Margaret Newmans Theory

Margaret Newmans Theory of Health as Expanding Consciousness1Margaret NEWMANDr. Newman studied nursing at the University of Tennessee, Memphis She received her graduate degree at the University of California in medical-surgical nursing, and received her masters degree in 1964.She earned her PhD at New York University in 1972, where she studied with Martha Rogers

Margaret NEWMANShe served as a director of nursing at a clinical research center, and taught nursing at Penn State University (1977-1984) and at University of Minnesota (1984-1996)In 1978 Dr. Newman began to articulate her ideas on the theory of health in nursing.

InfluencesMartha Rogers theory of Unitary Human Beings was the main basis of the development of her theory, Health as Expanding Consciousness

InfluencesDefined energy fields as the fundamental unit of living thingsPerson, family and environment exist as an interconnected, unitary whole

InfluencesItzhak Bentov The concept of evolution of consciousness Arthur Young The Theory of Process David Bohm The Theory of Implicate Health as Expanding ConsciousnessThe 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.Definition of TermsMovement essential property of matter and the change that occurs between two states of restTime - relate the rhythm of living phenomena Timing - recognized as important in the provision of nursing care, particularly in home healthSpace - discussed in conjunction with time and movement and not defined separately Definition of TermsPattern depicts the whole and is characterized by movement, diversity, and rhythmParts of a persons underlying pattern, that emerge from interaction:Physical signs and appearancesMental/Cognitive InsightsEmotional ExpressionsSpiritual InsightsPeople with similar life experiences will have similar patterns. - You can recognize a pattern between the patterns of similar people. This is helpful for nursing (Brown, 2011).The focus of pattern recognition should be the process of the evolving pattern, rather than the pattern itself (Pharris, 2011).Definition of TermsConsciousness - is the information of the system; the capacity of the system to interact with the environment. Includes cognitive awareness, but also the awareness of the interconnected living system - including the immune system and physiological/chemical system (Brown, 2011).Expanding consciousness (A pattern of the whole): the view of one's disease as the evolving pattern of the person-environment interaction, and not a separate entity of the body (Yamashita, 1999). The process of becoming more in touch with one's self, finding meaning in one's life, and becoming more connected with others (Pharris, 2010).Definition of TermsPattern recognition occurs within the observerChoice points - occurs when the old ways of doing things no longer work and new answers must be soughtAssumptionsHealth is a unitary process. This means both health and illness are a single process, which is referred to as "the pattern of the whole". (Yamashita, 1999)Disease can be considered a manifestation of the total pattern of the individual.The pattern of the individual that eventually manifests itself as a disease is primary and exists prior to structural or functional changesAssumptionsRemoval of the disease in itself will not change the pattern of the individualIf becoming ill is the only way an individual's pattern can manifest itself, then that is health for that person.Health is an expansion of consciousness.beliefsThe nurse's responsibility is not to cure an individual's disease or illness, but rather to prevent further sickness, assist in the recognition of their own power within themselves with the goal to achieve a higher level of consciousness (Pharris, 2010).Consciousness is an important "process of becoming more of oneself, of finding greater meaning in life, and of reaching new heights of connectedness with other people and the world. (Newman et. al., 2008)Health is a transforming process to higher levels of consciousness. (Newman et al., 2008)Nursing ParadigmHEALTH Health and illness are synthesized as health - the fusion on one state of being (disease) with its opposite (non-disease) results in what can be regarded as health.Synthesis of disease and non disease (Brown, 2011). Newman has stated that pattern recognition is the essence of the emerging health. Manifest health, encompassing disease and non-disease can be regarded as the explication of the underlying pattern of person-environment (Newman, 1998).Rather than being the opposite of illness, health includes patterns of disease and is an evolving unitary pattern of the whole (Pharris, 2011)

Nursing ParadigmNURSINGNursing is caring in the human health experience.Nursing is seen as a partnership between the nurse and client, with both grow in the sense of higher levels of consciousnessThe aim of nursing practice is to assist people to recognize the power that is within them to move to higher levels of consciousness (Endo, 2004).Help clients get in touch with the meaning of their lives by the identification of their patterns of relating (Madani et. al., 2009).Nursing ParadigmNURSINGThe nurses presence allows clients to recognize their own patterns of interacting with the environment (Madani et. al., 2009).Facilitates pattern recognition in clients by communicating and forming relationships with them at integral stages in their lives in a meaningful way (Madani et. al., 2009).Nursing as a unitary and transformative process. The nursing phenomenon is not a series of discrete works but a dynamic, unfolding process in the client- nurse relationship (Endo, 2004).Nurses are partners in the process of expanding consciousness (Madani et. al., 2009).Nursing ParadigmENVIRONMENTEnvironment is described as a universe of open systems PERSONSThe human is unitary, that is cannot be divided into parts, and is inseparable from the larger unitary field.Persons as individuals and human beings as a species are identified by their patterns of consciousness Persons are centers of consciousness within an overall pattern of expanding consciousnessIdentified by their individual patterns of consciousness."Does not possess consciousness but is consciousness".The definition of person also includes family and community.

Description of the TheoryThe 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 worldDescription of the TheoryThe manifestation of disease depends on the pattern of individual so the pathology of the diseases exists before the symptoms appear so removal of disease symptoms does not change the individual structure.Humans are open to the whole energy system of the universe and constantly interacting with the energy. With this process of interaction humans are evolving their individual pattern of whole.Description of the TheoryNewman also redefines nursing according to her nursing is the process of recognizing the individual in relation to environment and it is the process of understanding of consciousness.Time and space are the temporal pattern of the individual, both have complementary relationship. Humans are constantly changing through time and space and it shows unique pattern of reality.EVOLVING PATTERN OF THE NURSE-CLIENT PROCESSConnecting with the FamilyForming a Partnership for the InterviewCreating a Sense of Freedom for Limitless ExpressionFeeling a Sense of Timelessness for Awareness and InsightsResonating with each other as one for TransformationConclusionNewman's theory can be conceptualized asA grand theory of nursingHumans cannot be divided into partsHealth is central to the theory and is seen and is seen as a process of developing awareness of self and the environmentConsciousness is a manifestation of an evolving pattern of person-environment interactionTheory applied to nursingNurses must strive for pattern recognition and knowing the patient on a deep levelNurse client relationship often begins in times of disruption, uncertainty, and unpredictabilityNewman recognizes that nurses are change by their interactions with patients, just as patients are changed by their interactions with the nurses.

Theory applied to nursingNewmans model of Health is useful in the practice of nursing because it contained concepts used by the nursing profession. Movement and time are an intrinsic part of nursing intervention, that is, range-of- motion, ambulation, turning, coughing, and deep- breathing. These parameters are used each day by the nurse in practice.

Theory applied to nursingThe nurse is to help the client look for patterns in their life and together help the client conceptualize such patterns pertaining to the relationships in their lives.They are to act as a mirror for the client to recognize their pattern. This is done by listening to clients recollections, stories and descriptions of their life and illustrating these patterns to the client.By acknowledging and altering this pattern, one can develop a higher level of consciousness.Theory applied to nursingA nurse should help the client reflect on what is meaningful in their lives, so that the nurse can value these things as well. In order to be successful in nursing, one must establish a connection with the patient. Each patient is different, therefore each nurse-client relationship must be unique to be effective for health to ultimately be achieved.Theory applied to nursingWhen nurses engage with people in dialogue focused on meaning, they hold no judgment of good or bad, right or wrong (Pharris, 2011).Nurses regard whatever arises in the evolving pattern in the lives of individuals, families, and communities with a nonjudgmental, authentic presence (Pharris, 2011).

StrengthsProvokes a therapeutic nurse intervention.Interconnection between nurse and client occurs once both nurse and client are aware of ones own energy as to establish interaction between each others energy fields. This authenticity of the relationship prompts for a caring intervention by the nurse. (Tall & Yamashita, 1998)Can be applied to a multitude of situations.Health is a state of being with or without the presence of disease. A pattern is always developed within an individual that can become interrupted in which a choice point occurs. As a result, a movement between levels of consciousness occurs(Newman, 1999).

limitationsTheory is abstract.Although Newman's theory has been highly accepted and valued in the academic society, the lack of physical or concrete existence of her beliefs makes it difficult for individuals to accept(Newman, 1999)Research on theory is qualitative.This can create some misinterpretations of the theory resulting in incorrect results. Additionally, results can be influenced by the researcher's personal biases(Newman, 1999)referenceJones, D. A. (2006). Newmans health as expanding consciousness [Electronic version]. Nursing Science Quarterly, 19(4), 330-332.Moch, S. D. (1998). Health within illness: concept development through research and practice [Electronic version]. Journal of Advanced Nursing, 28(2), 305-310.Neill, J. (2002). Transcendence and transformation in the life patterns of women living with rheumatoid arthritis [Electronic version]. Advances in Nursing Science, 24(4), 27-47.Newman, M. A. (2010). Overview. In Health as expanding consciousness. Retrieved March 22, 2010, from http://healthasexpandingconsciousness.org/home/index.php?option=com_content &task=view&id=5&Itemid=6Newman, M. A. (2003). A world of no boundaries [Electronic version]. Advances in Nursing Science, 26(4), 240-245.referenceNewman. M. A. (2002). The pattern that connects [Electronic version]. Advances in Nursing Science, 24(3), 1-7.Pharris, M. D. (2005). Margaret A. Newmans theory of health as expanding consciousness and its applications. In M. E. Parker (Ed.), Nursing theories and nursing practice (2nd ed.). (pp. 217-233). Philadelphia: F. A. Davis. Pharris, M. D. (2002). Coming to know ourselves as a community through a nursing partnership with adolescents convicted of murder [Electronic version]. Advances in Nursing Science, 24(3), 21-42.Pharris, M. D. and Endo, E. (2007). Flying free: the evolving nature of nursing practice guided by the theory of health as expanding consciousness [Electronic version].Nursing Science Quarterly, 20(2), 136-140.Yamashita, M. (1999). Newmans theory of health applied in family caregiving in Canada [Electronic version]. Nursing Science Quarterly, 12(73), 73-79.Imogene kingCONCEPTUAL FRAMEWORK AND THEORY OF GOAL ATTAINMENTIMOGENE KINGKing was born Jan. 30, 1923 in West Point, Iowa.Bachelor in science of nursing from St. Louis University in 1948Master of science in nursing from St. Louis University in 1957.Doctorate from Teachers college, Columbia University.Theory of goal attainment was first introduced by Imogene King in early 1960's.Career & AchievementsKing practiced as a staff nurse, nurse educator & nurse administratorShe formulated her theory while she was an associate professor of nursing at Loyola University in Chicago, IllinoisA Theory for Nursing: Systems, Concepts, Process was published (1981)King has published many papers in relation to her theoryAfter 10 years of teaching at South Florida's Nursing School, King retired with the title "Professor EmeritusKnown as a nurse futurist, theorist, scholar, & educator whose leadership has been recognized nationally & internationallyHow her Theory Evolved...King's theory evolved in the mid-1960'sShe questioned: how nurses make decisions in their daily practice & how to define the nursing act, leading her to focus and develop the concept "human act" (King 1977)She wanted to describe the essence of nursing and the interactional patterns & goals that govern the nurse-patient relationshipKing began to explore different aspects of nursing that stayed the same, although the world was changing around it.Basic Concept of Theory: Goal AttainmentThe basic concept of the theory is that the nurse & patient communicate information, set goals together, & take actions to achieve those goals.It describes a system of relationships that allows a person to grow & develop in order to attain certain life goals.Conceptual Framework & Theory of Goal AttainmentStructure:is presented in 3 open systemsFunction:is demonstrated in reciprocal relations of individuals in interactionResources: includes both people (health professionals & their clients) and money, goods, and services for items needed to carry out specific activitiesDecision Making:occurs when choices are made in resources allocation to support attaining system goalsConceptual Framework & Theory of Goal AttainmentKing interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth, and development, time, and space into a Theory of Goal Attainment.3 Interacting SystemsPersonal Systemeach individual is a personal systemInterpersonal Systeminvolves individuals interacting with one anotherSocial Systemsgroups of people within a community or society that share common goals, interests, and valuesPersonal SystemPerception - a process of organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior.Self - a composite of thoughts and feelings that constitute a person's awareness of individual existence, of who and what he or she is.Growth & development - cellular, molecular, and behavioral changes in human beings that are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity.Personal SystemBody image - a person's perceptions of his or her body.Time - the duration between the occurrence of one event and the occurrence of another event.Space - the physical area called territory that exists in all directions.Learning - gaining knowledge.Interpersonal SystemInteractions - the acts of two or more persons in mutual presence; a sequence of verbal and nonverbal behaviors that are goal directed.Communication - the vehicle by which human relations are developed and maintained; encompasses intrapersonal, interpersonal, verbal, and nonverbal communication.Transaction - a process of interaction in which human beings communicate with the environment to achieve goals that are valued; goal-directed human behaviors.Interpersonal SystemRole - a set of behaviors expected of a person occupying a position in a social system.Stress - a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, involving an exchange of energy and information between the person and the environment for regulation and control of stressors.Coping - a way of dealing with stress.Social SystemOrganization - composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational goals. Authority - a transactional process characterized by active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization.Social SystemPower - the process whereby one or more persons influence other persons in a situation.Status - the position of an individual in a group or a group in relation to other groups in an organization.Decision making - a dynamic and systematic process by which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal.Control - being in charge.Model of Nurse-Patient InteractionWhen transactions are made between nurses, patients, and families, one can begin to predict that goals will be attained.

Interacting Systems ModelKing proposed that the nurse interacts in the system simultaneously at the 3 different levels: personal, interpersonal, & social frameworks.These levels are independent & at the same time co-exist to influence over-all nursing practice.

Interacting FrameworkKing believes the conceptual framework of Interpersonal system had the greatest impact on the development of her theory.She states, "Although personal systems & social systems influence quality of care, the major elements in a theory of goal attainment are discovered in the interpersonal systems in which two people, who are usually strangers, come together ina health care organization to help & to be helped to maintain a state of health that permits functioning in roles."Interacting FrameworkServes several purposes:to identify concepts that are essential knowledge for nursing as a disciplineto derive theories & test them in research which may result in scientific knowledge for nursingto serve as a structure to develop a curriculum for nursing educationto implement theory-based practice to deliver quality care to all individuals in hospitals, community healthcare agencies, and in familiesTheory of Goal AttainmentElements found in King's Goal Attainment Theory originated from the concepts in her Interacting Systems Framework, but it focuses on theInterpersonal System& interactions, communications, & transactions b/t two individuals, the nurse & the patient come together, communicate, & make transactions- they set goals & work to achieve the goals they set.Theory of Goal AttainmentThey each have a purpose, they perceive, judge, act & react upon each other; at the end of their communication, a goal is set & with this transactions are made.11 concepts were used to support Theory of Goal Attainment: perception, communication, interaction, transaction, self, role, growth & development, stress, coping, time, and space.AssumptionsThe focus of nursing is the care of the human being (patient).The goal of nursing is the health care of both individuals and groups.Human beings are open systems interacting with their environments constantly.The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process.AssumptionsPatients perceive the world as a complete person making transactions with individuals and things in the environment.Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.Theory applied to nursing practiceThe Transaction Process Model can be used in daily practiceMutually-set goals are created & achievedThese outcomes now become evidence-based practice (Fawcett, 2001)Nursing EducationKing's Conceptual Framework has been used to create nursing curriculum for various programsOhio State University undergraduate programLoyola University Chicago graduate programKing points out that a theory alone should not be used as the basis for nursing school curriculum (Fawcett, 2001).Nursing ResearchKing believes that her theory & framework contain various concepts that can be used as the basis for research. An example is:A study of perceptual congruency b/t clients & nurses was conducted to examine the interrelationship of the concepts of perception & transaction (Froman, 1995)Mary Killean (1996) used King's concept of perception to explore a theory regarding patient satisfactionKing stresses "There is no particular research method for any theory, as the method used relates to the problem being studied"Nursing ProcessThe goal of the nurse is to help patients maintain health so they can function in their individual roles.The nurse's function is to interpret information in the nursing process, to plan, implement, and evaluate nursing care.In the nurse-patient relationship, the nurse first uses his or her knowledge base to assess the patient and make a diagnosis.Nursing ProcessAfter the diagnosis, the nurse creates a plan for interventions to solve problems that were identified in the assessment and diagnosis.Once a care plan is created, actions are implemented to achieve the patient's health goals.Finally, the nurse evaluates the patient to determine whether or not the goals were achieved.Nursing ParadigmsPersonImogene King described a person existing in an open system as a spiritual being and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.HealthAccording to Imogene King, health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of ones resources to achieve maximum potential for daily living.Nursing ParadigmsEnvironmentIt is the background for human interactions. It involves: Internal environment transforms energy to enable a person to adjust to continuous external environmental changes.External environmentinvolves formal and informal organizations. The nurse is a part of the patients environment.Nursing ParadigmsNursingNursing for Imogene King is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition, exploring and agreeing on activities to promote health. The goal of the nurse in Imogene Kings theory is to help the client maintain health through health promotion and maintenance, restoration, and caring for the sick and dying.

King's PropositionsIf perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.If the nurse and patient make transaction, the goal or goals will be achieved.If the goal or goals are achieved, satisfaction will occur.If transactions are made in nurse-patient interactions, growth and development will be enhanced.King's PropositionsIf role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur.If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur.If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.StrengthsKings theory of goal attainment does describe a logical sequence of events.For the most part, concepts are clearly defined.Although the presentation appears to be complex, Kings theory of goal attainment is relatively simple.King formulated assumptions that are testable hypotheses for research.

WeaknessesKings theory contains major inconsistenciesShe indicates that nurses are concerned about the health care of groups but concentrates her discussion on nursing as occurring in a dyadic relationship.King says that the nurse and client are strangers, yet she speaks of their working together for goal attainment and of the importance of health maintenance.WeaknessesA major limitation is the effort required of the reader to sift through the presentation of a conceptual framework and a theory with repeated definitions to find the basic concepts.Another limitation relates to the lack of development of application of the theory in providing nursing care to groups, families, or communities.Analysis of TheoryThe social systems portion of the open systems framework is less clearly connected to the theory of goal attainment than are the personal and interpersonal systems.The citation of the individual being in a social system was not clearly explained considering that the social system encompasses other concepts and subconcepts in her theory.Analysis of TheoryThe model presents interaction which is dyadic in nature which implies that its applicability cannot be adapted to unconscious individuals.Multitude of views and definition is confusing for the reader. Because of multiple views on one concept such as what have been discussed in her concept of power blurs the point that the theorist is trying to relate to the readers.ConclusionOverall King's theory is very applicable to Nursing and it's practicesIt can be applied in education, the clinical setting, and research.I believe it will continue to be useful in the years to come, as other Mid-Range theories are built from her Grand TheoryReferencesAlligood, M.R. (2010, April 8). Family healthcare with King's theory of goal attainment. Nursing Science Quarterly, 23(2), 99-104. http://dx.doi.org/10.1177/0894318410362553Alligood, M.R., & Tomey, A. M. (2010). Nursing theorists and their work (7th ed.). Maryland Heights, Missouri: Mosby Elsevier.Calladine, M.L. (1996). Nursing process fro health promotion using King's theory. Journal of Community Health Nursing, 13(1), 51-57. Retrieved from cuw.summon.serialsolutions.comClarke, P.N., Killeen, M.B., Messmer, P.R., & Sieloff C. L. (2009, April). Imogene M. King's scholars reflect on her wisdom and influence on nursing science. Nursing Science Quarterly, 22(2), 128-133. http://dx.doi.org/10.1177/0894318409332568ReferencesFawcett, J. (2001, October). The nurse theorists: 21st-century updates - Imogene M. King. Nursing Science Quarterly, 14(4), 311-315. http://dx.doi.org/10.1177/089431840101400407Frey, M.A., Sieloff, C. L.,& Norris, D. M. (2002, April 1). King's conceptual system and theory of goal attainment: past, present, and future. Nursing Science Quarterly, 15(2), 107-112. http://dx.doi.org/10.1177/089431840201500204King, I.M. (1971). Toward a theory for nursing. New York, London, Sydney, Toronto: John Wiley and Sons, Inc.King, I. M. (1981). A theory for nursing systems, concepts, process. New York, Chichester, Brisbane, Toronto: A Wiley Medical Publication John Wiley & SonsMessmer, P. R. (2006, June 6). Professional model of care: using King's theory of goal attainment. Nursing Science Quarterly, 19(3), 227-229. http://dx.doi.org/10.1177/0894318406289887