Margaret A.

Newman's Contribution to Nursing Theory: Health as Expanding Consciousness

The initial idea for Newman's Health as Expanding Consciousness Theory came together as a result of an invitation to speak at a conference on nursing in 1978. It stems from Rogers' Theory of Unitary Human Beings. It was stimulated by concern for those for whom the absence of disease or disability is not possible. Newman was also influenced by Bentov's concept of the evolution of consciousness, Young's Theory of Process, and Bohm's Theory of Implicate. This grand theory of nursing claims that every person in every situation, regardless of how disordered and hopeless it may seem, is part of the universal process of expanding consciousness, which is a process of becoming more of oneself, finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world. Newman's theory makes six assumptions. They are: 1. Health encompasses conditions heretofore described as illness, or, in medical terms, pathology. 2. These pathological conditions can be considered a manifestation of the total pattern of the individual patient. 3. The pattern of the individual patient that eventually manifests itself as pathology is primary, and exists prior to structural or functional changes. 4. Removal of the pathology in itself will not change the pattern of the individual patient. 5. If becoming ill is the only way an individual patient's pattern can manifest itself, then that is health for that individual patient. 6. Health is an expansion of the consciousness. According to Newman, "The theory of health as expanding consciousness (HEC) was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses

often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness - a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world." Humans are open to the whole energy system of the universe and constantly interacting with the energy. With the process of interaction, humans are evolving their individual patterns of whole. According to Newman, the pattern of the individual patient is essential. The expanding consciousness is pattern recognition. How a disease manifests in an individual patient depends on the pattern of that patient, so the pathology of the disease exists before the symptoms appear. By this logic, the removal of the symptoms of the disease will not change the patient's individual structure or pattern. The model also addresses the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and have a complementary relationship. People are constantly changing through time and space, which is movement, which shows a unique pattern of reality. According to Newman, nursing is the process of recognizing the patient in relation to the environment, and it is the process of the understanding of consciousness. The nurse helps patients understand how to use the power they have within in order to develop a higher level of consciousness. Therefore, it helps to realize the process of disease, its recovery, and its prevention. Nursing is seen as a partnership between the nurse and patient, and both grow in the sense of higher levels of consciousness.

Margaret A. Newman was influenced by Martha Rogers' Theory of Unitary Human Beings, Itzhak Bentov's Concept of the Evolution of Consciousness, Arthur Young's Theory of Process, and David Bohm's Theory of Implicate as she developed her model of nursing. The Health as Expanding Consciousness theory makes the following assumptions:
Health encompasses conditions described as illness, or, in medical terms,

pathology.
These pathological conditions can be considered a manifestation of the total pattern

of the patient.
The pattern of the individual patient that eventually manifests itself as pathology is

primary, and exists prior to structural or functional changes.

Removal of pathology will not, in itself, change the pattern of the individual patient. If becoming ill is the only way an individual patient's pattern is able to manifest

itself, then that is health for that individual patient.

Health is an expansion of consciousness.

According to Newman, "the theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness - a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world." Patients are open to the whole energy system of the universe, as well as constantly interacting with the energy. This process of interaction allows people to evolve their individual patterns of whole. According to Newman, understanding the patient's pattern is essential. The pattern recognition is the expanding consciousness. The manifestation of disease depends on the pattern of the patient, so the pathology of the diseases exists before the symptoms begin to appear. Because of this, removal of the disease symptoms does not change the individual structure. Newman redefines nursing according to her nursing process of recognizing the

individual in relation to the environment, and it is a process of the understanding of consciousness. The nurse's understanding of people helps them use the power within to develop the higher level of consciousness. Therefore, it helps to realize the disease process, its recovery, and its prevention. She also explains the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and they have a complementary relationship. People are constantly changing through time and space, and it shows a unique pattern of reality. The theory explains that health and illness are synthesized as health. That is, the fusion of one state of being (disease) with its opposite (non-disease) results in what can be considered health. In this model, the human is unitary. He or she cannot be divided into parts, and is inseparable from the larger unitary field. People are individuals, and human beings are, as a species, identified by their patterns of consciousness. The person does not possess consciousness. Instead, the person is consciousness. People are centers of consciousness with an overall pattern of expanding consciousness. The environment is described as a "universe of open systems." In this model, nursing is "caring in the human health experience." It is seen as a partnership between the nurse and patient, with both growing in the "sense of higher levels of consciousness." Newman's theory is considered a grand nursing theory. She states that people cannot be divided into parts. Health is central to the theory, and is seen as a process of a developing awareness of the individual self and the person's environment. She also states that "consciousness is a manifestation of an evolving pattern of person-environment interaction." Newman's Health as Expanding Consciousness Theory is beneficial because it can be applied in any setting and "generates caring interventions." However, its drawbacks are that it is abstract, multidimensional, and qualitative, and there is little discussion on environment within the model. Patients are open to the whole energy system of the universe, as well as constantly interacting with the energy. This process of interaction allows people to evolve their

individual patterns of whole. According to Newman, understanding the patient's pattern is essential. The pattern recognition is the expanding consciousness. The manifestation of disease depends on the pattern of the patient, so the pathology of the diseases exists before the symptoms begin to appear. Because of this, removal of the disease symptoms does not change the individual structure. Newman redefines nursing according to her nursing process of recognizing the individual in relation to the environment, and it is a process of the understanding of consciousness. The nurse's understanding of people helps them use the power within to develop the higher level of consciousness. Therefore, it helps to realize the disease process, its recovery, and its prevention. She also explains the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and they have a complementary relationship. People are constantly changing through time and space, and it shows a unique pattern of reality. The theory explains that health and illness are synthesized as health. That is, the fusion of one state of being (disease) with its opposite (non-disease) results in what can be considered health. In this model, the human is unitary. He or she cannot be divided into parts, and is inseparable from the larger unitary field. People are individuals, and human beings are, as a species, identified by their patterns of consciousness. The person does not possess consciousness. Instead, the person is consciousness. People are centers of consciousness with an overall pattern of expanding consciousness. The environment is described as a "universe of open systems." In this model, nursing is "caring in the human health experience." It is seen as a partnership between the nurse and patient, with both growing in the "sense of higher levels of consciousness." Newman's theory is considered a grand nursing theory. She states that people cannot be divided into parts. Health is central to the theory, and is seen as a process of a developing awareness of the individual self and the person's environment. She also states that "consciousness is a manifestation of an evolving pattern of person-environment interaction." Newman's Health as Expanding Consciousness Theory is beneficial because it can be

applied in any setting and "generates caring interventions." However, its drawbacks are that it is abstract, multidimensional, and qualitative, and there is little discussion on environment within the model.
Exemplars of HEC Nursing Practice

One of the most frequently asked questions (FAQ) is, ow do nurses practice from the health as expanding consciousness (HEC) theoretical perspective?

HEC practice is not focused on simply treating disease, but rather on attending to how the current situation fits into the patient evolving pattern of interaction with that which is meaningful to her or him, and how the patient chooses to move forward. It attends to the whole of a person experience and being. It centers on recognizing life patterns. HEC practice gives insight not only to individual life patterns, but also to the pattern of the community interacting with the individual. Caring in the HEC perspective is nonjudgmental, noninterventionist, and involves being with rather than just doing for. It is caring in its deepest, most respectful sense.

From Margaret Dexheimer Pharris, Minneapolis, Minnesota, USA:

Newman HEC theory has been the basis of my nursing practice over the past decade. It has served as a basis for my interactions with my BSN and graduate nursing students. It has shaped my nursing care of adolescents experiencing violence, survivors of sexual assault and abuse, and people presenting to the local trauma center for emergent care. I have found its greatest power in working with people who have been labeled with the diagnosis of borderline personality disorder, in that the process of pattern recognition focuses on the interaction between the person and her or his environment. As pattern recognition unfolds, the person is able to see what was a manifestation of who they are at the core of their being, and what was a manifestation of their environment, the people around them as they were growing up. This insight is often transformative, pointing to a different way of interacting with others.

The exemplar I would like to offer is from the emergency room setting. Nurses often think that HEC practice can only happen in ontraditional nursing settings where the nurse has more time to interact with clients. This is not so. In every interaction nurses are providing patients with a reflection of themselves, whether it is intentional or not. Nurses in the US have been consistently found by national polls to be the most trusted of all professions. The public comes to us in a spirit of trust.

The setting is a major emergency department of a trauma center. It is a very busy day with ambulances pulling in. I am responsible for the care of the patients in three high-acuity rooms. My newest patient is brought in by ambulance. She comes to the emergency department for treatment of severe dehydration related to nausea and vomiting secondary to her AIDS infection. She has fear in her eyes. As I enter my patients rooms, I try to concentrate on being present in a way that the patient feels respected and regarded as a whole person. I try to be open to that which is important to the patient and realize that the patient only concern is not just what is happening to her physically. I realize that every encounter will be enfolded into the pattern of the patient evolving life interactions, and it could be a point of transformation. I try to care in a spirit that honors that reality. I use my body and my words to attend to creating a space in which the patient can reflect on that which is meaningful. As I perform emergent tasks, such as starting the IV, I try to ask a question to acknowledge the entirety of the patient experience, like, ow have you been getting on at home? or hat else are you concerned about? The question is not as important as the intent to be open to the concerns of the patient. My patient tells me she has five children and she is their sole parent. Tears well up as she reflects on issues surrounding facing her own death and how depleting it is to try to care for her teenaged children while she is sick herself. She reveals that she is isolated from any real support and has no one to talk with besides the children social worker. I reflected back to her, t sounds like things have been going along smoothly for you and your children up until this point, and that the care of your children has been most important to you. But now you feel isolated, especially as you reflect on facing your own death, and trying to care for yourself and your children. My patient nodded es and wept. We reflected on how she could change the constellation of people surrounding her and how she wanted to focus her energy in this stage of her life. I was able to offer her resources that could be helpful at this transformative time in her life. I believe that in attending to the whole of my patients experiences/being and the possibility of transformation, I can reflect that it is not just the physical body that is important. In this realization, the patient feels less limited by and focused on her physical condition. If all I did was start her IV, give her antiemetics, monitor hypotension, etc., I am reinforcing that the physical is all-important. In our brief interaction, what became obvious to my patient and to me, was that this point in her life was not just one of physical deterioration, but also a time of potential spiritual growth for her and her family. Health took on new meaning. Spending only a few more minutes, nurses are able to take the initiative to promote health, not just treat the problems caused by disease.

Source:

http://healthasexpandingconsciousness.org/home/index.php?

option=com_content&task=view&id=18&Itemid=34