in this discussion we will be talking about the concept of health wellness and illness a nurse must understand health and wellness largely determines the scope and nature of Nursing Practice a nurse is in a unique position to help individuals families communities and populations become or remain healthy a patient's health beliefs also influence their health practices some individuals think of health and wellness as the same thing or at the very least accompany one another however health may not always accompany well-being an individual who has the terminal illness may have a sense of well-being another person may sense a lack of well-being yet be in a good state of health the national vision of health promotion was initially expressed in 1979 with the US Surgeon General's report healthy people this report emphasized health promotion and disease prevention every decade since then the Surgeon General has updated the report establishing benchmarks and monitoring progress what we know today is the healthy people initiative currently we're in healthy people 2020 so this initiative provides evidence-based ten-year national objectives to promote health and prevent disease among all Americans healthy people 2020 identifies leading health indicators which are high priority health issues currently they're working to develop healthy people 2030 which will promote a holistic approach to health promotion and disease prevention when we talk about health it has been traditionally defined as the presence or absence of disease Florence Nightingale defined health at the state of being well and using every power the individual possesses to the fullest extent the definition here by the World Health Organization or who states that health is defined as a state of complete physical mental and social well-being not merely the absence of disease or infirmity it is the state of being that people defined in relation to their own values personality and lifestyle in 1980 the American Nurses Association defined health in its social policy statement as a dynamic state of being in which the developmental and behavioral potential of an individual is realized till its fullest extent possible so as a nurse we always need to be aware of our patients personal definitions of health and appreciate that as an individual they have their own definitions we must make sure that we understand the patient and their families perception of health and illness so that we can help them better attain a state of health so we use models to help explain complex concepts or ideas such as health and illness the models help us understand the relationships between the concepts and the patient's attitudes towards health and their health behaviors health beliefs are persons ideas convictions and attitudes about health and illness they are sometimes based on facts or misinformation sometimes on common sense or myths good or bad experiences or reality or false expectation because of the health belief influence on their health behavior they can positively or negatively affect the patient's level of health positive health behaviors maintain attain or regain health and prevent illness common positive health behaviors include having your immunizations at the proper times making sure that you have proper sleep patterns you're incorporating exercise into your routine stress management and nutrition negative health behaviors include practices that can be harmful to your health such as smoking drug or alcohol abuse poor diet and then refusal of certain medications in the first model that we are going to take a look at the health belief model this is going to address the relationship between a person's beliefs and their behaviors there are three components that made up this model the first component is the individual's perception of susceptibility to an illness the second component is an individual's perception of the serum at seriousness of the illness and the third component is the likelihood that a person will take preventive action the next model we will discuss is the health promotion model this model is going to define health as positive and dynamic so it's ever changing the health promotion is going to increase the patient's level of well-being it describes the multi-dimensional nature of people and how they react with their environment to pursue health this model is going to focus on three areas that include individual characteristics and experiences behavior specific knowledge and effect and behavioral outcomes one of the most widely used models to understand health and illness is going to be Maslow's hierarchy of needs Maslow's hierarchy provides a basis for nurses to care for patients of all ages in all health settings when you're applying this model the focus of care is on the patient's needs rather than strict adherence - hierarchy so as a nurse we must first understand the interrelationships of the basic human needs so if you look at the bottom the physiological are the basic human needs that are going to be necessary for human survival and health include oxygen fluid nutrition body temperature elimination shelter and sex although each person is going to have in unique individual needs all people share these basic human needs and they need these needs met in order to determine their level of health as you move up the model you can see the next level is going to focus on safety and security then you'll move up to love and belonging needs self-esteem and lastly self-actualization the holistic health model is going to explore the relationship between the body the mind and the spirit and how that affects a person's level of health and the goal is to promote optimal health a patient's decision about their health choices are typically influenced by the individual's health status beliefs and behaviors these factors may or may not be under conscious control individuals can usually control their health behaviors and can usually choose healthy or unhealthy activities such as external variables but they typically have little or no choice about their genetic makeup their age their sex or culture and sometimes their geographic environment which are all considered internal variables so internal variables are often described as non-modifiable variables because for the most part they cannot be changed so examples are going to include genetic factors such as race or history of heart disease mental illness disorders of cognition that can also expose them to health problems that the nurse and the patient must work together to be more diligent to influence those external variables so when we discuss external variables these are going modifiable variables such as exercise or diet social support systems and all of these can be used by the nurse to encourage healthy choices but they can also vary by culture so there are several factors that are going to influence a patient's health choices psychological or emotional factors include awareness of mind and body interactions and self-concept cognitive or intellectual factors include lifestyle choices health beliefs and spiritual and religious beliefs one choice that combines both types of factors is the use of non-traditional health providers so let's take a minute to review the topics that we have just discussed so this NCLEX question States according to Maslow's hierarchy of needs which of these needs would the patient seek to meet first a self actualization B self esteem C shelter or D love and belonging if you chose C shelter then you would be correct remember to go back and review the Maslow's hierarchy of needs and really look at the bottom level of all the physiological or basic human needs for next NCLEX review question after evaluating a patient's external variables the nurse concludes that health beliefs and practices can be influenced by a emotional factors B intellectual background C developmental stage and D socioeconomic factors if you chose D socio-economic factors you would be correct remember that external variables include a person's health beliefs and practices that include family practices psychosocial and socio-economic factors and cultural background one area of Nursing that we discuss is public health public health focuses on health promotion wellness and illness prevention there are health education legislation and policies that help individuals groups and communities improve their health decrease the incidence of disease and disability and improve the quality of life the concepts of health promotion health education and illness prevention are all closely related and sometimes overlapped all are going to be focused on the future and the differences among them involve motivations and goals so when we discuss health promotion this is going to help individuals maintain or enhance their present health motivates people to engage in healthy activities such as routine exercise and good nutrition to reach more stable levels of health health education is going to include topics such as physical awareness stress management and self responsibility health education helps people develop a greater understanding of their health and how to better manage their health risks lastly illness prevention is going to include activities such as amuse Asian programs and blood pressure screenings that can help protect people from actual or potential threats to their health they also help people avoid declines in their health and their ability to function original healthy people report from 1979 laid the foundation for a national prevention agenda today's health system tries to avoid hospital stays moving from a focus of occurring activity to one of promoting wellness and preventing illness and injury there are three levels of prevention primary prevention is going to focus on health promotion and illness prevention an example would be promoting the use of sunscreen to avoid the risk of some skin cancer another would be a campaign to encourage children to wear seatbelts and not to smoke so that it reduces risk later in life secondary prevention is going to include the diagnosis and treatment of disease so an example would be an activity to reduce the impact of an existing disease or injury so such a screening test to detect early stages of diseases or modified physical requirements or return back to work after some sort of injury and lastly tertiary prevention is going to seek to restore health following an illness or an accident and include breathability ssin and palliative services so this is an activity to lessen the impact of an ongoing illness or injury so an example would be a chronic disease management program or retraining in another career for an injured worker so let's review the different types of prevention you will use the concept of primary prevention when instructing a patient to a get a flu shot every year B take a blood pressure reading every day C explore hiring a patient with a known disability or D undergo physical therapy following a cerebral vascular accident if you chose a to get a flu shot every year you would be correct this is considered an activity to block disease or injury before it occurs so it's going to focus on health promotion and illness prevention a risk factor is an attribute quality environmental situation or trait that increases the vulnerability of an individual or group to an illness or an accident risk factors and behaviors risk factor modification and behavioral modification are integral components of Health Promotion wellness and illness prevention nurses in all areas of practice have the opportunity to reduce patient risk factors to promote health and decrease risks of injury or illness risk factors themselves do not cause disease or accidents instead they increase the chances that that individual community or popular we'll possibly experience a disease or dysfunction risk factors play a major role in how you identify a patient's health status they often influence health beliefs and practices if a person is aware of their presence people can modify some of their risk factors while others are non-modifiable so an example of a non modifiable risk factor would be factors such as age gender genetics and family history these are going to be factors that cannot be changed modifiable risk factors are going to be activities such as lifestyle practices and behaviors poor nutrition overeating insufficient rest and sleep this is going to be something that you can change environment is going to discuss where we live and the condition of that area so for example the air the water or the soil it determines how we live what we eat the different disease agents that we are exposed to our state of health and our ability as a person to adapt to our environment as a nurse one of our responsibilities is to help our patients identify modifiable and unmodifiable risk factors and help them understand what they can modify what they can control and eliminate to promote wellness and prevent illness health risk appraisal forms help identify health threats based on the presence of various risk factors once you've identified a patient's risk factors you can help them to implement appropriate and relevant health education and counseling to help that person change or implement behaviors to maintain and improve their health status current evidence supports that many people go through a series of five stages when they make a change this is described using the transtheoretical model of change so in this model of change the five stages begin with pre contemplation this is going to be the stage where the patient has no intent to make changes within the next six months then they move to the contemplation this is where they're considering a change within the next six months the preparation stage is where a small change is made in preparation for a change in the next month the action stage is where the patient is actively engaged in strategies to change behavior and this can last up to six months and then lastly the maintenance stage is sustained change over time it begins six months after action has started and it continually continues indefinitely so when we discussed the concept of illness we must realize that illness and disease are different concepts illness is defined as a state in which a person's physical emotional intellectual social developmental or spiritual functioning is diminished or impaired a person can feel ill in the presence or absence of disease many patients who have an illness feeling healthy sometimes illness motivates people to adopt healthy behaviors there are both acute and chronic illnesses that have the potential to affect many dimensions of functioning so an acute illness is usually usually reversible and has a short duration the symptoms typically appear abruptly can be intense and subside after a relatively short period chronic illness usually lasts more than six months is irreversible and affects functioning in one or more systems for this NCLEX review question it states that sally has decided to set aside 30 minutes a day to walk after work next week sally is in what stage of risk factor modification so if you chose C preparation you would be correct remember the definition of this stage is where the patient is making small changes in preparation for a change within the next month the people who are generally ill are going to act in a certain way that medical sociologists call it illness behavior people who are ill will often adopt cognitive affective and behavioral reactions that are influenced by socio-cultural and psychosocial factors illness behaviors affect how people monitor their bodies define and interpret their symptoms take remedial actions and use healthcare resources there are certain variables that influence illness and illness behavior and like we've discussed prior previous in the lecture there are internal and external variables internal variables are going to be perception of the illness and the nature of the illness whereas external variables include visibility of symptoms social group cultural background economics and accessibility to health care when somebody becomes ill we must remember that it's never an isolated life event that a patient and their family deal with changes resulting from the illness and the treatment each patient responds uniquely to their illness and that requires you as a nurse to individualize nursing interventions the patient if family commonly experienced behavioral and emotional changes changes in roles body image self-concept and family dynamics these events often greatly disrupt normal family functioning sometimes dealing with these challenges is an integral part of designing an individualized plan of care patients who are ill or injured may experience behavioral and emotional changes and these can be associated with short-term illnesses quickly healed injuries or chronic illnesses so as a nurse we are conditioned to care for our patients and their families but we also must remember that we need to care for ourselves in order to keep up and provide competent quality and safe care so in order to remain healthy you must make sure that you look at the different factors in your life make sure that you're eating a nutritious diet you're trying to get adequate sleep I know that can be difficult as you're in nursing school try to engage in exercise and different relaxed relaxation activities so maybe incorporate some sort of exercise program into your daily life or meditation so that that can help with stress management make sure that you establish a good work family balance yes nursing school is important and your work that you have to do and the grades that you want to achieve are important but make sure that you're not forgetting your balance of your family and friends because you do need to take some time off from your studies to have that part of your life become a positive make sure you engage in regular non work activities so take some time off for yourself go out to dinner with friends go see a movie take a walk in the park find something that you enjoy to help manage your stress also develop coping skills one thing we try to focus on is making sure that you find somebody in nursing school who is going to be your confidant or somebody to go through this experience with when you have somebody who understands what you're going through sometimes it makes it easier to cope with different situations so try to develop study groups or groups of friends in nursing school that you can open up to and you can relate to on different experiences as you go through the program make sure that you allow personal time for breathing make sure that you take time to focus on your spiritual health and if you need to find a mentor one great way that you can do that is join our student Nurses Association we have SMA on every campus and this is a way that you can interact with different nursing students from different semesters and different campuses and you can come together and find common interests and work to help support HTC's nursing program but also find somebody who I went through this program and maybe can offer you some support and guidance that maybe worked for them and then hopefully can help you if you work in the hospital currently maybe rely on some of the nurses there to be a mentor to you as you're going through the program so there's a lot of ways that you can care for yourself but the biggest thing is just taking that time out for yourself and not feeling guilty about it because our ultimate goal is for you to stay healthy and develop a sense of wellness as you're going through this program