Definition * Health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity. (WHO, 1947) * 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 1953) Wellness: Definition * Wellness is a state of wellbeing. It means engaging in attitudes and behaviors that enhance quality of life and maximize personal potential. * Wellness is a choice – a decision you make to move toward optimal health.
Wellness is a way of life – a lifestyle you design to achieve your highest potential for wellbeing. * Wellness is a process – a developing awareness that there is no end point but that health and happiness are possible in each moment here and now * Wellness is an efficient channeling of energy – received from the environment, transformed within you, and sent on to affect the world outside. * Wellness is the integration of mind, body, and spirit – the appreciation that everything you do, and think, and feel, and believe has an impact in your state of health.Wellness is the loving acceptance of yourself. Well-being: Definition * Well-being is a subjective perception of balance, harmony, and vitality (Leddy and (Pepper, 1993) Six Dimensions of Wellness: * According to Anspaugh et. Al.
A. Physical B. Social C. Emotional D. Intellectual E. Spiritual F.
Environmental Models of Health: Overview * Smith’s Models of Health * Leavell and Clark’s Agent-Host-Environment Model/Ecologic Model * Health-Illness Continua * Health Belief Model Smith’s Models of Health Clinical Model – People are viewed as physiologic systems with related functions, and health is identified by the absence of signs and symptoms of disease or injury. * Role Performance Model – Health is defined in terms of the individual’s ability to fulfill societal roles, that is, to perform work. * Adaptive Model – Health is a creative process; disease is a failure in adaptation, or maladaptation * Eudaemonistic Model – Health is seen as a condition of actualization or realization of a person’s potential. Leavell and Clark’s Agent-Host-Environment Model/Ecologic Model * Three Dynamic Interactive Elements Agent – Any environmental factor or stressor that by its presence or absence can lead to illness or 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 Health-Illness Continua * used to measure a person’s perceived level of wellness.
* Dunn’s High Level Wellness Grid – demonstrates the interaction of the environment with the illness-wellness continuum.The health axis extends from peak wellness to death, and the environmental axis extends from very favorable to very unfavorable. . High level 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 * Travis’ Illness-Wellness Continuum – ranges from high level wellness to premature death. Movement to the right of neutral point indicates increasing level of health and well-being. Moving to the left indicates a progressively decreasing state of health.
Increasing level of health is achieved in three steps: 1. Awareness 2. Education 3.
Growth Health Belief Model Rosenstock (1974) – a relation exists between a person’s belief and actions. * Proposed a health belief model intended to predict which individuals would or would not use such preventive measures as screening for early detection of cancer. * Becker modified this model to include the following components: 1. Individual Perceptions a. Perceived susceptibility – A family history of a certain disorder, such as diabetes or heart disease, may make the individual feel at high risk b. Perceived seriousness – In the perception of the individual, does the illness cause death, or has serious consequences? . Perceived Threat – Perceives susceptibility and perceive seriousness combine to determine the total perceived threat of an illness to a specific individual 2.
Modifying Factors a. Demographic Variables – age, sex, race, and ethnicity b. Socio-psychologic variables – Social pressure or influence from peers or other reference groups may encourage preventive health behaviors even when individual motivation is low. c. Structural Variables – knowledge about the target disease and prior contact with it. d. Cues to Action – can either be internal or external.
Internal – feelings of fatigue, uncomfortable symptoms, thoughts about the condition of an ill person who is close. * External – mass media campaigns, advice from others, reminder postcard from a physician, illness of family members or friend, newspaper or magazine article 3. Likelihood of Action e.
Perceived benefits of the action * E. g. refraining from smoking to prevent lung cancer and avoiding snacks to maintain weight b. Perceived barriers to action * E. g.
cost, inconvenience, unpleasantness, lifestyle changes Health Belief Model A.Rosenstock assumed that good health is an objective common to all people. B.
Becker added “positive health motivation” as a consideration. C. Pender adds two further considerations: 1.
The Importance of Health to the Person – Behavior indicating that health is perceived as something of value includes providing special foods and vitamins, having regular dental check-ups, participating in screening tests 2. Perceived Control – people who perceive that they have control over their own health are more likely to use preventive services than people who feel powerless.Stages of Wellness 1. Awareness 2. Education 3. Growth Wellness Behaviors and Healthy Lifestyles * Exercising aerobically at least 3x a week and engaging in other forms of moderate exercise * Not smoking * Limiting the consumption of alcohol to no more than two drinks per day and seven drinks per week * Taking actions to preserve the environment * Eating wholesome nutritious foods * Reducing caffeine intake * Taking time to help others who are less fortunate * Engaging in practices like meditation that have been shown to reduce stress * Practicing safer sex Avoiding inappropriately passive behavior * Avoiding inappropriately hostile or aggressive behavior * Balancing work with social and other activities Illness: Definition of Terms * Illness – a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished. It is highly subjective; only the individual person can say he or she is ill. * Disease – an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span.
* Etiology – the causation of disease.It includes identification of all causal factors that act together to bring about the particular disease. * Acute Illness – characterized by severe symptoms of relatively short duration.
The symptoms often appear abruptly and subside quickly, and depending on the cause, may or may not require intervention by health professionals. * Chronic Illness – one that lasts for an extended period, usually 6 months, and often for a person’s life; usually have a slow onset and often have periods of remission, when the symptoms disappear, and exacerbation, when the symptoms reappear.Illness behavior is a coping mechanism that involves ways individuals describe, monitor, and interpret their symptoms, take remedial actions, and use the health care system. Suchman’s Stages of Illness 1. Stage 1 – Symptom Experience * Person comes to believe something is wrong. * May experience some symptoms such as pain, rash, cough, fever, or bleeding. * Unwell person usually consults others about the symptoms or feelings * May try home remedies * If self management is ineffective, person enters next stage * 3 Aspects: a.
Physical experience of symptoms b.Cognitive aspect (the interpretation of the symptoms in terms that have some meaning to the person). c. The emotional response 2. Stage 2 – Assumption of the Sick Role * Person accepts the sick role and seeks confirmation from family and friends * Often continues with self-medication and delay contact with health care professionals as long as possible * People may be excused from normal duties and role expectations * When symptoms persist, person is motivated to seek professional help * Emotional Responses during this stage – withdrawal, anxiety, fear, and depression .
Stage 3 –Medical Care Contact * Sick person seeks the advice of a health professional either on their own initiative or at the urging of significant others * Information Obtained from Health Care Professionals: a. Validation of real illness. b. Explanation of symptoms in understandable terms. c. Reassurance that they will be all right or prediction of what the outcome will be. * Client may accept or deny the diagnosis.
If the diagnosis is accepted, the client usually follows the prescribed treatment plan.If diagnosis is not accepted, client may seek the advice of other health care professionals or quasi-practitioners who will provide a diagnosis that fits the client’s perceptions. 4. Stage 4 – Dependent Client Role * Dependent on health care professional for help * People vary greatly in the degree of ease with which they can give op their independence. Role obligations such as those of wage earners, father, mother, student etc. complicate the decision to give up independence. * Dependent on family and friends for support . Stage 5 – Recovery and Rehabilitation * Client is expected to relinquish the dependent role and resume former roles and responsibilities * For people with acute illness, the time is generally short and recovery is usually rapid * For people with long term illnesses and must adjust their lifestyle may find recovery difficult * For clients with permanent disability, this stage may require therapy to learn how to make major adjustment in functioning Levels of Prevention (Leavell and Clark) 1.
Primary Prevention – precedes disease or dysfunction and is applied to generally healthy individuals or groups * Purpose: to decrease the risk or exposure of the individual or community to disease. * Focus: health promotion; protection against specific health problems. * Levels of Prevention (Leavell and Clark) * Examples: a. Health education on healthy lifestyle b.
Immunizations c. Risks assessment for specific diseases d. Family planning services and marriage counseling e.
Environmental sanitation and provision of adequate housing, recreation, and work conditions 2.Secondary Prevention –includes prevention of complication and disabilities * Purpose: to identify individuals in an early stage of a disease process and to limit future disability. * Focus: early identification of health problems; prompt intervention to alleviate health problems * Examples: f.
Screening surveys and procedures of any type g. Encouraging regular medical and dental check-ups h. teaching self examination for breast and testicular cancer i. Assessing the growth and development of children j. Nursing assessments and care provided in home, hospitals and other agencies to prevent complications (e. .
turning bedridden clients to prevent pressure ulcers etc. ) 3. Tertiary Prevention – begins after an illness, when a defect or disability is fixed, stabilized, or determined to be irreversible. * Purpose: Help rehabilitate individuals and restore them to an optimum level of functioning within the constraints of disability. * Focus: restoration; rehabilitation * Examples: a. Referring a client who has had a colostomy to a support group b.
Teaching a client who has diabetes to identify and prevent complications c. Teaching a client to use crutches