Health, illness, and wellness Dr. Abdul-Monim Batiha

After the end of this chapter the student will be able to: Differentiate health, wellness, and well-being. Describe five dimensions of wellness. Compare various models of health. Identify factors affecting health status, beliefs, and practices. Identify health care adherence. Differentiate illness from disease and acute illness from chronic illness. Explain Suchman's stages of illness.

Introduction Health, wellness, and well-being have many definitions and interpretations. The nurse should be familiar with the most common aspects of the concepts and consider how they may be individualized with specific clients.

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

The World Health Organization (WHO) defined health as a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.

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

Most people define and describe 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.

Wellness & Well-Being Wellnessالعافية 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 dynamic process that is ever changing 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

The classic description of wellness was developed by Dunn in the early 1960s. According to Dunn (1961), high-level wellness means functioning to one’s maximum health potential while remaining in balance with the environment.

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 Copyright 2008 by Pearson Education, Inc. 12

Dimensions of Wellness Figure 17-2 The seven components of wellness. (From Wellness: Concepts and Applications, 6th ed. (p. 4) by D.J. Anspaugh, M.H. Hamrick, and F.D. Rosato, 2006. Reproduced with permission of the McGraw-Hill Companies.) Copyright 2008 by Pearson Education, Inc. 13

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.

2. Social. The ability to interact successfully with people and within the environment

3. Emotional. The ability to manage stress and to express emotions appropriately, Emotional wellness involves the ability to recognize, accept, and express feelings.

4. Intellectual. The ability to learn and use information effectively for personal, family, and career development

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

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.

7. Environmental. The ability to promote health measures that improve the standard of living and quality of life in the community

Factors influencing health status, beliefs, and practices: Internal factors External factors

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.

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.

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 (reduced). 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.

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.

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.

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.

There are several approaches to health maintenance: • Health promotion • Health protection • Disease prevention

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 29

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 30

Risk Factors Variables that increase the vulnerability of an individual or a group to an illness or accident Risk factors include: Genetic and physiological factors Age Environment Lifestyle Risk factors threaten health, influence health practices, and are important considerations in illness prevention activities. A risk factor can be a situation, habit, social or environmental condition, physiological or psychological condition, developmental or intellectual condition, spiritual condition, or other variable. Genetic and physiological factors, such as being overweight, affect physical functioning of the body. Age increases susceptibility to certain diseases. [Ask students to name a few. Suggested answers: cancer, BPH, dementia, Alzheimer's disease.] Environment includes cleanliness, heat, cold, overcrowding, and air quality. [Ask students: How does ethnicity fit in here?] Lifestyle contains those factors that have positive or negative effects on health, such as smoking, drinking, and using drugs. See Table 6-2 (on text p. 73) for information about Causes of Death in the United States in 2007 and Contributing Lifestyle Choices.

Risk Factor Modification and Changing Health Behaviors Precontemplation Not intending to make changes within the next 6 months Contemplationتأمل Considering a change within the next 6 months Preparation Making small changes in preparation for a change in the next month Table 6-3 (on text p. 74) presents the five stages of health behavior change. Identify risk factors in health promotion, wellness education, and illness prevention. Implement risk modification, health promotion, or illness prevention activities. Encourage patients to modify their lifestyles and adopt health promotion practices.

Risk Factor Modification and Changing Health Behaviors (cont’d) Improvement in health may involve a change in health behaviors. Action Actively engaged in strategies to change behavior; lasts up to 6 months Maintenance stage Sustained change over time; begins 6 months after action has started and continues indefinitely Implement risk modification, health promotion, or illness prevention activities. Encourage patients to modify their lifestyles and adopt health promotion practices. The transtheoretical model of change describes a series of changes through which patients progress for successful behavior change, rather than simply assuming that all patients are in an action stage.