10/25/2023

PRAYER BEFORE LECTURE/RLE COLLEGE OF NURSING

God our Father,

praise and glory to you for this day
of lectures/clinical activities;
send us your Holy Spirit to enlighten our minds
to learn new things, to gain new skills and most especially
to have our hearts formed anew and inclined unto you
so we may lovingly serve and care for the sick among us.
This we ask through the most Holy Name of Jesus Christ Your
Son, Forever and ever. Amen.

Our Lady of Fatima,

Pray for us! 10/25/2023 1

MODULE 10

MARGARET NEWMAN
ROSEMARIE PARSE
ERIKSON, TOMLIN, SWAIN

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MARGARET NEWMAN
• Born on October 10, 1933
• 1962: BSN at University of Tennessee
• 1964: MSN in University of California
• 1971: PhD at New York University
• Career: University of Tennessee, New York
University, Pennsylvania State University.

Theoretical Sources
 Martha Rogers’ Theory of Unitary Human Beings

 The health of a Human being is unitary phenomenon, an

evolving pattern of Human- Environment

 Itzhak Bentov’s Concept of the Evolution of Consciousness

 Life is the process of expanding consciousness. the

informational capacity of the system (Human Being} and
can be seen in the quality of interaction of the system with
the environment

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Theoretical Sources
 Arthur Young’s Theory of Process
 Theory of human evolution pinpointed the role of pattern
recognition for Newman. She explained that Young’s
ideas provided impetus for her to integrate the basic
concepts of her new theory, movement, space, time, and
consciousness, into a dynamic portrayal of life and health

 David Bohm’s Theory of Implicate as she developed her model

of nursing.
 theory of implicate order supports Newman’s postulate
that disease is a manifestation of the pattern of health.

 The 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.

 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 world.”

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HEALTH
Rogers’ insistence that health and illness are simply
manifestations of the rhythmic fluctuations of the life process
is the foundation for viewing health and illness as a unitary
process moving through variations in order-disorder.

From this standpoint, one can no longer think of health and

illness in the dichotomous way characterized in medical
science; that is, health as an absence of disease or health as
a continuum from wellness to illness. Health and the
evolving pattern of consciousness are the same.

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PATTERN
A person is identified by her or his pattern, which reflects
the pattern of the person within the larger pattern of the
environment. The pattern is evolving through permutations
of order and disorder, including what in everyday language
is called health and disease.

Pattern recognition emerges from a process of uncovering

meaning in a person’s life.

Meaning is inherent in pattern, and vice versa.

CONSCIOUSNESS
 Consciousness is both the informational capacity of
the system (Human Being} and the ability of the
system to interact with its environment (Newman,
1994).
 Includes not only cognitive and affective awareness,
but also the “interconnectedness of the entire living
system which includes physicochemical
maintenance and growth processes as well as the
immune system.

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Three Correlates of Consciousness

 Time
 Movement
 Space
 views the expansion of consciousness as what
life and health is all about, and the sense of time
is an indicator in the changing level of
consciousness.

The model also addresses the

interrelatedness of time, space, and
movement.

Time and space are the temporal

pattern of the patient, and have a
complementary relationship.

People are constantly changing

through time and space, which is
movement, which shows a unique
pattern of reality.

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PERSON
 Humans are open to the whole energy system of the
universe and constantly interacting with the energy.
With the process of interaction, humans are evolving
their individual patterns of whole..
 Persons as individuals are identified by their individual
patterns of consciousness (Newman, 1986) and
defined as “centers of consciousness within an overall
pattern of expanding consciousness” (Newman, 1986,
p. 31).

NURSING
 emphasizes the primacy of relationships as a focus of
nursing, both nurse-client relationships and
relationships within clients’ lives (Newman, 2008).

 “The emphasis of this process is on knowing/caring

through pattern recognition”

 The nurse helps patients understand how to use

the power they have within in order to develop a
higher level of consciousness.

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HEALTH
 Is the major concept of Newman’s theory of expanding
consciousness. A fusion of disease and nondisease creates a
synthesis regarded as health (Newman, 1979, 1991, 1992).

 Disease and non-disease each reflect the larger whole;

therefore, a new concept states that pattern recognition is the
essence of emerging health.

 “Manifest health, encompassing disease and nondisease, can

be regarded as the explication of the underlying pattern of
person-environment” (Newman, 1994, p. 11)

ENVIRONMENT
 Although environment is not explicitly defined, it is
described as being the larger whole, which contains the
consciousness of the individual.

 The pattern of person consciousness interacts within the pattern of

family consciousness and within the pattern of community
interactions (Newman, 1986).

 Client and environment are viewed as a unitary

evolving pattern (Newman, 2008).

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Newman’s theory makes six assumptions

1. Health encompasses conditions heretofore described
as illness, or, in medical terms, pathology.

2. These pathological conditions can be considered a

manifestation of the total pattern of the individual patient.

3. The pattern of the individual patient that eventually

manifests itself as pathology is primary, and exists prior
to structural or functional changes.

Newman’s theory makes six assumptions

4. Removal of the pathology in itself will not
change the pattern of the individual patient.

5. If becoming ill is the only way an individual

patient’s pattern can manifest itself, then that is
health for that individual patient.

6. Health is an expansion of the consciousness.

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PRACTICE
Newman’s Model of Health is useful in the practice of
nursing because it contained concepts used by the
profession. Movement and Time are an intrinsic part of
nursing intervention, that is Range-of-motion,
ambulation, coughing, turning and deep breathing.

EDUCATION
Newman did not advocate one model as the sole
basis for curriculum. Rather, students should
have the opportunity to study various
approaches to health and nursing and to choose
what is relevant to them in their practice and
research.

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RESEARCH
 Some researchers have attempted to test Newman's
propositions of time, space and movement.
Cooperative inquiry or interactive, integrative participation
 Newman stated that research should center on
investigations that are participatory in which client-
subjects are partners and co-researchers in the
search for health patterns.

TASK #1: Critical Thinking Activities

1. Choose one health situation in which you personally experience Health

Expanding Consciousness. Using the HEC model discuss how were you able to
manage the said situation.

2. Analyze factors that contribute to your participation in a health-expanding

consciousness activity with emphasis on the three principles.

3. Compare your own philosophy of health and that of HEC. How were you able
to define health in the context of illness?

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ROSEMARIE RIZZO
PARSE
“Human Becoming
Theory”

ROSEMARIE RIZZO PARSE



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Origin of the Human Becoming Theory

Assumptions

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Basic Concepts of the Human Becoming Theory

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MEANING


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RHYTHMICITY


TRANSCENDENCE


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PRINCIPLES


Nursing Paradigms and

Parse’s Theory


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Nursing Paradigms and Parse’s

Theory


Theory Overview: Parse Scholars Beliefs

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Theory Overview: Real World

Example
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Modeling and Role-modeling

Theory

Helen C. Erickson, Evelyn M. Tomlin, and Mary Ann P. Swain

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Helen C. Erickson
 BSN (1974), MS in psychiatric nursing and medical-surgical nursing (1976), and PhD in educational
psychology(1984): University of Michigan.
 Head Nurse: emergency room of the Midland Community Hospital in Midland, Texas
 Night Supervisor: Michigan State Home for the Mentally Impaired and Handicapped in Mount Pleasant.
 1960-1964: Director of Health Services at Inter-American University in San German, Puerto Rico. Staff nurse at St.
Joseph’s and University Hospitals in Ann Arbor, Michigan. Mental health nurse consultant to the Pediatric Nurse
Practitioner Program at University of Michigan and University of Michigan Hospitals—Adult Care.
 1978-1986: Assistant Instructor in the RN Studies Program at the University of Michigan School of Nursing,
Chairperson of the Undergraduate Program and Dean for Undergraduate Studies, Assistant Professor at the
University of Michigan, University of South Carolina College of Nursing as Associate Professor, Assistant Dean for
Academic Programs, and Associate Dean for Academic Affairs.
 Member of the American Nurses Association, American Nurses Foundation, Sigma Theta Tau, and the Institute for
the Advancement of Health.
 1986-1990: President of the Society for the Advancement of Modeling and Role-Modeling
 1986: chairperson of the First National Symposium on Modeling and Role-Modeling
 1988: Professor of Nursing, Chair of Adult Health, and Special Assistant to the Dean, Graduate Programs, at the
University of Texas School of Nursing in Austin.
 1996: Fellow into the American Academy of Nursing
 1997: Emeritus Professor at the University of Texas and The Helen Erickson Endowed Lectureship in Holistic Health
Nursing at the University of Texas at Austin.
 2001: Distinguished Faculty citation from Humboldt State University in California
 Erickson consults on research with the Modeling and Role-Modeling Theory

Evelyn M. Tomlin
 BSN: Pasadena City College, Los Angeles County General Hospital School of Nursing and University of
Southern California
 1976: MS in psychiatric nursing from the University of Michigan
 Clinical instructor: Los Angeles County General Hospital School of Nursing
 Staff Nurse: United States Embassy Hospital
 Taught fundamentals of nursing as Assistant Professor in the RN Studies Program at the University of
Michigan and she served as mental health consultant to the pediatric nurse practitioner program.
 Among the first 16 nurses in the United States to be certified by the American Association of Critical
Care Nurses.
 Member of Sigma Theta Tau Rho Chapter, California Scholarship Federation, and the Philomathian
Society.
 Presented programs based on the Modeling and Role-Modeling Theory, with emphasis on clinical
applications.
 First editor for the newsletter of the Society for the Advancement of Modeling and Role-Modeling
 1985 Big Rock, Illinois: teaching small community and nursing groups and working in a community shelter
serving the women and children of Fox Valley. She identifies herself as a Christian in retirement from
nursing for pay, but not from nursing practice. She is pursuing interests in the practice of healing prayer,
stating that she has always been interested in the interface of the Modeling and Role-Modeling Theory
and Judeo-Christian principles.
 Now retired after many years on the board of directors and as a volunteer at Wayside Cross Ministries in
Aurora, Illinois

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Mary Ann P. Swain

 BS in psychology from DePauw University
 MS and PhD in psychology from the University of Michigan.
 Taught psychology, research methods, and statistics as a teaching assistant at DePauw University and later as a
lecturer and professor of psychology and nursing research at the University of Michigan.
 1975: University of Michigan: Director of the Doctoral Program in Nursing for 1 year
 1977-1982: Chairperson of Nursing Research
 1981: recognized by the Rho Chapter of Sigma Theta Tau for Contributions to Nursing
 1983: Associate Vice President for Academic Affairs
 1983: honorary member of Sigma Theta Tau.
 Member of the American Psychological Association, associate member of the Michigan Nurses Association.
 Collaborated with nurse researchers on projects, including health promotion among diabetic patients and ways to
influence compliance among patients with hypertension.
 Helped Erickson publish a model that assessed an individual’s potential to mobilize resources and adapt to stress,
which is significant to the Modeling and Role-Modeling Theory.
 1994: Appalachia, New York, Provost and Vice President for Academic Affairs for Binghamton University for nearly
20 years.
 Director of PhD in Nursing program at Decker School of Nursing and Chair of the Department of Student Affairs.
 Her research interests are health development across the life span and interrelationships among life stressors,
healthy development, and illness.

MAJOR CONCEPTS & DEFINITIONS

MODELING
 The act of Modeling is the process the nurse uses as she develops an image and
an understanding of the client’s world—an image and understanding developed
within the client’s framework and from the client’s perspective ….

 The art of Modeling is the development of a mirror image of the situation from
the client’s perspective ….

 The science of Modeling is the scientific aggregation and analysis of data

collected about the client’s model. Modeling occurs as the nurse accepts and
understands her client.

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MAJOR CONCEPTS & DEFINITIONS

ROLE-MODELING

 The art of Role-Modeling occurs when the nurse plans and implements interventions that are
unique for the client.

 The science of Role-Modeling occurs as the nurse plans interventions with respect to her
theoretical base for the practice of nursing …. Role-Modeling is …. the essence of nurturance
….

 Role-Modeling requires an unconditional acceptance of the person as the person is while gently
encouraging the facilitating growth and development at the person’s own pace and within the
person’s own model.

 Role-Modeling starts the second the nurse moves from the analysis phase of the nursing process
to the planning of nursing interventions.

MAJOR CONCEPTS & DEFINITIONS

NURSING
 Nursing is the holistic helping of persons with their self-care activities in relation to their
health. This is an interactive, interpersonal process that nurtures strengths to enable the
development, release, and channeling of resources for coping with one’s circumstances and
environment. The goal is to achieve a state of perceived optimum health and contentment.

NURTURANCE
 Nurturance fuses and integrates cognitive, physiological, and affective processes, with the aim of
assisting a client to move toward holistic health. Nurturance implies that the nurse seeks to know and
understand the client’s personal model of his or her world, and to appreciate its value and significance for
that client from the client’s perspective.

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MAJOR CONCEPTS & DEFINITIONS

UNCONDITIONAL ACCEPTANCE

 Being accepted as a unique, worthwhile, important

individual—with no strings attached—is imperative if the
individual is to be facilitated in developing his or her own
potential. The nurse’s use of empathy helps the individual
learn that the nurse accepts and respects him or her as is.
The acceptance will facilitate the mobilization of resources
needed as this individual strives for adaptive equilibrium.

MAJOR CONCEPTS & DEFINITIONS

PERSON
 People are alike because they have holism, lifetime growth and development, and
their need for all. They are different because they have inherent endowment,
adaptation, and self-care knowledge.

HOLISM
 Human beings are holistic persons who have multiple interacting subsystems.
Permeating all subsystems are the inherent bases. These include genetic makeup and
spiritual drive. Body, mind, emotion, and spirit are a total unit, and they act
together. They affect and control one another interactively. The interaction of the
multiple subsystems and the inherent bases creates holism: Holism implies that the
whole is greater than the sum of the parts.

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MAJOR CONCEPTS & DEFINITIONS

BASIC NEEDS

 All human beings have basic needs that can be

satisfied, but only from within the framework of
the individual.

 Basic needs are met only when the individual

perceives that they are met.

MAJOR CONCEPTS & DEFINITIONS

LIFETIME DEVELOPMENT
 Lifetime development evolves through psychological and cognitive stages, as follows:

 ■ Psychological Stages

 Each stage represents a developmental task or a decisive encounter resulting in a turning point, a moment of
decision between alternative basic attitudes (e.g., trust versus mistrust or autonomy versus shame and doubt). As
a maturing individual negotiates or resolves each age-specific crisis or task, the individual gains enduring strengths
and attitudes that contribute to the character and health of the individual’s personality in his or her culture.

 ■ Cognitive Stages

 Consider how thinking develops rather than what happens in psychosocial or affective development …. Piaget
believed that cognitive learning develops in a sequential manner, and he has identified several periods in this
process. Essentially, there are four periods: sensorimotor, preoperational, concrete operations, and formal
operations.

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MAJOR CONCEPTS & DEFINITIONS

Affiliated individuation: an instinctual need for affiliated individuation.
Depend on support systems while simultaneously maintaining independence from these
support systems. They need to feel a deep sense of both the “I” and the “we” states of
being, and to perceive freedom and acceptance in both states

 How people are different

Inherent endowment
 Each individual is born with a set of genes that will to some extent predetermine
appearance, growth, development, and responses to life events. Clearly, both genetic
makeup and inherited characteristics influence growth and development. They might
influence how one perceives oneself and one’s world. They make individuals different
from one another, each unique in his or her own way

MAJOR CONCEPTS & DEFINITIONS

ADAPTATION: occurs as the individual responds to external and internal stressors in a
health-directed and growth-directed manner. Adaptation involves mobilizing internal and external
coping resources. No subsystem is left in jeopardy when adaptation occurs

 The individual’s ability to mobilize resources is depicted by the APAM. The APAM identifies three
different coping potential states:
 (1) arousal,
 (2) equilibrium (adaptive and maladaptive), and
 (3) impoverishment.

Each represents a different potential to mobilize self-care resources. “Movement among the states is
influenced by one’s ability to cope [with ongoing stressors] and the presence of new stressors”

 Nurses can use this model to predict an individual’s potential to mobilize self-care resources in
response to stress.

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MAJOR CONCEPTS & DEFINITIONS

MIND-BODY RELATIONSHIPS
 We are all biophysical, psychosocial beings who want to develop our potential,
that is, to be the best we can be.

SELF-CARE: use of knowledge, resources, and actions, as follows:

■ Self-Care Knowledge: a person knows what has made him or her sick, lessened his or her
effectiveness, or interfered with his or her growth, and what will make him or her well, optimize
his or her effectiveness or fulfillment (given circumstances), or promote his or her growth

■ Self-Care Resources are “the internal resources, as well as additional resources, mobilized
through self-care action that help gain, maintain, and promote an optimum level of holistic
health”

■ Self-Care Action is “the development and utilization of self-care knowledge and self-care
resources”

USE OF EMPIRICAL EVIDENCE

It has been tested as a classification
model as a predictor for health status
for length of hospital stay, and as it
relates to basic needs status.
Findings from these studies provide
beginning evidence for the proposed
three-state model across populations, a
relationship between health and ability
to mobilize resources, and an ability to
mobilize resources and needs status.
Two other studies have shown
relationships among stressors (measured
as life events) and propensity for
accidents and resource state and ability
to take in and use new information.

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USE OF EMPIRICAL EVIDENCE

Relationships among self-care knowledge, resources, and
activities have been demonstrated in several studies.

The self-care knowledge construct, was replicated and

found to be significantly associated with perceived control;
perceived autonomy and quality of life.

Self-directedness, need for harmony (affiliation), and need

for autonomy (individuation) were found when
multidimensional scaling was used to explore relationships
among self-care knowledge, resources, and actions.

Positive attitude was a major factor when health-directed

self-care actions were assessed. Physical activity in
patients after myocardial infarction was shown to be
affected by life satisfaction (not physical condition); life
satisfaction was predicted by availability of self-care
resources and resources needed; and resources needed
served as a suppressor for resources available.

When the Modeling and Role-Modeling Theory was used as a guideline, interviews
were used to determine the client’s model of the world. The following seven themes
emerged:

1. Cause of the problem, which was unique to the individual

2. Related factors, also unique to the individual

3. Expectations for the future

4. Types of perceived control

5. Affiliation

6. Lack of affiliation

7. Trust in the caregiver

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METAPARADIGM
NURSING
 “The nurse is a facilitator, not an effector. Our nurse-client relationship is an interactive,
interpersonal process that aids the individual to identify, mobilize, and develop his or her own
strengths to achieve a perceived optimal state of health and well-being” has defined this
relationship as facilitative-affiliation. The five aims of nursing interventions are to build trust,
affirm and promote client strengths, promote positive orientation, facilitate perceived control,
and set health-directed mutual goals.

PERSON
 Differentiation is made between patients and clients in this theory. A patient is given
treatment and instruction; a client participates in his or her own care. “Our goal is for
nurses to work with clients”. “A client is one who is considered to be a legitimate
member of the decision-making team, who always has some control over the planned
regimen, and who is incorporated into the planning and implementation of his or her
own care as much as possible”

METAPARADIGM

HEALTH
 “Health is a state of physical, mental, and social wellbeing, not
merely the absence of disease or infirmity. It connotates a state of
dynamic equilibrium among the various subsystems [of a holistic
person]”

ENVIRONMENT
 “Environment is not identified in the theory as an entity of its
own. The theorists see environment in the social subsystems as the
interaction between self and others both cultural and individual.
Biophysical stressors are seen as part of the environment”

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THEORETICAL ASSERTIONS
Based on the linkages between completion of developmental tasks and basic needs satisfaction; among basic needs
satisfaction, object attachment and loss, and developmental tasks; and between the ability to mobilize coping
resources and need satisfaction.

Three generic theoretical assertions constitute theoretical linkages implied in the theory as follows:

 1. “The degree to which developmental tasks are resolved is dependent on the degree to
which human needs are satisfied”.

 2. “The degree to which needs are satisfied by object attachment depends on the
availability of those objects and the degree to which they provide comfort and security
as opposed to threat and anxiety”.

 3. “An individual’s potential for mobilizing resources, the person’s state of coping
according to the APAM, is directly associated with the person’s need satisfaction level”

TASK #2 Case Study - Application

 Lucas 48 year old construction worker came to you to complaint about the
intensifying pain in his left foot while at rest. His foot was cool and pale, and he had
a history of vascular surgical procedures. He had many chronic health problems,
including type 2 diabetes, hypertension, and chronic obstructive pulmonary disease.
He also had a serious heart problems. He further mentioned that he is experiencing
abdominal ulcer due to skipping of meals. At home he is taking care of his elderly
grandmother, and sending two of his sibling to college. What is your MODELLING image
of Lucas? What will be the components of your ROLE–MODELING for Lucas?

 As a nurse, how can you help provide quality and appropriate nursing care using the 4
nursing paradigm.

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OPTIONAL PROJECT FOR TFN

 Attend SUNDAY masses of Fr. Nick our University Chaplain at the university chapel (9am);

 Participate in the Eucharistic Celebration either as reader, usher/greeter, choir, sacristan,

physical arrangement, technical/sound, etc; Please coordinate with Prof. Carol San Diego

 Take picture with Fr. Nick and post in your social media what you learn from the Homily that is
related to Nursing

 Each Sunday is equivalent to 5 point. Validated thru Attendance and SocMed post

OPTIONAL TFN PROJECT

For Other Religious Group
 Attend your regular SUNDAY worship/service

 Participate in the Sunday Worship/Service either as a reader, usher/greeter, choir, sacristan,

physical arrangement, technical/sound, etc;

 Take a picture with your pastor/minister and post on your social media what you learn from
preaching that is related to Nursing

 Each Sunday is equivalent to 5 points. Validated through Attendance and social media post.

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