SYNCHRONICITY ON

HUMAN SPACE – TIME

THEORY OF NURSING ENGAGEMENT IN A GLOBAL COMMUNITY
NURSING THEORISTS
 FRESLYN LIM-SACO, RN, MN
 Siliman University College of Nursing, Dumaguete
City, Philippines
 CLIFORD MASAYON KILAT, RN, MA
 St. Paul University Dumaguete, Dumaguete City,
Philippines
 ROZZANO LOCSIN, RN, PhD, FAAN
 Florida Atlantic University, Boca Raton, Florida
 Tokushima University, Tokushima, Japan
FRESLYN LIM – SACO, RN, MN
 Freslyn was born on June 1, 1983, the only girl in a brood
of four
 Freslyn spent her education years in Silliman University
– a “true-blue” – from Elementary until College
 She was a platoon leader and a no-nonsense CAT officer
who claimed her fair share of regard and respect
 Freslyn does research in Continuing Professional
Development of Nurses and End-of-Life Care. Her current
dissertation is about the meaning of nurses' caring for
persons with life-sustaining technologies at the end-of-
life
 Freslyn Lim-Saco currently works at the College of
ROZZANO LOCSIN, RN, PHD,
FAAN
Locsin was born in 1954
 He is a registered nurse, a native of Dumaguete City,
Philippines who resides and practices his nursing
profession at Tokushima University, Tokushima, Japan as
Professor Nursing
 He is Professor emeritus of Florida Atlantic University in
Boca Raton, Florida, USA
 Dr. Rozzano Locsin earned his Doctor of Philosophy in
Nursing degree from the University of the Philippines in
1988, and his Master of Arts in Nursing and Bachelor of
Science in Nursing from Silliman University in 1978 and
1976 respectively in the Philippines
 Locsin's research and scholarly works concerning
ROZZANO LOCSIN, RN, PHD,
FAAN
PUBLICATIONS:
 Advancing Technology, Caring, and Nursing (2001)
 Technological Competency as Caring in Nursing
(2005)
 Technology and Nursing: Practice, Concepts, and
Issues (2007)
 A Contemporary Nursing Process: The (Un)Bearable
Weight of Knowing in Nursing (2009)
ROZZANO LOCSIN, RN, PHD,
FAAN
AWARDS:
 Edith Moore Copeland Excellence in Creativity Award
from Sigma Theta Tau International Honor Society of
Nursing in 2003
 Outstanding Sillimanian Award and the Outstanding
Paulinian Award in the field of Nursing Education from
renowned Philippine schools.
 Julita V. Sotejo Medallion of Honor was awarded by the
University of the Philippines College of Nursing Alumni
Association International in Los Angeles, California.
 Through the Fulbright Scholar Award, he developed the
first Masters program in Nursing in Uganda while
ROZZANO LOCSIN, RN, PHD,
FAAN
AWARDS:
 With Mbarara University and the Fulbright Alumni
Initiative Award, he established the first Community-
based University Nursing Education Program
 In 2006, Dr. Locsin was inducted as Fellow of the
American Academy of Nursing (FAAN
 He was the first recipient of the Lillian O. Slemp
Endowed Chair in Nursing at the
University of Texas-Pan American in Edinburg, Texas in
2007
 In August 2009, he was the inaugural recipient of the
John F. Wymer, Jr. Distinguished Professor in Nursing at
HUMAN SPACE – TIME
THEORY
The HST theory is a study of caring, HST, and the
perspective of synchronicity and nursing engagement.
This theory aims to enlighten nurses in their practice
through an innovative demonstration of nursing care
processes grounded on authentic intentions of caring
transcending extant reductionist approaches.
Furthermore, SynHSTTNE is a useful theoretical base for
future research that aims to describe the meaningful
connectedness in human experiences of transcendence,
interconnectivity, emancipation, and equitability with
humanistic approaches in the discipline of nursing.
ASSUMPTIONS OF THE
HST THEORY (1)
 1. HST is a metaphysical sphere of caring experiences
among persons with patterns of occurrence viewed as
meaningful for both the nurse and the nursed.
ASSUMPTIONS OF THE
HST THEORY
 The theory claims that synchronicity and nursing
engagement occurs through the appreciation of the
integrality of human—environment and the time
being. This is illustrated, for example, as synchronistic
nursing engagement in various settings (e.g.,
emergency department, community setting, hospital
ward) perceiving the patient not as a disease or a
product of some stereotypical clients, rather as
individuals whose internal and external wholeness are
connected.
ASSUMPTIONS OF THE
HST THEORY (2)
 2. Nursing unfolds in a unitarily pattern of wholeness
integrated within the HST processes. Humans are
assimilating their lives with technology, instigating the
nursing profession toward transformations. The
conceptualization of caring, nursing, and technology
by Locsin (2015) elucidates the nursing profession as
continually evolving here, now, and beyond.
ASSUMPTIONS OF THE
HST THEORY
 Therefore, in enhancing caring praxis through
SynHSTTNE, the humanistic caring patterns are
beyond bedside procedures and routines or
technological expertise. According to Reed (1997),
nursing is developing, fostering, healing, helping,
nourishing, progressing, and sustaining the well-being
of humans, and to Smith (2015), “nursing is the voice
that represents the wholeness of the person; no other
discipline does this” (p. 514).
ASSUMPTIONS OF THE
HST THEORY (3)
 3. The nurse–nursed HST consciousness is irreducibly
evolving thus co-creating human transcendence. The
individual experiences and perspectives of the nurse
and the one being nursed are not deductively viewed
apart from the whole nurse–nursed relationship. This
is summarily illustrated, for instance, in the practice of
nursing in disaster occasions. Nurses in their practice
share the struggle with the people with resilient
attitude.
ASSUMPTIONS OF THE
HST THEORY (4)
 4. SynHSTTNE is a pan-dimensionally transforming
process of interconnectedness among humanity and
beyond infinity. Based on the tenets of the Rogerian
Science of Unitary Human Beings, pandimensionality
is viewed as “a nonlinear domain without spatial or
temporal attributes” (Watson & Smith, 2002), and
transformation is the outcome of the ever-evolving
human transcendence.
HST THEORY ASSUMPTIONS AND NURSING ENGAGEMENT RELATIONSHIP
FOUR LIFE PRINCIPLES
INTERCONNECTIVITY, EQUITABILITY, EMANCIPATION,
AND HUMAN TRANSCENDENCE
INTERCONNECTIVITY
 A principle of human interconnectedness of energy
 Interconnectivity leads to the understanding of holism
that the bio-psycho-social-spiritual dimensions of
persons are interrelated (Lai & Hsieh, 2003) and that the
whole being is more than the sum of its organs or
systems.
 The nurse does not focus only on biological curing but
considers the healing aspect of the whole person’s being
 The nurse becomes more cognizant of the whole
integrated person interacting with and influenced by
both internal and external environments (Lai & Hsieh,
2003)
EQUITABILITY
 A principle of justice and fairness in human caring
across healthcare systems
 It revolves around the value-based concept of equity
implying fairness in access to health care related to
the situated context despite differences in methods,
utilization, and outcomes (Cloninger et al., 2014).
 When there are meaningful relationships of persons
(i.e., among patients, family, and healthcare team),
the nurse is enabled to express equity in nursing care
through prioritization, triage, and cost-effective
measures in the processes of nursing engagement.
EMANCIPATION
 A principle of liberating the self and others from the limits
of human-space-time realities
 The human-space-time realities of health care could
include human factors or attributes such as fear, shame,
lack of communication skills, lack of knowledge,
powerlessness and human resources
 In the application of the NEP, to emancipate is to know
what the nurse can know, doing what one can do, and be
with the patient in the present given the limitations of the
HST
Space Factors
Physiologic, psychologic,
Internal Environment emotional, spiritual
Limitations conditions

Socio-economic-political
challenges
External
Environment
Limitations Organizational dynamics
that influence the nurse and
nursed
HUMAN TRANSCENDENCE
 Human transcendence indicates personal growth of
persons and professional growth among nurses
 “When people transcend their own egos, dedicate their
energy to something greater than the individual self,
and learn to build order against the trend of disorder”
(Pharris, 2015, p. 285), then the principle of human
transcendence is applied
 Through human transcendence, nurses and the nursed
can rise beyond their present difficulties. Just as self-
transcendence is revealed in the expansion of self-
boundaries that enhances well-being (Reed, 2015),
human transcendence is also evident in the ability to go
beyond the limits of the HST through nursing
APPLICATION OF THE
SYNCHRONICITY IN THE HST
THEORY IN PRACTICE
INTERPERSONAL RELATING (IR), TECHNOLOGICAL KNOWING (TK),
RHYTHMICAL CONNECTING (RC), AND TRANSFORMATIONAL
ENGAGING (TE)
INTERPERSONAL RELATING
 The nurturance of a relationship that appreciates the
self and others as whole and transcendental beings,
connecting to the nursed illuminated in the dance of
caring of persons (Boykin & Schoenhofer, 2013) in which
synchronicity is founded
 Synchronicity is enhanced through optimism,
perseverance, and keen intuition, while excessive levels
of anxiety, depression, anger, and resentment preclude
it (Davidson, 2016).
 Caring is manifested when the nurse interconnects with
the nursed in a metaphysical presence (Shearer, 2015)
through therapeutic communication aimed at nurturing
the wholeness of the self and the nursed.
TECHNOLOGICAL KNOWING
 Technological Knowing is the process that leads the
nurse in sensing relevant data and pattern information
about the nursed in interaction as persons and not as
objects of care (Locsin & Purnell, 2017)
 Moreover, the complementarity of caring and technology
is emphasized by the nurse’s technological competency
(Locsin, 2016) to the synchronistic life event shared with
the nursed within the HST.
RHYTHMICAL CONNECTING
 RC also allows the nurse and the nursed to participate in
the planning and implementation of equitable and
humanistic care
 Such partnership enables and empowers them to
discover transformation, healing, and wholeness
mutually
 RC is also illuminated when the nurse extends emphatic
care despite limited participation from the nursed
TRANSFORMATIONAL
ENGAGING
 Refers to the process of intimately concurring with the
recognized improvement of the caring moment and human
health experiences, a continuous evaluation and infinite
reflection of wholeness by both the nurse and the nursed
 Caring as an authentic intention in TE is manifested
through the driving force of the energies in the caring
moment using responsive sensing, expression of caring
intentions, and technological competence.
 Nurses carry out responsive sensing act and perform
relevant and significant nursing care in which compassion
and critical thinking enhance the authentic intention of
caring.
PROCESS OF SYNCHRONICITY IN HUMAN-SPACE-
TIME
SUMMARY
 Synchronicity in the HST Theory of Nursing Engagement
is focused on human caring, supports the praxis of
Nursing, informs health care policy, and serves as a
theoretical base for practice through the processes of IR,
TK, RC, and TE.
 Nurses worldwide are guided by the five elements of
caring as authentic intentions grounded in the theory:
dance of caring persons, caring moment, and expression
of caring intentions, responsive sensing, and
technological competency.
 Similarly, the theory can influence nursing research and
practice to address diverse human health experiences
guided by the four life principles of emancipation,
equitability, interconnectivity, and transcendence of
SUMMARY
 The nursing engagement process continuously develops
into a “theory-guided practice model that creatively
unites ideas” (Watson & Smith, 2002, p. 460)
 The belief that the HST consciousness and human
experiences being irreducibly evolving within the HST
drives the human beings to have faith, to hope, and to
love
 Nursing engagement then honors the self and others,
sustains human dignity, preserves humanity, and
upholds human caring through the synchronous
symphony of the caring elements.
ABRAHAM MASLOW
HIERARCHY OF NEEDS
BACKGROUND
• Abraham Harold Maslow, (born April 1,
1908, New York, New York, U.S.—died June
8, 1970, Menlo Park, California)
• American psychologist and philosopher
best known for his self-actualization theory
of psychology
• Maslow studied psychology at the
University of Wisconsin and Gestalt
psychology at the New School for Social
Research in New York City before joining
the faculty of Brooklyn College in 1937
• In 1951 he became head of the psychology
department at Brandeis University
(Waltham, Massachusetts), where he
remained until 1969
• Influenced by existentialist philosophers
and literary figures, Maslow was an
MASLOW’S HIERARCHY OF NEEDS
PHYSIOLOGIAL NEEDS
 These are biological requirements for human survival,
e.g. air, food, drink, shelter, clothing, warmth, sex,
sleep. If these needs are not satisfied the human body
cannot function optimally. Maslow considered
physiological needs the most important as all the other
needs become secondary until these needs are met.
 According to Maslow, some of these needs involve our
efforts to meet the body’s need for homeostasis; that is,
maintaining consistent levels in different bodily systems
(for example, maintaining a body temperature of 98.6
degrees).
SAFETY NEEDS
 Once people’s physiological requirements are met, the next
need that arises is a safe environment. Our safety needs
are apparent even early in childhood, as children have a
need for safe and predictable environments and typically
react with fear or anxiety when these needs are not met.
Maslow pointed out that, in adults living in developed
nations, safety needs can be more apparent in emergency
situations (e.g. war and disasters), but this need can also
explain why we tend to prefer the familiar or why we do
things like purchasing insurance and contributing to a
savings account.
LOVE AND BELONGING
 After physiological and safety needs have been fulfilled, the
third level of human needs is social and involves feelings of
belongingness. The need for interpersonal relationships
motivates behavior. Examples include friendship, intimacy,
trust, and acceptance, receiving and giving affection and
love. Affiliating, being part of a group (family, friends, work)
 Since Maslow’s time, researchers have continued to
explore how love and belonging needs impact well-being.
For example, having social connections is related to
better physical health and, conversely, feeling isolated
(i.e. having unmet belonging needs) has negative
consequences for health and well-being.
ESTEEM
 Classified into two categories: (I) esteem for oneself
(dignity, achievement, mastery, independence) and (II)
the desire for reputation or respect from others (e.g.,
status, prestige). Maslow indicated that the need for
respect or reputation is most important for children and
adolescents and precedes real self-esteem or dignity.
 When people’s esteem needs are met, they feel
confident and see their contributions and
achievements as valuable and important. However,
when their esteem needs are not met, they may
experience what psychologist Alfred Adler called
“feelings of inferiority.”
SELF – ACTUALIZATION
 Self-actualization refers to feeling fulfilled, or feeling that
we are living up to our potential. One unique feature of
self-actualization is that it looks different for everyone.
For one person, self-actualization might involve helping
others; for another person, it might involve
achievements in an artistic or creative field.
 Realizing personal potential, self-fulfillment, seeking
personal growth and peak experiences. A desire “to
become everything one is capable of
becoming”(Maslow, 1987, p. 64).
RELEVANCE OF HIERARCHY OF
NEEDS AND NURSING
 PHYSIOLOGICAL
 Nurses must have a decent work environment
 Nurses also need communication tools that enable
them to connect and collaborate more efficiently
 Addressing physiological aspects in a healthcare
environment will enable nurses to reclaim time for
basic human needs like rest and meals. As a result,
they will have more energy for patient care.
RELEVANCE OF HIERARCHY OF
NEEDS AND NURSING
 SAFETY
 Hospitals and other healthcare environments
should equip nurses with tools that enable them to
call for immediate help when their physical safety
is at risk
 Hospitals should also create processes or protocols
that make bullying unacceptable, and allow nurses
to resist bullying without fear of retaliation
RELEVANCE OF HIERARCHY OF
NEEDS AND NURSING
 LOVE AND BELONGING
 Nurses should also feel empowered at work, and know
their feelings and ideas matter
 Nurses should also be fully involved in co-designing,
implementing, and deploying new technology solutions
as they are often the ones using them
 Hospital leaders should seek out nurses’ perspectives
and expert advice on processes, policies and goals
RELEVANCE OF HIERARCHY OF
NEEDS AND NURSING
 ESTEEM
 Nurses went to school to take care of patients; and
when patient satisfaction and outcomes are good,
nurses feel a sense of accomplishment
 Technology can also be used for staff rounds, which
fosters a culture of communication to improve
employee engagement, trusted relationships, and
well-being
RELEVANCE OF HIERARCHY OF
NEEDS AND NURSING
 SELF – ACTUALIZATION
 Having established a solid foundation, nurse leaders can
be creative in establishing an environment where they
feel energized by their work
 Hospitals can also make nurses feel supported and
respected by giving them the tools they need to
communicate effectively with colleagues
 In a collaborative, secure and empowering environment,
nurses can easily and confidently provide excellent
patient care