“…As
you move toward wellness”, says the yoga coach to the class, experiencing relaxation
during their final breathing exercise. “As
you get your health back”, says the nurse discharging the patient, recovering
from a flare-up of colitis. Wellness and health, illness and disease: are they
antonyms and polar opposites or are they simply parts that come together to
make an entirety?
Historically,
wellness and illness were considered mutually exclusive: the meaning of wellness as the opposite to illness can
be traced to the 1600’s (Zimmer, 2010). Nowadays, the
definition of wellness encompasses health, and underlines the dynamic nature of
the concept (Mosby's
Medical, 2002).
Depending on the background, a great degree of variability exists in the
definition of wellness and the degree of separation of illness from health. For
example, in traditional Western medicine disease is the central concept of
patient care, a hospitalized individual is viewed in disconnect from his usual
state of health and well-being.
Luckily, nurses seem to sense the changes before
they even occur, and the advent of holistic nursing influenced the shift of traditional
paradigm from health as an opposite of disease to wellness being a multi-dimensional
phenomenon. According to Keegan, health/wellness and disease/illness constitute
parts of a process of human health experience (Keegan, 2009, p. 106). If human health
experience is a dynamic process, then its multi-faceted, transforming elements are
bound to influence each other.
The
concept of health/wellness (along with nursing, patient, and environment) is an
important building block for nursing theory and practice (Edwards, 1997). For me, nursing
practice is built on the interaction of these four components. It is mostly the
interaction between the four components that forms human health experience;
hence my nursing care should start at
some point on a continuum from wellness to illness and aid individuals in
achieving their optimal level of wellness. In the effort to accomplish this
goal, I find vital to consider the patient himself, as well as opportunities
and constraints of the environment. I think that patients’ physical and emotional
environment should be viewed inseparably from the health/wellness and
disease/illness because of their constant two-way influences and interactions.
Keegan notes that health attitudes determine patients’ willingness to accept
medical treatment and their perception of the extent of illness (Keegan,
2009, p. 108).
I find this very true. From the side of the white coat, IV antibiotics, charts,
and EKGs, it is hard to see pain, fear of unknown, and an overwhelming
intimidation from high-tech medical equipment. As I was looking for examples to
illustrate “the other side” of health experience, I referred yet again to my
beloved New Yorker. In a story called
Sudden Illness, Laura Hillenbard
describes her experiences with “un-wellness” and navigation of health care (Hillenbard,
2003).
In leu of discussing patients’ perception of their health and health
experiences this article can be an eye-opener. I think that recognizing that patients
have both differences and similarities in ways of perceiving, knowing, and
practicing care can allow nurses to communicate with patients more efficiently,
and, ultimately, develop a trusting relationship.
for those who like the New Yorker, here is a link to the article
http://archives.newyorker.com/?i=2003-07-07#folio=056
References:
Edwards, S. (1997). What is philosophy of nursing? The
Journal of Advanced Nursing , 25, 1089-1093.
Hillenbard, L. (2003,
July). Sudden Illness. The New Yorker , 56-65.
Keegan, L. (2009).
The Art of Holistic Nursing and the Humand Health Experience. In B. Dossey,
& L. Keegan, Holistic Nursing: A Handbook for Practice (pp.
101-112). Sudbury, MA: Jones and Bartlett Publishers.
Mosby's Medical, N.
a. (2002). Wellness. Elsevier.
Zimmer, B. (2010,
April 16). Wellness. The New York Times , pp. Retrieved on June 30,
2012 from http://www.nytimes.com/2010/04/18/magazine/18FOB-onlanguage-t.html.
