Monthly Archives: March 2012

Wordle: Health Philosophy
Plain Talk:  Nursing philosophy is the reasoning behind why we do nursing the way we do.  Go deeper:  Why we do nursing the way we do is dependent upon whatever we think ‘health’ is.  Whatever we think ‘health’ is reflects our beliefs about the purpose and experience of human life.

The Tortures of Nursing Theory Class

I dreaded the required graduate nursing theory class in 1997.  Who created this mental torture chamber and charged me good money for it?  Self-preservation requires you avoid these things.  Besides,  I would never use nursing theory or philosophy, or so I thought, because, come on, that is of absolutely no use in my work as an ER/trauma nurse.  Need I say my attitude was terrible?


Life has a way of mocking us when we reach, years later, an “aha” moment –  that moment of insight in which the past comes to bear on the present in surprise and wonder.  It was a moment when I realized that perhaps part of the reason nursing theory was so disdained by everyday nurses is that the ‘way’ we do nursing reflects our beliefs about health and human experience, and theory did not seem to capture the depth of reality we experience in practice.  Nursing practice is characterized by encounters with hearts and souls abiding in bodies, and the essence of nursing practice is grounded in how we relate to and support others through the healing process that engages skills and clinical knowledge.

Getting Down to the Real Problem

Nursing philosophy explains what nursing is and why nurses practice nursing the way they do. Nursing theory explains how nurses and patients create health and healing, by using models to describe how concepts and factors of health are related. It’s no wonder that nurses and nursing students thumb their nose at philosophy and theory, because if we don’t know, or haven’t articulated, the fundamental tenets of health in a way that is consistent with the human experience, then the disconnect from philosophy to practice will remain.

To blame nursing philosophy and theory is to make nursing the scapegoat for the bigger, more obscure problem:  the absence of a well-developed philosophy of health.  

Naivete and accepting the status quo in nursing philosophy is killing us.  We must develop philosophies of health that underpin nursing philosophy, theory, and practice.  Part of the key lies in drawing on what we intuitively know about wellness and illness, and what we know through actual experience about how patients heal.  The psychology scholars have done some marvelous work on well-being and happiness.  Tying those findings into health is OUR job, and creating those ties require a workable philosophy of health.

This is the path that led me to create the Perspectival Well-Being Model in which well-being is mediated by our sense of belonging in social relationships to others, by our sense of virtue, and the need to care for ourselves.  I posit that personal well-being is not grounded in self-centric thoughts and activities, but in being and acting in our worlds through virtue and relationship.  By focusing on the unbreakable tie between virtue, self, and others, there is plenty of room for the current understanding of health as a function of well-being and vice versa.  It is broad enough to account for a spectrum of health experiences:  from the well-being of the terminally ill or severely injured, to the ill-being of the socially isolated but physically healthy person.

Graffiti art in Dusseldorf, Germany

Plain Talk: Art and music can open your brain to new ways of thinking about life…and that’s what philosophy is…how we think about life.  The Kimmie Factor decreases when we explore art and music.  Read on…

The abstractions of philosophy throw students for a loop.  The subject seems so “out there”, “irrelevant to daily life”, and comments like “it won’t help me do my job as a nurse in the ER” abound.  Philosophy, for many nursing students, reminds me of my very needy, maladjusted, quirky grade school classmate, Kimmie (not her real name), who followed me everywhere.  I felt sorry for her, but I was so ill at ease with her following me.  I wanted her to go away and quit bothering me with her weirdness.  I just didn’t know how to handle her.  Instead of trying to find out who she really was, I kept her at arm’s length, just far enough I could politely ditch her, or I could welcome her into a conversation.  Just as long as I could control the interaction.

Tackling philosophy reminds me of the difficulty in befriending the awkward people in our lives.  It is not an easy task.  You lose your sense of control.  It takes your mind to an uncomfortable place, to a new way of thinking, where there is no GPS to ease the discomfort of this strange, unknown location.  Likewise, abstraction  can be intimidating when we have nowhere to anchor ourselves.  It’s easier to remain indoors and not answer the door, than it is to invite Kimmie into our lives.  We greatly dislike that loss of control for dealing with weirdness.  It’s what I call the “Kimmie Factor”.

Have you ever noticed how the arts & music crowd seem more philosophical in their conversations?  I don’t think it’s coincidental.  Art, music, and philosophy have much in common.  Some of you would respond, “Duh, those people are all weird, and impractical.”  I get that.  I once thought that, too.

The Kimmie Factor may well be limiting you from seeing the beauty of philosophy.  Is the Kimmie Factor preventing you from self-evaluation of your own life philosophies?  The Kimmie Factor puts us in an uncomfortable position where we can try our darndest at avoidance like I did, or the Kimmie Factor can be just the challenge you need to at least consider your own views.  On one level, you know that the Kimmie Factor demands attention.  I knew that befriending Kimmie was the right thing, but my own discomfort scared me off from a deeper relationship with her, something I regret now.  I wasn’t mean to her, but my neglect and minimal engagement when I knew better, was probably more of my loss than hers.

Philosophy has a strong Kimmie Factor.  It’s weird, and those old philosophers are so “out there”.  Who cares, after all?  Consider the job of philosophers.  They can’t quit asking questions about why we’re here, why we do what we do, why we think what we think, and what is the meaning of life.  Finding words for that is hard.  You are not so different because you and your friends talk about what life is like and why and why people do the things you do.  Those old philosophers were likely interesting guys, and every now and then, they were probably ordering pizza and hanging out with friends.  Shoot, they might have even had a real life, and owned a great dog!

You can decrease the Kimmie Factor by visiting art museums, attending art shows, and talking to artists.  When you expose your mind to many and varied types of art, you begin to think a little more “out of the box” abstractly.  Your mind will begin to acquaint your thoughts with an array of possibilities as to how these thoughts and beliefs might be organized.  It stretches you, you grow, you see life more full of possibilities, not only for yourself, but for the human race.

Exposure to good music also decreases the Kimmie Factor.  However you define what constitutes “good music”, the takeaway here is that the complexity of music and how it engages both sides of our brains, is a splendid way to increase your capabilities to thinking philosophically.  Music invades all parts of your brain.  Even the math side (yes, there’s hope for the mathaphobes).  It is not uncommon for brain-injured and stroke victims to retain the ability to sing all the verses of a song, yet not be able to communicate well verbally.  This happened to Gabby Giffords, the Congresswoman from Arizona who was shot in the head in January 2011.  She is regaining her speech through singing  Don’t limit yourself to a few types of music.  Listen with intention across genres. (Get the free Pandora for your computer so you can freely explore genres and artists without a financial outlay.)

Art, music, and philosophy have this commonality:  They are all ways of interpreting our world and feelings, a type of “sense-making” to provide us with a sense of coherence, meaning, and significance.  The Kimmie Factor imprisons you from seeing what you could be seeing, from feeling what you could be feeling, from thinking in different ways that would enhance your life.

Start today to decrease the Kimmie Factor.  Step outside your comfort zone.  Explore a topic of interest but go beyond what you usually seek out.  Look at the topic in philosophy, in art, in music, and other disciplines as well.  University and college fine arts departments are very good venues for the novice, due to the low cost and immense variety of music, dance, and art forms. Art exhibits change frequently, so you can go to the sculpture exhibit, modern art, the graphic design exhibit (one of my favs), etc.  Another venue I like are the little coffee shops, bars, and out-of-the-way places where the average Joe has his art displayed, and live music abounds to be enjoyed over coffee or drinks.  During free time at home, explore, or find new and upcoming artists.  View wholesome art/music videos on YouTube and Vimeo.

A good example of how art, music, and philosophy converge in video can be found in the Kony2012 documentary produced by Invisible Children, an advocacy group for the 30,000 children abducted, killed, and mutilated by Joseph Kony, leader of the LRA for 26 years running, has created a short documentary-gone-viral for the goal of ensuring the arrest of this man who is the #1 most wanted man in the world by the International Criminal Court.  The film is a superb creation of art, music, and a unique strategy for social action to bring Jospeh Kony to justice.  As you view it, think about how all these elements of art, music, and philosophy are composed to convey a set of life values (philosophy) and how those elements argue for a certain philosophy of life that values children, engages an idea of global responsibility in the sanctity of life, and of using technology for maintaining the rights of the voiceless.  The deeper value conveyed in this film is our responsibility to our fellow man.

The Kimmie Factor nearly prevented me from a life-enhancing evening.  Despite my love of music, my Kimmie Factor was loud and insistent that a percussion music performance would be the worst way to spend an evening.  Who would want to listen to drums and xylophones all evening?  <groan……..>  The Kimmie Factor wanted to reinforce my belief this was going to be like a high school trap drum solo.  But I had to go because my college-age daughter said it would be wonderful and you have to say ‘yes’ to these things.  Turns out it was a fabulous experience, especially the 17 large, native drums. The Kimmie Factor is easier to confront when you go with a friend.

Engage with people outside your familiar circle of friends.  Take someone with you.  Do this regularly and soon the Kimmie Factor will be a thing of the past.  (I promise you won’t develop an exponential weirdness factor in the process).

In 2009, I posted an article I wrote on Truth and Beauty, and how we seek it and are enthralled by it.  I stated that physics scientists are one the luckiest lots on the planet for their daily glimpses of beauty in math as it applies to understanding the universe.

The last few posts have centered on the role of virtue in well-being.  Here I take a slightly different trajectory to spur your thinking about how truth, beauty, and virtue are all synonymous.  I’d say most people don’t categorize ‘right judgments’ or ‘doing the right thing’ or morals as beauty, yet we act on this belief every day.  Think about the TV news story about a man who risks his own life to save a child from a tragic death.  Does anything grip our hearts as much as this?  Why?  Why would we say that’s a beautiful story?  Obviously, we’re not talking about physical beauty.  The beauty is in the ethic, the moral, the virtue, isn’t it?  Beauty is bound up in doing the right thing, in sacrifice for another, and is even more beautiful when performed for someone who is totally incapable of returning the favor.

Beauty is linked to truth, because truth informs our ideas of virtue and beauty.  We don’t value lies or deceit or murder.  These actions are all, at some level, untruth about how life should be.  We do not believe that in the ideal world that life should be full of evil.  Our ideas of truth and lies, of good and evil, are enacted in our laws.  We believe it is beautiful when justice is carried out.  

Stated conversely, we believe it is ugly when truth does not win, when people hate each other.  

My observations from Facebook:  I post occasionally on Facebook about humanitarian projects, of children and people in dire need, in hopes of raising awareness and financial support.  These posts don’t get many comments or “likes”.  Same minimal response when I post stories of amazing human accomplishments.  But, if I post a story or video about the the triumphs of love for the sake of another person, these posts get dozens of remarks, “likes”, and “shares”.  Why?  Because it appeals to our idea of beauty epitomized in truth and virtue.  We are not so astounded by mere accomplishment, or by the needs of the world.  

We are astounded by examples of beauty that approximate our idea of what we think perfect beauty looks like.  The aesthetic satisfaction of beauty is necessarily bound up in the ideals of truth and virtue.  Likewise, untruth and unvirtuous morals are ugly and repulsive to us.

I hope you see the link to health and well-being:  Ugliness does not lead us to develop health interventions, or nursing practice, or to allocate money for research.  Health/well-being is directly related to the quest for knowledge (truth) through research, the desire to do good (virtue) to others through evidence-based practice, and to treat all people as sacred beings (care/love).   
Summing up:  BEAUTY  = TRUTH = VIRTUE 


If you keep up with this blog, you know it can be kind of random.  I blog when I want to put up an idea, not necessarily to run a series of related articles.  Today’s a little different.  This is my third post, and it is related to the previous two posts.

My passion for orphans stems from three intensely personal connections:
1.  My grandson, Duncan (above).  Adopted by my daughter and son-in-law from Uganda, he comes from unbelievable circumstances, and has totally changed our lives with love and joy.  The entire experience over the last several years has left our family with a dedicated, unified purpose in helping orphans worldwide.  We have learned through adoption what “health” and “well-being” truly means.  Duncan, 2 weeks after arriving home, barely knowing any English, declared to his Mommy with great delight, “This is HOME!” while she was slathering him with lotion after drying off from his bath.  Even pre-schoolers know “home” when they have it.

The growth spurt that occurs post-adoption in most kids, affected him also.  He went from 2T to size 4 in a few short months!  This growth spurt is not just from nutrition.  There’s a neurohormonal connection between love and growth.  That’s an AMAZING phenomena, and nothing short of miraculous in my book.

LOVE (virtue in relationships) + FOOD + SAFETY = HEALTH!  WELL-BEING!  LIFE!

Don’t fail to see this!  I beg you!  If we FAIL to account for virtues, for love, for relationships, we fail to realize all that health really is.  Did you know that orphans would rather go with less food if it meant they were in loving relationships?  That shouldn’t surprise us, and it doesn’t, but let yourself SEE what this means!  Endeavors to improve physical health will fail without the twin need of love.  And love is informed by virtues, morals, and ethics.  We may not call it ‘love’, but when we rally for the dignity and sanctity of all persons, we’re saying all people are in need of purpose and meaning within themselves and in relationship to others.
My other blog is Orphan Health Project where you can find more on orphan issues.

2.  My mom, who was adopted at age 3 months.  My grandparents went to the orphanage, picked out this beautiful baby girl, named her Sandra Jan, and she grew up to be an artist.  Near the end of her short life of 53 years, a combination of smoking, hypertension, severe arterial blockage from cholesterol, and depression stopped her heart during a nap one day.  You’d never know she was ‘sick’.  She was beautiful, slender, outgoing, and kind.  My mom was the favorite in my group of friends.  Looking back now on my life, she seemed to have had bonding deficits, which is interesting because the orphan literature shows that early infant deprivation of affection can result in problems in adulthood, because the brain’s emotional connections do not develop properly in the absence of cuddling and nurturance.  The right thing for babies is LOVE.  Deprive a baby of love, and what do you get?  Maladaption, illness, and even death before age 3 from a lack of love.

3.  I was once orphaned from God, in need of divine love, He found me, adopted me, called me His own, and now I live in faith because of the miraculous work of Jesus Christ.  You should know that because it is on the basis of my beliefs and experiences with God that I write anything at all about well-being, perfection, health, sanctity of life, and virtue.  I cannot explain any of this without invoking the God of all who infuses me with life, love, and purpose!  My religious beliefs are from the trinitarian Christian faith:  God the Father, God the Son, and God the Holy Spirit.

In the end, my passions are all bound up together in God, people, and purpose.  When I consider the interplay between orphans and health (or well-being), then I see a beautiful analogy between redemption and well-being.  And what that should look like on earth.

Just thought you should know.  Every author needs to make their presuppositions and assumptions explicit.  Now you know.  I hope this sparks some debate in your own mind and heart about what you believe about health, life, and well-being.

Grace & Peace,

Plain Talk: The Perspectival Well-Being Model is a simple way to understand how virtue, self, and others is bound up in how we think of health, illness, and how nurses help people heal.

Ideas have a way of morphing, reshaping, and evolving until they reach a good fit with our frame of reference.  What started out as the Perspectival Worldview Model years ago has now reached an apex in my thoughts.  Through my research on health, altruism, and well-being, and my work with African orphans, I am now narrowing the model to how we understand health as well-being.  The fit is better than it was when it was centered on worldview.  It thrills me that it so aptly describes the general links between moral understandings, self, and relationships with others, including the settings in which we live.

The Perspectival Well-Being Model provides a conceptual framework for the how, where, and why of the way we think about health.  It is what I would call an ‘epistemic‘ (knowledge) framework because it informs us of how we think about health, and what dimensions give rise to our definitions of health.  It is an ‘ontologic‘ (the nature of what is) framework because it presumes humans as innately moral-minded, self-preserving, in need of purpose, and in relationship with others.  It is an ‘axiologic’ (the study of values) framework because morals inform and color all of life’s moments.

Health, in this model, would be defined as the conditions within each perspective that optimize our expression of ourselves as we live a life a purpose that is grounded in living for the good of humanity. Ultimately, this would be perfection in all perspectives (morals, self, others/environment) because that would be the milieu for perfect health.  In real life, though, alterations and adjustments occur constantly in every perspective through our daily activities, and health occurs as we move closer to the ideal.

When an ideal of health is conceptualized as the convergence of our self, ideal virtues, and right relationships, then health is no longer merely about a body that needs fixed, a mind that needs medicated, or improving living conditions.  Nursing is about restoration, but in so many cases, we don’t want people’s health to be merely restored to a former state, but to move towards the ideal.  As I said in the post prior to this one, that necessarily relies on a sense of rightness, of virtuous acts to move them closer to the ideal.  All good work in the world is done to move people to a better state and that good work is contingent on antecedent ideals of perfection.

The Perspectival Well-Being Model goes beyond traditional health models in 3 important ways:

  • It does not distinguish or divide between mind-body-spirit of persons.
  • It does not distinguish or divide between biological-psychological-social-spiritual models of persons.
  • The model is capable of epistemic, ontologic, and axiologic congruity.  There is no disconnect between what it means to be human, what it means to be healthy, or what it means to be virtuous.
Additionally, there are 2 features that broaden our understanding of well-being:
  • It implies the role of all people in contributing to the well-being of their fellow man by being the right person.
  • Each perspective (virtue, self, and others) is a full perspective of the other two perspectives.
Are you as excited as I am about this?  Even if I stand alone in my views, I stand firm…and happy.

Plain Talk:  Nursing philosophy is of little value without a well-articulated philosophy of health, ultimately it’s grounded in the sense of perfection, of what’s right, true, and good.  But virtues (morals and values) are unfortunately, a bit of a hush-hush topic, though it is implicit in every discussion about what makes people “healthy”.  Yet we cannot think intelligently about health without thinking of perfection and its ramifications, especially for how people are wired to belong to each other in right relationships.

I began my PhD work with the intent to influence nursing philosophy, to help solve the (apparent) disconnect between the quandary about the supposed theory-practice gap.  Over time, I came to realize that my contention was not so much with nursing philosophy, but with the missing element:  a well-articulated philosophy of health.  You will not find the term, ‘philosophy of health’ hardly anywhere.  Don’t you find that odd?  We have philosophies about everything.  And yet, in nursing, the health industry’s largest profession, has not developed a philosophy of health.  Incredible!  How can we even talk about nursing if we haven’t developed a philosophy of health?   What good are definitions of health if we don’t have a philosophy backing those definitions?  Just so you know, those philosophies are there….it’s just that no one has written one though the closest we might find is from Jean Watson (

Four axioms stand out to me about the theory-practice gap:
(1) Nursing has failed to give a full account of what it means to be human.
(2) The fundamental core of human existence is grounded in values, morals, and purpose.
(3) All definitions of health and well-being leave out (2).
(4) Nurses practice intuitively within (2).

These four axioms lead to one conclusion:  The theory-practice gap is a myth.  The disconnect between (1) and (4) is the problem.  It is the lack of nursing theory not accounting for an understanding of human beings in the way we understand human beings in our practice.  It’s an ontologic (the nature of a thing) problem.

The solution? A philosophy of health grounded in humanity as beings with purpose who act and live within values and morals.  The corollary to this is that we are made for social relationships.  We were made to belong to one another.  It’s evident in how we think of human flourishing & well-being:  It’s evident in how we live, work, play, and heal.

There are huge “so what” ramifications for such a philosophy:

  • People in harmful relationships suffer from the lack of virtue in others and maybe themselves, resulting in higher rates of illness, abuse, illness, depression, even suicide.
  • When in right relationships, people heal faster and more fully.
  • Right relationships are characterized by high virtues and morals:  Unselfishness, love, justice, mercy, grace, forgiveness, sacrifice, and seeking the higher good for the sake of another.
  • Those who are in right relationships enjoy better physical health, mental health, and well-being.
  • Health is not just that (worn-out and inept) idea of mind-body-spirit, but ultimately about being virtuous, about being the right person and being in right relationships.

Is this talk about virtue making your squirm?  Settle down.  This permeates your life! Your daily life is FULL of moral and value statements and decisions.  What you decide to do and why, and how you interpret the actions and words of someone else are ALWAYS framed by a sense of right and wrong.  Always.  Try to come up with an example where your moral compass is not functioning.  I doubt you can.

We were made to be virtuous people.  Virtue is hugely important to understanding health.  The absence of discussion of virtue in definitions of health is the missing link between theory and practice.  How this has escaped our notice and our discussions, I don’t know.  Perhaps it is so innate to us we don’t think about out loud.  Just look at what children teach us.  They die without affection, love, nurturing….they die if the virtuous, right morals to care for them are ignored.  Those who fail to care for children, or who harm children, are abominable to the public.  Virtues matter.  For everyone.  Virtues are at the CORE of life and death.  From the individual to the global world, virtues are the framework for everything:  peace, war, economic trade, human rights, improving health, making the world a better place.

This is a bit of a random post today, but I hope it gets you thinking.  If I can help the public and academia  understand the link between virtue, health, and well-being, I will have accomplished my goal and fulfilled my passion.  Thanks for listening, friends.

Plain Talk:  Well-being characterizes strong people, even those in the midst of adversity.

Research is the quest for knowledge of the ‘white spaces’ that lie outside the black marks, to go beyond the obvious into the absences, to examine the taken-for-granted backdrops of life.  The ‘white space’ I am researching is the subjective well-being of child-heads of households (sibling groups who live alone).  Subjective well-being is comprised of life-satisfaction (a cognitive assessment), and positive/negative affect (affective assessment).  What is so accommodating about this concept is its ability to account for vulnerability as well as well-being.  Well-being is not the absence of vulnerability but rather the existence of life-satisfaction in spite of vulnerability.  That’s not saying we should glorify or minimize adversity.  No.  Rather, it means that vulnerability does not snuff out the capacity for well-being!  That is GOOD NEWS!  How we foster and nurture well-being in the midst of well-being, however, remains unknown.  I, for one, am excited to find out more about this in this special population of children that has been characterized as poor, weak, and dependent children.  I don’t think they are like that.  I think they are probably very resourceful and wise beyond their years.  We’ll see. How thankful I am that the human spirit is just pretty darn resilient.  I’m going to Malawi in August 2012 to find out more about these children.  Stay tuned!

Plain Talk: Both quantitative and qualitative research are valid forms of argumentation.

Nursing researchers could learn a lot from Perelman & Olbrechts-Tyteca’s “The New Rhetoric” (1969), an invaluable treatise on logical argumentation. Here’s my idea:  If we called research ‘argumentation’, the playing field of the quantitative/qualitative battle would be leveled.  The term, ‘research’ has come to glorify quantitative research, which is such a shame, because the best research method is the one that answers the research question.  Given this, quant could be a bad choice.  Pick the wrong method and that study is headed to the paper shredder, not to mention you just forfeited tenure and fame.
If  argumentation became the predominant paradigm under which quantitative and qualitative were considered two different types of logical reasoning (argumentation), we might do away with the stereotypical meanings of ‘research’ as only referring to quantitative analysis.  By the way, argumentation is just another word for logical, critical reasoning.  Anyway, no longer would we tolerate this insane idea that quantitative research trumps qualitative research in regards to rigor.  Where did that come from, anyway?  Well, I’ll tell you.  It came from the Logical Positivist movement, and those rumors about math trumping language still persist.  HOWEVER:  Math and language are both symbols of our thoughts and concepts. It doesn’t matter if the argumentation is quantitative or qualitative in nature.  What matters is that it is logical, coherent, and convincing relative to what else we know about the world.  A truce for the standoff between quantitative and qualitative is found in the concept of argumentation.  
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