Margaret Newman's Theory of Health as Expanding Consciousness and a Nursing Intervention from a Unitary Perspective.

This mini-review aims to introduce Margaret Newman's theory of health as expanding consciousness and caring partnership as a nursing intervention. Emanating from a unitary and transformative perspective of nursing, caring partnership enables nurses to identify with cancer patients as well as to help the patients find meaning in their situation and their lives. In genuine patient-nurse interactions, both patients and nurses experience higher levels of consciousness.

Introduction

This review introduces Margaret Newman's theory of health as expanding consciousness (HEC),[123] which emanates from a unitary and transformative perspective of nursing. As medical technology advances, cancer patients have a great need of a caring connection with nurses. However, nurses often cannot establish those connections because of the demands of their time and energy for a treatment-focused care. Caring partnership, which is based on Newman's HEC theory, as a nursing intervention enables nurses to identify with cancer patients and to help the patients find meaning in their difficult situations and their lives. Consequently, both patients and nurses will grow even in extremely difficult situations.

Evolution of Newman's Health as Expanding Consciousness Theory

Newman proposed a new concept of health in a dialectical manner, that is, “DISEASE fuses with its opposite, absence of disease, NON-DISEASE, and brings forth a new concept of HEALTH” she continues, “This synthesized view incorporates disease as a meaningful aspect of health.”[2] Nurses may be reluctant to accept this view, especially if they are committed to problem-solving care. However, once nurses understand how this innovative concept of health evolved in Newman's life, they will understand the core concept of the theory.

Newman was in her early twenties when she began taking care of her mother who was diagnosed with amyotrophic lateral sclerosis, a degenerative neurological disease that progressively diminishes the movement of all muscles except those of the eyes. Caring for her mother over a 5-year period was a transformative process. She learned to live day by day and was fully immersed in the present. She wrote,

I learned that my mother, though physically incapacitated, was a whole person, just like anybody else. I came to know her and to love her in a way I probably never would have taken the time to experience had she not been physically dependent. The 5 years I spent with her before she died were difficult, tiring, restrictive in some ways, but intense, loving, and expanding in other ways.[2]

Although her mother's life was confined by the disease, her life was not defined by it. The mother and daughter experienced “wholeness” and “health” together despite having a progressive disease.

After her mother's death, she decided to study nursing and worked as a nurse. While pursuing her doctoral studies in nursing at New York University, she studied with Martha Rogers. Rogers’ Science of Unitary Human beings is a well-known nursing model because of the assumption about man; that is, “Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.”[4] Rogers viewed health and illness not as two separate realities but as a unitary and transformative process. This view is congruent with Newman's previous experience with her mother.

Overview of Newman's Health as Expanding Consciousness Theory

Newman's theory embraces a unitary and transformative paradigm of nursing as “caring in the human health experience.”[5] Her first step as a theorist evolved around 1979.[6] After elaborating her idea, three books were published in order.[123] The basic assumptions of the theory are synthesized as follows:

Health is an evolving unitary pattern of the whole, including patterns of disease

Consciousness is the informational capacity of the whole and is revealed in the evolving pattern

Pattern identified the person–environment process and is characterized by meaning.[3]

The basic assumptions of the theory are focused on pattern. Pattern refers to “information that depicts the whole, understanding of the meaning of all the relationships at once.”[2] Wholeness is identified in pattern. Pattern is constantly evolving. Each observable pattern is time specific and contains information that was enfolded and will unfold. The evolution and transformation of pattern occurs through the patient–environment interaction, that is, the manner in which the patient relates with the environment. A pattern can be demonstrated retrospectively as sequential patterns over time. Sometimes, a patient's life is orderly; other times, the patient goes through a difficult life passage that is seen as chaos. Order and disorder in the patient's life are part of expansion of consciousness.

A nurse enters this process with the patient, particularly at a time when the patient is experiencing chaos. The key is that the nurse and the patient can engage in the mutual process of pattern recognition. Thus, both of them will evolve to higher levels of consciousness.[2]

A nursing intervention calls for action that evolves out of pattern recognition. That is, the recognition of pattern provides personal insight into the meaning of the pattern and reveals the potential for action. This nursing intervention that is based on Newman's theory was named “caring partnership” in a patient–nurse relationship.

Caring Partnership in a Unitary Perspective

Newman's paradigmatic view shapes a new type of nursing intervention that focuses on the patient as a whole and finds meaning in the experience. She described this process as “HEC Praxis: The Process of Pattern Recognition.”[3] Praxis means a synthesis of theory, research, and practice. The elements of the research process are the same for practice; however, research usually requires recording of data.

Step 1: A mutual process of inquiry is established with a patient (patient and/or family)

Step 2: The patient is invited to talk about meaningful events and relationships in the patient's life. After the first meeting, the nurse transmutes the narrative to a simple diagram that illustrates the sequential configurations of relationships and events

Step 3. The diagram is shared with the patient and the dialogue resumes freely

Step 4. When the patient realizes the patient's pattern, partnership is terminated [Figure 1].

Figure 1

Process of caring partnership based on Newman's theory of health as expanding consciousness

Most nurses consider that a minimum of three meetings is needed. This process is not necessarily to “collect data” or obtain information through interviews. Rather, the aim is to interact genuinely with the patient. Through this authentic interaction, the patient and the nurse will experience higher levels of consciousness. This process was adopted as a nursing intervention for cancer patients,[7] families including patients,[8] and nurse students for cancer prevention[9] in a unitary perspective. This unitary approach for nursing patients with cancer was introduced into a practicing nurse group[10] and into an educational curriculum for an Oncology Certified Nurse Specialist in Master's Programs in Japan.[11] Praxis nature within Newman's theory was based on the aforementioned studies.[12] This article will be helpful for designing a nursing intervention from a unitary perspective.

Relevance of Newman's Health as Expanding Consciousness Theory Across Cultures

Newman's theory has been used throughout the world, but it was quickly embraced and understood by nurses from the Eastern cultures. They are less bound by linear thought and a physical concept of health; they are immersed more in the metaphysical aspect of human existence.[13] The author recommends the practice of “caring partnership” to nurses who provide care to patients with cancer, especially those going through a difficult situation, such as a gear change or end-of-life period. A case report that is based on Newman's HEC theory will be presented in this issue.

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Conflicts of interest

There are no conflicts of interest.