509725
research-article2013
NSQXXX10.1177/0894318413509725Nursing Science Quarterly 27(1)Bateman / Article
Article
Newman’s Theory of Health as Expanding Consciousness: A Personal Evolution
Nursing Science Quarterly 2014, Vol 27(1) 57–61 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318413509725 nsq.sagepub.com
Gina C. Bateman, RN,1 and Lyn Merryfeather, RN; PhD2
Abstract In this article, the authors demonstrate the value of using Newman’s theory of health as expanding consciousness for nurses and the clients they serve. A review of the conception and evolution of the theory and its link to spiritual ideology provides a multi-dimensional perspective of Newman’s ideas. Additionally, an exploration of the central concepts of the theory offers an in- depth view of the philosophical and practical tenets on which the theory is based. The authors also chronicle one nurse’s journey and evolution as a healthcare provider whose practice is rooted in Newman’s theory. Keywords Newman’s theory, nursing, spiritual Newman’s theory of health as expanding consciousness (1994) provides a perspective of nursing that recognizes and honors clients’ histories, unique attributes and experiences, desires and goals, and life journeys. It is important for the nurse to be fully present and attend to the patterns that exist in clients’ lives in order to create a safe environment for clients to adapt to and cope with life’s redirections (Newman, 2008). I am a nurse who strongly believes that health is an expression of life, however it may manifest. Newman’s theory both validates my perspective and inspires my work. My role as a nurse is to develop connections with my clients that inspire them to authentically explore their life patterns so that they may experience the quality of life that they desire. I have witnessed the success of using this strategy in my own life and in the lives of others. Historically, my nursing practice reflected the essence of Newman’s ideology in various ways. In achieving a greater understanding of the theory of health as expanding consciousness, my nursing practice has intentionally become rooted in this framework. It is both an honor and pleasure to discuss the conception and implementation of Newman’s theory of health as expanding consciousness, and to reveal my evolution and transformation as a person and as a nurse whose practice is rooted in Newman’s conceptual framework. Individuals have the ability to rise above their perceived limitations and evolve in ways that not only improve their circumstances, but also afford them a greater understanding of their existence (Newman, 1994). Nurses who anchor their practice in the concepts proposed by Newman (1994) would support the idea that the responsibility of a nurse is to facilitate the revelation of meaningful patterns that unfold in clients’ lives. Newman claimed that her proposed theory was inspired
not by spiritual tenets, but by her own experiences and by the ideas of other scholars who focused on the melding of the mind, body, and spirit in an effort to define and improve human health (Newman, 1994; 2008). Newman’s grand theory contains many of the assertions of spiritual philosophers. The certainty and importance of personal evolution through expanded consciousness in the process of life (Bentov, 1978; Chessick, 2004; Holmes, 1998); the healing that may occur when someone is fully present with another person (Guenther, 2011); the relationship between history, thoughts, perceptions, and present experiences (Chessick, 2004; Dalai Lama & Hopkins, 2002; Holmes, 1998); the effects of intention on personal experiences and physical and emotional environments (Dalai Lama & Hopkins, 2002; Holmes, 1998; Meixner, 2006); and the power of self-reflection on health and personal evolution (Chessick, 2004; Dalai Lama & Hopkins, 2002; Holmes, 1998) are poignant ideas that cross the borders of nursing, medicine, and spiritual ideologies. It appears that universal truths related to human existence transcend the limits and boundaries of original thought and unique disciplines. The theory of health as expanding consciousness is deeply thoughtful and filled with intricacies that may make it more difficult to comprehend than some other theories. However, when understood and embodied, the concepts depicted in the ontology have the power to transform nurses to accomplish exactly what the theory avows, which is to expand the consciousness of both nurses and patients. Nurses realize that 1
Alberta Health Services, Child and Adolescent Mental Health, Alberta, Canada 2 Instructor, University of Victoria
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health may include illness, even death (Newman, 2008). Further, explanations of the theory’s ideas foster the understanding that health is enhanced when a client’s “pattern of the whole” (Newman, 2008, p. 7) is uncovered in the safety of a caring and accepting nurse-client relationship (Newman, 1994; 2008).
Conception of Health as Expanding Consciousness As a child, Margaret Newman was encouraged to consider life from a philosophical standpoint by her father who taught his daughter about the power of perception and inner resolve (Pharris, 2010). Newman first felt a pull toward the profession of nursing when she realized that she could not effectively participate in missionary work without attending to both the spiritual and physical needs of the people whom she would serve (Pharris, 2010). Further to this discovery, Newman’s experience as a witness to her mother’s journey through a debilitating illness that eventually claimed her mother’s life deepened Newman’s understanding of health, and inspired her scholarly pursuit of nursing (Newman, 2008; Pharris, 2010). In addition to her life experiences, Newman credited Martha Rogers for inspiring her to further her nursing studies in graduate school (Newman, 2008, p. xv). According to Newman, Rogers asserted that the process of life is characterized by the ebb and flow of changing states of health that occur on a continuum. In addition, Rogers claimed that wellness and illness are not distinct entities to be considered or managed separately, but are informational tools that may be used by individuals to understand themselves more deeply (Newman, 2008, p. xv). Newman also acknowledged the significant influence of Bentov’s ideas on the development of her nursing theory (Newman, 1997; 2008, p. 3). Incorporating Bentov’s belief that the process of life is one of expanding consciousness with Rogers’ concepts became the underpinnings of the theory of health as expanding consciousness (Newman, 1997). In addition to her major influences, Newman (2008) noted the influence of the works of other scholars, such as Bohm (p. 7), who discussed the effect of implicate and explicate order and Ferguson (p. 11), who viewed pain and illness as informational sources that assist in the revelation of people’s intrinsic patterns. As Newman was pursuing graduate studies, she witnessed a demonstration of these scholarly insights in action with the unfolding of her friend’s experience with hyperthyroidism. As proponents of the medical model prepared to remove her friend’s thyroid gland in an effort to manage her condition, the woman explored the possible reasons for the occurrence of the issue and discovered the patterns within herself that likely contributed to her physical condition. Using this knowledge, Newman’s friend consciously reconfigured her life. Subsequently, her over-active thyroid gland regulated itself to the degree that she no longer required
surgery or the previously prescribed medical interventions (Newman, 2008). The medical model’s definition of health as the absence of disease is shortsighted and it does not serve people well. For people to discover the meaning of their lives and to have rich experiences, a paradigm shift was in order (Newman, 1994). Nursing practice rooted in the unitary- transformative theory of health as expanding consciousness focuses on clients’ wholeness; allows people to explore and express themselves genuinely; recognizes that individuals’ states of health are important indicators of areas of personal growth; and fuses the internal and external environments of clients and nurses to allow for mutual self-actualization (Newman, 1994; 2008). The goal of nursing from the tenets of Newman’s theory is to guide clients in a process of pattern recognition so that they may know themselves more intimately and gain the insights that support their evolution (Newman, 2008). This purpose is achieved through the development of an authentic connection between the nurse and the client that is encouraged by the nurse’s full presence in the client’s unfolding health experience. As the meaning of the client’s life experiences is explored, both the nurse and the client gain a more profound understanding of themselves and the other within the vast, universal environment that is the field of all possibilities (Newman, 2008, p. 9-10).
Implementation of Health as Expanding Consciousness Newman described the nurse-client relationship as a mutual engagement for the purpose of discovering the unfolding patterns that influence the client’s health (Newman, 1994; Pharris, 2010). It is imperative that the nurse be completely present and non-judgmental as the client reveals personal information (Newman, 1994; Pharris, 2010). The nurse’s actions are characterized as “caring in its deepest and most respectful sense” (Pharris, 2010, p. 303), focusing on the aspects of the client’s life that the person identifies as most relevant. A nurse must be prepared for and willing to accept a period of ambiguity, chaos and imbalance while a client forges a new life path (Pharris, 2010). The result of the nurse-client relationship throughout their journey together is the uncovering of patterns for both parties (Newman, 1994; Pharris, 2010). From a unitary-transformative perspective (Cowling & Chinn, 2001), clients who are facing health crises and who are seeking the assistance of healthcare professionals are recognized as demonstrating readiness to some degree, to move through a process of transformation (Pharris, 2010). It is at a point of chaos in a client’s life when the nursing actions professed in the theory of health as expanding consciousness are most helpful to the client (Pharris, 2010). The intention of nursing practice is to assist the client to achieve a level of self-awareness and self-reliance whereby the client, at some point in time, may continue the wellness journey independent of the nurse (Pharris, 2010).
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Bateman / Article There is no particular physical environment required for nurses to function from this theory. From what Newman (1994) explained, it is the nurse’s use of presencing and the demonstration of unconditional positive regard that fosters the therapeutic environment in which the client may learn to function at higher levels to improve health. The obstacles for nurses who practice from this perspective may come from other healthcare providers who believe that the proof of improvement in a client’s condition must be swift and obvious to the observer. Physical settings are much more important to nurses, doctors, and other healthcare practitioners who believe that outside influences are stronger than internal states. Being cared for in healthcare environments such as acute care and residential treatment settings in which a client’s responsibilities and relationships differ from real-life situations, may provide inaccurate examples of a person’s level of functioning. Facilitating the enhancement of a client’s internal strengths and personal awareness allows the person to improve functioning independent of the environment. There are real life demonstrations of the positive outcomes from the use of Newman’s theory. An exemplar offered by an emergency room/intensive care nurse demonstrated that Newman’s theory could be used effectively in busy, physical-health focused environments. The nurse providing the example stated that, while attending to clients’ physical needs, she explored what was meaningful to them in their everyday lives and what concerned them about their current experiences. In taking this approach, the nurse stated that she connected with her clients on a deeper level and that she was able to note patterns that emerged as clients related their personal stories. More importantly, the clients’ true needs were identified and the nurse was able to serve the individuals more effectively (Newman, 2008). Another example of incorporating Newman’s ideas into caring for a client provided evidence that use of the theory was effective in time-constrained situations. A nurse practitioner described her interaction with a client on a day when the nurse was stressed for time and felt rushed. As she took the opportunity to center herself and ensure that she was fully present by taking deep breaths and reciting a mantra before entering the room, she prepared for a mutually beneficial interaction with her client. In her discussion with the client, the nurse ensured that she heard all that the client was saying and noted the emotional weight of the client’s account. In being fully alert to the clients overall presentation, the nurse was able to respond compassionately and appropriately and to assist the client in creating an action plan that could be initiated immediately. The nurse accomplished her goal of being a responsible care provider to the client in 15 minutes, demonstrating that caring from this perspective can be efficient as well as effective (Newman, 2008).
My Evolution as a Nurse I entered the profession of nursing apparently on a whim. However, I have learned that in life there are no accidents.
Born to European immigrant parents, I grew up in an environment in which higher learning and personal evolution was not only undervalued, but was completely misunderstood. My family of origin was riddled with issues of parental discord, neglect, abuse, addiction, and mental health challenges. I grew up experiencing poverty, hate, and abandonment. However, I believe that the universe does not accept a vacuum. Opportunities to balance my fate were created by Spirit. In an attempt to move our family out of the watchful eyes of concerned neighbors, my father relocated my mother, two brothers, and me to a community where middle class, cohesive families were living honest existences with a strong sense of togetherness as families and as a community. I went to school with others who lived in what appeared to be loving families. Observing the lives of my peers, I could see what was right and just. I was determined to emulate what I noted to be better ways of living. Fortunately for me, my mother divorced my father. Unfortunately for me, my mother had her own issues that prevented her from being a loving and nurturing parent. At the time, my brothers were affected by drugs and involved in delinquent activities. I was trying to find a way of being that differed from the experiences of my family members. Consequently, I spent time with friends, studied hard, participated in sports and kept in touch with Spirit. I cannot explain how I knew that these measures would propel me into experiences filled with quality and meaning, except I observed that these practices benefitted the lives of others. My future hardships, though painful, became teaching tools and opportunities for growth. Before I decided to live purposefully and consciously, I was fearful, emotionally numb, and often portrayed myself as a hard-hearted individual. However, I came to believe that it is unwise to blame other people for being themselves and living out their destinies. I learned that my internal environment directed and commanded my life and that my point of power existed in my choices in the present moment. My decision to go to nursing school was the result of my keen observation of other people. As a young adult, I met a woman whom I came to know and greatly admire. She appeared to be the epitome of an exemplary woman. I could see that she was highly respected by others. That woman happened to be a nurse. Although I never saw her in action in her profession, she possessed the qualities that I wanted to embody. I wanted to be like her, so I entered nursing school. Even though my journey as a nurse had a rough start and I actually left the profession for 10 years, I remained true to my endeavor to be the kind of person I believed the exemplary woman to be, and I continued my journey of selfdiscovery. That journey eventually led me back to the discipline of nursing and to the quality of life I always believed that I deserved. On the tumultuous road that carried me out of my internal and external prisons, I constructed a strong emotional skeleton, grounded myself in what I felt was the truth of human existence and broke the cycle of
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dysfunction that was my birth-family’s legacy. I planned so that my children and I could have and be anything and everything we desired. While confronting family secrets and the dysfunction in my own marriage, I joined a spiritual center and I explored the ideas of insightful mystics and scholars in order to achieve a greater understanding of my place and purpose in the universe. According to Newman (2008), comprehending health and quality of life from a more enlightened perspective and assisting clients to do the same is the ultimate goal of nursing. Similarly, realizing the divine influence in my life and the lives of others was the spiritual journey on which I embarked. I can confidently say that I am still learning and growing as a nurse and a person. Demonstrations of kindness still sometimes make me cry. Watching or hearing about children suffering, even in fictional works, always makes me cry. As a result of my personal experiences, I understand many dichotomies of human experiences – pain and pleasure, sorrow and joy, chaos and calm, and hate and love. As a result, I believe that as a nurse, I not only approach client interactions from a clinical understanding, but from personal knowledge of pain, suffering, endurance, and transcendence. Exploring nursing theories in a baccalaureate degree program is allowing me to gain more insight into the relevance and impact of my nursing practice. Higher learning is a unique achievement in the history of my family. No one in either of my parent’s families obtained a university degree. My three boys and I will be the first ones to accomplish this scholarly goal and we are in a race to see who finishes first. Newman’s theory of health as expanding consciousness (Newman, 1994) reinforces what I know to be true about my responsibility to my clients. I have found that learning about and practicing spiritual philosophies is similar to discovering and using the concepts of nursing theories such as the ideas proposed by Newman (1994). As I intentionally interact with clients in meaningful ways to assist them in achieving their wellness goals, I become more self-aware, advancing to higher levels of consciousness with the knowledge that my evolution is a life-long venture.
Using Newman’s Theory When I was working at a residential substance abuse treatment facility, I was struck by how often clients stated that they were afraid to leave once the three-week program ended. It was also disconcerting that most of the clients, upon leaving the program, relapsed and either requested further intervention or returned to a level of functioning in their lives that was detrimental to their health. It appeared to me that there was a great deal of information being presented to the clients about what may have contributed to their substance abuse issues, and what they needed to do to change their experiences. However, there were few opportunities offered to the individuals to process their experiences or to practice new ways of functioning.
I believe that the design of the program contributed to the clients’ failures to maintain sobriety and achieve their goals. When I consider a substance abuse treatment program anchored in the theory of health as expanding consciousness, I can imagine outcomes more aligned with clients’ objectives to manage their lives differently. It is interesting that the nurses in the health services department who operated from Newman’s perspective were challenged and negatively judged by the addictions’ counselors. It became clear to me that viewing clients as intelligent, insightful, and experts in their own lives was not the common practice in that setting, so I chose to leave with the intention of finding work that was more aligned with my understanding of appropriate client care. Since learning more about Newman’s theory I realized how much my personal opinions and professional practice aligns with this theory. I believe in the unlimited potential of individuals no matter what may be evident in the present moment. In my daily practice, I behave in ways that support the highest good for all persons involved. I have been known to challenge colleagues who have self-serving practices or harmful biases. I do this because I believe in their abilities to move beyond their restrictive thinking and behaviors to be better care providers to their clients. For my clients, I set a daily intention to be considerate, compassionate, and supportive. When I allow my biases or frustrations to get the best of me, I refocus by reminding myself of my intentions. I attend to my inner dialogue and my responsibilities as a nurse more frequently since learning about and exploring Newman’s theory and concepts related to caring (Newman, 1994; Pharris, 2010). Lately, I have been devoting myself to using the Ho’oponopono Cleaning Tools, (Vitale and Len, 2007) about which I learned at the spiritual center that I attend, to elevate my ability to be of service to my clients. Before interacting with an individual, I focus my attention on that person and silently offer these words, “I love you, I’m sorry, please forgive me, thank you.” My belief is that by extending the healing vibrations of these statements, my clients may experience deep, energetic transformations. It is my mantra that allows me to focus on my professional and personal obligations to the people whom I serve. In an effort to be a better nurse, I have challenged the voice in my head that values productivity over quality of interactions with others. This shift in my practice has resulted in being more present with people, and subsequently, in clients telling me that they appreciated my caring nature and assistance. I have experienced tangible results since I changed my focus. I owe the majority of the shift to the focus that learning about nursing theories and philosophies has afforded me. I am truly grateful for the nurse scholars who devoted their careers to paving the way for meaningful and purposeful nurse-client experiences. Finally, attending to patterns in my life and changing the elements of my existence that do not serve me well has increased my effectiveness as a nurse. I have become more
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Bateman / Article aware of my effect in this world, and I feel a greater responsibility to extend myself to others to benefit humanity. In becoming more conscious of my history and emerging patterns and in taking steps to create a better experience for myself, I learned that change can be difficult, that support offered during challenging times is comforting, and that the rewards that result from exploring personal patterns are worth the work. I believe that truly understanding what evolution feels like and the effort required to expand one’s consciousness allows me to be a more caring nurse.
understanding crosses ideological barriers of nursing theories and spiritual philosophies melding commonly held beliefs that may be used in the pursuit of the meaning and purpose of life. It is with great wisdom that nurses embrace the tenets of nursing theory and build professional practices in the spirit of ideologies that resonate with their inner knowing.
Conclusion
Funding
The future of the world and of human existence is uncertain. With the effects of global warming and social insensitivity inspired by technological advancements that make it easy for people to avoid engaging in genuine, connected, and caring relationships, human existence is in jeopardy. Despite these facts, it appears that people need each other and that they need to consciously care for the environment in order to experience meaning in their lives. This awareness prevails and it is here that nursing grand theories, such Newman’s theory of health as expanding consciousness, have their relevance. The lens that views individuals as healthy, whole, and complete is an accepting, compassionate, and loving perspective that can inspire people to achieve the health they desire and deserve. Assisting one person at a time, when the time is right, has a ripple effect on the universal community. Moreover, the accepting environment created by nurses who understand unitary-transformative nursing perspectives can assist clients to realize their potential. Pioneers of nursing theory development, such as Margaret Newman, use their personal experiences and professional discoveries to instill creative and valuable ideas into the consciousness of nurses to inspire these unique healthcare professionals to influence human transcendence beyond former limits. I understand the power of Newman’s grand theory, both because of my own life experiences and as a result of transformations that I have witnessed in my clients. Health is the culmination of human experiences that result in the expansion of individual awareness, and in turn, the amplification of the collective consciousness. This
The authors received no financial support for the authorship and /or publication of this article.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.
References Bentov, I. (1988). Stalking the Wild Pendulum: On the Mechanics of Consciousness. Rochester: Destiny Books. Chessick, R. (2004). The silence of Socrates. American Journal of Psychotherapy, 58(4), 406-419. Cowling, W. R., & Chinn, P. L. (2001). Conversation across paradigm: Unitary-transformative and critical feminist perspectives. Scholarly Inquiry for Nursing Practice: An International Journal, 15(4), 347-365. Dalai, Lama, & Hopkins, J. (2002). How to practice: The way to a meaningful life. New York: Atria Books. Guenther, M. B. (March 2011). Healing:The power of presence. A reflection. Journal of Pain and Symptom Management, 41(3), 650-654. Holmes, E. (1998). The science of mind. New York: Penguin Putnum Inc. Meixner, U. (2006). Classical intentionality. Erkenntnis, 65, 25-45. Newman, M. A. (1994). Health as expanding consciousness (2nd ed.). New York: National League for Nursing Press. Newman, M. (1997). Evolution of the theory of health as expanded consciousness. Nursing Science Quarterly, 10(1), 22-25. Newman, M. A. (2008). Transforming presence: The difference that nursing makes. Philadelphia: F. A. Davis. Pharris, M.D. (2010). Margaret Newman’s theory of health as expanding consciousness. In M.E. Parker & M.C. Smith, (Eds.). Nursing theories and nursing practice (3rd ed.,pp. 290-313). Philadelphia: F. A. Davis. Vitale, J., & Len, I. H. (2007). Zero limits: The secret Hawaiian system for wealth, health, peace and more. Hoboken, NJ: Wiley.
Downloaded from nsq.sagepub.com at HOWARD UNIV UNDERGRAD LIBRARY on March 9, 2015
research-article2013
NSQXXX10.1177/0894318413509725Nursing Science Quarterly 27(1)Bateman / Article
Article
Newman’s Theory of Health as Expanding Consciousness: A Personal Evolution
Nursing Science Quarterly 2014, Vol 27(1) 57–61 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0894318413509725 nsq.sagepub.com
Gina C. Bateman, RN,1 and Lyn Merryfeather, RN; PhD2
Abstract In this article, the authors demonstrate the value of using Newman’s theory of health as expanding consciousness for nurses and the clients they serve. A review of the conception and evolution of the theory and its link to spiritual ideology provides a multi-dimensional perspective of Newman’s ideas. Additionally, an exploration of the central concepts of the theory offers an in- depth view of the philosophical and practical tenets on which the theory is based. The authors also chronicle one nurse’s journey and evolution as a healthcare provider whose practice is rooted in Newman’s theory. Keywords Newman’s theory, nursing, spiritual Newman’s theory of health as expanding consciousness (1994) provides a perspective of nursing that recognizes and honors clients’ histories, unique attributes and experiences, desires and goals, and life journeys. It is important for the nurse to be fully present and attend to the patterns that exist in clients’ lives in order to create a safe environment for clients to adapt to and cope with life’s redirections (Newman, 2008). I am a nurse who strongly believes that health is an expression of life, however it may manifest. Newman’s theory both validates my perspective and inspires my work. My role as a nurse is to develop connections with my clients that inspire them to authentically explore their life patterns so that they may experience the quality of life that they desire. I have witnessed the success of using this strategy in my own life and in the lives of others. Historically, my nursing practice reflected the essence of Newman’s ideology in various ways. In achieving a greater understanding of the theory of health as expanding consciousness, my nursing practice has intentionally become rooted in this framework. It is both an honor and pleasure to discuss the conception and implementation of Newman’s theory of health as expanding consciousness, and to reveal my evolution and transformation as a person and as a nurse whose practice is rooted in Newman’s conceptual framework. Individuals have the ability to rise above their perceived limitations and evolve in ways that not only improve their circumstances, but also afford them a greater understanding of their existence (Newman, 1994). Nurses who anchor their practice in the concepts proposed by Newman (1994) would support the idea that the responsibility of a nurse is to facilitate the revelation of meaningful patterns that unfold in clients’ lives. Newman claimed that her proposed theory was inspired
not by spiritual tenets, but by her own experiences and by the ideas of other scholars who focused on the melding of the mind, body, and spirit in an effort to define and improve human health (Newman, 1994; 2008). Newman’s grand theory contains many of the assertions of spiritual philosophers. The certainty and importance of personal evolution through expanded consciousness in the process of life (Bentov, 1978; Chessick, 2004; Holmes, 1998); the healing that may occur when someone is fully present with another person (Guenther, 2011); the relationship between history, thoughts, perceptions, and present experiences (Chessick, 2004; Dalai Lama & Hopkins, 2002; Holmes, 1998); the effects of intention on personal experiences and physical and emotional environments (Dalai Lama & Hopkins, 2002; Holmes, 1998; Meixner, 2006); and the power of self-reflection on health and personal evolution (Chessick, 2004; Dalai Lama & Hopkins, 2002; Holmes, 1998) are poignant ideas that cross the borders of nursing, medicine, and spiritual ideologies. It appears that universal truths related to human existence transcend the limits and boundaries of original thought and unique disciplines. The theory of health as expanding consciousness is deeply thoughtful and filled with intricacies that may make it more difficult to comprehend than some other theories. However, when understood and embodied, the concepts depicted in the ontology have the power to transform nurses to accomplish exactly what the theory avows, which is to expand the consciousness of both nurses and patients. Nurses realize that 1
Alberta Health Services, Child and Adolescent Mental Health, Alberta, Canada 2 Instructor, University of Victoria
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health may include illness, even death (Newman, 2008). Further, explanations of the theory’s ideas foster the understanding that health is enhanced when a client’s “pattern of the whole” (Newman, 2008, p. 7) is uncovered in the safety of a caring and accepting nurse-client relationship (Newman, 1994; 2008).
Conception of Health as Expanding Consciousness As a child, Margaret Newman was encouraged to consider life from a philosophical standpoint by her father who taught his daughter about the power of perception and inner resolve (Pharris, 2010). Newman first felt a pull toward the profession of nursing when she realized that she could not effectively participate in missionary work without attending to both the spiritual and physical needs of the people whom she would serve (Pharris, 2010). Further to this discovery, Newman’s experience as a witness to her mother’s journey through a debilitating illness that eventually claimed her mother’s life deepened Newman’s understanding of health, and inspired her scholarly pursuit of nursing (Newman, 2008; Pharris, 2010). In addition to her life experiences, Newman credited Martha Rogers for inspiring her to further her nursing studies in graduate school (Newman, 2008, p. xv). According to Newman, Rogers asserted that the process of life is characterized by the ebb and flow of changing states of health that occur on a continuum. In addition, Rogers claimed that wellness and illness are not distinct entities to be considered or managed separately, but are informational tools that may be used by individuals to understand themselves more deeply (Newman, 2008, p. xv). Newman also acknowledged the significant influence of Bentov’s ideas on the development of her nursing theory (Newman, 1997; 2008, p. 3). Incorporating Bentov’s belief that the process of life is one of expanding consciousness with Rogers’ concepts became the underpinnings of the theory of health as expanding consciousness (Newman, 1997). In addition to her major influences, Newman (2008) noted the influence of the works of other scholars, such as Bohm (p. 7), who discussed the effect of implicate and explicate order and Ferguson (p. 11), who viewed pain and illness as informational sources that assist in the revelation of people’s intrinsic patterns. As Newman was pursuing graduate studies, she witnessed a demonstration of these scholarly insights in action with the unfolding of her friend’s experience with hyperthyroidism. As proponents of the medical model prepared to remove her friend’s thyroid gland in an effort to manage her condition, the woman explored the possible reasons for the occurrence of the issue and discovered the patterns within herself that likely contributed to her physical condition. Using this knowledge, Newman’s friend consciously reconfigured her life. Subsequently, her over-active thyroid gland regulated itself to the degree that she no longer required
surgery or the previously prescribed medical interventions (Newman, 2008). The medical model’s definition of health as the absence of disease is shortsighted and it does not serve people well. For people to discover the meaning of their lives and to have rich experiences, a paradigm shift was in order (Newman, 1994). Nursing practice rooted in the unitary- transformative theory of health as expanding consciousness focuses on clients’ wholeness; allows people to explore and express themselves genuinely; recognizes that individuals’ states of health are important indicators of areas of personal growth; and fuses the internal and external environments of clients and nurses to allow for mutual self-actualization (Newman, 1994; 2008). The goal of nursing from the tenets of Newman’s theory is to guide clients in a process of pattern recognition so that they may know themselves more intimately and gain the insights that support their evolution (Newman, 2008). This purpose is achieved through the development of an authentic connection between the nurse and the client that is encouraged by the nurse’s full presence in the client’s unfolding health experience. As the meaning of the client’s life experiences is explored, both the nurse and the client gain a more profound understanding of themselves and the other within the vast, universal environment that is the field of all possibilities (Newman, 2008, p. 9-10).
Implementation of Health as Expanding Consciousness Newman described the nurse-client relationship as a mutual engagement for the purpose of discovering the unfolding patterns that influence the client’s health (Newman, 1994; Pharris, 2010). It is imperative that the nurse be completely present and non-judgmental as the client reveals personal information (Newman, 1994; Pharris, 2010). The nurse’s actions are characterized as “caring in its deepest and most respectful sense” (Pharris, 2010, p. 303), focusing on the aspects of the client’s life that the person identifies as most relevant. A nurse must be prepared for and willing to accept a period of ambiguity, chaos and imbalance while a client forges a new life path (Pharris, 2010). The result of the nurse-client relationship throughout their journey together is the uncovering of patterns for both parties (Newman, 1994; Pharris, 2010). From a unitary-transformative perspective (Cowling & Chinn, 2001), clients who are facing health crises and who are seeking the assistance of healthcare professionals are recognized as demonstrating readiness to some degree, to move through a process of transformation (Pharris, 2010). It is at a point of chaos in a client’s life when the nursing actions professed in the theory of health as expanding consciousness are most helpful to the client (Pharris, 2010). The intention of nursing practice is to assist the client to achieve a level of self-awareness and self-reliance whereby the client, at some point in time, may continue the wellness journey independent of the nurse (Pharris, 2010).
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Bateman / Article There is no particular physical environment required for nurses to function from this theory. From what Newman (1994) explained, it is the nurse’s use of presencing and the demonstration of unconditional positive regard that fosters the therapeutic environment in which the client may learn to function at higher levels to improve health. The obstacles for nurses who practice from this perspective may come from other healthcare providers who believe that the proof of improvement in a client’s condition must be swift and obvious to the observer. Physical settings are much more important to nurses, doctors, and other healthcare practitioners who believe that outside influences are stronger than internal states. Being cared for in healthcare environments such as acute care and residential treatment settings in which a client’s responsibilities and relationships differ from real-life situations, may provide inaccurate examples of a person’s level of functioning. Facilitating the enhancement of a client’s internal strengths and personal awareness allows the person to improve functioning independent of the environment. There are real life demonstrations of the positive outcomes from the use of Newman’s theory. An exemplar offered by an emergency room/intensive care nurse demonstrated that Newman’s theory could be used effectively in busy, physical-health focused environments. The nurse providing the example stated that, while attending to clients’ physical needs, she explored what was meaningful to them in their everyday lives and what concerned them about their current experiences. In taking this approach, the nurse stated that she connected with her clients on a deeper level and that she was able to note patterns that emerged as clients related their personal stories. More importantly, the clients’ true needs were identified and the nurse was able to serve the individuals more effectively (Newman, 2008). Another example of incorporating Newman’s ideas into caring for a client provided evidence that use of the theory was effective in time-constrained situations. A nurse practitioner described her interaction with a client on a day when the nurse was stressed for time and felt rushed. As she took the opportunity to center herself and ensure that she was fully present by taking deep breaths and reciting a mantra before entering the room, she prepared for a mutually beneficial interaction with her client. In her discussion with the client, the nurse ensured that she heard all that the client was saying and noted the emotional weight of the client’s account. In being fully alert to the clients overall presentation, the nurse was able to respond compassionately and appropriately and to assist the client in creating an action plan that could be initiated immediately. The nurse accomplished her goal of being a responsible care provider to the client in 15 minutes, demonstrating that caring from this perspective can be efficient as well as effective (Newman, 2008).
My Evolution as a Nurse I entered the profession of nursing apparently on a whim. However, I have learned that in life there are no accidents.
Born to European immigrant parents, I grew up in an environment in which higher learning and personal evolution was not only undervalued, but was completely misunderstood. My family of origin was riddled with issues of parental discord, neglect, abuse, addiction, and mental health challenges. I grew up experiencing poverty, hate, and abandonment. However, I believe that the universe does not accept a vacuum. Opportunities to balance my fate were created by Spirit. In an attempt to move our family out of the watchful eyes of concerned neighbors, my father relocated my mother, two brothers, and me to a community where middle class, cohesive families were living honest existences with a strong sense of togetherness as families and as a community. I went to school with others who lived in what appeared to be loving families. Observing the lives of my peers, I could see what was right and just. I was determined to emulate what I noted to be better ways of living. Fortunately for me, my mother divorced my father. Unfortunately for me, my mother had her own issues that prevented her from being a loving and nurturing parent. At the time, my brothers were affected by drugs and involved in delinquent activities. I was trying to find a way of being that differed from the experiences of my family members. Consequently, I spent time with friends, studied hard, participated in sports and kept in touch with Spirit. I cannot explain how I knew that these measures would propel me into experiences filled with quality and meaning, except I observed that these practices benefitted the lives of others. My future hardships, though painful, became teaching tools and opportunities for growth. Before I decided to live purposefully and consciously, I was fearful, emotionally numb, and often portrayed myself as a hard-hearted individual. However, I came to believe that it is unwise to blame other people for being themselves and living out their destinies. I learned that my internal environment directed and commanded my life and that my point of power existed in my choices in the present moment. My decision to go to nursing school was the result of my keen observation of other people. As a young adult, I met a woman whom I came to know and greatly admire. She appeared to be the epitome of an exemplary woman. I could see that she was highly respected by others. That woman happened to be a nurse. Although I never saw her in action in her profession, she possessed the qualities that I wanted to embody. I wanted to be like her, so I entered nursing school. Even though my journey as a nurse had a rough start and I actually left the profession for 10 years, I remained true to my endeavor to be the kind of person I believed the exemplary woman to be, and I continued my journey of selfdiscovery. That journey eventually led me back to the discipline of nursing and to the quality of life I always believed that I deserved. On the tumultuous road that carried me out of my internal and external prisons, I constructed a strong emotional skeleton, grounded myself in what I felt was the truth of human existence and broke the cycle of
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Nursing Science Quarterly 27(1)
dysfunction that was my birth-family’s legacy. I planned so that my children and I could have and be anything and everything we desired. While confronting family secrets and the dysfunction in my own marriage, I joined a spiritual center and I explored the ideas of insightful mystics and scholars in order to achieve a greater understanding of my place and purpose in the universe. According to Newman (2008), comprehending health and quality of life from a more enlightened perspective and assisting clients to do the same is the ultimate goal of nursing. Similarly, realizing the divine influence in my life and the lives of others was the spiritual journey on which I embarked. I can confidently say that I am still learning and growing as a nurse and a person. Demonstrations of kindness still sometimes make me cry. Watching or hearing about children suffering, even in fictional works, always makes me cry. As a result of my personal experiences, I understand many dichotomies of human experiences – pain and pleasure, sorrow and joy, chaos and calm, and hate and love. As a result, I believe that as a nurse, I not only approach client interactions from a clinical understanding, but from personal knowledge of pain, suffering, endurance, and transcendence. Exploring nursing theories in a baccalaureate degree program is allowing me to gain more insight into the relevance and impact of my nursing practice. Higher learning is a unique achievement in the history of my family. No one in either of my parent’s families obtained a university degree. My three boys and I will be the first ones to accomplish this scholarly goal and we are in a race to see who finishes first. Newman’s theory of health as expanding consciousness (Newman, 1994) reinforces what I know to be true about my responsibility to my clients. I have found that learning about and practicing spiritual philosophies is similar to discovering and using the concepts of nursing theories such as the ideas proposed by Newman (1994). As I intentionally interact with clients in meaningful ways to assist them in achieving their wellness goals, I become more self-aware, advancing to higher levels of consciousness with the knowledge that my evolution is a life-long venture.
Using Newman’s Theory When I was working at a residential substance abuse treatment facility, I was struck by how often clients stated that they were afraid to leave once the three-week program ended. It was also disconcerting that most of the clients, upon leaving the program, relapsed and either requested further intervention or returned to a level of functioning in their lives that was detrimental to their health. It appeared to me that there was a great deal of information being presented to the clients about what may have contributed to their substance abuse issues, and what they needed to do to change their experiences. However, there were few opportunities offered to the individuals to process their experiences or to practice new ways of functioning.
I believe that the design of the program contributed to the clients’ failures to maintain sobriety and achieve their goals. When I consider a substance abuse treatment program anchored in the theory of health as expanding consciousness, I can imagine outcomes more aligned with clients’ objectives to manage their lives differently. It is interesting that the nurses in the health services department who operated from Newman’s perspective were challenged and negatively judged by the addictions’ counselors. It became clear to me that viewing clients as intelligent, insightful, and experts in their own lives was not the common practice in that setting, so I chose to leave with the intention of finding work that was more aligned with my understanding of appropriate client care. Since learning more about Newman’s theory I realized how much my personal opinions and professional practice aligns with this theory. I believe in the unlimited potential of individuals no matter what may be evident in the present moment. In my daily practice, I behave in ways that support the highest good for all persons involved. I have been known to challenge colleagues who have self-serving practices or harmful biases. I do this because I believe in their abilities to move beyond their restrictive thinking and behaviors to be better care providers to their clients. For my clients, I set a daily intention to be considerate, compassionate, and supportive. When I allow my biases or frustrations to get the best of me, I refocus by reminding myself of my intentions. I attend to my inner dialogue and my responsibilities as a nurse more frequently since learning about and exploring Newman’s theory and concepts related to caring (Newman, 1994; Pharris, 2010). Lately, I have been devoting myself to using the Ho’oponopono Cleaning Tools, (Vitale and Len, 2007) about which I learned at the spiritual center that I attend, to elevate my ability to be of service to my clients. Before interacting with an individual, I focus my attention on that person and silently offer these words, “I love you, I’m sorry, please forgive me, thank you.” My belief is that by extending the healing vibrations of these statements, my clients may experience deep, energetic transformations. It is my mantra that allows me to focus on my professional and personal obligations to the people whom I serve. In an effort to be a better nurse, I have challenged the voice in my head that values productivity over quality of interactions with others. This shift in my practice has resulted in being more present with people, and subsequently, in clients telling me that they appreciated my caring nature and assistance. I have experienced tangible results since I changed my focus. I owe the majority of the shift to the focus that learning about nursing theories and philosophies has afforded me. I am truly grateful for the nurse scholars who devoted their careers to paving the way for meaningful and purposeful nurse-client experiences. Finally, attending to patterns in my life and changing the elements of my existence that do not serve me well has increased my effectiveness as a nurse. I have become more
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Bateman / Article aware of my effect in this world, and I feel a greater responsibility to extend myself to others to benefit humanity. In becoming more conscious of my history and emerging patterns and in taking steps to create a better experience for myself, I learned that change can be difficult, that support offered during challenging times is comforting, and that the rewards that result from exploring personal patterns are worth the work. I believe that truly understanding what evolution feels like and the effort required to expand one’s consciousness allows me to be a more caring nurse.
understanding crosses ideological barriers of nursing theories and spiritual philosophies melding commonly held beliefs that may be used in the pursuit of the meaning and purpose of life. It is with great wisdom that nurses embrace the tenets of nursing theory and build professional practices in the spirit of ideologies that resonate with their inner knowing.
Conclusion
Funding
The future of the world and of human existence is uncertain. With the effects of global warming and social insensitivity inspired by technological advancements that make it easy for people to avoid engaging in genuine, connected, and caring relationships, human existence is in jeopardy. Despite these facts, it appears that people need each other and that they need to consciously care for the environment in order to experience meaning in their lives. This awareness prevails and it is here that nursing grand theories, such Newman’s theory of health as expanding consciousness, have their relevance. The lens that views individuals as healthy, whole, and complete is an accepting, compassionate, and loving perspective that can inspire people to achieve the health they desire and deserve. Assisting one person at a time, when the time is right, has a ripple effect on the universal community. Moreover, the accepting environment created by nurses who understand unitary-transformative nursing perspectives can assist clients to realize their potential. Pioneers of nursing theory development, such as Margaret Newman, use their personal experiences and professional discoveries to instill creative and valuable ideas into the consciousness of nurses to inspire these unique healthcare professionals to influence human transcendence beyond former limits. I understand the power of Newman’s grand theory, both because of my own life experiences and as a result of transformations that I have witnessed in my clients. Health is the culmination of human experiences that result in the expansion of individual awareness, and in turn, the amplification of the collective consciousness. This
The authors received no financial support for the authorship and /or publication of this article.
Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the authorship and/or publication of this article.
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