MARGARET A. NEWMAN’S

HEALTH AS EXPANDING CONSCIOUSNESS

By: MARK ERWIN C. TAGURAN, RN

January 30, 2010

Objectives

• Describe the historical background of the development of Newman’s Health as Expanding Consciousness

• Define Newman’s concepts and assumptions– Expanding Consciousness– Consciousness– Movement– Time– Space– Pattern– Pattern Recognition– Transformation

• Present the relationship between Health as Expanding Consciousness and concepts in nursing’s metaparadigm

• Give an example of use of Health as Expanding Consciousness in clinical practice

Upon successful discussion of this theory, colleagues will be able to:

Theorist

MARGARET A. NEWMAN, R.N, PhD, F.A.A.N

Birthday:October 10, 1933 in Memphis, Tennessee

EDUCATION

1954 – Bachelor’s Degree in Home Economics and English at Baylor University in Waco, Texas

1962 - Bachelor’s Degree in Nursing at University of Tennessee in Memphis

1964 – Master’s Degree in Medical-Surgical Nursing and Teaching at University of California, San Francisco

1971 – Doctorate of Nursing Science and Rehabilitation at New York University

Employment

Director of Nursing of the Clinical research center at the University of Tennessee in Memphis

1971 to 1976- completed her graduate studies at New York University. She also worked and taught alongside nursing theorist Martha Rogers.

Rehabilitation Nursing stemmed her interest in health, movement & time.

1977- Professor in charge of graduate study in nursing at Pennsylvania State.

1984- Nurse theorist at the University of Minnesota.

1996- Retired from teaching.

Achievements

Received Outstanding Alumnus Award from the University of Tennessee College of Nursing in both 1975 and 2002

1976 – Newman was admitted into the American Academy of Nurses

1979 – American Journal of Nursing scholar

Newman participated as a member of the nurse theorist task force (1978-1982) with the North American Nursing Diagnosis Association (NANDA)

1984 – Received the Distinguished Alumnus Award from the Division of Nursing at New York University

1988 – Admitted into the hall of fame at the University Of Mississippi School Of Nursing

1996 – Received the E. Louis Grant Award for Nursing Excellence from the University of Minnesota

Newman is listed in the Who’s Who in American Women, Who’s Who in America, and Who’s Who in American Nursing.

Published three books, and several journal articles

Theory Development in Nursing (July 1, 1979)

Health As Expanding Consciousness (1986 and 1994)

Developing Discipline: Selected Works of Margaret Newman (1995)

Served on several editorial review panels

Currently a member of the advisory board of Advances in Nursing Science

CALL TO NURSINGINTRODUCTION OF THEORY

Cared for mother with ALS (Amyotrophic Lateral Sclerosis)

Amyotrophic lateral sclerosis (ALS), sometimes called Lou Gehrig's disease, is a rapidly progressive, invariably fatal neurological disease that attacks the nerve cells (neurons) responsible for controlling voluntary muscles.

In ALS, both the upper motor neurons and the lower motor neurons degenerate or die, ceasing to send messages to muscles. Unable to function, the muscles gradually weaken, waste away, and twitch. Eventually the ability of the brain to start and control voluntary movement is lost.

Individuals with ALS lose their strength and the ability to move their arms, legs, and body. When muscles in the diaphragm and chest wall fail, individuals lose the ability to breathe without ventilatory support. The disease does not affect a person's ability to see, smell, taste, hear, or recognize touch, and it does not usually impair a person’s thinking or other cognitive abilities.

However, several recent studies suggest that a small percentage of patients may experience problems with memory or decision-making, and there is growing evidence that some may even develop a form of dementia. The cause of ALS is not known, and scientists do not yet know why ALS strikes some people and not others.

REALIZATIONS1. Simply having a disease does not

make you unhealthy 2. Time, movement, and space are in

some way interrelated with health

Both Newman and her mother experienced 1. Alterations in movement, time, space and

consciousness.2. Greater sense of connectedness and increase

insight into the meaning of their experience and into the meaning of health.

EARLY INFLUENCESEARLY INFLUENCES

Martha RogersTheory of Unitary Human Beings

•Health and Illness are not two separate realities, but rather as a unitary process.

•All of reality is a unitary whole and that each human being exhibits a unique pattern.•Unitary human being is open and in interaction with its environment.•There are no real boundaries between human and environment; pattern is an identification of the wholeness.

•Life process as showing increasing complexity.

Dr. Newman with Martha Rogers, teacher and mentor, while in New York in June 1992

Supports Newman’s “Disease is a manifestation of the pattern of health” and “Health as a pattern of the whole with a normal progression towards higher levels of organization.”

David BohmTheory of Implicate Order

Newman incorporated Prigogine’s theory as an explanation for the timing of nursing presence as the patient fluctuates from one level of organization to a higher level.

Ilya

PrigogineTheory of Dissipative Structures

‘Normal’ Predictable Fluctuation Period of disorganization, unpredictability and uncertainty

Emergence of new order at higher level of organization

Time when partnership with an HEC nurse can be of great benefit

Giant Fluctuation

Figure 1. Prigogine’s Theory of Dissipative Structures applied to HEC nursing.

Discussion of the importance of insight, pattern recognition, and choice provided the impetus for the integration of Newman’s basic concepts of movement, space, time, and consciousness into a dynamic portrayal of health and life.

Arthur YoungStages of Human Evolution

Figure 2. Parallel between Newman’s Theory of Expanding Consciousnessand Young’s Stages of Human Evolution.

- Individual identity- Self consciousness- Self determination- Develop as the person breaks with authority

7 Stages of Human Evolution

Potential freedom – the capacity of the individual to evolve

- the collective is primary - the individual is not important- everything is regulated and initiative is not needed

Binding

Centering

- Human learns the law of the way things work and make choices that ultimately make human beyond space and time to a state of absolute consciousness.

- The individual learns that the old ways of being are no longer working and a new way of being is necessary.

-Stage of Self awareness, inner growth, and transformation.

– the turning point in which the individual learns the “law”. The emphasis on choice is on science and a search for laws with the new awareness of self limitations.

Choice

– Complete freedom and unrestricted choice.- Absolute consciousness which has been equated with love.

– Emphasis shifts away from self– development to something greater than the individual. - Energy is a dominant feature and one’s works develop a life of their own; the experience is one of unlimited growth.

– Increasing freedom from time

Decentering

Real Freedom

Unbinding

•Consciousness as evolving and being coextensive with the universe supports Newman’s theory of “Health is the process of expanding consciousness”.

•Defined consciousness as “a state in which contrasting concepts become reconciled and fused. Movement and rest fuse into one.

•Newman used Bentov’s conceptualization of time as an index of consciousness to demonstrate expanding consciousness across life span.

Itzhak

Bentov“Life as a Process of Expanding Consciousness.”

Affirming of Newman’s views of the nature of health and nursing.

Richard Moss

“Presentation of love as the highest level of consciousness”

Major Concepts and Definition of Terms

•Consciousness•Expanding Consciousness•Pattern •Pattern Recognition •Transformation •Movement•Time•Space

•The informational capacity of the system and the ability of the system to interact with its environment.•Not only cognitive and affective awareness, but also the “interconnectedness of the entire living system which includes physiochemical maintenance and growth processes as well as the immune system.•The person does not just possess consciousness but is consciousness.

CONSCIOUSNESS

•The highest level of consciousness is absolute consciousness and is equated with love, where all opposites are reconciled and experiences are all accepted equally and unconditionally, such as love and hate, pain and pleasure, and disease and nondisease.

•All experiences are equal and unconditional.•Transcendence is a process through which the person reaches the highest level of consciousness.

CONSCIOUSNESS

•A universal 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.

EXPANDING CONSCIOUSNESS

-Information that depicts the whole, understanding of the meaning and relationships at once. It is the fundamental attribute of all there is and gives unity in diversity.

-Identifies the wholeness of the person

•unfolds in time and cannot be predicted •dynamic (in constant movement)•identified across space and time

Health is a pattern of the whole

PATTERN

PATTERN

-Health assessment framework based on 9 patterns of person environment interactions that guide a nurse in making holistic observations consist of following dimensions:

-choosing, - moving-communicating, - perceiving-exchanging, - relating-feeling, - and valuing-knowing,

– Becoming aware of the pattern of the other person by becoming “in touch with one’s own pattern.” Health professional should focus on the pattern of other person, acting as the reference beam in a hologram.

PATTERN RECOGNITION

– a change that occurs all at once rather than in a gradual and linear fashion. As more information is obtained, the pattern evolves unidirectionally and becomes more highly organized.

TRANSFORMATION

MOVEMENT-SPACE-TIME

-Dimensions of merging patterns of consciousness.

-Represent the person as a center of consciousness.

Movement

•A reflection of consciousness. •An individual conveys his or her awareness of self through the movement involved in language, posture, and body movement.•The rhythm and pattern which are reflected in movement are an indication of internal organization of the person and his perception of the world.•Provides a means of communication beyond that which language can convey.

•An essential property of matter needed to bring about change.

•A pivotal choice point in the evolution of human consciousness. •The means whereby space and time become a reality and, therefore, is a means of becoming aware of self.•Movement through space is integral to the development of a concept of time in man and is utilized by man as a measure of time.

Movement

•A function of movement

•A measurement of consciousness

•Centers primarily on time as perceived duration or subjective time.

•Time and timing relate the rhythm of living phenomena

Time

•The unbounded three-dimensional expanse in which all matter exists

•The region that lies beyond the atmosphere, and all that it contains

•Distance or interval •Holographic sense: “Each moment has an explicate order and also enfolds all others, meaning that each moment of our lives contains all others of all time.”

Space

•Inextricably linked to each other and has a complementary relationship. “When one’s life space is decreased, as by either physical or social immobility, one’s time is increased.”

Time and Space

Theory Assumptions

•Health encompasses conditions heretofore described as illness or, in medical terms, pathology.

•These ‘pathological’ conditions can be considered a manifestation of the total pattern of the individual.

•The pattern of the individual that eventually manifests itself as pathology is primary and exists prior to structural or functional changes.

Theory Assumptions

Theory Assumptions•Removal of the pathology in itself will not change the pattern of the individual.

•If becoming ‘ill’ is the only way an individual’s pattern can manifest itself, then that is health for that person.

•Health is the expansion of consciousness.

From: Instrumental View – linear, causal, predictive, rational, controlling, dichotomous

Paradigm Shift

1. Particulate – deterministic paradigm: Isolatable, reducible entities with definable, measurable properties (i.e., A causes B, or atherosclerotic plaques causes heart attacks).

2. Interactive – integrative paradigm: Views reality as multidimensional and contextual. Multiple antecedents and probabilistic relationships are believed to bring about change in the phenomenon. (i.e., A+B+C+D are interrelated in their affect on heart attacks).

To: Relational View – pattern, emerging, unpredictable, unitary, intuitive, and innovative.

3. Unitary – transformative paradigm: “Unitary, self-organizing field embedded in a larger self – organizing field. It is identified by pattern and by interaction with the larger whole.”

Paradigm Shift

•Searching for patterns instead of treating symptoms

•Perceiving pain and disease as information instead of seeing them as totally negative

•Viewing the body as a dynamic field of energy that is continuous with a larger field instead of a machine in various states of repair and despair

•Seeing disease as a process rather than an entity

Paradigm Shift

Metapardigm

“The human is unitary, that is cannot be divided into parts and is inseparable from the larger unitary field”

•The person does not just possess consciousness but is consciousness.

•Centers of consciousness within overall pattern of expanding consciousness.

•Individual who is identified by a unique pattern. (Person can be defined as family, group or community)

•A person is unique and each individual’s patterns should be recognized as sequential over time.

Person

•Larger whole which is beyond the consciousness of the individual.

•The pattern of person-environment interactions shapes health by evolving to higher levels of consciousness of the self.

•Individuals patterns are embedded in family community society

•In unison with human beings

Environment

•“Health is the pattern of the whole, and ... wholeness cannot be gained or lost, in a way that becoming ill does not diminish wholeness but wholeness takes on a new form.”

•A unitary pattern of the whole and encompasses both disease and non-disease.

•Health is an outcome of the person’s interaction with the environment

•Disease is part of the environment; hence becomes part of person-environment interaction.

•The combination of disease and non-disease creates health

Health

“…the goal of nursing is not to make people well or to prevent their getting sick, but to assist people to utilize the power that is within them as they evolve toward higher levels of consciousness…”

Intervention is a form of nonintervention whereby the nurse’s presence helps client get in touch with the meaning of life by identifying their health patterns. Nurses also help clients identify different pattern of interactions.

Nursing

NURSEPATIENT

Pattern recognition: Becoming aware of the pattern of the other person by becoming “in touch with one’s own pattern.” Health professional should focus on the pattern of other person, acting as the reference beam in a hologram.

Nursing

Figure 3. Interaction pattern of two persons– A holographic model of intervention.

Nursing•Nurse-client interaction: A mutual process of attending to that which is meaningful to the patient as well as the nurse.

•Partnership demands that nurses develop tolerance for uncertainty, disorganization, and dissonance, even though it may be quite uncomfortable. It is in the state of disequilibrium that the potential growth exists.

•Newman states, “The rhythmic relating of nurse with client at this critical boundary is a window of opportunity for transformation in the health experience.”

Nursing out of HEC perspective involves being fully present to the patient without judgments, goals, or intervention strategies.

It involves working with the client, and not doing for the client. It is caring in its deepest, most respectful sense.

The nurse works together with the client through these critical choice points, when change takes place.

Nursing

Application

CASE STUDY: Max ArmstrongIs a 57-year-old white, married man lives in New

Liskeard with his stay-at-home wife Elsie. They have three grown children who live nearby. Mr. Armstrong is a smoker and has had angina on and off for the last few years. He is a long haul transport truck driver and is off for the week after a one week trip out west.

It is mid-January and a heavy snowfall warning is in effect. 15 centimetres of snow have already fallen. Elsie decides to make a hot stew to warm up and needs to get to the grocery store. She asks Max to shovel the driveway.

Max, being a loving husband, states “No problem, honey. Lord knows I love stew! I’ll be finished in a jiffy!”

While Max was shovelling he began to feel tightness in his chest. He soon discovered it was harder and harder to breathe and this time, his pain radiated to his arm and jaw. Before he knew it, he was on the snow covered ground in the driveway. His wife Elsie saw him collapse through the window and called 911.

After waking up after his MI in the ICU with Elsie by his side, Max explained he thought he was dead. He described his life flashing before his eyes and said he saw himself getting married, his children being born, and his granddaughter on the first day of school all over again. He described being pulled toward a bright light at the end of a tunnel and experiencing a sense of serenity and freedom.

Max had hit a “Choice Point” and in order to support Max while he is evaluating his life, the nurse would provide appropriate information regarding nutrition and smoking cessation and work with him to develop appropriate changes.

HEC ApproachNurses who form relationships with their clients can help them identify problematic patterns, move to a choice point, then to a higher level of consciousness, resulting in a reduction in problematic patterns of behaviour.

AssessThe nurse assists the client to recognize that his life patterns no longer function as they currently are and new ways of relating to his environment are necessary.

Max : 57 year old, white male, Hx of angina, Smoker, Trucker, Sedentary lifestyle, Poor eating habits, Poor sleeping patterns, Married with 3 grown children, Lives in New Liskeard (rural area), Recent MI caused a near death experience

Plan

While respecting the client's choices, the nurse assists the client in exploring resources for transformation.

Discuss with client possible changes to identified health patterns that are no longer functioning and discuss possible new ways of relating them or creating new health patterns.

Work with client not decide for client

Implement

The client integrates health strategies into his lifestyle.

Client will demonstrate improved nutrition habits.

Client will demonstrate increased physical activity by exercising 20 minutes each day.

Client will demonstrate improved sleeping habits by sleeping at least 7h/night.Client will demonstrate appropriate use of Nitro-glycerin by having an unexpired bottle at hand at all timesClient will begin smoking cessation measures.

Evaluate

The nurse examines the client's transformed relationship and how the interactions overcome the health challenge

Client has demonstrated improved nutrition habits.Client has increased physical activity.Client has demonstrated improved sleeping habits.Client has demonstrated appropriate use of Nitro-

glycerin.Client has begun a smoking cessation program

A new understanding has developed on how his environment relates to his health

The MI and near death experience had a great impact on Max. He re-evaluated his life and decided he had some big changes to make. Max started exercising; eating healthier and he even decided to quit smoking. Max cut down on the long distance runs he took so that he could get better sleep more often.

Elsie wanted to support Max’s lifestyle change so she started looking up healthier choices for his favourite recipes and even got a part-time job to help with the finances, and she always made sure Max had his Nitro- glycerine on him in case he has chest pain.

THANK YOU!