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Wellness, Health

and Illness

Concept of Health and Wellness

Sehat merupakan suatu keadaan yang sempurna baik fisik,
mental dan sosial, sehingga tidak hanya bebas dari penyakit
atau kelemahan
Sehat bukan merupakan suatu kondisi, tetapi merupakan
penyesuaian. Bukan merupakan suatu keadaan, tapi
merupakan proses. Proses di sini adalah adaptasi individu yang
tidak hanya terhadap fisik mereka, akan tetapi terhadap
lingkungan sosialnya
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

Definisi Sehat Dalam Keperawatan

Definisi Sehat Pender (1982)

Sehat merupakan perwujudan individu yang

diperoleh melalui kepuasan dalam
berhubungan dengan orang lain (Aktualisasi).
Perilaku yang sesuai dengan tujuan perawatan
diri yang kompeten. Sedangkan penyesuaian
diperlukan untuk mempertahankan stabilitas
dan integritas struktural.

Definisi Sehat Paune (1983)

Sehat merupakan fungsi efektif dari sumbersumber perawatan diri (self care Resouces)
yang menjamin tindakan untuk perawatan diri
( self care Aktions) secara adekual.
Self care Resoureces ----mencakup
pengetahuan, keterampilan dan sikap.
Self care Aktions ------ perilaku yang sesuai
dengan tujuan diperlukan untuk memperoleh,
mempertahankan dan menigkatkan fungsi
psicososial da piritual

an active process by which an individual

progresses towards maximum potential

possible, regardless of current state of health

Components of Wellness
1.physical, e.g.:
ability to carry out daily tasks
achieve fitness
maintain nutrition and proper body fat
avoid abusing drugs, alcohol, or using tobacco products
generally to practice positive life-style habits, e.g.:
ability to interact successfully with people and within the

environment of which each person is a part

develop and maintain intimacy with significant others
develop respect and tolerance for those with different
opinions and beliefs

3. emotional, e.g.:
ability to manage stress and express emotions appropriately
ability to recognize, accept, and express feelings
ability to accept ones limitations

4.intellectual, e.g.:
ability to learn and use information effectively for personal, family,

and career development

striving for continued growth and learning to deal with new
challenges effectively

5.spiritual, e.g.:
belief in some force (nature, science, religion, or a "higher power")

that serves to unite human beings and provide meaning and purpose
to life
includes a persons morals, values, and ethics

6. occupational
ability to achieve a balance between work and leisure time
beliefs about education, employment and home influence

personal satisfaction and relationships with others

7. environmental
ability to promote health measures that promote the

standard of living and quality of life in the community

influences include:

Models of health
and illness

Smiths models
of health and illness

clinical model
narrowest interpretation; medically-oriented model
health is seen as freedom from disease
illness is seen as the presence of disease

role performance model

ability to perform work, that is fulfill societal roles,
to the model; assumption of the model is that a persons
most important role is their work role
health is seen as the ability to fulfill societal roles
illness is seen as the inability to fulfill societal roles

adaptive model
ability to adapt to the environment and interact with
it to maximum advantage essential to the model
health is seen as adaptation
illness is seen as a failure of adaptation, or maladaptation

eudaemonistic model
most comprehensive, holistic, view of health; ability
to become self-actualized essential to the model
health is actualization or realization of ones potential
illness is seen as the failure to actualize or realize ones

Leavell and Clarks ecologic model (agent-hostenvironment model)




used primarily in predicting illness rather than promoting wellness

model is composed of three dynamic, interactive elements
the agent
factor (biologic, chemical, physical, mechanical,
psychosocial) that must be present or absent for an
illness to occur, e.g.:
presence of the legionella bacillus
the host
living beings (e.g., human or animal) capable of being infected or affected by the
agent, e.g.:
Legionnaire at the Legionnaires Conference at the Bellevue-Stratford Hotel in

everything external to the host that makes illness more or less likely, e.g.:
presence of stagnant water in the air conditioning system at the Bellevue-Stratford Hotel
in Philadelphi

view of health and illness

health is seen when all three elements are in
illness is seen when one, two, or all three
elements are not in balance

Health-illness continum

Dunns High-Level Wellness Grid

Protected poor Health

Very Favorable

High Level Wellness

Environment Axis

Peak Welness

Health Axis
Poor Health

Emergent High level wellness

composed of two axiss

A health axes which ranges from peak wellness
to death
A environmental axes which ranges from very
favorable to very unfavorable

the two axiss 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

Rosenstock/Beckers Health-Belief Model

based on motivational theory
composed of three components:

individuals perceptions, e.g.:

of perceived susceptibility
of perceived seriousness
perceived threat


factors (factors that modify an individuals perceptions), e.g.:

.demographic variables
e.g., age, gender, race, ethnicity, etc.
sociopsychologic variables
e.g., personality, social class, peer and reference group pressure, etc.
structural variables
e.g., knowledge about the disease, prior contact with the disease, etc.
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

Variables influencing health status, belief,

and practices
Variables influencing health status, belief, and practices
Internal Variables

genetic makeup
developmental level

Psychologic or Emotional
Mind-body interaction
Cognitive or Intellectual
Cognitive abilities
Educational background
Past experiences


Spiritual and religious beliefs and values


Pollution of air, food, water


Economic levels

Health Care Adherence

Extent of which an individuals behavior
coincides with medical or health advice

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

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

Concept of Illness and Disease

pathologic change in the structure or function of the body or


the response a person has to a disease; it is an abnormal

process in which the persons level of functioning is changed

compared with a previous level
influenced by the following:
others perceptions
the effects of changes in body structure and function
the effects of those changes on roles and relationships
cultural and spiritual values and beliefs

Causation of the disease

Types of illness
acute illness
has a rapid onset of symptoms that lasts for a limited and
relatively short period of time

e.g., typically less than six months

chronic illness
has a gradual onset of symptoms that lasts for an
extended and relatively long period of time

e.g., typically six months or longer

characterized by periods of remission and exacerbation

symptoms disappear
symptoms reappear

Illness Behaviors
behavior of individuals when they are ill
ways individuals describe, monitor, and

interpret their symptoms, take remedial

actions and use the health care system

Parsons four aspect s of the sick role

1. Clients are not responsible for their

2. Clients are excused from certain social roles
and tasks
3. Clients are obliged to try to get well as
quickly as possible
4. Clients or their families are obliged to seek
competent help

Suchman 5 Stages of Illness

1. Symptom experiences
a. Physical
b. Cognitive
c. Emotional
2. Assumption of the sick role
3. Medical Care Contact
a. Validation of real illness
b. Explanation of the symptoms in understandable terms
c. Reassurance that they will be alright or prediction of
what the outcome will be
4. Dependent Client Role
5. Recovery or Rehabilitation

Effects of Illness
Impact on Client
Behavioral Change
Emotional Change
Physical Changes
Lifestyle Changes

Impact on the Family

Member of the family who is ill
The seriousness and length of the illness
Cultural and social customs the family follows

Changes in the family:

Role Changes
Task reassignments and increased demands on time
Increased stress
Financial problems
Loneliness as a result of loss and separation
Change in social customs

Health promotion and wellness

health promotion is any activity undertaken for the purpose of
achieving a higher level of health and well-being
Healthy People 2010
two goals

help individuals of all ages increase life expectancy and improve the
quality of life

currently life expectancy is 74.9 years for European-Americans and 68
years for African- Americans

eliminate health disparities among different segments of the population


currently, years of healthy life is 63 years for European-Americans and
62 years for Hispanics, and 56 years for African-Americans

Levels of Health Promotion

(Leavell and Clark)
Primary Prevention
Health promotion
Protection against specific health problems
Secondary Prevention
Early identification of health problems
Prompt intervention to alleviate health


Tertiary Prevention
Restoration and rehabilitation

Types of health promotion programs


Community Based
Hospital Based
Health-organization programs
School Health-promotion programs
Worksite programs for health promotion

Programs for health promotion

Information dissemination
health promotion programs that use a variety of media to offer information to the public about
the risk or particular lifestyle
choices and personal behavior, as well as the benefits of changing that behavior and improving
the quality of life
e.g., billboards, posters, brochures, newspaper features, books, health fairs
health risk appraisal/wellness assessment programs
health promotion programs that appraise individuals of the risk factors inherent in their
lifestyles in order to motivate them to reduce specific risks factors and develop positive health
e.g., tools such as Health-Style: A Self-Test
lifestyle and behavioral change programs
health promotion programs geared toward enhancing the quality of life and extending the
lifespan through implementation of a healthy lifestyle or behavioral change in the individual
environmental control programs
health promotion programs developed in response to the recent growth in the number of
contaminants of human origin that have been introduced into our environment

The Nursing Process and Health Promotion


Health History
Physical Examination
Physical Fitness Examination
Lifestyles assessment
Spiritual Health assessment
Social support System review
Health risk assessment
Health Beliefs review
Life stress review
Validating assessment data

Wellness diagnosis
Readiness for enhanced

Identify health goals related behavior change options
Identify behavior or health outcomes
Develop Behavior change plan
Address environmental and interpersonal facilitators

and barriers of change

Determine a time for implementation
Commit to behavior-change goals



Enhancing behavior change