HEALTH AND ILLNESS

Nurses’ understanding of health and wellness determines the scope and nature of practice.
DEFINITIONS OF HEALTH
Health – the process through which a person seeks to maintain an equilibrium that promotes
stability and comfort, is a dynamic process that varies according to a person’s perception of wellbeing.
Health is individually defined by each person
On a personal level, individuals define health according to:
– how they feel
– absence or presence of symptoms of illness
– and ability to carry out activities
World Health Organization Defined:
– Health is the complete physical, mental, social (totality) well-being and not merely the
absence of disease or infirmity

DEFINITIONS OF ILLNESS
Is the inability of an individual’s adaptive responses
- Inability to maintain physical and emotional balance.
- Impairment of functional abilities.
- Highly subjective feeling of being sick or ill
- How the person feels towards sickness
2 Major Classification of illness
Acute illness – rapid in onset, intense manifestation, short duration. Usually reversible
Chronic illness – gradual, insidous onset, with lifelong changes, usually irreversible.

Five stages of illness(Suchman)

Stage I-symptom experiences
• Physical experience of symptoms
• Interpretation of the symptoms
• Emotional response
Stage 2 assumption of sick role
• Accepts sick role
• Continue with self treatment and delay consultation
• Seeks consultation when symptoms persists
Stage 3 medical care contact
• Seek professional help
• Validate illness
• Ask for explanation
• Prediction of outcome
Stage 4 dependent client role
• Client becomes dependent on professional help

Stage 5 recovery or rehabilitation

 Relinquish the dependent role and resume roles and responsibilities

DEFINITIONS OF WELLNESS
 Conditions in which an individual functions at optimal levels.
- Is a state of well-being.
7 Components of w e l l n e s s
1. Physical. The ability to carry out daily tasks, achieve fitness.
2. Social. The ability to interact successfully with people and within the environment.
3. Emotional. The ability to manage stress and to express emotions appropriately.
4. Intellectual. The ability to learn and use information effectively for personal, family, and career
development.
5. Spiritual. It provide meaning and purpose to life. It includes a person's own morals, values, and
ethics.
6. Occupational. The ability to achieve a balance between work and leisure time.
7. Environmental. The ability to promote health measures that improve the standard of living and
quality of life in the community.

DIMENSIONS OF HEALTH
• PHYSICAL - Genetic make up, age, developmental level, race, sex
• EMOTIONAL - Refers to feelings, Beliefs in one’s worth
• INTELLECTUAL - Cognitive abilities , educational background, experiences
• SPIRITUAL - Ability to practice moral or religious principles or beliefs
• SOCIO-CULTURAL - Sense of having support from family and friends
 Practices, values and beliefs that determine health
• Sexual dimension - Acceptance and ability to achieve satisfactory expression of one’s sexuality

MODELS OF HEALTH AND WELLNESS

1. Clinical model
 Health is identified by the absence of signs and symptoms of disease or injury.
 Opposite of heath is disease or injury
2. Role performance model
 People who can perform their roles are considered healthy.
3. Adaptive model
 Extreme good health is flexible adaptation to the environment and interaction to the
environment to maximum advantage
4. Eudemonistic model
 Health is seen as a condition of actualization or realization of a person’s potential.
5. Agent-host environment model (Leavell and clark)
 Also called ecologic model
 Used primarily in predicting illness
 Three dynamic interactive elements
 AGENT- Any environmental factor or stressor that by its presence or absence can lead to
illness and disease
 Host- Persons who may or may not be at risk of acquiring a disease
 Environment - All factors external to the host that may or may not predispose the
person to the development of disease
6. Health Illness Continua
 Used to measure a person's perceived level of wellness.
 Health and illness or disease can be viewed as the opposite ends of a health continuum.
a. DUNN’S HIGH LEVEL WELLNESS GRID
4 QUADRANTS OF HEALTH & WELLNESS
1.High level of wellness in a favorable environment.
 2. Emergent high level wellness in an unfavorable environment.
3. Protected poor health in a favorable environment
4. Poor health in an unfavorable environment
b. Travis's Illness-Wellness Continuum
The model illustrates two arrows pointing in opposite directions and joined at a
neutral point.
Movement to the right indicates increasing levels of health and well being which
is achieved in 3 steps: (a) awareness, (b) education (c) growth.

7. Health Promotion Model (Nola Pender)

People engage in health promoting behavior when they:
• Value health
• Perceive health as being w/in their control
• Can identify benefits in self care behaviors.
• Have a positive perception of their health status
Health Promoting Behavior is influenced by:
1. Indiv. Inherited and acquired characteristics
2. Significant others who model the behavior
3. Families, peers, and cargivers.

8. 4+model of wellness - A newer model, the 4+ model of wellness( Baldwin & Conger,2001)
Consist of four domains of the inner self-physical, spiritual, emotional, and the intellectual-
plus the elements of the outer systems (environment, culture, nutrition, safety and many
other elements).

Health Belief Model

Theories that are used to help determine how likely an individual is to participate in health
promotion and disease prevention activities.

Locus Of Control (LOC) - a concept from social learning tools use to determine whether clients like to
take action regarding health
- Determine which people will likely exhibit change in behavior
- INTERNALS (LOC) - Self determined.
- They believe they have a major influence on their health status.
- EXTERNAL(LOC) - Believe their health is controlled by outside forces.
Rosentock’s and becker’s health belief model
- Intended to predict which individuals would or would not use preventive measures
- Assumed that good health is an objective common to all people.

Components of the health belief

 INDIVIDUAL PERCEPTION
 MODIFYING FACTORS
 VARIABLES LIKELY TO AFFECT ACTION
INDIVIDUAL PERCEPTION
 PERCEIVED SUSCEPTIBILITY
 PERCEIVED SERIOUSNESS
 PERCEIVED THREAT
  PERCEIVED SUSCEPTIBILITY
• Family history of certain diseases may make the individual feel at high risk
 PERCEIVED SERIOUSNESS
• Does the illness cause death or have serious consequence?
 Perceived threat
• Determined by combined perceived susceptibility and perceived seriousness.
Modifying factors
 DEMOGRAPHIC VARIABLES
 SOCIOPSYCHOLOGIC FACTORS
 STRUCTURAL VARIABLES
 CUES TO ACTION
 DEMOGRAPHIC VARIABLES
 AGE , GENDER , RACE , ETHNICITY
 SOCIOPSYCHOLOGIC VARIABLES
 Social pressure from peers or other reference group (self help grp. )may
encourage preventive health behaviors.
 Structural variables
 Knowledge about target disease and prior contact with it influence preventive
behavior. (frequent exposure to disease).
 Cues to action
 INTERNAL-
 feeling of fatigue, uncomfortable symptoms or thoughts about the
condition of an ill person who is close.
 EXTERNAL-
 Mass media campaigns
 Advice from others
 Reminder postcard from physician or dentist
 Illness of family member or friend
 Newspaper or magazine article

 LIKELIHOOD OF ACTION
 PERCEIVED BENEFITS-PERCEIVED BARRIER
• PERCEIVED BARRIERS TO ACTION
• Eg. Cost, inconvenience, unpleasantness, lifestyle changes
 PERCEIVED BENEFITS OF THE ACTION:
• Refraining from smoking=prevention of lung cancer
• Eating nutritious food and avoiding snack=maintaining weight

Variables Influencing Health Behaviors- (Daniels et.al)

• Lifestyle
• Perceived Locus of control
• Self efficacy
• Healthcare attitudes
• Self concept ,
• Cognition,
• Age and developmental levels
 • Gender
• Prev. Experience with HC system
• Environment
• Economic resources

Three Levels of Prevention

Primary prevention
 The purpose of primary prevention is to decrease the risk or exposure of the
individual or community to disease.
• (a)health promotion
• (b) protection against specific health problems (e.g., immunization against
hepatitis B).
Secondary prevention
Its goal is to identify individuals in an early stage of a disease process and to limit
future disability.
• Focuses on:
a. early identification of health problems
b. prompt intervention to alleviate health problems.
Tertiary prevention
Focuses on:
a. Restoration and rehabilitation with the goal of returning the individual to an optimal
level of functioning