Health and healthy human being in Islamic thought: Reflection on application for the nursing concept - A philosophical inquiry.

INTRODUCTION: Health and healthy human being as a core concept of nursing have attracted considerable attention in the Western literature but have received less attention in the context of Eastern philosophy contexts.
METHODS: This study was done based on philosophical inquiry; this method could be accomplished by means of different approaches like philosophical analysis through concept analysis. There are different methods for concept analysis. Mors's method was employed to analyze the concept of health and healthy human being, we sought to clarify them according to ideas deriving from the Islamic thought. To achieve the research objective, Islamic texts were studied and analyzed based on the criteria of concept analysis (definition, attributes/characteristics, and beaneries).
RESULTS: Our analysis revealed in the Islamic thought human being is an integrated entity. Therefore, his health not only consists of each single dimension, but also the full health together with the health of society gets meaning in a balanced and coordinated set.
CONCLUSION: Based on the results, in this study, there are a series of similarities and differences with the perspectives of health in Islamic thought and holism paradigm available in nursing.

INTRODUCTION

Nursing as a profession has its own knowledge basics and specific concepts such as human being, health, environment, and nursing. These concepts play key roles in the nursing profession and have various definitions based on the philosophies dominant in nursing theories.[1] These concepts are inter-related, and each one makes the conceptual framework of the theories. Concepts form the foundation of a discipline and the essence of the philosophical underpinning that guide a profession.[2] Therefore, they must be interpreted according to the philosophies dominant in the societies, based on which the nursing practices are theorizing.

Fawcett regards nursing concepts discourse as a nursing challenge in the present century and argues that nursing needs to take into consideration the diversity of viewpoints in nursing.[3]

Western societies composed of much social and religious culture, therefore, healthcare providers recognize the challenges of providing care to patients from increasingly diverse cultural backgrounds.[4] Understanding the unique perspectives and beliefs of each patient is an essential component of providing competent health care. Therefore, the nursing system needs to adopt new theories to satisfy the needs of this social and religious culture.[56] Like Islam. Certainly, considering different viewpoints would help to realize more details that obviously would not be obtainable through just using single viewpoint. Today, the cultural, religious, and social differences in different societies (such as Islamic population) are a considerable challenge for the health care system of the US and West.

Islam is a living religion with, it is estimate, one-billion followers (Muslims, those who practice the religion of Islam) worldwide.[7] Which is in 120 Islamic and non-Islamic countries. In spite of the total population of Muslims, and its special philosophical views, very little has been published on understanding the Muslims’ perception, need and experience in health care systems in different countries.[89] Efforts to expand upon our narrow definitions of nursing metaparadigm concepts such as health will help expand, clarify, and promote the nursing discipline.

The literature review showed that the concept of health and healthy human being, according Islamic thought, regarding nursing literature have not been defined.[9] Hence, it is clear that revealing health and healthy human being characteristics in Islamic point of view for nurses who take care of Muslim patients would contribute to promote the nurses’ professional abilities. Nurse needs improve teaching related to the cultural and spiritual dimensions of care of Muslim patients.[7] By conceptualizing this core nursing metaparadigm concept from an Islamic thought perspective, we hope to create theoretical structures that will help redefine the art and science of effective nursing through an increasing spectrum of care contexts.[10] This article aimed to clarify “health” as a core concept in the most nursing models and theories,[11] and “healthy human being” in different paradigms, particularly Islamic thought, in order to provide appropriate means for developing a theory and re-defining the core concepts in nursing. Revealing the characteristics of health that derive from an Islamic viewpoint will be elevated to the capacity of nursing in delivering competent care across cultural contexts.[7]

METHODS

This report is a part of PhD dissertation entitles “nursing metaparadigm in Islamic thought: A philosophical inquiry,” accomplished during 1389–1391. To achieve the objectives of the study, we conducted a philosophical inquiry through concept analysis.

Philosophical inquiry uses intellectual analyses to clarify meanings. A philosophical inquiry could be accomplished by means of different approaches like philosophical analysis through concept analysis.[12]

There are different methods for concept analysis. They have been used in nursing with varying degrees of success.[13] In this study, Mors's method, critical analysis of the literature, was employed to analyze the concept of health and healthy human being. Mors's method has scientific rigor, intellectual reasoning, and ability in expanding the core concepts in the nursing discipline.[11]

There are four broad philosophical principles: Epistemological, pragmatic, linguistic, and logical – for assessing, determining, and evaluating the state of the science surrounding the concept.[1415]

Epistemological principle

Any concepts matured through this principle are clearly defined and its status in the texts is obvious, while this principle answers this question: Whether the concept is defined clearly and well differentiated from other concepts.

Logical principle

Deals with coherent integration of concepts with other concepts.

Pragmatic principle

Deals with efficiency criteria and relevance to the concepts in conceptualizing.

Linguistic principle

According this principle, concepts should be appropriate to their use in context.[1617]

Based on these principles, the literature of nursing was reviewed to assess the state of maturity of the concept of health and healthy human being based on Islamic thought. “Health and healthy human being and Islam” without limitations such as: Year, reference, authors and with limitation of languish (English or Persian) were used as key words or subject heading in several databases, such as MEDLINE-CINAHL and ISI index. The literature review showed the concept of health and healthy in the nursing literature were not defined. According to Morse, when a concept is not well-defined, its attributions and boundaries are not clear, either. Morse stress that concepts used in the discipline should be mature. An immature and undeveloped concept will result in a lack of understanding of its application.[18] Therefore, research team (consist of nursing specialist in ethics, expert in research methodology and conceptualization, and one Islamologist) concluded that these concept were immature and according Morse need for employing an appropriate method for advancing the concept.[19]

To achieve proper reliance for getting proper and exact advantage from Islamic sources, we benefitted from a group of experts in Islamic thought including a clergyman specialized in philosophy and Islamic thought. Besides during the process, different expert persons in Islamic thought: Clergyman, professor of philosophy and professor of theology from different universities guided us during various stages of the research as arbitrators.

Moreover, to make sure about the adequacy and sufficiency of the subject for nursing discipline, some members of the nursing board with rich educational experience in nursing and religious backgrounds confirmed research process and result as well.

Developing a concept using the Islamic literature as data

Concept development was done in three steps:

Following Morse's method,[1420] the researchers began by developing analytical questions on the notion of health and healthy human being in the Islamic literature. How of health and healthy human being are defined in Islamic thought? What are the attributes of health and healthy human being in Islamic thought? And where is the boundary of health and healthy human being concept in Islamic thought?

To advance the concept of human being, Islamic literature selection (data) was done. Islamic literature abounds in various books and other sources. These have chronologically been subject to reforms in their evolutionary process to a certain degree. Therefore, authors resorted to the literature such as Tafsir-e-Almizan, which enjoys both wide acceptance and validity among Muslims and has been by scrutinized quite a large number of researchers.[21]

Tafsir-e-Almizan is one of the most outstanding and comprehensive commentary texts on the Quran in this era that interprets Quran as the holy book of Muslims all over the world[22] through different approaches like philosophical approach using other verses and propositions of this book (Quran). Among Muslims, it is considered as one of the best commentaries of Quran in respect to its writing style. This commentary is very rich, comprehensive, accurate and powerful in communicating with different human thoughts.[23] Tafsir-e-Almizan has been translated into different languages. In the present study, Tafsir-e-Almizan, as the symbol of Islamic thought, is considered the core axiom of this study. Besides, in this study, literature of other Islamic authors (as a data) such as Motahari, Shirazi and so on, for more acceptance, were done.

On the basis of Mors's method, we generated a provisional theoretical definition to depict the concepts of health and healthy human being in Islamic thought. In the process, we worked out appropriate ways to articulate the concept's definition.[14]

Finally, the data obtained were analyzed and for a clearer presentation of the concept of health and healthy human being, we compared different nursing paradigms, specially a holistic paradigm, with the finding of our analysis.

Finding

A clear definition and description of the characteristics of the concepts facilitates ultimately of them. Based on the findings are presented according to the criteria (definition, attributes/characters, and boundaries) of the structural concept suggested by Morse et al.[18]

Definition of health

In the Islamic thought, health is interpreted as to be faultless, cleanness and redemption from any type of fault, as well as to be far from plagues and superficial and inwardly faults.[24] It consists of equilibrium in the entire existential dimensions of human being. Besides, lack of existence of such state is considered as illness and impairment. In the body of a living entity, the organs are in interaction and harmony with one another and not in struggle; that is, upon the entire existence of a living entity (human being), a unique life is dominant and all the organs follow one single life. Therefore, when this equilibrium is disturbed, the effort is made for the return to the state of equilibrium. Now, if this impairment and deviation is severe, it leads to death, and if the impairment is not too severe, its state returns to equilibrium.[25]

In most models and clinical theories, based on the method of understanding the essence of human being, the core concepts of nursing such as health have also been interpreted.[2627] Hence, the purpose of further clarification concept of health, characteristics/attributes of the aspect of the healthy human being introduced.

In the Islamic view human being is a unit of reality, a unique nature, and a unitary being created of two aspects: The material aspect that is the physics, and the immaterial aspect that is the soul. These two aspects are united.[28]

The material aspect receives different names: Nature, substance, body, and person.[29] The term “body” is more common with characteristics/attributes that consist of:

Lack of presence of weakness and deficiency in the structure and performance of the entire body's principle systems; and presence of equilibrium in the body's chemical compositions: The body of human being has a formula, and soundness of the body depends on the formula to be fixed and harmonic; otherwise, the body is ill.[30]

The immaterial aspect also has different labels: Spirit, psyche, and soul. In Islamic thought, the term “soul” is more common and has a divine nature. In this view, the soul is a divine angelic, metaphysical substance, the ordinances of which differ from the ordinances of the body or any other physical composition. The soul is incorporated with the body so that they seem to be just a single unit. In this viewpoint, body and soul are allied partners and form a whole together with the system of existence.[31]

In the Islamic viewpoint, nonmaterial structure of human being (soul) is stable on the set of acquired qualities (cognitive/perceptual, emotional, spiritual, and social) as well as nonacquired quality, namely pure nature (Fetrat); therefore, examination of this structure on the basis of characteristics and attributes as well as on the boundary of health or illness will be possible under the subsets of pure nature, specifically health of human being in the acquired dimensions.

Characteristics/attributes of healthy human being's nature (Fetrat)

In the Islamic viewpoint, human is born with a clean and sound nature; that is, intellect and heart, with the following characteristics and attributes:

One of the characteristics and attributes of sound intellect is that it is a means to find and follow correct way toward truth and good deeds.[32] It is the savior of human being from aberrations.[33] It is a modifier of the refractory and beastly forces of human being. It also causes the rational apprehension of issues[34]

One of the characteristics and attributes of the sound heart is in its submission because submission of the heart is equivalent with the submission of the entire existence of human being and denial of any type of hostility.[35] Such humble heart has the following characteristics and attributes:

It is the center station of God[36]

There exists no divine polytheism inside[36]

Thankful for divine blessing[37]

Being comforted in natural and equilibrium conditions[38]

Lack of rascal habits and qualities[36]

Avoidance from material belongings[39]

Avoidance from lie and useless talk.[39]

So in Muslim thinking human being's nature is clear with features such as:

Recriminator of human being at the time of committing error and mistake. Meaning that anytime human being commits to error or mistake, he becomes uneasy and recriminates himself, and in next stage, gets calm and would not go around evil

Causes the growth of human being’ personality and perfection: Sound nature in human being moves him toward blessing and perfection and growth of sound personality.[40]

Border of health with human being's nature's illness

The conscience of human being is in a manner that has a bond with charity and gets tranquility by doing so, while bad deeds and ugliness make it distressed and uneasy, and disintegrate its regularity and moderation.[41] The nature of human being is vulnerable; therefore, for desired effectiveness, it requires conscious and lasting care. Meaning that occasionally due to negligence, its effects are entirely diminished up to point that nothing is left of courtesy of human being except appearance, and his character turns into an animal habit, and even lower than that.[33]

In Islamic thought, at the time that human being entangles impairment in the structure of one of the areas of pure nature, that is, intellect and heart, and when the inward balance of each one and/or between them gets confused, he/she entangles with deviation or impairment in acquired dimensions. In this viewpoint, interaction of intellect and ignorance as well as interaction of heart and sin will be gradually developed through contact with the society and under abilities power and independence of human being. These interactions will have an essential role in the formation of human being’ acquired dimensions. Therefore, in continuation, for more clarity of the health concept, characteristics and attributes of the cognitive/perceptual, emotional, social, and spiritual dimensions in a healthy human being are presented.

Characteristics/attributes of the cognitive/perceptual dimension of healthy human being

The cognitive/perceptual dimension is of the dimensions that deals with the ability to collecting ability, processing, recalling, and exchanging information and, as a result, correct and intellectual decision-making. Therefore, when an individual makes a correct decision, in critical situations using cognitive abilities, he/she enjoys a sound health. Hence, foresight, comprehensive view, and recognition of good intention from mischief and good from evil are some of the outstanding examples of that.[42] A typical human being has the following abilities:

The power of recognizing such issues as the correct way and the criteria of distinguishing corrects from incorrect ones, truths and true teachings, general issues, and unknowns

Lack of following something that does not have knowledge and certainty about it. Such human being never goes after mistrust, doubt and fancy in his course of life. In daily life issues, either human being has personally knowledge and specialty or follows the knowledge of someone else that has certainty over his sayings.[43]

Therefore, the healthy human being does not accept issues without reason and does not fear of fantasy and eidetic. Conversely, individuals who have cognitive health are involved with fantasy, lack of bearing realities and lack of the distinction power of good and evil.

Characteristics/attributes of the emotional dimension of healthy human being

Emotion health consists of the ability of feeling and speaking out all types of affections and to control them deliberately. Otherwise, they are unsound are abnormal. Regulation of affections has accounted for one of the main constituents of the health of human being.[44] Islam has adjusted affections via becoming coordinated with the intellect and has given them the title of pursuing intellect. Therefore, individuals who enjoy emotional health have attributes of kindness, forgiveness, respect, and modesty.[45]

Characteristics/attributes of the social dimension of healthy human being

From the viewpoint of potentiality and talents, human beings have not been created equally. If they have been created as equal, naturally no bilateral and bonding needs were involved. God has created human being with different talents and potentialities and, in this way, has supplied contagious social life.[46] Therefore, human being is the entity that requires social relations, and without presence in the society, he/she never could be able to respond to various needs of his/her life. It is obvious that in such conditions, human being needs a series of principles and ethical standards in various social relations such as:

To have an active role in life: Healthy human being is responsible for his life. While consults with others and employs all his efforts toward providing his needs, he has hope to no one except God and is not burden to anyone[47]

Dynamism and purposivism in life: It means that the in healthy human being entire actions and behaviors, acquisition of God’ satisfaction and divine relationship is pursued. He is always after more sublime goals, and there exist a continual move and effort in him[42]

Ability to establish friendly relations with others: A healthy human being is capable of establishing communications, amicable and sincere relations with others[48]

To have serving motivation to fellow creature: Individuals who enjoy health act better in social duties and giving service to others relative to those who enjoy lesser health; the healthier is the individual, his tendency to accept responsibly, commitment and providing service to others would be stronger.[42]

Characteristics and attributes of the spiritual dimension of healthy human being

In the Islamic viewpoint, a human being who enjoys a sound pure nature, intellect and heart, would enjoy the health of spiritual dimension with the following characteristics and attributes:

Faith in monotheism: A sound pure nature has confession to this fact that I am needful entity, and my needfulness is to something, which resides outside my own essence, and that thing is a concern, which the chain of all necessities terminates to him[49]

Faith in prophecy: A person who has sound pure nature, after faith in monotheism, conceives to prophecy that this source (God) who does not remain unaware from needs of subsistence's entities; not even for a moment, how is it possible that. He remains heedless from guiding His servants and not to show them road to salvation from fatal actions and morals?[49]

Faith in justice and truth: If the soul of human being is sound, when confronting with truth, it enjoys from reaching to just and truth. Human being has been brought to existence as truth-seeking.[41]

In the Islamic thought, individuals who have a spiritual illness are involved with doubt, anxiety, weakness of faith, and cruelty of heart.

DISCUSSION

Concept of health and the related terms such as healthy human being are of concepts, which are always at the core attention of nursing scholars and theoreticians, and they make effort to achieve more of its lucidity. Here, we are going to compare the definitions of health in nursing based on Islamic thought and other nursing paradigm. In this regard, each paradigm definition of health in nursing would be presented.

The history of nursing shows that most often the definitions of the concepts such as the concept of health have emerged from the patterns that have been part of nursing scholars’ beliefs and other various sciences relevant to medicine. Based on these beliefs, nursing scholars have always brought such patterns as reductionism and holism under attention in defining human being and naturally his health as well. The concept of human being is as the central concept of nursing and, based on the definitions of human being made so far, other concepts of the paradigm such as health are defined as well.[26]

In the Islamic viewpoint, human being has formed from two aspects of material and nonmaterial (carnal desire and/or soul), In this viewpoint, body and soul are allied partners and form a whole together with the system of existence, and human being is full of attributes and perfections; not an aggregate of attributes and perfections. In addition, from Islamic viewpoint, human being in nonmaterial aspect (soul) has in born talents and capabilities which to appears, grows, and reaches to perfection under the cognitive/perceptive, emotional, social and spiritual lights. Hence; health not only consists of both aspects of material and nonmaterial, but also the existence of equilibrium and health between these two areas becomes the subject of attention as well. Furthermore, in definition of health, in addition to health of both material and nonmaterial aspect as whole and integrated, the equilibrium and/or health in each one of the subsets of nonmaterial aspect are subject of attention.

Based on the findings of this study, the Islamic thinkers’ viewpoint from human being and health shows the existence of a series of similarities and differences with the perspectives of reductionism and holism available in nursing, which attention to that is effective in explanation of Islamic viewpoint in this regard.

Reductionism paradigm

In this viewpoint, the two approaches of biological and medical models are considered.

Based on biological approach, health is applied to a state that human being is not merely affected by a physical impairment, which prevents his performance.[50] Furthermore, in the medical approach, which is impressed from Descartes’ dualism theory, the body of human being is assumed as similar to machine, and also mind of human being is holy and very different from that. In this viewpoint, the illness is limited to chemical, microbial, and genetic factors only and the role of economic and social factors is disregarded in the initiation of social and physiological illnesses.[51] However, in comparison with reductionism paradigm, in Islamic viewpoint, body and soul are assumed inseparable and impressed from each other.

Holism paradigm

In fact, the essence of nursing is holism and attention has been regarded to concepts of entity like human being as whole; relation of body, mind and soul as well as establishment of sociocultural communications of human being.[52]

In this paradigm, two reciprocal interaction worldview and simultaneous action worldview have generally been accepted and applied.[53]

Reciprocal interaction worldview

In this view, human being is an organized and intact multi-dimensional being viewed as a whole. Followers of this worldview define the existence of various inter-dimensional connections within human being with holistically. George Engel's view on bio-psyche-social elements is the most holistic unceasing view in medical science and nursing. George Engel's view on bio-psyche-social elements is the most holistic unceasing view in medical science and nursing that could be accepted as a model.[53]

The basis of this model has formed merely based on justification of illnesses (understanding the cause, diagnosis and treatment), and no attention has been made to the health of human being and methods of its development. Furthermore, it has led to the following viewpoints:

Illnesses (diseases) are assumed as independent of social behaviors. For example, in this viewpoint, the diabetes is completely dependent to physical factors, e.g., the level of Insulin. Furthermore, behavioral deviations are not considered as illness and/or deviation from the normal state unless bases of the physical disorder are depicted for them.[5455]

However, Islamic thinkers emphasize on the concept of health and not on illness (disease). In other words, in Islamic thought, to define health, it's opposite (i.e., illness) is not used. On the contrary, health has become recollected as a valuable blessing, and something that happiness of human being is provided and met under its shadow.[56]

In the Islamic viewpoint, in contrast to reciprocal interaction worldwide, human being is a unique reality and not as separated components which to be set aside. Human being is an integrated entity who fakes on varieties of lights. Therefore, his health not only consists of each single dimension, but also the full health together with the health of society gets meaning in a balanced and coordinated set.

Simultaneous action worldview

Here, human being is defined as a pattern. The metaphor is that the unitary human being is a whole creature, different and more than its total of elements.[3] This pattern is self-organized and changeable in an orderly manner. It is also manifested in interaction with the internal and external environments; in other words, human being is an indivisible unit. Changes occur continuously, and human is on the path of complexity.[53] In this worldview, in which body and mind are intermingled, differentiation between body and mind is considered as a mythical opinion. Therefore, the health and, therapeutically, care are neither purely physical nor mental. In this perspective, the entire disorders have physical and mental sources, so all treatments also are similarly focused on both physical and mental dimensions.

The Islamic thinkers’ viewpoint, similar to the followers of this viewpoint, human being is to the wholeness being, with the difference that in the Islamic viewpoint, attention also is made to the dimensions of human being (biological, cognitive, emotion, social, and spiritual). Therefore, the Islamic thinkers’ viewpoint, while views universality (like simultaneous viewpoint), also has regard on every single dimension separately (like the action view), and his comprehensiveness view has not prevented from ignoring the components and is exempt from nonunderstandable segregations and lack of applicable opinion of some of nursing theorists like Rogers and Parse. Hence, through introducing and presenting a more comprehensive definition of human being, and also considering every single dimension of human being, it can help nursing communities in various areas like theorization and clinic.

CONCLUSION

The health is a central concept in most nursing models and theories.[11] Our purpose in this article was to clarify the notion of health and healthy human being from a different viewpoint – Islamic thought – in order to provide a means for developing appropriate theorizing and reconsidering necessary concepts for nursing. By conceptualizing this core nursing metaparadigm concept from an Islamic thought perspective, we hope to create theoretical structures that will help redefine the art and science of effective nursing across an increasing spectrum of care contexts.

Revealing the characteristics of health that derive from an Islamic viewpoint will be relevant to the understandings of nurses who take care of Muslim patients and will make an important contribution to the capacity of nursing in delivering competent care across cultural contexts.[7] Thus, the authors believe that expanding the diversity and multiplicity of the metaparadigm concept by considering its application within the Muslim context can strengthen its overall relevance to the practice and evolving thought of nursing.

Human being in the Islamic thought is considered as wholeness being, attention has made to sound human being and to health with holism viewpoint, which is in accordance with the goals of holistic nursing. In most clinical theories and models, based on the consideration of human nature, the nursing metaparadigm concepts are defined as the concept. Therefore, given the fact that in Islamic thought, human is regarded as a comprehensive whole, here health is defined in the holistic framework. On the other hand, with respect to the point that in Islamic thought, human being has been defined accurately and broadly; this viewpoint can be taken as a proper philosophical basis toward presentation of holistic care to clients. It further can cover well the motto of World Health Organization in particular to health- “Health is the complete comfort in all physical, psychological and social aspects and is not only lack of illness and defect.” Based on this viewpoint, health is defined in terms of totality of person, not based on special part of the body; and not only attention has been to the entire influencing aspects on health and illness, but also there is a focus on optimal health, prevention from illness, and positive psychological and spiritual aspects.

However, in Islamic thought, because of human's definition, which is based on religious and divine philosophy, healthy is regarded not only as a responsibility and social commitment but also as a holy and altruistic job, benevolence, and among the highest forms of worship.

This issue could be applied in philosophical and scientific justification of employing variety of physical nursing techniques toward the care of psychological and spiritual areas of patients, and vice versa; in employing a variety of psychological measurements to physical care of patients. On this basis, believe that Islamic viewpoint could be a proper guidance in the manner and treat of nurses with client, and make possible the idea of complete presentation of care and attention to human aspects, as a whole and in interaction with the environment and universe. Furthermore, it can be a consolidated philosophical foundation in expressing and forming the nursing structure and, by this means, contribute to the knowledge development of the nursing profession.

In this study, there were some limitations such as: In order to utilize the precious religious text for example Quran we as were not expert (dominant) on Arabic and Islamic language had to use translation of Quran and specialist help.

Financial support and sponsorship

Isfahan University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.