Page 239 - Encyclopedia of Nursing Research

206 n HeAlTH DISpArITIeS IN rAcIAl AND eTHNIc MINOrITIeS

and adaptation (e.g., Johnson, 1990; roy & a person although the standard clinical con-
Andrews, 1999) also illustrate this approach cepts are not at issue. There are cases in the
H clearly. Johnson (1959) identified health as a second approach where success in practice
constantly moving equilibrium during the has not been achieved, yet success in prac-
health change process, whereas roy and tice implicitly determines what health is. If
Andrew’s (1999) model of health emphasizes someone does not have any signs and symp-
well-being rather than illness. toms of malady or disability and is still not
The second approach visions the goals actualized, the nurse has not done her job.
and practice of nursing for the future. What Does this make the nurse’s job unbounded?
currently passes for nursing is fundamentally Is the nurse being set up for burnout? Does
inadequate; only by articulating a proper con- nursing practically and theoretically want to
ception of health can we clearly explain what claim that its domain covers all of the actual
nurses should be doing. Assessing the results and potential health problems inherent in all
of this approach is much more difficult and of these meanings of health? The profession
controversial. In part, this is because some of must be clear about what a health problem is
the particular proposals reflect specific theo- so that it can determine who has the problem
ries of human nature or philosophical orien- and who does not.
tations, like existential phenomenology, that Nursing is not the only profession ana-
have assessments that are a matter of dispute. lyzing the idea of health. Much work is also
In addition, these nondescriptive approaches being done in the philosophy of medicine,
disagree not only in their proposals for what public health, and public policy. For exam-
nursing should be but also in what they iden- ple, some theories of health care allocation
tify as fundamentally wrong with current rest on specific conceptions of health and
nursing practice. disease—why there might be a right to ade-
Holistic theories of health are one type quate health care but not necessarily a right to
illustrating this second approach. Some of convenient transportation (e.g., having a car)
these are based on rogers’s (1994) science of gets explained in terms of the details of what
unitary human beings. They are attempts to is health and why it is important. Nursing
operationalize what rogers meant by health researchers should try to integrate these con-
as a state of continuous human evolution to cerns into current theories or at least explore
ever higher levels. examples are health as common themes in this work.
a process of becoming as experienced and
described by the person (parse, 1992) and Updated by Mary T. Quinn Griffin
as the totality of the life process, which is
evolving toward expanded consciousness
(Newman, 1990, 1994). In Fitzpatrick’s life-
perspective rhythm model, health is identified HealtH Disparities
as a basic human dimension in continuous in raCial anD etHniC
development (pressler & Montgomery, 2005).
The concept of health as self-actualization Minorities
is another type illustrating this approach, as
in Smith’s (1981; née Baigis) eudaimonistic
model and pender’s (1996; pender, Murdaugh, The term health disparity has been widely
& parsons, 2006) definition of health in her used to refer to inequalities in health sta-
health promotion behavior model. tus and access. For example, the National
How are these theories applicable to Institutes of Health (NIH) defines health dis-
practice? Within the context of these theories parities as differences in the incidence, prev-
of health, there can be something wrong with alence, mortality, and burden of diseases and