Wellness, Health and Illness

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

Concept of Health and Wellness

Health • Definition:

– State of being well and using every power the individual possesses – "Health is a state of complete physical, mental, and social well-

being and not merely the absence of disease" (WHO) – "Health is not a condition, it is an adjustment. It is not a state, but a

process. The process adapts the individual not only to our physical, but also our social, environments" (President’s Commission)

– most individuals define health as the following: • being free of symptoms of disease and pain as much as possible • being able to be active and able to do what they want or must do • being in good spirits most of the time

Wellness – an active process by which an individual

progresses towards maximum potential possible, regardless of current state of health

Components of Wellness

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

2.social, e.g.: – ability to interact successfully with people and within the

environment of which each person is a part – develop and maintain intimacy with significant others – develop respect and tolerance for those with different opinions and

beliefs

3. emotional, e.g.:– ability to manage stress and express emotions appropriately– ability to recognize, accept, and express feelings– ability to accept one’s limitations

4.intellectual, e.g.: – ability to learn and use information effectively for personal,

family, and career development – striving for continued growth and learning to deal with new

challenges effectively

5.spiritual, e.g.: – belief in some force (nature, science, religion, or a "higher

power") that serves to unite human beings and provide meaning and purpose to life

– includes a person’s morals, values, and ethics

6. occupational – ability to achieve a balance between work and leisure time – beliefs about education, employment and home influence

personal satisfaction and relationships with others

7. environmental – ability to promote health measures that promote the

standard of living and quality of life in the community • influences include: – Food–Water– air

MODELS OF HEALTH AND ILLNESS

Smith’s models of health and illness

• clinical model – narrowest interpretation; medically-oriented model • health is seen as freedom from disease • illness is seen as the presence of disease

• role performance model – ability to perform work, that is fulfill societal roles,

essentialto the model; assumption of the model is that a person’smost important role is their work role• health is seen as the ability to fulfill societal roles • illness is seen as the inability to fulfill societal roles

• adaptive model – ability to adapt to the environment and interact with it to

maximum advantage essential to the model • health is seen as adaptation • illness is seen as a failure of adaptation, or

maladaptation

• eudaemonistic model – most comprehensive, holistic, view of health; ability to

become self-actualized essential to the model • health is actualization or realization of one’s potential • illness is seen as the failure to actualize or realize one’s

potential

Leavell and Clark’s ecologic model (agent-host-environment model)

environment

Hostagent

• used primarily in predicting illness rather than promoting wellness

• model is composed of three dynamic, interactive elements – the agent

• factor (biologic, chemical, physical, mechanical,psychosocial) that must be present or absent for anillness to occur, e.g.:– presence of the legionella bacillus

– the host • living beings (e.g., human or animal) capable of being infected or

affected by the agent, e.g.: – Legionnaire at the Legionnaire’s Conference at the Bellevue-

Stratford Hotel in Philadelphia – environment

• everything external to the host that makes illness more or less likely, e.g.: – presence of stagnant water in the air conditioning system at the

Bellevue-Stratford Hotel in Philadelphi

• view of health and illness – health is seen when all three elements are in

balance – illness is seen when one, two, or all three

elements are not in balance

Health-illness continua

Dunn’s High-Level Wellness Grid

Very Favorable Environment

Peak Welness

Very Unfavorable Environment

Death

Protected poor Health High Level Wellness

Environment Axis

Poor Health Emergent High level wellness

Health Axis

• composed of two axis’s – A health axes which ranges from peak wellness to

death – A environmental axes which ranges from very

favorable to very unfavorable

• the two axis’s form four quadrants – high-level wellness in a favorable environment

• e.g., a person who implements healthy life- style behaviors and has the biopsychosocialspiritual resources to supportthis life-style

– emergent high-level wellness in an unfavorable environment • e.g., a woman who has the knowledge to implement healthy life-

style practices but does not implement adequate self-care practices because of family responsibilities, job demands, or other factors

– protected poor health in a favorable environment • e.g., an ill person whose needs are met by the health care system

and who has access toappropriate medications, diet, and health care instruction

– poor health in an unfavorable environment • e.g., a young child who is starving in a drought ridden country

Travis’ Illness-Wellness Continuum

Treatment ModelPremature

Death Disability Symptoms Signs Awareness EducationGrowth Wellness

High-level

Neutral Point

• composed of two arrows pointing in opposite directions and joined at a neutral point – movement to the right on the arrows (towards high- level

wellness) equals an increasing level of health and well-being • achieved in three steps:–Awareness– Education– growth

– movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health • achieved in three steps:– Signs– Symptoms– disability

• most important is the direction the individual is facing on the pathway – if towards high-level health, a person has a genuinely optimistic

or positive outlook despite his/her health status – if towards premature death, a person has a genuinely pessimistic

or negative outlook about his/her health status

• compares a treatment model with a wellness model – if a treatment model is used, an individual can move right only

to the neutral point • e.g., a hypertensive client who only takes his medications

without making any other life- style changes

– if a wellness model is used, an individual can move right past the neutral point • e.g., a hypertensive client who not only takes his

medications, but stops smoking, looses weight, starts an exercise program, etc

Locus of Control Model

• determine whether clients takes actions regarding health – Internals – health is largely self determined – Externals – health is largely controlled by outside

forces

Rosenstock/Becker’s Health-Belief Model• based on motivational theory • composed of three components:

– an individual’s perceptions, e.g.: • of perceived susceptibility • of perceived seriousness • perceived threat

– modifying factors (factors that modify an individual’s perceptions), e.g.: • .demographic variables

– e.g., age, gender, race, ethnicity, etc. • sociopsychologic variables

– e.g., personality, social class, peer and reference group pressure, etc. • structural variables

– e.g., knowledge about the disease, prior contact with the disease, etc. • cues to action

– e.g., mass media campaigns, advice from others, reminder postcard from a physician or dentist, illness of family member or friend, newspaper or magazine article

– likelihood of action • perceived benefits of the action MINUS • perceived barriers to action EQUALS

Variables influencing health status, belief, and practices

Variables influencing health status, belief, and practices • Internal Variables

– Biologic • genetic makeup• Age• developmental level

race • gender

– Psychologic or Emotional • Mind-body interaction

– Cognitive or Intellectual • Cognitive abilities• Educational background• Past experiences

– Spiritual • Spiritual and religious beliefs and values

– Environmental • Housing• Sanitation• Climate• Pollution of air, food, water

– Sociocultural • Economic levels• Lifestyle• Family• Culture

Health Care Adherence

• Adherence – Extent of which an individual’s behavior coincides

with medical or health advice

• Factors influencing Adherence – Client motivation to become well– Degree of lifestyle change necessary– Perceived severity of the health care problem– Value placed on reducing the threat of illness– Difficulty in understanding and performing specific behaviors– Degree of inconvenience of the illness itself or of the regimens– Beliefs that the prescribed therapy or regimen will or will not

help– Complexity, Side effects, and duration of the proposed therapy– Specific Cultural heritage that may make adherence difficult– Degrees of satisfaction and quality and type of relationship with

the health care providers – Overall cost of prescribed therapy

• Nursing action on Non Adherence 1. Establish why the client is not following the

regimen 2. Demonstrate caring 3. Encourage healthy behaviors through positive

reinforcements4. Use aids to reinforce teaching5. Establish a therapeutic relationship of freedom,

mutual understanding and mutual responsibility with the client and support persons

Concept of Illness and Disease

• Disease – pathologic change in the structure or function of the body or mind

• Illness – the response a person has to a disease; it is an abnormal process in

which the person’s level of functioning is changed compared with a previous level

– influenced by the following: • self-perceptions • others’ perceptions • the effects of changes in body structure and function • the effects of those changes on roles and relationships • cultural and spiritual values and beliefs

• Etiology– Causation of the disease

Types of illness• acute illness – has a rapid onset of symptoms that lasts for a limited and

relatively short period of time • e.g., typically less than six months

• chronic illness – has a gradual onset of symptoms that lasts for an extended

and relatively long period of time • e.g., typically six months or longer

– characterized by periods of remission and exacerbation • remission – symptoms disappear

• exacerbation – symptoms reappear

Illness Behaviors

• behavior of individuals when they are ill • ways individuals describe, monitor, and

interpret their symptoms, take remedial actions and use the health care system

Parsons four aspect s of the sick role

1. Clients are not responsible for their conditions

2. Clients are excused from certain social roles and tasks

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

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

Suchman 5 Stages of Illness

1. Symptom experiences a. Physical b. Cognitive c. Emotional

2. Assumption of the sick role 3. Medical Care Contact

a. Validation of real illnessb. Explanation of the symptoms in understandable termsc. Reassurance that they will be alright or prediction of what the

outcome will be

4. Dependent Client Role5. Recovery or Rehabilitation

Effects of Illness

• Impact on Client – Behavioral Change– Emotional Change– Physical Changes– Lifestyle Changes

• Impact on the Family – Factors: • Member of the family who is ill• The seriousness and length of the illness• Cultural and social customs the family follows

– Changes in the family: • Role Changes • Task reassignments and increased demands on time • Increased stress • Financial problems • Loneliness as a result of loss and separation • Change in social customs

Health promotion and wellness

health promotion is any activity undertaken for the purpose of achieving a higher level of health and well-being

• Healthy People 2010 – two goals

• help individuals of all ages increase life expectancy and improve the quality of life – particularly African-Americans

» currently life expectancy is 74.9 years for European-Americans and 68 years for African- Americans

• eliminate health disparities among different segments of the population – particularly African-Americans

» currently, years of healthy life is 63 years for European-Americans and 62 years for Hispanics, and 56 years for African-Americans

Focus areas of healthy people 2010

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

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

Levels of Health Promotion(Leavell and Clark)

• Primary Prevention – Health promotion – Protection against specific health problems

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

• Tertiary Prevention – Restoration and rehabilitation

Types of health promotion programs

1. Community Based2. Hospital Based3. Health-organization programs4. School Health-promotion programs 5. Worksite programs for health promotion

Programs for health promotion• Information dissemination

– health promotion programs that use a variety of media to offer information to the public about the risk or particular lifestylechoices and personal behavior, as well as the benefits of changing that behavior and improving the quality of life

– e.g., billboards, posters, brochures, newspaper features, books, health fairs • health risk appraisal/wellness assessment programs

– health promotion programs that appraise individuals of the risk factors inherent in their lifestyles in order to motivate them to reduce specific risks factors and develop positive health habits

– e.g., tools such as Health-Style: A Self-Test • lifestyle and behavioral change programs

– health promotion programs geared toward enhancing the quality of life and extending the lifespan through implementation of a healthy lifestyle or behavioral change in the individual

• environmental control programs – health promotion programs developed in response to the recent growth in the

number of contaminants of human origin that have been introduced into our environment

The Nursing Process and Health Promotion

• Assessment 1. Health History2. Physical Examination3. Physical Fitness Examination4. Lifestyles assessment5. Spiritual Health assessment6. Social support System review7. Health risk assessment8. Health Beliefs review9. Life stress review10. Validating assessment data

• Diagnosis – Wellness diagnosis

• “Readiness for enhanced”

• Planning – Identify health goals related behavior change options– Identify behavior or health outcomes– Develop Behavior change plan– Reiterate benefits of change– Address environmental and interpersonal facilitators and barriers of

change – Determine a time for implementation – Commit to behavior-change goals

• Implementation – Supporting – Counseling

• Individual • Telephone

– Facilitating– Teaching– Consulting– Enhancing behavior change– Modeling

• Evaluation