Change:
A Central Concern of DANIEL J.
Nursing
DEFEO, RN; MA*
The purpose of this paper is to explore the concept of change. More precisely, considering insights from Buddhism, existential philosophy, and modern developmental thought, this paper will discuss two aspects of change: (a) change as a fundamental, inevitable aspect of life, and (b) change as a process of risking to choose. The discussion includes an analysis of the correspondence of the concept with four nursing frameworks, and some implications for nursing theory, research, and practice.
Change is a principle basic to the universe. It has been the foundation of Eastern thought for thousands of years. The Tao Te Ching says: &dquo;The Ten Thousand things rise and fall without cease&dquo; (Lao Tsu, 1972, p. 2). Buddhism says: &dquo;The basic teaching ... is the teaching of
transiency, or change. That everything changes is the basic truth for each existence. No one can deny this truth, and all the teaching of Buddhism is condensed within it&dquo; (Suzuki, 1970, p. 102). The universe is in flux. Human beings, as part of the universe, are in
flux. As such, the human
being is process rather than an object. In existentialist terminology : &dquo;Man is not, but is forever becoming&dquo; (Clemence, 1966, p. 502). The views of Buddhism are congruent with existentialism: &dquo;Because each existence is in constant change there is no abiding self. In fact, the self nature of each existence is nothing but change&dquo; (Suzuki, 1970, p. 102).
Nursing theorists also focus on change in human life. Roy (1987) speaks of &dquo;adaptation&dquo; &dquo;constantly changing point&dquo; (p. 42). King (1981) notes that there are &dquo;continuous changes in individuals at the cellular, molecular, and behavioral levels&dquo; (p. 148). Rogers’ (1987) human field pattern &dquo;changes continuously and innovatively&dquo; (p. 143). Parse (1987) states frankly: &dquo;Man is always changing, always in the process of transforming&dquo; (p. 165). as a
The quest of much modern thought has been to discern pattern and structure within unceasing change, especially as it pertains to humans. Change in humans is often referred to as developing. The developmental-structuralists have described in detail the specifics of
Key Words: Change, Development, Transformation, King, Parse, Rogers, Roy Received April 17, 1989 Accepted May 25, 1989 West Virginia University, Morgantown, WV. *
Maslow ( 1968), Sullivan Freud (1969), Erickson (1963), Jung (1953), (1972), Piaget (1951), and Kohlberg (1981) have their differences, but they seem to agree: there is a coherent structure to human devel-
human
development.
oping. Wilbur (1983) is perhaps the foremost thinker in transpersonal psychology, the discipline that attempts to synthesize the insights of the developmental-structuralists and religious/philosophical thought to reveal the broad sweep of human development. A number of Wilbur’s insights are important in considering the concept of change. Regarding the thrust of human development, Wilbur (1983) notes: The cognitive studies of Piaget and Werner, the works of Loevinger and Arieti and Maslow and Jakobsen, the moral development studies of Kohlberg-all subscribe, in whole or in part, to the concept of stages of increasing complexity, integration, and unity. (p. 85)
Human developing is coherent. It is complex and diverse, yet there is an underlying integration and unity. Each individual unfolding mirrors a deeper pattern. This is the message of modern developmental thought. The basic structure of life exists before and after the individual. It is this deeper pattern which joins all human beings; it is the commonality that transcends geographical, cultural, and family differences. This commonality, however, is not that identity for each human being is a unique, never to be duplicated, unfolding of the deep pattern. It is that every human is provided with the identical rough script; the final product assumes a variety of forms. The rough script is real but so are the differences. Wilbur suggests an interesting metaphor. He likens human development to a 10-story building. Each floor represents a stage in the unfolding of human development: &dquo;each floor itself is a deep structure, while the variable components on each floor-its actual furniture so to speak-are surface structures&dquo; (1984, p. 45). The 10-story building and its floors are the givens, the commonalities, of
88
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on May 8, 2015
each human life, but. the arrangement of the particulars of each floor varies with historical era and culture. The
deep structures of consciousness are relatively ahistorical, collective, invariant, and cross-cultural, whereas their surface structures everywhere variable, historically conditioned, and culturally molded (p. 47). are
consider the onset of puberty. universal human event (at least potentially), part of the commonality of the human race. However, it is obvious that the specifics of this event for each individual are dramatically related to a multitude of factors: familial, cultural, and historical. Wilbur ( 1984) calls the upward movement of human development through new levels of greater complexity and diversity &dquo;transformation.&dquo; On the other hand, the stabilizing, the &dquo;fleshing out&dquo; of development that occurs on a particular level he calls &dquo;translation.&dquo; For
example,
This is
a
&dquo;
Development or growth, then, two
seems
to
occur
in
primary dimensions: horizontal-evolution-
and vertical-revolutionary-tranin short, translation and transformation.... Translation apparently has one major function: to integrate, stabilize, and equilibrate its given level; transformation apparently has one major function: to go beyond its given level. This dialectic of tensions seems to constitute much of the dynamic of development (1984, p. 45-48).
ary-historical scendental,
or
be concluded from this that human life always moving in at least two directions, vertical and horizontal. The individual, then, is a process of creative tension: sameness and difference, conformity and nonconformity (Parse, 1981 ). The universal pattern of change sets the stage, where the myriad of commonalities is recognized. Yet this universal pattern of change is embroidered with the richness of specific differences to create individuals as distinct as they are alike. However, the individual is always more than the interplay of forces. In addition to the tension between the universals of being human and the specifics of a given time and place, there is always the power of choice. It
can
is
A salamander
elk, and
be bush
can
only a salamander, an elk
bush. True, a bush is complete in its bushness, yet its limits are fairly obvious. You have learned the secret of the new direction. That is: a man can be many things. Maybe anything (Robbins, 1984, p. 42). Choosing is an important part of what makes an
a
a
each person recognizable as an individual. Certainly there is the unavoidable, the givens, that create the particular individual. Yet, at least partially, one chooses one’s path. The universal forces, the specific cultural factors, and the individual power of choice interact in creative tension. All travel along .a a
familiar highway; the style in which els is unique.
one
trav-
beings attempt to comprehend and developing. Change is not simply that happens; it is an activity in something Human
to shape their
one participates. One is the coauthor of one’s life. However, with such power comes risk. To participate in the creative act of change, to be an active force in one’s developing, involves risking to choose. Why is choosing a risk? If change is so obviously inevitable, and if, indeed, choosing is
which
how then
one
why
in creating an is this creative act so often
participates
of discomfort?
Why
does
one so
identity, a source
frequently
to what must change? Why does one so often seek to avoid, albeit futilely, reflective choosing? Much has been written about why humans refuse to face what must be faced. The Buddhists name the fear of change &dquo;attachment&dquo; and suggest that it is based in ignorance, in the false belief that one can hold
cling
back the flow
by clinging.
Of course, we must know our past and this is all right. But we should not keep holding on to anything we have done ... the past is the past; now we should work on something new (Suzuki, 1970, p. 71). To choose is risky, is frightening. To choose give up the comfortable old for the questionable new. To choose is to define and shape, to delineate, to make clear. To choose is to risk being ignored, laughed at, or chastised. To choose is to risk choosing unwisely, or regretting the &dquo;road not taken.&dquo; Faced with change, the individual often feels that clinging to the known is a refuge, a preferable alternative to the risky unknown. Yet it is in risking to choose that one asserts one’s unique being. One cannot forfeit one’s participation in the creative process of developing. Clinging to the known may appear to be abrogating one’s responsibility, but will not halt the flow of change. To refuse to choose is to choose a vague, ill-defined, shadowy route. It is in taking reflective, clear, creative responsibility that one becomes, as the existentialists say, &dquo;authentic.&dquo; &dquo;Freedom,&dquo; says Sartre (1965), &dquo;which manifests itself as anguish, is characterized by a constantly renewed obligation to is to
remake the self...&dquo; (p.
Certainly
it
34-35).
requires courage
to choose. Wil-
liam Blake said: Tell me what is the price of Experience. Do Men buy it for a song? Or wisdom for a dance in the street? No. It is bought with the price of all that has ( 1979, p. 218).
a man
One makes choices and bears the responsibility for the consequences of those choices
(Parse, 1981). From responsibility comes wisdom and experience. The price, however, can be substantial. 89
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on May 8, 2015
Commitment is the ... open-eyed acceptance of one’s full share of life.... It is the acceptance of full responsibility for one’s actions. It is the willingness to take risks.... Lack of commitment, on the other hand, is a refusal to use one’s freedom, to choose. It implies an inauthentic existence (Clemence, 1966, p. 504).
Developing, therefore, involves risking to choose. The human beings’ becoming involves the courage in choosing from alternatives and taking full responsibility for choices. In doing so one participates creatively in change. One partakes in one’s unique becoming. The awareness that you are here, right now, is the ultimate fact. to make our effort moment after moment is our way. The only thing we can actually study is that on which we are working in each moment (Suzuki, 1970, p. 89).
Correspondence of Roy
Frameworks of
the and Parse
Concept with the King, Rogers, and
All four theorists have a strong sense of the transitoriness of life. Developing and choosing are components of all four frameworks. However, each approaches the idea from a slightly different direction. In this paper they will be considered in pairs: Roy and King representing the totality paradigm, and Rogers and Parse representing the simultaneity paradigm. Also, a method of exploring the two paradigms using Wilbur’s (1984) concepts of translation and transformation is offered.
The
totality paradigm Roy and King
Roy views the individual as a dynamic system responding to change (coping/adapting) within and without. Awash in internal and external stimuli, the individual copes with the subtle and not so subtle imbalances these stimuli create. Coping occurs on both an au-
tomatic/neuroendocrine and
an
level
(the &dquo;regulator&dquo;)
intellectual/emotive level (the &dquo;cogna-
manifests through adaptive behavior classified according to various modes.
tor&dquo;). Coping
The person is viewed as an adaptive system with regulator and cognator control processes acting to cope with internal and external changing stimuli to produce adaptive and ineffective responses that are manifested in behavior... (Roy, 1983, p. 266).
The overall goal of the coping/adapting process is health. Adaptive responses are those that promote &dquo;integrity, wholeness, completeness.... This refers to the person in the total life context including goals of life, activity, and creativity&dquo; (Roy, 1987, p. 42). According to Roy, &dquo;Health is a state and a process of being and becoming an integrated and whole person&dquo; (1987, p. 42). Neither adaptation nor health are static states, but rather the process of
meet the challenge of universe of continual change. Change, for Roy, is adapting and coping with the environment.
continually changing to a
Adaptation level, in an attempt to capture the dynamic aspect of adaptation, has been redefined as a constantly changing point.... Health is a dynamic concept, it is a process of being and becoming (Roy, 1987, p. 42). Roy stresses the important role that choice and
creativity play in her theory. She states that the roots of her theory are twofold: system theory and humanism. Although system theory has mechanistic overtones with its characteristics of &dquo;inputs, outputs, and self-regulation and control&dquo; (1983, p. 248), humanistic philosophy is grounded in the concepts of &dquo;a person’s creative power, purposefulness, holism, viewpoint as a value, and the interpersonal process as significant&dquo; (Roy, 1987, p. 37). Persons live in interaction with their world, are goal and future oriented, and are concerned with the meaning of life.... A person is not to be viewed as a mechanical model.... A humanistic approach of necessity takes the person’s subjectivity, that is his or her opinions and viewpoints, conscious and unconscious, into account ( 1983, p. 260).
King’s theory also focuses on the importance of change. &dquo;Individuals are time-oriented beings&dquo; ( 1987, p. 108). &dquo;Time is a continuous flow of events in successive order that implies change, a past, and a future&dquo; ( 1987, p. 110). Humans exist in the midst of unceasing change not as passive observers, but as creators. Humans experience the relationships between events and in so doing structure the flow of time in a unique way. &dquo;Time is a duration between one event and another as uniquely experienced by each human being&dquo; (1987, p. 110). King has much in common with Roy. Working from a general system theory framework, she includes the familiar concepts of internal and external stressors and continual coping. Health, again, is the process and the goal. Health is defined as dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living ( 1983, p. 179). The dynamic life experiences of the individual are the predictable stages of growth and development conditioned by the norms of the time. Health involves a compromise between conforming to these norms and setting personal goals. Within the givens of the environment, individuals and groups of individuals exercise choice. The &dquo;self ... perceives, thinks,
desires, imagines, decides, identifies and selects
means
to achieve them&dquo;
goal,
(1987, p.
110). Less
sweeping than Roy, King
90
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narrows
the
focus to the interactive process and an analysis of how this process hinders or facilitates goal achievement. An awareness of others’ perceptions, open and clear communication, and mutual goal setting are important components of the process. Ultimately, the entire process is one of compromise to &dquo;maintain balance for growth, development, and performance,&dquo; (1987, p. 110). With the demands of the environment on the one hand, and the individual’s desires and needs on the other, goals are set, results are analyzed, and new goals are formulated. This is the process of change ac-
cording to King. The
simultaneity paradigm Rogers and Parse Rogers (1987) presents three &dquo;principles of homeodynamics,&dquo; principles dealing with &dquo;the nature and direction of change&dquo; (p. 143-144). The principle of helicy states that the nature of change is &dquo;continuous, innovative, probabilistic increasing diversity of human and environmental field patterns characterized by nonrepeating rhythmicities&dquo; (p. 144). In the previous discussion of developing, it was suggested that the individual is a unique variation of elements common to all humans. Rogers (1970), too, views developing as an in-
terplay of
forms and familiar rhythms. There are always &dquo;new levels of complexity,&dquo; yet &dquo;the universe exhibits pattern and organization. It is by no means chaotic&dquo; (p. 57). It is a universe of &dquo;orderly innovation&dquo; (p. 64). There is always a link with the past in the rhythm of change, but it is &dquo;nonrepetitive.&dquo; new
The helix is an evolving spiral. &dquo;As each new curve of the spiral appears, cyclical continuity is revealed. What seems to be repetition is in
reality only similarity&dquo; (p. 63). One is forever faced in each moment with the new, with &dquo;a future that cannot be foretold&dquo; (Rogers, 1970, p. 57). Yet one is not merely swept by the river of change. Rather, Rogers (1987) suggests that &dquo;people have the capacity to participate knowingly and probabilistically in the process of change&dquo; (p. 141). Parse develops more fully this consideration of change and the implications it has for human life. The notion of change appears repeatedly in Parse’s (1981, 1987) theory. &dquo;Man
always changing, always in t,he process of transforming&dquo; (p. 165). &dquo;One is only in the moment, which is fleeting&dquo; (p. 168). &dquo;Health is man’s unfolding ... a continuously changing is
process&dquo; (p. 160). Like Rogers, Parse notes that diversity and creativity are the hallmarks of change. &dquo;All is not known explicitly. Man is always unfolding mystery&dquo; (Parse, 1987, p. 164). There is a link with what was, but the emphasis is on diversity : &dquo;There are multiple possibilities unfolding&dquo; (p. 162).
Parse
(1987) explains the meaning of choice developing, particularly in the third
in human
of her three principles: &dquo;Cotranscending with the possibles is powering unique ways of originating in the process of transforming&dquo; (p. 165). This principle weaves together changing and choosing in the context of interaction with the environment and others. &dquo;Man coparticipates with environment in the simultaneous unfolding called change&dquo; (1981, p. 62). Humans are creative beings. One shapes becomis choosing through choice. &dquo;Originating ing a particular way of self emergence through inventing unique ways of living&dquo; ( 1981, p. 60). Through originating/choosing one is both in rhythm with the changing environment and ...
yet simultaneously transcending as one brings about the actual from the possible. Powering is the energy that drives originating. Powering is the creative tension, the give and take, the &dquo;pushing and resisting&dquo; that occurs &dquo;between man and nature, between man and man, between individuals and group, and between groups and groups&dquo; (1981, p. 57). In the rhythm of powering one interrelates with the environment, with the infinite possibles. In this interrelationship with the environment, one creatively chooses and generates the unique self.
Choosing, &dquo;distinguishing self from others,&dquo; (1987), is a weighty responsibility. responsibility for his choices&dquo; (p. 160). Transforming is &dquo;struggling&dquo; (p. 165). The rhythm of life is uneven: &dquo;the ups and downs, the struggles, the moments of joy, the unevenness of everyday living&dquo; (p. 168). Choosing is not easy: &dquo;Man cannot be all possibilities at once; in choosing one is both ennotes Parse &dquo;Man bears
abled and limited&dquo; ( 1981, p. 53). One faces the &dquo;ambiguity of not knowing the actual outcomes in living and paradox of uncertainty&dquo; ( 1981, p. 61). Human beings and the environment are linked in rhythmically transforming reality. In choosing from an infinity of possibles in each moment, each person shapes a unique devel-
oping. Implications for Nursing Theory, Practice,
and
Research
Theory The phenomenon of change as it relates to the human experience can be considered a central concern of nursing. This provides the basic cohesiveness of nursing theory. The two paradigms can be explored as two aspects of nursing’s overall concern with the phenomenon of change/developing. Wilbur’s (1984) concepts of translation and transformation offer a vehicle with which to approach nursing theory in general and especially the two para-
digms. 91
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Translation and the totality paradigm Roy and King are representative of what has come to be called the totality paradigm. This world view focuses on change in human life as a continual struggle between the human being and environment. Humans are &dquo;adaptive systems&dquo; (Roy, 1987, p. 38). &dquo;Internal and external influences, conditions and circumstances&dquo; (Roy, 1987, p. 42) affect the individual’s behavior. Humans attempt to cope, to maintain a balance, to reduce stress. In essence, the individual attempts to wrest a physical, psychic, and emotional stability (health) from an unstable, changing environment. &dquo;In the totality paradlgm, man is considered a bio-psycho-social-spiritual organism whose environment can be manipulated to maintain or promote balance&dquo; (Parse, 1987, p. 32). This is strikingly similar to Wilbur’s concept of translation: &dquo;Translation apparently has one major function: to integrate, to stabilize, and equilibrate...&dquo; ( 1984, p. 48). The totality paradigm focuses on the horizontal aspect of life, on the individual’s attempt to find stability within a given level of growth and development.
Not that the totality paradigm excludes vertical growth; Roy recently introduced the concept of becoming more, of moving beyond mere action/feedback loops. &dquo;This refers to the person in the total life context, including goals of creativity&dquo; ( 1987, p. 42). King suggests that man’s interaction with the environment leads to growth and that imagination plays an important role. Humans &dquo;desire and imagine&dquo; (1987, p. 110). Choice, though not the same as in the simultaneity paradigm, remains an important aspect of the human situation even within this approach. However, for the most part, the focus is on balance rather than potential. The major con...
cern
is
maintaining equilibrium,
or
correcting
alterations wrought by the shifting environment, internal and external. The totality paradigm is not incorrect, but its main focus is limited to one aspect of change: change as the universal force that upsets equilibrium. This paradigm is most useful when considering disease processes. A state of relative calm (physical, emotional) is interrupted by stress (trauma, disease, loss). Nursing is assisting the individual in an attempt to regain integrity, stability, and balance.
the environment. Man gives meaning to situations and is responsible for choices in moving beyond what is&dquo; (Parse, 1987, p. 136). The thrust of this world view is to encourage one to see that in any situation many options exist. &dquo;Peoples and their environments are perceived as continuously creative in their evolutions&dquo; (Rogers, 1987, p. 141 ). Humans are not seen as struggling to preserve a fragile stability, but rather are presented with a wealth of possibilities in each moment. It suggests that instead of coping with what is, one might discover what might be. Again, the simultaneity view is not incorrect. The limitations inherent in viewing the human situation as continual readjustment to maintain equilibrium are eliminated in the simultaneity paradigm, which emphasizes the vertical axis of change: change as the wondrous force that presents choice and possibility in each moment. There are some who might consider it unrealistic. Others might suggest that in comparison the totality paradigm offers a rather bland view of reality. Although the totality paradigms has been predominant, it is clear that the simultaneity paradigm has an important role to play in nursing theory. By considering change as the fundamental truth of human life and translation and transformation as two aspects of the phenomena of change, one can emphasize that the two paradigms are coexistent. Coexistence of the two paradigms can be demonstrated by expansion of Wilbur’s ( 1983, p. 119) diagram ...
(Figure 1). in the totality paradigm, is rephorizontal arrow and the osthe by in the simulline. Transformation, cillating taneity paradigm, is represented by the vertical arrow and a spiral resembling Rogers’ helix. Change is the eternal reality of human existence. Change can be conceptualized as moving on two axes, horizontal and vertical. Change on a horizontal axis represents stability-seeking, the continual oscillation between acceptable parameters. Change on a vertical axis represents the coming to be of the new, the exploration of new possibilities. Nursing theory focuses on horizontal and vertical change, translation and transformation, in the
Translation,
resented
human experience. Practice Nurses interact with humans in the midst of
Transformation and the simultaneity paradigm The simultaneity paradigm speaks to Wilbur’s concept of transformation: &dquo;to go beyond&dquo; (1984, p. 48). Rogers and Parse focus on the human being’s potential activity. All of the emphasis in the simultaneity paradigm is on the newness, the possibilities, the potential in each moment. &dquo;Man is an open being free to choose in rhythmical mutual interchange with
great change. Nursing practice can be seen in relation to the two paradigms and the two aspects of change, translation and transformation.
Nursing practice within the totality paradigm focuses on change as translation. The patient is viewed as an equilibrium-seeking system temporarily in a state of disequilibrium. Internal and external factors have up-
92
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on May 8, 2015
A Central Concern of DANIEL J.
Nursing
DEFEO, RN; MA*
The purpose of this paper is to explore the concept of change. More precisely, considering insights from Buddhism, existential philosophy, and modern developmental thought, this paper will discuss two aspects of change: (a) change as a fundamental, inevitable aspect of life, and (b) change as a process of risking to choose. The discussion includes an analysis of the correspondence of the concept with four nursing frameworks, and some implications for nursing theory, research, and practice.
Change is a principle basic to the universe. It has been the foundation of Eastern thought for thousands of years. The Tao Te Ching says: &dquo;The Ten Thousand things rise and fall without cease&dquo; (Lao Tsu, 1972, p. 2). Buddhism says: &dquo;The basic teaching ... is the teaching of
transiency, or change. That everything changes is the basic truth for each existence. No one can deny this truth, and all the teaching of Buddhism is condensed within it&dquo; (Suzuki, 1970, p. 102). The universe is in flux. Human beings, as part of the universe, are in
flux. As such, the human
being is process rather than an object. In existentialist terminology : &dquo;Man is not, but is forever becoming&dquo; (Clemence, 1966, p. 502). The views of Buddhism are congruent with existentialism: &dquo;Because each existence is in constant change there is no abiding self. In fact, the self nature of each existence is nothing but change&dquo; (Suzuki, 1970, p. 102).
Nursing theorists also focus on change in human life. Roy (1987) speaks of &dquo;adaptation&dquo; &dquo;constantly changing point&dquo; (p. 42). King (1981) notes that there are &dquo;continuous changes in individuals at the cellular, molecular, and behavioral levels&dquo; (p. 148). Rogers’ (1987) human field pattern &dquo;changes continuously and innovatively&dquo; (p. 143). Parse (1987) states frankly: &dquo;Man is always changing, always in the process of transforming&dquo; (p. 165). as a
The quest of much modern thought has been to discern pattern and structure within unceasing change, especially as it pertains to humans. Change in humans is often referred to as developing. The developmental-structuralists have described in detail the specifics of
Key Words: Change, Development, Transformation, King, Parse, Rogers, Roy Received April 17, 1989 Accepted May 25, 1989 West Virginia University, Morgantown, WV. *
Maslow ( 1968), Sullivan Freud (1969), Erickson (1963), Jung (1953), (1972), Piaget (1951), and Kohlberg (1981) have their differences, but they seem to agree: there is a coherent structure to human devel-
human
development.
oping. Wilbur (1983) is perhaps the foremost thinker in transpersonal psychology, the discipline that attempts to synthesize the insights of the developmental-structuralists and religious/philosophical thought to reveal the broad sweep of human development. A number of Wilbur’s insights are important in considering the concept of change. Regarding the thrust of human development, Wilbur (1983) notes: The cognitive studies of Piaget and Werner, the works of Loevinger and Arieti and Maslow and Jakobsen, the moral development studies of Kohlberg-all subscribe, in whole or in part, to the concept of stages of increasing complexity, integration, and unity. (p. 85)
Human developing is coherent. It is complex and diverse, yet there is an underlying integration and unity. Each individual unfolding mirrors a deeper pattern. This is the message of modern developmental thought. The basic structure of life exists before and after the individual. It is this deeper pattern which joins all human beings; it is the commonality that transcends geographical, cultural, and family differences. This commonality, however, is not that identity for each human being is a unique, never to be duplicated, unfolding of the deep pattern. It is that every human is provided with the identical rough script; the final product assumes a variety of forms. The rough script is real but so are the differences. Wilbur suggests an interesting metaphor. He likens human development to a 10-story building. Each floor represents a stage in the unfolding of human development: &dquo;each floor itself is a deep structure, while the variable components on each floor-its actual furniture so to speak-are surface structures&dquo; (1984, p. 45). The 10-story building and its floors are the givens, the commonalities, of
88
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on May 8, 2015
each human life, but. the arrangement of the particulars of each floor varies with historical era and culture. The
deep structures of consciousness are relatively ahistorical, collective, invariant, and cross-cultural, whereas their surface structures everywhere variable, historically conditioned, and culturally molded (p. 47). are
consider the onset of puberty. universal human event (at least potentially), part of the commonality of the human race. However, it is obvious that the specifics of this event for each individual are dramatically related to a multitude of factors: familial, cultural, and historical. Wilbur ( 1984) calls the upward movement of human development through new levels of greater complexity and diversity &dquo;transformation.&dquo; On the other hand, the stabilizing, the &dquo;fleshing out&dquo; of development that occurs on a particular level he calls &dquo;translation.&dquo; For
example,
This is
a
&dquo;
Development or growth, then, two
seems
to
occur
in
primary dimensions: horizontal-evolution-
and vertical-revolutionary-tranin short, translation and transformation.... Translation apparently has one major function: to integrate, stabilize, and equilibrate its given level; transformation apparently has one major function: to go beyond its given level. This dialectic of tensions seems to constitute much of the dynamic of development (1984, p. 45-48).
ary-historical scendental,
or
be concluded from this that human life always moving in at least two directions, vertical and horizontal. The individual, then, is a process of creative tension: sameness and difference, conformity and nonconformity (Parse, 1981 ). The universal pattern of change sets the stage, where the myriad of commonalities is recognized. Yet this universal pattern of change is embroidered with the richness of specific differences to create individuals as distinct as they are alike. However, the individual is always more than the interplay of forces. In addition to the tension between the universals of being human and the specifics of a given time and place, there is always the power of choice. It
can
is
A salamander
elk, and
be bush
can
only a salamander, an elk
bush. True, a bush is complete in its bushness, yet its limits are fairly obvious. You have learned the secret of the new direction. That is: a man can be many things. Maybe anything (Robbins, 1984, p. 42). Choosing is an important part of what makes an
a
a
each person recognizable as an individual. Certainly there is the unavoidable, the givens, that create the particular individual. Yet, at least partially, one chooses one’s path. The universal forces, the specific cultural factors, and the individual power of choice interact in creative tension. All travel along .a a
familiar highway; the style in which els is unique.
one
trav-
beings attempt to comprehend and developing. Change is not simply that happens; it is an activity in something Human
to shape their
one participates. One is the coauthor of one’s life. However, with such power comes risk. To participate in the creative act of change, to be an active force in one’s developing, involves risking to choose. Why is choosing a risk? If change is so obviously inevitable, and if, indeed, choosing is
which
how then
one
why
in creating an is this creative act so often
participates
of discomfort?
Why
does
one so
identity, a source
frequently
to what must change? Why does one so often seek to avoid, albeit futilely, reflective choosing? Much has been written about why humans refuse to face what must be faced. The Buddhists name the fear of change &dquo;attachment&dquo; and suggest that it is based in ignorance, in the false belief that one can hold
cling
back the flow
by clinging.
Of course, we must know our past and this is all right. But we should not keep holding on to anything we have done ... the past is the past; now we should work on something new (Suzuki, 1970, p. 71). To choose is risky, is frightening. To choose give up the comfortable old for the questionable new. To choose is to define and shape, to delineate, to make clear. To choose is to risk being ignored, laughed at, or chastised. To choose is to risk choosing unwisely, or regretting the &dquo;road not taken.&dquo; Faced with change, the individual often feels that clinging to the known is a refuge, a preferable alternative to the risky unknown. Yet it is in risking to choose that one asserts one’s unique being. One cannot forfeit one’s participation in the creative process of developing. Clinging to the known may appear to be abrogating one’s responsibility, but will not halt the flow of change. To refuse to choose is to choose a vague, ill-defined, shadowy route. It is in taking reflective, clear, creative responsibility that one becomes, as the existentialists say, &dquo;authentic.&dquo; &dquo;Freedom,&dquo; says Sartre (1965), &dquo;which manifests itself as anguish, is characterized by a constantly renewed obligation to is to
remake the self...&dquo; (p.
Certainly
it
34-35).
requires courage
to choose. Wil-
liam Blake said: Tell me what is the price of Experience. Do Men buy it for a song? Or wisdom for a dance in the street? No. It is bought with the price of all that has ( 1979, p. 218).
a man
One makes choices and bears the responsibility for the consequences of those choices
(Parse, 1981). From responsibility comes wisdom and experience. The price, however, can be substantial. 89
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Commitment is the ... open-eyed acceptance of one’s full share of life.... It is the acceptance of full responsibility for one’s actions. It is the willingness to take risks.... Lack of commitment, on the other hand, is a refusal to use one’s freedom, to choose. It implies an inauthentic existence (Clemence, 1966, p. 504).
Developing, therefore, involves risking to choose. The human beings’ becoming involves the courage in choosing from alternatives and taking full responsibility for choices. In doing so one participates creatively in change. One partakes in one’s unique becoming. The awareness that you are here, right now, is the ultimate fact. to make our effort moment after moment is our way. The only thing we can actually study is that on which we are working in each moment (Suzuki, 1970, p. 89).
Correspondence of Roy
Frameworks of
the and Parse
Concept with the King, Rogers, and
All four theorists have a strong sense of the transitoriness of life. Developing and choosing are components of all four frameworks. However, each approaches the idea from a slightly different direction. In this paper they will be considered in pairs: Roy and King representing the totality paradigm, and Rogers and Parse representing the simultaneity paradigm. Also, a method of exploring the two paradigms using Wilbur’s (1984) concepts of translation and transformation is offered.
The
totality paradigm Roy and King
Roy views the individual as a dynamic system responding to change (coping/adapting) within and without. Awash in internal and external stimuli, the individual copes with the subtle and not so subtle imbalances these stimuli create. Coping occurs on both an au-
tomatic/neuroendocrine and
an
level
(the &dquo;regulator&dquo;)
intellectual/emotive level (the &dquo;cogna-
manifests through adaptive behavior classified according to various modes.
tor&dquo;). Coping
The person is viewed as an adaptive system with regulator and cognator control processes acting to cope with internal and external changing stimuli to produce adaptive and ineffective responses that are manifested in behavior... (Roy, 1983, p. 266).
The overall goal of the coping/adapting process is health. Adaptive responses are those that promote &dquo;integrity, wholeness, completeness.... This refers to the person in the total life context including goals of life, activity, and creativity&dquo; (Roy, 1987, p. 42). According to Roy, &dquo;Health is a state and a process of being and becoming an integrated and whole person&dquo; (1987, p. 42). Neither adaptation nor health are static states, but rather the process of
meet the challenge of universe of continual change. Change, for Roy, is adapting and coping with the environment.
continually changing to a
Adaptation level, in an attempt to capture the dynamic aspect of adaptation, has been redefined as a constantly changing point.... Health is a dynamic concept, it is a process of being and becoming (Roy, 1987, p. 42). Roy stresses the important role that choice and
creativity play in her theory. She states that the roots of her theory are twofold: system theory and humanism. Although system theory has mechanistic overtones with its characteristics of &dquo;inputs, outputs, and self-regulation and control&dquo; (1983, p. 248), humanistic philosophy is grounded in the concepts of &dquo;a person’s creative power, purposefulness, holism, viewpoint as a value, and the interpersonal process as significant&dquo; (Roy, 1987, p. 37). Persons live in interaction with their world, are goal and future oriented, and are concerned with the meaning of life.... A person is not to be viewed as a mechanical model.... A humanistic approach of necessity takes the person’s subjectivity, that is his or her opinions and viewpoints, conscious and unconscious, into account ( 1983, p. 260).
King’s theory also focuses on the importance of change. &dquo;Individuals are time-oriented beings&dquo; ( 1987, p. 108). &dquo;Time is a continuous flow of events in successive order that implies change, a past, and a future&dquo; ( 1987, p. 110). Humans exist in the midst of unceasing change not as passive observers, but as creators. Humans experience the relationships between events and in so doing structure the flow of time in a unique way. &dquo;Time is a duration between one event and another as uniquely experienced by each human being&dquo; (1987, p. 110). King has much in common with Roy. Working from a general system theory framework, she includes the familiar concepts of internal and external stressors and continual coping. Health, again, is the process and the goal. Health is defined as dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living ( 1983, p. 179). The dynamic life experiences of the individual are the predictable stages of growth and development conditioned by the norms of the time. Health involves a compromise between conforming to these norms and setting personal goals. Within the givens of the environment, individuals and groups of individuals exercise choice. The &dquo;self ... perceives, thinks,
desires, imagines, decides, identifies and selects
means
to achieve them&dquo;
goal,
(1987, p.
110). Less
sweeping than Roy, King
90
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narrows
the
focus to the interactive process and an analysis of how this process hinders or facilitates goal achievement. An awareness of others’ perceptions, open and clear communication, and mutual goal setting are important components of the process. Ultimately, the entire process is one of compromise to &dquo;maintain balance for growth, development, and performance,&dquo; (1987, p. 110). With the demands of the environment on the one hand, and the individual’s desires and needs on the other, goals are set, results are analyzed, and new goals are formulated. This is the process of change ac-
cording to King. The
simultaneity paradigm Rogers and Parse Rogers (1987) presents three &dquo;principles of homeodynamics,&dquo; principles dealing with &dquo;the nature and direction of change&dquo; (p. 143-144). The principle of helicy states that the nature of change is &dquo;continuous, innovative, probabilistic increasing diversity of human and environmental field patterns characterized by nonrepeating rhythmicities&dquo; (p. 144). In the previous discussion of developing, it was suggested that the individual is a unique variation of elements common to all humans. Rogers (1970), too, views developing as an in-
terplay of
forms and familiar rhythms. There are always &dquo;new levels of complexity,&dquo; yet &dquo;the universe exhibits pattern and organization. It is by no means chaotic&dquo; (p. 57). It is a universe of &dquo;orderly innovation&dquo; (p. 64). There is always a link with the past in the rhythm of change, but it is &dquo;nonrepetitive.&dquo; new
The helix is an evolving spiral. &dquo;As each new curve of the spiral appears, cyclical continuity is revealed. What seems to be repetition is in
reality only similarity&dquo; (p. 63). One is forever faced in each moment with the new, with &dquo;a future that cannot be foretold&dquo; (Rogers, 1970, p. 57). Yet one is not merely swept by the river of change. Rather, Rogers (1987) suggests that &dquo;people have the capacity to participate knowingly and probabilistically in the process of change&dquo; (p. 141). Parse develops more fully this consideration of change and the implications it has for human life. The notion of change appears repeatedly in Parse’s (1981, 1987) theory. &dquo;Man
always changing, always in t,he process of transforming&dquo; (p. 165). &dquo;One is only in the moment, which is fleeting&dquo; (p. 168). &dquo;Health is man’s unfolding ... a continuously changing is
process&dquo; (p. 160). Like Rogers, Parse notes that diversity and creativity are the hallmarks of change. &dquo;All is not known explicitly. Man is always unfolding mystery&dquo; (Parse, 1987, p. 164). There is a link with what was, but the emphasis is on diversity : &dquo;There are multiple possibilities unfolding&dquo; (p. 162).
Parse
(1987) explains the meaning of choice developing, particularly in the third
in human
of her three principles: &dquo;Cotranscending with the possibles is powering unique ways of originating in the process of transforming&dquo; (p. 165). This principle weaves together changing and choosing in the context of interaction with the environment and others. &dquo;Man coparticipates with environment in the simultaneous unfolding called change&dquo; (1981, p. 62). Humans are creative beings. One shapes becomis choosing through choice. &dquo;Originating ing a particular way of self emergence through inventing unique ways of living&dquo; ( 1981, p. 60). Through originating/choosing one is both in rhythm with the changing environment and ...
yet simultaneously transcending as one brings about the actual from the possible. Powering is the energy that drives originating. Powering is the creative tension, the give and take, the &dquo;pushing and resisting&dquo; that occurs &dquo;between man and nature, between man and man, between individuals and group, and between groups and groups&dquo; (1981, p. 57). In the rhythm of powering one interrelates with the environment, with the infinite possibles. In this interrelationship with the environment, one creatively chooses and generates the unique self.
Choosing, &dquo;distinguishing self from others,&dquo; (1987), is a weighty responsibility. responsibility for his choices&dquo; (p. 160). Transforming is &dquo;struggling&dquo; (p. 165). The rhythm of life is uneven: &dquo;the ups and downs, the struggles, the moments of joy, the unevenness of everyday living&dquo; (p. 168). Choosing is not easy: &dquo;Man cannot be all possibilities at once; in choosing one is both ennotes Parse &dquo;Man bears
abled and limited&dquo; ( 1981, p. 53). One faces the &dquo;ambiguity of not knowing the actual outcomes in living and paradox of uncertainty&dquo; ( 1981, p. 61). Human beings and the environment are linked in rhythmically transforming reality. In choosing from an infinity of possibles in each moment, each person shapes a unique devel-
oping. Implications for Nursing Theory, Practice,
and
Research
Theory The phenomenon of change as it relates to the human experience can be considered a central concern of nursing. This provides the basic cohesiveness of nursing theory. The two paradigms can be explored as two aspects of nursing’s overall concern with the phenomenon of change/developing. Wilbur’s (1984) concepts of translation and transformation offer a vehicle with which to approach nursing theory in general and especially the two para-
digms. 91
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Translation and the totality paradigm Roy and King are representative of what has come to be called the totality paradigm. This world view focuses on change in human life as a continual struggle between the human being and environment. Humans are &dquo;adaptive systems&dquo; (Roy, 1987, p. 38). &dquo;Internal and external influences, conditions and circumstances&dquo; (Roy, 1987, p. 42) affect the individual’s behavior. Humans attempt to cope, to maintain a balance, to reduce stress. In essence, the individual attempts to wrest a physical, psychic, and emotional stability (health) from an unstable, changing environment. &dquo;In the totality paradlgm, man is considered a bio-psycho-social-spiritual organism whose environment can be manipulated to maintain or promote balance&dquo; (Parse, 1987, p. 32). This is strikingly similar to Wilbur’s concept of translation: &dquo;Translation apparently has one major function: to integrate, to stabilize, and equilibrate...&dquo; ( 1984, p. 48). The totality paradigm focuses on the horizontal aspect of life, on the individual’s attempt to find stability within a given level of growth and development.
Not that the totality paradigm excludes vertical growth; Roy recently introduced the concept of becoming more, of moving beyond mere action/feedback loops. &dquo;This refers to the person in the total life context, including goals of creativity&dquo; ( 1987, p. 42). King suggests that man’s interaction with the environment leads to growth and that imagination plays an important role. Humans &dquo;desire and imagine&dquo; (1987, p. 110). Choice, though not the same as in the simultaneity paradigm, remains an important aspect of the human situation even within this approach. However, for the most part, the focus is on balance rather than potential. The major con...
cern
is
maintaining equilibrium,
or
correcting
alterations wrought by the shifting environment, internal and external. The totality paradigm is not incorrect, but its main focus is limited to one aspect of change: change as the universal force that upsets equilibrium. This paradigm is most useful when considering disease processes. A state of relative calm (physical, emotional) is interrupted by stress (trauma, disease, loss). Nursing is assisting the individual in an attempt to regain integrity, stability, and balance.
the environment. Man gives meaning to situations and is responsible for choices in moving beyond what is&dquo; (Parse, 1987, p. 136). The thrust of this world view is to encourage one to see that in any situation many options exist. &dquo;Peoples and their environments are perceived as continuously creative in their evolutions&dquo; (Rogers, 1987, p. 141 ). Humans are not seen as struggling to preserve a fragile stability, but rather are presented with a wealth of possibilities in each moment. It suggests that instead of coping with what is, one might discover what might be. Again, the simultaneity view is not incorrect. The limitations inherent in viewing the human situation as continual readjustment to maintain equilibrium are eliminated in the simultaneity paradigm, which emphasizes the vertical axis of change: change as the wondrous force that presents choice and possibility in each moment. There are some who might consider it unrealistic. Others might suggest that in comparison the totality paradigm offers a rather bland view of reality. Although the totality paradigms has been predominant, it is clear that the simultaneity paradigm has an important role to play in nursing theory. By considering change as the fundamental truth of human life and translation and transformation as two aspects of the phenomena of change, one can emphasize that the two paradigms are coexistent. Coexistence of the two paradigms can be demonstrated by expansion of Wilbur’s ( 1983, p. 119) diagram ...
(Figure 1). in the totality paradigm, is rephorizontal arrow and the osthe by in the simulline. Transformation, cillating taneity paradigm, is represented by the vertical arrow and a spiral resembling Rogers’ helix. Change is the eternal reality of human existence. Change can be conceptualized as moving on two axes, horizontal and vertical. Change on a horizontal axis represents stability-seeking, the continual oscillation between acceptable parameters. Change on a vertical axis represents the coming to be of the new, the exploration of new possibilities. Nursing theory focuses on horizontal and vertical change, translation and transformation, in the
Translation,
resented
human experience. Practice Nurses interact with humans in the midst of
Transformation and the simultaneity paradigm The simultaneity paradigm speaks to Wilbur’s concept of transformation: &dquo;to go beyond&dquo; (1984, p. 48). Rogers and Parse focus on the human being’s potential activity. All of the emphasis in the simultaneity paradigm is on the newness, the possibilities, the potential in each moment. &dquo;Man is an open being free to choose in rhythmical mutual interchange with
great change. Nursing practice can be seen in relation to the two paradigms and the two aspects of change, translation and transformation.
Nursing practice within the totality paradigm focuses on change as translation. The patient is viewed as an equilibrium-seeking system temporarily in a state of disequilibrium. Internal and external factors have up-
92
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