Chapter 9 Grand Nursing Theories Based on Unitary Process

1. Chapter 9Grand Nursing Theories Based on Unitary Process

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

3. 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

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. 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.”

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

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

12. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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.

18. 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

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

20. 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.

21. 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.

22. 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

23. 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.

24. 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_human_beings.html

25. Margaret Newman Health as Expanding Consciousness

26. 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)

27. 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

28. 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

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

30. 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

31. 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

32. 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.

33. 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.

34. 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.

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

36. 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.

37. 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.

38. 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.

39. 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

40. 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 expandingconsciousness.

41. 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.”

42. 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

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

44. Rosemarie Parse The Theory of Humanbecoming

45. 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)

46. 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

47. 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).

48. 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

49. 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.

50. 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.