Health is the self-defined process through which a person seeks to maintain an equilibrium that promotes stability. “Health” refers to an individual’s physical status, emotional well-being, social relationships, intellectual functioning, and spiritual condition. Illness is the inability of an individual’s adaptive responses to maintain physical and emotional balance, resulting in an impairment of functional abilities. Illness is either acute (short-term) or chronic (a disruption in functional ability characterized by a gradual, insidious onset with lifelong changes that are usually irreversible). Chronically ill clients need to learn to cope with lifestyle changes, pain, lack of control, and threats to self-esteem.

Wellness is a condition in which an individual functions at optimal levels. The World Health Organization defined health in 1946 as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The American Holistic Nurses Association defines health as harmony an balance (homeostasis) among body, mind, and spirit. Adaptation is the process by which an individual achieves homeostasis. The factors influencing health status are beliefs and attitudes, cultural factors, environmental factors, lifestyle behaviors, political systems, socio-economic status, and religious factors. Some theorists discuss a health-illness continuum, in which an individual is either “well” (absent disease) or “ill” (with disease). This perspective has been challenged because the well person may have a degree of illness and the ill person may have some degree of wellness. High-level wellness means being able to function to one’s maximum while remaining in balance with the environment.

Behaviors are responses of an individual to external stimuli. Health-seeking behaviors are directed toward attaining and maintaining a state of well-being. Several factors influence health behaviors. Lifestyle is the person’s usual daily activities and routines. Locus of control is a person’s sense of control over events and situations affecting their lives. A person with internal control feels able to influence life events. A person with external control feels like a victim with little influences over life events. Self-efficacy is a person’s perception of his or her own ability to perform a task or make a change. Self-concept is an individual’s perceptions of self. Self-esteem is an individual’s perception of self-worth. Body image is an individual’s perception of physical self. An individual’s health behavior is also influenced by the inconvenience or cost of the change, the person’s perception of the severity of disease, the person’s perception of his or her own susceptility to a disease, family socialization, the person’s cognitive abilities, age and developmental level, gender (with women seeking health care more readily than men), the person’s previous experiences with the healthcare system, the quality of the environmental, and the person’s economic resources.

Health maintenance is behavior directed toward sustaining a current level of health. Health maintenance activities are behaviors an individual performs to maintain or improve a current level of health. An individual’s perception (sense and understanding of the world) of his or her current health status and level of knowledge about behaviors they need to change. The role of the nurse is to gain an understanding, or model, of the client’s perceptions.

The United States Public Health Service has established goals for the health of Americans, now called Healthy People 2010. The objectives of U.S. Healthy People 2010 are to promote healthy behaviors, promote healthy and safe communities, improve systems for personal and public health, and prevent and reduce diseases and disorders. The components of health maintenance are health promotion and disease prevention (health protection). Health promotion is behavior motivated by the desire to increase the levels of health and well-being and actualize or maximize the health potential of individuals, families, groups, communities, and society. Disease prevention (health protection) is behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of an illness.

International health promotion efforts have been carried out under the auspices of the World Health Organization (WHO) and the Pan American Health Organization (PAHO). International efforts have been geared more extensively to a community-developed rather than a health system-developed health promotion effort.

The nursing process is applied to health promotion in the same manner it is applied to the treatment of disease. Assessment of health promotion behavior begins with subjective data: the client’s self-perception of health and well-being, activities to maintain health, and risk behaviors (e.g., smoking, overeating, etc.). Risks can be physical (genetic background, age, or physiological conditions), environmental, or psychological/motivational. Objective data includes laboratory tests, such as cholesterol levels, blood glucose, or urine studies; vital signs; and x-rays, such as mammography.

The nursing diagnoses typically used for the functional health pattern of health maintenance are Ineffective Health Maintenance, Health-Seeking Behavior, Noncompliance, Deficient Knowledge, and Ineffective Regimen Management. Expected outcomes are derived to address the risk factors the nurse and client have identified. When planning nursing interventions, the nurse must consider the client’s beliefs, experiences, and input. Health promotion strategies the nurse can use are to create supportive environments, strengthen community action and participation, develop healthy public policy, develop personal skills, and reorienting health services toward gaining community input. Age affects health promotion, so the nurse should consider the developmental needs of the client when planning and implementing health promotion programs.

Additionally, the nurse needs to remember that client’s are holistic individual beings, in other words, complete units that cannot be reduced to the sum of their parts. Therefore, health has many components, based on the needs identified by Maslow: physiological, safety and security, love and belonging, self-esteem, and self-actualization needs. The needs are arranged on a pyramid. Those at the bottom, beginning with the physiological and safety/security, must be met before the other needs can be met. Another way to describe needs are in the physiological, psychological, intellectual, sociological, spiritual, and sexual dimensions.

In the physiological dimension, the nurse needs to teach clients breast self-examinations, testicular examinations, and skin self-examinations, through instruction and return demonstrations. Additional nursing activities in the physiological dimension include assessing nutritional patterns and educating clients on healthy diets, assessing sleep activities and offering suggestions on sleep and rest,

In the psychological dimension, nurses should treat clients as unique individuals, protect confidentiality and privacy, use touch and personal space therapeutically, recognize and respect cultural differences, and decrease anxiety through stress management techniques. The goals of the nurse in the psychological dimension are to improve the client’s self-esteem, establish a trusting relationship with the client, help the client develop social skills, and help the client cope with losses. In the sociocultural dimension, nurses focus on client empowerment, the process of enabling others to do for themselves.

In the intellectual dimension, the nurse assesses the client’s ability to understand, judgment, and memory, and considers these factors and others (such as physiological and psychological conditions) when developing a teaching plan appropriate to the client’s developmental level. The spiritual dimension is not simply religious belief. It is a personal, individual set of beliefs and practices related to the meaning or purpose of one’s life. The sexual dimension includes the person’s sexuality (appearance, feelings, attitudes, beliefs, and behavior related to being male or female) and sex roles (culturally determined patterns associated with being male and female).

The final stage of the nursing process is evaluation. In relationship to health promotion, the nurse discusses how well the client has achieved his or her own health goals in addition to the factors that facilitate or impede success. Together, they reevaluate and adjust health goals if necessary.