Page 350 - Encyclopedia of Nursing Research

NeWMAN’S THeORy OF HeALTH n 317

for clinical purposes. However, the Brazelton Sleep–wake patterns can also be used
system is the most limited for research as it to predict developmental outcome (ednick
can only be used with infants between 36 et al., 2009). Measures of sleep–wake states N
and 44 weeks PMA, and Thoman’s is the during the preterm predict Bayley scores
most flexible as it has been used with 27-week during the first year. Developmental changes
PMA preterm infants through 1-year-olds. and stability in the amounts of specific sleep
Sleeping and waking states have wide- behaviors during the preterm period and
spread physiological effects. The functioning the first year are related to developmental
of cardiovascular, respiratory, neurological, and health outcomes in the second and third
endocrine, and gastrointestinal systems dif- year. eeG sleep measures in preterm infants
fers in different states. Sleeping and waking have been related to developmental outcome
also affect the infant’s ability to respond to at up to 8 years (Holditch-Davis & Blackburn,
stimulation. Thus, infant responses to nurses 2007). For example, Arditi-Babchuk, Feldman,
and parents depend to a great deal on the and eidelman (2009) found that rapid eye
state the infant is in when the stimulation movement activity at 32–36 weeks PMA was
is begun. Timing routine interventions to related to Bayley scores at 6 months. Infants
occur when the infant is most responsive is who showed more rapid active sleep devel-
an important aspect of current systems of opment in the preterm period had higher
individualized nursing care. average cognitive skills and better language
Studies have indicated that sleep and and fine motor abilities at 3 years than those
waking patterns are closely related to neu- of other preterm infants (Holditch-Davis,
rological status (Halpern, MacLean, & Belyea, & edwards, 2005). In summary, sleep-
Baumeister, 1995). State patterns of infants ing and waking patterns appear to provide
with neurological insults differ markedly an excellent index of neurodevelopmental
from those of healthy infants. Abnormal status in preterm and full-term infants that
neonatal eeG patterns are associated with can be scored either behaviorally or by eeG.
severe neurological abnormalities and
major neurodevelopmental sequelae dur- Barbara Medoff-Cooper
ing childhood. Also, preterm infants with Diane Holditch-Davis
severe medical illnesses exhibit patterns of
sleep–wake states that differ from those of
healthier preterms, although most of these
differences disappear when infants recover NewmaN’s theory of health
(Holditch-Davis & Blackburn, 2007). Sleep
and wakefulness may be directly related to
brain development. For example, because Margaret Newman’s contributions to nurs-
ReM sleep is less common in adults than ing science and practice span 35 years of sus-
non-ReM sleep but active sleep is more tained scholarship on her theory of health
common than quiet sleep in infants, active as expanding consciousness. Her theory is a
sleep has been hypothesized to be necessary grand theory, focusing on a unitary-transfor-
for brain development (Roffwarg, Muzio, mative paradigm for nursing and on research
& Dement, 1966). Also, eeG changes over as praxis.
age in sleep architecture, increasing spec- Newman’s (1979) conceptual framework
tral energies, and greater spectral eeG of health was introduced in her book Theory
coherence probably indicate maturational Development in Nursing. This framework was
changes in the brain, including synaptogen- expanded and refined in two editions of
esis, evolution of neurotransmitter pools, Health as Expanding Consciousness (Newman,
and myelination. 1986, 1994) and in Transforming Presence