Perspectival Well-Being Model

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.

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.
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