GLOBAL ADVANCES IN HEALTH AND MEDICINE
oPTIMAL HeALING eNvIRoNMeNTS
Healing, a Concept Analysis
愈合,一项概念性分析
Análisis conceptual de la sanación
appendices
available online
Author Affiliations
National Institute on
Aging, Bethesda,
Maryland (Dr Firth);
Samueli Institute,
Alexandria, Virginia
(Ms Smith, Dr Sakallaris,
Ms Bellanti, and
Ms Crawford); University
of Texas Health Science
Center, San Antonio,
Texas (Dr Avant).
Correspondence
Bonnie R. Sakallaris,
PhD, RN
BSakallaris@SIIB.org
Citation
Global Adv Health Med.
2015;4(6):44-50. DOI:
10.7453/gahmj.2015.056
Disclosures
The authors completed
the ICMJE Form for
Disclosure of Potential
Conflicts of Interest
and had no conflicts
to disclose.
Funding
This work is supported
by the US Army Medical
Research and Materiel
Command under Award
No. W81XWH-10-1-0938.
The views, opinions and/
or findings are those of
the authors and should
not be construed as an
official Department
of the Army position,
policy, or decision unless
so designated by other
documentation.
Kimberly Firth, PhD, United States; Katherine Smith, MPH, United States; Bonnie R. Sakallaris, PhD, RN, United States; Dawn
M. Bellanti, MSN, CRNP, United States; Cindy Crawford, BA, United States; Kay C. Avant, PhD, RN, FNI, FAAN, United States
INTRoDUCTIoN
Healing is a commonly used term, and yet rigorous research on the definition and meaning of healing
has been published infrequently, and understanding
of the concept remains confusing and inexact.1
Clinicians and patients are overwhelmed with a
healthcare system focused on disease over health
creation, reductionist, fragmented, costly, and often
ineffective. In response, there has been an increasing
recognition that quality healthcare and the delivery
of that care need to take a more holistic, patient-centric
approach, an approach that emphasizes healing as
important as curing. In 2004, Samueli Institute,
Alexandria, Virginia, proposed a whole-system, healing-focused framework for delivering care and coined
the term optimal healing environments (OHE). An OHE is
comprised of people in relationships, their health-creating and healing behaviors, and the surrounding
physical environment. An OHE supports and stimulates patient healing by addressing the social, psychological, physical, spiritual, and behavioral components
of healthcare, enabling the person’s innate capacity to
heal.2 The OHE framework (Figure) is composed of 4
domains or integrated environments that reinforce
each other by acting synergistically. Each environment
is applicable on a personal level to the important relationships in our lives and to the organizations and
physical environments where we work, play, and
receive healthcare.3
Originally developed by consensus of experts,
the OHE framework evolved over the past decade
through insight gained at exemplar organizations
and practices, and new information generated
through research activities.3 The individual constructs as described lacked operational definitions to
guide measurement. The research team wanted to
create operational definitions for each of the concepts
in the OHE framework to inform future research and
facilitate measurement and evaluation of the concepts. Since healing is the desired outcome of an OHE
and is central to all other constructs in the framework, the research team made the decision to subject
healing to concept analysis methodology. The aim of
this article is to describe the use of a rigorous methodology, concept analysis, to clarify the meaning of
healing and propose an operational definition of healing in order to further the scientific understanding
and translation of OHEs into practice.
Methodology
We used concept analysis methodology because
of its stated purposes to examine the basic elements of
a widely used concept to clarify meaning, develop
operational definitions that help validate the construct, and facilitate instrument development in practice.4 The Walker and Avant method of concept analysis was employed as it is widely used and highly
regarded in the field as a process for bringing about
clarification, identification, and meaning of concepts.5 The methodology has critics, particularly
regarding depth, rigor, and replicability of the findings as the methods used to analyze are influenced by
the skill, knowledge, culture, and understanding of
the analyst and the framework being used.6 The
Walker and Avant method of concept analysis is criticized for lack of integration between the steps and
INTERNAL
INTERPERSONAL
BEHAVIORAL
EXTERNAL
Healing
intention
Healing
relationships
Healthy
lifestyles
Healing
spaces
Personal
wholeness
Healing
organizations
Integrative
care
Ecological
resilience
MAKING HEALING AS IMPORTANT AS CURING
Figure Optimal Healing Environments framework.
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optimal Healing environments
hEaLINg, a cONcEPT aNaLYSIS
limited applicability and clinical relevancy.7 We
employed multiple actions to mitigate these criticisms throughout the process.
The Walker and Avant methodology includes 9
steps: (1) select the concept for analysis; (2) determine
the aims of the analysis; (3) identify all uses of the
concept; (4) determine defining attributes based on
the literature review; (5) construct or identify a model
case; (6) identify contrary, borderline, related, invented, and/or illegitimate cases; (7) identify antecedents
and consequences related to the concept; (8) define
empirical referents; and (9) create a final definition of
the concept.4 The steps are not linear but are iterative
in nature and may occur “out of order” as 1 step
informs another throughout the philosophic inquiry.
We identified healing as the concept to study fulfilling the work of Step 1. Step 2 was to determine the
aim of the study, which was “to develop an operational
definition of healing in order to study the OHE framework.” We deliberately chose to use the OHE framework to focus the analysis despite the limitations that
predetermined frameworks impose on the analysis.
Step 3 was to identify all uses of the concept. The
use of the OHE framework limited the context of healing to humans, so descriptions and definitions of healing in relation to political relationships, conflict, the
environment, and so forth were reviewed but not
included in the analysis.
Early in the process of the analysis, we located 5
published concept analyses related to healing, 3 on
healing, 1 on self-healing, and 1 on healing and chronic pain. The preexisting analyses provided insight
into how others have conceptualized healing (Table
1) but did not provide the operational clarity that we
sought to further our understanding of healing as it
manifests in optimal healing environments.
After reviewing the existing concept analyses,
researchers launched an in-depth review that included journals, books on healing, and journal articles. A
wide variety of dictionaries were searched: historical,
abridged and unabridged, the Laffal Concept Dictionary
of English,12 an etymological dictionary, complemen-
tary and/or alternative medicine dictionaries, and
ancient medical dictionaries stored at the National
Institutes of Health’s National Library of Medicine
(NLM). We conducted searches in PubMed/Medline,
ProQuest, CINAHL, PsycInfo, and Google Scholar
using the term healing as a keyword from database
inception through July 2015. This search strategy
yielded thousands of results, which were screened by
the research team. The majority focused on specific
curative procedures and medications in human and
animal models. The OHE framework is a holistic
approach to healing, so subsequent searches were
limited to human research using the Title/Abstract
delimiter where available and “defin*” or “meaning”
as key words. The authors pulled literature from reference lists, bibliographies, and other sources in addition to the formal search strategy (eg, unpublished
literature, book chapters, and non–peer-reviewed
articles). The researchers reviewed all retrieved articles, books, and web pages looking for definitions and
descriptions of healing. The information was compiled into a comprehensive list of 118 healing definitions and descriptions (Appendix A, available at www.
gahmj.com). The team reviewed all data, noting words
and phrases used repeatedly to define or describe the
characteristics and consequences of healing. We used
the team approach to data analysis to mitigate the
impact of individual knowledge, skill, and culture on
the analysis.
A total of 99 key terms and phrases were extracted from the data and recorded as well as the number
of times each was mentioned (Appendix B, available
at www.gahmj.com). The 99 key terms were the “first
cut” and formed the foundation for determining the
core attributes of healing. Next, we eliminated redundancies and collapsed the terms into higher order
concepts. For example, the terms progression, journey,
emergent process, shift, and evolving collapsed into the
higher-order concept process. Fourteen higher order
concepts evolved from 99 original key terms and
phrases. These 14 higher-order concepts were the “second cut” of the analysis.
Table 1 Definitions of Healing From Existing Concept Analysis Work
Authors
Definition
JA Glaister
Healing is a natural active and multidimensional process that is individually expressed with common patterns. Healing is
influenced by body-condition, personal attitudes, and relationships.1(p67)
D McElliott
Theoretical definition: Healing is a positive, subjective, unpredictable process involving transformation to a new sense of
wholeness, spiritual transcendence, and reinterpretation of life.
Operational definition: Healing is the personal experience of transcending suffering and transforming to wholeness.8(p251)
MC Wendler
Healing is an experiential, energy-requiring process in which space is created through a caring relationship in a process of
expanding consciousness and results in a sense of wholeness, integration, balance, and transformation and which can
never be fully known.9(p836)
WJW Robb
Self-healing is the active, personal process that, upon the use of an energetic catalyst, results in the rechanneling of
innate, vital energy forces throughout the journey towards transcendence.10(p74)
AA Smith
No definition proposed. Three attributes of healing:
Sense of transcending the immediate environment or situation
Sense of timeless connection, unity, and interdependence with the self and others
Sense of inner knowing, strength, and peace11(p23)
optimal Healing environments
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
Table 2 Defining Attributes of Healing, Antecedents, and Consequences
Antecedents
Defining Attributes
Consequences
Brokenness
Connection with self or others
Holistic transformative process
Innate or naturally occurring process
Multidimensional
Involves repair and recovery of mind, body, and spirit
Positive change
Finding meaning
Personal wholeness
Steps 4 through 8 required multiple meetings
where the team examined the higher-order concepts
in order to group them into mutually exclusive categories: defining attributes (key characteristics of healing), antecedents (necessary for healing to occur), or
consequences (result of healing). Consensus was not
declared until all team members agreed that the defining attributes immediately called the concept of healing (and only healing) to mind. At times, we shifted
higher-order concepts into different categories. For
example, repair and recovery was first categorized as a
consequence of healing. However, it became clear
that without repair and recovery, the defining attributes did not bring the concept of healing immediately to mind, and thus we reclassified the process of
repair and recovery as a defining attribute. After
lengthy discussions and examinations, 4 final defining attributes, 2 antecedents and 3 consequences were
agreed upon, from which evolved a working definition of healing (Table 2).
The team tested antecedents, attributes, and consequences with actual and composite cases to clarify,
refine, and validate the defining attributes. A model
case is a clear example of the concept that contains all
defining characteristics. A borderline case almost
exemplifies the concept but lacks one or more of the
defining attributes. Contrary cases are clearly not representative of the concept being studied.4 Finally, we
reviewed the literature for empirical referents.
Empirical referents are the measurable ways to demonstrate healing.
DeFINITIoNS oF HeALING
The word healing comes from the old-English
term haelen, meaning “wholeness”13 and often refers to
the process of moving toward a desired wholeness or
achievement of cohesion.14 Healing is an intervention,
an outcome, and a process, and at times, all three.15 It
also describes an ability or power,10 energy,16 and
cleansing of grief, trouble, or evil.17 The concept is
relevant in a wide range of disciplines, including
medicine, nursing, psychology, public health, education, religion, and spirituality. Healing occurs in multiple dimensions—physical, mental, emotional, spiritual, familial, social, communal, and environmental.
Healing occurs at multiple levels from the micro level,
as in cellular wound healing, to the macro level, as in
national and global healing. Healing originates from
within the individual and from external sources (eg,
human healers and God) or substances (eg, herbs and
medicines). Perspectives on healing come from healthcare practitioners, patients, priests, rabbis, energy
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practitioners, spiritual healers, people close to death,
people living with pain and other chronic illnesses,
people who have suffered abuse and neglect, and those
who have suffered hardship such as divorce, miscarriage, or death of a child.18-21
DeFINING ATTRIBUTeS oF HeALING
Defining attributes are the characteristics of a
concept that differentiate that concept from other
similar or related concepts.4 Four defining attributes
emerged in this concept analysis. Healing is a holistic
transformative process; it is personal; it is innate or
naturally occurring; it is multidimensional; and it
involves repair and recovery of mind, body, and spirit.
The positive, transformative process, progression, or journey does not occur in a single instant but
evolves over time.22 Studies support healing as a process of moving away from an undesired state to a state
of renewal.22-24 The process is dynamic, emergent,
and experiential. It is a journey and an experience.
Multiple healthcare providers and patients describe it
as “an evolving process that may require changes in
direction and final destination.”18(p310) Healing
involves the whole person—mind, body, and spirit.
Holistic processes integrate multiple dimensions synergistically, creating a new dimension that is more
than the sum of the original dimensions; “Healing
requires understanding the patient as a whole person,
not just addressing a discrete physical problem.”18(p310)
Though cure usually occurs solely on the physical or
mental level, healing does not; it occurs holistically in
the mind, body, and spirit.
The process of healing is transformative; it changes the individual in expected and unexpected ways,
creating a new entity. The individual transcends distress, suffering, and the disease state and becomes a
different person. People are transformed from the old
to the new. Some describe both the healer and healee
transforming in a positive direction.25
Healing involves repair and recovery in multiple
dimensions—mind, body, and spirit. We are all broken in some way and in need of healing. The healing
process engages the individual’s innate ability to
repair damage and recover function. Repair means to
fix or mend and to recover is to return to a previous
state.26 In healing, repair and recovery may occur at
the micro level of cells and tissue, the orderly series of
cellular processes that restore tissue integrity.27
Healing also involves repair and recovery at the emotional, psychological, social, and spiritual levels, such
as when an assault victim overcomes intense anxiety
and moral distress.28 Spiritual repair is described by
optimal Healing environments
hEaLINg, a cONcEPT aNaLYSIS
Kubler-Ross as when “the spiritual quadrant opens
and matures”23 and can be seen in the amputee who
overcomes anger and blame by making a commitment to use the negative experience to help other
amputees.29 Repair and recovery of mind, body, and
spirit are what differentiates healing from cure. When
people are cured, their disease or disease symptoms
are physically eradicated, but they may or may not
repair or recover in other areas.24 Healing, on the
other hand, involves repair and recovery in all aspects
of the physical, psychic and spiritual person: in other
words, healing is concerned with wholeness for the
total person.30
ANTeCeDeNTS oF HeALING
The antecedents of healing are conditions or
actions necessary for healing and usually precede the
experience of healing. They include a brokenness and
relationships with others and/or oneself.
Activation of the repair or recovery process
occurs in response to a defect, disruption, disharmony, or malfunctioning. Living beings are complex
physical, mental, spiritual, and energy systems, and
disruption can occur in any of the systems. For example, physiological healing is a response to a biological
injury or imbalance, but the injury may lead to mental disruption expressed by swift mood changes, difficulty concentrating, and anxiety as seen in the transition from acute pain associated with injury to chronic
pain.11 As previously mentioned, the human condition is one of brokenness and healing occurs naturally
all of the time: “By becoming aware that our lives are
a continual process of healing, we can learn to come
to peace with any illness or injury that may
manifest.”30(p187) In the context of significant hurt,
healing may need to be facilitated by healers and healing practices. Medical intervention may provide relief
of suffering and cure but may not be sufficient to
facilitate healing. Stories of healing suggest that healing is more complex than “fixing the broken part.”24
Healing occurs in the context of a relationship:
“At the heart of nearly every healing story are one or
more critical relationships.”31 The relationships critical for the healing process to occur may involve
friends, family, community, a higher being, or oneself19; for some, it is even achieved through relationship and connection with a pet.32 Anthropological
research highlights the therapeutic impact of the
relationship between healers and healees.33,34 Healing
is an innate capability, a natural process; therefore,
the healing relationship is facilitative.
CoNSeQUeNCeS oF HeALING
Healing results in positive change, finding meaning, and the realization of wholeness. These consequences differentiate healing from cure in that cure
may occur without the patient finding meaning or realizing wholeness of mind-body-spirit. Healing results in
positive changes at many levels, including but not lim-
optimal Healing environments
ited to physical health. Improvements in mental, emotional, social, or spiritual harmony are examples of
healing outcomes.1 The positive change that occurs in
healing is not limited to the event at hand but continues
as the person progresses through life.35
A common outcome of healing is a reinterpretation of the event or situation that provides meaning
and transcends the situation. It may include understanding and reinterpreting one’s condition such that
a new sense of purpose is found. For some, meaning is
found in their actual illness. Others find it through
helping others. As Victor Frankl so eloquently
described in Man’s Search for Meaning, “suffering ceases to be suffering in some way, in the moment it finds
a meaning.”36 Moreover, according to Smith11, “In
order to say that healing is occurring there must be a
sense of inner knowing . . . The person has a sense of
meaning and purpose in life.”11(p23)
The realization of wholeness is the integration of
physical, emotional, intellectual, energy, and spiritual
systems into a balanced and harmonious total being,
the sum of which is greater than its individual parts.37
Wholeness is harmony of body, mind, and spirit and
may involve social and environmental elements.38,39
Healing and the resulting wholeness are individual processes and personal experiences unique to
the individual40 and occurring within the life narrative of the person experiencing the phenomenon.23
While a healthcare provider can evaluate objective
data in order to determine if a person is “cured,” only
the individual can determine that healing has
occurred. Hence, a consequence of healing is a
uniquely subjective and personal realization and perception of wholeness.
TeST CASeS
The defining attributes of healing were exposed
to actual and constructed cases. Cases are useful to
test the defining attributes and to refine them using
comparative reflection.
A Model Case of Healing
A search of the literature, both published and lay
literature (eg, newspaper articles, personal communications) resulted in the adoption of the following
model case of healing:
Jorge Morales settled in a rapidly growing urban
Mexican immigrant community in the United
States when he was in his teens. Jorge took great
pride in learning English and advancing his education, believing that independence was important for assimilating into American society. As a
gay male, Jorge was well aware of his risks for
contracting HIV, but was devastated when he
discovered his partner had the disease and was
dying. Feeling betrayed and depressed by his
partner’s infidelity, Jorge ignored his own symptoms until he needed hospitalization; he could no
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GLOBAL ADVANCES IN HEALTH AND MEDICINE
longer deny his own HIV status. As he lay desperately ill and alone in his hospital bed, a group
of doctors came to his bedside, informed him that
he had “full-blown AIDS” and walked away.
Although his body responded to the HIV
medicines, his spirit did not. Dejected, Jorge
returned home to live with his mother, but there
was little solace there. She understood neither his
sexual orientation nor his disease. She was terrified of catching AIDS and refused to touch him,
even insisting that he eat on his own dinnerware
and wash his clothes and linens separately.
Disconnected and empty of hope, he planned a
return to the United States to die. Before leaving,
however, his 11-year-old sister tearfully pleaded
with him to live for her. “I want you to give me
away at my wedding,” she said. Clinging to this
lifeline of hope, he returned to the United States.
With a reason to live, Jorge sought help in a
small inner-city family medicine office near his
apartment. Unlike the physicians at the hospital,
this doctor treated him as if he, Jorge, distinctly
mattered. Over time, Jorge grew to trust his doctor.
He felt this doctor was able to get into his head,
particularly when he would say, “Don’t you want
to see your sister get married?” In return, Jorge
worked hard to adhere to his medical regimen.
Meanwhile, Jorge began to take care of his
home, giving him a sense of pride and control. His
work provided a place of support and gave him
needed self-respect. Over time, and with the persistent intercession of his sister, Jorge’s mother gained
a better understanding of his life with AIDS, and
Jorge was able to arrange for her to move from
Mexico into an apartment in his building. While
he may never be “cured” from his disease, Jorge
has experienced healing.31(ppS41-S42)
Jorge’s case embodies the defining attributes of
healing; he experienced a holistic transformative process integrating his physical, emotional, and social
systems resulting in positive movement toward higher physical, emotional, social, and relational health
and wellbeing. Jorge’s case demonstrated repair and
recovery within the context of his incurable disease.
The antecedent criteria were met. Jorge was broken in body, mind, and spirit, and it was in the context
of the relationships with his sister and doctor that he
began to heal. The consequences of healing were demonstrated as Jorge found meaning in a variety of areas,
moved toward wholeness in mind and spirit and
made many positive changes in his life. In this particular example, healing occurred even though Jorge
has an incurable disease.
A Borderline Case of Healing
The following is a constructed case while providing an example of a process toward repair and recovery that does not exemplify healing.
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Jimmy, a 50-year-old banker diagnosed with
multiple sclerosis (MS), grew up with an absentee, alcoholic father. He placed a high value on
achievement and hard work and referred to himself as a “workaholic.” Jimmy had difficulty
expressing his emotions, often raging at his wife
and three children.
Jimmy managed to continue working
despite his decreasing mobility. Tensions at home
increased as work left him exhausted, edgy, and
anxious. His doctor suggested reducing his work
hours, incorporating gentle exercise to keep up his
strength, and medication to address his anxiety
and edginess. Jimmy utilized the antidepressants
but did not follow through on alterations in life
style to reduce stress.
Two years after his diagnosis, Jimmy had an
exacerbation of his MS symptoms necessitating
hospitalization. Frightened and frustrated, he
lashed out at his wife and the hospital staff. His
physician checked in on him each day during
rounds and called his room each evening. It
touched Jimmy that someone who was so busy
would consistently check on him. One evening,
after a very difficult day physically, Jimmy asked
to see his physician. He was told that his doctor
was in surgery that was expected to last into the
evening and that the doctor would not be able to
see him until the next day. However, that night
after 10 PM the physician walked into Jimmy’s
room. The physician pulled up a chair and made it
clear that he was there for as long as Jimmy needed. Jimmy and the physician talked for over an
hour, during which Jimmy shared his anxieties
about his inability to perform at work and provide
for his family. The physician listened with care and
validated Jimmy’s concerns and struggles. That
night, Jimmy slept better than he had in weeks.
Over the next few months, Jimmy began
incorporating many of the doctor’s suggestions.
His physical symptoms began to subside and his
relationships with his wife and children have
taken a greater priority in his life. While much
improved, he continued to struggle emotionally
and described his daily life as “just getting out of
bed, when I can, and making it through the best I
know how.”
This constructed case demonstrated progress
towards improved physical repair and recovery of
functioning, as seen by the considerable diminishment of physical symptoms and better sleep, as well
as improved social/relational functioning, manifested
by his improved relationships with his wife and children. There is also evidence of the consequences of
finding meaning and positive change as he incorporates his doctor’s suggestion to reduce work hours and
his family becomes more of a priority in his life.
However, Jimmy still had a significant amount of
optimal Healing environments
hEaLINg, a cONcEPT aNaLYSIS
emotional brokenness and gave no indication that he
considered himself to be healing or healed. Thus, his
situation lacked the defining attribute of holism and
the consequence of a self-realized perception of
wholeness or healing.
A Contrary Case of Healing
Our constructed contrary case shows a nearly
complete failure of healing.
From the age of 10, Ron always wanted to be a
soldier in the US Army. Immediately following
high school graduation, Ron enlisted in the
army. A year after basic training, Ron received
his first deployment to Iraq. He felt gratitude
and honor about being called to do what was in
his heart and what he was prepared for—fighting for his country.
Two years later, during his second deployment, Ron was seriously injured by an improvised
explosive device while driving a Humvee on a
mission. He sustained serious physical injuries
and witnessed the death of a fellow soldier. Ron
was immediately attended to and sent to the nearest medical facility. Once he was stabilized, Ron
was flown back to the United States where he was
treated by an expert team of specialists. Despite
the injuries, Ron’s prognosis was very good.
Over the next several months, Ron’s progress
toward full physical recovery failed to materialize,
however, as Ron’s disappointment in himself and
in his self-professed “inability to save my friend”
overwhelmed him. Ron seldom attends physical
therapy, and his physical functioning is declining.
He was diagnosed with posttraumatic stress disorder and urged to continue with his medication regimen and to seek therapy, either individually or via
a support group. Ron rejected the suggestion of
therapy, preferring to be left alone.
Ron’s example lacks any of the defining attributes of healing. His physical abilities continue to
decline, and he has mental, cognitive, and emotional
disruptions, with no evidence that there will be repair
and recovery in those areas or that he is undergoing or
will undergo any sort of holistic transformation. Ron
also has isolated himself, rejecting any sort of relationship, which is an antecedent to the healing process. Clearly, Ron’s story does not embody a holistic,
transformative process of repair and recovery in mind,
body, or spirit.
oPeRATIoNAL DeFINITIoN oF HeALING
The operational definition that emerged from the
concept analysis: Healing is a holistic, transformative
process of repair and recovery in mind, body, and spirit
resulting in positive change, finding meaning, and movement toward self-realization of wholeness, regardless of the
presence or absence of disease.
optimal Healing environments
eMPIRICAL ReFeReNTS
Empirical referents are vital because they support the concept’s validity by providing ways to measure the existence of the concept. The research team
anticipated the emergence of quantitative measures
of healing through the concept analysis process. We
concluded that given the highly subjective and personal nature of healing, a mixed-methods approach to
measurement is most appropriate. This approach
engenders a more robust understanding of the healing construct via interview probes expressly geared to
the understanding of the holistic, transformative processes of the healing experience, as well as the quantitative measures of physiological change, symptom
resolution, improved sense of wellbeing, sense of
coherence, and enhanced relationships. Categories of
qualitative data may include (1) changes in sensations
and feelings; (2) changes in self-concepts and values;
(3) changes in medical symptoms and complaints;
and (4) construction of meaning or cognitive reframing.41 Miller et al recommend a composite measure of
healing that incorporates physiological parameters,
symptom relief scales, biomarkers, health status and
functional status scales, wholeness scales. and measures of functional relationships.42 Healing has different empirical referents in different contexts, situations, and cultures. Measurement is possible using
established biometrics for repair and recovery in concert with qualitative information on transformative
change, personal wholeness, and meaning.
DISCUSSIoN
The aim of this study was to extract the defining
attributes of healing in order to provide a clear and
comprehensive definition of healing, a definition that
could be used to operationalize the concept and measure it. The predominant clinical use of the concept is
to convey full recovery from illness or repair of injury
as in wound healing, disease management, and cure.
The team acknowledged the biomedical use of the
concept and included repair and recovery as a defining attribute. This decision was the result of significant debate and return to the literature with the conclusion that healing involves repair and recovery in
the multiple dimensions of our humanity; mind,
body, and spirit. Our use of the OHE framework to
guide the concept analysis led us to focus on literature
that examined healing as a holistic concept over the
prevailing biomedical focus on repair and recovery.
As early as 400 BC, Hippocrates described healing
as a natural process leading to restoration of wholeness, creating harmony between body and soul. 8
Twenty-first century work added the dimension of
the mind. Our search for definitions and descriptions
of healing led to a set of defining attributes that support the conclusions of previous concept analyses.
This congruence of attributes described across centuries validated our understanding of healing as an
innate transformative process. The existing literature
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on the subject also provided an understanding that
healing requires a brokenness or disruption of health
and that the facilitation of healing, although personal
in nature, does not occur in isolation but in relationship with one’s self or another, frequently between
healer and healee but also between the person and an
important other. The literature also revealed that outcomes of healing include positive change, finding
meaning, and the realization of personal wholeness.
CoNCLUSIoN
To view or download
the full-text article, visit:
www.gahmj.com/doi/full/
10.7453/gahmj.2015.056
An operational definition of healing with antecedents, defining attributes, and consequences
emerged through the process of concept analysis. We
tested the findings using multiple cases, ultimately
resulting in a model case, a borderline case, and a contrary case.
The definition provided here and supported by
the literature contends that healing is a holistic, transformative process of repair and recovery in mind, body, and
spirit resulting in positive change, finding meaning, and
movement towards self-realization of wholeness, regardless
of the presence or absence of disease. Healing may or may
not include cure, defined as the eradication of physical symptoms of illness or disease.
This definition of healing, as well as its antecedents,
consequences, and empirical referents, provides a solid,
evidence-based foundation for understanding and
describing the seminal construct of the OHE framework.
Acknowledgments
The authors wish to acknowledge Courtney Boyd
and Charmagne Paat, both of the Samueli Institute,
for their assistance in the literature search and Kelly
Gourdin for her assistance with the development of
the contrary case.
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