Conference Proceedings - School of Nursing & Midwifery - Trinity ...

School of Nursing & Midwifery, Trinity College Dublin: 8 th Annual Interdisciplinary Research Conference
Transforming Healthcare Through Research, Education & Technology: 7 th – 9 th November 2007
Conference Proceedings
environment- that are implicated in inequalities in health outcomes’
(p: 749-50). Given that nursing in Ireland is now a four year
honours degree one might reasonably expect final year nursing
students to have a highly nuanced view of what health means.
The World Health Organisation has offered two definitions of health
(WHO 1946; WHO 1986) both of which are problematic. For
instance in its 1946 definition; ‘Health is a state of complete
physical, mental and social well being and not merely the absence
of disease and infirmity’ (WHO 1946; 1) no model or operational
definitions were provided. While this rather utopian description has
provoked much argument, the understanding inherent in this
definition has clearly moved beyond a narrow disease-free view of
health (Seedhouse 1986). In response to such criticisms WHO
moved to broaden this definition in 1985 by publishing Health for All
by 2000 and in 1986 the Ottawa Charter for Health Promotion.
These documents emphasise the need to assist individual’s ability to
control and improve their health and are thus broader definitions
than that developed in 1946 (Thuriaux 1988). According to Bowling
(2003) modern definitions of health include notions of
‘completeness’ and ‘full functioning’ of both mind and body. When
these ideas are investigated they appear to include things like the
ability to deal with stress, having a social support system, being
integrated into a community, having high morale and being satisfied
with life. Also included are feelings of psychological well being and
satisfaction with levels of physical condition. Clearly health is a
multi-faceted concept and any simplistic definition will struggle to
encompass all possible elements that may be associated with
notions of what health means.
For instance patients presenting with similar biological experiences,
or events, can be understood to mean different things across time
and place according to prevailing cultural norms. These social
values and these disparities in interpretation may lead to different
responses and actions. In terms of the conventional biomedical
model, health can be seen as the absence of disease or illness and
symptoms are taken as physical manifestations of malfunctioning
within the body. While the biomedical model outlined above is
rather simplistic having been subjected to stringent criticism from
amongst others nursing models of care (Roper 1985) and
sociologists (Friedson 1970; Illich 1976; Navarro 1986; Nettleton
1995; Scrambler 2002; White 2002) there is nevertheless an
enduring belief in its efficacy. ‘The body is isolated from the person,
the social and material causes of disease are neglected and the
subjective interpretations and meanings of health and illness are
deemed irrelevant’ (Nettleton 1995: 3). While irrelevant might well
be overstating the case there can be no doubting the commanding
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