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Saturday, June 30, 2012

Health, Wellness, and Health Experience

    “…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. 
  Health attitudes and beliefs are an essential part of patients’ emotional environment.Keegan notes that health attitudes determine patients’ willingness to accept medical treatment and their perception of the extent of illness (Keegan, 2009, p. 108).

    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


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