FUNDAMENTALS OF NURSING

Week 3: Health, Wellness and Illness

A. Health Promotion
a. It is a way of thinking that revolves around a philosophy of wholeness, wellness, and
well-being.
b. Many people are aware of the relationship between lifestyle and illness and are
developing health-promoting habits, such as getting adequate exercise, rest, and
relaxation; maintaining good nutrition; and controlling the use of tobacco, alcohol,
and other drugs
c. Concept of Individuality - the nurse becomes acquainted with the client as an
individual, using the total care principles that apply to this person at this time. d.
Concept of Holism - nurses must keep the whole person in mind and strive to
understand how one area of concern relates to the whole person
e. Concept of Homeostasis
i. Physiological Homeostasis - means that the internal environment of the body
is relatively stable and constant. Four main characteristics:
1. They are self-regulating.
2. They are compensatory.
3. They tend to be regulated by negative feedback systems.
4. They may require several feedback mechanisms to correct only
one physiological imbalance
ii. Psychological homeostasis - emotional or psychological balance or a state
of mental well-being. Prerequisites:
1. A stable physical environment in which the person feels safe and
secure.
2. A stable psychological environment from infancy onward, so that
feelings of trust and love develop.
3. A social environment that includes adults who are healthy role
models.
4. A life experience that provides satisfactions.
f. Assessing the health of individuals - A thorough assessment of an individual’s
health status is basic to health promotion
g. Needs Theories
i. Maslow’’s Hierarchy of Needs
1. Physiological needs
2. Safety and security needs
3. Love and belonging needs
4. Self-esteem needs
5. Self-actualization
ii. Kalish’s Hierarchy of Needs
1. Physiological needs
2. Stimulation needs
3. Safety and security needs
4. Love and belonging needs
5. Self-esteem needs
 6. Self-actualization
iii. Characteristics of Basic Needs
1. People meet their own needs relative to their own priorities.
2. Although basic needs generally must be met, some needs can be
deferred.
3. Failure to meet needs results in one or more homeostatic
imbalances, which can eventually result in illness.
4. A need can make itself felt by either external or internal stimuli. 5. A
person who perceives a need can respond in several ways to meet it.
6. Needs are interrelated. Some needs cannot be met unless related
needs are also met.
h. Defining Health Promotion
i. Edelman and Mandle (2010) “prevention, in a narrow sense, means
avoiding the development of disease in the future, and, in the broader sense,
consists of all interventions to limit progression of a disease” ii. Leavell and
Clark (1965) - Three Levels of Prevention:
1. Primary Prevention
a. Health promotion
b. Protection against specific health problems
2. Secondary Prevention
a. Early identification of health problems
b. Prompt intervention to alleviate health problems
3. Tertiary prevention
a. Restoration and rehabilitation
iii. Pender, Murdaugh and Parsons (2011)
1. Health promotion - “behavior motivated by the desire to increase
well-being and actualize human health potential”
2. Disease prevention/health protection - “behavior motivated by a
desire to actively avoid illness, detect it early, or maintain
functioning within the constraints of illness”
i. Health Promotion Model
i. Individual Characteristics and Experiences
1. Personal factors
2. Prior related behavior
ii. Behavior-Specific Cognitions and Affect
1. Perceived benefits of action
2. Perceived barriers to action
3. Perceived self-efficacy
4. Activity-related affect
5. Interpersonal influences
6. Situational influences
iii. Behavioral Outcome
j. Stages of Health Behavior Change
i. Precontemplation Stage - the person does not think about changing his or her
behavior in the next 6 months
ii. Contemplation Stage - the person acknowledges having a problem,
 seriously considers changing a specific behavior, actively gathers
information, and verbalizes plans to change the behavior in the near
future
iii. Preparation Stage - the person intends to take action in the immediate future
iv. Action Stage - the person actively implements behavioral and cognitive
strategies of the action plan to interrupt previous health risk behaviors and
adopt new ones.
v. Maintenance Stage - the person strives to prevent relapse by integrating newly
adopted behaviors into his or her lifestyle.
vi. Termination Stage - the individual has complete confidence that the
problem is no longer a temptation or threat.
k. The Nurse’s Role in Health Promotion
i. Model healthy lifestyle behaviors and attitudes.
ii. Facilitate client involvement in the assessment, implementation, and
evaluation of health goals.
iii. Teach clients self-care strategies to enhance fitness, improve nutrition,
manage stress, and enhance relationships.
iv. Assist individuals, families, and communities to increase their levels of
health.
v. Educate clients to be effective health care consumers.
vi. Assist clients, families, and communities to develop and choose
health-promoting options.
vii. Guide clients’ development in effective problem solving and decision
making.
viii. Reinforce clients’ personal and family health-promoting behaviors. ix.
Advocate in the community for changes that promote a healthy
environment.

B. Health, Wellness and Well-Being

a. Health
i. Florence Nightingale - a state of being well and using every power the
individual possesses to the fullest extent
ii. WHO - a state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity
iii. Talcott Parsons - the ability to maintain normal roles
iv. U.S. President’s Commission on Health Needs - Health is not a condition; it is
an adjustment. It is not a state but a process
v. American Nurses Association - Health and illness are human experiences. The
presence of illness does not preclude health, nor does optimal health
preclude illness
vi. Health is a highly individual perception. Definitions vary according to an
individual’s previous experiences, expectations of self, age, and
sociocultural influences. Nurses should be aware of their own personal
definitions of health and appreciate that other people have their own
individual definitions as well.
b. Wellness and Well-Being
 i. Anspaugh, Hamrick and Rosato - Seven Components of Wellness 1.
Environmental
2. Social
3. Emotional
4. Physical
5. Spiritual
6. Intellectual
7. Occupational
ii. Hood - Well-being is a subjective perception of vitality and feeling well… can
be described objectively, experienced, and measured… and can be plotted
on a continuum. It is a component of health.
c. Models of Health and Wellness
i. Clinical Model - the opposite of health is disease or injury
ii. Role Performance Model - people who can fulfill their roles are healthy even
if they have clinical illness
iii. Adaptive Model - health is flexible adaptation to the environment; disease is a
failure in adaptation or maladaptation
iv. Eudaimonistic Model - health is the condition of actualization or realization of a
person’s potential
v. Agent-Host-Environment Model - when the variables are in balance,
health is maintained
vi. Health-Illness Continua - Health and illness or disease can be viewed as the
opposite ends of a health continuum. From a high level of health a person’s
condition can move through good health, normal health, poor health, and
extremely poor health, eventually to death.
vii. Dunn’s Health Grid - demonstrates the interaction of the environment with the
illness–wellness continuum
d. Variables Influencing Health Status, Beliefs and Practices
i. Internal variables
1. Biologic dimension - genetic makeup, sex, age, developmental
level
2. Psychological dimension- mind-body interactions
3. Cognitive dimension - lifestyle, spiritual and religious beliefs
ii. External variables
1. Environment
2. Standards of living
3. Family and cultural beliefs
4. Social support networks
e. Health Belief Model (Rosenstock and Becker)
i. health-related action depends on the simultaneous occurrence of three
factors:
1. sufficient motivation to make health issues be viewed as important 2.
belief that one is vulnerable to a serious health problem or its
consequences
3. belief that following a particular health recommendation would be
beneficial
 ii. Individual perceptions
1. Perceived susceptibility
2. Perceived seriousness
3. Perceived threat
iii. Modifying factors
1. Demographic variables
2. Sociopsychological variables
3. Structural variables
4. Cues to action
iv. Likelihood of action
1. Perceived benefits of the action
2. Perceived barriers to action
f. Health Care Adherence
i. Adherence is the extent to which an individual’s behavior coincides with
medical or health advice.
ii. To enhance adherence, nurses need to ensure that the client is able to perform
the activities, understands the necessary instructions, is a willing participant
in establishing goals of therapy, and values the planned outcomes of
behavior changes
iii. Factors influencing adherence
1. Client motivation 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
5. Ability to understand and perform specific behaviors
6. Degree of inconvenience of the illness itself or of the regimens 7.
Beliefs that the prescribed therapy or regimen will or will not help 8.
Complexity, side effects, and duration of the proposed therapy 9.
Cultural heritage, beliefs, or practices that support or conflict with the
regimen
10. Degree of satisfaction and quality and type of relationship with the
health care providers
11. Overall cost of therapy
iv. When a nurse identifies nonadherence, it is important to take the following steps:
1. Establish why the client is not following the regimen
2. Demonstrate caring
3. Encourage healthy behaviors through positive reinforcement 4.
Use aids to reinforce teaching
5. Establish a therapeutic relationship of freedom, mutual
understanding, and mutual responsibility with the client and
support persons
g. Illness and Disease
i. Illness - a highly personal state in which the person’s physical, emotional,
intellectual, social, developmental, or spiritual functioning is thought to be
diminished.
ii. Disease - can be described as an alteration in body functions resulting in a
 reduction of capacities or a shortening of the normal life span.
iii. Etiology - the causation of a disease or condition
iv. Acute Illness - symptoms of relatively short duration
v. Chronic Illness - lasts for an extended period, usually 6 months or longer, and
often for the person’s life
vi. Remission - period wherein the symptoms disappear
vii. Exacerbation - period wherein the symptoms reappear
h. Illness Behaviors - a coping mechanism, involves ways individuals describe, monitor,
and interpret their symptoms, take remedial actions, and use the health care
system.
i. Stage 1: Symptom Experiences
1. The physical experience of symptoms
2. The cognitive aspect
3. The emotional aspect
ii. Stage 2: Assumption of the Sick Role
1. The individual now accepts the sick role and seeks confirmation
from family and friends
iii. Stage 3: Medical Care Contact
1. Sick people seek the advice of a health professional either on their
own initiative or at the urging of significant others.
iv. Stage 4: Dependent Client Role
1. After accepting the illness and seeking treatment, the client
becomes dependent on the professional for help
v. Stage 5: Recovery or Rehabilitation
1. During this stage the client is expected to relinquish the dependent role
and resume former roles and responsibilities
i. Effects of Illness
i. Impact on the Client
1. Behavioral and emotional changes
2. Changes in self-concept and body image
3. Lifestyle changes
ii. Impact on the Family
1. Role changes
2. Task reassignments and increased demands on time
3. Increased stress due to anxiety about the outcome of the illness for
the client and conflict about unaccustomed responsibilities 4. Financial
problems
5. Loneliness as a result of separation and pending loss
6. Change in social customs