Chapter 9 Grand Nursing Theories Based on Unitary Process

Science of Unitary Humans Martha Rogers “The story of nursing is a magnificent epic of service to mankind” M. E. Rogers, 1971 Science of Unitary Humans

Martha Rogers—(cont.) Martha Rogers was born in 1914 in Dallas, TX. Diploma from the Knoxville General Hospital School of Nursing (1936) BS in Public Health from George Peabody College in Nashville

Martha Rogers—(cont.) Executive director of the VNA in Phoenix for several years MA in Public Health Supervision from Teacher’s College, Columbia University (1945) Master’s degree in public health in 1952 and Doctor of Science (DSc) in 1954 from Johns Hopkins Chair of the Department of Nursing Education at NY University (1954–1979) Died in 1994

Martha Rogers—Books Educational Revolution in Nursing (1961)— encouraged liberal university education for nurses Reveille in Nursing (1964)—described a curriculum for nursing education Theoretical Basis of Nursing (1970)—contained the basis of her theory

Science of Unitary Human Beings For her model, Rogers drew from anthropology, psychology, sociology, physics, mathematics, and literature. Her work can also be traced to Nightingale as well as Einstein, Burr, and Northrop (electrodynamic theory/electrical fields) and von Bertalanffy (systems theory). Continuing development relates to chaos theory and quantum physics.

Science of Unitary Human Beings—(cont.) Concepts are derived from the view of the universe as a collection of open systems, which interact continuously without causality. Human beings are dynamic energy fields, integral with environmental fields. Both human and environmental fields are identified by pattern and characterized by a universe of open systems.

Question Which of the following is TRUE regarding the Science of Unitary Human Beings? The universe is a collection of open systems, which interact continuously without causality. Human beings are dynamic energy fields, distinct and separate from environmental fields. Human and environmental fields are identified by pattern and characterized by closed systems.

Answer A. The universe is a collection of open systems, which interact continuously without causality. Rationale: Important elements of Rogers’ theory involve the integration between humans and their environment as well as the universe and its entirety being an “open system.”

Science of Unitary Human Beings—(cont.) Humans are “unitary” being (not holistic). Cannot be understood by looking at their parts

Science of Unitary Human Beings—(cont.) Four building blocks of the model Energy fields Universe of open systems Pattern Four dimensionality (pandimensionality)

Science of Unitary Human Beings—(cont.) Energy fields Fundamental unit of both living and non-living Energy signifies the dynamic nature of the field. Energy fields are infinite and pandimensional.

Science of Unitary Human Beings—(cont.) Energy fields—(cont.) Human field—irreducible, indivisible energy field identified by pattern and manifesting characteristics that are specific to the whole Environmental field—irreducible energy field that is integral with the human field

Science of Unitary Human Beings—(cont.) Universe of open systems Energy fields are infinite, open, and integral with each other. Human and environmental fields are in continuous process and are open. Change affects both systems mutually. Humans do not adapt to their environment but are a part of it.

Science of Unitary Human Beings—(cont.) Pattern—Energy fields are identified by their distinguishing characteristics of energy; each human pattern is unique and integral with its environmental field. Patterns are unique and include behaviors, qualities, and characteristics of the field. Pattern is continually changing and may manifest disease, illness, feelings, or pain.

Science of Unitary Human Beings—(cont.) Pandimensionality—nonlinear domain without spatial or temporal attributes; infinite domain without limit Although we live in a three-dimensional world, we are aware of other dimensions that affect us. Rogers describes the idea of a unitary whole.

Science of Unitary Human Beings—(cont.) Homeodynamics—Changes in the life process in man are inseparable from environmental changes and reflect mutual interaction between the two; changes are irreversible and nonrepeatable; increasingly complex of pattern. Life process is homeodynamic and principles of homeodynamics (resonancy, helicy, integrality) present a way of perceiving unitary human beings.

Science of Unitary Human Beings—(cont.) Helicy—continuous innovative, unpredictable, increasing diversity of human and environmental patterns (spiral, nonrepetitive) movement Resonancy—continuous change from lower to higher frequency wave patterns in human and environmental fields Integrality—continuous mutual human and environmental field interaction process

Central Components in Rogers’ Theory (Focus of Study or Care) Unitary Human Being (Energy Field Openness Pattern Pandimensional) Environment Principles of Homeodynamics (Nature of Unitary Human Development) Resonancy Helicy Integrality Specify the Nature of

Science of Unitary Human Beings—(cont.) Assumptions Major components of Rogers’ model revolve around building blocks (energy fields, openness, pattern, and pandimensionality) and the principles of homeodynamics. These explain the nature and direction of the interactions between humans and the environment.

Science of Unitary Human Beings—(cont.) Nursing is an art and science concerned with maintaining and promoting health, preventing illness, and caring for the sick and disabled. Purpose of nursing is to help humans achieve well-being within their potential. Nursing care should support simultaneous human and environmental change.

Science of Unitary Human Beings—(cont.) Nursing is an empirical science. Nursing is a humanistic science. The science of nursing is a prerequisite to the process of nursing. Nursing practice seeks to Promote symphonic interaction between man and environment Strengthen the coherence and integrity of the human field Direct patterning of the human and environmental fields for realization of maximum health potential

Science of Unitary Human Beings—(cont.) Society of Rogerian scholars began in 1988. Publishes Visions: The Journal of Rogerian Nursing Science Many scholars are devoted to continuing her work.

Science of Unitary Human Beings—Resources http://www.societyofrogerianscholars.org/index.html http://www.nurses.info/nursing_theory_person_rogers_ martha.htm http://currentnursing.com/nursing_theory/unitary_huma n_beings.html

Expanding Consciousness Margaret Newman Health as Expanding Consciousness

Margaret Newman—(cont.) Born in 1933—Memphis, TN BA in Home Economics and English from Baylor (sic ‘em Bears) (1954) BSN—University of Tennessee, Memphis, TN (1962) MSN (medical-surgical nursing and nursing education)— UCSF (1964) PhD in Nursing and Rehabilitation from NYU (1971)

Margaret Newman—(cont.) Became interested in nursing as she cared for her mother (ALS) Faculty positions at University of Tennessee, NYU, Penn State, and University of Minnesota Retired in 1996

Margaret Newman—(cont.) First presented her theory at a nursing theory conference in New York in 1978 Strongly influenced by Martha Rogers (student of Rogers at NYU) Professor emeritus at University of Minnesota Currently involved in scholarship related to her theory and nursing theory in general

Margaret Newman—Books Theory Development in Nursing (1979) Health as Expanding Consciousness (1986, 1994, 1999) A Developing Discipline (1995) Transforming Presence (2007)

Health as Expanding Consciousness Focus on those “for whom health as the absence of disease or disability is not possible.” Originally focused on people facing the uncertainty, debilitation, loss, and death associated with chronic illness Progressed to include all persons regardless of health status

Health as Expanding Consciousness—(cont.) Asserts that everyone is part of the universal process of expanding consciousness, which includes: Becoming more of oneself Finding greater meaning in life Reaching new dimensions of connectedness with other people and the world

Health as Expanding Consciousness—(cont.) Assumptions Health encompasses disease or pathology. Disease can be a manifestation of the underlying patterns of the person. The pattern of the person manifests itself as disease, is primary, and exists prior to structural or functional changes. Health is the expansion of consciousness.

Health as Expanding Consciousness—(cont.) Humans are unitary and cannot be divided into parts. Humans are open energy systems in continual contact with a universe of open systems (the environment). Changes occur simultaneously—not in linear fashion.

Question Which of the following is NOT one of the assumptions of Newman’s Health as Expanding Consciousness theory? Disease can be a manifestation of the underlying patterns of the person. Humans are open energy systems in continual contact with a universe of open systems (the environment). Changes occur in linear fashion. The pattern of the person is primary and exists prior to structural or functional changes.

Answer Changes occur in linear fashion. Rationale: In Newman’s work, changes occur simultaneously—not in linear fashion.

Health as Expanding Consciousness—(cont.) Health is an essential component of the theory. Health is a process of developing awareness of self and the environment. Health includes the ability to perceive alternatives and respond accordingly. Health encompasses illness or pathology and pathologic conditions. Health can be viewed as manifestations of the pattern(s) of the individual.

Health as Expanding Consciousness—(cont.) Fluctuations in patterns that result in sickness can reorganize the relationship of pattern more harmoniously. Illness may provide the disequilibrium needed to maintain vital active exchange with the environment— The result is growth or evolution to create a new sense of balance.

Health as Expanding Consciousness—(cont.) New paradigm of health is important to nursing. Nurses who view disease as a manifestation of pattern can contribute to a new awareness of the person– environment interaction.

Health as Expanding Consciousness—(cont.) Pattern and pattern recognition are important concepts. Pattern—relatedness; framework seen in the person– environment interactions; includes movement, diversity, and rhythm Pattern recognition—illuminates the possibilities for action and is key to evolving a higher level of consciousness Time and space—describe temporal patterns that define being within the world

Health as Expanding Consciousness—(cont.) Nursing is caring in the human health experience. Caring is a moral imperative for nursing. Caring requires that we are open and vulnerable. Care should evolve from treatment of symptoms to a search for pattern. Nurses should assist people in getting in touch with their own pattern of expanding consciousness.

Health as Expanding Consciousness—(cont.) Focus of nursing is not on identifying what is wrong and planning to correct the problems. The nurse should partner with the client in pattern identification and coming together in a time of chaos and change. The client can determine action possibilities for transformation and “expanding consciousness.”

Health as Expanding Consciousness—(cont.) Has been used on a limited basis in nursing education Some research conducted—mostly looking at pattern recognition. Some examples of application in practice

Health as Expanding Consciousness—Resources http://healthasexpandingconsciousness.org http://nursing-theory.org/nursing-theorists/Margaret-A- Newman.php http://currentnursing.com/nursing_theory/Newman_Heal th_As_Expanding_Consciousness.html

Rosemarie Parse The Theory of Humanbecoming

Rosemarie Parse—(cont.) BSN—Duquesne University, Pittsburgh MSN and PhD—University of Pittsburgh Faculty positions at University of Pittsburgh, Duquesne University, Hunter College (New York) Currently professor at Loyola University (Chicago)

Rosemarie Parse—Publications Man-Living-Health: A Theory of Nursing (1981) Illuminations: The Human Becoming Theory in Practice and Research (1995) The Human Becoming School of Thought (1998) Community: A Human Becoming Perspective (2003) Founding editor of Nursing Science Quarterly

The Theory of Humanbecoming Humanbecoming theory sets quality of life from the person’s own perspective as the goal of nursing practice. Theory first published in 1981 as “Man-Living-Health Theory.” Name changed to “Human Becoming Theory” in 1992 (to remove “man” from title).

The Theory of Humanbecoming—(cont.) Human science nursing theory—derived from Dilthey, Heidegger, and Sarte as well as Rogers Three themes: meaning, rhythmicity, and transcendence

The Theory of Humanbecoming—(cont.) Assumptions Humans coexist in rhythmical patterns with the environment. Humans are open beings, freely choosing meaning in situations. Humans are unitary, continuously co-constituting patterns of relating. Humans transcend multidimensionally with the possibilities.

The Theory of Humanbecoming—(cont.) Assumptions—(cont.) Becoming is unitary human-living-health. Becoming is a rhythmically co-constituting human– universe process. Becoming is the human’s patterns of relating value priorities. Becoming is an intersubjective process of transcending with the possible. Becoming is unitary human’s emerging.

The Theory of Humanbecoming—(cont.) Humanbecoming is freely choosing personal meaning in situations in the intersubjective process of living values priorities. Humanbecoming is cocreating rhythmical patterns of relating in mutual process with the universe. Humanbecoming is cotranscending multidimensionally with the emerging possibilities.

The Theory of Humanbecoming—(cont.) Concepts of Humanbecoming Languaging Valuing Imagining Revealing– concealing Enabling–limiting Connecting– separating Powering Originating Transforming

The Theory of Humanbecoming—(cont.) Nurses guide individuals and families in choosing possibilities in changing the health process. This is accomplished by intersubjective participation with clients. Practice focuses on illuminating meaning. The nurse acts as a guide to choose possibilities in changing health experiences.

The Theory of Humanbecoming—(cont.) Nurses do not focus on changing an individual’s behavior to fit a defined nursing process. Nurses understand the human–universe process and practice “true presence” with the person and family. The nurse “dwells with the rhythms of the person and family” as they move through the experience.

The Theory of Humanbecoming—(cont.) Meaning “Structuring meaning multidimensionally is cocreating reality through the languaging of valuing and imaging.” Translation: People coparticipate in creating what is real for them through self-expression in living their values in a chosen way.

The Theory of Humanbecoming—(cont.) Rhythmicity “Cocreating rhythmical patterns of relating is living the paradoxical unity of revealing–concealing and enabling–limiting while connecting–separating” Translation: The unity of life encompasses apparent opposites in rhythmic patterns of relating. In living moment to moment, the individual illustrates self as opportunities and limitations in moving with and apart from others.

The Theory of Humanbecoming—(cont.) Transcendence “Cotranscending with the possibilities is powering unique ways of originating in the process of transforming.” Translation: Moving beyond the “now” moment is forging a unique path for the individual within ambiguity and continuous change.

The Theory of Humanbecoming—(cont.) Nurses illuminate meaning, synchronize rhythms, and mobilize transcendence. The theory has received considerable interest but limited use in practice. A number of devotees to Parse’s work Research is qualitative/phenomenologic. Parse has written a qualitative nursing research book.

Question Who among the following theorists included the major assumptions of freely choosing personal meaning, cocreating rhythmical patterns of relating, and cotranscending multidimensionally? A. Martha Rogers B. Margaret Newman C. Rosemarie Parse

Answer C. Rosemarie Parse Rationale: Parse developed her theory on the philosophical underpinnings of the existential–phenomenologic thought incorporating principles and concepts from Rogers. These assumptions are about humans and becoming.

The Theory of Humanbecoming—Resources http://www.humanbecoming.org/ http://currentnursing.com/nursing_theory/Rosemary_Par s_Human_Becoming_Theory.html