432 UNIT IV Nursing Theories
express that this theory and method makes sense to
Importance use in nursing. They contend that the theory is natu-
Transcultural nursing theory has important outcomes ral to nursing and leads to fresh insights about care,
for nursing. Rendering culture-specific care is an health, and well-being. Unquestionably, it is the the-
essential goal in nursing. It places the transcultural ory of today and tomorrow in our growing and
nursing theory central to the domain of nursing increasingly multicultural world. The research and
knowledge acquisition and use. The theory is highly theory provide a pathway to advance the profession of
useful, applicable, and essential to nursing practice, nursing and the body of transcultural knowledge for
education, and research. The concept of care as the application in nursing practice, education, research,
primary focus of nursing and the base of nursing and clinical consultation worldwide.
knowledge and practice is long overdue and essential
for advancing nursing knowledge and practices. This
theory could be the means to establish a sound and
defensible discipline and profession, guiding practice CASE STUDY
to meet a multicultural world. An elderly Arab-American Muslim man who
spoke little English was admitted to the hospital
Summary for increasing pain in his left foot while at rest. His
This chapter introduces Dr. Madeline Leininger, who foot was cool and pale, and he had a history of
vascular surgical procedures. He had many chronic
has championed the nature, importance, and major health problems, including type 2 diabetes, hyper-
features of the Theory of Culture Care Diversity and tension, and chronic obstructive pulmonary dis-
Universality. Leininger’s ethnonursing research method ease. He also had had a myocardial infarction and
and the enablers are presented to show the fit between several cerebral vascular accidents. While in the
the theory and the method. Fully understanding the hospital, he developed abdominal pain and under-
theory and the method (with the enablers) leads to went a cholecystectomy. This elderly grandfather
credible and meaningful study findings. With under- had a large family, including a wife, nine children,
standing, the research becomes meaningful, exciting, and many grandchildren. His wife insisted that all
and rewarding to do, and the researcher develops con- family members visit him every day while he was
fidence and competence in use of the theory and the in the hospital. The family wanted the man’s face
method. turned toward Mecca (toward the East) while they
As a premier theory in nursing, culture care is prayed with him. They brought tape-recorded pas-
greatly valued worldwide. Other disciplines have also sages from the Koran, which they played at his
found the theory and the method helpful. Nurses who bedside. Other families who were visiting their
use the theory and the method frequently communi- sick relatives complained to the nurses that the
cate how valuable it is to discover culturally based Arab family was taking up the entire waiting
ways to know and practice. Practicing nurses now room, and there was no place for anyone else to sit.
have holistic, culturally based research findings for As a nurse, how might you use the three modes
use as they care for clients of diverse and similar from the Theory of Culture Care Diversity and
cultures or subcultures in different countries. New- Universality to provide culturally congruent care
comers to the theory and the method may benefit for this elderly man and his family, as well as for
from experienced expert mentors in addition to the other clients and their families in the critical
studying transcultural research conducted using the care unit?
theory and the method. Most important, nurses often
CHAPTER 22 Madeleine M. Leininger 433
CRITICAL THINKING ACTIVITIES
1. Select four research studies reported in the Journal minerals, and other over-the-counter medica-
of Transcultural Nursing that used Leininger’s tions and preparations, which demands a trans-
Theory of Culture Care Diversity and Universality. cultural knowledge base
Select studies that represent different cultures, g. Spiraling health care costs; forced use of health
different research settings, and culture that is maintenance organizations; lack of health in-
different from your own. surance; increased reliance on self-diagnosis,
a. Review each of the studies and outline the rela- treatment, and care; and increased availability
tionship of the theory to the domains of inquiry, of diagnostic test kits for acquired immunode-
purpose, assumptions, definitions, methods, ficiency syndrome, glucose monitoring, choles-
research design, data analysis, nursing deci- terol screening, ovulation and pregnancy, fecal
sions, and conclusions. occult blood, and the like
b. Identify evidence from these studies, and confirm h. Problems related to cultural conflicts, stress,
the Theory in relation to the domain of inquiry pain, and cultural imposition practices
theory tenets and derivable consequences. 3. Arrange an interview experience at a health center
2. Imagine you are to give a 3-minute class presenta- or public health department with persons of diverse
tion on the usefulness of the Theory of Culture cultures. Ascertain the following:
Care Diversity and Universality in the twenty-first a. Identify the cultures represented by the clientele
century and prepare an outline of your presenta- with the use of Leininger’s theory and the Sunrise
tion. Consider the current trends of consumers Enabler.
of health care, cultural diversity factors, and b. What is the cultural mix of the staff (physicians,
changes in medical and nursing school curricula. nurses, social workers, and clerics) of the center
Following are some examples of trends and or health department? How does the cultural
changes you may want to consider: background of the staff differ from that of the
a. The importance of transcultural nursing knowl- clientele?
edge in an increasingly diverse world c. Arrange a conference with the director and
b. Growth of lay support groups to provide infor- nursing staff, and ascertain their culture-based
mation and sharing of experiences and support attitudes, values, and beliefs, and those that are
for clients, families, and groups experiencing reflected in the clients using the center or de-
chronic, terminal, or life-threatening illnesses partment. Compare and contrast the values,
or treatment modalities from diverse or similar attitudes, and beliefs of the staff with those of
(common) cultures the clients. What are the cultural similarities
c. Use of cultural values, beliefs, health practices, and differences?
and research knowledge in undergraduate and d. Survey the printed materials (e.g., visual aids,
graduate nursing curricula across the life span artifacts, and paintings) in the waiting and
d. Inclusion of alternative or generic care in nurs- examination rooms and in the classrooms to
ing curricula, such as medicine men (Native identify the cultures and languages that are
American healers, curers, and herbalists in the depicted.
Southwest) and selected substantiated Chinese e. On the basis of data obtained from this experi-
methods shown to be effective for the treatment ence, how can the Theory of Culture Care
of chronic disease Diversity and Universality be used to provide
e. Use of cultural caring research knowledge as culturally sensitive and congruent care to cli-
the new and future direction of nursing in the ents who use the center or department?
twenty-first century 4. Identify the type of prerequisite knowledge, expe-
f. The increased number of books, audiotapes, riences, attitudes, and skills needed to effectively
and videotapes published on health mainte- use the Theory of Culture Care Diversity and
nance, alternative medicine, herbs, vitamins, Universality.
434 UNIT IV Nursing Theories
POINTS FOR FURTHER STUDY
n Leininger, M. M. (2006). Envisioning the future of n Leininger, M. M. (2011). Leininger’s reflection on
the culture care theory and the ethnonursing her ongoing father protective care research. Online
method. In M. M. Leininger and M. R. McFarland Journal of Cultural Competence in Nursing and
(Eds.), Culture care diversity and universality: A Healthcare, 1(2), 1–13.
worldwide theory of nursing (2nd ed., pp. 389–394). n McFarland, M. R., & Eipperle, M. K. (2008).
Sudbury, (MA): Jones & Bartlett. Culture care theory: A proposed theory guide
n Leininger, M., & McFarland, M. R. (2006). Trans- for nurse practitioners in primary care settings.
cultural nursing: The theory of culture care. DVD Contemporary Nursing Journal, 28(2), 48–63.
set of three. n McFarland, M. R., Mixer, S. J., Webhe-Alamah,
n Morgan, M. G. (2010). Leininger’s theory of culture H., Burk, R. (2012). Ethnonursing: A qualitative
care diversity and universality in nursing practice. research method for all disciplines. Online Inter-
In M. R. Alligood (Ed.), Nursing theory: Utilization national Journal of Qualitative Methods, 11(3).
and application (4th ed., pp. 411–428). Maryland University of Alberta, Canada.
Heights, (MO): Mosby-Elsevier. n McFarland, M., Wehbe-Alamah, H., Wilson, M., &
n Leininger, M. (1998). Transcultural Nursing Society Vossos, H. (2011). Synopsis of findings discovered
website at: www.tcns.org. within a descriptive meta-synthesis of doctoral
n Leininger, M. (2005). Major contributions of dissertations guided by the Culture Care Theory
qualitative and quantitative criteria to evaluate with use of the ethnonursing research method.
research. PowerPoint Presentation. Available at: Online Journal of Cultural Competence in Nursing
www.madeleine-leininger.com. and Healthcare, 1(3), 24–39.
n Leininger, M. M. (2007). The evolution of trans- n Miller, J. E., Leininger, M., Leuning, C., Paquiao, D.,
cultural nursing with breakthroughs to discipline Andrews, M., Ludwig-Beymer, P., Papadopoulos, I.
status. Unpublished manuscript. Available at: (2008). Transcultural nursing society position state-
www.madeleine-leininger.com. ment on human rights. Unpublished manuscript.
n Leininger, M. M. (2008). TCN certification: A global Available at: www.madeleine-leininger.com.
mandate. Unpublished manuscript. Available at:
www.madeleine-leininger.com.
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Leininger, M. (Ed.). (1978b). Transcultural nursing care of tration. In B. Henry, C. Arndt, M. DiVincenti, &
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Leininger, M. (2002b). Part I. The theory of culture care Leininger, M. M. (1989b). The transcultural nurse specialist:
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(Eds.), Transcultural nursing: Concepts, theories, research, vadis (where goeth the field)? Journal of Transcultural
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Transcultural nursing: Concepts, theories, research, & Leininger, M. M. (1990b). Ethnomethods: The philosophic
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Leininger, M. M. (2006a).Culture Care Diversity and knowledge. Journal of Transcultural Nursing, 1(2), 40–51.
Universality Theory and Evolution of the Ethnonurs- Leininger, M. M. (1990c). Issues, questions, and concerns
ing Method. In M. M. Leininger and M. R. McFarland related to the nursing diagnosis cultural movement
(Eds.), Culture care diversity and universality: A world- from a transcultural nursing perspective. Journal of
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(MA): Jones & Bartlett. Leininger, M. M. (1990d). Leininger clarifies transcultural
Leininger, M. M. (2006b). Culture care of the Southern Suda- nursing (Letter to the Editor). International Nursing
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(Eds.), Culture care diversity and universality: A worldwide Leininger, M. M. (1990e). The significance of cultural con-
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Leininger, M.M. (2006c). Ethnonursing method and Leininger, M. M. (1991a). Transcultural nursing goals and
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Selected Book Prefaces and Forewords Leininger, M. M. (1991c). Second reflection: Comparative
Leininger, M. M. (2003). Foreword. In M. R. Andrews & care as central to transcultural nursing. Journal of
J. S. Boyle, Transcultural concepts in nursing care (4th ed.). Transcultural Nursing, 3(1), 2.
Philadelphia: Lippincott. Leininger, M. M. (1991d). Transcultural care principles,
Leininger, M. M. (2008). Foreword. Contemporary Nursing human rights, and ethical considerations. Journal of
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Selected Journal Articles Leininger, M. (1992). Transcultural nursing care values, be-
Leininger, M. M. (1984). Qualitative research methods—to liefs, and practices of American (USA) gypsies. Journal
document and discover nursing knowledge. Western of Transcultural Nursing, 4(1), 17–28.
Journal of Nursing Research, 6(2), 151–152. Leininger, M. (1994a). Nursing’s agenda of health reform:
Leininger, M. M. (1987). Importance and uses of ethno- Regressive or advanced—Discipline status. Nursing
methods: Ethnography and ethnonursing research. Science Quarterly, 7(2), 93–94.
Recent Advances in Nursing, 17, 12–36. Leininger, M. (1994b). Reflections: Culturally congruent
Leininger, M. M. (1988a). Leininger’s theory of nursing: care: Visible and invisible. Journal of Transcultural
Cultural care diversity and universality. Nursing Science Nursing, 6(1), 23–25.
Quarterly, 1(4), 152–160. Leininger, M. (1995a). Culture care theory, research, and
Leininger, M. (1988b). Leininger’s theory of nursing: Cultural practice. Nursing Science Quarterly, 9(2), 71–78.
care diversity and universality. Nursing Science Quarterly, Leininger, M. (1995b). Founder’s focus: Nursing theories
1(4), 152–160. and cultures: Fit or misfit. Journal of Transcultural
Leininger, M. M. (1989a). The Journal of Transcultural Nursing, 7(1), 41–42.
Nursing has become a reality. Journal of Transcultural Leininger, M. (1996a). Culture care theory, research and
Nursing, 1(1), 1–2. practice. Nursing Science Quarterly, 9(2), 71–78.
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Leininger, M. (1996b). Founder’s focus: Transcultural Brooke, D., & Omeri, A. (1999). Beliefs about childhood
nurses and consumers tell their stories. Journal of immunization among Lebanese Muslim immigrants
Transcultural Nursing, 7(2), 32–36. in Australia. Journal of Transcultural Nursing, 10(3),
Leininger, M. (1997). Overview of the theory of culture 229–236.
care with the ethnonursing research method. Journal of Clarke, P. N., McFarland, M. R., Andrews, M. A., &
Transcultural Nursing, 8(2), 32–52. Leininger, M. M. (2009). Caring: Some reflections on
Leininger, M. (1999). Transcultural nursing: An imperative the impact of the culture care theory by McFarland
for nursing practice. Imprint, 46(5), 50–52. and Andrews and a conversation with Leininger.
Leininger, M. (2002). Culture care theory: A major contri- Nursing Science Quarterly, 22(3), 233–239.
bution to advance transcultural nursing and practices. Davis, R. (2010). Voices of native Hawaiian Kupuna
Journal of Transcultural Nursing, 13(3), 189–192. (Elders) living with chronic illness: “Knowing who I
Leininger, M. (2007). Theoretical questions and concerns: am.” Journal of Transcultural Nursing, 21(3) 237–245.
Response from the theory of Culture Care Diversity Gunn, J., & Davis, S. (2011) .Beliefs, meanings, and practices
and Universality perspective. Nursing Science Quarterly, of healing with botanicals recalled by elder African
20(1), 9–13. American women in the Mississippi Delta. Online Jour-
Leininger, M. (2011). Leininger’s reflection on the ongoing nal of Cultural Competence in Nursing and Healthcare,
father protective care research. Online Journal of Cul- 1(1), 37–49.
tural Competence in Nursing and Healthcare, 1(2), 1–13. Higgins, B. (2000). Puerto Rican cultural beliefs: Influence
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and problems of adjustment among elderly Filipinas
23
CHAP TER
Margaret A. Newman
1933 to Present
Health as Expanding Consciousness
Janet Witucki Brown and Martha Raile Alligood
“We have to embrace a new vision of health. Our caring must be linked
with a concept of health that encompasses and goes beyond disease. The
theory of health as expanding consciousness provides that perspective”
(Newman, 2008, p. 2).
University, Newman was a Professor at the University of
Credentials and Background Minnesota in Minneapolis until her retirement in 1996,
of the Theorist where she is Professor Emeritus. During her nursing
Margaret A. Newman was born on October 10, 1933, education career, she was Director of Nursing for the
in Memphis, Tennessee. She earned a bachelor’s Clinical Research Center at the University of Tennessee,
degree in home economics and English from Baylor Acting Director of the PhD Program in the Division
University in Waco, Texas, and a second bachelor’s of Nursing at New York University, and Professor-
degree in nursing from the University of Tennessee in in-Charge of the Graduate Program and Research in
Memphis (M. Newman, curriculum vitae, 1996). Her Nursing at Pennsylvania State University (M. Newman,
master’s degree in medical-surgical nursing and teach- curriculum vitae, 2000).
ing is from the University of California, San Francisco. Newman achieved numerous honors, including
She earned her PhD in nursing science and rehabilita- admission to the American Academy of Nursing
tion nursing in 1971 from New York University. in 1976; the Outstanding Alumnus Award from the
After holding academic positions at the University of University of Tennessee College of Nursing in Mem-
Tennessee, New York University, and Pennsylvania State phis in 1975 and 2002; the Distinguished Alumnus
Courtesy New York University, 2009
Previous authors: Snehlata Desai, M. Jan Keffer, DeAnn M. Hensley, Kimberly A. Kilgore-Keever, Jill Vass Langfitt, and LaPhyllis Peterson.
The authors wish to thank Margaret A. Newman for her contributions to the chapter.
442
CHAPTER 23 Margaret A. Newman 443
Award, Division of Nursing, from New York University and discussed conclusions concerning changes neces-
in 1984; admission to the Hall of Fame at the University sary for hospital nursing practice (Newman & Autio,
of Mississippi School of Nursing in 1988; Latin- 1986). From 1986 to 1997, Newman investigated
American teaching fellow in 1976 and 1977; and sequential patterns of persons with heart disease and
American Journal of Nursing scholar in 1979. She was cancer in relation to the theory of health as expanding
Distinguished Faculty at the Seventh International consciousness (Newman, 1995c; Newman & Moch,
Conference on Human Functioning at Wichita, Kansas, 1991). Other publications reflect her passion for inte-
in 1983; received the E. Louise Grant Award for Nursing gration of nursing theory, practice, and research;
Excellence from the University of Minnesota in 1996; is evolving viewpoints on trends in philosophy of nurs-
listed in Who’s Who in American Women, Who’s Who in ing; and analysis of theoretical models of nursing
America,and Who’s Who in American Nursing;and was practice and nursing research (Newman, 1992, 1997b,
included in the Nursing Theorists, Portraits of Excellence, 1999, 2003). During 1989 and 1990, Newman was
vol. 1, 1990 videotape series sponsored by the Helene principal investigator of a project that explored the
Fuld Health Trust (M. Newman, curriculum vitae, theory and structure of a professional model of nurs-
2000; personal communication, 2004). She was a Dis- ing practice at Carondelet St. Mary’s Community
tinguished Resident at Westminster College in Salt Lake Hospitals and Health Centers in Tucson, Arizona
City, Utah, in 1991; received the Distinguished Scholar (Newman, 1990b; Newman, Lamb, & Michaels, 1991).
in Nursing Award at the New York University Division Newman has consulted regarding the expansion
of Nursing in 1992; received the Sigma Theta Tau of her theory of health in more than 40 states and
Founders Elizabeth McWilliams Miller Award for Ex- numerous foreign countries and has served on edito-
cellence in Research in 1993; and received the Nurse rial review panels, including Nursing Research, West-
Scholar Award at Saint Xavier University School of ern Journal of Nursing Research, Nursing and Health
Nursing in 1994 (M. Newman, curriculum vitae, 2000). Care, Advances in Nursing Science, Nursing Science
Newman first presented her ideas on a theory of Quarterly, and the advisory board of Advances in
health in 1978 at a conference on nursing theory in Nursing Science(M. Newman, personal communica-
New York. During this time, she was also pursuing tion, 2004).
research on the relationship of movement, time, and
consciousness and expanding development of her
theory of health as expanding consciousness. In 1985, Theoretical Sources
as a traveling research fellow, Newman conducted The theory, Health as Expanding Consciousness,
workshops in New Zealand and at the University of stems from Rogers’ (1970) science of unitary human
Tampere in Finland, where she was featured at a beings. Rogers’ assumptions regarding wholeness,
weeklong conference on the theory of consciousness pattern, and unidirectionality are foundational to
as it related to nursing (M. Newman, personal com- Newman’s theory (M. Newman, personal communi-
munication, 1988). cation, 2004). Hegel’s fusion of opposites (Acton,
Newman has presented and published papers, 1967) helped Newman conceptualize fusion of health
articles, and book chapters on topics pertaining to her and illness into a new concept of health. Bentov’s
theory of health as expanding consciousness. She (1977) explication of life as the process of expanding
published Theory Development in Nursing(1979), consciousness prompted Newman to assert her new
Health as Expanding Consciousness(1986, 1994), A concept of health as the process of expanding con-
Developing Discipline: Selected Works of Margaret sciousness (M. Newman, personal communication,
Newman(1995a), and Transforming Presence: The Dif- 2004).
ference That Nursing Makes (2008). In 2011, Nursing Bohm’s (1980) theory of implicate order supports
Science Quarterly,volume 24, number 3, recognized Newman’s postulate that disease is a manifestation
Dr. Newman with a special issue honoring her and of the pattern of health. Newman (1994) stated that
her work. she began to comprehend “the underlying, unseen
In 1986, Newman did a case study analysis of prac- pattern that manifests itself in varying forms, in-
tice at three sites within the Minneapolis-St. Paul area cluding disease, and the interconnectedness and
444 UNIT IV Nursing Theories
omnipresence of all that there is” (p. xxvi). Young’s regarding the nature of health (Newman, 1994).
(1976) theory of human evolution pinpointed the Newman incorporated Prigogine’s (1976) theory
role of pattern recognition for Newman. She ex- of dissipative structures as an explanation for the
plained that Young’s ideas provided impetus for her timing of nursing presence as the patient fluctuates
to integrate the basic concepts of her new theory, from one level of organization to a higher level
movement, space, time, and consciousness, into a (M. Newman, personal communication, 2004). Al-
dynamic portrayal of life and health (Newman, though Newman (1997a) acknowledges the contri-
1994). Moss’s (1981) experience of love as the high- butions of these theories to her theory, she states that
est level of consciousness was important to Newman, her theory “was enriched by them, but was not based
providing affirmation and elaboration of her intuition on them” (p. 23).
MAJOR CONCEPTS & DEFINITIONS
Health manifestations of the pattern of a person are the
Health is the “pattern of the whole” of a person and genetic pattern that contains information that
includes disease as a manifestation of the pattern of directs becoming, the voice pattern, and the move-
the whole, based on the premise that life is an ongo- ment pattern (Newman, 1986). Characteristics of
ing process of expanding consciousness (Newman, pattern include movement, diversity, and rhythm.
1986). It is regarded as the evolving pattern of the Pattern is conceptualized as being somehow inti-
person and environment and is viewed as an increas- mately involved in energy exchange and transfor-
ing ability to perceive alternatives and respond in a mation (Newman, 1994). According to Newman
variety of ways (Newman, 1986). Health is “a trans- (1987b), “Whatever manifests itself in a person’s life
formative process to more inclusive consciousness” is the explication of the underlying implicate pat-
(Newman, 2008, p. 16). tern . . . the phenomenon we call health is the man-
Using Hegel’s dialectical fusion of opposites, ifestation of that evolving pattern” (p. 37).
Newman explained conceptually how disease fuses In Health as Expanding Consciousness, Newman
with its opposite, nondisease or absence of disease, (1986, 1994) developed pattern as a major concept
to create a new concept of health that is relational that is used to understand the individual as a
and is “patterned, emergent, unpredictable, unitary, whole being. Newman described a paradigm shift
intuitive, and innovative,” rather than a traditional in the field of health care: the shift from treatment
linear view that is “causal, predictive, dichotomous, of disease symptoms to a search for patterns and
rational, and controlling” (Newman, 1994, p. 13). the meaning of those patterns. Newman (1994)
Health and the evolving pattern of consciousness stated that the patterns of interaction of person-
are the same. The essence of the emerging paradigm environment constitute health. Individual life pat-
of health is recognition of pattern. Newman (1994) terns according to Newman (2008) move “through
sees the life process as progression toward higher peaks and troughs, variations in order-disorder
levels of consciousness. that are meaningful for the person” (p. 6). An
event such as a disease occurrence is part of
Pattern a larger process. By interacting with the event,
Pattern is information that depicts the whole and no matter how destructive the force might be, its
energy augments the person’s energy and enhances
understanding of the meaning of all of the relation- his or her power. One must grasp the pattern of
ships at once (M. Newman, personal communica- the whole to see this (Newman, 1986).
tion, 2004). It is conceptualized as a fundamental
attribute of all there is, and it gives unity in diversity Consciousness
(Newman, 1986). Pattern is what identifies an indi- Consciousness is both the informational capacity of
vidual as a particular person. Examples of explicit the system and the ability of the system to interact
CHAPTER 23 Margaret A. Newman 445
MAJOR CONCEPTS & DEFINITIONS—cont’d
with its environment (Newman, 1994). Newman contrasting concepts become reconciled and fused.
asserts that understanding of her definition of Movement and rest fuse into one” (p. 67). Absolute
consciousness is essential to understanding the the- consciousness is equated with love, where all oppo-
ory. Consciousness includes not only cognitive and sites are reconciled and all experiences are accepted
affective awareness, but also the “interconnected- equally and unconditionally, such as love and hate,
ness of the entire living system which includes pain and pleasure, and disease and non-disease.
physicochemical maintenance and growth processes Reed (1996) concurred with Newman’s theory that
as well as the immune system” (Newman, 1990a, the phase of evolutionary development is when the
p. 38). person moves beyond a focus on self that is limited
In 1978, Newman identified three correlates of by time, space, and physical concerns suggesting
consciousness (time, movement, and space) as man- transcendence as a process through which the per-
ifestations of the pattern of the whole. The life pro- son moves to a high level of consciousness.
cess is seen as a progression toward higher levels of
consciousness. Newman (1979) views the expansion Movement-Space-Time
of consciousness as what life and health is all about, Newman emphasizes the importance of examin-
and the sense of time is an indicator in the changing ing movement-space-time together as dimensions
level of consciousness. of emerging patterns of consciousness rather than
Newman (1986) integrates Bentov’s (1977) defi- as separate concepts of the theory (M. Newman,
nition of absolute consciousness as “a state in which personal communication, 2004).
Use of Empirical Evidence in terms of theory development, it must have three
Evidence for the theory of health as expanding con- components, as follows: (1) having as its purpose
sciousness emanated from Newman’s early personal the testing of theory, (2) making explicit the theo-
family experiences. Her mother’s struggle with amy- retical framework upon which the testing relies, and
otrophic lateral sclerosis and her dependence on (3) reexamining the theoretical underpinnings in
Newman, then a young college graduate, sparked her light of the findings (Newman, 1979). She believed
interest in nursing. From that experience, the idea that if health is considered an individual personal
that “illness reflected the life patterns of the person process, then research should focus on studies that
and that what was needed was the recognition of that explore changes and similarities in personal mean-
pattern and acceptance of it for what it meant to that ing and patterns.
person” (Newman, 1986, p. 3).
Throughout Newman’s writings, terms such as call to
nursing, growing conscience-like feeling, fear, power, Major Assumptions
meaning of life and health, belief of life after death, rituals The foundation for Newman’s assumptions (M. New-
of health, and love are used, providing a clue concerning man, personal communication, 2000) is her definition
Newman’s endeavors to make a disturbing life experi- of health, which is grounded in Rogers’ 1970 model for
ence logical. Her life experience triggered beginning nursing, specifically, the focus on wholeness, pattern,
maturation toward theory development in nursing. and unidirectionality. From this, Newman developed
Within her philosophical framework, Newman began the following assumptions that support her theory to
to develop a synthesis of disease-nondisease-health as this day (Newman, 2008).
recognition of the total patterning of a person. 1. Health encompasses conditions heretofore described
Research has been conducted on the theoretical as illness or, in medical terms pathology . . .
sources (Newman, 1987b). In 1979, Newman wrote 2. These “pathological” conditions can be considered a
that in order for nursing research to have meaning manifestation of the total pattern of the individual . . .
446 UNIT IV Nursing Theories
3. The pattern of the individual that eventually mani- Nurses facilitate pattern recognition in clients by
fests itself as pathology is primary and exists prior forming relationships with them at critical points in
to structural or functional changes . . . their lives and connecting with them in an authentic
4. Removal of the pathology in itself will not change way. The nurse-client relationship is characterized by
the pattern of the individual . . . “a rhythmic coming together and moving apart
5. If becoming “ill” is the only way an individual’s as clients encounter disruption of their organized,
pattern can manifest itself then that is health for predictable state” (Newman, 1999, p. 228). She states
that person . . . that the nurse will continue to connect with clients as
From these assumptions, Newman set forth the they move through periods of disorganization and
thesis: Health is the expansion of consciousness (Newman, unpredictability to arrive at a higher, organized state
personal communication, 2008). (Newman, 1999). The nurse comes together with
Newman’s implicit assumptions about human nature clients at these critical choice points in their lives and
include being unitary, an open system, in continuous participates with them in the process of expanding
interconnectedness with the open system of the uni- consciousness. The relationship is one of rhythmicity
verse, and continuously engaged in an evolving pattern and timing, with the nurse letting go of the need
of the whole (M. Newman, personal communication, to direct the relationship or fix things. As the nurse
2000). She views unfolding consciousness as a process relinquishes the need to manipulate or control, there
that will occur regardless of what actions nurses per- is greater ability to enter into this fluctuating, rhyth-
form. However, nurses assist clients in getting in touch mic partnership with the client (Newman, 1999).
with what is going on and in that way facilitate the pro- Newman has diagrammed this nurse-client interac-
cess (Newman, 1994). tion of coming together and moving apart through
Newman designated “caring in the human health the processes of recognition, insight, and transforma-
experience” (M. Newman, personal communication tion (Figure 23–1) Nurses are seen as partners in the
2004; Newman, Sime, & Corcoran-Perry, 1991, p. 3) as process of expanding consciousness, and are trans-
the focus of nursing and specified this focus as the formed and have their lives enhanced in the dialogical
metaparadigm of the discipline. She asserts the interre- process (Newman, 2008). As facilitator, the nurse
lated concepts of nursing, person, health, and environ- helps an individual, family, or community to focus on
ment as inherent in this focus (M. Newman, personal patterns of relating (M. Newman, personal communi-
communication, 2004). Coming from a unitary, trans- cation, 2004). Thus the nursing process is one of pat-
formative paradigm of the discipline, Newman does not tern recognition.
see these concepts in isolation, and therefore she does Newman’s early suggestion (Newman, 1995b) was
not discuss them separately, but has elaborated on nurs- that the NANDA health assessment framework, which
ing and health. In the following paragraphs, implicit was based on unitary person-environment patterns of
definitions from Newman’s work are used to discuss the interaction, be used to facilitate clients’ pattern recog-
four components. nition (Roy, Rogers, Fitzpatrick, et al., 1982). At the
time, the patterns were intended to guide nurses to
Nursing make holistic observations of “person-environment
Newman emphasizes the primacy of relationships as behaviors that together depict a very specific pattern
a focus of nursing, both nurse-client relationships and of the whole for each person” (Newman, 1995b,
relationships within clients’ lives (Newman, 2008). p. 261). Newman (2008) since has emphasized con-
During dialectic nurse-client relationships, clients get centrating on what is most meaningful to clients in
in touch with the meaning of their lives through iden- their own stories and patterns of relating.
tification of meanings in the process of their evolving Within the theory, the role of the nurse in nurse-
patterns of relating (Newman, 2008). “The emphasis client interactions is seen as a “caring, pattern-
of this process is on knowing/caring through pattern recognizing presence” (Newman, 2008, p. 16). The
recognition” (Newman, 2008, p. 10). Insight into nurse perceives patterns in client’s stories or se-
these patterns provides clients with illumination of quences of events that change with new informa-
action possibilities, which then opens the way for tion. According to Newman (2008), it is important
transformation (Newman, 1990a). for nurses to view clients’ stories comprehensively.
CHAPTER 23 Margaret A. Newman 447
Release of anger/hurt
Meaningful relationships
PATIENT
Place in world
Lack of connections
Searching for place in world
Pulsating as
ONE
Connection
with nurse
Unconditional acceptance
Fully present power of presence
NURSE Reflecting pattern
Experiencing transforming
FIGURE 23-1 Nurse and patient coming together and moving apart in process recognition, insight, and
transformation. (From Newman, M. A. [2008]. Transforming presence: The difference that nursing makes.
Philadelphia: F. A. Davis.)
Through active listening, nurses enter the whole family consciousness and within the pattern of com-
through the parts and intuit the whole from the pat- munity interactions (Newman, 1986). A major as-
tern. Differences are viewed as part of a unified sumption is that “consciousness is coextensive in the
whole. The nurse facilitates client insight through universe and resides in all matter” (Newman, 1986,
sharing the process of pattern recognition, opening p. 33). Client and environment are viewed as a unitary
action possibilities (Newman, 1987b). evolving pattern (Newman, 2008).
Newman identifies interaction between person and
Person environment as a key process that creates unique con-
Throughout Newman’s work, the terms client, patient, figurations for each individual. Patterns of person-
person, individual,and human being are used inter- environment evolve to higher levels of consciousness.
changeably. Clients are viewed as participants in the The assumption is that all matter in the universe-
transformative process. environment possesses consciousness, but at different
Persons as individuals are identified by their indi- levels. Interpretation of Newman’s view clarifies that
vidual patterns of consciousness (Newman, 1986) and health is the interaction pattern of a person with the
defined as “centers of consciousness within an overall environment. Disease in a human energy field is a mani-
pattern of expanding consciousness” (Newman, 1986, festation of a unique pattern of person-environment
p. 31). The definition of persons includes family and interaction.
community (Newman, 1994).
Health
Environment Health is the major concept of Newman’s theory of
Although environment is not explicitly defined, it is expanding consciousness. A fusion of disease and
described as being the larger whole, which contains nondisease creates a synthesis regarded as health
the consciousness of the individual. The pattern of (Newman, 1979, 1991, 1992). Disease and non-disease
person consciousness interacts within the pattern of each reflect the larger whole; therefore, a new concept
448 UNIT IV Nursing Theories
of health, “pattern of the whole,” is formed (Newman, which an individual expresses thoughts and feelings
1986, p. 12). Newman (1999) further elaborated her about the reality of experiences. An individual con-
view of health by stating that “health is the pattern of veys awareness of self through the movement
the whole, and wholeness is” (p. 228). This wholeness involved in language, posture, and body movement
cannot be gained or lost. Becoming ill does not dimin- (Newman, 1979). An indication of the internal orga-
ish wholeness within this perspective, but wholeness nization of a person and of that person’s perception
takes on a different form. Newman (2008) states that of the world can be found in the rhythm and pattern
pattern recognition is the essence of emerging health. of the person’s movement. Movement patterns pro-
“Manifest health, encompassing disease and non- vide additional communication beyond that which
disease, can be regarded as the explication of the un- language can convey (Newman, 1979).
derlying pattern of person-environment” (Newman, The concept of time is seen as a function of move-
1994, p. 11). Therefore, health and evolving pattern of ment (Newman, 1979). This assertion was supported
consciousness are the same; specifically, health is by Newman’s (1972) studies of the experience of time
viewed “as a transformative process to more inclusive as related to movement and gait tempo. Newman’s
consciousness” (Newman, 2008, p. 16). research demonstrated that the slower an individual
walks, the less subjective time is experienced. How-
Theoretical Assertions ever, when compared with clock time, time seems to
“fly.” Although individuals who are moving quickly
Early Designation of Concepts subjectively feel that they are “beating the clock,” they
and Propositions report that time seems to be dragging when checking
Early writings focused heavily on the concepts of a clock (Newman, 1972, 1979).
movement, space, time, and consciousness. In Theory Time is also conceptualized as a measure of con-
Development in Nursing, Newman (1979) delineated sciousness (Newman, 1979). Bentov (1977) measured
the relationships between movement, space, time, and consciousness with a ratio of subjective to objective
consciousness. One proposition was that there was a time and proposed this assertion. Newman applied
complimentary relationship between time and space this measure of consciousness to subjective and objec-
(Newman, 1979, 1983). Examples of this relationship tive data from her research. She found that the con-
were given at the macrocosmic, microcosmic, and sciousness index increased with age. Some of her
humanistic (everyday) levels. At the humanistic level, research has also supported the finding of “increasing
highly mobile individuals live in a world of expanded consciousness with age” (Newman, 1982, p. 293).
space and compartmentalized time. There is an in- Newman cited this evidence as support for her posi-
verse relationship between space and time in that tion that the life process evolves toward consciousness
when a person’s life space is decreased, such as by expansion. However, she asserted that certain moods,
physical or social immobility, then that person’s time such as depression, might be accompanied by a dimin-
is increased (Newman, 1979). ished sense of time (Newman & Gaudiano, 1984).
Movement is a “means whereby space and time
become a reality” (Newman, 1983, p. 165). Human- Synthesis of Patterns of Movement,
kind is in a constant state of motion and is constantly Space-Time, and Consciousness
changing internally (at the cellular level) and exter- As the theory evolved, Newman developed a synthesis
nally (through body movement and interaction with of the pattern of movement, space, time, and con-
the environment). This movement through time and sciousness (M. Newman, personal communication,
space is what gives humankind a unique perception 2004, 2008). Time was not merely conceptualized as
of reality. Movement brings change and enables the subjective or objective, but was also viewed in a holo-
individual to experience the world (Newman, 1979). graphic sense (M. Newman, personal communication,
Movement was also referred to as a “reflection of 2000). According to Newman (1994), “Each moment
consciousness” (Newman, 1983, p. 165). It is the has an explicate order and also enfolds all others,
means of experiencing reality and also the means by meaning that each moment of our lives contains all
CHAPTER 23 Margaret A. Newman 449
others of all time” (p. 62). Newman (1986) illustrated In Health as Expanding Consciousness (Newman,
the centrality of space-time in the following example: 1986, 1994), Newman’s theory encompassed the work
of Young’s spectrum of consciousness (Young, 1976).
Mrs. V. made repeated attempts to move away She saw Young’s central theme as one in which self
from her husband and to move into an educa- and universe were of the same nature. This essential
tional program to become more independent. She nature could not be defined but was characterized by
felt she had no space for herself, and she tried to complete freedom and unrestricted choice at both the
distance herself (space) from her husband. She beginning and the end of life’s trajectory (Newman,
felt she had no time for leisure (self), was over- 1986).
worked, and was constantly meeting other peo- Newman established a corollary between her
ple’s needs. She was submissive to the demands model of health as expanding consciousness and
and criticism of her husband (p. 56).
Young’s conception of the evolution of human beings
Space, time, and movement later became linked (Figure 23–2). She explained that individuals came
with Newman’s (1986) assertion that the intersection into being from a state of consciousness, and that they
of movement-space-time represented the person as a were bound in time, found their identity in space,
center of consciousness. Further, this varied from and, through movement, learned the “law” of the way
person to person, place to place, and time to time. that things worked; they then made choices that ulti-
Newman (1986) also emphasized that the crucial task mately took them beyond space and time to a state of
of nursing is to be able to see the concepts of move- absolute consciousness (Newman, 1994).
ment-space-time in relation to each other, and con- Newman (1994) also stated that restrictions in
sider them all at once, recognizing patterns of evolving movement-space-time have the effect of forcing an
consciousness. awareness that extends beyond the physical self.
Ground of
CONSCIOUSNESS
(Potential freedom) (Real freedom)
TIME TIMELESSNESS
(Binding) (Unbinding)
SPACE BOUNDARYLESSNESS
(Centering) (Decentering)
MOVEMENT
(Choice)
FIGURE 23-2 Parallel between Newman’s theory of expanding consciousness and Young’s stages
of human evolution. (From Newman, M. A. [1990]. Newman’s theory of health as praxis. Nursing Science
Quarterly, 3[1], 37–41.)
450 UNIT IV Nursing Theories
When natural movement is altered, space and time are
also altered. When movement is restricted (physical or Logical Form
social), it is necessary for an individual to move beyond Newman used both inductive and deductive logic in
self, thereby making movement an important choice early theory development. Inductive logic is based on
point in the process of evolving human consciousness observing particular instances and then relating those
(Newman, 1994). She assumed that the awareness cor- instances to form a whole. Newman’s theory develop-
responded to the “inward, self-generated reformation ment derived from her earlier research on time per-
that Young [spoke] of as the turning point of the ception and gait tempo. Time and movement, with
process” (Newman, 1994, p. 46). When a person pro- space and consciousness, were subsequently used as
gresses to the state of timelessness, there is increasing central components in her early conceptual frame-
freedom from time. Finally, the last stage is absolute work. These concepts helped explain “the phenomena
consciousness, which Newman asserted is equated of the life process and therefore of health” (Newman,
with love (Newman, 1994). 1979, p. 59). Newman (1997a) describes the evolution
of the theory as it moved from linear explication and
Emphasis on the Experiential Process testing of concepts of time, space, and movement to
of Nurse-Client an elaboration of interacting patterns as manifesta-
With the realization that the early research testing of tions of expanding consciousness. Evolution of the
propositional statements stemmed from a mechanis- theory of health as expanding consciousness as a process
tic view of movement-space-time consciousness and of evolving in conjunction with research progressed
failed to honor the basic assumptions of her theory, through several stages (Newman, 1997a, 1997b).
Newman shifted focus to authentic involvement of These stages included testing the relationships of the
the nurse researcher as a participant with the client in concepts of movement, space, and time; identifying
the unfolding pattern of expanding consciousness sequential person-environmental patterns; and rec-
(Newman, 2008). The unitary, transformative para- ognizing the centrality of nurse-client relationships
digm demanded that the research honor and reveal or dialogue in the clients’ evolving insight and
the mutuality of interaction between nurse and client, accompanying potential for action. The process
the uniqueness and wholeness of pattern in each actually became cyclical as the original concepts of
client situation, and movement of the life process movement-space-time emerged as dimensions in the
toward higher consciousness. Newman (2008) states, unitary evolving process of consciousness (Newman,
“The nature of nursing practice is the caring, pattern- 1997a).
recognizing relationship between nurse and client—a
relationship that is a transforming presence” (p. 52). Acceptance by the Nursing Community
The protocol for this research was first started
in 1994, and variations of this guide continue to be Practice
implemented in current praxis research. Litchfield Newman believes that research within the theory of
(1999) explicated this process as “practice wisdom” in health as expanding conscious is praxis, which she
her work with families of hospitalized children, and defines as a “mutual process between nurse and client
Endo (1998) analyzed the phases of the process in her with the intent to help” (Newman, 2008, p. 21). Fur-
work with women with ovarian cancer. The data ther, this process focuses “on transformation from
of this praxis research reveal evidence of expanding one point to another and incorporates the guidance of
consciousness in the quality and connectedness of the an a priori theory” (Newman, 2008, p. 21). Research
client’s relationships and support the importance of and practice with the theory are interwoven.
the nurse’s creative presence in participants’ insight In Newman’s view, the responsibility of profes-
(M. Newman, personal communication, 2004, 2008). sional nurses is to establish a primary relationship
Variations of the praxis research have been utilized in with the client for the purpose of identifying mean-
numerous populations and settings (Newman, 2008; ingful patterns and facilitating the client’s action po-
Picard & Jones, 2007). tential and decision-making ability (Newman, 2008).
CHAPTER 23 Margaret A. Newman 451
Communication and collaboration with other nurses, (Jonsdottir, 1998; Noveletsky-Rosenthal, 1996); life
associates, and health care professionals are essential patterns of people with hepatitis C (Thomas, 2002); and
(Newman, 1989). Nurses as primary care providers patterns of expanding consciousness in persons with
who are focused completely on relationships with HIV and AIDS (Lamendola & Newman, 1994).
clients can relate well to her view of the role of profes- Litchfield (1999) described the patterning of nurse-
sional nursing, which Newman (Newman, Lamb, & client relationships in families with frequent illness
Michaels, 1991) refers to as nursing clinician-case and hospitalization of toddlers, and its use in family
manager, which is the sine qua non of the integrative health. Magan, Gibbon, and Mrozek (1990) reported
model. on implementation of the theory, as one of several
Relating her theory of health as expanding con- theories, in the care of the mentally ill. Weingourt
sciousness and acknowledging the contemporary and (1998) reported on the use of Newman’s theory
radical shift in philosophy of nursing that views health of health with elderly nursing home residents, and
as a unitary human field dynamic embedded in a Capasso (2005) reported increased emotional and
larger unitary field, Newman (1979) believes that “the physical client healing as a result of use of the theory
goal of nursing is not to make people well, or to pre- in nurse-client interactions.
vent their getting sick, but to assist people to utilize the Additional research includes studies that involved
power that is within them as they evolve toward recognizing health patterns in persons with multiple
higher levels of consciousness” (p. 67). The task of sclerosis (Gulick & Bugg, 1992; Neill, 2005) and
nursing is not to try to change the pattern of a person, spousal caregivers of partners with dementia (Brown
but to recognize it as information that depicts the & Alligood, 2004; Brown, Chen, Mitchell, et al.,
whole and relate to it as it unfolds (Newman, 1994). 2007; Schmitt, 1991), as well as patterns in adoles-
From the Newman perspective, nursing is the study cent males incarcerated for murder (Pharris, 2002)
of “caring in the human health experience” (Newman, and life experiences of Black Caribbean women
Lamb, & Michaels, 1991, p. 3). The role of the nurse in (Peters-Lewis, 2006). Additional studies have in-
this experience is to help clients recognize their pat- cluded life patterns of women who successfully lose
terns, which results in the illumination of action pos- weight and maintain weight loss (Berry, 2002); vic-
sibilities that open the way for transformation. timizing sexuality and healing patterns (Smith,
The theory has been used in practice with various 1997); meaning of the death of an adult child to an
client populations. Kalb (1990) applied Newman’s the- elder (Weed, 2004); experience of family members
ory of health in the clinical management of pregnant living through the sudden death of a child (Picard,
women hospitalized for complications of maternal-fetal 2002); nurse facilitation of health as expanding con-
health. Smith (1995) worked with the health of rural sciousness in families of children with special health
African-American women. Yamashita (1995, 1999) care needs (Falkenstern, 2003); and health as ex-
studied Japanese and Canadian family caregivers, and panding consciousness to conceptualize adaptation
Rosa (2006) worked with persons living with chronic in burn patients (Casper, 1999).
skin wounds. Several studies have focused on patterns Newman’s research as praxis has also been used to
of persons with rheumatoid arthritis (Brauer, 2001; describe the lived experience of life passing in middle-
Neill, 2002; Schmidt, Brauer, & Peden-McAlpine, 2003). adolescent females (Shanahan, 1993); patterns of
Research studies have focused on patterns of patients expanding consciousness in women in midlife (Picard,
with cancer as a meaningful part of health (Barron, 2000) and women transitioning through menopause
2005; Bruce-Barrett, 1998; Endo, 1998; Endo, Nitta, (Musker, 2005); pattern recognition of high-risk preg-
Inayoshi, et al., 2000; Gross, 1995; Karian, Jankowski, & nant women (Schroeder, 1993) and low-risk pregnant
Beal, 1998; Kiser-Larson, 2002; Moch, 1990; Newman, women (Batty, 1999); and patterns in families of med-
1995c; Roux, Bush, & Dingley, 2001; Utley, 1999). Other ically fragile children (Tommet, 2003). It was the
studies include life patterns of persons with coronary framework for analysis of patterns for evidence of
heart disease (Newman & Moch, 1991); patterns of empowerment in community health care workers by
persons with chronic obstructive pulmonary disease Walls (1999).
452 UNIT IV Nursing Theories
Quinn (1992) reconceptualized therapeutic touch that nursing is at the intersection of the focus of the
as shared consciousness. Lamb and Stempel (1994) health care industry; therefore, “nursing is in position
described the role of the nurse as an insider-expert. to bring about the fluctuation within the system that
Newman, Lamb, and Michaels (1991) described the will shift the system to a new higher order of func-
role of the nurse case manager at St. Mary’s as ema- tioning” (p. 90). Newman (2008) proposes that,
nating from a philosophical and theoretical base “attention to the nature of transformative learning
agreeing with the unitary-transformative paradigm will help to establish the priorities of the discipline”
and exemplifying an integrated stage of professional (p. 73). As students and teachers directly engage in
nursing. Further, the theory of health as expanding intuitive awareness, they resonate with each other in
consciousness has been proposed as beneficial for the a transforming way (Endo, Takaki, Abe, et al., 2007).
school nurse working with adolescents with insulin- However, as the paradigm shift has taken place
dependent diabetes (Schlotzhauer & Farnham, 1997). in nurses’ views of their relationships with clients,
Gustafson (1990) found that practice as a parish examples of application of the theory in traditional
nurse supported Newman’s theory of health as dem- roles are evident (Newman, personal communication,
onstration of pattern recognition. More recently, 2008).
Endo and colleagues (2005) conducted action re- Examining the pragmatic adequacy of Newman’s
search involving practicing nurses and found that theory in relation to nursing education reveals that
nurses experienced deeper meaning in their lives as a teaching the research method associated with the the-
result of the transformative power of pattern recog- ory also teaches students a practice method that is
nition in their work with clients. Flanagan (2005) congruent with the theory, and it is a means for students
found that preoperative nurses working within the to experience transformation through pattern recogni-
theory saw the effect of their presence in changing tion (Newman, 2008). Newman sees theory, practice,
patient experiences. Ruka (2005) developed a model and research as a process rather than as separate
of nursing home practice for use in pattern recogni- domains of the nursing discipline. Teaching the theory
tion with persons with dementia. Pierre-Louis and of health as expanding consciousness necessitates a shift
colleagues (2011) studied patterns in the lives of in thinking from a dichotomous view of health to a
African-American women with diabetes within synthesized view that accepts disease as a manifestation
health as expanding consciousness, and MacLeod of health. Not only that, learning to let go of the profes-
(2011) studied experiences of spousal caregivers. sional’s control and respecting the client’s choices
Ness (2009) studies pain expression in perioperative are integral parts of practice within this framework.
Somali women. Dyess (2011) focused on the concept Students and practicing nurses who plan to use
of faith in the context of health as expanding con- Newman’s theory face personal transformation in learn-
sciousness. Haney and Tufts (2012) used health as ing to recognize patterns through nurse-client interac-
expanding consciousness to frame a home health care tions. An individual’s personal experience will be the
study of electronic communication for parental well- core not just of teaching and practice, but of research
being and satisfaction in medically fragile children. as well. Newman (1994) explained that the nurse needs
to sense his or her own pattern of relating as an indica-
Education tion of the nurse-client interacting pattern. She empha-
Newman (1986) stated that ideally, a new role is sized that there needs to be a sense of the process of the
needed for the nurse in the paradigm of the evolving relationship with clients from within, giving attention to
consciousness of the whole. “Nurses need to be free to the “we” in the nurse-client relationship (Newman,
relate to patients in an ongoing partnership that is not 1997b).
limited to a particular place or time” (Newman, 1986, Newman’s theory has been used in nursing educa-
p. 89). She suggested that nursing education revolve tion to provide some content into a model called the
around pattern as a concept, substance, process, and healing web. This model was designed to integrate
method. Education by this method would enable nursing education and nursing service together with
nursing to be an important resource for the continued private and public education programs for baccalau-
development of health care. Newman (1986) stated reate and associate nursing degree programs in South
CHAPTER 23 Margaret A. Newman 453
Dakota (Bunkers, Bendtro, Holmes, et al., 1992). With evolution of the theory, the praxis research
Jacono and Jacono (1996) suggested that student cre- incorporated practice and assisted clients in pattern
ativity could be enhanced if nursing faculty applied recognition (Newman, 1990a). Schorr, Farnham,
the theory recognizing that all experience has the and Ervin (1991) investigated the health patterns in
potential for expanding the creativity (consciousness) 60 aging women, using the theory as a framework. A
of individuals. Picard and Mariolis (2002, 2005) study of music and pattern change in chronic pain
described the application of the health as expanding by Schorr (1993) also supported Newman’s theory of
consciousness theory to teaching psychiatric nursing. health as expanding consciousness. Fryback’s (1991)
Endo and colleagues (2007) describe faculty becom- dissertation revealed that persons with acquired
ing involved with students in a project of pattern immunodeficiency syndrome (AIDS) and human
recognition that resulted in transformation of student immunodeficiency virus (HIV) infection did, in fact,
relationships. Clarke and Jones (2011) discuss describe health within physical, health promotion,
expanding consciousness theory in nursing education and spiritual domains consistent with Newman’s
and practice. theory.
Newman observed that her research not only
Research assisted clients who participated, but she and fellow
At first, Newman’s theory of health was useful in the researchers also gained a better understanding of self
practice of nursing because it contained the concepts as a nurse researcher and insight of the limitations of
of movement and time that are used by the nursing methods in earlier studies. Newman (1994) stated
profession and intrinsic to nursing interventions such that research should center on investigations that are
as range of motion and ambulation (Newman, 1987a). participatory in which client-subjects are partners
Early research with the theory manipulated concepts and co-researchers in the search for health patterns.
of space, time, and movement. Besides Newman, sev- This method of inquiry is called cooperative inquiry or
eral researchers conducted research about time, space, interactive, integrative participation. Newman (1989,
or movement. Newman and Gaudiano (1984) fo- 1990a) developed a method to describe patterns as
cused on the occurrence of depression in older adults unfolding and evolving over time. She used the
and decreased subjective time. Mentzer and Schorr method of interviewing a subject regarding different
(1986) used Newman’s model of duration of time as time frames to establish a pattern for that subject
an index to consciousness in a study of institutional- (Newman, 1987b). Newman (1990a) stated that dur-
ized older adults. Engle (1986) addressed the relation- ing the development of a methodology to test the
ship between movement, time, and assessment of theory of health, “sharing our (researcher’s) percep-
health. Schorr and Schroeder (1989) studied differ- tion of the person’s pattern with the person was
ences in consciousness with regard to time and move- meaningful to the participants and stimulated new
ment, and in another study found that relationships insights regarding their lives” (p. 37). In 1994, she
among type A behavior, temporal orientation, and described a protocol for the research and labeled
death anxiety as manifestations of consciousness had it hermeneutic dialectic. This method allows the pat-
mixed results (Schorr & Schroeder, 1991). During the tern of person-environment to reveal itself without
1980s, Marchione, using health as expanding con- disturbing the unity of the pattern (M. Newman, per-
sciousness, investigated and reported the meaning sonal communication, 2000). From the inception
of disabling events in families, presenting a case study of Newman’s theory in the 1970s until the present,
in which an additional person became part of the numerous nurse practitioners and scientists have
nuclear family. The addition was a disruptive event used the theory to incorporate the concepts into their
for the family and created disturbances in time, nursing practice or to elaborate the theory through
space, movement, and consciousness, suggesting that research. Newman advocates convergence of nursing
Newman’s work with patterns could be used to under- theories as the basis of the discipline (Newman,
stand family interactions (Marchione, 1986). Marchione 2003). She sees health as expanding consciousness as
(1986) and Pharris (2005) both advocate application of emerging from a Rogerian perspective, incorporating
the theory to practice with communities. theories of caring, and projecting a transformative
454 UNIT IV Nursing Theories
process (Newman, 2005). Future researchers will mode. However, quantitative methods are inadequate
be greatly assisted by Smith’s (2011) comprehensive to capture the dynamic, changing nature of this the-
review of the theory of health as expanding con- ory. A hermeneutic dialectic approach was developed
sciousness research literature. and has been used extensively for full explication of
its meaning and application.
Further Development Importance
Previously discussed research studies have supported The focus of Newman’s theory of health as expanding
the theory of health as expanding consciousness, consciousness provides an evolving guide for all
illuminating the importance of pattern recognition in health-related disciplines. In the quest for under-
the process of expanding consciousness. The theory standing the phenomenon of health, this unique view
has been used extensively in exploring and under- of health challenges nurses to make a difference in
standing the experience of health within illness, sup- nursing practice by the application of this theory. The
porting a basic premise of the theory, that disruptive volume and breadth of literature cited in this chapter
situations provide a catalytic effect and facilitate is evidence that Newman’s theory has stood the test of
movement to higher levels of consciousness. time with global importance.
Critique Summary
Clarity Although Newman started with a rational, empirical
Semantic clarity is evident in the definitions, de- approach that was both inductive and deductive, she
scriptions, and dimensions of the concepts of the found it restrictive and “not consistent with the para-
theory. digm from which the theory was drawn” (1997a,
p. 23). Little by little, she relinquished some of the
Simplicity experimental control, and her work evolved to a more
The deeper meaning of the theory of health as expand- interactive, integrative approach that continued to be
ing consciousness is complex. The theory as a whole objective and controlled. When that still did not
must be understood rather than isolating the concepts. work, she shifted from the scientific paradigm with its
As Newman advocated in the 1994 edition of her book, objectivity and control and allowed the principles of
Health As Expanding Consciousness, the holistic ap- her theoretical paradigm to guide her research. Then
proach of the hermeneutic dialectic method is consistent she began to see the core of pattern and process
with the theory and requires a high level of understand- as nursing practice. She saw the evolving pattern
ing of the theory on the part of the researcher to extend as meaning in process that required an approach
the theory in praxis research (M. Newman, personal of mutual process, not just objective observation.
communication, 1996). Patterns showed that expanding consciousness was
related to quality and connectedness of relationships.
Generality The nurse researcher’s creative presence was impor-
The concepts in Newman’s theory are broad in scope tant to the participant’s insight. Newman (1986) con-
because they all relate to health. The theory has been cluded that individuals experience a theory in living
applied in many cultures and is applicable across the it. She labeled her research as hermeneutic dialectic.
spectrum of nursing care situations (M. Newman, The theory of health as expanding consciousness,
personal communication, 2004). Application of the along with the research as praxis method, has been
theory is universal in nature. The broad scope pro- used extensively in nursing practice with a variety
vides a focus for middle-range theory development. of individuals, family and community situations,
nursing education, and practice models and nursing
Accessibility research in the United States and many other coun-
In the early stages of development, aspects of the tries. Newman continues to write, consult, and lec-
theory were tested with the traditional scientific ture, advancing her work.
CHAPTER 23 Margaret A. Newman 455
CASE STUDY two sisters and their sole daughter. They were
very self-sufficient, grew large gardens, had their
Alice is an 81-year-old widow who has lived alone own livestock, and rarely went into town. All
in a low-income apartment complex in a small these family members are now deceased except
rural, Appalachian town since her husband’s death the granddaughter, who insisted that Alice leave
8 years ago. She has one surviving family member, the cabin and move into town after the death
a granddaughter, who lives 30 miles away. Alice of her husband. It is apparent that Alice’s past
has never learned to drive and depends on her patterns have been those of independence and
granddaughter for all transportation to physician limiting social contact to mainly family members.
appointments and for shopping and getting medi- The nurse shares her perceptions with Alice,
cations. Her income is $824 monthly, and she who confirms and verifies the pattern identifica-
requires several expensive prescriptions for arthri- tion. Alice states, “I just don’t know how long I am
tis, hypertension, and cardiac problems. She has going to manage by myself anymore.” The nurse
osteoarthritis in her knees and requires a quad helps her explore sources of help, besides the
cane for support and safety when getting around granddaughter, that will help Alice remain in her
her apartment. A visiting nurse stops by weekly apartment as independently as possible. Alice
to check her blood pressure and to give her an relates that there is one man, a few doors away
injection for her arthritis. The visiting nurse notes who has stopped several times to ask if she needed
that Alice’s blood pressure is elevated, and Alice anything from the grocery store, but she hasn’t
states that she has been unable to get her medica- asked him because she hates to bother him and
tion because her granddaughter’s car is broken. doesn’t want “to be beholden.” After further dis-
Alice mentions that she is low on food in the cussion, she decides that she will ask him to pick
apartment because she can’t get out to shop. up staples and medications for her and will pay
Alice admits that she hardly knows or speaks him back by baking him some bread, saying,
to her neighbors despite having lived there for “I just love to bake anyway and haven’t had anyone
8 years, and she still feels like a stranger and much to bake for.”
doesn’t want to “push myself in.” She says that she In subsequent weekly visits, Alice and the
hates to bother people and “won’t hardly unless nurse explore the possibility of getting medica-
I just have to.” She says she sometimes gets lonely tions at a reduced price through the local nurse-
for “her people,” who are all deceased. managed clinic. Alice states that she might try
The visiting nurse, in working with Alice, rec- getting to know some of her neighbors. The nurse
ognizes the current situation as a choice point, helps Alice make arrangements to be picked up
with potential for increased interaction with oth- by the Senior Van for physician appointments. As
ers and increased consciousness. The old ways no Alice begins to build her own support system,
longer work for Alice, and new ways of relating she finds that she relies on the nurse less for help
are necessary. The nurse incorporates the ele- with maintaining her independence, and they
ments of Newman’s method to assist Alice in pat- resume their previous pattern of the nurse check-
tern recognition for the purpose of discovering ing her blood pressure and giving her injections
new potentials for action. As the nurse has Alice weekly. However, Alice and the nurse have now
relate her story, through dialogue and interacting developed a relationship that has transformed
with Alice, she helps Alice recognize past patterns them both, and the nurse is often met at the door
of relating and how present circumstances have with the smell of fresh-baked bread and an invi-
changed those patterns. Alice talks about how she tation to “have a bite.” They both enjoy this new
and her husband lived for 56 years in a rural relationship.
mountain cabin with few neighbors except for
456 UNIT IV Nursing Theories
CRITICAL THINKING ACTIVITIES
1. What is the nurse scientist view of nursing with 5. Consider a patient you have cared for in the past,
health as expanding consciousness? and describe how health as expanding conscious-
2. How does this view direct knowledge development ness (pattern of the whole) might have changed
for nursing? what you did with that patient.
3. What changed Newman’s view of health, health
care practice, and nursing practice?
4. Describe your own view of health, health care
practice, and nursing practice, and compare your
views with those of Newman.
POINTS FOR FURTHER STUDY
n http://www.healthasexpandingconsciousness.org Available through: Fitne, Inc, 5 Depot Street,
n Brown, J. W. (2010). Newman’s theory of health Athens, OH 45701, (800) 691–8480.
and nursing practice. In M. R. Alligood (Ed.), n Newman, M. A. (2008). Transforming presence:
Nursing theory: Utilization & application The difference that nursing makes. Philadelphia:
(4 ed., pp. 457–478). Maryland Heights, F.A. Davis.
th
MO: Mosby-Elsevier. n Smith, M.C. (2011). Integrative Review of Research
n Margaret Newman, nurse theorists: Portraits of Related to Margaret Newman’s Theory of Health
excellence (Videotape). (1990). Helene Fuld as Expanding Consciousness. Nursing Science
Health Trust. Oakland, (CA): Studio Three Quarterly, 24(3), pp. 256–263.
Production. Athens, OH: Fitne, Inc.
n Newman, M. A. (1997). Margaret Newman:
Health as expanding consciousness (CD-ROM).
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Jacono, B. J., & Jacono, J. J. (1996). The benefits of Newman Newman, M. A. (1972). Time estimation in relation to gait
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time: Exertion and perceived duration. Nursing Science Newman’s theory of health as expanding consciousness:
Quarterly, 4(3), 104–112. A personal journey. International Journal for Human
Smith, C. A. (1995). The lived experience of staying Caring, 6(2), 48–54.
healthy in rural African American families. Nursing Nelson, M. L., Howell, J. K., Larson, J. C., & Karpiuk, K. L.
Science Quarterly, 8(1), 17–21. (2001). Student outcomes of the healing web: Evalua-
Smith, S. K. (1997). Women’s experiences of victimizing tion of a transformative model for nursing education.
socialization. Part I: Responses related to abuse and Journal of Nursing Education, 40, 404–413.
home and family environment. Issues in Mental Health Newman, M. A. (1981). The meaning of health. In G. E.
Nursing, 18, 395–416. Laskar (Ed.), Applied systems research and cybernetics:
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medically fragile. Nursing Science Quarterly, 16(3), Newman, M. A. (1987). Nursing’s emerging paradigm:
239–246. The diagnosis of pattern. In A. M. McLane (Ed.),
Utley, R. (1999). The evolving meaning of cancer for long- Classification of nursing diagnoses. Proceedings of
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Weingourt, R. (1998). Using Margaret A. Newman’s theory of Newman, M. A. (1993). Prevailing paradigms in nursing.
health with elderly nursing home residents. Perspectives in Nursing Outlook, 40(1), 10–14.
Psychiatric Care, 34(3), 25–30. Newman, M. A. (1996). Prevailing paradigms in nursing.
Yamashita, M. (1999). Newman’s theory of health applied to In J. W. Kenney (Ed.), Philosophical and theoretical per-
family caregiving in Canada. Nursing Science Quarterly, spectives for advanced nursing practice (pp. 302–307).
12(1), 73–79. Sudbury, (MA): Jones & Bartlett.
Newman, M. A. (1996). Theory of the nurse-client part-
Additional Suggested Readings nership. In E. Cohen (Ed.), Nurse case management in
Alligood, M. R. (2011). Nursing theory–guided research. the 21st century (pp. 119–123). St. Louis: Mosby.
Nursing Science Quarterly, 24(3),195–196. Newman, M. A. (1997). A dialogue with Martha Rogers
Brown, J. W. (2010). Newman’s theory of health in nursing and David Bohm about the science of unitary human
practice. In M. R. Alligood (Ed.), Nursing theory: Utili- beings. In M. Madrid (Ed.), Patterns of Rogerian know-
zation & application (4th ed., pp.457–478). Maryland ing (pp. 3–10). New York: National League for Nursing.
Heights, (MO): Mosby-Elsevier. Newman, M. A. (2003). The immediate applicability of
Dean, P. J. (2002). Aesthetic expression. A poem dedicated nursing praxis. Quality Nursing: The Japanese Journal of
to the nursing theories of Martha Rogers and Margaret Nursing Education and Nursing Research, 9(5), 4–6.
Newman. International Journal for Human Caring, 6, 70. Yamashita, M. (1997). Family caregiving: Application of
Ford-Gilboe, M. V. (1994). A comparison of two nursing Newman’s and Peplau’s theories. Journal of Psychiatric
models: Allen’s developmental health model and and Mental Health Nursing, 4, 401–405.
Newman’s theory of health as expanding conscious- Yamashita, M. (1998). Family coping with mental illness:
ness. Nursing Science Quarterly, 7(3), 113–118. A comparative study. Journal of Psychiatric and Mental
Jonsdottir, H., Litchfield, M., & Pharris, M. D. (2003). Health Nursing, 5, 515–523.
Partnership in practice. Research and Theory for Yamashita, M. (1998). Newman’s theory of health as ex-
Nursing Practice, 17, 51–63. panding consciousness: Research on family caregiving
Marchione, J. (1993). Margaret Newman: Health as expand- in mental illness in Japan. Nursing Science Quarterly,
ing consciousness. Newbury Park, (CA): Sage. 11(3), 110–115.
24
CHAP TER
Rosemarie Rizzo Parse
Humanbecoming
Debra A. Bournes and Gail J. Mitchell
“The assumptions and principles of humanbecoming incarnate
a deep concern for the delicate sentiments of being human and
show a profound recognition of human freedom and dignity”
(Parse, 2007b, p. 310).
New York University College of Nursing, and she is
Credentials and Background currently adjunct professor. Dr. Parse is founder and cur-
of the Theorist rent editor of Nursing Science Quarterly, and President of
Rosemarie Rizzo Parse is a graduate of Duquesne Discovery International. She founded the Institute of
University in Pittsburgh and received her master’s and Humanbecoming, where she teaches the ontological,
doctorate degrees from the University of Pittsburgh. epistemological, and methodological underpinnings of
She was a faculty member of the University of Pittsburgh, the humanbecoming school of thought (Parse, 1981,
Dean of the Nursing School at Duquesne University, 1998, 2005, 2007b, 2010, 2011b, 2012b).
(1977 to 1982), Professor and Coordinator of the Center Dr. Parse is a Fellow in the American Academy
for Nursing Research at Hunter College of the City of Nursing, where she initiated and chaired the nurs-
University of New York (1983 to 1993), Professor and ing theory–guided practice expert panel. As editor
Niehoff Chair at Loyola University Chicago (1993 to of Nursing Science Quarterly, she spearheaded a
2006), and Distinguished Professor Emeritus at Loyola well-known, highly cited venue for nurse scholars
University Chicago (2006 to present). In January 2007, to share and debate matters important to nursing
she became a Consultant and Visiting Scholar at research and theory development. For this and other
Photo copyright 1998 by Jonas, Pittsburgh, PA.
The authors wish to thank Dr. Rosemarie Rizzo Parse for reviewing this chapter.
464
CHAPTER 24 Rosemarie Rizzo Parse 465
works, Dr. Parse has received several honors. She has laughing, joy-sorrow, feeling respected, contentment,
received two Lifetime Achievement Awards (one feeling very tired, and quality of life for persons with
from the Midwest Nursing Research Society and one Alzheimer’s disease); and taught theory and research
from the Asian American Pacific Islander Nurses™ courses in institutions of higher learning, for example,
Association), the Rosemarie Rizzo Parse Scholarship Loyola University Chicago, University of Cincinnati,
was endowed in her name at the Henderson State University of Dayton, University of South Carolina, and
University School of Nursing, her books were twice others.
named “best picks” by Sigma Theta Tau International, Parse is an articulate, courageous, and vibrant leader
and the Society of Rogerian Scholars honored her with with a strong vision and deliberate determination to
the Martha E. Rogers Golden Slinky Award. In 2008, advance the discipline of nursing. She is well-known
she received the New York Times Nurse Educator of internationally for her humanbecoming school of
the Year Award, and in 2012 she received the Medal of thought—a nursing perspective focused on quality of
Honor at the University of Lisbon in Portugal. life and human dignity from the perspective of patients,
Throughout her career, Dr. Parse has made out- families, and communities. She is an inspirational men-
standing contributions to the discipline and profession tor whose diligent loving presence, consistent and will-
of nursing through progressive leadership in nursing ing availability, and respectful and gentle urgings have
knowledge development, research, education, and prac- helped many seasoned and budding nurse scholars to
tice. She has explored the ethics of human dignity, pursue their dreams. Those who have had the honor of
set forth humanbecoming tenets of human dignity working with her as students and colleagues are hon-
(Parse, 2010), and developed teaching-learning (Parse, ored to have been mentored by this truly outstanding
2004), mentoring (Parse, 2008b), leading-following nurse leader (Bournes, 2007; Cody, 2012).
(Parse, 2008a, 2011a), community (Parse, 2003, 2012b),
and family (Parse, 2009a) models that are used world-
wide. She has published 9 books (Morrow, 2012b; Parse, Theoretical Sources
1974, 1981, 1985, 1987, 1995, 1998, 1999a, 2001b, 2003) The humanbecoming school of thought is grounded
and more than 150 articles and editorials about matters in human science proposed by Dilthey and others
pertinent to nursing and other health-related disci- (Cody & Mitchell, 2002; Mitchell & Cody, 1992;
plines. Dr. Parse has shared her knowledge in over 300 Parse, 1981, 1987, 1996, 1998, 2007b, 2010, 2012b).
local, national, and international presentations and The humanbecoming school of thought is “consistent
workshops in more than 35 countries on 5 continents. with Martha E. Rogers’ principles and postulates
Her works have been translated into many languages, about unitary human beings, and it is consistent
and she consults throughout the world with nursing with major tenets and concepts from existential-
education programs and health care settings that phenomenological thought, but it is a new product, a
are utilizing her work to guide research, practice, lead- different conceptual system” (Parse, 1998, p. 4). She
ership, education, and regulation of quality standards. developed her theory while working at Duquesne
She has planned and implemented many international University in Pittsburgh (during the 1960s and
conferences on nursing theory, the humanbecoming 1970s) when Duquesne was regarded as the center of
school of thought, qualitative research, and quality the existential-phenomenological movement in the
of life. United States. Dialogue with scholars such as van
Parse has chaired over 40 doctoral dissertations, Kaam and Giorgi stimulated her thinking on the
guided over 300 students with creative research con- lived experiences of human beings and their situated
ceptualizations, and mentored faculty and students freedom and participation in life.
on qualitative and quantitative research proposals, Parse synthesized the science of unitary human
grant applications, and manuscripts for publications. beings, developed by Martha E. Rogers (1970, 1992)
She developed basic and applied science research with the fundamental tenets from existential-
methods (Parse, 2001b, 2005, 2011b); conducted mul- phenomenological thought, articulated by Heidegger,
tiple qualitative research studies about living experi- Sartre, and Merleau-Ponty and secured nursing as a
ences of health and quality of life (such as hope, human science. She contends that humans cannot be
466 UNIT IV Nursing Theories
reduced to component parts and be understood. The basic tenet, human subjectivity, means viewing
Rather, persons are living beings who are different human beings not as things or objects, but as indivis-
from schemata that divide them. Parse challenges the ible, unpredictable, everchanging beings (Parse, 1998,
traditional medical view of nursing and distinguishes 2007b) and as a mystery of being with nonbeing.
the discipline of nursing as a unique, basic science Human beings live all-at-onceness as the becoming
focused on human experiences. She supports the no- visible–invisible becoming of the emerging now
tion that nurses require a unique knowledge base (Parse, 2012b). Parse posits that humans’ presence
that informs their practice and research, knowledge with the world is personal and that humans live mean-
of humanuniverse and health that is essential to ful- ing as their becoming who they are. As people choose
fill their commitment to humankind (Parse, 1981, meanings and projects according to their value priori-
1987, 1993, 2007b, 2010, 2012b). ties, they coparticipate with the world in indivisible,
She drew on Rogers’ principles of helicy, inte- unbounded ways (Parse, 1981, 1998, 2007b, 2012b).
grality, and resonancy and her postulates (energy Persons are inseparable from the world and craft
field, openness, pattern, and pandimensionality) unique relationships. A person’s becoming is complex
(Parse, 1981; Rogers, 1970, 1992). These ideas un- and full of explicit-implicit meaning (Parse, 1981,
derpin Parse’s notions about persons as open beings 1998, 2007b, 2012b).
who relate with the universe illimitably, that is, Coconstitution means any moment is cocreated
“with indivisible, unbounded knowing extended to with the constituents of the situation (Parse, 1981,
infinity” (Parse, 2007b, p. 308), and who are indivis- 1998, 2007b, 2012b). Human beings choose mean-
ible, unpredictable, everchanging, and recognized ing with the particular constituents of day-to-day
by patterns (Parse, 1981, 1998, 2007b, 2012b). life. Life happens, events unfold in expected and
From existential-phenomenological thought, Parse unexpected ways, and the human being coconsti-
drew on the tenets of intentionality and human sub- tutes personal meaning and significance. Coconsti-
jectivity and the corresponding concepts of coconsti- tution surfaces with opportunities and limitations
tution, coexistence, and situated freedom (Parse, for human beings as they live their presence with
1981, 1998, 2007b, 2012b). She uses the prefix co on the world, and as they make choices about what
many of her words to denote the participative nature things mean and how to proceed. The term coconsti-
of persons. Co means together with, and, for Parse, tution refers to creating different meanings from the
humans can never be separated from their relation- same situations. People change and are changed
ships with the universe—thus her 2007b conceptual- through their personal interpretations of life situa-
izations of humanbecoming and humanuniverse as one tions. Various ways of thinking and acting unite
word. Relationships with the universe include all the familiar patterns with newly emerging ones as peo-
linkages humans have with other people and with ple craft their unique realities.
ideas, projects, predecessors, history, and culture Coexistence means “the human is not alone in any
(Parse, 1981, 1998, 2007b, 2012b). dimension of becoming” (Parse, 1998, p. 17). Human
From Parse’s perspective, humans are intentional beings are always with the world of things, ideas, lan-
beings. That is, human beings have an open and guage, unfolding events, and cherished traditions,
meaningful stance with the universe and people, proj- and they also are always with others—not only con-
ects, and ideas that constitute lived experience. Hu- temporaries, but also predecessors and successors.
man beings are intentional whose involvements are Humans are community (Parse, 2003). Indeed, Parse
not random but are chosen for reasons known and posits that “without others, one would not know that
not known. Parse says that being human is being in- one is a being” (Parse, 1998, p. 17). Persons think
tentional and present, open, and knowing with the about themselves in relation to others and how they
world. Intentionality is also about purpose and how might be with their plans and dreams. Connected
persons choose direction, ways of thinking, and act- with freedom, Parse describes an abiding respect for
ing with projects and people. People choose attitudes human change and possibility.
and actions with illimitable options (Parse, 1981, Finally, situated freedom means that human be-
1998, 2007b, 2012b). ings emerge in the context of a time and history,
CHAPTER 24 Rosemarie Rizzo Parse 467
a culture and language, physicality, and potentiality. For example, all humans live paradoxical rhythms
Parse suggests that human freedom means “reflec- of certainty-uncertainty, joy-sorrow, and others,
tively and prereflectively one participates in choosing and they move with the rhythm of their paradoxical
the situations in which one finds oneself as well as experiences—at times focusing on certainty or joy,
one’s attitude toward the situations” (Parse, 1998, for instance, yet always having an awareness of living
p. 17). Humans are always choosing what is important the uncertainty or sorrow inherent in situations.
in their lives. They decide the attention to give to situ- Likewise, freedom, although a cornerstone of Parse’s
ations, projects, and people. In day-to-day living, early thinking, is seen in a new light in her most recent
people choose and act on their value priorities, and thinking. Parse (2007b) stated that freedom is “contex-
value priorities shift as life unfolds. Sometimes acting tually construed liberation” (p. 309). People have
on beliefs is as important as achieving a desired out- freedom with their situations to choose ways of being.
come. Personal integrity is intimately connected to Finally, mystery, the fourth postulate, is presented
situated freedom. in a more specific way as something special that
In 2007 and in 2012, Parse published important transcends the conceivable and as the unfathomable
conceptual refinements for the humanbecoming school and unknowable that always accompanies the “indi-
of thought. First, in 2007, she changed human becom- visible, unpredictable, everchanging humanuniverse”
ing and human-universe to humanbecoming and huma- (p. 309).
nuniverse. These changes, according to Parse (2007b), In 2012, Parse introduced new conceptualiza-
further specify her commitment to the indivisibility of tions that further specify the meaning of the all-
cocreation. Parse’s new concepts of humanbecoming at-onceness of human experience from a humanbe-
and humanuniverse demonstrate through language coming perspective. Her belief system (ontology)
that there is no space for thinking that humans can underpinning humanbecoming “specifies that with
be separated from becoming or the universe—these humanuniverse the human is an august presence, a
notions are irreducible. seamless symphony of becoming, living the emerg-
In addition, Parse (2007b) specified four postulates ing now. Becoming visible–invisible becoming of the
that permeate all principles of humanbecoming. The emerging now is the living moment that brings to
four postulates are illimitability, paradox, freedom, and the fore the idea that meaning changes with each
mystery. The four postulates further specify ideas em- unfolding living experience incarnating the remem-
bedded within Parse’s school of thought. Illimitability bered with the prospected all-at-once” (Parse,
represents Parse’s thinking about the indivisible, un- 2012b, p. 44). The becoming visible–invisible be-
predictable, everchanging nature of humanbecoming. coming of the emerging now is the universe of his-
Parse (2007b) stated, “Illimitability is the ‘unbounded tories and experiences and hopes and dreams that
knowing extended to infinity, the all-at-once remem- cocreate each moment, as humans live and shape
bering and prospecting with the moment’” (p. 308). their lives with their illimitable, unbounded know-
Indivisible, unbounded knowing “is a privileged ing. Human living experiences surface moment to
knowing accessible only to the individual living the moment like waves surfacing from an ocean. What
life” (Parse, 2008e, p. 46). Paradox has always been is becoming visible in human experience is what is
affiliated with humanbecoming, and Parse’s bringing happening in the moment that is explicitly known
it forth as a postulate that permeates all theoretical and described by the person living it. It is like waves
principles emphasizes the importance of paradox with that are swelling to the top of the ocean—visible for
humanuniverse cocreation. She stated, “paradoxes are a moment, yet always shifting and changing and be-
not opposites to be reconciled or dilemmas to be over- ing cocreated with what is happening in the entirety
come but, rather, are lived rhythms . . . expressed as a of the ocean, invisible beneath the surface yet cocre-
pattern preference” (Parse 2007b, p. 309), “incarnating ating the waves that are becoming visible with their
an individual’s choices in day-to-day living” (Parse, invisible becoming.
2008e, p. 46). Humans make choices about how they Based on her latest thinking, Parse (2007b, 2012b)
will be with paradoxical experiences and continuously refined the wording of the three principles of her
make choices about where to focus their attention. theory as indicated in the following.
468 UNIT IV Nursing Theories
MAJOR CONCEPTS & DEFINITIONS
Three principles constitute the humanbecoming meaning, possibility, and consequence. Nurses cannot
theory flowing from these themes—meaning, rhyth- completely know another’s imaging, but they explore,
micity, and transcendence (Parse, 1981, 1998, 2007b, respect, and bear witness as people struggle with shap-
2012b). Each principle contains three concepts that ing, exploring, integrating, rejecting, and interpreting.
require thoughtful exploration to understand the
depth of the humanbecoming theory. The principles Valuing
(Parse, 2012b) are as follows: Paradox: Confirming–Not Confirming
1. Structuring meaning is the imaging and valuing Valuing is the second concept of the first principle.
of languaging. The paradox of valuing is confirming–not confirming
2. Configuring rhythmical patterns is the revealing- (Parse, 1998, 2007b, 2012b). This concept is about
concealing and enabling-limiting of connecting- how persons confirm and do not confirm beliefs in
separating. light of a personal perspective or worldview (Parse,
3. Cotranscending with possibles is the powering 1981, 1998, 2007b, 2012b). Persons are continuously
and originating of transforming (p. 45). confirming–not confirming beliefs as they are making
choices about how to think, act, and feel. These
Principle I: Structuring Meaning choices may be consistent with prior choices, or they
“Structuring meaning is the imaging and valuing of may be radically different and require a shifting of
languaging” (Parse, 2012b, p. 45), proposing that per- value priorities. Sometimes people may think about
sons structure, or choose, the meaning of their reali- anticipated choices, and once the choice arrives they
ties, and this choosing happens with explicit-tacit change their thinking and direction in life. Values
knowing. Sometimes questions are not answerable, reflect what is important in life to a person or a family.
since people may not know why they think or feel one For Parse, living one’s value priorities is how an indi-
way or another. This first principle posits that people vidual expresses health and humanbecoming. Nurses
create their reality illimitably with others, and they learn about persons’ values by asking them what is
show or language their reality in the ways they speak most important.
and remain silent and in the ways they move and stay
still. As people language their realities, they language Languaging
their value priorities and meanings according to this Paradoxes: Speaking–Being Silent and Moving–
principle. This principle has three concepts: (1) imag- Being Still
ing, (2) valuing, and (3) languaging. Languaging is the third concept of the first principle.
The paradoxes of languaging are speaking–being
Imaging silent and moving–being still (Parse, 1998, 2007b,
Paradoxes: Explicit-Tacit and Reflective- 2012b). Languaging is a concept that is visible and
Prereflective relates to how humans symbolize and express their
Imaging is the first concept of the first principle. The imaged realities and their value priorities. When lan-
paradoxes of imaging are explicit-tacit and reflective- guaging is visible to others, it is expressed in patterns
prereflective (Parse, 1998, 2007b, 2012b). Imaging is that are shared with those who are close. Family
an individual’s view of reality. It is the shaping of per- members or close friends often share similar patterns,
sonal knowledge in explicit and tacit ways (Parse, such as speaking, moving, and being quiet (Parse,
1981, 1998, 2007b, 2012b). Some knowing is a reflec- 1981, 1998, 2007b, 2012b). People disclose things
tive, deliberate process, while other knowing is prere- about themselves when they language and when they
flective. For Parse, people are inherently curious and are silent and remain still. Nurses witness the lan-
seek answers. The answers to questions emerge as guaging that people show, but cannot know the
persons explore meaning in light of reality and their meaning of the languaging. To understand the lan-
view of things. Imaging is a personal interpretation of guaging, nurses ask people what their words, actions,
CHAPTER 24 Rosemarie Rizzo Parse 469
MAJOR CONCEPTS & DEFINITIONS—cont’d
and gestures mean. It is possible that persons still may how to be with others, nurses cocreate what happens
not know the meaning of their languaging, and in when they are with persons.
that case the nurse respects the process of coming to
understand the meaning of a situation. Explicating Enabling-Limiting
meaning takes time, and people know when it is right Paradox: Potentiating-Restricting
to illuminate the meaning and significance of an Enabling-limiting is the second concept of the
event or happening. second principle. It is connected with the paradox
potentiating-restricting (Parse, 2007b, 2012b).
Principle 2: Configuring Rhythmical Enabling-limiting is related to the potentials and
Patterns opportunities that surface with the restrictions and
The second principle of humanbecoming is “configur- obstacles of everyday living. Every choice, even those
ing rhythmical patterns is the revealing-concealing made prereflectively, has potentials and restrictions.
and enabling-limiting of connecting-separating” It is not possible to know all the consequences of any
(Parse, 2012b, p. 45). This principle means that human given choice; therefore, people make choices amid
beings create patterns in day-to-day life, and these the reality of ambiguity. Every choice is pregnant
patterns tell about personal meanings and values. In with possibility in both opportunity and restriction.
the patterns of relating that people create, many free- This is verified in practice daily when patients and
doms and restrictions surface with choices; all pat- families say things like, “This is the worst thing that
terns involve complex engagements and disengage- could have happened to our family, but it has helped
ments with people, ideas, and preferences. The second us in many ways.” Enabling-limiting is about choos-
principle has three concepts: (1) revealing-concealing, ing from the possibilities and living with the conse-
(2) enabling-limiting, and (3) connecting-separating. quences of those choices. Nurses help others as they
contemplate the options and anticipated conse-
Revealing-Concealing quences of difficult choices.
Paradox: Disclosing-Not Disclosing
Revealing-concealing is the first concept of the sec- Connecting-Separating
ond principle. The paradox of revealing-concealing Paradox: Attending-Distancing
is disclosing–not disclosing (Parse, 2007b, 2012b). Connecting-separating is the third concept of
Revealing-concealing is the way persons disclose and the second principle. The paradox connected with
keep hidden the persons they are becoming with the connecting-separating is attending-distancing (Parse,
becoming visible–invisible becoming of the emerg- 2007b, 2012b). This concept relates to the ways
ing now (Parse, 1981, 1998, 2007b, 2012b). There is persons create patterns of connecting and separating
always more to tell and more to know about self as with people and projects. Patterns created reveal
well as others. Sometimes people know what they value priorities. Connecting-separating is about com-
want to say, and they deliver messages about what is munion-aloneness and the ways people separate from
becoming visible to them with great clarity; at other some to join with others. Connecting-separating
times, people may surprise themselves with the mes- is also about the paradox attending-distancing and
sages they give as what is becoming visible shifts and explains the way two people can be very close and
changes with the invisible becoming of their emerg- yet separate. Sometimes there is connecting when
ing now. Some aspects of reality and experience people are separating because persons can dwell with
remain concealed. People also disclose–not disclose an absent presence with great intimacy, especially
differently in different situations and with different when grieving for another (Bournes, 2000a; Cody,
people. Patterns of revealing-concealing are cocre- 1995b; Pilkington, 1993). Nurses learn about persons’
ated and intimately connected with the intentions of patterns of connecting-separating by asking about
those persons cocreating the moment. In choosing their important relationships and projects.
Continued
470 UNIT IV Nursing Theories
MAJOR CONCEPTS & DEFINITIONS—cont’d
Principle 3: Cotranscending with Possibles following two paradoxes: (1) conforming–not
The third principle of humanbecoming is “cotrans- conforming and (2) certainty-uncertainty (Parse,
cending with possibles is the powering and originating 1998, 2007b, 2012b). People strive to be like oth-
of transforming” (Parse, 2012b, p. 45). The meaning ers, and yet they also strive to be unique. Choices
of this principle is that persons continuously change about originating occur with the reality of cer-
and unfold in life as they engage with and choose from tainty-uncertainty. It is not possible to know all
infinite possibilities about how to be, what attitude that may come from choosing to be different or
or approach to have, whom to relate with, and what from choosing to be like others. For some, there is
interests or concerns to explore. Choices reflect the danger in being too much like others; for others,
person’s ways of moving and changing with the be- the danger is in being different. Each person de-
coming visible–invisible becoming of the emerging fines and lives originating in light of their world-
now. The three concepts of this principle are as follows: view and values. Originating and creating anew is
(1) powering, (2) originating, and (3) transforming. a pattern that coexists with constancy and confor-
mity (Parse, 1981, 1998, 2007b, 2012b). Humans
Powering craft their unique patterning of originating as they
Paradoxes: Pushing-Resisting, Affirming–Not engage the possibilities of everyday life. Nurses
Affirming, Being-Nonbeing witness originating with persons choosing how
Powering, the first concept of the third principle, is they are going to be with their changing health
patterns.
connected with the paradoxes pushing-resisting,
affirming–not affirming, and being-nonbeing (Parse, Transforming
1998, 2007b, 2012b). Powering is a concept that conveys
meaning about struggle and life and the will to go on Paradox: Familiar-Unfamiliar
despite hardship and threat. Parse (1981, 1998, 2012b) Transforming, the third concept of the third principle,
describes powering as pushing-resisting that is always is explicated with the paradox familiar-unfamiliar
happening and that affirms being in light of the possi- (Parse, 1998, 2007b, 2012b). Transforming is about
bility of nonbeing. People constantly engage being and the continuously changing and shifting views that
nonbeing. Nonbeing is about loss and the risk of death people have about their lives as they live what is
and rejection. Powering is the force exerted, the push- becoming visible to them with the invisible becoming
ing to act and live with purpose amid possibilities for of their emerging now. People are always struggling
affirming and holding what is cherished while simulta- to integrate the unfamiliar with the familiar in living
neously living with loss and the threat of nonbeing. everydayness. When new discoveries are made, peo-
There is resistance with the pushing force of powering, ple change their understanding and life patterns, and
because persons live with others who are powering with worldviews shift with insights that illuminate a famil-
different possibilities in the visible-invisible becoming iar situation in a new light. Transforming is the ongo-
of the emerging now. Conflict, according to Parse ing change cocreated as new information and insights
(1981, 1998, 2007b, 2012b), presents opportunities to become visible in the emerging now, as people find
clarify meanings and values, and nurses enhance this ways to change in the direction of their cherished
process by being present with persons who are explor- hopes and dreams (Parse, 1981, 1998, 2007b, 2012b).
ing issues, conflicts, and options. Nurses, in the way they are present with others, help
or hinder a person’s efforts to clarify their hopes,
Originating dreams, and desired directions.
Paradoxes: Certainty-Uncertainty, Conforming–
Not Conforming
Originating, the second concept of the third prin-
ciple, is about human uniqueness and holds the
CHAPTER 24 Rosemarie Rizzo Parse 471
builds new knowledge about humanbecoming
Use of Empirical Evidence (Doucet & Bournes, 2007; Parse, 2012b). Knowledge
Research guided by the humanbecoming theory is of humanbecoming contributes to the substantive
meant to enhance understanding of the theoretical knowledge of the nursing discipline. Disciplinary
foundation, or the knowledge contained in the knowledge is different from the practical or technical
assumptions, postulates, principles, and concepts of knowledge that nurses use in health care settings.
humanbecoming (Doucet & Bournes, 2007; Parse, Disciplinary knowledge is theoretical that identifies
1998, 2007b, 2012b). Research is not used to test the phenomenon of concern for nurses—for Parse
Parse’s theory. Nurses assume people have unique (1998, 2007b, 2012b) is humanbecoming. According
meanings of life situations; persons have freedom; to Parse (1998), “scholarly research is formal inquiry
humans are indivisible, unpredictable, ever changing leading to the discovery of new knowledge with the
beings; and persons relate with others and the uni- enhancement of theory” (p. 59). The idea of new
verse in paradoxical patterns. To test these beliefs knowledge with enhancement of theory requires
would be comparable to testing the assumption that attention to clarify distinctions among different ways
humans are spiritual beings or that people are com- of thinking.
posed of complex systems. These statements are ab- Research guided by humanbecoming explores uni-
stract beliefs based on experience, observation, and versal living experiences with people as they live them
beliefs about the nature of reality. The foundational or with the becoming visible–invisible becoming of their
ontological statements are value laden, and, as noted day-to-day lives. Parse contends there are universal
earlier, a nurse either has an attraction and commit- human experiences, such as hope, joy, sorrow, grief,
ment to these foundational beliefs or not. The idea fear, and confidence. Research participants’ accounts
of a human being who is indivisible, unpredictable, of their living experiences in humanbecoming-guided
everchanging and free to choose meaning is an as- research are descriptions of their “remembering-
sumption that is either believable or not. Assumptions prospecting of the phenomenon [being studied] as it
about human beings are theoretical, not factual. A is appearing with the emerging now. It is living the
student or a nurse relates to one notion of human experience being described” (Parse, 2012b, p. 49) in
being or another. According to Parse (1991, 1999b, light of what is becoming visible to them about the
2008c, 2008d, 2009b) this is why there is a need for experience in the moment. This means that research
multiple views; the discipline of nursing can and does guided by humanbecoming explores universal experi-
accommodate different views and different theories ences as people live them. People live in the moment,
about the phenomenon of concern to nursing— and what is remembered and what is hoped for are
human-universe-health. In agreement with Hall, Parse always viewed within the context of what is becoming
(1993) stated the following when discussing the issue visible in the emerging now. Universal experiences
of testing the humanbecoming theory: are not reduced to linear time frames because living
experiences are cocreated with “indivisible, un-
The human becoming theory does not lend itself bounded knowing” (Parse, 2007b, p. 308). A nurse
to testing, since it is not a predictive theory and is researcher conducting a Parse method study invites
not based on a cause-effect view of the human- persons to speak about a particular universal experi-
universe process. The purpose of the research is not ence. For instance, a participant might talk about his
to verify the theory or test it but, rather, the focus is or her experience of grieving (Cody, 1995a, 2000;
on uncovering the essences of lived phenomena to Pilkington, 1993). The researcher guided by human-
gain further understanding of universal human becoming knows that the person’s reality encom-
experiences. This understanding evolves from con- passes what is remembered and what is imagined or
necting the descriptions given by people to the the- hoped for as it is appearing in the moment (Parse,
ory, thus making more explicit the essences of being 2007b). The researcher assumes that the person
human. (p. 12)
knows his or her experience and can offer an account
Therefore, research with Parse’s theory expands of the experience as he or she lives and knows it. What
understanding about human living experiences and is shared about the experience under study is what
472 UNIT IV Nursing Theories
Parse (2008e) calls “truth for the moment” (p. 46). happen over and over as context and earth are separated
Truth for the moment is the person’s description of from the core ideas or nuggets that eventually stand out
his or her reality, an expression of “personal wisdom” from the surrounding context or earth. Panning for
(Parse, 2008e, p. 46) about the phenomenon under gold is backbreaking work, and Parse’s research method
study in light of what is happening and known in that is also arduous. Both processes include excitement and
instant. Truth, from this perspective, is “unfolding anticipation of what is to be discovered. The extraction-
evidence, testimony to everchanging knowing, as new synthesis processes of the Parse method separates out
insights shift meaning and truth for the moment” core ideas that are present in all participants’ descrip-
(Parse, 2008e, p. 46). Thus, research evidence is “truth tions of the living experience under study. Core ideas,
for the moment” (p. 46). like gold nuggets, are isolated but not yet refined to a
In 1987, Parse first developed a specific research form that makes them meaningful in the world at large.
method consistent with the humanbecoming theory; Gold nuggets are refined into coins or jewelry. Core
since then, her humanbecoming hermeneutic method ideas are refined to the language of humanbecoming
has been articulated (Cody, 1995c; Parse, 1998, 2001b, and nursing science, so other nurses see not only the
2005, 2007a, 2011b). A third applied science method gold nuggets but also the meaningfulness of the newly
(qualitative descriptive preproject-process-postproject) refined ideas in light of a language of nursing science.
has also been articulated (Parse, 1998, 2001b, 2005, Because all research is theory driven, research findings
2011b). For information about these methods, see The are interpreted in light of the guiding frame of reference
Human Becoming School of Thought: A Perspective for to advance disciplinary knowledge.
Nurses and Other Health Professionals (Parse, 1998)
and Qualitative Inquiry: The Path of Sciencing (Parse,
2001b). Additional detail and updates about the Major Assumptions
humanbecoming modes of inquiry are found in Parse’s Parse (1998) synthesized “principles, tenets, and con-
and others articles (Doucet & Bournes, 2007; Parse, cepts from Rogers, Heidegger, Merleau-Ponty, and
2005, 2011b). The Parse research method records Sartre . . . in the creation of the assumptions about the
accounts of personal experiences and systematically human and becoming, underpinning a view of nurs-
examines these accounts to identify the aspects of ing grounded in the human sciences. Each assumption
living experiences shared across participants. Core is unique and represents a synthesis of three of the
concepts, or ideas shared across all participants, form a postulates and concepts drawn from Rogers’ work and
structure of the phenomenon under study. The struc- from existential phenomenology” (p. 19). Parse draws
ture defined by Parse (2011b) is “a description of the upon the work of other theorists to build a solid foun-
emerging now…The emerging now incarnates remem- dation for a new nursing science. Accordingly, the
bering-prospecting about the [living] experience” assumptions underpinning humanbecoming focus
(p. 13). New knowledge is embedded in the core con- on beliefs about humans and about their becoming
cepts and, once discovered, enhances theory and visible–invisible becoming, which is health (Parse,
understanding in ways beyond the particular study. The 2012a). Parse does not specify separate assumptions
weaving of new knowledge with the theoretical concepts about the universe because the universe is illimitable
expands understanding of the content of the humanbe- and cocreated with humans—rather than separate
coming theory, and new knowledge develops disciplin- from humans as evident in Parse’s (2012b) newly
ary and interdisciplinary thinking and dialogue. updated assumptions about humans and becoming:
A metaphor of panning for gold describes the Parse Parse (1998; 2012b) synthesized the original nine
method. The researcher gathers descriptions from par- assumptions about humans and becoming into four
ticipants like a person panning for gold gathers up the assumptions about humanbecoming as follows:
earth. The extraction-synthesis processes of the Parse 1. Humanbecoming is structuring meaning, freely
method is likened to the gathering, sifting, swirling, choosing with situation.
seeking, and separating, as when panning. Researchers 2. Humanbecoming is configuring rhythmical hu-
following the Parse method work to separate particular manuniverse patterns.
context from core ideas. The gathering and discovering
CHAPTER 24 Rosemarie Rizzo Parse 473
3. Humanbecoming is cotranscending illimitably struggle or acquiesce, to be certain or uncertain,
with emerging possibles. to hope or despair—all these options surface in day-
4. Humanbecoming is humanuniverse cocreating to-day living. Considering and choosing from these
a seamless symphony. options is cotranscending with the possibles.
(Parse, 2012b, p. 45)
Nursing
Three themes arise from the assumptions of the Consistent with her beliefs, Parse writes about nurs-
humanbecoming school of thought. These include ing as a basic science. Parse (2000) wrote, “It is the
(1) meaning, (2) rhythmicity, and (3) transcendence hope of many nurses that nursing as a discipline will
(Parse, 1998). The postulates illimitability, paradox, enjoy the recognition of having a unique knowledge
freedom,and mystery (Parse, 2007b) permeate the base and the profession will be sufficiently distinct
three themes. Meaning is borne in the messages that from medicine that people will actually seek nurses
persons give and take with others in speaking, mov- for nursing care, not medical diagnoses” (p. 3). For
ing, silence, and stillness (Parse, 1998, 2012b). over 30 years, Parse has been advanced the belief that
Meaning indicates the significance of something and nursing is a basic science, and that nurses require
is chosen by people. Outsiders cannot decide the theories that are different from other disciplines.
meaning or significance of something for another Parse believes that nursing is a unique service to
person. Nurses cannot know what it will mean for a humankind. This does not mean that nurses do
family to hear news of an unexpected illness or not benefit from and employ knowledge from other
change in health until they learn the meaning it disciplines and fields of study. It means that nurses
holds from the family’s perspective. Sometimes the primarily rely on and value the knowledge of nursing
significance of something is not known until mean- theory in their practice and research activities. Parse
ing is explored and possibilities examined. Personal (1992) has articulated clearly that she believes “nurs-
meanings are shared with others when people ing is a science, the practice of which is a performing
express their views, concerns, hopes, and dreams. art” (p. 35). From this view, nursing is a learned disci-
According to Parse (1998) meaning is connected pline, and nursing theories guide research and prac-
with moments of day-to-day living, as well as with tice. These beliefs reflect those of Rogers (1970).
the meaning or purpose of life. Nursing practice for those choosing Parse’s theory is
Rhythmicity is about patterns and possibility. guided by a methodology that emerges directly from
Parse (1981, 1998) suggests that people live unrepeat- humanbecoming ontology. The practice dimensions
able patterns of relating with others, ideas, objects, and processes are illuminating meaning (explicating),
and situations. Their patterns of relating incarnate synchronizing rhythms (dwelling with), and mobilizing
their priorities, and these patterns are changing con- transcendence (moving beyond). For practice method-
stantly as they integrate new experiences and ideas ology, refer to The Human Becoming School of Thought:
with what is becoming visible-invisible in the emerg- A Perspective for Nurses and Other Health Profes-
ing now. For Parse, people are recognized by their sionals (Parse, 1998). For humanbecoming-guided
unique patterns. People change their patterns when practice, refer to Bournes & Naef, 2006; Bunkers, 2011,
they integrate new priorities, ideas, and dreams, and 2012b; Hayden, 2010; Hegge, 2012; Jasovsky, Morrow,
show consistent patterns that continue like threads of Clementi, & Hindle, 2010; Jonas-Simpson, 2010; Oaks
familiarity and sameness throughout life. & Drummond, 2009; Peterson-Lund, 2011; Smith,
Transcendence is the third major theme of the 2010; and Tanaka, Katsuno, & Takahashi, 2012. Parse
humanbecoming school of thought. Transcendence is (1993) describes nursing practice as living the art of
about change and possibility, the infinite possibility humanbecoming in the following way:
that is humanbecoming. “The possibilities arise with
. . . [humanuniverse] . . . as options from which to The nurse is in true presence with the individual
choose personal ways of becoming” (Parse, 1998, (or family) as the individual (or family) uncovers
p. 30). To believe one thing or another, to go in one the personal meaning of the situation and makes
direction or another, to be persistent or let go, to choices to move forward in the now moment with
474 UNIT IV Nursing Theories
cherished hopes and dreams. The focus is on the Human beings come into the world through others
meaning of the liv[ing] experience for the person and live their life cocreating patterns of communion-
(or family) unfolding “there with” the presence of aloneness. This means that persons change and are
the nurse . . . The living of the theory in practice changed in relating with others, ideas, objects, and
is indeed what makes a difference to the people events. People become known and understood as they
touched by it. (p. 12) cocreate patterns of relating with people, ideas, cul-
ture, history, meanings, and hopes. To understand
Nursing, for Parse, is a science, and the performing human life and human beings, an individual must
art of nursing is practiced in relationships with persons start from the premise that all people are intercon-
(individuals, groups, and communities) in their pro- nected with predecessors, contemporaries, and even
cesses of becoming. Parse (1989) sets forth the follow- people who are not yet present in the world. Parents
ing set of fundamentals for practicing the art of nursing: may imagine and have a relationship with a child long
• Know and use nursing frameworks and theories. before the child is conceived and long after a child is
• Be available to others. lost through death (Jonas-Simpson, 2010; Pilkington,
• Value the other as a human presence. 1993). That people have relationships with their par-
• Respect differences in view. ents and other loved ones who are no longer in this
• Own what you believe and be accountable for your world are examples of the indivisibility, mystery, and
actions. complexity of humanuniverse and humanbecoming.
• Move on to the new and untested.
• Connect with others.
• Take pride in self. Theoretical Assertions
• Like what you do. Parse’s (1981, 1998, 2012b) principles are the asser-
• Recognize the moments of joy in the struggles of tions of the humanbecoming theory. Each principle
living. interrelates the nine concepts of humanbecoming:
• Appreciate mystery and be open to new discoveries. (1) imaging, (2) valuing, (3) languaging, (4) reveal-
• Be competent in your chosen area. ing-concealing, (5) enabling-limiting, (6) connect-
• Rest and begin anew. (p. 111) ing-separating, (7) powering, (8) originating, and
(9) transforming (Figure 24–1). Research projects
Person, Environment, Health Viewed generate structures that further specify relation-
as Humanuniverse, Humanbecoming, ships among theoretical concepts. For example,
and Health Naef and Bournes (2009) studied the experience
Parse (1998, 2007b, 2012b) views the concepts human, of waiting for persons on a list to receive a lung
universe,and health as inseparable and irreducible. To transplant, and presented the following theoreti-
emphasize this inseparability, she specified humanuni- cal structure: “The lived experience of waiting is
verse and humanbecoming as one word (Parse, 2007b). enabling-limiting the imaging-valuing of powering
For Parse, health is humanbecoming. It is the becoming connecting-separating” (Naef & Bournes, 2009,
visible-invisible of the emerging now as humans live p. 145). Theoretical structures are used to enhance
their lives structuring meaning, configuring rhythmical understanding of phenomena as readers consider
patterns, and cotranscending with possibles (Parse, participant descriptions that connect to the con-
2012a). Parse (1990) speaks of health as a personal com- cepts of humanbecoming. For more humanbecom-
mitment, which means, “an individual’s way of becom- ing research, the reader is referred to an overview of
ing is cocreated by that individual, incarnating his or studies (Doucet and Bournes, 2007 and other recent
her own value priorities” (p. 136). For Parse (1990), publications; Baumann, 2008, 2012b; Bournes &
health is a flowing process, a personal creation, and a Milton, 2009; Bunkers, 2010b, 2012a; Condon,
personal responsibility. Personal health may be changed 2010a, 2010c; Doucet, 2012a, 2012b; Florczak, 2010,
as commitment is changed, which “include[s] creative 2012; Maillard-Struby, 2012; Morrow, 2010; Parse,
imagining, affirming self, and spontaneous glimpsing of 2005, 2008e, 2009c, 2011b, 2012b; Peterson-Lund,
the paradoxical” (Parse, 1990, p. 138). 2012; Smith, 2012).
CHAPTER 24 Rosemarie Rizzo Parse 475
Principle 1: Structuring Principle 2: Configuring Principle 3:
meaning is the imaging rhythmical patterns is the Cotranscending with
and valuing of revealing-concealing and possibles is the powering
languaging. enabling-limiting of and originating of
connecting-separating. transforming.
Revealing- Enabling-
Imaging Valuing Concealing Limiting Powering Originating
Languaging Connecting- Transforming
Separating
Concepts in the squares: Powering emerges with the revealing-concealing of imaging.
Concepts in the ovals: Originating emerges with the enabling-limiting of valuing.
Concepts in the triangles: Transforming emerges with the languaging of connecting-separating.
FIGURE 24-1 Relationship of principles, concepts, and theoretical structures of the human becoming theory. (From Parse, R. R.
[1998]. The human becoming school of thought: A perspective for nurses and other health professionals [p. 56]. Thousand Oaks, (CA):
Sage. Principles updated from Parse, R. R. [2012b]. New humanbecoming conceptualizations and the humanbecoming community
model: Expansions with sciencing and living the art. Nursing Science Quarterly, 25, 44–52.)
Logical Form community (Bournes & Ferguson-Paré, 2007; Bournes
The inductive-deductive process was central to the & Flint, 2003; Bournes & Naef, 2006; Bunkers, 2010a,
creation of the humanbecoming theory. The theory 2010c, 2011, 2012b; Hayden, 2010; Hegge, 2012;
originated from Parse’s personal experiences with her Jasovsky Morrow, Clementi, et al., 2010; Mitchell,
readings and in nursing practice. She deductively- Bournes, & Hollett, 2006; Oaks & Drummond, 2009;
inductively crafted major components of humanbe- Peterson-Lund, 2011; Smith, 2010; Tanaka, Katsuno, &
coming from the science of unitary human beings and Takahashi, 2012; and others). A community of nurse
existential-phenomenological thought. She intuitively scholars is advancing humanbecoming in practice,
and methodically derived the assumptions, postulates, research, and education. The theory has made a differ-
principles, concepts, and practice and research meth- ence to nurses and to persons (patients) experiencing
odologies of the humanbecoming school of thought. humanbecoming practice. This includes nurses who
Figure 24–1 illustrates how the principles, concepts, work with older adults and with children. The theory
and theoretical structures connect in simplicity and guides practice for nurses who work with families
complexity. Abstraction and complexity create possi- (Parse, 2009a) and with persons in hospital settings,
bility for growth, scholarship, and sustainability. clinics, and community settings (Parse, 2003, 2012b).
A community-based health action model, for instance,
Acceptance by the Nursing Community has been developed and has received support from the
local community and other funding agencies (Crane,
Practice Josephson, & Letcher, 1999). The theory was used as an
The range of publications about humanbecoming dem- overarching theoretical guide to develop a decisioning
onstrates the broad scope of acceptance by the nursing model for nurse regulators at a State Board of Nursing
476 UNIT IV Nursing Theories
(Benedict, Bunkers, Damgaard, et al., 2000; Damgaard sequencing. The curriculum plan was updated in
& Bunkers, 1998, 2012). The theory has generated con- 1998 in The Human Becoming School of Thought:
troversy and scholarly dialogue about nursing as an A Perspective for Nurses and Other Health Profession-
evolving discipline and a distinct human science. It is als. Parse outlined philosophy, goals, conceptual
not a question of whether or not the theory works in a framework, themes, program indicators, culture con-
particular area of practice; it has been lived by nurses in tent, and evaluation in a sample curriculum plan
the operating theater, in parishes, in shelters, in boards consistent with humanbecoming.
of nursing, in acute care hospitals, in long-term and A master’s curriculum consistent with humanbe-
community settings, and in any setting where nurses coming was developed at Olivet Nazarene University
have relationships with persons and families. in Kankakee, Illinois (Milton, 2003a). To date, most
students who study the humanbecoming school of
Education thought and are guided by the theory in their practice
The humanbecoming school of thought and the phil- and research activities were introduced to it at the
osophical assumptions and theoretical beliefs speci- master’s level. Parse’s ideas and theory are increas-
fied by Parse (1981, 1998, 2012b) have fueled many ingly integrated into undergraduate programs to
scholarly dialogues about outcomes in practice, expand options for students being taught that nursing
research, and education when different theories guide is an art and a science. For example, an undergraduate
practice. In Nursing Science Quarterly and other jour- curriculum was designed, implemented, and accred-
nals, nurses have advanced dialogue and debate about ited at California Baptist University in Riverside,
the role of theory in nursing practice, the limitations California (C. Milton, personal communication, July
and contributions of the medical model, the ethics of 6, 2012). In addition, undergraduate and graduate
nursing diagnoses and the nurse-person relationship, students at York University and at Humber College in
paternalism and health care, the knowledge of ad- Toronto, Ontario, Canada, have opportunity to study
vanced nursing practice, paradigmatic issues in nurs- humanbecoming.
ing, the limitations of evidence-based nursing, the
possibilities and politics of human science, freedom Research
and choice, the focus of community-based nursing, Humanbecoming theory has guided research studies
the nature of truth, leadership and nursing theory, in many different countries about numerous living
and the scope of mistakes in nursing. experiences, including feeling loved, feeling very
Parse (2004) created a humanbecoming teaching- tired, having courage, waiting, feeling cared for, griev-
learning model that has been used in a variety of ways ing, caring for a loved one, persisting while wanting
with students in academic settings (Baumann, 2012a; to change, feeling understood, and being listened to,
Bunkers, 2009; Condon, 2009, 2012a, 2012b; Condon & as well as time passing, quality of life, health, lingering
Hegge, 2011; Delis, 2012; Letcher & Yancey, 2004; presence, hope, and contentment (Doucet & Bournes,
Milton, 2012b; Ursel & Aquino-Russell, 2010) and 2007). The Parse and humanbecoming hermeneutic
practice settings (Bournes & Naef, 2006). Teachers in method generate new knowledge about universal liv-
academic and practice settings have contributed new ing experiences (Cody, 1995b, 1995c; Parse, 2001a,
understanding and new processes of teaching-learning, 2001b, 2005, 2007a, 2011b, 2012b). Research findings
and Parse’s theory was used as a model for explicating have enhanced understanding of how people experi-
pros and cons of teleapprenticeship (Norris, 2002). The ence hope while imaging new possibilities and how
humanbecoming school of thought is included in nurs- people create moments of respite amid the anguish of
ing courses at the undergraduate and graduate levels in grieving a loss. Research findings are woven with the
many schools of nursing. theory, so findings also inform thinking beyond any
In Man-Living-Health: A Theory of Nursing, Parse particular study.
(1981) presented a sample master’s in nursing cur- In the grieving and loss studies, researchers de-
riculum. She outlined this process-based curriculum scribed a rhythm of engaging and disengaging with
in detail, including course descriptions and course the one lost and with others who remind the one
CHAPTER 24 Rosemarie Rizzo Parse 477
grieving about the one lost (Cody, 1995a; Florczak, her own learning about the phenomenon of feeling
2008; Pilkington, 1993, 2008). Women who had a respected that surfaced through the research process—
miscarriage already had a relationship with their was the following poem:
babies, and the anguish of losing the child was so The oak tree stands
intense that women invented ways to distance them- noble on the hill
selves from the reality of the lost child. When they even in
were alone, the pain was unbearable, and when they cherry blossom time.
were with others, the anguish was both eased and Basho (1644–1694/1962)
intensified as consoling expressions mingled with
words acknowledging the reality of the lost child Parse (2006) interpreted the artistic expression
(Pilkington, 1993; MacDonald & Jonas-Simpson, saying, “The oak tree stands noble, acknowledged as
2009). Women described rhythms of engaging- such with the potential of being disregarded amid the
disengaging with the lost child and close others, pain, beauty of cherry blossoms, yet there is delight in the
and respite. Connecting the rhythm to the theoretical fortification of being known as oak tree. Oak tree and
concept connecting-separating and to the idea of lin- cherry blossoms live a mutuality of being prized as
gering presence means nurses can think about and be individually unique and uniquely together” (p. 55).
present with those experiencing grieving and loss. Subsequently, Parse (2011b) introduced metaphorical
How do families in palliative care express their engag- emergings to the Parse research method. She did this
ing and distancing from the one who is moving after examining reports of many Parse research
toward death? How do parents losing adult children method studies and noting:
engage and disengage with the absent children? Linguistic descriptions of universal [living] experi-
Research studies about loss and grieving may further ences by participants were rife with metaphors
enhance understanding about connecting-separating that creatively expressed the meaning of universal
with knowledge for nursing practice. [living] experiences. Metaphors are phrases, attri-
In 2004, Mitchell developed a framework for cri-
tiquing humanbecoming research that expanded op- butions to objects or ideas that offer surprise twists
on meanings . . . . To extract metaphors expressed
tions for critics engaging humanbecoming-guided by participants from dialogues about universal
nursing science. Parse (2011b) continues to refine the [living] experiences and to creatively conceptualize
research method. Parse changed the name of the par- them in light of the ontology of humanbecoming
ticipant proposition to language-art, and she added a expands knowledge of the experiences. (p. 13)
process requiring the researcher to select or create an
artistic expression showing how the researcher was Parse (2011b) used the 2006 study on feeling re-
transfigured through the research process (Parse, spected to illustrate the use of metaphorical emergings
2005). The artistic expression enhances understand- with the Parse research method. The metaphorical
ing of what the researcher learned about the phenom- emergings that arose from the participants’ descrip-
enon under study. For instance, in a study on the tions of feeling respected in that study (Parse, 2006)
experience of feeling respected, Parse (2006) reported included: “Feeling respected feels like everything is fir-
that 10 adult participants in her study described feel- ing on all cylinders; I’m just euphoric for half an hour
ing respected as “an acknowledgement of personal after class” (p. 53). Describing what can be learned
worth” (p. 54). They described, for example, feeling from this metaphor in light of the study, Parse (2011b)
confident, being trusted, feeling appreciated, and wrote the following:
experiencing joy when feeling respected (Parse, 2006).
Parse showed that in each case, the participant spoke This metaphor further illuminates the meaning
about feeling respected as a “fortifying assuredness of feeling respected when connected to the core
amid potential disregard emerging with the fulfilling concepts (fortifying assuredness amid potential
delight of prized alliances” (p. 54). Parse’s (2006) artis- disregard, fulfilling delight, and prized alli-
tic expression for this study—that is, her depiction of ances) and when elaborated with the ontology
478 UNIT IV Nursing Theories
of humanbecoming. Firing on all cylinders is the than with the actual concepts. The nondirectional
driving force of pushing-resisting in powering statements that do not specify causal or predictive
onward with the buoyant momentum of fortify- relationships about humanuniverse are discomforting
ing assuredness. The fortifying assuredness with for some.
feeling respected arises with illimitable imagin- The concepts of humanbecoming often resonate
ings that cocreate anew the familiar-unfamiliar with people when considered at the level of human
preferred preferences lived with opportunities experience. For instance, the concept of valuing at the
amid limitations. The euphoric feeling in the level of human experiences focuses on the ways per-
metaphor is the fulfilling delight of being ele- sons choose and act on what is important in their
vated with regard, yet with the remembered and lives. This idea should be inherently familiar, as
ever-present potential for disregard. The living should the idea that people sometimes disclose inti-
paradox of regard-disregard reveals and at once mate details about their lives and sometimes keep
conceals the diversity in connecting-separating secrets from others (revealing-concealing). Pickrell,
with prized alliances that surface with feeling Lee, Schumacher, and Twigg (1998) noted that a first-
respected. The metaphor “firing on all cylinders time reader might be tempted to dismiss the concepts
. . . [with euphoria]” brings feeling respected to as too simple to convey the complexity inherent in
light as a powerful force of unwavering buoy- the theory, but they caution that to do so would be a
ancy in confirming human engagements. It mistake. Parse’s principles describe a complex and real-
shows the lived experience of feeling respected as istic picture of humanbecoming that provides a mean-
a cocreation languaged in the emerging now ingful framework for understanding the illimitability,
that all-at-once incarnates the mystery of being mystery, freedom, and paradox of humanuniverse.
human. (p. 14)
Generality
Critique The humanbecoming school of thought was selected
as a theoretical guide by nurses and other health profes-
Clarity sionals in different settings, including acute care, long-
Humanbecoming is an abstract and complex school term care, and community. The theory helped nurses
of thought that includes the humanbecoming theory be with individuals, families, and groups and was evalu-
(the principles). It is a theory, rather than a model, ated in practice settings where patients commented on
since its concepts and interrelationships are in prin- the positive difference it made (Jonas, 1995; Mitchell,
ciples written at an abstract level of discourse—the Bernardo, & Bournes, 1997; Bournes & Ferguson-Paré,
language of science. The theory penetrates the foun- 2007; Northrup & Cody, 1998; Williamson, 2000).
dations of traditional nursing and health care in gen- Humanbecoming has helped leaders to create beneficial
eral. This penetration may be limited to cracklike change in organizational culture, and it has informed
fissures or streams of activity to expand opportunities development of standards of care (Mitchell & Bournes,
and advance thinking. This requires nurses to explore 1998), best-practice guidelines (Nelligan, Grinspun,
ways that are helpful to enhance the quality of life for Jonas-Simpson, et al., 2002; Registered Nurses Associa-
patients. tion of Ontario, 2002), decision-making tools for nurse
regulators (Benedict, Bunkers, Damgaard, et al., 2000;
Simplicity Damgaard & Bunkers, 1998, 2012), mentoring pro-
In keeping with the theoretical discourse, the major grams for novice nurses (Bournes & Plummer, 2011;
concepts of humanbecoming are defined in abstract Bournes, Plummer, Hollett, et al., 2011), and leadership
philosophical terms. The language has been a source and research programs for nurses who work at the point
of comfort and discomfort for nurses (Mitchell & of care (Bournes, 2013). The theory of humanbecoming
Bournes, 2000; Mitchell, Bournes, & Hollett, 2006). changes what professionals see when they engage with
Discomfort with the language is sometimes related persons in practice and research. The theory changes
more with unfamiliar beliefs and assumptions about the thinking, acting, attitudes, and approaches that pro-
human beings and how they relate with the universe fessionals rely on to fulfill their intentions with others
CHAPTER 24 Rosemarie Rizzo Parse 479
(see Humanbecoming/80–20: An Innovative Profes- and on the other hand that. Finally nurses ask, how
sional Development Program for Nurses at: http:// do I believe people change? Do people make choices
www.nursingchannel.org/programs.html).Indeed, the that help them move in the direction of their own
humanbecoming theory changes the intentions and hopes and dreams? Humanbecoming theory explores
purposes of professionals, and there is no limit to how these questions.
this learning may contribute to meaningful practices
and approaches for all professional activities linked Importance
with research, education, and leadership. Parse calls nursing a human science, and, as such, it
represents particular beliefs that have been around for
Accessibility longer than 100 years. The humanbecoming theory
Accessibility of the theory is evaluated with evidence has taken human science beliefs into service and
addressed in the following questions: knowledge development in new and important ways.
• Does evidence (taken here to mean “does reality”) The humanbecoming research and practice method-
support the theory? ologies are generating transformations in care and a
• Do the principles and concepts of the humanbe- renewed sense of professional purpose. Consider
coming theory make sense to nurses when they are these examples:
with people in practice? 1. Nurses in two Canadian provinces spent 24 months
• Does the humanbecoming theory help nurses be evaluating humanbecoming-guided care, and these
with people in ways that are helpful and that make acute care nurses reported enhanced satisfaction
a difference from the patient’s perspective? and purpose in their work as professional nurses
• Is the theory useful for administrators and re- (Bournes & Ferguson-Paré, 2007; Mitchell, Bournes,
searchers? & Hollett 2006).
• Do research findings expand knowledge and en- 2. Teams of humanbecoming researchers, practitioners,
hance the theoretical base? artistic writers, actors, and consumers produced a
The answer to these questions is, clearly, an enthu- research-based drama called I’m Still Here about liv-
siastic “yes.” The theory is useful because it provides a ing with Alzheimer’s disease. The Murray Alzheimer
meaningful foundation that is helpful for nurses who Research and Education Program at the University
want to live certain values in practice and research of Waterloo funded the production of a DVD version
(Bournes & Ferguson-Paré, 2007; Mitchell, Jonas- of the drama, as well as an educational guide
Simpson, & Ivonoffski, 2006). informed by humanbecoming theory, research, and
A nurse who is learning the theory might ask the self-reflective practice (Mitchell, Jonas-Simpson, &
following questions: Ivonoffski, 2006). Hundreds of health professionals
• What does humanbecoming theory say about people, and families in countries around the globe have pur-
and do I believe in these ideas as they are presented? chased the DVD and educational guide (available at
• Am I comfortable with the basic beliefs espoused http://www.marep.uwaterloo.ca/products/still.html).
in the humanbecoming theory? Researchers Mitchell, Dupuis, and Jonas-Simpson
The answers to the initial questions about evidence toured a live performance of I’m Still Here to com-
or congruence with reality often lead to a decision to plete a longitudinal study funded by the Social Sci-
pursue the more difficult task of studying the theory. ences and Humanities Research Council of Canada
A commitment to learn more requires some attrac- (SSHRC); this study evaluated knowledge translation
tion to the basic underlying values and assumptions through artistic performance.
about humanuniverse and health. These values recog- 3. Jonas-Simpson’s work on loss for mothers who
nize that people have their own unique views about experience the loss of their baby has been in-
life and their health situations. They speak about what formed by humanbecoming and findings pre-
things mean on a personal level; value their priorities sented in New York in an interactive exhibit of
and pursue what is important to them; want to make stories, poetry, photographs, and research-inspired
their own choices; and speak about paradoxical paintings by artist Ann Bayly for professionals and
thoughts and feelings, saying on the one hand this mothers invited to share their own stories in a
480 UNIT IV Nursing Theories
journal. Most recently, it has informed the cocre- importance of listening and being nonjudgmental.
ation of two videos: Enduring Love: Transforming They also described being more satisfied in their
Loss is about how mothers and their families live roles, understanding how humanbecoming can
with the loss of a child, and Why Did Baby Die? guide their relationships with their colleagues and
Mothering Children Living with the Loss, Love and with patients and families, feeling renewed in their
Continuing Presence of a Baby Sibling focuses on commitment to nursing, and learning from
the surviving children. Both videos are available younger nurses. Protégé participants also shifted
from http://bookstore.yorku.ca. in the way they described the importance of the
4. The humanbecoming mentoring model (Parse, mentoring experience. They appreciated the guid-
2008b) was used in a study (Bournes & Plummer, ance and advice about work and skills that they
2011) that examined the impact of a mentoring had anticipated would come with the mentoring
program with experienced critical care nurses and experience, but they also shared that the mentor-
new graduate nurses interested in a career in criti- ship was inspiring to them and helped them to
cal care. It was designed to address critical issues imagine many career possibilities for their future
relating to recruitment and retention of critical in nursing. They also described respecting others’
care nurses, to enhance nurse mentoring capacity views, being less judgmental and more under-
at a university-affiliated teaching hospital, to eval- standing, listening more attentively to others’ sto-
uate a mentoring program for staff nurses, and to ries, and gaining new friends. They described
extend knowledge about the effectiveness and gen- acquiring new insights about people and about
eralizability the humanbecoming 80/20 model nursing, feeling more rounded, and understanding
(Bournes & Ferguson-Paré, 2007). A total of 11 themselves and their career goals more clearly.
experienced critical care nurse participants and 13 They also appreciated seeing the bigger picture in
new graduate nurse participants engaged in the relation to having a better understanding of the
program together. They spent 80% of their time in variety of nursing roles and of the various practice
direct patient care and 20% on professional devel- settings represented by participants in the study.
opment, with a focus on learning about humanbe- 5. The humanbecoming leading-following and teaching-
coming-guided nursing practice and mentoring learning models are used in Geneva, Switzerland,
and working together in mentoring dyads. The in health care settings and community centers for
experienced critical care nurses also participated families of persons living with cancer.
in separate humanbecoming mentor development There are convincing indications that the human-
workshops throughout the study. Findings dem- becoming theory is a fitting guide for practitioners
onstrated an overall increase in satisfaction of who want to create respectful partnerships with peo-
critical care nurses shown in the results of serial ple seeking assistance with health and quality of life.
employee opinion surveys. Sick time, overtime, More than 2 decades ago, Phillips (1987) suggested
and turnover trended downward among the par- that Parse’s work would transform the knowledge base
ticipant group as compared to nonparticipants. and the practice of nursing to a unitary perspective.
Mentor group participants shifted in the ways in Indeed, the humanbecoming theory is transforming
which they described the importance of the men- practice in numerous settings, and evaluations are
torship experience. Mentor participants, though positive (Bournes, 2002b; Bournes & Ferguson-Paré,
frustrated at times with having to learn theory, ap- 2007; Bournes, Plummer, Hollett, et al., 2011; Jonas,
preciated the refreshing and satisfying opportunity 1995; Legault & Ferguson-Paré, 1999). The humanbe-
to engage with their protégés. They described feel- coming theory directs attention to persons’ meanings
ing respected, feeling supported, and being chal- of health and quality of life and to their wishes, needs,
lenged in their learning to view the importance concerns, and preferences for information and care.
of nursing in a new way. They also described The future of health care is based on the development
deeper, more connected relationships than they of theories and practices that honor and respect peo-
had anticipated prior to the study. They spoke ple as experts about life experience and health. At least
about respect and concern for one another and the five of the largest teaching hospitals in Canada have
CHAPTER 24 Rosemarie Rizzo Parse 481
supported nurses piloting and implementing stan- and teach the humanbecoming school of thought, more
dards of practice that are explicitly informed by hu- nurses explore the theory in practice. Learning the
manbecoming. University Health Network, the largest theory requires formal study, quiet contemplation, and
teaching hospital affiliated with the University of creative synthesis. As more nurses use the theory in
Toronto, supported nurses to use 20% of their time to practice and research and leadership, their scholarly
participate in teaching-learning sessions informed by dialogue advances the nursing discipline.
humanbecoming. A 2-year-long pilot study evaluated The theory of humanbecoming continues as a
changes when a surgical unit used humanbecoming theory for the future. As nurses question how they are
patient-centered care (Bournes & Ferguson-Paré, relating with others and question the knowledge base
2007). This pilot was replicated on a cardiosciences of the discipline, the humanbecoming theory pro-
unit at Regina General Hospital in Saskatchewan, vides a perspective and field of possibilities for change
Canada (Bournes, Ferguson-Paré, Plummer, & Kyle, and growth. Administrators who engage nurses are
2009) and on two additional units at University Health continuing to clarify not only what they want from
Network in Toronto, Canada, with similar results professionals but also how they want professionals to
(Bournes & Ferguson-Paré, 2007). perform. The mechanistic approach continues to lose
appeal for health care professionals whose mandate is
to relate to people as human beings living with health
Summary and illness, hope and no hope, joy and sorrow, and life
Work with the humanbecoming school of thought con- and death. This theory is a humanbecoming approach
tinues to evolve, as does the theory itself. An important for nurses and even more as humankind evolves.
development happened in 1998, when Parse extended
the humanbecoming school of thought and introduced
the text, Community: A Humanbecoming Perspective CASE STUDY
(2003), which offers new concepts about change in Mrs. Brown, a 48-year-old woman, is living with a
community. Further explication of the community diagnosis of breast cancer. She has just come into
model is found in Parse’s (2012b) article, “New Human- the oncology clinic for her third round of chemo-
becoming Conceptualizations and the Humanbecom- therapy. When asked how she is doing, Mrs. Brown
ing Community Model: Expansions with Sciencing and starts speaking about how tired she is and how she
Living the Art.” Parse has created humanbecoming is feeling burdened with keeping secrets from her
teaching-learning (Parse, 2004), mentoring (Parse, daughter. Mrs. Brown has not told her daughter
2008b), leading-following (Parse, 2008a, 2011a), and about her cancer diagnosis because she is afraid of
family models (Parse, 2009a) that are being utilized in how her daughter might react. Mrs. Brown says
research, leadership, practice, and education settings she is just barely holding on to things at this time,
(Bournes, 2013; Condon, 2010b, 2011; Maillard-Struby, and she cannot take much more. She is also con-
2012; Florczak, Falkenstern, & Baumann, 2010; Kim, cerned about the chemotherapy and what she can
Lee, & Baumann, 2011; Milton, 2010a, 2010b, 2011, expect, because the side effects are getting more
2012a; Morrow, 2012a). Ongoing research expands un- intense. Consider Mrs. Brown in the critical think-
derstanding and illuminates new relationships among ing activities that follow.
theoretical concepts. As schools of nursing introduce
CRITICAL THINKING ACTIVITIES
1. Think about Parse’s (1998) practice methodology— In order to invite Mrs. Brown to speak, the nurse
illuminating meaning (explicating), synchronizing may initially ask her to say more about her situa-
rhythms (dwelling with), and mobilizing transcen- tion. In the cadence of speech, Mrs. Brown may
dence (moving beyond). Nurses live true presence pause, giving the nurse an opening to pose ques-
with persons, and this means centering and pre- tions that assist Mrs. Brown’s exploration of how
paring to bear witness to Mrs. Brown’s reality. she is feeling. The nurse may ask: What is the
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