theriault

What Kind of "Healthy" Are You?
by Eileen Theriault, RN

Almost every magazine today has an article about some aspect of health. What exactly does "healthy" mean? This is often discussed among health professionals in an effort to direct health care. The public will benefit from being a part of this discussion.
     Judith Smith R.N., in her book, The Idea of Health (Smith 1983), presents us with four models of health for consideration. These models are offered as alternative ideas of health and not seen as mutually exclusive. A progressive expansion of the idea of health is seen, viewing individuals within broader and broader concepts.
     The narrowest view of health is the Clinical model, in which the patient is considered healthy when free from pain or symptoms of disease. Regardless of how happy and fulfilled one feels, one is not healthy if signs and symptoms of disease are present. This is the view typically represented in traditional medical care.
     In the Role performance model, an individual is considered healthy if they are able to effectively perform their daily role. This definition provides for a minimum conception of health. Only when one can no longer perform in one’s role is illness acknowledged.
       In the Adaptive model, health allows the individual to effectively interact in their physical and social environment. A constant adaptation is occurring in order to maintain health. One is physically sound and socially fit, creatively adjusting to circumstances within the environment. When the individual’s use of self-corrective responses to cope with certain changes within the environment fails, their is an absence of health.
     In the Eudaimonistic model, there is a very broad view of health. It extends the idea of health to general well being and self realization. One’s full potential is constantly evolving. It is a holistic view. All aspects of an individual’s life impacts health.
     Traditional medical care fits the clinical model. Medical care is not synonymous with eudaimonistic health care. How one views health will dictate society’s expectation of health care. How inclusive should it be? What should one expect from a health care provider? What should health insurance cover?
       Let us consider the ubiquitous health problem of back pain and how this may be managed in the various models. Imagine the following scenarios of health care provided according to the different views of health.
     One seeks help for acute lower back pain. This is the third attack in six months. Now that pain is severe, medical care is sought.
     In the clinical view of health, a physical exam and maybe an X-ray and MRI are done. If all are found negative for obvious pathology, one may be prescribed a muscle relaxant, rest for 48 hours and maybe some physical therapy. Health is considered obtained when pain subsides.
      In the role performance model, one seeks care because one can no longer perform their role. We have had pain for some time, increasing stiffness, now pain is radiating down the leg. Unable to sit for long periods and unable to bend we must now seek care. We may get the same prescription as above. Pain may subside over time but the individual may not be able to perform optimally and may live in constant fear of relapse. Health is obtained when the individual is able to again perform their role.
    In the adaptive model, at this point, one is unable to adapt to the restrictions of the back pain. Many aspects of the physical and social environment have been considered. Various treatments-applications of heat and cold, chiropractic, medications, exercises, physical therapy, use of proper body mechanics and avoidance of activities that may trigger the pain have all been instituted. Family and friends have been supportive and have helped with daily routines. This has brought varying degrees of relief but the individual is unable to fully function using their own adaptive mechanisms.
    In the eudaimonistic model, we recognize this individual’s inability to realize their evolving potential due to increasing limitations in their mobility accompanied by pain. In this situation the individual may be counseled by a holistic nurse who can help them see that perhaps this persistent back pain is a "health message". It may be viewed as an opportunity to examine their lives more closely. Family and work dynamics as well as all aspects of the individual’s environment such as nutrition, exercise, rest, stress and spiritual practices are considered as influences in health promotion. The interconnection between emotions and physical health is made. Issues relating to fear, anger, loss, and security are explored. The nurse, whose philosophy of care is holistic, is truly present for this patient. The patient is heard. Significant information is gathered and the individual recognizes the relationship between life circumstances and the origin of this health problem. Problems may be identified that are often seen with chronic lower back pain such as issues around safety, security and financial stresses (Myss 1997). Discussion follows on various types of healing practices that may fit with the individual’s unique life experience. External sources can often provide only limited healing. In Western medicine we are taught to seek healing from without, in Eastern medicine the focus is from within. An integrative medicine recognizes the benefits of both.
    Eudaimonistic healing often involves a program of self help. Information is provided about gentle movements like yoga and Qigong, meditation, breathing and message as well as biofeedback and energy work. Modalities are offered that may move the patient in the direction of self healing. These modalities decrease stress and promote relaxation, triggering dozens of changes in our physiology, allowing us to curb the "constant vigilance" we tend to hold over our lives. There is a change in brain chemistry and brain wave frequency which produces a release of a healing mix of neurotransmitters and hormones (Jahnke 1997). Relaxation techniques are especially important in offsetting the muscle spasms that trigger back pain. Gentle movements can help accelerate cell metabolism and gently builds body strength (Jahnke 1997). Energy work can help to circulate and harmonize our vital energy (which the Chinese call Qi) to promote health. Acupuncture may be offered. This treatment releases endorphins which aids in pain management.
      A support group might be discussed as it may provide a "healing field" for this individual as they do their healing work. The energy within this group can be healing. Healing group fields are numerous. Formal groups that address identified issues such as stress and pain management may be helpful. Others can be a warm, supportive, nurturing home, frequent contact with friends that support your healing or a religious group in the community. Together the holistic nurse and patient decide the best plan of care based on what the patient feels is right for them at this moment in time. Previous strategies that have been helpful are incorporated into this new plan. Medications may temporarily ease the tension in the body but do not address the pervasive tension in the mind and spirit. Bibliotherapy may be used to allow the patient to become more familiar with a wide variety of healing techniques and strategies that have been used successfully by others. Such books may suggest options to the patient that may facilitate active participation in healing.
       This eudaimonistic model is addressing the present "health message" and is looking to prevent others at the same time. Incorporating healing practices into daily life prepares the individual for stresses. They are weaving the cloth for the parachute for when they need it instead of being unprepared when crisis hits. It is also realized that disease and illness are a part of life and people need to be supported through these often painful times, making their own decisions about what is best for them. These difficult times can often result in personal growth.
     Different models will appeal to different people. Different problems may dictate different approaches. Do we want this broad model of eudaimonistic health available to us? The conclusion of how healthy we are depends on which model we choose to use, personally and nationally. If we broaden our view of health, care will not stop at the health care practitioners door.

References

Jahnke, R.(1997). The Healer Within: The Four Essential Self-Care Methods for Creating Optimal Health. San Francisco: Harper Collins.

Myss, C. (1997). Why People Don’t Heal and How They Can. New York: Three Rivers Press.

Smith, J.(1983). The Idea of Health: Implications for the Nursing Professional. New York: Teachers College Press.

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