San Jose State University
Beginning with a holistic definition in
ancient times, the predominantAmerican definition
of health now focuses on physical health
and disease symptoms. This limited
definition of health is an inadequate
foundation for holistic health care strategies. This
article provides a conceptual model with
an expanded definition of health as a basis for
holistic and conventional health
strategies. The model includes concepts of balance,
energy systems, and mind-body integration
from non-Western health practices.Aholistic
definition of health suggests an expanded
range of positive, pleasurable health
behaviors. The visual representation of
the model can be used by health care professionals
and clients to identify disease reduction
strategies or a health improvement
program for well individuals.
Understanding and expanding the conceptualization of
health and health improvement strategies
offers the possibility of improving client
satisfaction and health status outcomes.
Keywords: health definition; conceptual model;
holistic health
Is health the absence of disease symptoms? Is it the ability to
work
and carry out ones role? Does health
include emotional and spiritual
components? What is optimal health? There
is little consensus on the
definition of health, which has changed
over time, but the current,
most common description of health is no
longer adequate for todays
holistic health promotion strategies
(Larson, 1999; Pender,
Murdaugh,&Parsons, 2002). The purpose
of this article is to describe
the evolution of the concept of health and
suggest additions to current
98
AUTHORS NOTE: The author thanks Ms. Kim
Houck, Ms. Toni Taylor, and Drs. Jayne
Cohen, Marian Yoder, Chris Hooper, and
Robert Hyde for wise feedback on the model
and the article.
JOURNAL OF HOLISTIC NURSING, Vol. 22 No.
2, June 2004 98-115
DOI: 10.1177/0898010104264775
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definitions of health. A second purpose is
to provide a conceptual
model representing an expanded definition
of health that is an appropriate
basis for conventional and holistic health
practices, thus providing
a greater array of positive, feasible
health improvement strategies.
This models expanded health definition
provides ideas for
healthy behaviors that are pleasurable, in
contrast to the typical
onessuch as do not smoke, drink, gain
weight, or sit still. Improvements
in health outcomes depend on broader, more
relevant conceptualizations
of health, meaningful not only for health
professionals
but also for clients (Larson, 1999).
Current health definitions and models
often reflect the dualistic
Cartesian philosophy underlying the
medical model that the mind
and body represent different functioning
systems. As such, the models
represent aWestern view of health and
illness that divides health
into distinct components (e.g., physical,
emotional, and social)
(McKenna, 2003). Other health traditions,
however, suggest that balanced,
integrated (holistic) energy systems
regulate health (Davis,
2000). Nurses with limited
conceptualizations of health, for example,
health as the absence of physical
symptoms, will be excluded fromthe
trend toward strategies based on holistic understandings of
health. In
contrast, holistic nurses use concepts of mind-body integration,
energy systems, and balance (Matteliano, 2003; Popoola, 2003).
Currently, the U.S. health system fails to provide satisfactory
health promotion or disease prevention services to the population
(Lee&Estes, 2001). Alternative health practices are
increasingly popular
in the United States as visits to complementary providers
increased 47% between 1990 and 1996 (Berrey & White, 2000).
Yet
these practices are not well supported by current conventional
health
definitions and typical Western health care strategies.
EVOLUTION
OF THE CURRENT CONCEPT OF HEALTH
The Greek goddess Hygeia represented the idea that humans
could remain healthy if they lived rationally. Health was defined
holistically and thought to be influenced by ones habits of
living,
exercise, environment, and food (Stanhope & Lancaster, 2000).
Later,
however,Western views of health came to focus primarily on
physical
health. Pender et al. (2002) and Larson (1999) described the
subsequent
evolution of the concept of health in much greater detail than is
possible here. For many years, the definition of health emphasized
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mainly physical wholeness and progressed to include mental health
only prior to 1900. Freedom from disease, physical or mental, then
became the typical definition for health as medical science
evolved
through the 1900s with effective treatments for many diseases
(Pender et al., 2002).
These earlyWestern models for health were based on the machine
model of the human body that divided problems into understandable
components, leading to medical specialties that focus on a
particular
body system. Defining health as freedom from disease is still
pervasive
among many people who believe that health is simply the
absence of symptoms (Larson, 1999). Despite its shortcomings, this
model has provided the impetus behind much of medical research in
the United States and the rest of the world. Although this
conceptmay
be viewed as limited, it has provided a concrete definition and
the
foundation for spectacular advances in medical research (Larson,
1999, p. 126).
Well-being . The concept of health as
well-being was introduced in
theWorld Health Organizations (WHO, 1948) definition of health as
a state of complete physical, mental, and social well-being and
not
merely the absence of disease or infirmity. The characterization
of
health as well-being is described by others as a capacity for
living
(Carlson, 2003); being able to feel good during a life of
mobility, enjoyment,
and social relationships (Breslow, 1999); optimistic expectations
(Neilson, 1988); and optimal individualized fitness so that one
lives a full, creative life (Goldsmith, 1972). Pender et al.
(2002) defined
health and well-being as actualization of inherent and acquired
human potential through goal directed behavior, competent
self-care,
and satisfying relationships with others, while adjustments are
made
to maintain structural integrity and harmony with relevant
environments
(p. 22). TheWHOdefinition also provided a popular and persuasive
consideration of several different dimensions of health, such
as physical (structure and function), social, role, mental
(emotional
and intellectual), and general perceptions of health status. As
such,
some consider it the first holistic definition, providing an
important
step in moving past a focus on physical aspects of health (Larson,
1999).
This expanded WHO definition of health met with considerable
criticism, however, as the dimensions became increasingly
difficult to
measure. A healthy social role was harder to define than healthy
physiology; well-being was not clearly defined. Another criticism
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was that the concepts were culturally bound and varied among
different
cultures. Still another criticism was that this utopian definition
of
complete well-being was not possible; therefore, everyone lacks
health (Larson, 1999).
Accepting these difficulties and complexities, however, may be the
only way to define health in a meaningful way. Simplifying and
reducing a concept to easily measured variables does not necessarily
increase validity. In addition, relevant models of health must
allow
for cultural definitions of quality of life and well-being and
cultural
influences on health. Similarly, meaningful concepts for
middle-class
majority Americans will not necessarily be relevant to other
social
groups; therefore, the models must allow for appropriate
adaptation.
Although broad, this concept of health as multidimensional
wellbeing
provides a goal to which individuals can aim in the presence of
disease or disability (Morris, 1998).
Health promotion . Defining health as
well-being provided the
groundwork for the concept of health promotion, distinct from
disease
prevention, which is an essential part of a contemporary concept
of health. Pender et al. (2002) defined health promotion as
increasing
the level of well-being and self-actualization of a given
individual or
group (p 34). The American Journal of Health
Promotion (AJPH , n.d.)
defined health promotion as the science and art of helping people
change their lifestyle to move toward a state of optimal health.
Health promotion, or health improvement, is relevant for people
who
are well and want prevention, are at risk or in early stages of
disease,
and are chronically ill, as well as those who need acute disease
treatment
(Jahnke, 2001). Those with chronic, disabling conditions and
even those with terminal diagnoses can improve aspects of their
wellbeing,
thus demonstrating health improvement in the broadest sense.
Thus, health promotion or health improvement rests on a broad
definition of health as well-being.
Multidimensional health . Although the WHO definition
of health
included many dimensions rather than a limitation to the physical
dimension, it still suggests boundaries between distinct
dimensions
rather than a more integrative approach. Currently, the Web site
for
the AJPH (n.d.) displays a figure
representing health as a pentagon
with five distinct wedges, each divided from the others by
boundaries.
These separate wedges represent emotional, social, intellectual,
spiritual, and physical components of health. This type of model
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supports the conventional medical model that divides health into
separate components rather than supporting the holistic,
integrated
concepts of mind-body wholeness.
In contrast, nurses have historically described truly holistic,
integrated
theoretical understandings of health by describing individuals
as living systems that function purposefully as a unit
(Roy&McLeod,
1981) with mind and body components that can only be understood
in terms of the total system (Newman, 1994). Other theorists have
laid
a foundation for nurses integration of physical, mental, social,
spiritual,
and occupational dimensions by arguing for individuals who
cannot be reduced into parts (Rogers, 1986), forming one unitary
system
composed of integrated subsystems (Roy&McLeod, 1981). More
recently, the American Holistic Nurses Association continued this
theoretical view by stressing the interconnectedness of the
biopsycho-
social-spiritual dimensions and describing the individual as
a unitary whole in mutual process with the environment (Dossey
&
Guzzetta, 2000, p. 28). These holistic, integrated models do not
draw
arbitrary lines between dimensions. However, these theoretical
models
are complex, often not appropriate for client education, and
difficult
to translate for nursing students and community health education
programs. A simpler model is needed for health improvement
programs at all levels.
Western medicine and nursing have thus far contributed the
concepts
of health as well-being, health promotion, and the multiple
dimensions of health to a current health definition. However,
todays
concepts of health do not include the non-Western health concepts
of
energy systems, a full holistic integration of mind and body, and
balance
among various bodily systems. Adding these concepts will expand
the current definition of health and provide nurses with a more
adequate conceptual basis for holistic health practices.
EASTERN
PERSPECTIVE CONTRIBUTION
Energy systems . Many Eastern medicine
traditions assume human
beings are made up of energy systems and a vital life force
(Anderson,
2003). The flow and balance of vital energy or life force provides
an
underlying principle of traditional Chinese medicine (TCM),
Ayurvedic medicine, and other traditions. To maintain health, this
energy connecting mind and body must be moving and flowing
because its stagnation creates disease. The purpose of healing
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strategies from these traditions is to ensure that energy remains
balanced
and flowing smoothly throughout the body (Carlson, 2003;
McKenna, 2003). These practices are used to complement
conventional
health care, to be an alternative to conventional care, to
maintain
wellness, and to recover fromsymptomsof disease (Slater, 2000).
Mind-body integration . Conventional health care
professionals
accept the view that the body represents one functioning system
and
the mind another. This view, consistent with the mainstreamWestern
concept of health, asserts that each system can affect the other
but
essentially sees disease as either physical or mental. However,
this
idea is being replaced with a holistic, integrated vision of
inseparable
components of a dynamic mind-body system (Pert, Dreher, &
Ruff, 1998, p. 30). This integrated view of mind and body is
consistent
with nursing theorists who defined individuals and their
environments
as unbroken wholeness (Watson, 2000) and as total systems
(Newman, 1994; Roy&McLeod, 1981), irreducible into parts
(Rogers,
1986).
More recent information about the integration of the nervous,
endocrine, and immune systems and emotions support the
bodymind concept (Bartol&Courts, 2000). Further evidence for
an
integrated mind-body system is provided by psychoneuroimmunology,
a rapidly evolving multidisciplinary field founded on
the premise that psychosocial factors, the central nervous system,
and
the immune system are intimately linked (Tyll et al., 2000).
Common
examples that mind and body are not separate are provided as
mental
states, such as perceived stress and grieving, and depress the
physical
immune system; perceived stress raises blood pressure; and
meditation
changes levels of stress hormones and melatonin (Carlson, 2003).
Social support and coping styles are mediators in stressful
situations,
providing links with immune status and clinical health status
(Tyll et
al., 2000). There is evidence of communication between
neuropeptides from the brain and the immune system, with each
system
having receptors for the others chemicals; in addition, there is
evidence of emotions biochemicals affecting the immune system
(Carlson, 2003).
Meditation, yoga, and tai chi are examples of strategies that aim
to
improve health using both mental and physical aspects (Carlson,
2003). Some mind-body strategies use meridian and acupuncture
points to affect both mind and body outcomes. Shang (2001)
described
a theory and supporting evidence to explain the meridian and
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acupuncture system. Most acupuncture points and meridians show
evidence of high electrical conductance and a density of gap
junctions
12 times higher than in other areas of the body (Comunetti,
Laage, Schiessl, & Kistler, 1995). Gap junctions are channels
between
cells made of protein complexes that facilitate communication and
increase electrical conductivity (Ewart et al., 1997). Structures
with a
high density of gap junctions are known as organizing centers
(Meyer
et al., 1997). These centers perform the role of intercellular
communication
and growth regulation in the early embryo, preceding the
development of other physiological systems such as the nervous
system.
According to Shangs (2001) theory, the meridian system consists
of the cells in organizing centers that may remain interconnected
and
underdifferentiated as the individual develops. The similarities
between acupuncture points and organizing centers suggest that acupuncture
points, which lie along the meridians, arise from these centers
(Shang, 1989). This interconnected relationship of mind and body
is an essential ingredient of a new, truly holistic, integrated
view of
health.
Balance . Balance and harmony between
the opposing forces of yin
and yang are one of the basic principles of TCM. The symbol of
this
balance is the circle divided into two equal portions with a
serpentine
line. The yang half is white, representing active, bright, warm,
expanding qualities. The dark half represents yin, the dark, cool,
passive,
inner qualities. According to TCM, the human body has aspects
that correspond to yin and yang, and health depends on balance and
harmony between these two dynamic forces and the associated
human aspects. The opposing forces are interdependent, like night
and day, or sleep and waking, because each dimension cannot exist
without the other complementary force. In this medical system,
specific
physiological symptoms or diseases are categorized as yin or
yang imbalance, and the appropriate intervention is taken to
restore
and maintain equilibrium (McKenna, 2003).
An ancient healing system from India is the practice of Ayurveda
that, similar to TCM, emphasizes balance in ones lifestyle, such
as
eating, drinking, playing, working, and exercising (McKenna,
2003).
Adding the concept of balance to a definition of health changes
the
typical American view of health. Relevant health strategies might
then include balancing rest and activity, work and play, calorie
intake
and output, and mental and physical activity.
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Balance, energy systems, and holistic integration of the body and
mind must be included in a relevant, contemporary health
definition
that supports todays holistic health practices. These
improvements
complement the multidimensional aspects of health and the
perspective
that health is well-being and optimal function.
THE
CIRCLE OF HEALTH
Figure 1 shows a simple representation of health that is truly
holistic,
because all included components apply to body (physical) and
mind or spirit (nonphysical) dimensions. This model also includes
Saylor / THE CIRCLE OF HEALTH 105
Figure
1: The Circle of Health.
NOTE: © 2003 Coleen Saylor.
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the concepts of balance and energy. The design of the circle is
modeled
after the symbol from TCM that represents the balance and harmony
between the fundamental principles of yin and yang (McKenna,
2003). This representation or definition of health is intended for
teaching
clients and health providers about health improvement. The
model does not provide a list of risk factors or health promotion
behaviors.
To be relevant for the current American culture, this model is
necessarily
culturally bound. Subjective concepts such as quality of life
and well-being can only be assessed in the context of the culture
and
value systems in which individuals live (Haas, 1999). For example,
the light side of the circle is labeled as activity and
performance. In
some cultures, performance at ones occupation might not
necessarily
represent health, as it does in manyWestern cultures. The other,
dark
side of the circle is labeled as renewal and recovery, concepts
more
consistent with non-Western health traditions that acknowledge the
cycle of day and night, rest and work. Individuals are encouraged
to
adapt this figure as necessary to be relevant and culturally
appropriate
for the target population.
Health is defined in this model as optimal function, well-being,
and quality of life, as stated in the center gray circle. This
central circle
is a part of both the dark and light sides, a symbol that both
activity/
performance and renewal/recovery are necessary for health and are
a
part of well-being and quality of life. This definition includes
physical
(biological function and structural integrity), mental (emotional
and
intellectual function), spiritual, social, and role function.
Physical
function includes the typical physical aspects of normal blood
pressure,
blood chemistry, bone density, structural range of motion, and
so forth. Most of these indicators are objective. Mental function
includes mental health and normal cognitive function. Spiritual
function
includes belief systems, values, faith, or religious practices
that
provide purpose and meaning. Social and role function includes
ones ability to sustain appropriate rewarding social
relationships
and assume desired roles such as spouse, parent, friend, or
employee
(Goldsmith, 1972; Larson, 1999; Neilson, 1988; Ware, 1987).
Well-being and quality of life represent subjective perceptions,
judgments, and expectations of individuals about their health
(Sullivan, 2003). These multidimensional concepts encompass
physical,
psychological, social, and spiritual aspects of health. There is
no
consensus about these definitions, and the terms quality of life , well-
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being , and wellness are often used interchangeably
in the literature
(Haas, 1999).
The two sides of the model contain components that further define
health holistically. These definitions are based on the components
of
holistic health (Saylor, 2003) and will be described below. These
components
provide goals from which individuals can select. These
individually
chosen goals can then be matched with appropriate health
behaviors for that particular person. Somemaychoose to increase
rest
and recreation to balance their work life. Others may choose to
increase physical activity to improve strength and fitness, and
others
may join social groups to expand their socially supportive
network.
Activity and performance . Similar to the concept of
yang, the light
side of the circle of health represents activity and
expansiveness,
going out, or giving out. This side, labeled as activity and
performance,
represents components of health, including (a) energy,
strength, fitness, and stamina; (b) happiness, enjoyment, and
satisfaction;
(c) growth and development; and (d) occupational and/or social
role performance. This activity and performance component overlaps
with the central core of optimal function, well-being, and quality
of
life and includes both physical and mental dimensions. For
example,
energy, strength, fitness, and stamina are both physical and mental,
if
indeed the two can be separated. These components include
conventional
physical and mental energy, vital life force, and the ability to
overcome mental and physical challenges (Larson, 1999; Newman,
1994; Pender et al., 2002; Rogers, 1986) as well as endurance and
toughness, as appropriate for the individuals age and situation.
Goldsmith (1972) described fitness for full, fruitful, creative
living
(p. 213). Those with chronic illness would be expected to have
less
energy and strength; however, health improvement aims to increase
energy and strength through nutrition, rest, exercises, and so
forth.
Those with impairments of physical functionmayimprove their
wellbeing
and quality of life by enhancing mental vitality and toughness,
expanding the use of social support systems, and finding a sense
of
purpose and meaning in their activities.
Happiness, enjoyment, and satisfaction may be thought of as
predominantly
mental attitudes; however, the interaction of attitudes
and thoughts with the immune system, stress response system, and
health status indicators defy characterizing an attitude such as
happiness
or sadness as simply mental. These components include contentment,
joy, and all types of pleasure (e.g., bodily comfort, sexual and
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intellectual satisfaction) (Neilson, 1988; Pender et al., 2002) as
well as
fulfillment, cheerfulness, or hopefulness. Individuals may improve
their health, using this definition, by including activities that
provide
pleasure and satisfaction, such as hobbies, friends,
entertainment,
and satisfying aspects of ones occupation. Those with limited
time,
money, or mobility can still identify pleasures to enhance their
health
such as friendships, good food, books, music, or learning
anewskill.
The growth and development components of health indicate normal
development in each phase of life, actualization of human
potential,
and progress toward higher levels of function (Neilson, 1999;
Pender, 1996; Pender et al., 2002). These attributes include
normal
physical growth for children as well as mental, emotional and
social
development and actualization for adults. Healthy adults seek
maturation
and expansion and extension of their capabilities, building up
their potential as it is individually relevant. Individuals may
improve
their health and well-being by continued learning, new
experiences,
and all varieties of self-improvement activities.
Performance in occupational and social roles includes effective
performance of roles and tasks and socially valued levels of
activities
for social roles (Larson, 1999; Parsons, 1958). Healthy
individuals
demonstrate accomplishment and execution, and they carry out their
roles and tasks successfully in ways that are valued culturally.
Healthy parents are able to take care of their children
satisfactorily,
children are successful at forming friendships and attaining
school
expectations, professionals manage to carry out the expectations
of
their occupations, and retired individuals enjoy the roles of
grandparent
or volunteer. Many individuals may not be able to assume these
typical roles, but women who are disabled or unemployed, for
example,
perform socially important roles of friend, wife, or daughter.
Programs
that help parents become better caregivers or fairer
disciplinarians
of their children improve not only the childrens health but also
that of the parents because the important parent role is then more
successfully
accomplished. Employed individuals with high levels of job
stress or work demand can improve their health by relieving some
of
the stress. If that is not possible, other aspects of health, such
as physical
fitness, enjoyment of hobbies, or development of new skills, may
provide feasible strategies to improve health.
Using the central core and light side of the circle, a healthy
child
could be characterized as one with optimal (normal) physical
growth
and development functions; one with adequate energy and fitness
for
activities, taking pleasure from aspects of family, peer, and
school
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activities; and onewhodemonstrates appropriate social roles at
home
and school. This child is well nourished, lives in a safe
environment,
and usually meets appropriate social expectations. A healthy
senior
might be described as one with age-appropriate physical function
(cardiovascular function, bone density), adequate strength and
energy to engage in desired activities, and satisfactory
participation
in social groups. This senior might be a reasonably contented
80-yearold
who walks regularly, eats a nutritious diet, controls hypertension
with medication and diet, is involved with activities of church
and
neighborhood groups, and sees her family regularly.
Renewal and recovery . The dark side of the figure
represents taking
in, the passive, inner qualities similar to the yin dimension of
the
TCM symbol. This component of health, labeled renewal and
recovery,
includes (a) rest, relaxation, and peacefulness; (b) nourishment;
(c) social support; (d) sense of purpose and meaning; and (e)
balance,
adaptation, and resiliency. These components overlap the central
core
of optimal function, well-being, and quality of life, and many of
these
concepts overlap each other as well. Delightful relationships with
a
loved one can provide relaxation and emotional nourishment as well
as social support. Each of the renewal and recovery components is
holistic, including physical and nonphysical dimensions. Because
health is defined by many Americans as physical fitness, lack of
disease
symptoms, and the ability to engage in physical activities, this
restorative part of health has been overlooked.
Rest, relaxation, and peacefulness include sleep, physical
relaxation,
and recreation activities as well as mental peacefulness (Pender
et al., 2002; Roy & McLeod, 1981). These components include
spare
time, tranquility, inactivity, diversion, or stillness. Health can
be
improved by making sure to get adequate amounts of sleep, by
providing
for relaxation and recreation in complement to the usual family
or work roles, and by balancing activity and productivity with
unhurried time and peacefulness. The American values of accomplishment
and competition do not support the importance of rest
and peacefulness in attaining health, and many individuals find
this
aspect a difficult one.
Nourishment includes proper dietary nutrients, intellectual
challenge,
and emotional fulfillment (Pender et al., 2002; Roy & McLeod,
1981). Physical bodies need appropriate levels of calories,
nutrients,
minerals, and vitamins. In addition to physical nourishment, this
component includes all forms of sustenancethat which sustains the
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mind or spirit, provokes the intellect, and provides emotional
contentment
or satisfaction. Health can be improved by appropriate
amounts of calories and other dietary nutrients as well as
interesting
work or hobbies, satisfying relationships, or feelings of
contribution.
Social support includes satisfactory relations with significant
others
and support systems (Larson, 1999; Roy & McLeod, 1981). This
component includes having the social interactions to obtain help,
assistance, or relief. Those who provide social support may be
known
as benefactor, friend, sponsor, family member, or partner. This
support
may be in the form of helpful information, emotional approval,
the taking over of tasks, or provision of other logistical
assistance, for
example. Health improvement activities include decreasing isolation,
providing linkages with similar others, and identifying those who
can provide friendship or assistance. These supportive,
healthimprovement
activities can include contact with friends or others
with similar circumstances via e-mail, phone or personal visits,
solving
logistical problems with information or instrumental help, or
setting
up informal meetings with longtime friends or family.
Health includes having a sense of purpose and meaning, having
activities that transcend ones self, or having a sense of
spirituality
(Larson, 1999; Pender et al., 2002). This component includes
having a
sense that life has significance and makes a difference. Some
achieve
this sense through religious faith and affiliation; others plant
trees for
a better environment, raise children, provide quality nursing
care, or
take care of an elderly neighbor. Health improvement activities
include any that add meaningfulness, substance, and a sense of
contribution
to ones life.
The final components of health on the renewal and recovery side of
the model are balance, adaptation, and resiliency. This includes
achieving balance between physical and mental, input and output,
and rest and work as well as mediating stressful, depressing
aspects
of ones work. Several authors have emphasized the adaptive aspect
of good health as a harmonious interaction with ones environment,
including physical, social, and emotional contexts; coping
ability; and
resistance to disequilibrium (Goldsmith, 1972; Larson, 1999; Roy
&
McLeod, 1981; Selye, 1975). More recently,
Dossey and Guzzetta
(2000) stated that natural systems theory
(Bertalanffy, 1973) and
holism provide a conceptualization of
health as harmonious interaction
and balance among components of an
individuals life. Minimized
stress and disease result from ones
ability to adapt to or maintain
balance with ones surroundings (Selye,
1975), whereas disability
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is a lack of balance between ones capabilities and the
environmental
demands (Larson, 1999). Humor is an example of a strategy used by
nurses to cope and adapt to difficult, stressful patient
situations
(Wooten, 2000). Other health improvement activities include
reducing
stress, increasing rest and recreation, and balancing other
complementary aspects of ones life.
Using the central core and dark side of the model, a healthy
individual
could be characterized as one with normal physical functioning,
no signs of pathophysiology, and a sense of well-being. This
individual
sleeps well and enjoys reading books and hiking for a change
of pace from her job. This individuals weight and nutritional
status
are within normal limits. Involvement in an environmental activist
group provides a sense of purpose in the
effort to leave the world a
better place, and the others in that group have expanded the
circle of
friends. Family members and a few close friends are supportive and
enjoy holiday meals, family dinners, movies, and hikes together.
Although
this individual has a stressful job and has recovered from
some health problems in the past, she pays attention to the
balance of
work and play and uses her lunch hour to walk or do meditation
exercises
on most days; however, inadequate time provides the greatest
barrier to regular renewal activities.
Aperson with a chronic disease, such as diabetes, can also improve
his or her health by including renewal and recovery aspects of
this
health concept. Crucial physiological factors are the maintenance
of appropriate levels of blood glucose, skin integrity, proper
diet,
and insulin administration. However, this diabetic woman is also a
mother, university administrator, and painter. Balancing rest and
recreation
activities against work demands is imperative for her health.
Spending satisfying time with her family and continuing an
exciting
research activity with a team of colleagues provides the emotional
fulfillment
and intellectual challenge she needs for well-being and
quality of life.
SUMMARY
The circle of health provides a visual representation and expanded
definition of holistic health. The concepts of balance, harmony, and
mind-body integration have been added to traditionalWestern ideas
of physical, mental, spiritual, social, and role optimal function,
wellbeing,
and quality of life. This holistic definition of health is
essential
Saylor / THE CIRCLE OF HEALTH 111
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distribution.
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as a foundation for complementary and alternative health promotion
strategies that offer enormous promise for health care
professionals
and clients as disease reduction strategies or as a health
improvement
program for well individuals. Even those with serious illness can
improve many aspects of their well-being using this model. Health
is
the way in which we live well despite our illnesses and
disabilities.
This expanded definition of health is relevant for those who are
ill as
well as those without disease (Morris, 1998).
Clients can use this circle of health model along with information
about their individual health risks or disease conditions to
identify
health promotion strategies. Afew priorities can be selected;
perhaps
one person is most concerned with balancing work and relaxation,
whereas another person may choose to focus on gaining more energy
and stamina. Clients can then identify one or more strategies
designed
to improve the various components of health listed in the light
and dark areas. More relevant words can be substituted so that the
health concepts are meaningful and feasible for each individual.
This model provides a basis for nurses to suggest an expanded
range of health behaviors. The possible health improvement
strategies
include pleasurable ones, such as taking a nap, calling a friend,
or
growing roses, in addition to the usual admonitions to exercise,
restrict calories, and eat vegetables. This expanded definition of
health provides an expansion fromthecommonAmerican health
definition
as physical fitness (strength and cardiovascular fitness),
absence of symptoms (blood pressure, blood chemistry), and
avoidance
of risky behavior (smoking, unsafe sex).
By understanding and expanding the conceptualization of health
and health improvement strategies, the prospects of improving
client
satisfaction and health status outcomes are greatly increased
(Larson,
1999). Nurses can be the leaders and educators in strategies based
on
an expanded definition of health.
19-11-2009 om 16:17 geschreven door prutske
