Health , Wellness, And Illness

Health, wellness and health promotion By: JULIE C. YU-SANTOS, M.D.

Liezel A. Castillo

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Health 

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

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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 Liezel A. Castillo

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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”

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What is your definition of Health? a.

b.

c.

Being free of symptoms of disease and pain as much as possible Being able to be active and to do what you want or must Being in good spirits most of the time

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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

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7 Components of Wellness (Anspaugh, Hamrick, Rosato)

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

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Physical – positive lifestyle habits Social – interaction, respect, tolerance Emotional – stress management Liezel A. Castillo

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7 Components of Wellness 

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Intellectual – growth and learning Spiritual – morals, values, ethics Occupational – balance in work and leisure Environmental (food, water, air) – standard of living

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Model of health and illness 

Model > is a theoretical understanding

way of 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 Liezel A. Castillo

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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

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2. agent-host clark’s)

–environment model( leavell and

> 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

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Agent-host-environment model environment

agent

host

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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

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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

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Very favorable environment High level wellness

Protected poor health

death

environment

health

Axis

peak wellness

axis Emergent high level wellness

Poor health Very unfavorable environment

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Travis-illness –wellness continuum

b)

> 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

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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 Disease symptoms sign

awareness education growth

High level wellness

Treatment model

Neutral point No discernible illness or dse.

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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

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Individual perception

modifying factors Demographic variables (age, race Sex, ethnicity) Sociopsychologic variables (peer pressure ,personality) Structural variables (knowledge about the disease)

Perceived susceptibility To disease Perceived seriousness of disease

Perceived threat of disease

likelihood of action Perceived benefits of Preventive action minus Perceived barriers to Preventive action

Likelihood of taking Recommended preventive Health action

Cues to action mass media campaign Advice from others Illness of family members Newspaper or magazine articles Liezel A. Castillo

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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

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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 children but rare in elders

in

Developmental Level - Infants: lack physiologic and psychologic maturity; defenses are lower Liezel A. Castillo

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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.

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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 Liezel A. Castillo

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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

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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.

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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.

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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

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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.

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Variables influencing Health Status, Beliefs and Practices 

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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

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HEALTH BELIEFS/BEHAVIORS 

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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. 2. 3.

immunization proper sleep pattern adequate exercises

negative health behaviors 1. 2. 3.

smoking drug or alcohol abuse poor diet Liezel A. Castillo

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Health care adherence Adherence – extent to which individual’s behavior coincides with medical or health advice

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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 Liezel A. Castillo

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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

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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

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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 assessmentused 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 Liezel A. Castillo

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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

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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

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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

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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)

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Illness behavior - coping mechanism - ways in which individuals describe, monitor and interpret their symptoms, take remedial action, and use the health care system

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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 Liezel A. Castillo

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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

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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 Liezel A. Castillo

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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 Liezel A. Castillo

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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 Liezel A. Castillo

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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 Liezel A. Castillo

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5 STAGES OF ILLNESS Stage 5 Recovery or Rehabilitation - resume former roles and responsibilities - long term responsibilities and permanent disability necessitate adjustment Liezel A. Castillo

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Effects of Illness 

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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

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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 Liezel A. Castillo

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Family – role changes, task

reassignments and increase demand on time, increased stress, financial problems, loneliness d/t separation and loss, change in social customs

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