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CHAPTER 13 Martha E. Rogers 231

a framework for the development of nursing knowledge
through the generation of grand and middle-range CASE STUDY
theories. Charlie Dee is a 56-year-old male client with a
30-year history of smoking two packs of cigarettes
Accessibility per day. He is seeing nurse practitioner Sandra Gee
Drawing on knowledge from a multitude of scientific for the first time after being diagnosed with chronic
fields, Rogers’ conceptual model is deductive in logic obstructive pulmonary disease. Pattern appraisal
with an inherent lack of immediate empirical support begins with eliciting the client’s description of his
(Barrett, 1990b). As Fawcett (1995) points out, failure to experience with this disease, his perceptions of his
properly categorize the work as a conceptual model health, and how the disease is expressed (symp-
rather than as a theory leads to “considerable misunder- toms). Mr. Dee states that he has a productive
standings and inappropriate expectations” (p. 29), cough that is worse in the morning, gets short of
which can result in the work being labeled inadequate. breath whenever he is physically active, and always
As noted earlier, the development of the model by feels tired. Through specific questions, the nurse
Rogerian scientists has resulted in the generation of practitioner discovers that Mr. Dee has experienced
testable theories accompanied by tools of measurement. a change in his sleep patterns and nutritional intake.
He is sleeping for shorter periods and eating less.
Importance She also learns that Mr. Dee’s wife smokes, and that
Rogers’ science has the fundamental intent of under- they have indoor cats for pets. He does not think
standing human evolution and its potential for human that his wife will be amenable to changing her hab-
betterment. The science “coordinates a universe of its or getting rid of the cats. During this appraisal,
open systems to identify the focus of a new paradigm the nurse seeks to discover what is important to
and initiate nursing’s identity as a science” (Rogers, Mr. Dee and how he defines healthy.
1989, p. 182). Mutual patterning involves sharing knowledge
Although all the metaparadigm concepts are ex- and offering choices. Upon completion of the ap-
plored, the emphasis is on the integrality of human- praisal, the nurse summarizes what she has been
environmental field phenomena. Rogers suggested told and how she understands it. In this way, the
many ideas for future studies; on the basis of this and nurse and the client can reach consensus about
the research of others, it can be said that the concep- what activities would be acceptable to Mr. Dee.
tual model is useful. Such utility has been proven Ms. Gee provides information about the disease
in the arenas of practice, education, administration, and suggestions that will increase his comfort. Non-
and research. invasive interventions include breathing retraining,
recommendations for a high-protein high-calorie
diet, eating smaller meals more frequently, sleeping
Summary with the head elevated, and using progressive relax-
The Rogerian model emerged from a broad historical ation exercises at bedtime. The nurse recommends
base and has moved to the forefront as scientific knowl- that the Dees buy a HEPA filter and humidifier to
edge has evolved. Understanding the concepts and assist in removing environmental pollutants and
principles of the Science of Unitary Human Beings maintaining proper humidity in the home.
requires a foundation in general education, a willing- Because Mr. Gee has expressed a desire to quit
ness to let go of the traditional, and an ability to perceive smoking, the nurse suggests that he use forms of
the world in a new and creative way. Emerging from a centering, such as guided imagery and meditation,
strong educational base, this model provides a challeng- to supplement the nicotine patches prescribed by
ing framework from which to provide nursing care. The his physician. She also provides him with written
abstract ideas expounded in the Rogerian model and material about the disease that he can share with
their congruence with modern scientific knowledge his wife. At the end of the visit, Mr. Dee states that
spur new and challenging theories that further the he feels better knowing that he has the power to
understanding of the unitary human being. change some things about his life.