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452 UNIT IV Nursing Theories

Quinn (1992) reconceptualized therapeutic touch that nursing is at the intersection of the focus of the
as shared consciousness. Lamb and Stempel (1994) health care industry; therefore, “nursing is in position
described the role of the nurse as an insider-expert. to bring about the fluctuation within the system that
Newman, Lamb, and Michaels (1991) described the will shift the system to a new higher order of func-
role of the nurse case manager at St. Mary’s as ema- tioning” (p. 90). Newman (2008) proposes that,
nating from a philosophical and theoretical base “attention to the nature of transformative learning
agreeing with the unitary-transformative paradigm will help to establish the priorities of the discipline”
and exemplifying an integrated stage of professional (p. 73). As students and teachers directly engage in
nursing. Further, the theory of health as expanding intuitive awareness, they resonate with each other in
consciousness has been proposed as beneficial for the a transforming way (Endo, Takaki, Abe, et al., 2007).
school nurse working with adolescents with insulin- However, as the paradigm shift has taken place
dependent diabetes (Schlotzhauer & Farnham, 1997). in nurses’ views of their relationships with clients,
Gustafson (1990) found that practice as a parish examples of application of the theory in traditional
nurse supported Newman’s theory of health as dem- roles are evident (Newman, personal communication,
onstration of pattern recognition. More recently, 2008).
Endo and colleagues (2005) conducted action re- Examining the pragmatic adequacy of Newman’s
search involving practicing nurses and found that theory in relation to nursing education reveals that
nurses experienced deeper meaning in their lives as a teaching the research method associated with the the-
result of the transformative power of pattern recog- ory also teaches students a practice method that is
nition in their work with clients. Flanagan (2005) congruent with the theory, and it is a means for students
found that preoperative nurses working within the to experience transformation through pattern recogni-
theory saw the effect of their presence in changing tion (Newman, 2008). Newman sees theory, practice,
patient experiences. Ruka (2005) developed a model and research as a process rather than as separate
of nursing home practice for use in pattern recogni- domains of the nursing discipline. Teaching the theory
tion with persons with dementia. Pierre-Louis and of health as expanding consciousness necessitates a shift
colleagues (2011) studied patterns in the lives of in thinking from a dichotomous view of health to a
African-American women with diabetes within synthesized view that accepts disease as a manifestation
health as expanding consciousness, and MacLeod of health. Not only that, learning to let go of the profes-
(2011) studied experiences of spousal caregivers. sional’s control and respecting the client’s choices
Ness (2009) studies pain expression in perioperative are integral parts of practice within this framework.
Somali women. Dyess (2011) focused on the concept Students and practicing nurses who plan to use
of faith in the context of health as expanding con- Newman’s theory face personal transformation in learn-
sciousness. Haney and Tufts (2012) used health as ing to recognize patterns through nurse-client interac-
expanding consciousness to frame a home health care tions. An individual’s personal experience will be the
study of electronic communication for parental well- core not just of teaching and practice, but of research
being and satisfaction in medically fragile children. as well. Newman (1994) explained that the nurse needs
to sense his or her own pattern of relating as an indica-
Education tion of the nurse-client interacting pattern. She empha-
Newman (1986) stated that ideally, a new role is sized that there needs to be a sense of the process of the
needed for the nurse in the paradigm of the evolving relationship with clients from within, giving attention to
consciousness of the whole. “Nurses need to be free to the “we” in the nurse-client relationship (Newman,
relate to patients in an ongoing partnership that is not 1997b).
limited to a particular place or time” (Newman, 1986, Newman’s theory has been used in nursing educa-
p. 89). She suggested that nursing education revolve tion to provide some content into a model called the
around pattern as a concept, substance, process, and healing web. This model was designed to integrate
method. Education by this method would enable nursing education and nursing service together with
nursing to be an important resource for the continued private and public education programs for baccalau-
development of health care. Newman (1986) stated reate and associate nursing degree programs in South