Nursing is a learned profession and is both a science and an art. It is an empirical science and, like other sciences, it lies in the phenomenon central to its focus. Rogerian nursing focuses on concern with people and the world in which they live—a natural fit for nursing care, as it encompasses people and their environments. The integrality of people and their environments, operating from a pandimensional universe of open systems, points to a new paradigm and initiates the identity of nursing as a science. The purpose of nursing is to promote health and well-being for all persons. The art of nursing is the creative use of the science of nursing for human betterment (Rogers, 1994b). “Professional practice in nursing seeks to promote symphonic interaction between human and environmental fields, to strengthen the integrity of the human field, and to direct and redirect patterning of the human and environmental fields for realization of maximum health potential” (Rogers, 1970, p. 122). Nursing exists for the care of people and the life process of humans.

Rogers uses the term health in many of her earlier writings without clearly defining the term. She uses the term passive health to symbolize wellness and the absence of disease and major illness (Rogers, 1970). Her promotion of positive health connotes direction in helping people with opportunities for rhythmic consistency (Rogers, 1970). Later, she wrote that wellness “is a much better term …. because the term health is very ambiguous” (Rogers, 1994b, p. 34).

Rogers uses health as a value term defined by the culture or the individual. Health and illness are manifestations of pattern and are considered “to denote behaviors that are of high value and low value” (Rogers, 1980). Events manifested in the life process indicate the extent to which a human being achieves maximum health according to some value system. In Rogerian science, the phenomenon central to nursing’s conceptual system is the human life process. The life process has its own dynamic and creative unity that is inseparable from the environment and is characterized by the whole (Rogers, 1970). Using this definition as a foundation for their research, Gueldner, and colleagues (2005) postulate that a human being’s sense of well-being (wellness) manifests itself by higher frequency and increasing pattern diversity.

In “Dimensions of Health: A View from Space,” Rogers (1986b) reaffirms the original theoretical assertions, adding philosophical challenges to the prevailing perception of health. Stressing a new worldview that focuses on people and their environment, she lists iatrogenesis, nosocomial conditions, and hypochrondriasis as the major health problems in the United States. Rogers (1986b) writes, “A new world view compatible with the most progressive knowledge available is a necessary prelude to studying human health and to determining modalities for its promotion whether on this planet or in the outer reaches of space” (p. 2).

Rogers (1994a) defines environment as “an irreducible, pandimensional energy field identified by pattern and manifesting characteristics different from those of the parts. Each environmental field is specific to its given human field. Both change continuously and creatively” (p. 3). Environmental fields are infinite, and change is continuously innovative, unpredictable, and characterized by increasing diversity. Environmental and human fields are identified by wave patterns manifesting continuous mutual change.

Historically, nursing has equated practice with the practical and theory with the impractical. More appropriately, theory and practice are two related components in a unified nursing practice. Alligood (1994) articulates how theory and practice direct and guide each other as they expand and increase unitary nursing knowledge. Nursing knowledge provides the framework for the emergent artistic application of nursing care (Rogers, 1970).

Within Rogers’ model, the critical thinking process directing practice can be divided into three components: pattern appraisal, mutual patterning, and evaluation. Cowling (2000) states that pattern appraisal is meant to avoid, if not transcend, reductionistic categories of physical, mental, spiritual, emotional, cultural, and social assessment frameworks. Through observation and participation, the nurse focuses on human expressions of reflection, experience, and perception to form a profile of the patient. Mutual exploration of emergent patterns allows identification of unitary themes predominant in the pandimensional human-environmental field process. Mutual understanding implies knowing participation but does not lead to the nurse’s prescribing change or predicting outcomes. As Cowling (2000) explains, “A critical feature of the unitary pattern appreciation process, and also of healing through appreciating wholeness, is a willingness on the part of the scientist or practitioner to let go of expectations about change” (p. 31). Evaluation centers on the perceptions emerging during mutual patterning.

Noninvasive patterning modalities used within Rogerian practice include, but are not limited to, acupuncture, aromatherapy, touch and massage, guided imagery, meditation, self-reflection, guided reminiscence, humor, hypnosis, dietary manipulation, transcendent presence, and music (Alligood, 1991a; Jonas-Simpson, 2010; Larkin, 2007; Levin, 2006; Lewandowski, et al., 2005; Malinski & Todaro-Franceschi, 2011; Siedliecki & Good, 2006; Smith, Kemp, Hemphill, & Vojir, 2002; Smith & Kyle, 2008; Walling, 2006; Yarcheski, Mahon, & Yarcheski, 2002). Barrett (1998) notes that integral to these modalities are “meaningful dialogue, centering, and pandimensional authenticity (genuineness, trustworthiness, acceptance, and knowledgeable caring)” (p. 138). Nurses participate in the lived experience of health in a multitude of roles, including “facilitators and educators, advocates, assessors, planners, coordinators, and collaborators,” by accepting diversity, recognizing patterns, viewing change as positive, and accepting the connectedness of life (Malinski, 1986, p. 27) These roles may require the nurse to “let go of traditional ideas of time, space, and outcome” (Malinski, 1997, p. 115).

The Rogerian model provides a challenging and innovative framework from which to plan and implement nursing practice, which Barrett (1998) defines as the “continuous process (of voluntary mutual patterning) whereby the nurse assists clients to freely choose with awareness ways to participate in their well-being” (p. 136).

Rogers clearly articulated guidelines for the education of nurses within the Science of Unitary Human Beings. Rogers discusses structuring nursing education programs to teach nursing as a science and as a learned profession. Barrett (1990b) calls Rogers a “consistent voice crying out against antieducationalism and dependency” (p. 306). Rogers’ model clearly articulates values and beliefs about human beings, health, nursing, and the educational process. As such, it has been used to guide curriculum development in all levels of nursing education (Barrett, 1990b; DeSimone, 2006; Hellwig & Ferrante, 1993; Mathwig, Young, & Pepper, 1990). Rogers (1990) stated that nurses must commit to lifelong learning and noted, “The nature of the practice of nursing (is) the use of knowledge for human betterment” (p. 111).

Rogers advocated separate licensure for nurses prepared with an associate’s degree and those with a baccalaureate degree, recognizing that there is a difference between the technically oriented and the professional nurse. In her view, the professional nurse must be well rounded and educated in the humanities, sciences, and nursing. Such a program would include a basic education in language, mathematics, logic, philosophy, psychology, sociology, music, art, biology, microbiology, physics, and chemistry; elective courses could include economics, ethics, political science, anthropology, and computer science (Barrett, 1990b). With regard to the research component of the curriculum, Rogers (1994b) stated the following:

Barrett (1990b) notes that with increasing use of technology and increasing severity of illness of hospitalized patients, students may be limited to observational experiences in these institutions. Therefore, the acquisition of manipulative technical skills must be accomplished in practice laboratories and at alternative sites, such as clinics and home health agencies. Other sites for education include health promotion programs, managed care programs, homeless shelters, and senior centers.

Rogers’ conceptual model provides a stimulus and direction for research and theory development in nursing science. Fawcett (2000), who insists that the level of abstraction affects direct empirical observation and testing, endorses the designation of the Science of Unitary Human Beings as a conceptual model rather than a grand theory. She states clearly that the purpose of the work determines its category. Conceptual models “identify the purpose and scope of nursing and provide frameworks for objective records of the effects of nursing” (Fawcett, 2005, p. 18).

Emerging from Rogers’ model are theories that explain human phenomena and direct nursing practice. The Rogerian model, with its implicit assumptions, provides broad principles that conceptually direct theory development. The conceptual model provides a stimulus and direction for scientific activity. Relationships among identified phenomena generate both grand (further development of one aspect of the model) and middle-range (description, explanation, or prediction of concrete aspects) theories (Fawcett, 1995).

Two prominent grand nursing theories grounded in Rogers’ model are Newman’s health as expanding consciousness and Parse’s human becoming (Fawcett, 2005). Numerous middle-range theories have emerged from Rogers’ three homeodynamic principles as follows: (1) helicy, (2) resonancy, and (3) integrality (Figure 13–1). Exemplars of middle-range theories derived from homeodynamic principles include power-as-knowing-participation-in-change (helicy) (Barrett, 2010), the theory of perceived dissonance (resonancy) (Bultemeier, 2002), and the theory of interactive rhythms (integrality) (Floyd, 1983). In her overview of Rogerian science–based theories, Malinski (2009) identifies work within specific concepts: (1) self-transcendence (Reed, 2003), enlightenment (Hills & Hanchett, 2001), and spirituality (Malinski, 1994; Smith, 1994); (2) turbulence (Butcher, 1993) and dissonance (Bultemeier, 2002); (3) aging (Alligood & McGuire, 2000; Butcher, 2003); (4) intentionality (Ugarizza, 2002; Zahourek, 2005); and (5) unitary caring (Watson & Smith, 2002). Other middle-range theories encompass the phenomena of human field motion (Ference, 1986), as well as creativity, actualization, and empathy (Alligood, 1991b).

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