1. Concept of Health Wellness
and Illness
Prepare by
Chanak Trikhatri
B.Sc.N, MA (Sociology), MN (Advance Adult Health/Medical
Surgical ), RN
Department of Medical Surgical Nursing
NMCTH
2. Health
• There is no consensus (agreement) about any
definition of health. There is knowledge of
how to attain(reach) a certain level of health,
but health itself cannot be measured.
• Traditionally health has been defined in terms
of the presence or absence of disease.
Nightingale defined health as a state of being
well and using every power the individual
possesses to the fullest extent
3. Health Definition
• State of being well and using every power the individual
possesses
• "Health is a state of complete physical, mental, and social
well-being and not merely the absence of disease" (WHO,
1974)
• "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)
• Most individuals define health as the following:
– being free of symptoms of disease and pain as much as possible
– being able to be active and able to do what they want or must do
– being in good spirits most of the time
4. Contd…
• Health is a dynamic state that continually change
as a person adapts to changes in the internal and
external environment. Illness is an abnormal
process in which functioning of a person is
diminished or impaired in one or more
dimensions.
• H.S. Hayman defines “health as a state of feeling
should in body, mind and spirit, with a sense of
reserve power”
• Health is a function of adjustment as adaptation
(R. Dubois)
5. The American Nurses Association
Defined Health
A dynamic state of being in which the
developmental and behavioral potential (possible)
of an individual is realized to the fullest extent
possible
6. Some Philosophy regarding Health
• Health is a fundamental human right
• Health is the essence of productive life, and not the
result of ever increasing expenditure of medical care
• Health is inter-sectoral
• Health is an integral part of development
• Health is in central to the concept of quality of life
• Health involves international responsibility and
individual state
• Health and its maintenance is a major social investment
• Health is world wide social goal
7. View’s on Health
• Biomedical scientists: they stress mainly on germ
theory that is they believe disease occur as a
result of microorganisms’ invasion. Their thought
is rejected as it doesn’t solve some major health
problems as malnutrition, accidents mental illness
• Ecologists: they view health as a harmonious
equilibrium between man and his environment.
Disease is said to be the individuals’
maladjustment to his environment
8. Contd…
• Sociologists: they believe health is not only
biomedical phenomenon but is also influenced
by social, psychological, cultural, economical
and political factors
• Holistic View: this view is synthesis of views
of all experts. This views health as a
multidimensional process involving well-being
of the whole person in the context of his
environment
9. Various Model of Health
Health and illness are complex that is dynamic. A model
is theoretical way of understanding a complex
phenomenon. Health models help to understand client’s
health behavious and belief so that effective health care
can be provided. Health models helps nurses to
understand the relationship between health of the client
and various variables affecting it such as nutrition, life
style, health practice etc.
Model represent various ways of approaching complex
wishes. Models of health and illness contain a
combination of biological characteristics behavioural
factors and social conditions.
10. Contd…
• Health – illness continuum model
• High level wellness model
• Agent – host environment model
• Health belief model
• Holistic health model
• Health promotion model
12. Health-Illness Continuum
• Measure person’s perceived level of wellness
• Health and illness/disease opposite ends of a
health continuum
• Move back and forth (forward) within this
continuum day by day
• Wide ranges of health or illness
13. Contd…
• Health and illness can be viewed as the opposite
ends of a health continuum
• From high level of health a person’s condition can
move through good health -- normal health --
poor health -- extremely poor health -- to death.
• People move back and forth within this
continuum day by day.
• How people perceive themselves and how others
see them in terms of health and illness will also
affect their placement on the continuum.
14. Characteristics of Health-Illness
Continuum Model
• At any time any person’s health status holds a
place on certain point between two ends of
health-illness continuum
• Any point on the health-illness continuum is a
synthetically representation of various aspects
of individual in physiology, psychology and
society.
15. Nurses Responsibilities
• To help the client to identify their place on the
health-continuum.
• To assist the clients to adopt some measures in
order to reach a well state of health.
17. Contd…
• Composed of two arrows pointing in opposite
directions and joined at a neutral point
1.Movement to the right on the arrows (towards
high-level wellness) equals an increasing level of
health and well-being
Achieved in Three Steps:
a. Awareness
b. Education
c. Growth
18. Contd…
2. Movement to the left on the arrows (towards
premature death) equates a progressively
decreasing state of health
Achieved in Three Steps:
a. Signs
b. Symptoms
c. Disability
19. Contd…
3. Most important is the direction the individual
is facing on the pathway
a. If towards high-level health, a person has a
genuinely optimistic or positive outlook
despite his/her health status
b. If towards premature death, a person has a
genuinely pessimistic or negative outlook
about his/her health status
20. Contd…
4. Compares a treatment model with a wellness model
a. If a treatment model is used, an individual can move
right only to the neutral point
Example: a hypertensive client who only takes his
medications without making any other life-style
changes
b. If a wellness model is used, an individual can move
right past the neutral point
Example: hypertensive client who not only takes his
medications, but stops smoking, looses weight, starts
an exercise program, etc.
21. High Level of Wellness Model
It shows a method of functioning oriented towards maximizing
the potential of an individual while maintaining balance and
purposeful direction with environment. This is holistic in
nature. It allows nurse to care for individual with regard to all
dimensional factors. It emphasizes health promotion and
illness prevention rather than only treatment. It defines process
that help individual to know who and what he/she is
• Being- recognizing self as separate and individual
• Belonging- being part of a whole
• Becoming- growing and developing
• Befitting- making personal changes to belief the self for the
future
22. Contd…
• Dun (1961), recognizes health as an ongoing
process toward a person’s highest potential of
functioning. This process involves the person,
family and the community.
• It describe high level wellness as the
experience of a person alive with the glow of
good health, alive to the tips of their fingers
with energy to burn, tingling with vitality at
times like this the world is a glorious place
23.
24. Contd
• Two axes
– X- axis is health: it extends from peak wellness to
death
– Y- axis is environment: it extends from very
favorable environment to very unfavorable
environment
25. Contd…
• Quadrant 1
– High-level wellness in favorable environment e.g., a person who implements
healthy life- style behaviors and has the biopsychosocialspiritual resources to
support this life-style
• Quadrant 2
– Protected poor health in favorable environment e.g., an ill person whose needs
are met by the health care system and who has access to appropriate
medications, diet, and health care instruction
• Quadrant 3
– Poor health in unfavorable environment e.g., a young child who is starving in a
drought ridden country
• Quadrant 4
– Emergent high level wellness in unfavorable environment e.g., a woman who
has the knowledge to implement healthy life-style practices but does not
implement adequate self-care practices because of family responsibilities, job
demands, or other factors
26. Contd…
• Encourages the nurse to care for the total person
• Involve functioning to one’s maximum potential
while maintaining balance and a purposeful
direction
• Regards wellness as an active state oriented
toward maximizing the potential of the individual,
regardless of his or her state of health
• Incorporates the processes of being, belonging,
becoming and befitting
27. Agent-Host-Environment Model
• Each factor constantly
interacts with the others
• When in balance, health is
maintained
• When not in balance,
disease occurs
• Used primarily in
predicting illness rather
than promoting wellness
• Model is composed of
three dynamic, interactive
elements
28.
29. Contd…
• By Leavell and Clark (1965)
• Useful for examining causes of disease in an individual
• The agent, host and environment interact in ways that create
risk factors and understanding these are important for the
promotion and maintenance of health
• An agent is an environmental factor or stressor that must be
present or absent for an illness to occur
• A host is a living organism capable of being infected or
affected by an agent
• The host reaction is influenced by family history, age, and
health habits
• The environment is the situation of circumtances where host
live
31. Health Belief Model by Rosentock
• Based on motivational theory
• Concerned with what people perceive about
themselves in relation to their health
• Consider perceptions (influences individuals
motivation towards results)
– Perceived susceptibility
– Perceived seriousness
– Perceived benefit out of the action
32. Contd…
• modifying factors (factors that modify an individual’s perceptions), e.g.:
1. Demographic variables e.g., age, gender, race, ethnicity, etc.
2. Sociopsychologic variables e.g., personality, social class, peer and
reference group pressure, etc.
3. Structural variables e.g., knowledge about the disease,
prior contact with the disease, etc.
4. Cues to action e.g., mass media campaigns, advice from others,
reminder postcard from a physician or dentist, illness of family
member or friend, newspaper or magazine article
• Likelihood of action
1. Perceived benefits of the action MINUS
2. Perceived barriers to action EQUALS
34. Holistic Health Model
• A comprehensive view of the person as a bio
psychosocial and spiritual being and sometime holistic
health model is said to be alternative medicine
• The holistic health care model comes from a variety of
scientific philosophical, social bases that describe
similar phenomenon
• The model empower the patients to engage in their own
healing power which comprises of concepts of energy,
holism, the mind body connection, and balance in order
to expand the definition of health
35. Contd…
• The holistic health model uses the different
techniques that in the past the health community
viewed as experimental or alternative
• Alone it is realized that personal health choice has
intensive and powerful impact of an individual
health
• Some of widely used holistic interventions
include aromatherapy, meditation, music therapy,
and relation therapy, therapeutic touch, applied in
health care setting such as meditation, breathing
exercise
37. Contd…
• Model is proposed by Pender (1996)
• It define health as a positive, dynamic state, not merely
the absence of disease
• The model was proposed as a framework for integrating
the perspectives of nursing and behavioural science and
the factors that influence health behaviour
• Health promotion is desire to increase well-being and
actualize human health potential, whereas health
protection is behaviour that is motivates by a desire to
avoid illness, detect it early or maintain function within
the constraints of an illness
38. Contd…
• The model describe the multidimensional
nature of people as they interact in their
environment to pursue health
• The model emphasize on the three function of
patient’s cognitive perceptual
– Individual characteristics experiences
– Behaviour specific cognitions and affect
– Behavioural outcome
39. .
Other Models of Health
• Clinical Model
• Role Performance Model
• Adaptive Model
• Eudemonistic Model
40. Clinical Model
• Provides the narrowest interpretation of health
• People viewed as physiologic systems
• Health identified by the absence of signs and
symptoms of disease or injury
• State of not being “sick”
• Opposite of health is disease or injury
41. Role Performance Model
• Ability to fulfill societal roles
• Healthy even if clinically ill if roles fulfilled
• Sickness is the inability to perform one’s role
42. Adaptive Model
Creative process
Disease is a failure in adaptation or
maladaption
Extreme good health is flexible adaptation to
the environment
Focus is stability
The aim of treatment is to restore the ability of
the person to adapt.
43. Copyright 2008 by Pearson Education, Inc.
Eudemonistic Model
• Comprehensive view of health
• Condition of actualization (make real) or
realization of a person’s potential
• Illness is a condition that prevents self-
actualization
• Actualization is the apex of the fully
developed personality
Dictionary:
• eudemonism: morality evaluated according to
happiness
44. Wellness
• Wellness is an active dimensional process of becoming
aware of making choices towards higher level of well-
being and towards a more successful existence
• Wellness further describes health status. It allows health
to be placed on a continuum from one’s optimal level
(“wellness”) to a maladaptive state (“illness”)
• Wellness is a developing awareness that there is no end
point but that health and happiness are possible in each
moment here and now
• It is holistic concept, looking at the whole person, not just
their blood pressure, body fat, exercise behaviour or what
a person had lunch and involves all possible dimension
45. Contd..
The state of being in good health, especially as an
actively pursued goal, measures of a patient’s progress
toward wellness. The health system focused on
wellness not sickness
Wellness is a dynamic process that is ever changing.
The well person usually has some degree of illness and
the ill person usually has some degree of wellness.
This concept of a health continuum negates the idea
that wellness and illness are opposite because they may
occur simultaneously in the same person in varying
degrees
46. Well-being
“Well-being is a subjective perception of vitality
(energy) and feeling well. It can be described
objectively, experienced, and measured and can
be plotted ( design) on a continuum.” It is a
component of health. .Well being is vitality
considered as a subjective perception of balance
harmony and stability. It is state rather than a
process
48. 1. Physical
• The ability to carry out daily tasks, achieve
fitness (e.g. pulmonary, cardiovascular,
gastrointestinal), maintain adequate nutrition
and proper body fat, avoid abusing drugs and
alcohol or using tobacco products, and
generally to practice positive lifestyle habits.
49. 2. Social.
• The ability to interact successfully with people
and within the environment
50. 3. Emotional.
• The ability to manage stress and to express
emotions appropriately, Emotional wellness
involves the ability to recognize, accept, and
express feelings.
51. 4. Intellectual.
• The ability to learn and use information
effectively for personal, family, and career
development
52. 5. Spiritual.
• The belief in some force (nature, science,
religion, or a higher power) that serves to unite
human beings and provide meaning and
purpose of life
53. 6. Occupational.
• The ability to achieve a balance between work
and leisure time, A person's beliefs about
education, employment, and home influence
personal satisfaction and relationships with
others.
54. 7. Environmental.
• The ability to promote health measures that
improve the standard of living and quality of
life in the community
55. Component of High Level of
Wellness
• High level of esteem and positive outlook
• A foundation philosophy and a sense of purpose
• A strong sense of personal responsibility
• A good sense of human and plenty of fun in life
• A concern for others and respect for the
environment
• A conscious commitment to personal excellence
• A sense of balance and an integrated lifestyle
56. Contd….
• Freedom from addictive behaviour or negative
health inhibiting nature
• A capacity to cope with whatever life presents
and to continue to learn
• Highly conditioned and physically fit
• A capacity to love and an ability to nature
• A capacity to manage life’s demands
• A capacity to communicate effectively
58. 1. Internal factors
–Biologic dimension genetic makeup, sex,
age, and developmental level all
significantly influence a person's health.
–Psychological dimension emotional factors
influencing health include mind-body
interactions and self-concept.
–Cognitive dimension include lifestyle
choices and spiritual and religious beliefs.
59. 2. External factors
• Environment.
• Standards of living. Reflecting occupation, income,
and education.
• Family and cultural beliefs. Patterns of daily living
and lifestyle to offspring( children).
• Social support networks. Family, friends, or confidant
(best friend) and job satisfaction helps people avoid
illness.
60. Health Care Adherence
• Adherence (obedience) : is the extent to
which an individual's behavior for example,
taking medications, following diets or making
lifestyle changes. Degree of adherence may
range from disregarding (ignoring) every
aspect of the recommendations to following
the total therapeutic plan.
61. Disease
• Disease can be described as an alteration in
body functions resulting in a reduction of
capacities or shortening of the normal life
span.
• The causation of a disease is called its
etiology.
62. Illness
Illness: Is a highly personal state in which
the person's physical, emotional,
intellectual, social, developmental, or
spiritual functioning is thought to be
diminished. Illness is usually associated
with disease but may occur independently
of it. Illness is a highly personal state in
which the person feels unhealthy or ill.
63. Contd…
• Illness is an abnormal process in which any aspect of a
person’s functioning is diminished or impaired as compared
with his previous condition.
• Illness not only refers to the presence of specific disease, but
also to the individual perception and behavour in response to
the disease as well as the impact of the disease on the
psychosocial environment
• Illness is subjective state of the person who feels aware of not
being well. It is just opposite to health. It goes through certain
stages which may occur slowly and are highly individualized.
Main stages of illness are:
– Transition from health to illness
– Acceptance of illness
– Convalescence
64. Transition from Health to Illness
This stage starts when person considers that he
or she might be ill ad ends when others
acknowledge that the person is ill. Illness may
begin with vague, nonspecific symptoms that a
person initially attempts to deny. The symptoms
is a subjective indication of organic or psychic
malfunctioning or changes in a person’s
condition that indicates some physical or mental
state of disease
65. Contd…
When symptoms persists a person may seek
medical consultation but still not admit to being
ill.
– Recognition of symptoms (unpleasant sensations)
pain, fever, rashes, indigestion etc.
– Loss of energy/stamina or feeling or weakness
– Decreased ability of function
– Fear of diagnosis or treatment
66. Acceptance of Illness
This stage occurs as the person stops denying illness and takes on
a ‘sick role.’ This stage may be a tie of considerable physiologic
and psychological dependence, when the ill person becomes
unusually focused on the self.
– Define himself/herself as being sick
– Seeks validation of this experience from others
– Gives up normal activities and assumes sick role
– On the basis of health belief and practice, the person may
choose to do nothing, takes medication to relieve symptoms
and seeks medical care
– Expresses anger, guilt towards own illness
– Accepts the diagnosis
– Increase dependency
67. Convalescence
As convalescence takes place a person passes
through a transition from illness to health. Usually
resolution of physical illness proceeds the
individual’s return to normal psychological and
functioning. The person new sense of worth and
reduce anxiety enable him/her again to use those
abilities typical of health.
– Recovery and rehabilitation
– Gives up dependent role
– Resumes normal activities and responsibilities
68. Task of Convalescence
During this period of convalescence there is a
great need of psychological adjustment.
Following are the tasks which completed to
return the previous state
• Reassessment of life’s meaning
• Reintegration of body image
• Resolution of role change
69. There are many ways to classify illness
and disease:
• Acute illness is typically characterized by
severe symptoms of relatively short duration.
• A chronic illness is one that lasts for an
extended period, usually 6 months or longer,
and often for person's life.
70. There are several approaches to health
maintenance:
• Health promotion
• Health protection
• Disease prevention
71. Suchman Describes Five Stages of Illness
• Stage 1 symptoms experiences.
• Stage 2 assumption of the sick role
confirmation from family and friends.
• Stage 3 medical care contact.
• Stage 4 dependent client role.
• Stage 5 recovery or rehabilitation.
72. Eleven Stages of Illness
Igun proposed eleven stage of illness
1. Symptoms experience
a. Experiencing the actual symptoms
b. Becoming aware that there may be a problem
c. Giving label and meaning to the symptoms
d. Responding with fear or anxiety
2. Self treatment
3. Communication significant with others
4. Assessment of symptoms
5. Assumption of the sick
6. Expression of concern
7. Assessment of probable efficacy of treatment or appropriateness of treatment
sources
8. Selection of treatment plan
9. Implementation of treatment
10. Evaluation of the effects f the treatment
11. Recovery or rehabilitation
73. Impact of Illness
On the Client
• Behavioral and
emotional changes
• Loss of autonomy
• Self-concept and body
image changes
• Lifestyle changes
On the Family
• Depends on:
– Member of the family
who is ill
– Seriousness and length
of the illness
– Cultural and social
customs the family
follows
74. Impact of Illness: Family Changes
Role changes
Task reassignments
Increased demands on time
Anxiety about outcomes
Conflict about unaccustomed responsibilities
Financial problems
Loneliness as a result of separation and pending loss
Change in social customs
