Health, Wellness, and Illness

1. Health, Wellness, and Illness By Dr. M. Saleh

2. Concepts of health, wellness, and well-being • Definitions of Health: • There is no consensus about any definition of health. • Traditionally health has been defined in terms of the presence or absence of disease. • Florence Nightingale’s definition of health: • Health is a state of being well and using every power the individual possesses to the fullest extent.

3. Concepts of health, wellness, and well-being World Health Organization (WHO) definition: Health is a state of complete physical, mental, and social well-being, and not merely the absence of the disease or infirmity.

4. Concepts of health, wellness, and well-being ANA definition: Health is “a dynamic state of being in which the developmental and behavioral potential of an individual is realized to the fullest extent possible”. So health is more than a state or the absence of disease, it includes striving toward optimal functioning.

5. Concepts of health, wellness, and well-being Personal Definitions of Health: Many people define health as the following: Being free from symptoms of disease and pain as much as possible. Being able to be active and to do what they want or must. Being in good spirits most of the time.

6. Concepts of health, wellness, and well-being Definition of Wellness Wellness is a state of well-being. It means engaging in attitudes and behaviors that enhance quality of life and maximize personal potential.

7. Concepts of health, wellness, and well-being Basic concepts of wellness include: Self responsibility An ultimate goal A dynamic, growing process Daily decision making in the areas of nutrition, stress management, physical fitness, preventive health care, emotional health, and (the whole being of the individual).

8. Concepts of health, wellness, and well-being Components of wellness Anspaugh and colleagues propose seven components of wellness. To realize optimal health and wellness people must deal with the factors within each component:

9. Concepts of health, wellness, and well-being 1- Physical • The ability to carry out daily tasks. • The ability to achieve fitness (e.g. pulmonary, cardiovascular) • Maintain adequate nutrition • Avoid abusing drugs or using tobacco products • Practice positive lifestyle habits

10. Concepts of health, wellness, and well-being 2- Social • The ability to interact successfully with people within the environment of which each person is a part • The ability to develop respect and tolerance for people with different opinions and beliefs

11. Concepts of health, wellness, and well-being 3- Emotional • The ability to manage stress, and to express emotions and feelings appropriately 4-Intellectual • The ability to learn and use information effectively for personal, family, and career development

12. Concepts of health, wellness, and well-being 5-Spiritual • The belief in some force (nature, science, religion) that provide meaning and purpose to life • It includes a person’s own morals, values and ethics

13. Concepts of health, wellness, and well-being 6- Occupational • The ability to achieve a balance between work and pleasure time • A person’s belief about education, employment, and home influence personal satisfaction and relationships with others

14. Concepts of health, wellness, and well-being 7- Environmental • The ability to promote health measures that improve the standard of living and quality of life in the community. This includes influences such as food, water, and air.

15. Models of Health and Wellness Models can be helpful in assisting health professionals to meet the health and wellness needs of individuals.

16. Models of Health and Wellness 1- Clinical model • In this model the opposite of health is disease or injury. • The health is identified by the absence of signs and symptoms of disease or injury.

17. Models of Health and Wellness 2- Role performance model • Health is defined in terms of individual’s ability to fulfill societal roles, that is, to perform work. • According to this model, people who can fulfill their roles are healthy even if they appear clinically ill. People usually fulfill several roles.

18. Models of Health and Wellness 3- Adaptive model • The focus of the adaptive model is adaptation. • The aim of treatment is to restore the ability of the person to adaptive, that is, to cope.

19. Models of Health and Wellness 4- Eudemonistic model • In this model health is seen as a condition of actualization or realization of a person’s potential. • Illness in this model is a condition that prevents self-actualization.

20. Models of Health and Wellness 5- Agent-Host-Environmental Model • It has three dynamic interactive elements; Agent, Host, and Environment. • Agent: any environmental factor that by its presence or absence can lead to illness, e.g. food, pollution. • Host: a person who may or may not be at risk of acquiring a disease. • Environment: all factors external to the host and includes: • Physical environment: e.g. living conditions, climate. • Social environment: e.g. interactions with others, life events. • When the variables are in balance, health is maintained. When variables are not in balance, disease occurs.

21. Models of Health and Wellness • Health- illness continua • Grids or graduated scales can be used to measure a person’s perceive level of wellness. • Dunn’s High – Level Wellness Grid • Travis’s Illness – Wellness Continuum

22. Models of Health and Wellness • Dunn’s High – Level Wellness Grid • Dunn describes a health grid in which a health axis and an environmental axis intersect.

23. Dunn’s High – Level Wellness Grid 1- High-level wellness in a favorable environment • Example: a person who implements healthy lifestyle behaviors and has bio-psychosocial, spiritual, and economic resources to support this lifestyle.

24. Dunn’s High – Level Wellness Grid 2- Emergent high level wellness in an unfavorable environment • Example: a person who has the knowledge to implement healthy lifestyle practices but does not implement adequate self care practices because of the responsibilities, job demands, or other factors.

25. Dunn’s High – Level Wellness Grid 3- Protected poor health in a favorable environment • Example: an ill person whose needs are met by the health care system and who has access to appropriate medications, diet, and health care instruction.

26. Dunn’s High – Level Wellness Grid 4- Poor health in an unfavorable environment • Example: a young child who is starving in a drought stricken country.

27. Models of Health and Wellness • Travis’s Illness – Wellness Continuum • The model illustrates 2 arrows pointing in opposite directions and joined at a neutral. • This continuum ranges from high-level wellness to premature death.

28. Variable Influencing Health Status, Beliefs, and Practices. 1- Internal variable: A) Biologic Dimension: genetic makeup, sex, age, and developmental level all significantly influence a person`s health.

29. Internal variable B) Psychological Dimension: • Mind-body: responses to stress affect body function. - Increasing attention is being given to the mind`s ability to direct body`s functioning. Relaxation, meditation, and biofeedback techniques are gaining wider recognition by individuals and health care professionals. - Emotional reactions also occur in response to body conditions.

30. Psychological Dimension • Self-concept: is how a person feels about self (self-esteem) and perceives the physical self (body image), needs, roles, and abilities. Self-concept affects how people view and handle situation.

31. Internal variable C) Cognitive Dimension: Cognitive or intellectual factors influencing health include lifestyle choice and spiritual and religious beliefs. - lifestyle: sociocultural factors and personal characteristics. - Practices that have potentially negative effects on health are often referred to as risk factors.

32. Variable Influencing Health Status, Beliefs, and Practices. 2- External variables: A) Environment: - For instance, malaria and malaria-related conditions occur more frequently in tropical rather than temperate climates. - Pollution. - Tobacco. - Radiation.

33. External variables B) Standard of living: - Hygiene. - Food habits. - The ability to seek health care. C) Family and Cultural beliefs: - The family passes on patterns of daily living and lifestyle to offspring. D) Social Support Networks.

34. Health Care Adherence Adherence is the extent to which an individual’s behavior coincides with medical or health advice. Factors influencing adherence: 1. Client motivations to become well. 2. Degree of lifestyle change necessary. 3. Perceived severity of the health care problem. 4. Value placed on reducing the threat of illness.

35. Factors influencing adherence 5. Difficulty in understanding and performing specific behaviors. 6. Degree of inconvenience of the illness itself or of the regimens. 7. Beliefs that the prescribed therapy will or will not help. 8. Complexity, side effects, and duration of the proposed therapy. 9. Specific cultural heritage that may make adherence difficult.

36. Factors influencing adherence (cont.) 10. Degree of satisfaction and quality and type of relationship with the health care providers. 11. Overall cost of prescribed therapy. Steps that a nurse should take to reduce client’s non-adherence: 1. Establish why the client is not following the regimen. 2. Demonstrate caring.

37. Steps that a nurse should take to reduce client’s non-adherence (cont.) 3. Encourage healthy behaviors through positive reinforcement. 4. Use aids to reinforce teaching. 5. Establish a therapeutic relationship of mutual understanding with the client and support person.

38. Illness and Disease • Illness: is a highly personal state in which the person’s physical, emotional, intellectual, social, developmental, or spiritual functioning is thought to be diminished. • May or may not be related to disease. • It is highly subjective.

39. Disease • It is an alteration in body functions resulting in a reduction of capacities or a shortening of the normal life span. • Today, multiple factors are considered to interact in causing disease. • Etiology: is the causation of a disease. • Etiology includes description of all causal factors that act together to bring about the disease.

40. Classification of Diseases/Illnesses Acute illness • Severe symptoms of relatively short duration. • Symptoms often appear abruptly and subside quickly. • May or may not require medical interventions. • May be serious or minor.

41. Chronic illness • Lasts for an extended period, usually 6 months or longer. • Often have a slow onset. • Often have periods of remission (when the symptoms disappear), and exacerbation (when the symptoms reappear). • Modify activities of daily living, social relationships, and perception of self and body image.

42. Illness Behaviors • People behave in certain ways when become ill. • Behavior is affected by many variables such as age, sex, occupation, religion, education, socioeconomic status, personality, psychological stability, modes of coping, and ethnic origin.

43. Parsons described 4 aspects of sick role: • Clients are not held responsible for their condition. • Clients are excused from certain social roles and tasks. • Clients are obliged to try to get well as quickly as possible. • Clients or their families are obliged to seek competent help.

44. Stages of Illness • Such man describes five stages of illness 1. Symptoms experiences. 2. Assumption of the sick role. 3. Medical care contact. 4. Dependent client role. 5. Recovery or rehabilitation. Note: Not all clients progress through each stage.

45. Stage 1. Symptoms Experiences: • At this stage the person comes to believe something is wrong. • It has 3 aspects: 1. Physical experience of symptoms. e.g. cough. 2. The cognitive aspect (interpretation of symptoms). 3. The emotional response (e.g. fear, anxiety).

46. Symptoms Experiences (cont.) • Unwell person usually consults others about the symptoms or feelings and validates that the symptoms are real. • Try home remedies. • If self management is ineffective, the individual enters the next stage.

47. Stage 2. Assumption of the sick role • The individual now accepts the sick role and seeks confirmation from family and friends. • People often continue with self treatment and delay contact with health care professionals as long as they can. • People may be excused from normal duties and role expectations.

48. Assumption of the sick role (Cont.) • Emotional responses e.g. withdrawal, anxiety, fear,…are common. • When symptoms persist, increase, the person seeks professional help.

49. Stage 3: Medical care contact • Sick people seek the professional advice and asking for 3 types of information: • Validation of real illness. • Explanation of the symptoms in understandable terms. • Reassurance that they will be all right or prediction of what the outcome will be.

50. Stage 3: Medical care contact (Cont.) • The health professional determine that client does not have an illness or an illness is present. • The client may: • Accept the diagnosis. • Deny the diagnosis.