Concept Analysis: Health - Jill Collins MSN Portfolio



Concept Analysis: Health

Jill Collins RN, BSN

Jerilyn Rodgers, RN BSN

Washburn University

Theoretical Foundations for Advanced Nursing Practice

NU 500

Washburn University

December 2nd, 2009

“Health is something of an enigma. Like the proverbial elephant, it is difficult to define but easy to spot when you see it” (Bury, 2005). The professional nurse of today is faced with many challenges. Maybe the grandest of those challenges is to help a client understand, achieve, and maintain health. The actual process involved in understanding and achieving health is not difficult in and of itself. The biggest challenge lies in defining what it is to have “good health” or to be “healthy”. The challenge lies in the fact that a person’s definition of health is always subjective and is dependent on a multitude of factors which will be reviewed in this concept analysis of health.

A concept analysis is a tool that “gives framework and purposiveness to thinking that might otherwise meander indefinitely and purposelessly among the vast marshes of intellect and culture” (Wilson, 1969). There are eight steps to approaching a concept analysis (Walker & Avant, 1995). These steps are illustrated in Table 1 in appendix A and will be used to conduct this concept analysis of health.

Why the concept of health? The authors of this concept analysis have 20 years of combined emergency nursing experience. They have had the opportunity to interact with a multitude of people ranging in age, socioeconomic status, cultures, disease processes and acute illnesses. They have a relatively short period of time to interact with their clients, getting them back up on their feet and on their way to restoring health. In reflecting upon this, however, these authors have realized it is their own perception of health they are attempting to restore their clients to. They have realized a need to be able to define what it means to be “healthy” from the client’s perspective. There also seems to be relatively little in the review of literature on health as a concept in regard to how the nursing profession can utilize the concept to help clients to achieve better outcomes.

Purpose of Analysis

One of, if not the ultimate goal of nursing is to help clients achieve health. This is difficult to achieve and can be quite frustrating if one does not fully understand what it means to a particular client to be “healthy”. The client’s perception may be quite different than the perception of the nurse. It should be recognized that for nurses, health may be a great concern but it is not necessarily so for the client. Health is often part of the “natural attitude” to life where the meanings are often taken for granted and are unconsidered most of the time until one becomes ill (Bury, 2005). Once the nurse can fully grasp the concept of health from a client’s perspective, the nurse becomes more productive in helping the client to achieve and maintain their health. The nature of nursing care is determined by the understanding of health concepts. In fact, in the foundation of all nursing theories is the consideration of health and how it is perceived by the nursing theorist. These concepts of health are important and useful to the theoretical foundation of nursing practice. It is important to clarify the concept of health in order to develop both theory and research and for the development of instruments to measure health (Wang, 2005).

Review of Literature

Introduction

On November 11th, 2009 a literature search was conducted on Washburn University’s Mabee Library website. This was done by using the Cinahl and Proquest databases. Within the data bases, an initial search was done with the word “health”. This search brought 167,614 hits on Cinhal. The search was then narrowed by using the terms “health” and “concept” which brought 4696 hits on Cinhal and 7251 on Proquest. The authors then narrowed the search to “health” and “concept analysis” which gave 149 hits in Cinahl and 131 hits on Proquest. The authors also conducted a Google scholar search on November 11th, 2009 using the terms “health” and “concept analysis” giving 2,340,000 hits. For purposes of this analysis, those were narrowed to only studies specifically relating to defining health. The final list of articles and books can be found in the references.

Article Review

Yurkovich and Lattergrass conducted a study to define health and perceptions of illness from the perspective of American Indians experiencing persistent mental illness. The purpose of this study was to enhance the health care providers’ awareness and knowledge of the existence of difference clients’ perception of health. With this understanding, health care providers in turn enable their clients to better understand their own health-seeking behaviors (Yurkovich & Lattergrass, 2008). The study focused on the 40% of American Indian/Alaska Natives who live in rural reservations. Significance of the research was based on multiple reports and studies indicating minority groups, because of lower income, under education, types of occupation and acculturation, have a higher percentage of experiencing mental illness. This, coupled with reduced availability of support systems, places this vulnerable population at great risk. Grounded theory methodology was used in collecting data and analysis. Forty four interviews of Native American Indians (NAI) experiencing persistent mental illness (PMI) were interviewed. Results indicated a composite definition of health as “being in balance/equilibrium, having a sense of harmony, and not being out of control of spiritual, cognitive, emotional and physical domains” (Yurkovich & Lattergrass, 2008). The Circle of Wellness model fit the NAI due to the spiritualism of this population. The authors concluded “deficits in healthy social environments and relationships affect the ability of NAI with PMI to maintain health” (Yurkovich and Lattergrass, 2008). Health professionals must integrate spirituality and advocate for healthy environments to be able to manage culturally competent care.

A qualitative study was conducted by Johansson, Weinehall and Emmelin on Swedish health professionals’ view of health and health promotion. The overall objective of this study was to gain an understanding of how health professionals interpret the concept of health and health promotion and how they perceive their role in health promotion practices (Johansson, Weinehall & Emmelin, 2009). The study was based on focus group discussions and analyzed the data using qualitative content analysis. Seven focus group discussions with a total of 34 participants were carried out. The results were categorized into three main topics: concept of health, concept of health promotion and health promotion in practice. Their findings lead them to conclude the participants described health as “a multi-faceted concept”, “a subjective assessment” and “health is about life, the whole life” (Johansson, Weinehall & Emmelin, 2009). The description of health promotion was described as diffuse, elusive and difficult to apply and was viewed very differently by the participants based on their personal practice. This study suggests different interpretations of health promotion can lead to “misunderstandings and pose barriers to further development of a health promoting practice” (Johansson, Weinehall & Emmelin).

An article written by Bennett, Perry and Lawrence (2009) discussed the meaning of health, approaches to health promotion, public health and health protection as it relates to primary care. This was in direct relation to the United Kingdom shifting towards developing policies with an emphasis on the promotion of health in recent years. The purpose was to encourage nurses to build up the skills necessary to look at their communities and appropriately assess the health promotion requirements, then provide culturally sensitive interventions. Throughout the article the authors established eleven “time out” boxes, asking the readers to participate in exercises designed to help the reader develop strategies of health promotion related to their communities. In conclusion, the authors wrote the article to provide nurses with key issues to be aware of in order to promote the health of their respective communities, thus tackling some of the “inequalities in health that persist in the UK today” (Bennett, Perry & Lawrence, 2009).

Summary

There seems to be one common theme in regard to the concept or definition of health in

the review of literature. Most people know what it means to be “healthy” for them but it

becomes very difficult to put it into an exact definition that fits every person. Most of the

literature reviewed provided definitions of what “health” is in reference to the World Health

Organization’s (WHO) definition. There were only 2 articles that these authors could find that

were specifically a concept analysis of health. One of those articles was in Chinese and the other

was written in 1989 (Simmons, 1989). This made the concept analysis a little more difficult and

shows that this concept is one that could benefit from updated literature.

Definitions

Merriam-Webster defines health as “the condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain” or “the general condition of the body” (Merriam-Webster, 2009). The most prevalent definition used in the literature reviewed is the WHO definition. The WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity (WHO, 1946). The WHO also added to this in 1986 during the Ottawa Charter for Health Promotion by saying health is “a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities” (WHO,1986). In the study on health in Native American Indians, Yurkovich and Lattergrass emphasize “health is not merely and end in itself, but rather a means of attaining human well-being within the constraints in which man finds himself.” “Health then is a process of gaining a sense of personal well-being at any moment in time within one’s established boundaries/context” (Yurkovich & Lattergrass, 2008).

Nursing theorist Dorothy Johnson defines health as “a purposeful, adaptive response physically, mentally, emotionally, and socially to internal and external stimuli in order to maintain stability and comfort “ (Fawcett, 2005). Theorist Myra Levine states “every individual defines health for himself or herself” (Fawcett, 2005).

Most of the literature breaks down health into two categories, the bio or medical portion and the social portion. The bio portion focuses on the body viewing health and disease as opposites of each other. The social or “holistic” portion also encompasses spiritual and emotional aspects and indicates that health and disease are concepts related to the whole human being (Johansson, Weinehall, & Emmelin, 2009). For the purposes of this paper, health will be difined as a process by which one is able to attain overall personal well-being with regard to physical, social (which includes environment, culture and lifestyle), emotional (which includes mental and intellect), and spiritual aspects of his/her life.

Defining Attributes

Defining attributes are a cluster of characteristics that are frequently associated with the concept and are seen over and over again in the literature (Walker & Avant, 1995). There are several attributes that are consistent in the literature review about health and what it means to be healthy. The five major attributes noted are: health is subjective, health has a physical or bio component, health has a spiritual component, health has a social component and health has a emotional component. Each of these will be reviewed briefly.

In the review of literature, health is repeatedly talked about as being subjective in nature. Though as nurses we often want the client to ultimately become what is engrained in us as healthy, it is really the client’s perception of what being healthy is that should guide is in the care of that particular client. Nurses must realize every client they work with will have a different notion of what being healthy is. This presents a major challenge to the nursing profession. Nursing theories, research and nursing processes revolve around this notion.

The physical or bio component of health refers to the body itself and disease processes or acute illnes that may be present. This component of health is what most health professionals are largely focused on. “This is hardly surprising, given the fact people turn to medicine in times of trouble, not when they are feeling well” (Bury, 2005). According the Bury, healthcare has been largely individualistic in orientation and has paid less attention to the client’s social situation or the larger environment (Bury, 2005). Having a physical disability does not necessarily cause one to believe they are “unhealthy”. For people who have stable disabilites like diabetes, being healthy may be redefined to incorporate how the person feels at a particular moment and not in relation to the general norm. “Adaptation to illness or disability alters the baseline from which the individual judges the nature of health and its implications” (Bury, 2005).

The spiritual component is structured around the assumption that most people have a higher power they look to for guidance in their lives. This higher power does not have the same meaning for everyone but often a disruption in this relationship has consequences in the client’s health. The spiritual component supports other components and helps to maintain, for example, the mental/emotional component (Yurkovich & Lattergrass, 2008).

The social component takes into account culture, environment, and lifestyle. For example, in the Native American Indian culture, people often define healthy as simply being able to work everyday (Yurkovich & Lattergrass, 2008). Some people view themselves healthy if they are able to get out of the house and interact with others on a day to day basis while this may be of less important to others. Lifestyle factors such as smoking, exercise, and diet often define how healthy people view themselves (Bennett, Perry, & Lawrence, 2009). “Additional significant determinants of health include the broader socioeconomic, cultural, environmental and political structures, as well as global issues. Through being aware of these issues, healthcare professionals will be mindful that factors affecting health are multifactorial and are much more complex than individual lifestyle choices” (Bennett, Perry, & Lawrence, 2009)

Intellect, which is considered a part of the mental component for purposes of this analysis, also affects how clients view their health. “Quoting data from India and the USA, Sen shows the higher the level of education in a population, the higher the level of reported illness” (Bury, 2005). This is directly related to the fact that with higher levels of education, clients often spend time researching and reporting symptoms they have been observing in themselves (Bury, 2005).

The mental/emotional component is a large driving factor in how clients view their health. A client may be in the best physical shape of his/her life but if an adverse life event occurs, mental state often declines (i.e. depression) and the client has a difficult time viewing himself/herself as healthy. On the same note, if a client strongly believes that he/she is physically ill or will die, this is often the end result. This can be illustrated in cancer patients. Those who have a strong will to live and be as healthy as possible often outlive those who mentally are ready to give up after the diagnosis.

Antecedents

Antecedents are events, conditions, or situations that must occur prior to the occurrence of the concept (Walker & Avant, 1995). The antecedents identified for the concept of health are: a perceived need to be healthy, access to health services, access to basic human needs such as clean water and nutrition, the ability to gain knowledge in order to make rational decisions and lifestyle choices in regard to one’s health, the ability to adapt and/or adjust to life events, and support from people surrounding the client.

Consequences

Consequences are the outcomes of the concept having taken place (Walker & Avant, 1995). Consequences of health include: improved quality of life, the ability to actively engage in life, and maximization of a client’s potential.

Emperical Indicators

Emperical indicators are observable and measureable phenomena that give evidence to the existence of the concept (Walker & Avant, 1995). The emperical referents for health are difficult to define due to the fact that health is a subjective experience for each client encountered. There are obviously many ways to measure physical health such as BMI, blood pressure, cholesterol levels, blood glucose levels, etc. There is IQ scoring to measure intellect. There is not a way identified to measure spiritual health. There is little in the literature to support a way to measure social health. Using a ProQuest search, there were many tools found for self-assessments of health. However, people often find it easier to define what mental illness is rather that mental health. “No matter how many definitions people try to come up with regarding mental health, its assessment is still a subjective one” (Nordqvist, 2009).

Model Case

A model case is one that incorporates all of the defining attributes of health which are that health is subjective and has physical, mental/emotional/intellectual, social/cultural/lifestyle, and spiritual components. Mr. Smith is a 46 year-old African American, 1 pack per day smoker, with a familial history of cardiac disease. He suddenly experiences excruciating chest pain. He calls 911 and is transported to the nearest chest pain center where is he is diagnosed with an acute myocardial infarction and taken to the cardiac catheterization lab where his blocked artery is opened with a cardiac stent and blood flow to his heart muscle is returned. He is admitted to the hospital for continued treatment. He is educated on cardiovascular disease including a risk factor assessment. He is offered information on smoking cessation and diet modification as well as advice on implementing an exercise program. He is started on medication appropriate for his condition. He was visited by pastoral care and assessment was made of his spiritual well-being. He was visited by social work to assess finances, access to appropriate health care needs, and his social support system. In the next six months, Mr. Smith was able to quit smoking, and make appropriate diet adjustments, maintain appropriate medication and exercise regimens and follow up with his physician. He was able to express he has an improved quality of life, is able to enjoy time with his wife and kids, and is able to actively participate in life. He feels “healthy”.

Invented Case

An invented case involves using thoughts, which are fabricated, often reading like science fiction, to represent the concept. Frannie the Ford truck was driving to see her friend Ginny the GMC. On her way to Ginny’s, her engine began to make a terrible noise and Frannie didn’t feel so well. She quickly found a service station and pulled in. A quick diagnostic test, done by the mechanic, showed Frannie had a loose belt. The mechanic was able to replace the belt and Frannie’s engine was soon up and running again. The mechanic educated Frannie on the need for routine maintenance of her engine (physical), tires, and transmission as well as keeping fluid levels (spiritual) checked and her interior (mental/emotional/intellect) and exterior could drive forever. She had herself serviced every 3000 miles. She was able to drive in the Indy 500 with her friend Ginny the GMC and was able to drive faster than she ever did before.

Conclusion

This concept analysis brings to light there are many “definitions” and “perceptions” of what health is. The important factor for the nursing profession to take into consideration is health is subjective to the client. The nursing profession must utilize this concept in order to help our clients achieve what is an ideal state for them to live life to its fullest and to be happy and “healthy”.

References

Bennett, C., Perry, J., & Lawrence, A. (2009). Promoting health in primary care. Nursing

Standard, 23, 48-56.

Bury, M. (2005). Health and Illness. Malden, MA: Polity Press.

Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing

Models and Theories. Philadelphia, PA: F. A. Davis Company.

Johansson, H., Weinehall, L, & Emmelin, M. (2009). “It depends on what you mean”: a

Qualitative study of Swedish health professionals’ views on health and health promotion.

BMC Health Services Research, 9, 191-203.

Merriam-Webster. (2009). Merriam-Webster Online. Retrieved November 20th, 2009, from

Merriam-Webster Online: .

Nordqvist, C. (2009). Medical News Today. Retrieved November 16th, 2009, from Medical

News Today: .

World Health Organization (1946). Constitution of the World Health Organization. Geneva.

World Health Organization (1986). Ottawa Charter for Health Promotion. Geneva.

Simmons, S. (1989). Health: a concept Analysis. International Journal of Nursing Studies,

26, 155-161.

Walker, L.O. & Avant, K.C. (1995). Strategies for Theory Construction in Nursing. Norwalk,

CT: Appleton & Lange.

Wang, Y. (2005). A concept analysis of health (abstract). Hu Li Za Zhi, 52, 40-43.

Wilson, J. (1969). Thinking With Concepts. New York: Cambridge University Press.

Yurkovich, E.E. & Lattergrass, I. (2008). Defining health and unhealthiness: Perceptions held

by Native American Indians with persistent mental illness. Mental Health, Religion &

Culture, 11, 437-459.

Appendix A

|Table 1 Eight-step approach to concept analysis | |

|Decide on a concept | |

|Determine the aims or purposes that can be revealed | |

|Identify all uses of the concept that can be revealed | |

|Determine the defining attributes | |

|Construct a model case | |

|Construct additional cases | |

|Identify antecedents and consequences | |

|Define empirical referents | |

| | |

Appendix B

Model: Health as a concept with defining attributes

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HEALTH

PHYSICAL

SPIRITUAL

MENTAL

EMOTIONAL

INTELLECT

SOCIAL

CULTURAL

ENVIRONMENT

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