Key Co n c ep t #1 : T he Il l ne s s - We l ln e s s Co n t in uu m

We l ln es s i s a p ro c e ss , n ev er a sta ti c sta te .

M o st o f us t h ink o f w el ln es s in t er m s o f ill ne s s; we as s um e t h at t he ab se n ce o f il l ne s s in d ic at e s we ll n es s. T her e ar e a ct ua lly m any de g r e e s o f w el ln e s s, j u st a s t her e a r e m any deg r ee s o f il lne s s . T he I ll ne s s - We ll ne s s Co nt in u um ill u st r at e s t he r el at io ns h ip of the

t r e at m e nt p ar a d ig m t o t h e we ll ne s s par a d ig m.

M o v ing fr o m t he ce nt er t o t he le ft s ho w s a pr o g r e s s iv ely wo r se n ing st at e o f he alt h. M o v ing t o t he r ig h t o f ce nt er in d ic a t es in cr ea s ing le v e ls o f hea lt h an d we ll be ing . T he t r eat me nt par ad ig m ( dr ug s , he r bs , s ur g er y , p s y cho t her apy , a c up un ct ur e , a nd so o n) c an br ing y o u u p t o t he ne ut r a l po int , w her e t he sy m pt o ms o f d is ea se h av e be e n a ll ev iat ed . T he wel l ne ss par ad i g m, wh ic h ca n be ut il ize d at a ny po int o n t h e co nt in u um , he lp s y o u mo v e t o war d h i g her lev el s o f

we ll ne s s. T he we l lne s s p ar ad ig m d ir e ct s y o u bey o n d ne ut r a l an d e n co ur ag e s y o u t o mo v e a s far t o t he r ig ht a s po s s ib le. I t is no t me a nt t o r ep la ce t h e t r e at me nt p ar ad ig m o n t he l eft s id e o f t h e co nt in u u m, b ut t o wo r k in har mo ny w it h it . I f y o u ar e il l, t he n t r e at m e nt is im po r t ant , b ut do n' t st o p at t h e ne ut r a l po int . U se t he we ll ne s s par a d ig m t o mo v e t o w ar d h ig h -l ev e l we ll ne s s.

Ev e n t ho u g h p eo p le o ft en l a ck p hy s i c a l sy m pt o m s , t he y m ay st il l b e bo r e d, de pr e ss ed , t en se , anx io us , o r s im ply u n ha p py w it h t he ir l iv e s . S u ch e mo t i o na l st at e s o ft en set t he st ag e fo r p hy s ic al a nd me nt a l d ise a se. E v en c an cer ca n be br o ug ht o n by e x ce s s iv e st r e s s t hat we ak en s t he imm u ne sy st e m . N eg at iv e emo t io nal st at es ca n a ls o le a d t o ab u se o f t he bo dy t hr o ug h s mo k ing , o v er dr in k ing al co ho l , an d o v e r eat ing - a t t em pt s t o su b st it ut e fo r o t her m o r e ba s ic hu m an ne e d s s u c h a s a ck no w le dg m ent a nd r e s pe ct , a s t imu lat in g a nd s up po r t iv e e nv ir o nm ent , an d a se n s e o f p ur po s e an d mea n ing .

We l ln e ss is no t a st at ic st at e . H ig h - lev e l we ll ne s s inv o lv e s g iv ing g o o d c ar e t o y o u r p hy s ica l sel f , u s ing y o ur m in d c o nst r u ct iv ely , e x pr e s s ing y o ur e mo t io n s e f fe ct iv el y , be ing cr e at iv ely inv o lv e d w it h t ho s e ar o u n d y o u, a nd be ing co nc er n ed a bo ut y o ur phy s ic a l,

psy c ho lo g ic a l, a n d s p ir it u al e nv ir o nm ent s . I n f a ct , it ' s no t so m u c h whe r e y o u ar e o n t he co nt in u um , b u t w h ic h d ir e ct io n y o u' r e fa c ing .

H ig h -le v el

wel l n es s

do e s

no t

pr ec lu de

p er io ds

of

il l ne ss

an d

we ak n e s s , no r do e s it at t em pt t o de n y t h at de at h is a n at ur al p ar t o f l ife . ( A s y o u ' l l f i nd in t h e se ct io n Wel l ne ss a nd F i nd ing M ea n ing , dy ing ca n be do ne fr o m a p la ce o f we ll ne s s) . A w a r en es s o f t h is par a do x ev en t u al l y le d u s t o ex pa nd t h e mo d el , bu t f ir s t a l it t l e ba ck g r o un d.

Th e I ll ne s s -We l ln es s Co nt inu u m w as f ir st env is io ne d by Jo h n in 197 2, lat e o ne ev e n ing a ft er ev er y o ne el se at h is o f f ice in t h e U .S . P ub l ic H ea lt h S er v ic e Ho sp it a l in Balt im o r e, M ar y la nd , ha d g o ne ho m e . I t w as a me ld ing o f t he h ealt h r isk co nt in u um cr eat e d by Le w is R o b b ins ( cr eat o r o f t he H ea lt h R isk A ppr a is a l) a nd A br a h am M as lo w' s co n c ept o f se l f - ac t u al iz at io n.

O nc e it w as p u bl i sh ed in 19 75 , t he co nt in u u m be c am e a n im me d iat e s uc ce s s, a n e asy w ay t o ill u st r at e wh at t h is n ew ly em er g ing w el lne s s co n c e pt w as a ll abo ut . H eal t h pr a ct it io ner s a nd ed u cat o r s beg a n u s ing it ; so o n it w as a pp ear ing in bo o k s , j o ur na l s, a nd s l ide pr e se nt at io n s ev er y wh er e ar o u nd t h e wo r l d. We n at u r ally in c lu de d it in t he f ir st e d it i o n o f t h is bo o k , a nd we co nt in u e t o do so b e ca u se o f it s v is ua l im p ac t . To t h is da y it is r epr int e d in he alt h an d m ed ic a l t e x t bo o k s wo r ld w i de.

Ho w e v e r , a s imp l e mo del c an no t a l way s co nv ey a co mp lex co nc ept . F o r a n um ber o f y ear s we h ad r e co g n ized t h at t he co n t in u um co u ld be m isl e a d ing in o ne v er y s ig n if ic an t ar e a. W e k ne w it is po s s ib le t o be phy s ic al ly il l y et o r ie nt e d t o wa r d w el ln es s , o r t o be ph y s ic a lly he a lt hy y et f un c t io n ing mo d el fr o m an il ln es s s ho w me nt al it y . t h is O ur o ne For

d ime ns io na l

s im ply

co u ld n' t

d ist in ct io n.

e x am p le , im ag ine d is a bl ed , s ic k , o r dy ing peo pl e w ho ar e t ak in g r e s po n s ib il it y fo r t h e ir l iv e s an d ar e co n sc io us ly e ng ag e d in t he e x pe r ie nc e. I f o nl y t he phy s ic a l d i me ns io n wer e co ns id er e d, t he y wo ul d fa ll o n t h e l eft s ide o f t h e co nt in u u m, b ut if e mo t io n al , int e l le ct u al , a nd sp ir it ua l d im en s io ns ar e t ak e n int o a c co u nt t h e y wo ul d de f in it ely b e o n t h e r ig ht s ide o f t h e co nt in u u m.

Introduction

A model is a theoretical way of understanding a concept or idea. Models represent different ways of approaching complex issues. There are different models of health.

Clinical model

The absence of signs and symptoms of disease indicates health. Illness would be the presence of conspicuous signs and symptoms of disease.

People who use this model of health to guide their use of healthcare services may not seek preventive health services , or they may wait until they are very ill to seek care.

Clinical model is the conventional model of the discipline of medicine.

Role performance model

Health is indicated by the ability to perform social roles. Role performance includes work, family and social roles, with performance based on societal expectations.

Illness would be the future to perform a persons roles at the level of others in society.

This model is basis for work and school physical examination and physician excused absences.

The sick role, in which people can be excused from performing their social roles while they are ill, is a vital component of the role performance model.

Adaptive model

The ability to adapt positively to social, mental, and physiological change is indicative of health.

Illness occurs when the person fails to adapt or becomes inadaptive toward these changes.

As the concept of adaptation has entered other aspects of culture , this model has become widely accepted.

Agent-Host-Environmental model: by Leavell and Clark(1965)

This model is useful for examining causes of disease in an individual. The agent, host and environment interact in ways that create risk factors, and understanding these is important for the promotion and maintenance of health.

An agent is an environmental factor or stressor that must be present or absent for an illness to occur.

A host is a living organism capable of being infected or affected by an agent. The host reaction is influenced by family history, age, and health habits.

High Level Wellness Model by Dunn(1961):

This model recognizes health as an ongoing process toward a persons highest potential of functioning.

This process involves the person, family and the community. He describes high-level wellness as the experience of a person alive with the glow of good health, alive to the tips of their fingers with energy to burn, tingling with vitality at times like this the world is a glorious place.

The wellness- illness continuum (Travis and Ryan 1988) is a visual comparison of high-level wellness and traditional medicines view of wellness.

High level wellness according to Ardell(1977) is a lifestyle focused approach which you design for the purpose of pursuing the highest level of health within your capability.

Holistic Health Model by Edelman and Mandle, 2002

Holism represents the interaction of a persons mind, body and spirit within the environment.

Holism is based on the belief that people (or their parts) can not be fully understood if examined solely in pieces apart from their environment.

Holism sees people as ever charging systems of energy. In this model, nurses consider clients the ultimate experts regarding their own health and respect clients subjective experience as relevant in maintaining health or assisting in healing.

In holistic model of health, clients are involved in their healing process, thereby assuming some responsibility for health maintenance.

Nightingales Theory of Environment

Florence Nightingales environmental theory focuses on preventive care for populations.

She suggested that disease was more prevalent in poor environments and that health could be promoted by providing adequate ventilation, pure water, quiet, warmth, light and cleanliness.

"Poor environmental conditions are bad for health and that good environmental conditions reduce disease."

This is one way to measure a persons level of health. This model views health as a constantly changing state, with high level wellness and death being on opposite ends of a graduated scale, or continuum.

This continuum illustrates the dynamic state of health, as a person adapts to changes in the internal and external environments to maintain a state of wellbeing..

Milios Framework for Prevention

Nancy Milio developed a framework for prevention that includes concepts of community oriented, population- focused care.

Milio stated that behavioural patterns of the populations-and individuals who make up populations are a result of habitual selection from limited choices.

She challenged the common notion that a main determinant for unhealthful behavioural choice is lack of knowledge.

Milios framework described a sometimes neglected role of community health nursing to examine the determinants of a communitys health and attempt to influence those determinants through public policy.

Levels of Prevention Model

This model, advocated by Leavell and Clark in 1975, has influenced both public health practice and ambulatory care delivery worldwide.

This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at the other.

The model delineates three levels of the application of preventive measures that can be used to promote health and arrest the disease process at different points along the continuum.

The goal is to maintain a healthy state and to prevent disease or injury.

It has been defined in terms of four levels:

Primordial prevention Primary prevention Secondary prevention Tertiary prevention

Primordial prevention

Prevention of the emergence or development of risk factors in population or countries in which they have not yet appeared.

Efforts are directed towards discouraging children from adopting harmful lifestyles.

Primary prevention

An action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.

It includes the concept of positive health, that encourages the achievement and maintenance of an acceptable level of health that will enable every individual to lead a socially and economically productive life.

Secondary prevention

Action which halts the progress of a disease at its incipient stage and prevents complications.

The domain of clinical medicine. An imperfect tool in the transmission of disease. More expensive and less effective than primary prevention.

Tertiary prevention

All measures available to reduce or limit impairment and disabilities, minimize suffering caused by existing departures from good health and to promote the patient's adjustment to irremediable conditions.

The Health Belief Model

This model is based on the premise that for a behavioral change to succeed, individuals must have the incentive to change, feel threatened by their current behaviour, and feel that a change will be beneficial and be at acceptable cost.

They must also feel competent to implement that change . The purpose of the model is to explain and predict preventive health behavior.

Tannahill Model of Health Promotion

Health Education: communication activity aimed at enhancing well-being and preventing ill-health through favorably influencing the knowledge, beliefs, attitudes and behavior of the community

Health Protection: refers to the policies and codes of practice aimed at preventing ill-health or positively enhancing well-being, for example, no smoking in public places. Health Protection is responsible for the development and implementation of legislation, policies and programs in the

areas of Environmental Health Protection, Community Care Facilities, and Emergency Preparedness

Prevention: refers to both the initial occurrence of disease and also to the progress and subsequently the final outcome

The Social Model

A social health model is aimed at incorporating the social and economic, as well as biophysical context of health status,

It is based on knowledge of the experience, views and practices of people with disabilities.

It locates the problem within society, rather than within the individual with a disability

Rules are determined within a framework of choice and independent living with strong support from organized disability communities.

The biases of the social model include:

o

limiting the causes of disability either exclusively or mainly to social and environmental policies and practices, or

advancing perceptions of disability that emphasize individual rights rather than advancing broader economic rights.

Social-Ecological Model

The ultimate goal is to stop violence before it begins. Prevention requires understanding the factors that influence violence. CDC uses a four-level social-ecological model to better understand violence and the effect of potential prevention strategies.

This model takes into consideration the complex interplay between individual, relationship, community and societal factors.

It allows us to address the factors that put people at risk for experiencing or perpetrating violence.

Mental Health Promotion Model

purpose of mental health promotion for people with mental illness is to ensure that individuals with mental illness have power, choice, and control over their lives and mental health, and that their communities have the strength and capacity to support individual empowerment and recovery.

The person with mental illness is the central focus: participating in her/his community, involved in decision-making about mental health services, and choosing which supports are most appropriate.

There are four key resources which should be available to the person to support their mental health:
o o o

a) mental health services; b) family and friends; c) consumer groups and organizations; and

d) generic community services and groups.

AIDS Risk Reduction Model

It believes change is a process. Individuals must go through with different factors affecting movement.

This model proposes that the further an intervention helps clients to progress on the stage continuum, the more likely they are to exhibit change.

Individuals must pass through three stages;

A) Labeling - one must label their actions as risky for contracting HIV (i.e. problematic). Three elements are necessary

Knowledge about how HIV is transmitted and prevented, Perceiving themselves as susceptible for HIV and Believing HIV is undesirable

B) Commitment this decision-making stage may result in one of several outcomes

Making a firm commitment to deal with the problem Remaining undecided, Waiting for the problem to solve itself, or Resigning to the problem: Weigh cost and benefits- giving up pleasure (high risk) for less pleasure (low risk)

C) Enactment This includes three stages:

Seeking information, Obtaining remedies, and Enacting solutions