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446 UNIT IV Nursing Theories

3. The pattern of the individual that eventually mani- Nurses facilitate pattern recognition in clients by
fests itself as pathology is primary and exists prior forming relationships with them at critical points in
to structural or functional changes . . . their lives and connecting with them in an authentic
4. Removal of the pathology in itself will not change way. The nurse-client relationship is characterized by
the pattern of the individual . . . “a rhythmic coming together and moving apart
5. If becoming “ill” is the only way an individual’s as clients encounter disruption of their organized,
pattern can manifest itself then that is health for predictable state” (Newman, 1999, p. 228). She states
that person . . . that the nurse will continue to connect with clients as
From these assumptions, Newman set forth the they move through periods of disorganization and
thesis: Health is the expansion of consciousness (Newman, unpredictability to arrive at a higher, organized state
personal communication, 2008). (Newman, 1999). The nurse comes together with
Newman’s implicit assumptions about human nature clients at these critical choice points in their lives and
include being unitary, an open system, in continuous participates with them in the process of expanding
interconnectedness with the open system of the uni- consciousness. The relationship is one of rhythmicity
verse, and continuously engaged in an evolving pattern and timing, with the nurse letting go of the need
of the whole (M. Newman, personal communication, to direct the relationship or fix things. As the nurse
2000). She views unfolding consciousness as a process relinquishes the need to manipulate or control, there
that will occur regardless of what actions nurses per- is greater ability to enter into this fluctuating, rhyth-
form. However, nurses assist clients in getting in touch mic partnership with the client (Newman, 1999).
with what is going on and in that way facilitate the pro- Newman has diagrammed this nurse-client interac-
cess (Newman, 1994). tion of coming together and moving apart through
Newman designated “caring in the human health the processes of recognition, insight, and transforma-
experience” (M. Newman, personal communication tion (Figure 23–1) Nurses are seen as partners in the
2004; Newman, Sime, & Corcoran-Perry, 1991, p. 3) as process of expanding consciousness, and are trans-
the focus of nursing and specified this focus as the formed and have their lives enhanced in the dialogical
metaparadigm of the discipline. She asserts the interre- process (Newman, 2008). As facilitator, the nurse
lated concepts of nursing, person, health, and environ- helps an individual, family, or community to focus on
ment as inherent in this focus (M. Newman, personal patterns of relating (M. Newman, personal communi-
communication, 2004). Coming from a unitary, trans- cation, 2004). Thus the nursing process is one of pat-
formative paradigm of the discipline, Newman does not tern recognition.
see these concepts in isolation, and therefore she does Newman’s early suggestion (Newman, 1995b) was
not discuss them separately, but has elaborated on nurs- that the NANDA health assessment framework, which
ing and health. In the following paragraphs, implicit was based on unitary person-environment patterns of
definitions from Newman’s work are used to discuss the interaction, be used to facilitate clients’ pattern recog-
four components. nition (Roy, Rogers, Fitzpatrick, et al., 1982). At the
time, the patterns were intended to guide nurses to
Nursing make holistic observations of “person-environment
Newman emphasizes the primacy of relationships as behaviors that together depict a very specific pattern
a focus of nursing, both nurse-client relationships and of the whole for each person” (Newman, 1995b,
relationships within clients’ lives (Newman, 2008). p. 261). Newman (2008) since has emphasized con-
During dialectic nurse-client relationships, clients get centrating on what is most meaningful to clients in
in touch with the meaning of their lives through iden- their own stories and patterns of relating.
tification of meanings in the process of their evolving Within the theory, the role of the nurse in nurse-
patterns of relating (Newman, 2008). “The emphasis client interactions is seen as a “caring, pattern-
of this process is on knowing/caring through pattern recognizing presence” (Newman, 2008, p. 16). The
recognition” (Newman, 2008, p. 10). Insight into nurse perceives patterns in client’s stories or se-
these patterns provides clients with illumination of quences of events that change with new informa-
action possibilities, which then opens the way for tion. According to Newman (2008), it is important
transformation (Newman, 1990a). for nurses to view clients’ stories comprehensively.