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philosophy of health

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?

Aha!

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:  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 (www.watsoncaringscience.org).

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.

“It’s perfect!”

Per-fect: [adj., n. pur-fikt; v. per-fekt]:  Flawless, faultless, complete, excellent, blameless, exact, pure, without deviation, undefiled, conforming absolutely to an ideal.

Plain Talk:  Unspoken ideas of a perfect world affect everything in our lives, including ideas of health.  Where we get mixed up is in thinking that health is the ultimate perfection that we should aim for.

Ah, perfection…have you thought about how the concept of perfection is the standard for life?  What do we think about as the measuring stick for choices?  Studies of consumer behavior point indirectly to this idea of perfection.  We shop, we look, we analyze, and we try to find what will most satisfy us with regard to beauty, quality, and utility.  There is a quiet undercurrent in our thinking and living that houses the notion that there is a perfection to everything.  It usually plays out like this:

The shop-a-holic:  “It’s not perfect, but it was on sale.”
The ecstatic shop-a-holic:  “It’s so perfect for the party!”
The excuse-maker: “I’m not perfect. No one is.”
To my OCD friend:  “Hurry up!  It doesn’t have to be perfect.”
The sufferer:  “Someday there will be no more tears or pain.”
The lover:  “I love you.”
The courtroom:  “Do you promise to tell the truth, the whole truth, and nothing but the truth?”
The gift:  “It’s the perfect gift for her.”
The teenager:  “It’s the bomb!”
Mathematician:  “I have the answer.”
The prayerful: “Forgive my sin.”
Religion:  God.

More often, awareness of perfection manifests as “should” and “ought”.  The way life should  be, and the way others should  treat us.  Though we make allowances for ourselves and others because we know perfection is not possible in this life, we still hold it as the benchmark by which we compare everything else.

Just as in our moral lives, the concept of perfection drives ideas of health.  And steering ideas in health is a combination of what abilities the research world has at hand to develop health into a more perfect state.  All you need to do is peruse the health headlines in popular media.  Researchers continue to map the human genome to find secrets in the DNA that we can tinker with to prolong life, annihilate disease, and improve the quality of living.  We want to cure cancer, live longer, destroy depression once and for all, combat obesity, and have perfect children. 

The perfection quest is, after all, what backgrounds the widely-used term, “health-related quality of life”.  Quality of life is an alias for our pursuit of perfection.  Unfortunately, it ends in a relativized version of perfection, because of other factors in our lives that hinder perfection…hindrances like genetics, lifestyle choices, income, and the nature of our relationships with friends and family.  Quality of life, in its perfected form, would be described as peace and purpose.  A health-related quality of life, therefore, is based on an abstract perception of perfect health.

Where I take issue with the idea of health-related quality of life is that happiness, peace, and purpose are equated to health.  Just look at the TV commercials for health products that promise vibrancy, bounce, energy, longevity, sexual ecstasy, and love!  Health is big business, and money is pouring in for these promises of the intangible positives that health seems to promise but can’t deliver. 

Questions for you:
1. How is that we have this innate idea of perfection?  How is it that we are able to perceive the idea of perfect health, perfect life, perfect love, perfect family, perfect self, perfect peace, and perfect truth?
2. How does health-related quality of life affect personal peace and sense of life purpose?  Is it possible to have a poor health-related quality of life yet still experience personal peace and life purpose?  If so, how? If not, why not?

http://dictionary.reference.com/browse/perfect
http://en.wikipedia.org/wiki/Perfection

Plain Talk:  Thinking outside the box might mean that we’re really talking about something else…something besides the box.  We’re questioning all the conventional assumptions.

“Society shuns what society celebrates”.*
How true. We celebrate love, community, sacrifice for others, virtues, strong convictions in tandem with those esteemed virtues yet on another level we despise virtues and value our independent selves above community.  Where does healthcare focus its interventions?  On the SELF.

What’s wrong with us? In thinking about our philosophy of health, shouldn’t the litmus test for where we should place our healthcare dollars be grounded in what we value in our societal celebrations? Rather than focus health interventions solely on the self, shouldn’t it also be on how we, at the individual level, interact with the community at large? Shouldn’t it be in what we celebrate, like virtuous living characterized by love and unselfishness and giving? YES!

So rather than go with the status quo of independent enablement for health, what would happen if we assumed responsiblity for each other, beginning with love and social responsibility, those things that create health-enabling endorphins and other positive physical effects? What would change?

Am I crazy? YES!
Is it right? I’m sure of it.

We need to not only think outside the box, but question if what we’re in is really a box, after all.

*Scott Belsky, CEO, Behance.

Plain Talk:  Google’s search engine confirms it:  Philosophies of health don’t really exist.  And they should.  They must if nursing is going to advance in its philosophical work.  That’s the only way healthcare will advance past the current models.

The Details:
Nursing philosophy is hard because most of the time what is being referred to is not nursing philosophy, but health philosophy.  The professor assigns the nursing students the ever-elusive, most hated assignment:  “Write a 5-10 page paper on your nursing philosophy, undergird it with theory, and demonstrate how it is implemented in the four domains of nursing (nurse, patient, environment, health), and justify your reasons for your position.”  This is literally an impossible assignment.  Volumes have been written on these subjects.  It cannot be addressed in a short paper.  The single revelation here is that even professors don’t understand it.  I don’t fault them, though, because our discipline has not adequately pursued the development of philosophy.

I’ve realized over the last few years, though, that the main difficulty lies in the fact that we have not adequately stated a philosophy of health.  With all the various interpretations and dimensions of health discussed in nursing, psychology, medicine, and sociology, we are still missing something.  I think that “something” is found in our presuppositions…our fundamental beliefs and assumptions that guide our view and interpretation of the world. 

The quandaries of the nursing philosophy assignment is a clue to the fact that we don’t have it quite right.  Look at how nursing views “health”:  physical, emotional, spiritual, environmental.  It’s a modular idea.  We took the medical paradigm of the body’s mechanical functioning, glued on emotional and spiritual dimensions, and set it against a backdrop of environment.  When all systems are “go”, we want to call it “health” or “energy” or “being”.  Even integrative medicine that emphasizes nutrition, stress reduction, and exercise are generally based on a modular approach.

If nursing is going to make sense of nursing philosophy, it needs to consider philosophies of health.   The current philosophy of health as stated in the paragraph above is inadequate.  Before we can be prescriptive (make recommendations for people’s health) we must be proscriptive (describe what health is & is not).  Since health has come to mean more than the physical, and more along the lines of human flourishing, then we have to figure out what constitutes human flourishing.

Enough for now.

(Photo source:  Research Haven)

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