NSC 201 (FOUNDATION OF NURSING I)

CONCEPTS OF HEALTH, WELLNESS, ILLNESS, AND DISEASE

Introduction

To some people, health and illness nearly means the same thing or as accompanying one another.
In fact most individuals and societies in the past have viewed good health or wellness as
synonymous to absence of illness. This limited view fails to notice the complex interrelationships
between the physiological, emotional, intellectual, socio-cultural, developmental and spiritual
dimensions of health and illness (Cox, 1995). However like Kozier, Erb, Berman and Burke
(2016) rightly noted, health may not always accompany well-being as a person with terminal
illness may have a sense of well-being while somebody else may lack a sense of well-being yet
be in good health. As nurses we therefore need a comprehensive and vigorous understanding of
health and illness as this may go a long way to affect scope and nature of nursing practice.

Concept of Health

Many people define and describe health as the following:

 Being free from symptoms of disease and pain as much as possible

 Being able to be active and to do what they want or must
 Being in good spirits most of the time.

The above attributes indicate that health is not something that a person achieves suddenly at a
specific time. It is an ongoing process - a way of life through which a person develops and
encourages every aspect of the body, mind, and feelings to interrelate harmoniously as much as
possible. Traditionally, health was defined in terms of the presence or absence of disease.
Florence Nightingale (1860/1969) defined health as a state of being well and using every power
the individual possesses to the fullest extent. The World Health Organization (WHO) (1948)
takes a more holistic view of health. Its constitution defines health as “a state of complete
physical, mental, and social well-being, and not merely the absence of disease or infirmity.” This
definition reflects concern for the individual as a total person functioning physically,
psychologically, and socially. Mental processes determine people’s relationship with their
physical and social environment, their attitudes about life, and their interaction with others. It

1
also places health in the context of environment. Dubo (1978) views health as a creative process.
In his words, individuals are actively and continually adapting to their environments. He stressed
that individuals must however have sufficient knowledge to make informed choices about their
health and also income and resources to act on choices. Pike and Forster (1995) compliments
Dubo’s statement by arguing that it is important to take into account people’s own perceptions
and views on health and that different people will see and express these in different ways.
Individuals as they continuously adapt to their environment therefore are at different stages/level
of wellness.

It is also noteworthy that people responds to the environment in which they find themselves as an
integrated whole. This brings us to the concept of holism. Holism is a philosophy that views the
“whole person”. The person is seen as a complete unit that cannot be reduced to the sum of its
parts. Health in holistic sense therefore is total wellness - wellness of mind, spirit as well as
body (Timby, 1996). But in view of the fact that it is virtually impossible for someone to be well
and stay well, or get well and remain well forever, nurses are expected to assists people in the
prevention of illness and restoration of health through holistic health care i.e. comprehensive and
total care of a person.

Nurses should be aware of their own personal definitions of health and appreciate that other
people as well have their own individual definitions. A person’s definition of health influences
behavior related to health and illness. By understanding clients’ perceptions of health and illness,
nurses can provide more meaningful assistance to help them maintain, regain, or attain a state of
optimal health.

Concept of Wellness

Wellness is a state of well-being. Carroll and Miller (1991) which states that term wellness
connotes good physical self-care, using ones’ mind constructively, expressing ones emotion
effectively, interacting creatively with others and being concerned about one’s physical and
psychological environment. According to Kozier, Erb, Berman & Burke (2000), the basic aspects
of wellness include self-responsibility; an ultimate goal; a dynamic, growing process; daily
decision making in areas of nutrition, stress management, physical fitness, preventive health
care, emotional health, and other aspects of health; and most importantly, the whole being of the

2
individual. Using the works of Anspaugh, Hamrick, & Rosata (1991) as the basis, they declared
further that there are seven (7) components to wellness and for people to realize optimal health
and wellness, individuals must take note of the factors within each component

 Environmental: - The ability to promote health measures that improves the standard of
living and quality of life in the community. This includes influences such as food, water,
and air.
 Social: - The ability to interact successfully with people and within the environment, and
to develop respect and tolerance for those with different opinions and beliefs.
 Emotional: - The ability to manage stress and to appropriately express emotions.
Emotional wellness involves the ability to recognize, accept, and express feelings and to
accept one’s limitations.
 Physical: - The ability to carry out activities of daily living, achieve fitness, maintain
adequate nutrition/diet and proper body fat, avoid abusing drugs/substance, and generally
practice positive lifestyle habits.
 Spiritual: - The belief in some force (nature, science, religion, or a higher power) that
serves to unite human beings and provide meaning and purpose to life. It includes a
person’s own morals, values, and ethics.
 Intellectual: - The ability to learn effectively and use information appropriately for
personal, family, and career development. Intellectual wellness involves striving for
continued growth and learning to deal with new challenges.
 Occupational. The ability to achieve a balance between work and leisure time. A person’s
beliefs about education, employment, and home influence personal satisfaction and
relationships with others.

The seven components overlap to some extent, and factors in one component often directly affect
factors in another. For example, a person who learns to control daily stress levels from a
physiological perspective is also helping to maintain the emotional endurance needed to cope
with a crisis.

3
Concept of Illness and Disease

The term illness and disease to the unprofessional means the same thing and no wonder they are
used interchangeably in everyday language. However the two terms are not the same, even
though they may or may not be related. Any deviation from the accepted standard of well-being
is regarded as illness. To Kozier, Erb, Berman & Burke (2016) illness is highly personal state in
which the person’s physical, emotional, intellectual, social, developmental, or spiritual
functioning is thought to be diminished. For instance an individual may have a disease, say
hypertension and not feel ill. By the same token a person can feel ill, that is feeling
uncomfortable, yet have no visible disease. Therefore illness can be described as a situation in
which somebody fails to perform his/her normal roles in the society. Illness is highly subjective;
only the individual person can say he or she is ill.

Disease on the other hand is a biological parameter of non-health, a pathological abnormality

that is indicated by a set of signs and symptoms. It could also be described as an alteration in
body functions resulting in a reduction of capacities or a shortening of the normal life span. It
could also be a result of breakdown of anatomic structures of an organism or a result of stress
that the body cannot cope with. It may even not be organic phenomenon interfering with body
function but the fabric of antisocial behavior. Traditionally, intervention by primary care
providers has the goal of eliminating or ameliorating disease processes. Primitive people thought
“forces” or spirits caused disease. Later this belief was replaced by the single-causation theory.
Today multiple factors are considered to interact in causing disease and determining an
individual’s response to treatment. The causation of a disease or condition is called its etiology.

Etiology of Illnesses and Diseases

Before the advent of science, diseases were thought to be consequences of running foul to the
laws of the gods/deity i.e. a punishment inflicted on man by demons or evil spirits secondary to
offending the deity. This explains why the first line of action when somebody falls sick then is to
appease the gods. This was later replaced by the single causation theory. Today we however
know that multiple factors are considered to be instrumental to causing disease. Outlined below
therefore are some of the etiological agents of the various diseases confronting man:

 Inherited genetic defects

4
  Developmental defects/Congenital malformations. Example: Atria septal Defect
 Biological agents or toxins
 Physical agents such as temperature extremes, chemicals, or radiations
 Biochemical imbalances within the body.

It should however be mentioned as noted by Stephen (1992) that though many of these factors
are interrelated, the causes of many diseases are still unknown.

Classification of Illnesses and Diseases

Illness may be classified as acute, chronic or terminal. Could also be classified as Primary (1 o)
or Secondary (2 o). An acute illness is one that comes on suddenly and last a relatively short
time. Example: Bacterial conjunctivitis, Gastroenteritis to mention a few. Acute illnesses are
usually severe but curable; some however lead to long-term problems because of their sequelae.
Sequelae are ill effects that result from permanent or progressive organ damaged cause by a
disease or its treatment. A chronic illness on the other hand, is one that is gradual in onset and
last a relatively long time. Examples include Arthritis, Chronic renal failure [CRF],
Hypertension, and Diabetes Mellitus. A terminal illness is one in which there is no known cure.
The terminal stage of an illness is one in which death has become inevitable.

A primary illness is one that has developed independently of any other disease. Any subsequent
disorder that develops from a pre-existing condition is referred to as secondary illness. An
example of secondary is Hypertension leading to Congestive Cardiac Failure (CCF).
Furthermore, illness could be classified according to their etiological factors as follows:
Hereditary, Congenital and Idiopathic.

 Hereditary: - A hereditary illness is one that is transmittable down the family tree i.e.
from parent to their offspring through their genetic code. A common example in our
environment is sickle cell anemia. Hereditary illnesses may be manifested immediately
after birth or develop at some time later.
 Congenital: - Congenital disorders are those that are present at birth and are products of
faulty embryonic development especially during the first three month of intrauterine life
otherwise referred to as period of organogenesis. Example includes Fallot tetralogy.

5
  Idiopathic: - An idiopathic illness is one that for which there is no known cause.
Treatment is usually palliative (directed at relieving symptoms alone). A typical example
is cancer.

Health–Illness Continuum

Health–Illness Continuum which is also called Illness-Wellness continuum is a graphic

illustration of wellbeing proposed in 1972 by an American author and physician John W. Travis
to illustrate that wellbeing is more than simply an absence of illness, but incorporates both
physical and mental health. Travis believed that the standard approach to medicines which
assumes a person is well when there are no signs or symptoms of disease was insufficient. The
continuum composed of two arrows pointing in opposite direction and joined at a neutral point.
There is no distinct boundary across which people move from health to illness or from illness
back to health. Movement to the right to the arrow (towards high-level wellness) equals an
increase in status of health and wellbeing through awareness, education, and growth. Movement
to the left to the arrow (towards premature death) equates a progressively decreasing state of
health through signs, symptoms, and disability. Most important is the direction the individual is
facing of the pathway.

If a person is moving towards high-level of health, a person has a positive outlook despite his/her
health status. If a person is moving towards premature death, a person has a negative outlook
about his/her health status.

The Health-Illness continuum is an important tool for nurses to assess a patients’ overall health
status and identify areas for improvement. It helps nurses in guiding patients/clients in making
informed decisions about their health and wellbeing. By understanding the continuum, nurses
can help patients/clients to move towards higher levels of wellness. In summary, the health-
Illness/ Illness-Wellness continuum provides a framework for understanding health as a dynamic
and multifaceted concept, encouraging individuals to strive for optimal wellness by making
positive choices and actively managing their health.

Schematic Representation of John Travis Health-Illness continuum

6
HUMAN NEEDS

Health and human needs are inextricably interrelated. Humans need a number of essentials to
survive. The assertion that all individuals irrespective or age, sex, race or creed have needs that
they strive to satisfy is therefore is no exaggeration. The Cambridge International Dictionary of
English defined ‘Needs’ as things one must have or things required to live a satisfactory life i.e.
things essential to life and quality living. As a corollary, illness or risk of illness occurs when
individuals are not able to satisfy one or more of their basic needs.

Since the soul of nursing is caring, much of our career is weaved around helping people to satisfy
these needs. This is consistent with the position of that renowned nurse theorist, Virginia
Henderson, who submitted that Nursing is primarily assisting the individual (sick or well) in the
performance of those activities contributing to health, or its recovery (or to a peaceful death)
which he would have performed unaided if he had the necessary strength, will, or knowledge, as
well as helping the individual to be independent of such assistance as soon as possible.
Achieving this is however no mean work. This is because human beings are not merely
physiological creatures and their needs are multifaceted and multidimensional. Besides, every
individual is a unique being and as such requires some unique needs in addition to the basic
human needs.

Overview of Individual Needs

Human needs are many. They encompass both physical and nonphysical elements needed for
human growth and development, as well as all those things humans are innately driven to attain.
Human needs therefore can be broadly classified into two major groups viz: Primary needs and
Secondary needs (Rosdahl, 1995).

Primary needs otherwise known as basic needs, are survival needs. They must be met to sustain
life. Put differently, their absence or non-satisfaction causes great threat to human existence. As
such they take precedence over other needs called secondary needs.

Secondary needs or Meta needs (growth needs) as they are sometimes referred to, are additional
higher needs that must be met to maintain the quality of life. They include justice, goodness,
beauty, order, unity, etc. Basic needs normally take priority over growth needs. For example, a

7
person who lacks food or water will not normally attend to justice or beauty needs. Unlike the
basic needs, the Meta needs can be pursued in any order, depending upon a person's wants or
circumstances, as long as the basic needs have all been met.

The Basic Human Needs

Abraham Harold Maslow was a renowned psychologist and philosopher who lived between
April 1, 1908 and June 8, 1970. He was a scholar and was referred to as the father of humanistic
psychology. In 1943, Abraham H. Maslow observed and concluded that human needs are
hierarchical in nature. That is, each need has a specific ranking or order of obtainment; the need
network for most people is very complex, with a number of needs affecting the behaviors of each
person at any point in time. People respond to these needs in a progressive manner from simple
physiological needs to more complex needs; and that they do so as whole and integrated beings.
Lower level need must be satisfied in general, before higher level needs are activated sufficiently
to drive behavior. The hierarchy provides a framework for understanding patients as multifaceted
human beings. Patient care should be holistic, not just medical. Nurses must assess and adress
spectrum of patient needs- physical, emotional, mental, and social( Jackson et al 2023).
According to Maslow (1943), there are at least five sets or categories of needs, which we can
classify as Basic Human Needs. They are physiological, safety/security, love and belongings,
self-esteem and self-actualization needs. But he later described aesthetic needs, cognitive needs,
and self-transcendence, which are now often incorporated into the hierarchy (Koltko et al 2006).
These needs are related to each other, being arranged in a hierarchy of priority. The less priority
needs are minimized, even forgotten or denied. But when a need is fairly well satisfied, the next
priority ('higher') need emerges, in turn to dominate the conscious life and to serve as the center
of organization of behavior, since gratified needs are not active motivators. Ordinarily the
satisfaction of these wants is not altogether mutually exclusive, but only tends to be. The average
member of our society is most often partially satisfied and partially unsatisfied in all of his wants
(Maslow, 1943).

 Physiological needs: air, water, food and nutrients, activity and exercise, sleep an rest,
elimination of waste, sexual gratification;
 Safety/Security needs: the need for shelter, out of danger, free from harm, feel safe and
secure;

8
  Love and Belongings : the need to be accepted by others and to have strong personal ties
with one's family, friends, and identity groups;
 Self Esteem: the need to achieve, be competent, gain approval and recognition;
 Cognitive needs: knowledge and understanding,, curiosity, exploration for meaning and
predictability;
 Aesthetic needs: appreciation and search for beauty, balance, and other form of aesthetic
expression.
 Self-Actualization: the need to find self-fulfillment and reach one's potential in all areas
of life; and
 Transcendence needs: this level emphasizes altruism, spiritual connection, and helping
others to achieve their potential.

Maslow's needs pyramid starts with the basic items of food, water, and shelter. These are
followed by the need for safety and security, then belonging or love, self-esteem, and finally,
personal fulfillment (Self Actualization). According to him, the first level needs, which are
physiologic, occupying the bottom of the pyramid/ladder, are the most important as they are
activities needed to sustain life such as breathing and eating. Each higher level represents one
of lesser importance to human existence than the one previous to it. Maslow believed that it
is when a particular physiological need is met with relative degree of satisfaction that other
needs of lesser importance to human existence take precedence. However by progressively
satisfying needs at each subsequent level, people can realize their maximum potential for
health and well-being (Timby, 1996).

Schematic Representation of Maslow Hierarchy of Needs