Health is a central concept in most if not all versions of the metaparadigm of nursology (Fawcett, 2019). I have defined health as “human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6) and conceptualize health as inclusive of wellness, illness, and disease within that process. I deliberately separated wellness from illness and disease when I realized many years ago that the term, promotion of health, could mean that nursologists’ activities were directed toward promotion of illness and disease as well as wellness, rather than indicating that nursologists’ activities are directed toward promoting wellness and preventing illness and disease.
However, I recently realized that my conceptualization of health is Euro-centric and reflects my privilege as a white, Anglo-Saxon nursologist (Chinn, 2020). Accordingly, when I had the honor of speaking virtually with faculty and graduate program learners at St. Mary’s College Graduate School of Nursing in Kurume, Japan, in February 2021, I invited the learners to share their thoughts about health by responding to three questions. The questions and their responses constitute most of the remainder of this blog.
• The first question is: What is your definition of health?
• Inasmuch as the nursology curriculum at St. Mary’s College School of Nursing is based on the Roy Adaptation Model (RAM), I then asked this question: To what extent is your definition of health consistent with the Roy Adaptation Model definition of health, which is: “A state and process of being and becoming an integrated and whole human being” (Roy, 2009, p. 48).
• Finally, I asked: How does your definition of health affect what you think and do as a nursologist?
GRADUATE PROGRAM LEARNER TAKAKO TANAKA’S THOUGHTS ARE:
I define health as a feeling of harmony between body, mind, and living in society. Even if people have a disease or disability, they can be considered healthy if they feel that they are able to do what they want to do, while coping with their environment. My definition of health is similar to that of the RAM, in that human health in the RAM is not just a high or low level of health. Instead, it is about growth and development as we interact with our environment. Output behavior, when healthy, is positive adaptive behavior. According to the RAM, if energy is not spent on maladaptive coping, this energy can promote healing and enhance health, even in states of illness. I also believe that if people have a lifestyle disease, for example, and can controls the disease by going to the hospital and taking appropriate medication to stabilize the disease, and are able to live as members of society, then they are healthy. My definition of health has been informed by my work in public health nursing, as I learned to always value the concept of health promotion. Individually and collectively, I want to help people understand their health problems and support them to achieve independence and self-determination on their own, which will likely lead to illness prevention. Furthermore, I believe that it is essential to create an environment that supports health.
GRADUATE PROGRAM LEARNER MIHO YOSHIOKA’S THOUGHTS ARE:
I define health as a state in which subjective well-being and objective health indicators are in marvelous harmony. Subjective well-being differs depending on the culture, customs, and environmental values of each individual; and even if they have a disease or handicap, I think that they are in health if they feel well-being within themselves. However, I ask if there is a possibility of being a detriment to themselves, such as leaving the illness to their own discretion, are they truly healthy? Therefore, I dare to consider that a state in which these conflicting things are in marvelous harmony can be called health. The RAM emphasis on an interaction between the person and the environment is consistent with my idea of subjective well-being. The RAM emphasizes that health behaviors based on individual values are adaptive and can never be measured by the values of others, which helps me to understand that whether people consider themselves healthy is a complete affirmation of their diverse values. However, the RAM contention that health behaviors cannot be measured is not consistent with the inclusion of objective aspects of health in my definition. In recent years, people’s lifestyles and values have changed, and subjective well-being, an aspect of my definition of health, has also diversified. The practice of providing sensitive care for the different needs of each individual requires a holistic understanding of that individual. A nursologist is the professional who is closest to the client. By paying attention to and engaging with the client, I think that we can become aware of the needs of that person and provide individualized nursology that protects human consideration and dignity. I also think that nursology, which requires being close to the client, is important in terms of developing trust and respect for their subjective well-being. Moreover, I think that nursology practice is caring for others, which is essential for curing and healing. Therefore, the attitude of facing each individual, the full use of professional knowledge and experience with dignity to maintain and improve well-being, and cooperation with clients while caring for them, are all affected by my definition of health and by our thinking and acting as a nursologist.
GRADUATE PROGRAM LEARNER MASUMI OKA’S THOUGHTS ARE:
I define health as a state of understanding and accepting of one’s condition, and also a quest for health itself. Although the World Health Organization (1948) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” I regard health as the way of understanding the state of experiencing a disease or disability, accepting one’s response to the disease or disability, and trying to become satisfied and fulfilled despite the disease or disability. My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. There are subjective and objective aspects to health, but factors such as ideals, goals, and prejudices toward health are the driving force behind the quest for health. I believe that human beings are creatures that constantly seek “health” and have the power to control their way of life. In other words, the act of pursuing “health” itself becomes human empowerment, and I think that it also affects one’s quality of life. My definition of health has been greatly influenced by the RAM definition of health. Being and becoming a whole and integrated human being can be interpreted as a quest for health, so that process is health itself. The RAM considers health from the perspective of human goals and the significance of existence, and lack of integration is said to denote inadequate health. The facilitation of the process of integration is seen as care for my idea of a “quest for health” and is consistent with all human care required of nursologists. My definition of health has a great influence on my thinking and behavior as a nursologist. I believe that supporting the acceptance of people with a disease or disability and considering together with them is caring for their “quest for health.” Quality of life changes significantly depending on how disease or disorder is perceived and understood. As a nursologist, I think that by being involved in the process of accepting illness and disability and supporting people’s ability to satisfy themselves, they can accept and love their existence. As a nursologist, I would like to continue to study and learn the potential “investigative power of health” of human beings and contribute to the development of the science of nursology in the future.
GRADUATE PROGRAM LEARNER TATSUNARI HARA’S THOUGHTS ARE:
My definition of health has two aspects: it is the situation in which people think of their condition as being “good” despite any physical malady they might have, and it is also the process they are going through in changing or adapting to their condition to become “better” in terms of their own understanding of the word. My definition of health has been greatly influenced by the RAM, as I learned nursology through the RAM. My definition of health is, however, more abstract than that of the RAM, as my definition emphasizes the largely subjective nature of health. My definition of health has influenced by thoughts and actions. Thus, I understand that nursologists strive to establish a caring connection to patients by ascertaining what kind of state they think is good, their goals and abilities required to attain that state, how they perceive their current situation, and what their values are. Furthermore, as I work in rehabilitation nursology, I see many of the patients leave the hospital with remaining disabilities to go on with their lives. Therefore, we nursologists may be required to change our ideas about health so that we can work together with the patients while thinking about how to establish health in their lives, and encourage any necessary changes they may need to make.
GRADUATE PROGRAM LEARNER MIHO ISHIBASHI’S THOUGHTS ARE:
I think that health is not a concept that opposes illness, but a process in which a person interacts with the environment as a human being and tries to become a person looking positively toward their hopes and wishes. Health in the RAM is an integrated overall condition or process. Nursologists say that by promoting adaptation, they contribute to human health, quality of life, and dignified death. I think that for people to be the people they are, nursologists have to understand the hopes and wishes of what the people want to be and do, as well as understand and support them physically, mentally, and socially. I believe it is necessary to understand the environment surrounding a person, think about the influences that affect their health, and consider how to manage these aspects to make people healthy. I think it is necessary to act as a nursologist to understand people’s hopes and wishes people and to help them attain these hopes and wishes.
GRADUATE PROGRAM LEARNER YUKIE NAKANISHI’S THOUGHTS ARE:
I think of health as being familiar with one’s self, having the ability to deal with problems, and having the ability to make decisions. The notion of health in the RAM as a state of integration is consistent with my thoughts about health. Until I entered graduate school, I was convinced that “health” was not having any illnesses or disability. However, even if one has an illness or a disability, I have now come to think that true health is the ability to face oneself, accept what one has become, and move forward toward the future. While studying the RAM and bioethics, I have learned it is important to learn that “person” equals “life”, and that it is equally important to think about a person’s “purpose of life” and “meaning of life” while practicing nursology. Nursologists are practitioners of caring, so I have realized that it may be inadequate to not understand what health is. In the future, I would like to continue learning so I can augment my humanity and human power, learn more about the attitudes necessary for caring, and put them to practical use.
As I began to write this blog, I realized that I did not know the Japanese word for health; Google translate provided an answer: Kenkō, which is written in Japanese characters as 健康 (https://translate.google.com/?sl=en&tl=ja&text=health%20&op=translate)
I was remiss in not having invited the St. Mary’s College Graduate School of Nursing faculty and learners to share the word each uses for health. Therefore, I do not know whether their responses reflect a Euro-centric or Japanese meaning for the word.
When I sent a draft of this blog to Eric Fortin, of the St. Mary’s College School of Nursing faculty, he replied with his interpretation of the Japanese characters for health. I am, therefore, indebted to Mr. Fortin (personal communication, April 26, 2021), who wrote “健 means ‘humans build,’ and ‘康’ means “breathing space, . , , probably implying the lack of obstruction or disease. So, ‘humans building breathing space’ implies being healthy.”
Chinn, P. (2020, January 14). Decolonizing nursing. nursology.net. https://nursology.net/2020/01/14/decolonizing-nursing/
Fawcett, J. (2019, March 21) Questions and Answers about our Discipline: Name and Metaparadigm. Paper presented at the Nursing Theory: A 50 Year Perspective Past and Future Conference. Sponsored by Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. nursology.net. . https://nursology.net/wp-content/uploads/2019/03/cwru-paper-fawcett-3-28-19.pdf
Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.
Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.
World Health Organization. (1948). Preamble to the constitution. World Health Organization. https://www.who.int/about/who-we-are/constitution
10 thoughts on “The Definition of Health: Thoughts from Japan”
Thank you! This is wonderful to read and ponder. I particularly like the observation that health is a quest, maybe rather than a state. We might say “process”.
Nancy, Thank you for your comment. I regard health as the process of living and dying as the defintionof health for my version of the metaparadigm concepts (human beings, environment, health, nursologist activiities).
The translation of the Japanese characters stimulated this question in my own thinking – in relation to the RAM and in general: what are the similarities, overlaps and differences between “healthy” and “health”?
Thank you for you rcomment. That is a good question to ponder. Sandro Galea, Dean of the Boston University School of Public Health recently wrote (I am liberally paraphrasing) that although we tend to thnnk of health as the end goal. perhaps we should instead think of health as the means to live, with living as the goal. .
My definition also incorporates a holistic perspective that includes the meaning of healing, and I think that it is also a love of one’s existence, including existence with others. — MASUMI OKA
I love that. I love the idea that when one sees health as actually a process and by using that perspective in life, one can dare heal themselves, broadly speaking. Thank you Masumi and Dr. Fawcett. Lots to think about; now I wish grad school had us define health using RAM. Just amazing! @thealthphd
Thank you very much for your comment. There almost always is lots to think about. How would you define health using Roy’s Adaptation Model–or in what ways is your definition of health similar to or different from that of RAM?
Thank you for asking me, Dr. Fawcett. You definitely got my creative juices moving!!!
This conceptual model is very powerful. When reading Sister Roy’s work, she uses humanism and veritivity in her life and work. She said that relationships with each other are not random, but that their fabrics are interwoven with purpose and sweet anointing. When we see the potential in each other (e.g, students, friends, spouse, significant other), we also see into their future and what they can become.
When I worked at the bedside last Friday, there was a client who was nervous about the recommendation to cardiac rehab. He was high risk for CHF and the health care team thought rehab would help extend his life. As we know, CHFers may experience cardiopulmonary deterioration rapidly, on any given day. So I tried to talk to him; first assessing his home and family life to make the connection about any positive aspects of rehab. I didn’t want him to go back home without the proper care, supervision, and training for his long-term health. In my mind, there was a flicker of hope that the longstanding institutional structure of a rehab center in which an interdisciplinary team of nurses, PT/OT, cardiologist, and staff who see his situation as unique, apart from that of similar clients, and served to provide quality care.
To this day, Dr. Fawcett, I do not know if he said “yes” to cardiac rehab. But, I am happy. By applying the belief in our shared purpose with each other, however brief, and that which aligns with my professional duty and mental framework, such as seeing purpose in those whom we encounter (new and old), we can hope for a better tomorrow. I appreciate how Sister Roy aligns her conceptual model with patient teaching. It is the most important thing about attaining health. In other words, in order to become healthy, we need to know what health means to you. In my example I used physical health, but health can have different domains too, like spiritual. So then, that will provide different general implications. There is a balance as Lida mentioned. Though we can neither measure nor apply RAM in practice directly, I know that I can use it every day to guide me.
I love conceptual models. ❤️ Cheers to education, research, and nursing practice!!! If I get to see you speak again, I hope it will be on your Theory of adaptation during childbirth.🙂
UCONN School of Nursing
Thank you for this valuable blog which introduce the world of East point of view about nursing metaparadigms. When I was trying to define health from the perspective of Iranian philosophy and mysticism, I have found many shared concepts about health and wellness and most accurately what is the ultimate of life in Eastern thoughts. All of them value subjective characteristic of health and that the weight of this subjective orientation is not considered equal for all the aspects of the body-mind-spirit, implied as human being. Actually, I have realized that body is valued as it is considered the means of one’s non- physical energetic dimension to go through this process of living to evolve. In fact, health is that process of living which human being actualizes the inherent potentials toward higher state of knowing and loving. This worldview and emphasize of how health of one is connected with others though what the one does, is the remarkable issue found in all Eastern thoughts.
Lida, Thank you very much for your comment, which adds to all nursologists’ understanding of the meaning of health in diverse cultures.
Thea, Thank you for your second comment and for sharing your experience with the person who has a medical diagnosis of CHF. It seems to me that you focused on the entire person, not only on his physical health by telling him about cardiac rehab. Within the context of Roy’s adaptation model, your discussion wiht this man emphasized all four adaptive modes, even it not explicit!
I am delighted that you love conceptual models!!!! We always use some conceptual model to guide what we are doing although, alas, we are not alwarys aware of that. See Fawcett, J. (2019, January 22) The Impossibility of Thinking “Atheoretically.” Blog post available at https://nursology.net/2019/01/22/the-impossibility-of-thinking-atheoretically/
Keep up the great work!!!!