Health in Nursing and Newman’s Theory
Newman’s Theory of Health
contributions to nursing science and nursing practice span 30 years of
sustained scholarship on the theory of health as expanding consciousness.
Newman’s theory of health exemplifies her focus on a unitary transformative
paradigm for the discipline of nursing and on research as practice methodology.
Newman’s Conceptual Work and Book
Newman’s conceptual framework of health was introduced in her book
Theory Development in Nursing (1979) and was expanded and refined in two
editions of her book Health as Expanding Consciousness (1986, 1994).
Her work
was published at a time when fewer abstract theories of nursing based on
current practice were emphasized. Rather than being viewed as visionary with a
creative and futuristic conceptualization of health, Newman’s highly abstract
grand theory as well as other grand theories of nursing was dismissed by the
majority of nurses as far removed from the real world of everyday practice.
As
scientists in other disciplines revolutionized their former mechanistic world
views to align more closely with a unitary transformative paradigm, Newman’s
theory of health has achieved greater acceptance by nurse scientists and
practitioners, particularly transcultural nurses and holistic nurses.
Theoretical Inspiration
Newman’s (1986, 1994) theory of health was inspired by her own
nursing experiences, grounded in Rogers’ science of unitary human beings and
later expanded to include premises from Benton’s life process as expanding
consciousness and Prigogine’s theory of dissipative structures.
She
reconceptualized health as a manifestation of an underlying unitary field
pattern rather than as a health disease dichotomy. Health was defined as a
unitary pattern of the whole, reflecting the dynamic, evolving human
environment, the process of expanding consciousness which occurs within a
multidimensional matrix of movement, time, and space.
Consciousness was defined
as the informational capacity of the whole. She utilized Bohm’s theory of
undivided wholeness of reality and young’s theory of human evolution to support
the concept of unitary field pattern and the pivotal influence of human choice.
Nursing practice was defined as a mutual process of attainement during which the
underlying patterns of the client and nurse are identified and both individuals
are transformed.
Newman as Nursing Advocate
Newman was an early eloquent advocate for nursing to identify,
develop, and differentiate a paradigm that addressed the unique knowledge of
nursing embodied in practice and in scholarly inquiry. In collaboration with
Sime and Corcoran-Perry (Newman, Sime, & Corcoran-Perry, 1991, p. 3), she
defined the focus of nursing as “caring in the human health
experience.” Differences between
(a) the prevailing particulate deterministic
and interactive integrative paradigms that had previously shaped nursing
education, research, and practice.
(b) a unitary transformative paradigm for
the discipline of nursing in the future were discussed.
In the
unitary-transformative paradigm, “a phenomenon is viewed as a unitary,
self-organizing field embedded in a larger self-organizing field” (Newman
et al., p. 4) and is identified by its pattern and its interaction with the
larger whole.
Change is unidirectional and unpredictable, with systems moving
through stages of organization and disorganization to increasingly complex
levels. Knowledge, which is personal and involves pattern recognition, is seen
as a function of both the viewer and the phenomenon viewed.
Model of Nursing Practice Levels
In accordance with the unitary transformative paradigm, Newman
(1990b) described a model of differentiated nursing practice having three
levels based on education, with advanced practice nurses having graduate
preparation in the unitary-transformative paradigm.
Newman proposed using
nursing diagnoses that recognize patterns of person environment interaction,
rather than the North American Nursing Diagnosis Association diagnoses which
reflect a static client in isolation from the environment.
Her work
subsequently moved away from conventional assessment and diagnosis as part of
the nursing process toward nursing practice and research using her model of
research as practice, in which nursing interventions may be viewed as inherent
in the mutual process of client and nurse pattern recognition.
Newman (1990a)
identified the lack of conceptual fit between conventional quantitative
research methods and the unitary-transformative paradigm of her theory of
health.
She posited that nurse scientists: should use research as praxis
methodology, a hermeneutic method of inquiry in which the client and nurse are
core searchers in identifying, describing, and verifying the client’s pattern
of expanding consciousness from narrative data about the most meaningful events
in the client’s life.
Nurse scientists identified patterns of individual study
participants in their practice, with qualitative comparison of patterns across
study participants. Research as practice is therefore both a research method
and a transformative intervention.
Newman’s Theory and Nursing Research
Early quantitative research using conventional methods emphasized
testing propositions derived from Newman’s (1979) conceptual framework of
health, focusing on the concepts of movement, time, space, and consciousness
(Engle, 1996), Nurse scientists included Engle, Guadiano, Mentzer, Newman,
Schorr, and Tompkins.
Healthy adults were studied in community and laboratory
settings with predominantly small, nonprobability samples of male college
students, female college students, older adults, and older women.
Elaboration and Refinement in the Newman’s Concept
Subsequent elaboration and refinement of Newman’s (1986, 1994)
theory of health shifted the focus of research to health as expanding
consciousness, recognition of unitary field pattern, and research as praxis
methodology (Engle, 1996).
Nurse scientists. included Lamendola, Moch, Newman,
Schorr, and Schroeder. Small convenience samples of adults with and without
health. Problems were studied in community and health care settings, including
adults who exercised regularly, women with rheumatoid arthritis, women with
breast cancer, adults: with cancer, adults with coronary heart dis ease, and persons
with HIV/AIDS.
Much of the current research has demonstrated a transcultural
theory application. International nurse scientists include Connor and
Litchfield in New Zealand, Endo in Japan, Jonsdottir in Iceland, and Yamashita
in Canada.
The preceding studies have demonstrated the congruency of Newman’s
theory of health and of the research as practice methodology for pattern
identification with different cultures (Engle & Fox-Hill, 2005).
Outcomes of Newman’s’ Theory
Newman’s theory of health exemplifies the relationship between theory,
research, and practice. The mutual process of evolving pattern recognition by
the client and nurse using research as practice informs nursing practice.
As
pattern recognition occurs, clients gain insights that create the opportunity
for action. This practice approach exemplifies the participatory paradigm
(Litchfield, 1999) emphasized by current health care systems that values shared
decision making, collaboration, and partnering with multicultural clients,
families, and interdisciplinary health care providers.