As medical science has advanced and been able to lengthen and support the lives of many people who live with health limitations, nursing has also matured and developed greater capacity to provide care that enriches the quality of life for patients, especially those with disabling and chronic conditions. Nursing theory has provided support in the development of the art and science of caring for individuals with challenged states of health. Newman's theory of Health as Expanding Consciousness (HEC) can be looked to in particular when considering the health of those who have disabilities and chronic illnesses.1
The HEC is a theory developed by Newman1 in the 1970s in order to explain a new approach to the concept of health. The theory deemphasized the focus on the fight against disease as it emphasized the journey for the patient. This theoretical framework affected the way in which the concept of health was viewed. Instead of thinking of disease and health as entities that can only exist in the absence of each other, health was viewed as an expansion of consciousness during the pattern of one's life.
Newman1 began to subconsciously construct this theory before she began her nursing career. While caring for her mother who was living with amyotrophic lateral sclerosis, Newman recognized that her mother was still a complete person, though challenged by physical movement. When she began her nursing career, she advocated for the notion that illness is part of a life pattern, and that recognition of the pattern of expansion of consciousness is vital in the life journey of the person. Health is not a state of complete freedom from disease. Interestingly, Newman was both a professor of mine in my undergraduate nursing program and my first supervisor. In her quiet, calm manner, she enabled new nurses to think beyond the obvious and to involve patients as partners in working together toward the goal of improved health. At that time patients typically were the recipients of care: that is, care was given to them by any of the members of the health team, and they were relatively passive recipients. Newman taught me and others how to provide patients with information about their health status so they could make more informed choices about their care and in some cases ways of living.
Interestingly, during my doctoral program in public health, the professor who taught the course Ecology of Health was to the eye a physically disabled person. As a result of polio he had obvious physical limitations. However, he brought home to students that how one views one's own health is personally defined. By the readings, class discussion, and pure observation, we learned this lesson. He clearly stated that he was physically deformed, but that he was a healthy person. Our self-definition of health does influence how we care for ourselves and likely others.
In the presence of disability and chronic illness there can be and often is health. In nursing we are an integral part of promoting the health of all individuals. It is the belief in their health and promotion of it that help to increase their quality of life and positive perception of themselves. This issue of Family & Community Health includes a variety of articles that demonstrate examples of the promotion of health in those with disabilities and chronic illnesses. The articles include research and a variety of practice examples across a spectrum of disabilities and chronic conditions in different ages and cultures. They clearly examine health promotion for those who may have been preconceived as being unhealthy by their disease states. I hope the articles in this issue can help you in your practice and care of individuals with limitations.
Jeanette Lancaster
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