Plain Talk: Thinking of health as mind-body-spirit, while useful, in its own right, leaves out the importance of meaning and purpose that we know we are made for. We have to include this when we think of health.
No nurse (at least in the western world) sees nursing as “just” caring for the sick, the babies, and the old people. Heaven forbid. Hopefully, we’ve come much farther than that. But we have much farther to go, in my opinion.
If I asked you to tell me how nursing is different than medicine, you’d probably offer that medicine is disease-focused, and nursing is holistic, and by that you would mean that nursing considers the “whole” person. You would describe to me that people are not just bodies, but also made of a unity of body, mind, and spirit. Nurse scholars have offered similar concepts. McEwen &Wills (2007) put it this way: “Person refers to a being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his parts.” (p. 43).
We’ll come back to this.
Next, consider the objectives of the nursing profession: care of the sick, care of the well, assisting self-care activities, helping people attain their human health potential. McEwen &Wills (2007) continue: “The purposes of nursing care include placing the client in the best condition for nature to restore health, promoting the adaptation of the individual, facilitating the development of an interaction between the nurse and the client in which jointly set goals are met, and promoting harmony between the individual and the environment. Furthermore, nursing practice facilitates, supports, and assists individuals, families, communities, and societies to enhance, maintain, and recover health and to reduce and ameliorate the effects of illness.” (p. 43).
I hoped you picked up on the common bond between these well-accepted explanations of person and of the purpose of nursing. The commonality is that of a systems framework. When man is conceptualized as a system, then any nursing interventions will necessarily be systems-oriented, if nursing is to be at all congruent with their philosophical foundations. But for reasons I’ll discuss below, I think this is a thoroughly short-sighted framework that has squelched the work of nursing, at least theoretically speaking.
At the risk of sounding disrespectful, one can pretty easily substitute “dog” (especially a smart dog like mine) in the above definitions and have coherent statements. I’m not saying nurse scholars through the ages think of humans as mere systems. It’s obvious they don’t think that. I definitely appreciate the great difficulty that arises in finding adequate language to describe the nature of man. That’s been the plague of philosophy for ages, after all.
But is there a more robust conceptualization of man and by extension, nursing, that will take us beyond this constrictive framework of “mind-body-spirit”? I believe there is. Indeed, nurse researchers have come close to it in their studies on hope.
What I am proposing is a re-conceptualization of man within nursing philosophy that places the focus on vision, passion, and purpose of the individual. This new paradigm more rightly aligns “health” with the true nature of man. Health is not a repair schedule in which “systems” are fixed and fiddled. Health, true health, is when people possess a passion for the purpose of enriching the lives of others and themselves by virtue of a higher vision for a meaningful life that reaches outside themselves to others in goodness. This is the only explanation offered by say, a patient with terminal cancer, who is consumed not by cancer, but is consumed with life purpose. This vision and passion I speak of is akin to hope but not the same as hope. I think passion is much deeper than hope and I think it is more representative of how we would describe true health. It is a passion fueled by virtue.
As nurses, if our calling is to direct patients towards true health, then our focus cannot solely be on a systems orientation. The absence of physical (system) illness is not true health. The absence of mental (system) illness is not true health. The absence of emotional (system) illness is not true health. The absence of spiritual (system) distress is not true health. A “working” systems paradigm cannot constitute true health, because we are not, fundamentally speaking, a set of systems.
We must look far beyond the confines of systems paradigms. Is it possible to instill a sense of vision, passion, and purpose in our patients? Of course it is. The opportunities are immense. This is a huge field ripe for some creative and scholarly research focused on optimizing the individual to live a life of importance, of service, of love.
Lack of purpose robs. Lack of passion starves. Lack of vision kills. We were not made for ourselves only…such thinking is destructive to our souls and bodies. Think how much “healthier” we would all be if we just had a megadose of vision, passion, and purpose to benefit others and truly impact our world.
The new metaparadigm for true health:
Perceive the vision.
Possess the passion.
Pursue the purpose.
Stay tuned. More to come as we flesh this out little by little and see how it fits within the Perspectival Evidentialism model. Let me know your thoughts.
McEwen, M. and Wills, E. M. (2007). Theoretical Basis for Nursing. 2nd ed. (Philadelphia: Lippincott Williams & Wilkins.