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Health Maintenance,
Health Promotion, and
Wellness
Health, Illness, and Wellness

 Health is the process through which a
  person seeks to maintain an equilibrium
  that promotes stability and comfort.
 Health is a dynamic process that varies
  according to a person’s perception of
  well-being.
Health, Illness, and Wellness

 Health refers to all aspects of a person’s
  life.
  •   Physical status
  •   Emotional well-being
  •   Social relationships
  •   Intellectual functioning
  •   Spiritual condition
Health, Illness, and Wellness

 Illness is the inability of an individual’s
  adaptive responses to maintain physical
  and emotional balance, which results in
  an impairment of functional abilities.
 Wellness is the condition in which an
  individual functions at optimal levels.
Models of Health

 Health is the maintenance of harmony
  and balance among body, mind, and
  spirit.
  • Balance or homeostasis is an equilibrium
    among psychological, physiological,
    sociocultural, intellectual, and spiritual
    needs.
Models of Health

   Clinical model
   Health-belief model
   High-level wellness model
   Social learning theory
   Host-agent-environment model
   Health promotion model
MODELS OF HEALTH

CLINICAL MODEL
  • Traditional Perspective
  • Health is absence of illness
  • Individuals who are not sick are healthy
HEALTH BELIEF MODEL
  • Rosenstock
  • Expectations direct behavior that leads to the fulfillment of
    the expectations
  • Group values exert influence on beliefs about health
  • Belief may change as the person grows and develops
MODELS OF HEALTH

HIGH LEVEL WELLNESS MODEL
 Dunn
 Health is influenced by the interaction among
  the individual, family and community
 Health is viewed toward achieving one’s
  fullest potential
 Health is viewed as an attempt toward
  achieving one’s fullest potential
MODELS OF HEALTH

SOCIAL LEARNING THEORY
 Bandura
  • Beliefs strongly influence action
 Rosenstock
  • Behavior is influenced by expectations and
    reinforcements
MODELS OF HEALTH

HOST AGENT ENVIRONMENT MODEL
 Leavell and Clark
 Health depends on the interaction of host
  agent and environment
 Balance among these elements results in
  health
 Illness occurs when there is an imbalance in
  one of the three elements
 Model is used most often in predicting risk of
  illnes
MODELS OF HEALTH

HEALTH PROMOTION MODEL
 People engage in health promoting behavior when
  they:
  •   Value health
  •   Perceive health as being within their control
  •   Can identify benefits in self-care behaviors
  •   Have a positive perception of their health status
 Health promoting behavior is influence by:
  • An individual’s inherited and acquired characteristics
  • Significant others, who model the behavior, expect the
    behavior to occur, and facilitate the behavior
  • Families, peers, and health care providers
Cultural Influence on Health

 Culture affects how an individual views
  health and illness.
 One’s cultural background influences
  health-related behaviors and
  expectations of treatment when illness
  occurs.
Family Influences on
           Health Care
 Families help determine the following:
  •   Whether or not to seek treatment.
  •   What type of treatment is appropriate.
  •   Who should provide the treatment or care.
  •   Where the treatment or care should be
      provided.
Family Influences on
        Health Care
 Families are often the major caregivers
  for their relatives.
 Extended families and communities have
  traditionally acted as a buffer against
  excessive stress and illness.
Family Influences on
         Health Care
 Lack of social support from family or
  significant others results in psychological
  and spiritual isolation, which may
  negatively impact a person’s
  physiological state.
Illness Perspectives

 Illness is the result of a disease or injury
  that affects functioning and occurs when
  there is an inability to meet one’s needs.
 An acute illness is usually characterized
  by a rapid onset, intense manifestations,
  and a relatively short duration.
 A chronic illness is usually characterized
  by a gradual, insidious onset with lifelong
  changes, usually irreversible.
Parson’s 4 Aspects of the Sick
           Role


 Clients are not held responsible for their
  condition
 Clients are excused from certain social roles
  and tasks
 Clients are obliged to try to get well as quickly
  as possible.
 Clients or their families are obliged to seek
  competent help
Suchman’s Stages of Illness

 Stage 1 – Symptom Experience
  • Person comes to believe something is wrong.
  • May experience some symptoms such as pain, rash,
    cough, fever, or bleeding.
  • Unwell person usually consults others about the
    symptoms or feelings
  • May try home remedies
  • If self management is ineffective, person enters next
    stage
  • 3 Aspects:
        • Physical experience of symptoms
        • Cognitive aspect (the interpretation of the symptoms in terms that
          have some meaning to the person)
        • The emotional response
Suchman’s Stages of Illness

 Stage 2 – Assumption of the Sick Role
  • Person accepts the sick role and seeks confirmation
    from family and friends
  • Often continues with self-medication and delay contact
    with health care professionals as long as possible
  • People may be excused from normal duties and role
    expectations
  • When symptoms persist, person is motivated to seek
    professional help
  • Emotional Responses during this stage – withdrawal,
    anxiety, fear, and depression
Suchman’s Stages of Illness

 Stage 3 –Medical Care Contact
 Sick person seeks the advice of a health professional either
  on their own initiative or at the urging of significant others
 Information Obtained from health Care Professionals:
      - Validation of real illness
      - Explanation of symptoms in understandable terms
      - Reassurance that they will be all right or prediction of what
        the outcome will be
 Client may accept or deny the diagnosis. If the diagnosis is
  accepted, the client usually follows the prescribed treatment
  plan. If diagnosis is not accepted, client may seek the
  advice of other health
 care professionals or quasi-practitioners who will provide a
  diagnosis that fits the client’s perceptions.
Suchman’s Stages of Illness

 Stage 4 – Dependent Client Role
  • Dependent on health care professional for help
  • People vary greatly in the degree of ease with
    which they can give op their independence.
    Role obligations such as those of wage earners,
    father, mother, student etc. complicate the
    decision to give up independence.
  • Dependent on family and friends for support
Suchman’s Stages of Illness

 Stage 5 – Recovery and Rehabilitation
  • Client is expected to relinquish the dependent
    role and resume formers roles and
    responsibilities
  • For people with acute illness, the time is
    generally short and recovery is usually rapid
  • For people with long term illnesses and must
    adjust their lifestyle may find recovery difficult
  • For clients with permanent disability, this stage
    may require therapy to learn how to make
    major adjustment in functioning.
Wellness Perspectives

 Wellness places health on a continuum,
  from one’s optimal level (wellness), to a
  maladaptive state (illness).
 High-level wellness means functioning to
  one’s maximum health potential while
  remaining in balance with the
  environment.
Health Behaviors and Variables
         Influencing Health
 Behavior is defined as the observable
  response of an individual to external
  stimuli.
 All behavior has meaning.
FACTORS CAUSING ILLNESS

 Predisposing Factor – a condition that is characterized by a
  previous tendency and susceptibility to a disease
          E.g. Family history of heart disease
 Contributing Factor – a condition that helps bring about an
  illness
         E.g. Smoking
               Obesity
 Precipitating Factor – a condition that brings on an illness
  with undue rapidity, suddenly hastens the onset of illness,
  or activates it under certain conditions.
        E.g. stressful event
Health Behaviors and Variables
           Influencing Health
 Variables Influencing Health
  •   Lifestyle
  •   Locus of Control
  •   Self-Efficacy
  •   Health Care Attitudes
  •   Self-Concept
  •   Cognition
Health Behaviors and Variables
         Influencing Health
 Variables Influencing Health
  • Age and Developmental Levels
  • Gender
  • Previous Experiences with the Health Care
    System
  • Environment
  • Economic Resources
Health Maintenance

 Behavior directed toward maintaining a
  current level of health
 Health maintenance activities are the
  activities/behaviors an individual
  performs to maintain or improve a current
  level of health.
Health Maintenance

 Characteristics of Health Maintenance
  • Perception
  • Motivation
  • Maintenance
Health Promotion and Disease
          Prevention (Health Protection)
 Health Promotion
  • Behavior motivated by the desire to shape a
    healthy lifestyle.
  • Process of enabling people to increase
    control over their health and to improve their
    health.
  • Includes avoidance of unhealthy behaviors.
  • Health promotion efforts intervene with
    healthy, rather than ill populations.
Health Promotion and Disease
         Prevention (Health Protection)
 Disease Prevention
  • Activities/behaviors that protect people from
    the ill effects of actual or potential health
    threats
    - Primary prevention
    - Secondary prevention
    - Tertiary prevention
LEVELS OF PREVENTION
                    (Leavell and Clark)
Primary Prevention – precedes disease or dysfunction and is
  applied to generally healthy individuals or groups
Purpose: to decrease the risk or exposure of the individual or
  community to disease.
Focus:
   • health promotion
   • protection against specific health problems.
Examples:
 Health education on healthy lifestyle
 Immunizations
 Risks assessment for specific diseases
 Family planning services and marriage counseling
 Environmental sanitation and provision of adequate housing,
  recreation, and work conditions
   Quit smoking
   Avoid/limit alcohol intake
   Exercise regularly
   Eat well-balanced diet
   Reduce fat and increase fiber in diet
   Take adequate fluids
   Maintain ideal body weight
LEVELS OF PREVENTION
                      (Leavell and Clark)
Secondary Prevention –includes prevention of complication and
   disabilities
Purpose: to identify individuals in an early stage of a disease
   process and to limit future disability.
Focus:
 early identification of health problems
 prompt intervention to alleviate health problems
Examples:
 Screening surveys and procedures of any type
 Encouraging regular medical and dental check-ups
 teaching self examination for breast and testicular cancer
 Assessing the growth and development of children
 Nursing assessments and care provided in home, hospitals
   and other agencies to prevent complications (e.g. turning
   bedridden clients to prevent pressure ulcers etc.)
 Annual physical examination
 Regular Pap smear for women
 Monthly BSE for women who are 20
  years old and above
 Sputum for TB
 Annual guiac stool test and rectal
  examination for clients over 50 years
LEVELS OF PREVENTION
                     (Leavell and Clark)
Tertiary Prevention – begins after an illness, when a defect or
  disability is fixed, stabilized, or determined to be irreversible.
Purpose: Help rehabilitate individuals and restore them to an
  optimum level of functioning within the constraints of
  disability.
Focus:
 restoration
 rehabilitation
Examples:
 Referring a client who has had a colostomy to a support
  group
 Teaching a client who has diabetes to identify and prevent
  complications
 Teaching a client to use crutches
 Undergo speech therapy after
  laryngectomy.
 Attend self-management education for
  diabetes.
 Participate in cardiac rehabilitation of MI.
 Physical therapy after CVA.

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Health care 100

  • 2. Health, Illness, and Wellness  Health is the process through which a person seeks to maintain an equilibrium that promotes stability and comfort.  Health is a dynamic process that varies according to a person’s perception of well-being.
  • 3. Health, Illness, and Wellness  Health refers to all aspects of a person’s life. • Physical status • Emotional well-being • Social relationships • Intellectual functioning • Spiritual condition
  • 4. Health, Illness, and Wellness  Illness is the inability of an individual’s adaptive responses to maintain physical and emotional balance, which results in an impairment of functional abilities.  Wellness is the condition in which an individual functions at optimal levels.
  • 5. Models of Health  Health is the maintenance of harmony and balance among body, mind, and spirit. • Balance or homeostasis is an equilibrium among psychological, physiological, sociocultural, intellectual, and spiritual needs.
  • 6. Models of Health  Clinical model  Health-belief model  High-level wellness model  Social learning theory  Host-agent-environment model  Health promotion model
  • 7. MODELS OF HEALTH CLINICAL MODEL • Traditional Perspective • Health is absence of illness • Individuals who are not sick are healthy HEALTH BELIEF MODEL • Rosenstock • Expectations direct behavior that leads to the fulfillment of the expectations • Group values exert influence on beliefs about health • Belief may change as the person grows and develops
  • 8. MODELS OF HEALTH HIGH LEVEL WELLNESS MODEL  Dunn  Health is influenced by the interaction among the individual, family and community  Health is viewed toward achieving one’s fullest potential  Health is viewed as an attempt toward achieving one’s fullest potential
  • 9. MODELS OF HEALTH SOCIAL LEARNING THEORY  Bandura • Beliefs strongly influence action  Rosenstock • Behavior is influenced by expectations and reinforcements
  • 10. MODELS OF HEALTH HOST AGENT ENVIRONMENT MODEL  Leavell and Clark  Health depends on the interaction of host agent and environment  Balance among these elements results in health  Illness occurs when there is an imbalance in one of the three elements  Model is used most often in predicting risk of illnes
  • 11. MODELS OF HEALTH HEALTH PROMOTION MODEL  People engage in health promoting behavior when they: • Value health • Perceive health as being within their control • Can identify benefits in self-care behaviors • Have a positive perception of their health status  Health promoting behavior is influence by: • An individual’s inherited and acquired characteristics • Significant others, who model the behavior, expect the behavior to occur, and facilitate the behavior • Families, peers, and health care providers
  • 12. Cultural Influence on Health  Culture affects how an individual views health and illness.  One’s cultural background influences health-related behaviors and expectations of treatment when illness occurs.
  • 13. Family Influences on Health Care  Families help determine the following: • Whether or not to seek treatment. • What type of treatment is appropriate. • Who should provide the treatment or care. • Where the treatment or care should be provided.
  • 14. Family Influences on Health Care  Families are often the major caregivers for their relatives.  Extended families and communities have traditionally acted as a buffer against excessive stress and illness.
  • 15. Family Influences on Health Care  Lack of social support from family or significant others results in psychological and spiritual isolation, which may negatively impact a person’s physiological state.
  • 16. Illness Perspectives  Illness is the result of a disease or injury that affects functioning and occurs when there is an inability to meet one’s needs.  An acute illness is usually characterized by a rapid onset, intense manifestations, and a relatively short duration.  A chronic illness is usually characterized by a gradual, insidious onset with lifelong changes, usually irreversible.
  • 17. Parson’s 4 Aspects of the Sick Role  Clients are not held responsible for their condition  Clients are excused from certain social roles and tasks  Clients are obliged to try to get well as quickly as possible.  Clients or their families are obliged to seek competent help
  • 18. Suchman’s Stages of Illness  Stage 1 – Symptom Experience • Person comes to believe something is wrong. • May experience some symptoms such as pain, rash, cough, fever, or bleeding. • Unwell person usually consults others about the symptoms or feelings • May try home remedies • If self management is ineffective, person enters next stage • 3 Aspects: • Physical experience of symptoms • Cognitive aspect (the interpretation of the symptoms in terms that have some meaning to the person) • The emotional response
  • 19. Suchman’s Stages of Illness  Stage 2 – Assumption of the Sick Role • Person accepts the sick role and seeks confirmation from family and friends • Often continues with self-medication and delay contact with health care professionals as long as possible • People may be excused from normal duties and role expectations • When symptoms persist, person is motivated to seek professional help • Emotional Responses during this stage – withdrawal, anxiety, fear, and depression
  • 20. Suchman’s Stages of Illness  Stage 3 –Medical Care Contact  Sick person seeks the advice of a health professional either on their own initiative or at the urging of significant others  Information Obtained from health Care Professionals: - Validation of real illness - Explanation of symptoms in understandable terms - Reassurance that they will be all right or prediction of what the outcome will be  Client may accept or deny the diagnosis. If the diagnosis is accepted, the client usually follows the prescribed treatment plan. If diagnosis is not accepted, client may seek the advice of other health  care professionals or quasi-practitioners who will provide a diagnosis that fits the client’s perceptions.
  • 21. Suchman’s Stages of Illness  Stage 4 – Dependent Client Role • Dependent on health care professional for help • People vary greatly in the degree of ease with which they can give op their independence. Role obligations such as those of wage earners, father, mother, student etc. complicate the decision to give up independence. • Dependent on family and friends for support
  • 22. Suchman’s Stages of Illness  Stage 5 – Recovery and Rehabilitation • Client is expected to relinquish the dependent role and resume formers roles and responsibilities • For people with acute illness, the time is generally short and recovery is usually rapid • For people with long term illnesses and must adjust their lifestyle may find recovery difficult • For clients with permanent disability, this stage may require therapy to learn how to make major adjustment in functioning.
  • 23. Wellness Perspectives  Wellness places health on a continuum, from one’s optimal level (wellness), to a maladaptive state (illness).  High-level wellness means functioning to one’s maximum health potential while remaining in balance with the environment.
  • 24. Health Behaviors and Variables Influencing Health  Behavior is defined as the observable response of an individual to external stimuli.  All behavior has meaning.
  • 25. FACTORS CAUSING ILLNESS  Predisposing Factor – a condition that is characterized by a previous tendency and susceptibility to a disease E.g. Family history of heart disease  Contributing Factor – a condition that helps bring about an illness E.g. Smoking Obesity  Precipitating Factor – a condition that brings on an illness with undue rapidity, suddenly hastens the onset of illness, or activates it under certain conditions. E.g. stressful event
  • 26. Health Behaviors and Variables Influencing Health  Variables Influencing Health • Lifestyle • Locus of Control • Self-Efficacy • Health Care Attitudes • Self-Concept • Cognition
  • 27. Health Behaviors and Variables Influencing Health  Variables Influencing Health • Age and Developmental Levels • Gender • Previous Experiences with the Health Care System • Environment • Economic Resources
  • 28. Health Maintenance  Behavior directed toward maintaining a current level of health  Health maintenance activities are the activities/behaviors an individual performs to maintain or improve a current level of health.
  • 29. Health Maintenance  Characteristics of Health Maintenance • Perception • Motivation • Maintenance
  • 30. Health Promotion and Disease Prevention (Health Protection)  Health Promotion • Behavior motivated by the desire to shape a healthy lifestyle. • Process of enabling people to increase control over their health and to improve their health. • Includes avoidance of unhealthy behaviors. • Health promotion efforts intervene with healthy, rather than ill populations.
  • 31. Health Promotion and Disease Prevention (Health Protection)  Disease Prevention • Activities/behaviors that protect people from the ill effects of actual or potential health threats - Primary prevention - Secondary prevention - Tertiary prevention
  • 32. LEVELS OF PREVENTION (Leavell and Clark) Primary Prevention – precedes disease or dysfunction and is applied to generally healthy individuals or groups Purpose: to decrease the risk or exposure of the individual or community to disease. Focus: • health promotion • protection against specific health problems. Examples:  Health education on healthy lifestyle  Immunizations  Risks assessment for specific diseases  Family planning services and marriage counseling  Environmental sanitation and provision of adequate housing, recreation, and work conditions
  • 33. Quit smoking  Avoid/limit alcohol intake  Exercise regularly  Eat well-balanced diet  Reduce fat and increase fiber in diet  Take adequate fluids  Maintain ideal body weight
  • 34. LEVELS OF PREVENTION (Leavell and Clark) Secondary Prevention –includes prevention of complication and disabilities Purpose: to identify individuals in an early stage of a disease process and to limit future disability. Focus:  early identification of health problems  prompt intervention to alleviate health problems Examples:  Screening surveys and procedures of any type  Encouraging regular medical and dental check-ups  teaching self examination for breast and testicular cancer  Assessing the growth and development of children  Nursing assessments and care provided in home, hospitals and other agencies to prevent complications (e.g. turning bedridden clients to prevent pressure ulcers etc.)
  • 35.  Annual physical examination  Regular Pap smear for women  Monthly BSE for women who are 20 years old and above  Sputum for TB  Annual guiac stool test and rectal examination for clients over 50 years
  • 36. LEVELS OF PREVENTION (Leavell and Clark) Tertiary Prevention – begins after an illness, when a defect or disability is fixed, stabilized, or determined to be irreversible. Purpose: Help rehabilitate individuals and restore them to an optimum level of functioning within the constraints of disability. Focus:  restoration  rehabilitation Examples:  Referring a client who has had a colostomy to a support group  Teaching a client who has diabetes to identify and prevent complications  Teaching a client to use crutches
  • 37.  Undergo speech therapy after laryngectomy.  Attend self-management education for diabetes.  Participate in cardiac rehabilitation of MI.  Physical therapy after CVA.