Newman’s Theory of Health Margaret Newman, a prominent nurse theorist, has made significant contributions to the discipline of nursing through her development of the theory of health as expanding consciousness. Her work, which spans over 30 years, emphasizes a unitary transformative paradigm for nursing and integrates research as a core practice methodology. This article delves into Newman’s theory of health, her conceptual framework, her role as a nursing advocate, the application of her theory to nursing practice and research, and the outcomes associated with her theory.
Newman’s Theory of Health
Overview of the Theory:
Margaret Newman is recognized for her visionary approach to nursing, particularly through her development of the theory of health as expanding consciousness. This theory proposes that health is not merely the absence of disease but a reflection of the whole person’s life pattern and consciousness. Newman’s work focuses on a unitary transformative paradigm, which sees human beings as open systems interacting continuously with their environments, influencing and being influenced by them in a dynamic, evolving process.
Newman’s theory suggests that health encompasses the entire range of human experience, including periods of illness or health crises, which can lead to greater awareness and consciousness. Thus, health is defined as a “pattern of the whole,” reflecting a dynamic human-environmental interaction. The theory moves away from the dichotomy of health versus disease, suggesting instead that all experiences, whether considered healthy or pathological, contribute to a person’s growth and expanding consciousness.
Newman’s Conceptual Work and Book
Newman introduced her conceptual framework in her book, Theory Development in Nursing (1979). This work was later expanded and refined in her subsequent books, Health as Expanding Consciousness (1986, 1994).
Her theory was initially received with skepticism by many within the nursing community, as it was highly abstract and grand, which was not typical for nursing theories at the time. Most nursing theories were more grounded in everyday practice. However, as scientific thinking in other disciplines evolved towards a more holistic, unitary transformative paradigm, Newman’s theory gained greater acceptance among nurse scientists and practitioners, particularly those in transcultural and holistic nursing.
Theoretical Inspiration
Newman’s theory was inspired by her own nursing experiences and was initially grounded in Martha Rogers’ Science of Unitary Human Beings. It was later expanded to incorporate principles from Benton’s concept of life processes as expanding consciousness and Prigogine’s theory of dissipative structures, which describes how systems evolve over time in response to changes in their environment.
In this context, Newman reconceptualized health not as a dichotomy of health and disease but as a manifestation of a unitary field pattern that evolves over time. Health is seen as an expression of consciousness, defined as the informational capacity of the whole. Newman drew on Bohm’s theory of undivided wholeness of reality and Young’s theory of human evolution to support her concept of a unitary field pattern, which emphasizes the influence of human choice.
In Newman’s view, nursing practice is a mutual process between the nurse and the client, where both parties are transformed through their interactions. This process involves identifying the underlying patterns of the client’s life and working together to expand consciousness.
Newman as a Nursing Advocate
Newman was an early and influential advocate for nursing to identify, develop, and differentiate a unique paradigm that addressed the distinctive knowledge base of nursing, both in practice and scholarly inquiry. Collaborating with Sime and Corcoran-Perry (Newman, Sime, & Corcoran-Perry, 1991), she defined the focus of nursing as “caring in the human health experience.”
Newman emphasized the differences between:
- The Prevailing Paradigms:
- Particulate-Deterministic Paradigm: A mechanistic view where phenomena are seen as separate parts.
- Interactive-Integrative Paradigm: A view that emphasizes interactions and integration between parts.
- The Unitary-Transformative Paradigm:
Newman advocated for a new paradigm in which phenomena are seen as unitary, self-organizing fields embedded in a larger self-organizing field, identified by their pattern and interaction with the larger whole. Change is considered unidirectional and unpredictable, with systems moving through stages of organization and disorganization to increasingly complex levels.
Model of Nursing Practice Levels
Newman (1990b) proposed a model of differentiated nursing practice based on the unitary transformative paradigm, which included three levels of practice based on the nurse’s education:
- Advanced Practice Nurses: Nurses with graduate-level preparation in the unitary-transformative paradigm.
- Nursing Diagnoses: Newman suggested moving away from the static diagnoses of the North American Nursing Diagnosis Association, which often reflect a client isolated from their environment, towards recognizing patterns of person-environment interactions.
- Research as Practice: Newman’s approach shifts nursing away from conventional assessment and diagnosis methods towards a model where nursing practice and research are intertwined. Nursing interventions are seen as part of a mutual process of pattern recognition between client and nurse.
Newman’s Theory and Nursing Research
Early research on Newman’s theory employed conventional quantitative methods to test propositions derived from her conceptual framework of health, focusing on the concepts of movement, time, space, and consciousness (Engle, 1996). Studies were conducted with healthy adults in community and laboratory settings, using small non-probability samples, including male and female college students, older adults, and older women. Researchers like Engle, Guadiano, Mentzer, Newman, Schorr, and Tompkins were involved in these studies.
Elaboration and Refinement in Newman’s Concept
Subsequent elaboration and refinement of Newman’s theory shifted the focus of research to health as expanding consciousness, recognizing unitary field patterns, and using research as a praxis methodology (Engle, 1996). Nurse scientists such as Lamendola, Moch, Newman, Schorr, and Schroeder continued this work with small samples of adults, both healthy and with health problems, in community and healthcare settings.
These studies included populations such as adults who exercised regularly, women with rheumatoid arthritis, women with breast cancer, adults with cancer or coronary heart disease, and people living with HIV/AIDS. Newman’s theory has also demonstrated applicability across different cultures, with international nurse scientists such as Connor and Litchfield in New Zealand, Endo in Japan, Jonsdottir in Iceland, and Yamashita in Canada showing congruence of the theory with diverse cultural contexts (Engle & Fox-Hill, 2005).
Outcomes of Newman’s Theory
Newman’s theory of health exemplifies the interconnectedness of theory, research, and practice in nursing. The mutual process of evolving pattern recognition between the client and nurse using research as practice informs nursing interventions and decision-making. As patterns are recognized, clients gain insights that enable them to take meaningful actions in their lives.
Newman’s approach aligns with the participatory paradigm (Litchfield, 1999) that is emphasized in contemporary healthcare systems. This paradigm values shared decision-making, collaboration, and partnership with multicultural clients, their families, and interdisciplinary healthcare providers. Newman’s theory supports these values by emphasizing that both nurses and clients are active participants in the health experience, contributing to a deeper understanding of health as expanding consciousness.
Conclusion
Margaret Newman’s theory of health as expanding consciousness offers a profound shift in how health, illness, and nursing practice are conceptualized. Her work moves beyond the traditional views of health as merely the absence of disease, instead framing it as an ongoing process of expanding awareness and consciousness.
Newman’s theory provides a robust framework for nursing practice, research, and education, encouraging nurses to view their practice as a dynamic process that involves mutual growth and transformation for both the nurse and the client. Her advocacy for a unitary-transformative paradigm has influenced a new generation of nurse scientists and practitioners who see health as a complex, evolving interaction between human beings and their environments.
As the field of nursing continues to evolve, Newman’s theory will likely continue to inspire and guide nursing practice and research, promoting a holistic understanding of health that integrates scientific knowledge with compassionate care.