CONCEPTS OF HEALTH, WELLNESS & ILLNESS

HEALTH

 Traditionally health was defined in terms of the presence and absence of

disease.
 Health is a state of being well and using every power the individual
possesses to the fullest extent (Nightingale, 1969).
 Health (World Health Organization, 1948) is a state of complete physical,
mental and social well being and not merely the absence of disease or
infirmity. This definition reflects concern for the individual as a total
person functioning physically, psychologically, and socially. Mental
processes determine people’s relationship w/ their physical and social
surroundings, their attitudes about life, and their interaction with others. It
also places health in the context of environment. People’s lives, and
therefore their health, are affected by everything they interact with not only
environmental influences such as climate and the availability of food,
shelter, clean air and water to drink, but also other people, including
family, lovers, employers, coworkers, friends and associates.
 Health has also been defined in terms of role and performance, health as
the ability to maintain normal roles (Parsons, 1951).
 Health is a dynamic state of being in which the developmental and
behavioral potential of an individual is realized to the fullest extent
possible (American Nurses Association, 1980). In this definition, health is
more than the absence of disease; it includes striving toward optimal
functioning.
 Health (Brill & Kilts, 1980) is a dynamic process, which continually
changes as the interactions between individuals and their internal &
external environments change. These mean that an individual state of
health changes when there are changes in his environments, both internal
& external.
 Health (Harding & Shyrock, 1991) is every organ working properly. You
must have health, if every function of your body perform its appointed task
efficiency and in harmony with all of your body activities. Your heart must
beat, your lungs must breathe, your eyes must see, your ears hear and
your mind must intelligently comprehend all that is happening.
 Health is a continuous balancing of the physical, emotional, social,
intellectual and spiritual components of an individual in such a fashion as
to produce happiness and higher quality of existence. This definition
indicates that health is not static and that the potential for change is
always present.

Notes: - Health is a highly individual perception. Many factors affect individual

definitions of health. Definitions vary according to an individual’s previous
experiences, expectations of self, age, and socio-cultural influences.

WELLNESS

 Wellness is a state of well-being.

 Basic aspects 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, and
emotional health; and most importantly, the whole being of the individual.
 engaging in attitudes and behaviors that enhance the quality of life and
maximize personal potential

DIMENSIONS/ COMPONENTS OF WELLNESS

Achieving a high level wellness requires the individuals to constantly

balance and maintain the following components:
1. Physical Dimension

The ability to carry out daily task, develop cardiovascular fitness, maintain
adequate nutrition and proper body fat, avoid abusing drugs and alcohol or using
tobacco products, and generally invest in positive lifestyle habits.

It encourage regular physical activity, cardiovascular flexibility and

strength, knowledge about food and nutrition, medical self-care, and appropriate
use of the medical system, while discourage excessive use of tobacco, drugs
and alcohol.

Genetic make-up, age, developmental level, race, and sex are all part of
an individual’s physical dimensions and strongly influence health status and
practices.
Examples:
1. The toddler just learning to walk is prone to fall and injury
2. The young woman, who has a family history of breast cancer and diabetes
therefore, is a higher risk to develop these conditions.)
3. Down syndrome, hemophilia, cystic fibrosis )

2. Emotional Dimension

 The ability to control stress and to express emotions appropriately and

comfortably.
 Emotional wellness is the ability to recognize, accept, and express
feelings and to accept one’s limitations.
 It focuses on the degree to which a person feels positive about self and
enthusiastic about life.

It emphasizes:
a. awareness and acceptance of one’s feeling
b. the capacity to manage one’s feeling
c. the ability to cope effectively with stress
d. the ability to maintain satisfying relationships with others
e. the assessments and acceptance of one’s limitations.

How the mind and body interact to affect body function and to respond to
body conditions also influence health. Long term stress affects the body systems
and anxiety affects health habits; conversely, calm acceptance and relaxation
can actually change responses to illness.

i.e. Prior to a test a student always have diarrhea.

Extremely nervous about a surgery, a man experience severe pain

following his operation.

Using relaxation techniques, a pregnant woman reduces her pain

during delivery of her baby.

3. Intellectual Dimension

 The ability to learn and use information effectively for personal, family,
and career development. Intellectual wellness means striving for
continued growth and being able to learn to deal with new challenges
effectively.

 It encourage stimulating and creative mental activities and the use of

available community resources to expand one’s knowledge and
increased the potential for sharing with others.
  The intellectual dimensions encompass cognitive abilities. Educational
background and past experience. These influence client’s response to
teaching about health and reactions to heath care during illness. They
also play a major role in health behaviors.

i.e. An elderly woman, who has only a third grade education who needs
teaching about complicated diagnostic tests.

A young college student with diabetes who follows a diabetic diet

but continues to drink beer and eat pizza with friends several times
a week.

4. Social Dimension

 The ability to interact successfully with people and within the environment
of which each person is a part. It is the ability to develop and maintain
intimacy with significant others and respect and tolerance for those with
different opinions and beliefs.

 It focuses on the interdependence with others nature, developments of

harmony in the family, and contribution to the welfare of the human and
environment community.

5. Occupational Dimension

 The ability to achieve a balance between work and leisure time.

 A person’s belief about education, employment, and home influence
personal satisfaction and relationships with others.
 It focuses on preparation for work that will produce personal satisfaction
and enrichment of life.

6. Spiritual Dimension

 The belief in some forces that’s serves to unite human beings. This force
can include nature, science, religion, or a higher power. It also includes a
person’s own morals, values and ethics.

 It provides meaning and direction in life and enables each person to grow,
learn, and meet new challenges.

 It is the ability to discover, articulate, and act on his basic purpose in life. It
involves seeking meaning and purpose in human life.

 These are important components of the way the person behaves in health
& illness.

i.e. Some religions require baptism for both livebirths and stillbirths.
Other religion opposed blood donation & transfusion.

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.

Notes: - The seven components of wellness overlap to some extent, and the
factors in one component often directly affect factors in another. Some of the
factors in one component are under the individual’s direct control, and some are
not. Example: A person who learns to control daily stress levels from a
physiological perspective is also helping to maintain the emotional stamina
needed to cope with a crisis. Wellness involves working on all aspects of the
model.
 - Health and wellness are not synonyms. Health refers simply to a
physical body being free from diseases, but wellness is an overall balance of
your physical, social, spiritual, emotional, intellectual, environmental, and
occupational well-being. Wellness is a lifestyle and is not an end to be achieved.
Wellness means that one strives for balance throughout his whole life. On the
other hand, health would be that a person wants to lose weight and lower blood
pressure. Once he does this, he is considered healthy. Health is a goal one can
achieve while wellness is a dynamic concept that continues for a lifetime.
-
(http://premierrapport.com/what-is-the-difference-between-health-and-
wellness)
-
MODELS OF HEALTH AND WELLNESS

Because health is a complex concept, various researchers have developed

models or paradigms to explain health and in some instances its relationship to
illness or injury. Models can be helpful in assisting health professionals to meet
the health and wellness needs of individuals.

1. Clinical Model

 The narrowest interpretation of health occurs in clinical model. People as

viewed as physiological systems w/ related functions, and health is
identified by the absence of signs and symptoms of disease or injury. It is
considered as the state of not being sick. In this model the opposite of
health is disease or injury.

 Many medical practitioners use the clinical model in their focus on the
relief of signs and symptoms of disease and elimination of malfunction and
pain. When the signs and symptoms are no longer present, the medical
practitioner considers the individual’s health restored.

2. Role Performance Model

 Health is the ability to fulfill societal roles, that is, to perform his or her
work.
 This means that an individual is healthy if he/she is able to do his/her
duties & responsibilities given to him/her in a particular field from which
he/she belongs.
 People who can fulfill their roles are healthy even if they have clinical
illness.
 e.g. A man who works all day at his job as expected is healthy even
though an x-ray of his lung indicates a tumor.
 In this model sickness is the inability to perform one’s work role.

3. Adaptive Model

 In adaptive model, health is a creative process; disease is a failure in

adaptation, or maladaptation. The aim of treatment is to restore the ability
of a person to adapt (to cope). Extreme good health is a flexible
adaptation to the environment.
 The focus of this model is stability, although there is an element of growth
and development.

4. Eudaemonistic Model

 This model incorporates a comprehensive view of health. Health is seen

as a condition of actualization or realization of a person’s potential.
Actualization is the apex of the fully developed personality, described by
Abraham Maslow.
 In this model the highest aspiration of people is fulfillment and complete
development, which is actualization.
  Illness in this model, is a condition that prevents self-actualization.

5. AGENT- HOST-ENVIRONMENT MODEL (also called the ecologic model)

This model is used primarily in predicting illness rather than in promoting

wellness, although identification of risk factors that result from interactions of
agent, host and environment are helpful in promoting and maintaining health. ‘

Three dynamic interactive elements:

1. Agent - any environmental factor or stressor ( biologic, chemical,

mechanical, physical, or psychosocial ) that by its presence or absence(
e.g. lack of essential nutrients) can lead to illness or disease.
2. Host – Person(s) who may or may not be at risk of acquiring a disease.
Family history, age, lifestyle habits influence the host reaction’s. The
physical or psychological situations or conditions putting people at risk for
illness.
3. Environment- all factors external to the host that may or may not
predispose the person to the development of the disease. Physical
environment include climate, living conditions, sound (noise) levels, and
economic level. Social environment include interactions with others and
life events, such as death of a spouse.

Notes: Agent-host-environment factors constantly interacts with the

others, health is an ever changing state. When the variables are in
balance, health is maintained; when variables are not in balance, disease
occurs.

6. Health – Illness Continua

 Health-illness continua (grids or graduated scales) can be 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. From
a high level of health a person condition can move through good health,
normal health, poor health, and extremely poor health, eventually to death.
 People move back and forth within this continuum day by day. There is no
distinct boundary across which people move from health to illness or from
illness back to health. How people perceive themselves and how others
see them in terms of health and illness will also affect their placement on
the continuum.

a. Dunn’s High-level Wellness Grid

 Dunn (1959) described a health grid in which a health axis and an
environmental axis intersect.
 The 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. The intersection of the two axes
forms 4 quadrants of health and wellness.

1. High-level wellness in a favorable environment – Ex. A person who

implements a healthy lifestyle behaviors and has the biopsychosocial,
spiritual, and economic resources to support this lifestyle.
2. Emergent high-level wellness in an unfavorable environment – Ex.
A woman who has the knowledge to implement healthy lifestyle practices but
does not implement adequate self-care practices because of family
responsibilities, job demands, or other factors.
 3. Protected poor health in a favorable environment – Ex. An ill person
(w/ multiple fractures or severe hpn) whose needs are met by the health care
system and who has access to appropriate medications, diet, and health
instructions.
4. Poor health in an unfavorable environment – Ex. A young child who
is starving in a drought-stricken country.

b. Illness-Wellness Continuum (Travis & Ryan, 2004)

 The illness-wellness continuum ranges from high-level wellness to

premature death.
 The model illustrates two arrows pointing in opposite directions and joined
at a neutral point. Movement to the right of the neutral point indicates
increasing levels of health and well-being for an individual. This is
achieved in (3) steps of wellness: awareness, education, & growth.

Awareness

 Seeing how you are presently conducting your life.

 Take charge of your own life and health by taking calculated risks or
recognition that you have a choice and carries with it the consequences of
those choices.

 Taking responsibility for choices which results in illness does not mean
taking on blame. With blame, you berate yourself for not learning a lesson
or burden yourself with guilt which created more stress. With
responsibility, you accept that you engineered your life situations, and that
you can change it as well. You open yourself to learn the valuable lessons
which consequences offer.

 Asserting your rights as consumer in the medical company, asking

questions, seeking other opinions, and accepting that you known better
than anyone else.

Education

 Exploring options; looking within and receiving others.

  “You don’t trust what you don’t know.” You can’t give what you
don’t have.”

 24-hours a day throughout your entire life you can make use of
your body’s built-in feedback system. Self-trust means learning
about how your body works, and at the same time loving and

respecting it for the magnificent and powerful creation it is. It means

at turning to the signs and signals, both internal & external. It also
includes listening to yourself to discover what you want to change.
Most imputably, it involves a new way of thinking based in the
knowledge that the only true healer is the one inside the skin, and
the realization that patience and compassion are the keywords in
the3 process.

 If we are to be well, we need to start listening to every cell in the

body, then provide it the best conditions possible so that it can
continue healing itself. Only the body heals itself.

Growth

 Trying out some options.

 The journey toward higher levels of wellness poses a similar challenge

and requires similar preparations. The equipment is less tangible, so it
may be easy to neglect what is most essential. In remembering
knowledge, self-trust, and perseverance, you might forget love &
compassion. Yet, these form the “knapsack” that carries all your
resources.

 All the things in the universe are connected. All the things in the body
are connected as well. There is simply no place where body start and
the mind stops; no place in the universe starts and the individual stops.

 In contrast, movement to the left of the neutral point indicates progressive

decreasing levels of health; from occurrence of signs, symptoms to
developing disability and ultimately if no treatment is done, leads to
premature death. It is possible to be physically ill and at the same time
oriented toward wellness, or be physically healthy and at the same time
function from an illness mentality.

High-level wellness is defined as an integrated method of functioning

which is oriented toward maximizing the potential of which the individual is
capable, within the environment where he is functioning.

c. The 4+ Model of Wellness (Baldwin & Conger, 2001)

 consists four domains of the inner self – physical, spiritual, emotional, and
intellectual plus the elements of the outer systems – environment, culture,
nutrition, safety, and many other elements. The health care provider
assesses the inner self for strengths and excesses, sources of nurturing
and of depletion.

7. Health Belief Models

 Help to determine whether an individual is likely to participate in disease

prevention and health promotion activities. These models can be useful
tools in developing programs for helping people w/ a healthier lifestyles
and more positive attitudes toward preventive health measures.
 a. Health Locus of Control Model

 This can be used to determine whether clients are likely to take action
regarding health, that is, whether clients believe that their health status is
under their own or others control.
 People who believe that they have a major influence on their own health
status that health is largely self-determined. People who exercise internal
control are more likely (than others) to take the initiative on their own
health care, be more knowledgeable about their health, make and keep
appointments w/ primary care providers, maintain diets, and give up
smoking. By contrast, people who believe their health is largely controlled
by outside forces.

b. Rosenstock’s and Becker’s Health belief Model

 Rosenstock (1950s) proposed a health belief model intended to predict

which individuals would or would not use preventive measures.
 Becker (1974) modified Rosenstock’s health belief model to include
individual perceptions, modifying factors, and variables likely to affect
initiating action.

Individual perceptions include:

 Perceived susceptibility – a family history of a certain disorder,
such as DM or heart disease, may make the individual feel at
increased risk. Awareness of personal high-risk lifestyle behaviors
also increases perceived susceptibility.
 Perceived seriousness – In the perception of an individual, does
the illness cause death or have serious consequences?
 Perceived threat – perceived susceptibility and perceived
seriousness combine to determine the total perceived threat of an
illness to a specific individual.

Modifying factors (factors that modify a person’s perceptions)

 Demographic variables – include age, sex, race and ethnicity
 Sociopsychological variables – social pressure or influence from
peers or other reference groups may encourage preventive health
behaviors even when individual motivation is low.
 Structural variables – knowledge about the target disease and
prior contact w/ it are structural variables that are presumed to
influence preventive behavior.
 Cues to action – cues can be either internal or external. Internal
cues include feelings of fatigue, uncomfortable symptoms, or
thoughts about the condition of an ill person who is close.

Likelihood of action (The likelihood of a person taking recommended

preventive health action depends on the perceived benefits of the action
minus the perceived barriers to the action.)
 Perceived benefits of the action – examples include that in order
to prevent lung CA one refrains from smoking, and to maintain
weight, one eats nutritious foods and avoid snacks.
 Perceived barriers to action – examples include cost,
inconvenience, unpleasantness, and lifestyle changes.
8. Yin and Yang

 The Chinese define health as a flow of energy called Yin and Yang

YIN YANG
= negative = positive
= dark = light
= cold (contraction) = warm (expansion)
= female (feminine principle) = male (masculine principles)
= outside of the body surface = inside of the body
= font of the body = back of the body
= receptive female = creative male

Yin Yang
Compassion + knowledge = wholeness
Harmony will of “TAO”

Any imbalance between Yin and Yang = disease

“Tai chi” ------ “Tao”

supreme ultimate

 Chinese seek health through ACCUPUNCTURE, MASSAGE, SPIRITUAL

HEALING, HERBS, MEDICATION, AND PHILOSOPHY

 Blood tests are prohibited because blood is thought to provide

strength and it is irreplaceable.

9. Iceberg Model

The individual’s current state of health – is it one of disease or vitality – is

just like the tip of an iceberg.

 This is the apparent part – what shows; your present health condition,
whether you are fat or slim, or whatever.
  If you do not like it, you can attempt to change it. But whenever you
knock some off, more of the same comes up to takes its place.

 Underneath this tip is the remaining parts of the iceberg, which are not
seen above the water. Similarly with individual’s state of health, to be
to understand all that creates and supports the health status of the
individual, you have to look underwater, to see the other levels.

 The first level is the Lifestyle /Behavioral level – this includes the
following:

a. What food you eat

b. How you use and exercise your body
c. How you relax & let go of stress
d. How you safeguard yourself form the different hazards around
you.

 Many of us allow lifestyles that we know are destructive to us & to our

environment. Yet, we may feel powerless to control or change them.
To understand why, we must look deeper, to the next level is – the
Psychological / Motivational Level which indicates the following:

a. What moves us to lead the lifestyle we have chosen?

b. What payoffs we get from being overweight, smoking, reckless
driving, or eating well, being considerate to others, getting
regular exercise.

 The deepest level is the Spiritual/Being/Meaning Level. This may

transpersonal, philosophical or metaphysical aspects of an individual. It
may be called a REALM because it has no clear boundaries. It also
includes the following:

a. Mystical & mysterious and everything else in the unconscious

b. mind,
c. Concerns such issues as your reason for being.
d. The real meaning of your life,
e. Your place in the universe.
 Ultimately, this realm determines whether the tip iceberg, representing
your state of health, is one of diseases or wellness.

ILLNESS
 Highly personal state in which the person’s physical, emotional
intellectual, social, developmental or spiritual functioning is thought to be
diminished.
 It is not synonymous with disease and may or may not be related to
disease. An individual could have a disease and not feel ill. Illness is
highly subjective; only the individual person can say he or she is ill.

 A state in which someone's needs are not sufficiency met you to allow the
individual to have a sense of physical & psychological well being.

 Response of the person to a disease; it is an abnormal process in which

the person’s level of functioning is changed.

DISEASE
 Refers to an alteration in body function resulting in a reduction of
capacities or a shortening of the normal life span
 Medical term meaning there is a pathologic change in the structure or
function of the body and mind.
ILLNESS BEHAVIOR
 A coping mechanism, involves ways individuals describe, monitor, and
interpret their symptoms, take remedial actions and use the health care
system.
 How people behave when they are ill is highly individualized and affected
by many variables, such as age, sex, occupation, socioeconomic status,
religion, ethnic origin, psychological stability, personality, education and
modes of coping.

STAGES OF ILLNESS

Suchman (1979) described (5) stages of illness:

 Not all clients progress through each stage. For ex., the client who
experiences heart attack is taken to the emergency department and
immediately enters stages 3 & 4, medical care contact & dependent client
role. Other clients may progress through only the first two stages and then
recover.

1. Symptom Experience

It is transition stage during which people come to believe that something is

wrong. Either significant person mentions that they look ill or people experience
some symptoms, which can appear insidiously.

It has (3) aspects:

1. Physical experience of symptoms

2. Cognitive aspects – interpretation of symptoms/evaluation of changes
3. Emotional response ( e.g. fear of anxiety )

The person is aware that something is wrong, usually recognizes a physical

sensation or limitation in functioning, but does not suspect a specific diagnosis.

During this stage, the ill person usually consults others close to them about their
symptoms or feelings, validating with support people that the symptoms are real.
They try home remedies for possible relief of symptom. If self-management is
ineffective, the individual enters the next stage.

2. Assumption of the Sick Role

It signals the acceptance of the illness. They decide that the symptoms or
concerns are sufficiency severe to suggest that they are sick.

If the symptoms persist and become severe, they assume the sick role.
Sick people seek confirmation from the family and social groups that they are
indeed ill and that they be excused from normal duties and responsibilities.

Some seek professional help quickly; other continues self-treatment, often

following the suggestions of family and friends.

They are usually afraid but they now accept that they are ill even though
they may not be able to accept possible reasons.

At the end, they experience one or two outcomes. They may find the
symptoms have changed and that they feel better, if the family member support
the perceptions of such persons, they are no longer considered or consider
themselves sick. Then, they will resume normal obligations. When symptoms of
illness persist, the person is motivated to seek professional help.

3. Medical Care Contact

 If, however, the symptoms persist or increase and if lack of improvement
is validated by the family or significant others, then they know they should seek
some treatment.

Sick people seek the advice of a health professional either on their own
initiative or advice of significant others.
They ask for (3) types of information.
1. Validation of real illness
2. Explanation of the symptoms in understandable terms.
3. Reassurance that they be all right or prediction of what the outcome will
be.
The client may accept or deny the diagnosis. If the diagnosis is accepted, the
client usually follows the prescribed treatment plan. If the diagnosis is not
accepted, the client may seek the advice of other health care professionals who
will provide a diagnosis that fits the client’s perceptions.

4. Dependent Patient Role

When a health professional has validated that the person is ill, the
individual becomes a client, dependent on the professional for help.

They may or may not be reluctant to accept a professional’s

recommendations, or alternately suggestions.

They become more passive and accepting. They accept care, sympathy,
and protection from the demands and stresses in life. They can adopt the
dependent role in a hospital, at home or in a community setting. They must also
adjust to the disruptions of daily schedule.

Some regress to an earlier behavioral stage in their development.

Dependence needs vary with individuals; some may meet needs that never been
met, others have a minimal needs and do everything possible to return to
independent functioning and few may even try to maintain independence.

5. Recovery or Rehabilitation

They learn to give up the sick and returns to former roles and functions.
Readiness for social functioning may not coincide with physical readiness.
This stage can arrive suddenly, such as when the symptoms disappeared.
However, in the case of chronic illness, the final stage may involve an adjustment
to a prolonged in health and functioning. People who have long-term illnesses
and must adjust their lifestyle may find recovery more difficult. For clients with
permanent disability, this final stage may require therapy to learn how to make
major adjustments in functioning.

Reference used for revision:

 Berrnan, A. & Snyder, S. (2012). Kozier and Erb’s Fundamentals

of Nursing: Concepts, Process and Practice. 9th ed. Singapore:
Pearson Education, Inc.