Health, Wellness, and Illness

Health, wellness and
health promotion
By: JULIE C. YU-SANTOS, M.D.
Liezel A. Castillo 1
Health
 WHO
“state of complete physical, mental and social well-being not
merely the absence of disease or infirmity”
 Nightingale
“state of being well and nursing every power the individual
possesses to the full extent”
American Nurses Association

- “A dynamic state of being in which the developmental
and behavioral potentials of an individual, is realized
in the fullest extent possible.”
- striving toward optimal functioning
Disease
“ abnormal vital function involving any structure, part, or
system of an organism”
“ specific illness or disorder characterized by a
recognizable set of manifestations, attributable to heredity,
infection, diet, or environment”
What is your definition of Health?
a. Being free of symptoms of disease and pain

as much as possible
b. Being able to be active and to do what you
want or must
c. Being in good spirits most of the time
Wellness ,and well-being
 Wellness - state of well
being
Well-being
- (Hood and Leddy 2002)
- component of health
- subjective perception of
vitality and feeling well
…described objectively,
experienced and
measured …plotted on a
continuum
7 Components of Wellness (Anspaugh,
Hamrick, Rosato)
**To realize optimal health
and wellness, deal with
the factors within each
component.
 Physical – positive
lifestyle habits
 Social – interaction,
respect, tolerance
 Emotional – stress
management
7 Components of Wellness
 Intellectual – growth and
learning
 Spiritual – morals, values,
ethics
 Occupational – balance in
work
and leisure
 Environmental (food, water,
air) – standard of living
Model of health and illness
 Model > is a theoretical way of
understanding 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:
1. smith model of health – discuss 4 model of health
a. clinical model – presence of sign and symptoms
of disease
- narrowest interpretation of health
use mainly by medical practitioner
b. role performance model –health is defined in terms
individual ability to fulfill societal role
c. adaptive role- adaptation to environment
d. eudaemonistic model- most comprehensive model
health views as condition of
actualization or realization of a
person potential
- highest aspiration is fulfillment
2. agent-host –environment model( leavell and
clark’s)
> also called ecologic agent ,used in
predicting illness rather than promoting
wellness
has 3 dynamic interactive elements:
1. agents- stressors/environment factors that
by it presence or absence can lead to
illness or disease
2. host –who may or may not be at risk of
acquiring the disease
3. environment –external to the host
 Agent-host-environment model
environment
agent host
3. Health illness continua :used of grid cylinder
a) Dunn’s high level wellness grid
– described a health
axis and environment axis
intersect
1) high-level wellness in favorable environment
ex. Person who implement healthy lifestyle
and has complete resources to support
his lifestyle
2) emergent-high level wellness in unfavorable
environment- ex. Person who has knowledge
to implement healthy lifestyle but does not
implement adequate self-care bec. Of some
family responsibility
3) protected poor health in favorable
environment
ex. Ill person whose needs are met by the
health care system
4) poor health in an unfavorable

environment
ex. Young child who is starving in a drought
stricken country
Very favorable
environment
High level wellness

Protected poor
health environment
death health Axis peak wellness
axis
Poor health Emergent high level
wellness
Very unfavorable
environment
b)Travis-illness –wellness
continuum
> compose of 2 arrows pointing in
opposite direction and joined at neutral point
> movement to the left of neutral
point indicate progressive decrease in state of
health
>movement to the right of the
neutral point indicates increasing level of health
 traditional treatment model > help only the individual move from
left to the neutral point
 Wellness model > help move individual beyond the neutral point
to high level of wellness
Wellness model
High level
Disease symptoms sign awareness education growth wellness
Treatment model
Neutral
point
No discernible illness or dse.
4. Health belief model – based on motivation theory,
has 3 components
a) individual perception >include perceived
susceptibility, perceived threat
and perceived seriousness
b) modifying factors > include demographic

variables
sociopsychologic variables,
structural ariables, cues to action
c) likelihood of action > depend on perceived

benefits of action minus the
perceived barriers to the action
Individual perception modifying factors likelihood of action
Demographic variables (age, Perceived benefits of

race Preventive action
Sex, ethnicity) minus
Sociopsychologic variables Perceived barriers to
(peer pressure ,personality) Preventive action
Structural variables
(knowledge
about the disease)
Perceived susceptibility
To disease Likelihood of taking
Perceived seriousness Recommended preventive
of disease Perceived threat of disease Health action
Cues to action
mass media campaign
Advice from others
Illness of family members
Newspaper or magazine articles
Health locus of control model
 Belief that health is under own or others’
control
INTERNALS – health is self determined
- take initiative in health care
- knowledgeable about own
health
- adhere to health care
regimens
EXTERNALS – health controlled by outside

forces
Internal Variables
1. Biologic Dimension:
Genetic makeup – temperament, activity level,
intellectual level, susceptibility to
specific disease
Sex - Male: Stomach Ulcers, Respiratory Diseases

Female: Rheumatoid Arthritis, Osteoporosis
Age - Arteriosclerosis common in middle age

Whooping Cough and Measles are common in
children but rare in elders
Developmental Level - Infants: lack physiologic

and psychologic maturity; defenses are
lower
2. Psychologic Dimension:
- mind-body interactions and self
concept affect health status
- Emotional responses affects
body function.
Example:
A student who is extremely anxious
during exam may experience urinary
frequency and diarrhea.
3. Cognitive Dimension:
Lifestyle choices – way of
living, behavior influenced by
sociocultural factors and
personal characteristics
Example: smoking, over eating,

lack of exercise, alcoholism
Spiritual and religious beliefs

Example:
Jehovah’s Witnesses oppose
blood transfusion
External variables
1. Environment
Climate: Malaria - tropical countries
Pollution: Air – Respiratory
Water – Diarrhea
Noise – Hearing Loss
Pesticides and Chemical use: ingested by
people; harmful to health
Radiation: Sun - Cancer of the skin
(Caucasians)
Chemicals - Asbestos – Cancer
Acid Rain – Sulfur Dioxide, Nitrogen
Oxide
Emissions produced by Ore
Smelters
Green House Effect: Entrapment of carbon

dioxide in the earth’s surface due to air
pollution leading to global warming.
2. Standards of Living
- Related to Health, Morbidity and Mortality
- Hygiene, food habits and the propensity to seek
health care advice and follow health regimens vary
among high income and low income groups.
Low Income Families

- “if people can work, they are healthy”
- fatalistic and believe that illness is not
preventable.
Poverty Stricken Areas
- slum neighborhood -
overcrowding thus poor
sanitation
Occupational Roles
- Industrial Workers –
exposed to
carcinogenic agents
- Affluent People –
predisposed to
stressful social and
occupational role
3. Family and Cultural Beliefs
- Family passes on patterns of daily living and
lifestyle to offspring i.e. A man who was abused as a
child may physically abuse his small son
- certain cultural practices affect perception of home
remedies vs medical practices
4. Social Support Networks

- Support network of family, friends and confidant
and job satisfaction helps people avoid illness.
Variables influencing Health
Status, Beliefs and Practices
 Health Status – i.e. anxiety, depression, or
acute illness; pulse rate and temperature
 Health Beliefs – concepts about health that

an individual believes true
 Health Behaviors – actions people take to

understand health state i.e. maintaining
proper nutrition
HEALTH
BELIEFS/BEHAVIORS
 Health beliefs > are person's ideas, convictions
and attitudes about health and
illness
> have positively or negatively
effect client health
 Health behaviors
positive health behaviors:
1. immunization
2. proper sleep pattern
3. adequate exercises
negative health behaviors
1. smoking
2. drug or alcohol abuse
3. poor diet
Health care adherence
Adherence – extent to which individual’s
behavior coincides with medical or health
advice
Nursing Interventions to enhance

adherence:
 Ensure client is able to perform prescribed
therapy
 Ensure client understands instructions
 Ensures that client is a willing participant
in establishing goals of therapy
 Ensures that client values planned
outcomes of behavior changes
Nursing interventions in nonadherence:
2. Establish why client is not following
regimen
3. Demonstrate caring
4. Encourage healthy behavior through
positive reinforcement
5. Use aids to reinforce teaching
6. Establish a therapeutic relationship of
freedom, mutual understanding, and
mutual responsibility with client and
support persons

Health promotion
Is any activity undertaken for the purpose of
achieving a higher level of health and well being
 Directed toward improving well being and
actualizing the health potential of individual ,
families, groups and communities.
3 level of prevention :
1. primary level of prevention-generalizes
health promotion and specific
protection against disease
2. secondary prevention- emphasizes early
detection of disease, prompt
intervention including prevention
of complication
3. tertiary prevention –focus on client
rehabilitation and restore them
to optimum level
Types of health promotion:

1. information dissemination –most basic type ,
raises the level of knowledge and awareness
of individual and group about health habit
2. health appraisal/ wellness assessment-
used to appraise the individual of the risk factors
inherent in their life
3. lifestyle and behavior change program-
participation of individual and geared toward
the enhancing quality of life and extending the
lifespan
4. worksite wellness program- program
enhancing quality of life
5. environmental control program
 Nurses role in health promotion:
1. model healthy lifestyle behavior and attitudes
2. facilitate client involvement in the assessment,
implementation , evaluation of health goal
3. teach client self-care strategies to enhance
fitness, improve nutrition.
4. assist individual, families, and communities to
develop and choose health promoting option
5. teach client to be effective health care consumers
6. guide the client’s development in effective
problem solving and decision making
7. reinforce the client personal and family health
promoting behaviors
8. advocate in the community for changes that
promote a healthy environment
Illness and disease
Illness -
- highly personal state
- physical, emotional,
intellectual social,
developmental or
spiritual functioning is
thought to be diminished
- not the same with
disease and may or may
not be related to disease
- highly subjective; only
the person can say she or
he is ill
Disease
- alteration in body functions
- results in reduction of capacities or a shortening of
normal life span.
Etiology - cause of a certain disease; may or

may not be known
Classification of Disease or Illness
1.Acute
- severe symptoms of short duration.
- Symptoms appear abruptly and subside quickly.
- may or may not require intervention
- following illness, most people return to normal level
of wellness
2.Chronic
- lasts for an extended period; 6 months or longer
- slow onset and often has period of REMISSION
(symptoms disappear) and EXACERBATION
(symptoms reappear)
Illness behavior
- coping mechanism
- ways in which individuals
describe, monitor and interpret
their symptoms, take remedial
action, and use the health care
system
4 Aspects of the Sick Role
(Parsons 1979)
1.Clients are not held

responsible for their
condition
2.Clients are excused from

certain 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
 3 distinct criteria to determine illness
(according to Bauman)
1. the presence of symptoms

2. the perception of how they feel
3. their ability to carry out daily
activities
5 Stages of Illness
Suchman (1979)
Stage 1 Symptom
Experiences
- physical experience of
symptoms
- cognitive aspect
- emotional response
* May consult others and

try home remedies
5 STAGES OF ILLNESS
Stage 2 Assumption
of the Sick Role
- accepts sick role

- seeks confirmation
from family and friends
- continue with
treatment
- excused from normal
duties and expectations
- emotional responses
common
- sx persist, seek
professional health
5 STAGES OF ILLNESS
Stage 3 Medical Care
Contact
- seek advice of
health professional to:
* validate real
illness
* explain illness in
understandable terms
* reassurance
- may accept or deny
diagnosis
5 STAGES OF ILLNESS
Stage 4 Dependent
Client Role
- after seeking
treatment, may be
dependent on
professional
- others try to
maintain
independence as
soon as
possible
5 STAGES OF ILLNESS
Stage 5 Recovery
or Rehabilitation
- resume former
roles and
responsibilities
- long term
responsibilities
and permanent
disability
necessitate
adjustment
Effects of Illness
 Privacy-described as comfortable feeling
reflecting a deserved degree of social
retreat or freedom from authorized intrusion
 Autonomy –is the state of being independent

and self-directed without outside control
 Lifestyle- a general way of living based on the

interplay between living condition in the
wide sense and individual pattern of
behavior as determined by sociocultural
factors and personal characteristic
Client
- behavioral, emotional changes, self
concept, body images, and lifestyle
changes
- privacy is usually affected
Nursing intervention:
1. explanations about adjustments
2. arrangements to accommodate
lifestyle
3. encourage health professionals to
become aware of changes and give
support
4. reinforce desirable changes in
practice
Family – role changes, task
reassignments and increase
demand on time, increased
stress, financial problems,
loneliness d/t separation and
loss, change in social customs


Health, Wellness, and Illness

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Health, Wellness, and Illness

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Health, wellness and

American Nurses Association

a. Being free of symptoms of disease and pain

>Assist health professionals to

* Nurses’ broad definition of health

* People’s health beliefs influence their

4) poor health in an unfavorable

High level wellness

death health Axis peak wellness

b) modifying factors > include demographic

c) likelihood of action > depend on perceived

Demographic variables (age, Perceived benefits of

EXTERNALS – health controlled by outside

Sex - Male: Stomach Ulcers, Respiratory Diseases

Age - Arteriosclerosis common in middle age

Developmental Level - Infants: lack physiologic

Example: smoking, over eating,

Spiritual and religious beliefs

Green House Effect: Entrapment of carbon

Low Income Families

4. Social Support Networks

 Health Beliefs – concepts about health that

 Health Behaviors – actions people take to

Nursing Interventions to enhance

Types of health promotion:

Etiology - cause of a certain disease; may or

1.Clients are not held

2.Clients are excused from

3.Clients are obliged to try to

4.Clients or their families are

1. the presence of symptoms

* May consult others and

- accepts sick role

 Autonomy –is the state of being independent

 Lifestyle- a general way of living based on the

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