13. Unitary human beings



Unitary human beings



Mary E. Gunther



Credentials and background of the theorist


Martha Elizabeth Rogers, the eldest of four children of Bruce Taylor Rogers and Lucy Mulholland Keener Rogers, was born May 12, 1914, in Dallas, Texas. Soon after her birth, her family returned to Knoxville, Tennessee. She began her college education (1931 to 1933) studying science at the University of Tennessee. Receiving her nursing diploma from Knoxville General Hospital School of Nursing (1936), she quickly obtained a BS degree from George Peabody College in Nashville, Tennessee (1937). Her other degrees included an MA degree in public health nursing supervision from Teachers College, Columbia University, New York (1945), and an MPH (1952) and an ScD (1954) from Johns Hopkins University in Baltimore.


Photo credit: Kathleen Leininger, Shiner, TX.


Previous authors: Kaye Bultemeier, Mary Gunther, Joann Sebastian Daily, Judy Sporleder Maupin, Cathy A. Murray, Martha Carole Satterly, Denise L. Schnell, and Therese L. Wallace. Earlier editions of this chapter were critiqued by Dr. Lois Meier and Dr. Martha Rogers.


Rogers’ early nursing practice was in rural public health nursing in Michigan and in visiting nurse supervision, education, and practice in Connecticut. Rogers subsequently established the Visiting Nurse Service of Phoenix, Arizona. For 21 years (from 1954 to 1975), she was professor and head of the Division of Nursing at New York University. After 1975, she continued her duties as professor until she became Professor Emerita in 1979. She held this title until her death on March 13, 1994, at 79 years of age.


Rogers’ publications include three books and more than 200 articles. She lectured in 46 states, the District of Columbia, Puerto Rico, Mexico, the Netherlands, China, Newfoundland, Columbia, Brazil, and other countries (M. Rogers, personal communication, March 1988). Rogers received honorary doctorates from such renowned institutions as Duquesne University, University of San Diego, Iona College, Fairfield University, Emory University, Adelphi University, Mercy College, and Washburn University of Topeka. The numerous awards for her contributions and leadership in nursing include citations for Inspiring Leadership in the Field of Intergroup Relations by Chi Eta Phi Sorority, In Recognition of Your Outstanding Contribution to Nursing by New York University, and For Distinguished Service to Nursing by Teachers College. In addition, New York University houses the Martha E. Rogers Center for the Study of Nursing Science. In 1996, Rogers was inducted posthumously into the American Nurses Association Hall of Fame.


In 1988, colleagues and students joined her in forming the Society of Rogerian Scholars (SRS) and immediately began to publish Rogerian Nursing Science News, a members’ newsletter, to disseminate theory developments and research studies (Malinski 2009). In 1993, the SRS began to publish a refereed journal, Visions: The Journal of Rogerian Nursing Science. The society includes a foundation that maintains and administers the Martha E. Rogers Fund. In 1995, New York University established the Martha E. Rogers Center to provide a structure for continuation of Rogerian research and practice.


A verbal portrait of Rogers includes such descriptive terms as stimulating, challenging, controversial, idealistic, visionary, prophetic, philosophical, academic, outspoken, humorous, blunt, and ethical. Rogers remains a widely recognized scholar honored for her contributions and leadership in nursing. Butcher (1999) noted, “Rogers, like Nightingale, was extremely independent, a determined, perfectionist individual who trusted her vision despite skepticism” (p. 114). Colleagues consider her one of the most original thinkers in nursing as she synthesized and resynthesized knowledge into “an entirely new system of thought” (Butcher, 1999, p. 111). Today she is thought of as “ahead of her time, in and out of this world” (Ireland, 2000, p. 59).


Theoretical sources


Rogers’ grounding in the liberal arts and sciences is apparent in both the origin and the development of her conceptual model, published in 1970 as An Introduction to the Theoretical Basis of Nursing (Rogers, 1970). Aware of the interrelatedness of knowledge, Rogers credited scientists from multiple disciplines with influencing the development of the Science of Unitary Human Beings. Rogerian science emerged from the knowledge bases of anthropology, psychology, sociology, astronomy, religion, philosophy, history, biology, physics, mathematics, and literature to create a model of unitary human beings and the environment as energy fields integral to the life process. Within nursing, the origins of Rogerian science can be traced to Nightingale’s proposals and statistical data, placing the human being within the framework of the natural world. This “foundation for the scope of modern nursing” began nursing’s investigation of the relationship between human beings and the environment (Rogers, 1970, p. 30). Newman (1997) describes the Science of Unitary Human Beings as “the study of the moving, intuitive experience of nurses in mutual process with those they serve” (p. 9).




MAJOR CONCEPTS & DEFINITIONS


In 1970, Rogers’ conceptual model of nursing rested on a set of basic assumptions that described the life process in human beings. Wholeness, openness, unidirectionality, pattern and organization, sentience, and thought characterized the life process (Rogers, 1970).


Rogers postulates that human beings are dynamic energy fields that are integral with environmental fields. Both human and environmental fields are identified by pattern and characterized by a universe of open systems. In her 1983 paradigm, Rogers postulated four building blocks for her model: energy field, a universe of open systems, pattern,and four-dimensionality.


Rogers consistently updated the conceptual model through revision of the homeodynamic principles. Such changes corresponded with scientific and technological advances. In 1983, Rogers changed her wording from that of unitary man to unitary human being, to remove the concept of gender. Additional clarification of unitary human beings as separate and different from the term holistic stressed the unique contribution of nursing to health care. In 1992, four-dimensionality evolved into pandimensionality. Rogers’ fundamental postulates have remained consistent since their introduction; her subsequent writings served to clarify her original ideas.


Energy field


An energy field constitutes the fundamental unit of both the living and the nonliving. Field is a unifying concept, and energy signifies the dynamic nature of the field. Energy fields are infinite and pandimensional. Two fields are identified: the human field and the environmental field. “Specifically human beings and environment are energy fields” (Rogers, 1986b, p. 2). The unitary human being (human field) is defined as an irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and that cannot be predicted from knowledge of the parts. The environmental field is defined as an irreducible, pandimensional energy field identified by pattern and integral with the human field. Each environmental field is specific to its given human field. While not necessarily quantifiable, an energy field has the inherent ability to create change (Todaro-Franceschi, 2008). In this case, both human and environmental fields change continuously, creatively, and integrally (Rogers, 1994a).


Universe of open systems


The concept of the universe of open systems holds that energy fields are infinite, open, and integral with one another (Rogers, 1983). The human and environmental fields are in continuous process and are open systems.


Pattern


Pattern identifies energy fields. It is the distinguishing characteristic of an energy field and is perceived as a single wave. The nature of the pattern changes continuously and innovatively, and these changes give identity to the energy field. Each human field pattern is unique and is integral with the environmental field (Rogers, 1983). Manifestations emerge as a human-environmental mutual process. Pattern is an abstraction; it reveals itself through manifestation. A sense of self is a field manifestation, the nature of which is unique to each individual. Some variations in pattern manifestations have been described in phrases such as “longer versus shorter rhythms,” “pragmatic versus imaginative,” and time experienced as “fast” or “slow.” Pattern is changing continually and may manifest disease, illness, or well-being. Pattern change is continuous, innovative, and relative.


Pandimensionality


Rogers defines pandimensionality as a nonlinear domain without spatial or temporal attributes, or as Phillips (2010) notes: “essentially a spaceless and timeless reality” (p. 56). The term pandimensional provides for an infinite domain without limit. It best expresses the idea of a unitary whole.


Use of empirical evidence


Being an abstract conceptual system, the Science of Unitary Human Beings does not directly identify testable empirical indicators. Rather, it specifies a worldview and philosophy used to identify the phenomena of concern to the discipline of nursing. As was mentioned previously, Rogers’ model emerged from multiple knowledge sources; the most readily apparent of these are the nonlinear dynamics of quantum physics and general system theory.



Evident in her model are the influence of Einstein’s (1961) theory of relativity in relation to space-time and Burr and Northrop’s (1935) electrodynamic theory relating to electrical fields. By the time von Bertalanffy (1960) introduced the general system theory, theories regarding a universe of open systems were beginning to affect the development of knowledge within all disciplines. With the general system theory, the term negentropy was brought into use to signify increasing order, complexity, and heterogeneity in direct contrast to the previously held belief that the universe was winding down. Rogers, however, refined and purified the general system theory by denying hierarchical subsystems, the concept of single causation, and the predictability of a system’s behavior through investigations of its parts.


Introducing quantum theory and the theories of relativity and of probability fundamentally challenged the prevailing absolutism. As new knowledge escalated, the traditional meanings of homeostasis, steady state, adaptation,and equilibrium were questioned seriously. The closed-system, entropic model of the universe was no longer adequate to explain phenomena, and evidence accumulated in support of a universe of open systems (Rogers, 1994b). Continuing development within other disciplines of the acausal, nonlinear dynamics of life validated Rogers’ model. Most notable of this development is that of chaos theory, quantum physics’ contribution to the science of complexity (or wholeness), which blurs the boundaries between the disciplines, allowing exploration and deepening of the understanding of the totality of human experience.


Major assumptions


Nursing


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.



Person


Rogers defines person as an open system in continuous process with the open system that is the environment (integrality). She defines unitary human being as an “irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole” (Rogers, 1992, p. 29). Human beings “are not disembodied entities, nor are they mechanical aggregates. …. Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts” (Rogers, 1970, pp. 46–47). Within a conceptual model specific to nursing’s concern, people and their environment are perceived as irreducible energy fields integral with one another and continuously creative in their evolution.


Health


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).


Environment


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.


Theoretical assertions


The principles of homeodynamics postulate a way of perceiving unitary human beings. The evolution of these principles from 1970 to 1994 is depicted in Table 13–1. Rogers (1970) wrote, “The life process is homeodynamic …. these principles postulate the way the life process is and predict the nature of its evolving” (p. 96). Rogers identified the principles of change as helicy, resonancy, and integrality. The helicy principle describes spiral development in continuous, nonrepeating, and innovative patterning. Rogers’ articulation of the principle of helicy describing the nature of change evolved from probabilistic to unpredictable, while remaining continuous and innovative. According to the principle of resonancy, patterning changes with the development from lower to higher frequency, that is, with varying degrees of intensity. Resonancy embodies wave frequency and energy field pattern evolution. Integrality, the third principle of homeodynamics, stresses the continuous mutual process of person and environment. The principles of homeodynamics (nature, process, and context of change) support and exemplify the assertion that “the universe is energy that is always becoming more diverse through changing, continuous wave frequencies” (Phillips, 2010, p. 57). In addition, Todaro-Franceschi (2008) reminds us that this changing nature is intrinsic to, not outside of, fields.



TABLE 13-1  


Evolution of Principles of Homeodynamics: 1970, 1983, 1986, and 1992











































An Introduction to the Theoretical Basis of Nursing, 1970 Nursing: A Science of Unitary Man, 1980 Science of Unitary Human Beings: A Paradigm for Nursing, 1983 Dimensions of Health: A View From Space, 1986 Nursing Science and the Space Age, 1992
Resonancy
Continuously propagating series of waves between man and environment Continuous change from lower- to higher-frequency wave patterns in the human and environmental fields Continuous change from lower- to higher-frequency wave patterns in the human and environmental fields Continuous change from lower- to higher-frequency wave patterns in the human and environmental fields Continuous change from lower- to higher-frequency wave patterns in the human and environmental fields
Helicy
Continuous, innovative change growing out of mutual interaction of man and environment along a spiraling longitudinal axis bound in space-time Nature of change between human and environmental fields is continuously innovative, probabilistic, and increasingly diverse, manifesting nonrepeating rhythmicities Continuous innovative, probabilistic, increasing diversity of human and environmental field patterns, characterized by nonrepeating rhythmicities Continuous, innovative, probabilistic, increasing, and environmental diversity characterized by nonrepeating rhythmicities Continuous, innovative, unpredictable, increasing diversity of human and environmental field patterns
Reciprocy
Continuous mutual interaction between the human and environmental fields
Synchrony
Change in the human field and simultaneous state of environmental field at any given point in space-time Continuous, mutual, simultaneous interaction between human and environmental fields Continuous, mutual human field and environmental field process Continuous, mutual human field and environmental field process Continuous, mutual human field and environmental field process


Image


Conceptualized by J. S. Daily; revised by D. Schnell & T. Wallace; updated by C. Murray.


In 1970, Rogers identified the following five assumptions that are also theoretical assertions supporting her model derived from literature on human beings, physics, mathematics, and behavioral science:



Logical form


Rogers uses a dialectic method as opposed to a logistical, problematic, or operational method, that is, Rogers explains nursing by referring to broader principles that explain human beings. She explains human beings through principles that characterize the universe, based on the perspective of a whole that organizes the parts.



Rogers’ model of unitary human beings is deductive and logical. The theory of relativity, the general system theory, the electrodynamic theory of life, and many other theories contributed ideas for Rogers’ model. Unitary human beings and environment, the central components of the model, are integral with one another. The basic building blocks of her model are energy field, openness, pattern, and pandimensionality providing a new worldview. These concepts form the basis of an abstract conceptual system defining nursing and health. From the abstract conceptual system, Rogers derived the principles of homeodynamics, which postulate the nature and direction of human beings’ evolution. Although Rogers invented the words homeodynamics (similar state of change and growth), helicy (evolution), resonancy (intensity of change), and integrality (wholeness), all definitions are etymologically consistent and logical.


Acceptance by the nursing community


Practice


The Rogerian model is an abstract system of ideas from which to approach the practice of nursing. Rogers’ model, stressing the totality of experience and existence, is relevant in today’s health care system, where a continuum of care is more important than episodic illness and hospitalization. This model provides the abstract philosophical framework from which to view the unitary human-environmental field phenomenon. Within the Rogerian framework, nursing is based on theoretical knowledge that guides nursing practice. The professional practice of nursing is creative and imaginative and exists to serve people. It is rooted in intellectual judgment, abstract knowledge, and human compassion.


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).


Education


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:



Undergraduate students need to be able to identify problems, to have tools of investigation and to do studies that will allow them to use knowledge for the improvement of practice, and they should be able to read the literature intelligently. People with master’s degrees ought to be able to do applied research …. The theoretical research, the fundamental basic research is going to come out of doctoral programs of stature that focus on nursing as a learned field of endeavor (p. 34


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.


Research


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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Jan 8, 2017 | Posted by in NURSING | Comments Off on 13. Unitary human beings

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