Newman's Theory of Health in Nursing

 Health in Nursing and Newman's Theory

Newman's Theory of Health,Newman's Conceptual Work and Book,Theoretical Inspiration Newman as Nursing Advocate,Model of Nursing Practice Levels,Newman's Theory and Nursing Research.Elaboration and Refinement in the Newman's Concept,Outcomes of Newman's' Theory.

Newman's Theory of Health

     Margaret Newman is an eminent, visionary nurse theorist whose contributions to nursing science and nursing practice span 30 years of sustained scholarship on the theory of health as expanding consciousness. 

    Newman's theory of health exemplifies her focus on a unitary transformative paradigm for the discipline of nursing and on research as practice methodology.

Newman's Conceptual Work and Book

    Newman's conceptual framework of health was introduced in her book Theory Development in Nursing (1979) and was expanded and refined in two editions of her book Health as Expanding Consciousness (1986, 1994). 

    Her work was published at a time when fewer abstract theories of nursing based on current practice were emphasized. Rather than being viewed as visionary with a creative and futuristic conceptualization of health, Newman's highly abstract grand theory as well as other grand theories of nursing was dismissed by the majority of nurses as far removed from the real world of everyday practice. 

    As scientists in other disciplines revolutionized their former mechanistic world views to align more closely with a unitary transformative paradigm, Newman's theory of health has achieved greater acceptance by nurse scientists and practitioners, particularly transcultural nurses and holistic nurses.

Theoretical Inspiration

    Newman's (1986, 1994) theory of health was inspired by her own nursing experiences, grounded in Rogers' science of unitary human beings and later expanded to include premises from Benton's life process as expanding consciousness and Prigogine's theory of dissipative structures. 

    She reconceptualized health as a manifestation of an underlying unitary field pattern rather than as a health disease dichotomy. Health was defined as a unitary pattern of the whole, reflecting the dynamic, evolving human environment, the process of expanding consciousness which occurs within a multidimensional matrix of movement, time, and space.     

Consciousness was defined as the informational capacity of the whole. She utilized Bohm's theory of undivided wholeness of reality and young's theory of human evolution to support the concept of unitary field pattern and the pivotal influence of human choice. 

    Nursing practice was defined as a mutual process of attainement during which the underlying patterns of the client and nurse are identified and both individuals are transformed.

 Newman as Nursing Advocate

    Newman was an early eloquent advocate for nursing to identify, develop, and differentiate a paradigm that addressed the unique knowledge of nursing embodied in practice and in scholarly inquiry. In collaboration with Sime and Corcoran-Perry (Newman, Sime, & Corcoran-Perry, 1991, p. 3), she defined the focus of nursing as "caring in the human health experience." Differences between 

(a) the prevailing particulate deterministic and interactive integrative paradigms that had previously shaped nursing education, research, and practice.

(b) a unitary transformative paradigm for the discipline of nursing in the future were discussed. 

    In the unitary-transformative paradigm, "a phenomenon is viewed as a unitary, self-organizing field embedded in a larger self-organizing field" (Newman et al., p. 4) and is identified by its pattern and its interaction with the larger whole. 

    Change is unidirectional and unpredictable, with systems moving through stages of organization and disorganization to increasingly complex levels. Knowledge, which is personal and involves pattern recognition, is seen as a function of both the viewer and the phenomenon viewed.

Model of Nursing Practice Levels

    In accordance with the unitary transformative paradigm, Newman (1990b) described a model of differentiated nursing practice having three levels based on education, with advanced practice nurses having graduate preparation in the unitary-transformative paradigm. 

    Newman proposed using nursing diagnoses that recognize patterns of person environment interaction, rather than the North American Nursing Diagnosis Association diagnoses which reflect a static client in isolation from the environment. 

    Her work subsequently moved away from conventional assessment and diagnosis as part of the nursing process toward nursing practice and research using her model of research as practice, in which nursing interventions may be viewed as inherent in the mutual process of client and nurse pattern recognition. 

    Newman (1990a) identified the lack of conceptual fit between conventional quantitative research methods and the unitary-transformative paradigm of her theory of health. 

    She posited that nurse scientists: should use research as praxis methodology, a hermeneutic method of inquiry in which the client and nurse are core searchers in identifying, describing, and verifying the client's pattern of expanding consciousness from narrative data about the most meaningful events in the client's life. 

    Nurse scientists identified patterns of individual study participants in their practice, with qualitative comparison of patterns across study participants. Research as practice is therefore both a research method and a transformative intervention.

Newman's Theory and Nursing Research

    Early quantitative research using conventional methods emphasized testing propositions derived from Newman's (1979) conceptual framework of health, focusing on the concepts of movement, time, space, and consciousness (Engle, 1996), Nurse scientists included Engle, Guadiano, Mentzer, Newman, Schorr, and Tompkins. 

    Healthy adults were studied in community and laboratory settings with predominantly small, nonprobability samples of male college students, female college students, older adults, and older women.

Elaboration and Refinement in the Newman's Concept 

    Subsequent elaboration and refinement of Newman's (1986, 1994) theory of health shifted the focus of research to health as expanding consciousness, recognition of unitary field pattern, and research as praxis methodology (Engle, 1996). 

    Nurse scientists. included Lamendola, Moch, Newman, Schorr, and Schroeder. Small convenience samples of adults with and without health. Problems were studied in community and health care settings, including adults who exercised regularly, women with rheumatoid arthritis, women with breast cancer, adults: with cancer, adults with coronary heart dis ease, and persons with HIV/AIDS. 

    Much of the current research has demonstrated a transcultural theory application. International nurse scientists include Connor and Litchfield in New Zealand, Endo in Japan, Jonsdottir in Iceland, and Yamashita in Canada. 

    The preceding studies have demonstrated the congruency of Newman's theory of health and of the research as practice methodology for pattern identification with different cultures (Engle & Fox-Hill, 2005).

Outcomes of Newman's' Theory

    Newman's theory of health exemplifies the relationship between theory, research, and practice. The mutual process of evolving pattern recognition by the client and nurse using research as practice informs nursing practice. 

    As pattern recognition occurs, clients gain insights that create the opportunity for action. This practice approach exemplifies the participatory paradigm (Litchfield, 1999) emphasized by current health care systems that values shared decision making, collaboration, and partnering with multicultural clients, families, and interdisciplinary health care providers.