’s Adherence – extent to which individual’s

behavior coincides with medical or health behavior coincides with medical or health adviceadvice

Nursing Interventions to enhance Nursing Interventions to enhance adherence:adherence:

1.1. Ensure client is able to perform prescribed Ensure client is able to perform prescribed therapytherapy

2.2. Ensure client understands instructionsEnsure client understands instructions3.3. Ensures that client is a willing participant Ensures that client is a willing participant

in establishing goals of therapyin establishing goals of therapy4.4. Ensures that client values planned Ensures that client values planned

outcomes of behavioroutcomes of behavior changes changes


Nursing interventions in nonadherence:Nursing interventions in nonadherence:1.1. Establish why client is not following Establish why client is not following

regimenregimen2.2. Demonstrate caringDemonstrate caring3.3. Encourage healthy behavior through Encourage healthy behavior through

positive reinforcementpositive reinforcement4.4. Use aids to reinforce teachingUse aids to reinforce teaching5.5. Establish a therapeutic relationship of Establish a therapeutic relationship of

freedom, mutual understanding, and freedom, mutual understanding, and mutual responsibility with client and mutual responsibility with client and support personssupport persons


Health promotionHealth promotion Is any activity undertaken for the purpose of Is any activity undertaken for the purpose of

achieving a higher level of health and well beingachieving a higher level of health and well being Directed toward improving well being and Directed toward improving well being and

actualizing the health potential of individual , actualizing the health potential of individual , families, groups and communities.families, groups and communities.

3 level of prevention :3 level of prevention :1. 1. primary levelprimary level of prevention-generalizes of prevention-generalizes

health promotion and specific health promotion and specific protection against diseaseprotection against disease

2. 2. secondary secondary prevention- emphasizes early prevention- emphasizes early detection of disease, prompt detection of disease, prompt intervention including prevention intervention including prevention of complicationof complication


3. 3. tertiary preventiontertiary prevention –focus on client –focus on client rehabilitation and restore them rehabilitation and restore them to optimum levelto optimum level

Types of health promotion: Types of health promotion: 1. 1. information disseminationinformation dissemination –most basic type , –most basic type ,

raises the level of knowledge and raises the level of knowledge and awareness awareness of individual and group about health of individual and group about health habithabit2. 2. health appraisal/ wellness assessment-health appraisal/ wellness assessment- used to appraise the individual of the risk factors used to appraise the individual of the risk factors inherent in their life inherent in their life 3. lifestyle and behavior change program-3. lifestyle and behavior change program-

participation of individual and geared toward participation of individual and geared toward the enhancing quality of life and extending the enhancing quality of life and extending

the the lifespan lifespan 4. 4. worksite wellness program-worksite wellness program- program program enhancing enhancing quality of lifequality of life5. 5. environmental control programenvironmental control program


Nurses role in health promotionNurses role in health promotion::

1. 1. model healthy lifestyle behavior and attitudesmodel healthy lifestyle behavior and attitudes

2. facilitate client involvement in the assessment, 2. facilitate client involvement in the assessment, implementation , evaluation of health goal implementation , evaluation of health goal

3. teach client self-care strategies to enhance 3. teach client self-care strategies to enhance fitness, improve nutrition.fitness, improve nutrition.

4. assist individual, families, and communities to 4. assist individual, families, and communities to develop and choose health promoting option develop and choose health promoting option

5. teach client to be effective health care 5. teach client to be effective health care consumers consumers

6. guide the client’s development in effective 6. guide the client’s development in effective problem solving and decision making problem solving and decision making

7. reinforce the client personal and family health 7. reinforce the client personal and family health promoting behaviorspromoting behaviors

8. advocate in the community for changes that 8. advocate in the community for changes that promote a healthy environmentpromote a healthy environment


Illness and diseaseIllness and diseaseIllness - Illness -

- - highly personal state highly personal state

- physical, emotional, - physical, emotional, intellectual social, intellectual social, developmental or developmental or spiritual functioning is spiritual functioning is thought to be diminishedthought to be diminished- not the same with - not the same with disease and may or may disease and may or may not be related to diseasenot be related to disease- highly subjective; only - highly subjective; only the person can say she or the person can say she or he is illhe is ill


DiseaseDisease- alteration in body functions - alteration in body functions - results in reduction of capacities or a shortening of - results in reduction of capacities or a shortening of

normal life span.normal life span.

EtiologyEtiology - - cause of a certain disease; may or cause of a certain disease; may or may not be knownmay not be known


Classification of Disease or IllnessClassification of Disease or Illness

1.Acute 1.Acute - - severe symptoms of short duration.severe symptoms of short duration.

- Symptoms appear abruptly and subside quickly.- Symptoms appear abruptly and subside quickly.

- may or may not require intervention- may or may not require intervention- following illness, most people return to normal - following illness, most people return to normal level level of wellnessof wellness

2.Chronic2.Chronic- - lasts for an extended period; 6 months or longerlasts for an extended period; 6 months or longer

- slow onset and often has period of REMISSION - slow onset and often has period of REMISSION (symptoms disappear) and EXACERBATION (symptoms disappear) and EXACERBATION (symptoms reappear)(symptoms reappear)


Illness behaviorIllness behavior- - coping mechanismcoping mechanism

- ways in which individuals - ways in which individuals describe, monitor and interpret describe, monitor and interpret their symptoms, take remedial their symptoms, take remedial action, and use the health care action, and use the health care systemsystem


4 Aspects of the Sick Role4 Aspects of the Sick Role (Parsons 1979)(Parsons 1979)

1.Clients are not held 1.Clients are not held responsible for their responsible for their conditioncondition

2.Clients are excused from 2.Clients are excused from certain roles and taskscertain roles and tasks

3.Clients are obliged to try to 3.Clients are obliged to try to get well as quickly as get well as quickly as possiblepossible

4.Clients or their families are 4.Clients or their families are obliged to seek competent obliged to seek competent helphelp


3 distinct criteria to determine illness 3 distinct criteria to determine illness ((according to Baumanaccording to Bauman))

1. the presence of symptoms 1. the presence of symptoms

2. the perception of how they feel 2. the perception of how they feel

3. their ability to carry out daily 3. their ability to carry out daily activities activities


5 Stages of Illness5 Stages of IllnessSuchman (1979)Suchman (1979)

Stage 1 Symptom Stage 1 Symptom ExperiencesExperiences- physical experience of - physical experience of symptomssymptoms- cognitive aspect- cognitive aspect- emotional response- emotional response

* May consult others and * May consult others and try home remediestry home remedies


5 STAGES OF ILLNESS5 STAGES OF ILLNESS

Stage 2 Assumption Stage 2 Assumption of the Sick Roleof the Sick Role

- accepts sick role- accepts sick role- seeks confirmation - seeks confirmation from family and friendsfrom family and friends- continue with - continue with treatmenttreatment- excused from normal - excused from normal duties and expectationsduties and expectations- emotional responses - emotional responses commoncommon- sx persist, seek - sx persist, seek professional healthprofessional health


5 STAGES OF ILLNESS5 STAGES OF ILLNESSStage 3 Medical Care Stage 3 Medical Care

ContactContact- seek advice of health - seek advice of health professional to:professional to:

* validate real * validate real illnessillness

* explain illness * explain illness in understandable in understandable termsterms

* reassurance* reassurance- may accept or deny - may accept or deny diagnosisdiagnosis



Stage 4 Dependent Stage 4 Dependent Client RoleClient Role- after seeking - after seeking treatment, may be treatment, may be dependent on dependent on professionalprofessional- others try to - others try to maintain maintain independence as independence as soon as soon as possiblepossible



Stage 5 Recovery Stage 5 Recovery or Rehabilitationor Rehabilitation- resume former - resume former roles and roles and responsibilitiesresponsibilities- long term - long term responsibilities responsibilities and permanent and permanent disability disability necessitate necessitate adjustmentadjustment


Effects of IllnessEffects of Illness PrivacyPrivacy-described as comfortable feeling -described as comfortable feeling

reflecting a deserved degree of reflecting a deserved degree of social social retreat or freedom from authorized retreat or freedom from authorized

intrusionintrusion

Autonomy Autonomy –is the state of being independent –is the state of being independent and self-directed without outside control and self-directed without outside control

LifestyleLifestyle- a general way of living based on the - a general way of living based on the interplay between living condition in the interplay between living condition in the wide sense and individual pattern of wide sense and individual pattern of behavior as determined by sociocultural behavior as determined by sociocultural factors and personal characteristic factors and personal characteristic


ClientClient- behavioral, emotional changes, self - behavioral, emotional changes, self concept, body images, and lifestyle concept, body images, and lifestyle changeschanges

- privacy is usually affected- privacy is usually affected Nursing interventionNursing intervention::

1. explanations about adjustments1. explanations about adjustments2. arrangements to accommodate 2. arrangements to accommodate lifestylelifestyle3. encourage health professionals to 3. encourage health professionals to become aware of changes and give become aware of changes and give supportsupport4. reinforce desirable changes in 4. reinforce desirable changes in practicepractice


Family Family – – role changes, task role changes, task reassignments and increase reassignments and increase demand on time, increased demand on time, increased stress, financial problems, stress, financial problems, loneliness d/t separation and loneliness d/t separation and loss, change in social customsloss, change in social customs


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Health , Wellness, And Illness