Far Eastern University Institute of Nursing Graduate Studies

Theoretical Foundation of Nursing Nursing theories: Martha Rogers Science of Unitary Human Being Margaret Newmans Theory of Health as Expanding Consciousness

Prepared by: Cindy B. Clemente, RN

Submitted to: Ms. Eufremia Octaviano

SCIENCE OF UNITARY HUMAN BEING MARTHA E. ROGERS

BACKGROUND OF THE THEORIST * Born on May 12, 1914 in Dallas, Texas * Diploma in Nursing from Knoxville General Hospital (1936) * Bachelors Degree from George Peabody College in Nashville, Tennessee (1937) * Masters Degree in public health nursing from Teachers College, Columbia University in New York * Masters Degree in public health and Doctor of Science from Johns Hopkins University in Baltimore, Maryland * Head of the Division of Nursing of New York University (1954) OVERVIEW: Educational revolution in nursing (1961) Reveille in nursing (1964) An introduction to the theoretical basis of nursing (1970)

ABSTRACT IN NATURE becomes the basis for theory development that addressed the specific nature of nursing in caring for the unitary human being Rogers used the word UNITARY to connote human beings as unified wholes, greater than the sum of their parts; in fact, as not even being composed of parts. Rogers abandoned the word HOLISM, because of its widespread and often inaccurate use FIVE ASSUMPTIONS (about man) 1. Man is a unified whole, possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts. 2. Man and environment are continuously exchanging matter and energy with one another 3. The life process evolves irreversibly and unidirectionally along the space-time continuum 4. Pattern and organization identify man and reflect his innovative wholeness 5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion NURSING PARADIGMS PERSON (UNITARY HUMAN BEINGS) - an irreducible, indivisible, pandimensional energy identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts - an open system, constantly exchanging energy with the environment - characterized as sentient and thinking ENVIRONMENT - an irreducible, pandimensional energy field identified by pattern and integral with the human field - all that is external to unitary man

NURSING - the study of unitary, irreducible, indivisible human and environmental fields: people and their world - nursing is a learned profession which is both an empirical science and an art. FOCUS: People and the manifestations that emerge from the mutual human/ environmental field process HEALTH - unitary human health signifies an irreducible human field manifestation and disease and pathology are value terms when the human field manifests characteristics that may be deemed undesirable - health is relative and infinite. FIVE BUILDING BLOCKS OF THE CONCEPTUAL SYSTEM Energy Field - provides a way to perceive people and their environment as irreducible wholes - an energy field is a dynamic field having no real boundaries and extending to infinity. Openness - there are no boundaries or barriers to inhibit energy flow between fields Pattern - defined as distinguishing characteristic of an energy field perceived as a single wave. - the manifestations of field patterning that emerge are observable events. Pandimensionality - defined as a nonlinear domain without spatial or temporal attributes - also referred as space-time, four-dimensionality, and multi-dimensionality HOMEODYNAMIC PRINCIPLES - Describe the nature and direction of human development and the nature of the interaction between unitary man and environment PRINCIPLE OF HELICY - describe the unpredictable but continuous, nonlinear evolution of energy fields as evidenced by nonrepeating rhytmicities. - describe the nature of change PRINCIPLE OF INTEGRALITY - defined as continuous mutual human field and environmental field process - process by which change takes place PRINCIPLE OF RESONANCY - defined as an ordered arrangement of rhythms characterizing both the human field and the environmental field that undergoes continuous dynamic metamorphosis in the humanenvironment process - how change takes place

HEALTH AS EXPANDING CONSCIOUSNESS MARGARET NEWMAN

BACKGROUND OF THE THEORY: * Born on October 10, 1933 * Bachelors degree from University of Tennessee (1962) * Masters degree from University of California (1964) * Doctorate degree from New York University (1971) ASSUMPTIONS 1. Health encompasses conditions known as disease 2. Disease can be considered a manifestation of the underlying pattern of the person 3. The pattern of the person that manifests itself is primary and exists prior to structural or functional changes 4. Health is the expansion of consciousness NURSING PARADIGMS HUMAN BEINGS - human beings are unitary with the environment. - identified by patterns - humans are moving toward ever-increasing organization and are capable of making their own decisions HEALTH - a meaningful reflection of the whole - defined as the informational capacity of the system and is seen as the ability of the person to interact with the environment NURSING - defined as caring in the human health experience. -The need is to let go, embrace our experience, and allow the expansion of consciousness to unfold. - A profession, presenting three stages in the growth of the profession. 1. FORMATIVE nursing was in the process of becoming, of establishing its identity, and individual practitioners were responsible for their own practice. 2. NORMATIVE nursing lost some of its authority and was more competitive and persuasive in relation to the environment. During this stage, nursing moved primarily into the hospital setting and nurses became employees. 3. INTEGRATIVE nursing will relate to other health care providers and to clients as partners, in a cooperative , mutual manner - Newman suggests that three nursing roles are essential to the integrative model. - PROFESSIONAL NURSING ROLE: primary integrative role; nursing clinician/ case manager. The other two role are that of nursing team leader and staff nurse - NURSING CLINICIANS/ CASE MANAGER embraces the whole of the nursing paradigm - STAFF NURSE functions primarily from the medical or disease-oriented paradigm

NURSING TEAM LEADER serves as a liaison between the two to integrate and coordinate all into individualized care for every client KEY CONCEPTS MOVEMENT - integral to relationships and is a means whereby time and space become a reality. Space, time and movement are linked. In fact, the intersection of movement-space-time represents the person as a center of consciousness and varies from person to person, place to place, time to time TIME - considered an index of consciousness SPACE - further identified as life-space, personal space, and inner space - discussed in conjunction with time and movement and not defined separately. PATTERN - information that depicts the whole, understanding of the meaning and relationships at once. It is fundamental attribute of all there is and gives unity in diversity. - constantly moving unidirectionally and evolving and may be enfolded in a larger pattern that is in the process of unfolding. CONSCIOUSNESS - the information of the system; the capacity of the system to interact with the environment - the essence of all matter; persons do not possess consciousness, they are consciousness - the highest level of consciousness is absolute consciousness, which equates with love that embraces all experience equally and unconditionally

Newman drew upon Youngs conceptualization of the evolution of human beings to describe the levels of consciousness in her theory and the dynamics of movement from one level to another. These stages can be conceptualized as seven equidistant points on a V shape. Beginning at the uppermost point on the left is the first stage, Potential freedom. The next stage is binding. In this stage, the individual is sacrificed for the sake of the collective, with no need for initiative because everything is being regulated for the individual. The third stage, centering, involves the development of an individual identity, self-consciousness, and self-determination. Individualism emerges in the selfs break with authority. The fourth stage, choice, is situated at the base of the V. In this stage, the individual learns that the old ways of being are no longer working. It is a stage of self-awareness, inner growth and formation. A new way becomes necessary. Newman described the fifth stage, decentering, as being characterized by a shift from the development of self (individualization) to dedication to something greater than the individual self. The person experiences outstanding competence; his or her works have a life of their own beyond the creator. The task is transcendence of the ego. Form is transcended, and the energy becomes the dominant feature in terms of animation, vitality, a quality that is somehow definite. In this

stage, the person experiences the power of unlimited growth and has learned how to build order against the trend of disorder. Newman stated that few experience the sixth stage, unbinding, or the seventh stage, real freedom, unless they have these experiences of transcendence characterized by the fifth stage. It is in the moving through the choice point and the stages of decentering and unbinding that a person moves on to higher levels of consciousness.