The concept of health is a critical concept for nursing as it informs the profession’s goals, scope, and outcomes of practice. The goals of nursing are to restore, maintain, and promote health; the scope of nursing’s concern is with problems of health. When nursing practice assists people back to a healthy condition, successful outcomes are correctly declared. To be effective, nurses must have an understanding of health. Health has been conceptualized in many ways in our society, including physical, emotional, mental, spiritual, and social well-being; what people in a culture value or desire; maximization of potential; high-level wellness; fulfillment of personal goals; successful performance of social roles; successful interaction with the environment; and proper functioning.
Health has also been viewed as subjective or relative (self-report), objective (measured against an agreed-upon standard), comparative (a more-or-less condition viewed as a continuum or gradation), classificatory (a dichotomy), holistic (indivisible), a state (condition), and a process (continuous change over time). Thus, with such multiple, sometimes overlapping, sometimes redundant, sometimes contradictory conceptions of health, the term has to be understood in terms of the purposes to which it is being applied. What is the meaning of health for nursing science, that is, for human responses to actual and potential health problems? The concept of health has been dominated by two broad approaches:
(a) descriptive analysis, and
(b) visioning the goals and practice of nursing for the future.
In this context, the intention of the descriptive analysis is to understand the aims, goals, and criteria of success in current nursing practice. Investigators are trying to understand, systematize, and render coherent what nurses understand themselves to be doing and to clarify the different forms that disease or failures of health can take.
Assessing the results of this approach amounts to determining which conception makes better sense of nursing practice and how the different parts of nursing practice fit together. To most nursing clinicians and researchers, regardless of specialty area, the conception of health most applicable to practice is health as the absence of signs and symptoms of physiological malady and disability. Most nurses spend their careers observing, administering, modifying therapies, interpreting conditions, and treating people who are sick and need to be restored to health or teaching them how to stay free of those signs and symptoms. There are many theories that illustrate this approach. These include Nightingale’s conceptualization of health as an innate process that could be influenced by education, lifestyle changes, and improvement of environment (Nightingale, 1885).
Smith’s (ne´e Baigis) clinical, role performance, and adaptive models of health (Smith, J. A., 1981) also illustrates this approach as do the conceptual models, including the self-care framework (Orem, 2001). Orem identified health as the state of being whole and sound, where sound means strength and absence of disease, and whole means nothing is missing. She conceptualized health as an outcome of self-care and as an influencing factor on both selfcare agency and self-care demand. Finally, theories focused on stability, balance, and adaptation (e.g., Johnson, 1990; Roy & An-drews, 1999) also illustrates this approach clearly. D. E. Johnson (1961) identified health as a constantly moving equilibrium during the health change process where as Roy’s model of health emphasizes well-being rather than illness. The second approach visions the goals and practice of nursing for the future.
What currently passes for nursing is fundamentally in adequate; only by articulating a proper conception of health can we clearly explain what nurses should be doing. Assessing the results of this approach is much more difficult and controversial. In part, this is because some of the particular proposals reflect specific theories of human nature or philosophical orientations, like existential phenomenology, that have assessments that are a matter of dispute. In addition, these non descriptive approaches disagree not only in their proposals for what nursing should be but also in what they identify as fundamentally wrong with current nursing practice.
Holistic theories of health are one type illustrating this second approach. Some of these are based on M. E. Rogers’ (1990) science of unitary human beings. They are attempts to operationalize what Rogers meant by health as a state of continuous human evolution to ever higher levels. Examples are health as a process of becoming as experienced and described by the person (Pase, 1992), and as the totality of the life process, which is evolving toward expanded consciousness (Newman, 1990a). In Fitzpatrick’s life-perspective rhythm model, health is identified as a basic human dimension in continuous development (Pressler & Montgomery, 2005).
The concept of health as self-actualization is another type illustrating this approach, as in Smith’s (ne´e Baigis) eudaimonistic model (Smith, J. A., 1981) and Pender’s (1996) definition of health in her health-promotion behavior model. How are these theories applicable to practice? Within the context of these theories of health, there can be something wrong with a person even though the standard clinical Health Disparities 245 concepts are not at issue. There are cases in the second approach where success in practice has not been achieved, yet success in practice implicitly determines what health is.
If someone does not have any signs and symptoms of malady or disability and is still not actualized, the nurse has not done her job. Does this make the nurse’s job unbounded? Is the nurse being set up for burnout? Does nursing practically and theoretically want to claim that its domain covers all of the actual and potential health problems inherent in all of these meanings of health? The profession must be clear about what a health problem is so that it can determine who has the problem and who does not.
Nursing is not the only profession analyzing the idea of health. Much work is also being done in the philosophy of medicine, public health, and public policy. For example, some theories of health care allocation rest on specific conceptions of health and disease—why there might be a right to adequate health care but not necessarily a right to convenient transportation (e.g., having a car) gets explained in terms of the details of what is health and why it is important. Nursing researchers should try to integrate these concerns into current theories or at least explore common themes in this work.