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.

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:  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:  When children are deprived of love, it affects their DNA, immune system, and brain function!  The implications of this for understanding health are astounding! 

Yale School of Medicine (article here) has discovered that a lack of nurturing in orphans induces epigenetic changes in DNA that weaken the immune system and adversely affect brain development and function.   

If that doesn’t astound you, then you haven’t thought it through.  Lack of love causes changes at the genetic level that result in weakened bodies and minds.  That alone should blow your mind.  Human beings are creatures made to thrive on love.  Who are the most contented people, regardless of disability level?  Those who are loved, who have purpose in life, and find meaning in life…meaning that includes generosity to others…love.

You should be thinking now of what that means for health research, health interventions, and health policy.  If ever there was a call for health scholars to lobby for money for well-being research, this is it.  And if ever the was a reason to advocate for infants and children, this is it.

For an intriguing look at epigenetics, read this article from TIME, “Why DNA Isn’t Your Destiny” …A great read!

Plain Talk:  Well-being is not equal-being.  Attempts to equalize income and opportunities for all people ignore the life-sustaining necessity of being in loving relationships, a fact being borne out in the physiological research.  Healthcare researchers should focus more on this dimension of health. 

“Vulnerable populations”

“Health disparities”

These are the designer catch-phrases in modern health.  The problem, as I see it, is that vulnerability is such a broad term that can mean anything from extreme deprivation to normal life events experienced by all people, like loss of a parent.  Bottom line is that everyone is vulnerable in different ways at different times.  The current paradigms of health, while claiming to be focused on well-being, actually only advocate meeting physical and psychological needs.  When vulnerability is so defined, then only the poor qualify for the remedy, because only the poor have been assigned vulnerability status. 

Does that strike you as odd?  It does me.  Since when are only the poor vulnerable?  The wealthy are also vulnerable, but in less visible ways.  First of all, there is not much research on vulnerability of the wealthy.  Using a scholarly search engine through a library, there was only 1 hit for “vulnerability of the wealthy” compared to 89 hits for “vulnerability of the poor”.  Psychological research and Gallup polls tell us over and over that well-being of people does not vary that much over income levels once life’s most basic needs are met.  This is true across the world.  It’s because peace and purpose are not dependent upon equalizing socioeconomic status.

It’s true that income correlates with longevity.  Here’s the rub:  Somehow we have come to equate longevity with well-being.  Is this true?  Is long life the mark of a life well-lived?  The well-lived life is not a life lived long!  Naturally, most people hope to live a long life.  But they want a long, happy & satisfied life.  People seek peace and purpose.  Those that don’t experience it may consider suicide.

There is a need to match the FIT between what it means to be human and what it means, ultimately, to be healthy.  We have to move beyond vulnerability thinking, move past the idea of the “multi-problem poor”, to the bigger picture of what it means for people to live in harmony with themselves and those around them.  This is the life people consider as “well-being”…that sense that even during adversity and vulnerability, they still stand strong…and more often than not, that involves a social network of “relational belonging”…or, more simply, love.

Rate the well-being and vulnerability of these two people:
Bob, age 44, is a millionaire several times over, divorced, has no close friends, and has contemplated suicide, despite the fact he could buy anything he wanted.

Frank, an 86 year old widower, barely makes enough to meet expenses, has a close-knit network of family and friends, volunteers his time, has found meaning in life’s adversities, and is thankful for his life.

Or consider this true-life example:  J. Paul Getty, one of the richest men in the world said, “I would gladly give all my millions for just one lasting marital success.”  This from a man who was married 5 times.

Well-being should never mean the same as alleviation of vulnerability.  If it does, then we do not understand what it means to be human beings…beings for whom thriving means acceptance, affirmation, belonging, and loving.  Thriving is not realized in self-isolation.  Thriving is found in “relational belonging”…or love.  And love can occur alongside vulnerability, and is capable of disarming many forms of vulnerability, according to the latest neurophysiological research.

What do you think?

If you’re interested, here’s the results of my Google search.  Notice how both vulnerabiltiy and well-being are assumed to be related to income.
Google search results on vulnerability:

  • vulnerability and poverty – 22,500,000
  • vulnerability and wealth – 11,100,000 
  • vulnerability and low income – 8,780,000
  • vulnerability and high income – 3,400,000

 Google search results on well-being:

  • well-being and poverty – 163 million
  • well-being and wealth – 180 million
  • well-being and low income – 114 million
  • well-being and high income – 141 million

For the most exhaustive scholarly research on well-being, check out Ed Diener, psychologist, who has been researching this for 30+ years and has 300+ publications on the topic.

Plain Talk:  Love, Significance, and Human Dignity are central to understanding health.  These are not just niceties but critical to life.

The Details:
The Altruistic Health Paradigm is the result of fine-tuning the Perspectival Evidentialism model into a broader application.  While the Perspectival Evidentialism model describes a pragmatic process of nursing, the beauty of this model is the adaptability to an altruistic health paradigm.  The simplicity of the model allows adaptation at a myriad of levels from societal contexts of health philosophy to individual contexts to ethical contexts.  It’s really versatile and flexible for speaking of the paradigm’s three perspectives at any level, for any population, and for any culture. 

What I’m working with right now is rudimentary.  I have taken the three perspectives (Normative, Existential, and Subjective) of the model and, after much thought, have decided that the best representation of ultimate human purpose and fulfillment is most aptly characterized by the following:
1.  Normative (law, ethic) = Love
2.  Existential (I, me, self) = Human Dignity
3.  Subjective (others, situational, relationships) = Significance

Coherent discussion of each perspective (love, human dignity, and significance) is fundamentally dependent upon the other two perspectives.  Indeed, it is very difficult, if not impossible, to discuss each perspective independent of the other two perspectives.

This Altruistic Health Paradigm is, I feel, what truly comprises nursing philosophy, though nursing philosophies usually stop at “mind-body-spirit” and call it holism.  I’m not sure why in healthcare we avoid talking about the great ethical and practical foundation of love, yet we miss the bigger picture when we do so.  Perhaps it seems so intuitively right that nursing philosophers felt that no more explication was necessary.  Certainly, the most similar word used in nursing has been compassion.  While ‘compassion’ is related to love, no other word or concept can truly suffice for “love”.

We need to articulate the redemptive aspect of healthcare that we are after, and the ultimate is not healthy systems, but a healthy person with purpose and passion who is infused with dignity, significance, and love.  It is human flourishing.  I am keenly aware that using “love” may confer some namby-pamby sentiment but that level of meaning is very shallow and illusionary at best.  Love in the ultimate sense is anything but that. Love in the ultimate, redemptive sense is that which seeks the best in and for another person and enables them to achieve it not only for their own sake, but for the sake of others.

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