Concept of health and wellness, dimensions of health,and models of health and wellness,health illness continuum model, factors influencing of health,risk factor of influencing health ,level of disease prevention,illness and illness behaviour ,impact of illness on family and patient ,health care agency , hospital classification of hospital,health care team, national health policy 2017.in fundamental of nursing full chapter

1. Ms. Pinki
Community Health Nursing

2. Health
 WHO Definition :- Health is state of complete physical,
mental, social wellbeing and not merely an absence of
disease or infirmity and ability to lead a socially and
economically productive life.
 Health is state of being that people define in relation to
their own value, personality, and lifestyle. Each person has
personal concept of health.
 Pender and colleagues (2015) define health as the
actualization of inherent and acquired human potential
through goal- directed behaviour, competent self-care and
satisfying relationships with otherwhile adjustments are
made as needed to maintain structural integrity and
harmony with the environment.

3. Concept of health
 Bio-medical concept
 Ecological concept
 Psychosocial concept
 Holistic concept

4. Dimension of health and wellness
 Physical dimension
 Social dimension
 Emotional dimension
 Intellectual dimension
 Spiritual dimension
 Occupational dimension
 Environmental dimension

5. Concept of wellbeing
 Standard of living
 Level of living
 Quality of life

6. Concept of health – illness continuum
 The health illness continuum is graphic illustration of a
well being, concept first proposed by John W Travis in
1972.
 In this model, the opposite directions are joined at a
natural point. Moving to the right of the neutral point
increasing wellness, which achieved by awareness,
education, and growth. Moving to the left indicates
decreasing wellness due to various disabilities, signs, and
symptoms of illness.

7. Cont..
 The illness wellness continuum illustrates the relationship of
the treatment paradigm to the wellness paradigm.
 The treatment paradigm (such as drugs, AYUSH, surgery,
psychotherapy, and so on) can bring you up to the neutral point,
where the symptoms of disease have been alleviated.
 The wellness paradigm, which can be utilized at any point on
the continuum, helps you move toward higher level of
wellness. The wellness paradigm directs you beyond neutral
and encourages you to move as far to the as possible. It is not
meant to replace the treatment paradigm on the left side of the
continuum, but do not stop at the neutral point. Use the
wellness paradigm to move toward high level wellness.

9. Concept of health – illness continuum

10. Model of health and wellness
 A model is theoretical way of understanding a concept or
idea. Model represent different ways of approaching
complex issues. Because health and illness are complex
concept, models explain the relationships between these
concepts and a patients attitudes toward health and health
behaviours.
 Health beliefs are a persons ideas convictions, and attitude
about health and illness. They may be based on factual
information or misinformation, common sense or myths,
or reality or false expectations. Because health beliefs
usually influence health behaviour, they can positively or
negatively affect a patient’s level health.

11. Cont.…
 Positive health behaviours are activities related to
maintaining, attaining, or regaining good health and
preventing illness. Common positive health
behaviours include immunization, proper sleep
patterns, adequate exercise, stress management, and
nutrition. Negative health behaviour include practice
actually or potentially harmful to health such as
smoking, drug or alcohol abuse, poor diet, and refusal
to take necessary medication.

12. Cont..
1. Health belief model-
Rosenstoch’s (1974) and becker maiman’s (1975)
health belief model addresses the relationship between a
person’s beliefs and behaviours. The health belief model
helps you understand factors influencing patients
perception, beliefs, and behaviour to plan care that will
most effectively help patients maintain or restore health
and prevent illness.
The first component of this model involves an
individual’s perception of susceptibility to an illness.
For example..

13. Cont.…
 A patients need to recognize, the familial link for
coronary artery disease, after this link is recognized,
particularly when one parent and two siblings have
died in their fourth decade from myocardial
infarction, the patient may perceive the personal risk
of heart disease.
 The second component is an individual’s perception
of the seriousness of the illness. This perception is
influenced and modified by demographic and
sociopsychological variables, perceived threats of the
illness and cues to action,

14. Cont..
 (e.g, mass media campaigns and advice from family,
friends and medical professionals). For example a
patient may not perceive his heart disease to be
serious, which may affect the way he takes care of
him self.
 The third component is the likelihood that a person
will take preventive action. This component result
from a person’s perception of the benefits of and
barriers to taking action. Preventive actions include
lifestyle changes, increased adherence to medical
therapies, or a search for medical advice or treatment.

15. Model Of Health And Illness
Demographic variables
Sociopsychological
variables
Perceived
susceptibility and
seriousness of disease
Perceived threat of
disease
Perceived benefits
action minus
perceived barriers to
preventive action
Likelihood of taking
recommended
preventive health
action
Cues to action
Individual perception Modifying factor Likelihood action
Health belief model*

16. Self
actualization
Self –esteem
Love and belonging
Safety and security need
Physiological need
Maslow’s hierarchy of need

17. Health promotion model
 health premotion model.docx

18. The agent host environment
Host
Agent Environment
Epidemiological
Triad

19. The agent
 Biological agent – bacteria, virus, fugues.
 Physical agent – radiation (cancer), heat, cold (frost bite).
 Chemical agent – acids, metal, mercury poisoning, lesd
poisoning.
 Nutritional agent – diet due to lack nutrition (protein
energy malnutrition)

20. The Environment
 Physical environment- air, food, water,
 Biological environment- plants (allergy), animal
(anthrax), insects (malaria), (dengue).
 Socioecomic environment- finical status, education,
proper housing hygiene.

21. The host
 A variety of factors influences age, sex, genetic factor, life
style.

22. Holistic model of health
 Holistic health and wellness is sustained by physical,
nutritional, emotional, social, spiritual, intellectual, and
environment.

23. Factors influencing health and health beliefs
1. Human biology
Genetic inheritance
Age
Race
Self-concept
2.Environment
Physical environment
Biological environment
Social environment
Lifestyle

24. Others factors
 Internal variables
a. Development stage
b. Intellectual background
c. Perception of function
d. Emotional factor
e. Spiritual factors
• External variables
a. Family practices
b. Psychosocial and socioeconomic factors
c. Cultural background

25. Risk factors influencing health
 Genetic inheritance
 Age
 Environment
 Lifestyle

26. Levels of disease prevention
 Level of prevention are classified into 4 stages
1. Primordial prevention
2. Primary prevention
3. Secondary prevention
4. Tertiary prevention

27. Primordial prevention
Primordial prevention is defined as prevention of risk
factors themselves, beginning with change in social and
environmental conditions in which these factors are
observed to develop, and continuing for high risk children,
adolescents and young adults.
Primordial prevention, a relatively new concept, is
receiving special attention in the prevention of chronic
diseases. For example, many adult health problems (e.g.
obesity, hypertension) have their early origins in
childhood, because this is the time when lifestyles are
formed(for example, smoking, eating patterns, physical
exercise).

28. Primary prevention
Primary prevention can be defined as the action taken
prior to the onset of disease, which removes the possibility
that the disease will ever occur.
Primary prevention may be accomplished by measures of-
1.) Health promotion
2.) Specific protection
1. Health promotion
 Health Education
 Environmental Modification
 Life Style change
 Nutritional Intervention
2. Specific Protection
Vaccination
Contraceptive
Mosquito net
Quarantine
RTA road accident (use helmet)

29. Secondary prevention
It is defined as “ An Action which halts the progress of a
disease at its incipient stage and prevents complications.”
The specific interventions are:
a)Early diagnosis (e.g. screening tests, case findings,
breast self examination, pap smear test, radiographic
examinations etc.
b) Adequate Treatment
c) Referral

30. Tertiary prevention
It is used when the disease process has advanced beyond
its early stages.
It is defined as “all the measures available to reduce or
limit impairments and disabilities, and to promote the
patients’ adjustment to irremediable conditions.”
Intervention that should be accomplished in the stage of
tertiary prevention are-
1) Disability limitation, and
2) Rehabilitation.

31. Disability limitation
Disease
Impairment
Disability
Handicap
Diseases are often known to be medical conditions that
are associated with specific symptoms and signs.
Any loss or abnormality of physiological,
psychological, or anatomical structure or function.
Any restriction or lack of ability to perform an ability in
normal range of human being.
Permanent disability or impairment of an
individual

32. Rehabilitation is “ the combined and coordinated use of
medical, social, educational, and vocational measures for
training and retraining the individual to the highest possible
level of functional ability.”

33. Types of Rehabilitation
Medical rehabilitation: (restoration of Bodily Function).
Vocational rehabilitation:( restoration of the capacity to
earn a livelihood)
Social rehabilitation: (restoration of family and social
relationship).
Psychological rehabilitation: (Restoration of personal
dignity and confidence).

34. Examples of Rehabilitation
Establishing schools for the blind.
Exercises in neurological disorders
Prosthetic restoration of lost tooth

35. Illness And Illness Behaviour
An illness is the response ,the person has to disease . It is an
abnormal process in which the persons level of functioning
is changed compared with a previous level.
Persons physical, emotional, intellectual, social,
developmental or spiritual functioning is diminished. Illness
is highly subjective ; only the individual person can say he
or she is ill.
ILLNESS BEHAVIOR A coping mechanism , involves
ways individual describes ,monitor ,interpret their symptoms
,take remedial actions , and the use of health care system.

36. STAGES OF ILLNESS BEHAVIOUR
Edward suchman (1972) identified stages of illness behaviour.
1. Symptoms experience Awareness of physical changes. Pain,
rashes and lump etc
2. Assumption of sick role Accept sick role and seek
confirmation, Self treatment, Excuses, Emotional responses,
Illness persist seek professional help
3. Medical care contact Seek professional advice, Accept or
deny diagnosis, Follow the treatment plan
4. Dependent client role Dependent for professional help,
Accept their dependence on the primary care provider.
5. Recovery and rehabilitation Resume former roles and
responsibilities. Acute illness (short term) – recovery fast,
Chronic illness (Long term) s– recovery difficult

37. Impact on the client
Experience behavioral and emotional changes
CHANGES IN SELF CONCEPT loss of self esteem loss
of self concept
Diet activity exercise rest and sleep CHANGES IN LIFE
STYLE

38. Impact on the family
Factors :-
Member of the family who is ill.
Seriousness and length of illness
Cultural and social customs the family follows
Impacts
Role changes.
Task reassigned and increased demands on time.
Stress.
Financial problems.
Loneliness.
Change in social customs.

39. Health Care Agencies
 The person is always the focus of care. Staff members
have special talent, knowledge, and skills. All work to
meet the person needs. Types of healthcare agencies
include hospital, long-term care centers, memory care
facilities, home health care agencies, adult day care center,
rehabilitation, doctors offices, clinics, center for persons
with mental illnesses, center for disability, drug and
alcohol treatment centers, center for rape, abuse, suicide.

40. Purpose Of Health Care Agencies
 Health promotion
 The goal is to reduce the risk of agencies
 Disease prevention
 Detection and treatment of disease
 Rehabilitation and restoration care
 Health promotion includes physical and mental health
 Many agencies are learning sites for students
 People receive teaching and counseling about healthy living
 Risk factors and early warning signs of disease are identified
 Measures are taken to reduce risk factors and prevent disease
 Detection and treatment of disease involve diagnostic tests,
physical exams, surgery, emergency care, and drugs

41. Types Of Health Care Agencies
health care is provided in various settings.
Outpatient services
Clinics
a. Institutions (public , private, military)
b. Hospice care
c. Rehabilitation care
Health care organization
WHO
UNICEF
UNDP
The Indian / International Red Cross Society

42. Health care team
The physician
The nurse
Dietitian
Physiotherapist
The social worker
The occupational therapist
Paramedical technologist
The pharmacist
Respiratory therapist

43. Hospital
 Introduction -: The word “hospital “derived from the
Latin word HOSPILE which in turn derived from French
word “hospes” that means “ a host or a guest” A hospital
is a health care institution providing treatment to patients
with specialized staff and equipment.

44. Cont.….
 Definition-: Hospital is an integral part of a social and
medical organization ,the functions of which is to provide
for the population complete health care both curative and
preventive , and whose outpatients services reach out to
the family and its home environment . The hospital is also
a center for the training of health worker and for bio social
researches. According to WHO
 “Hospital is an institution for the care, cure and treatment
of the sick and wounded, for the study of disease and for
the training of doctors and nurses.” According to
Steadman medical dictionary.

45. Function of hospital
Patient care
Diagnosis and treatment of disease
Out patient services
Medical education and training
Medical and nursing research
Prevention of disease and promotion of health.

46. Classification of hospital
They classified according to ,
Length of stay of the patient
Clinical basis
Ownership /control basis
Objectives
Size
Management
System of medicine

47. National health policy 2017
 The national health policy of 1983 and the national health
policy 2002 have served well in guiding the approach for
the health sector in the five-year plans, now 14 year after
the last health policy. The context has changed in 4 major.
1. First the health priorities are changing. Although
maternal and child mortality have rapidly declined. The
growing burden on account of non-communicable
disease and some infection.
2. The second important change is the emergence of a
robust health care industry estimated to be growing at
double digit.

48. Cont.…
3. The third change is the growing incidence of catastrophic
expenditure due to health care cost, which are presently
estimated to be major contributors to poverty.
4. Fourth a rising economic growth enables enhanced fiscal
capacity, therefor a new health policy responsive to these
contextual changes is required.

49. Principal of national health policy
 Equity
 Affordability
 Universality
 Patient centered and quality of care
 Accountability
 Pluralism
 Decentralization

50. Targets of NHP 2017
• Reduce total fertility rate- 2.1 by 2019
• Reduce under 5year age mortality rate 23/1000 by 2025
• Reduce maternal mortality rate 100/lakh by 2020
• Increase life expectancy rate 67.5 to 70 years by 2025
• Reduce still birth rate in single digit by 2025