CONCEPT OF HEALTH & WELLNESS

Health

• Traditionally health has been defined in the term of the Presence or absence of disease.
• A series of successful and continuous adaptation to a continuously changing environment.
• The conditions of being sound in body, mind or spirit and especially free from physical disease or pain (Webster).
• Soundness of body or mind; that condition in which their functions are duly and efficiently discharge (Oxford English Dictionary).
• "A state of relative equilibrium of body, form and function which result from its successful dynamic adjustment to forces tending to disturb it. It is not passive interplay between body substance and forces impinging upon it but an active response of body forces working towards readjustment." (Perkin)
• According to the Nightingale – "Health is a state of being well and using every power of the individual processes to the fullest extent.
• According to the WHO "Health is a state of complete physical, mental, and social well-being and not merely the absence of disease"
  • These are four aspects or dimensions emerge - (a) Physical (b) Mental (c) Social and spiritual.
    • Physical well-being means having the physical strength, endurance and energy to work towards your goals.
    • Mental well-being is ability to cope with the world in a way that brings you satisfaction;
    • Social well-being means development of relationships with others – both with people in your immediate surroundings and with the larger community through cultural, spiritual and political activities.
• "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 on health need of U.S.)
• According to the ANA – "health is a dynamic state of being in which the developmental and behavior potential of an individual is realized to the fullest extent possible."
• 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

Concepts of Health

• The new concepts are bound to emerge based on new patterns of thought. The changing concept of health is mainly of four types:

Biomedical Concept

• Traditionally health has been viewed as "absence of disease" if one person is free from disease, s/he is considered as healthy. This concept is known as "Biomedical Concept", it has basis is germ theory of disease.
• The medical profession viewed the human body as a machine, disease because of the breakdown of the machine and one of the Doctor's tasks as repair of machine. Thus, health in a narrow view became ultimate goal of medicine.
• The limitation of this concept is that, it has minimized the role of environmental, social, psychological and cultural determinants of health.

Ecological Concept

• The ecologist put forward another hypothesis, which viewed health as a dynamic equilibrium between man and his environment, and disease as a maladjustment of the human organisms to the environment.
• Ecological and cultural adaptations determine not only the occurrence of disease but also the availability of food and the population explosion.
• History argues that improvement in human adaptation to natural environment can lead to longer life expectancies and a better quality of life.
• The concept supports the need for clean air, safe water, ozonic layer in the atmosphere, etc. to protect us from exposure to unhealthy factors.

Psycho social Concept

• Contemporary developments in social sciences revealed that health is not only a biomedical phenomenon, but also one, which is in the need by social psychological, cultural, economic and political factors of the people concerned. Health is both a biological and social phenomenon.

Holistic Concept

• Holism means viewing a person's health as a balance of body, mind, and spirit. Treating only the body will not necessarily restore optimal health. In addition to physical needs, nurses must also consider clients' psychological, sociocultural, developmental, and spiritual needs.
• Holistic model is a synthesis of biomedical & ecological model & psychosocial concept. It recognizes the strength of social, economic, political and environmental influence on health.
• It has been defined as unified or multidimensional process involving the well-being of the whole person in the context of his environment.
• Holistic concept implies that, all sectors of society have an effect on health, in particular, agriculture, animal husbandry, food, industry, education, housing, public works, communications and health sectors the emphasis is on promotion and protection of health.

Wellness

• Wellness is a state of well-being. It is an active process by which an individual progresses towards maximum potential possible, regardless of current state of health.
• Basic aspects include:
  • Self-responsibility
  • An ultimate goal
  • A dynamic, growing process
  • Daily decision-making in areas related to health
  • Whole being of the individual

Components of Wellness

1. physical, e.g.:
   1. ability to carry out daily tasks.
   2. achieve fitness
   3. maintain nutrition and proper body fat
   4. avoid abusing drugs, alcohol, or using tobacco products
   5. generally to practice positive life-style habits
2. social, e.g.:
   1. ability to interact successfully with people and within the environment of which each person is a part
   2. develop and maintain intimacy with significant others
   3. develop respect and tolerance for those with different opinions and beliefs
3. emotional, e.g.:
   1. ability to manage stress and express emotions appropriately
   2. ability to recognize, accept, and express feelings
   3. ability to accept one's limitations
4. intellectual, e.g.:
   1. ability to learn and use information effectively for personal, family, and career development
   2. striving for continued growth and learning to deal with new challenges effectively
5. spiritual, e.g.:
   1. belief in some force (nature, science, religion, or a "higher power") that serves to unite human beings and provide meaning and purpose to life
   2. includes a person's morals, values, and ethics
6. occupational
   1. ability to achieve a balance between work and leisure time
   2. beliefs about education, employment and home influence personal satisfaction and relationships with others
7. environmental
   1. ability to promote health measures that promote the standard of living and quality of life in the community
      1. influences include:
         1. food
         2. water
         3. air

Modal of health care

Health model is a complex concept that is gives the explanations and relationship between the health and illness or injury. These models can be helpful in assign the need of health and wellness.

Clinical model (M.B. Belloc & L. Breslo, 1972)

• The clinical model is narrowest interpretation of health. It is a medically oriented model.
• According to the model –
  • Health is seen as freedom from disease
  • Illness is seen as the presence of disease

Role performance model (Parsons, 1958)

• Health is defined in term of the individual ability to perform work, which is fulfil the societal roles.
• According to the model –
  • Health is seen as the ability to fulfill societal roles
  • Illness is seen as the inability to fulfill societal roles

Adaptive model

• This model is biased on the ability to adapt to the environment and interact with it.
• According to the model –
  • Health is seen as adaptation
  • Illness is seen as a failure of adaptation, or maladaptation

Eudemonistic model

• The Eudemonistic model is the most comprehensive, holistic, view of health.
• According to the model –
  • Health is actualization or realization of one's potential
  • Illness is seen as the failure to actualize or realize one's potential

Agent-Host-Environment Model

• The agent host environment model describes the cause of illness. It is used primarily in predicting illness rather than promoting wellness
• The model is composed of three dynamic, interactive elements –
  • Agent
  • Host
  • Environment

The Agent-Host-Environment triangle

Ecological model of health equilibrium

• The agent - Any factor or stressor. It can be biological, chemical, physical, mechanical, and psychosocial
• The host- Living beings (e.g., human or animal)
• Environment - This includes all the external factors that make illness more or less likely to occur.
• According to the model the health and illness -
  • Health is seen when all three elements are in balance
  • Illness is seen when one, two, or all three elements are not in balance

Health-illness continua

• Measure person's perceived level of wellness
• Health and illness/disease opposite ends of a health continuum
• Move back and forth within this continuum day by day
• Wide ranges of health or illness

Dunn's High-Level Wellness Grid

• composed of two axis's
  • a health axes which ranges from peak wellness to death
  • a environmental axes which ranges from very favorable to very unfavorable
• the two axis's form four quadrants
  • high-level wellness in a favorable environment
    • e.g., a person who implements healthy life-style behaviors and has the biopsychosocialspiritual resources to support this life-style
  • emergent high-level wellness in an 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
  • protected poor health in a 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
  • poor health in an unfavorable environment
    • e.g., a young child who is starving in a drought ridden country

Travis' Illness-Wellness Continuum

• composed of two arrows pointing in opposite directions and joined at a neutral point
  • movement to the right on the arrows (towards high-level wellness) equals an increasing level of health and well-being
    • achieved in three steps:
      • awareness
      • education
      • growth
  • movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health
    • achieved in three steps:
      • signs
      • symptoms
      • disability
• most important is the direction the individual is facing on the pathway
  • if towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status
  • if towards premature death, a person has a genuinely pessimistic or negative outlook about his/her health status
• compares a treatment model with a wellness model
  • if a treatment model is used, an individual can move right only to the neutral point
    • e.g., a hypertensive client who only takes his medications without making any other life-style changes
  • if a wellness model is used, an individual can move right past the neutral point
    • e.g., a hypertensive client who not only takes his medications, but stops smoking, looses weight, starts an exercise program, etc.

Rosenstock/Becker's Health-Belief Model

• Health belief model proposed Rosenstock (1974). It is biased on what people perceived or believe to be true about them in relation to health. The health belief model is based on motivational theory.
  • It is composed of three components:
    

Individual perceptions

• Perceived susceptibility - A family history of a certain disorder, such as diabetes or heart disease, may make the individual feel at high risk.
• Perceived seriousness - In the perception of the individual, does the illness cause death or has serious consequences? For example - the spread of acquired immune deficiency syndrome (AIDS) reflects the general public's perception of the seriousness of this illness.
• Perceived threat - perceived susceptibility and perceived seriousness combine to determine the total perceived threat of an illness to a specific individual. For example, a person who perceives that many individuals in the community have AIDS may not necessarily perceive a threat of the disease; if the person is a drug addict or a homosexual, however, the perceived threat of illness is likely to increase because the susceptibility is combined with seriousness.

Modifying Factors

• Demographic variables - Demographic variables include age, sex, race, and ethnicity. For example, infant does not perceive the importance of a healthy diet; an adolescent may perceive peer approval as more important than family approval and as a consequence may participate in hazardous activities or adopt unhealthy eating and sleeping patterns.
• Sociopsychologic variables - Social pressure or influence from peers or other reference groups (e.g., self-help or vocational groups) may encourage preventive health behaviors even when individual motivation is low. Expectations of others may motivate people. For example, not to drive an automobile after drinking alcohol.
• Structural variables - Knowledge about the target disease and prior contact with 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.
  • External cues are 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

• The likelihood of a person's 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 refraining from smoking to prevent lung cancer, and eating nutritious foods and avoiding snacks to maintain weight.
  • Perceived barriers to action - Examples include cost, inconvenience, unpleasantness, and lifestyle changes.

Variables influencing health status, belief, and practices

Variables are following –

• Internal Variables
  • Biologic dimension
    • genetic makeup
    • age
    • sex
    • developmental level
    • race
  • Psychological or Emotional dimension
    • Mind-body interaction
    • Self-concept and self-perception
  • Cognitive or Intellectual dimension
    • Life style
    • Spiritual and religious beliefs and values
• External variables
  • Environmental
    • Geographical location
    • Housing
    • Sanitation
    • Climate
    • Pollution of air, food, water
  • Standard of living
    • Class of family
    • Occupation
    • Economic levels
    • education
  • family and cultural belief's
    • pattern of daily living
  • social dimension
    • Social network (Family, Friends )
    • Job satisfaction

Health Care Adherence

• Adherence is the extent of which an individual's behavior coincides with medical or health advice. ( for example, taking medications, following diets, or lifestyle changes)

Factors influencing Adherence

• Client motivation to become well
• Degree of lifestyle change necessary
• Perceived severity of the health care problem
• Value placed on reducing the threat of illness
• Difficulty in understanding and performing specific behaviors
• Degree of inconvenience of the illness itself or of the regimens
• Beliefs that the prescribed therapy or regimen will or will not help
• Complexity, Side effects, and duration of the proposed therapy
• Specific Cultural heritage that may make adherence difficult
• Degrees of satisfaction and quality and type of relationship with the health care providers
• Overall cost of prescribed therapy

Nursing action on Non-Adherence

• Establish why the client is not following the regimen
• Demonstrate caring
• Encourage healthy behaviors through positive reinforcements
• Use aids to reinforce teaching
• Establish a therapeutic relationship of freedom, mutual understanding and mutual responsibility with the client and support persons.