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454 UNIT IV Nursing Theories

process (Newman, 2005). Future researchers will mode. However, quantitative methods are inadequate
be greatly assisted by Smith’s (2011) comprehensive to capture the dynamic, changing nature of this the-
review of the theory of health as expanding con- ory. A hermeneutic dialectic approach was developed
sciousness research literature. and has been used extensively for full explication of
its meaning and application.
Further Development Importance
Previously discussed research studies have supported The focus of Newman’s theory of health as expanding
the theory of health as expanding consciousness, consciousness provides an evolving guide for all
illuminating the importance of pattern recognition in health-related disciplines. In the quest for under-
the process of expanding consciousness. The theory standing the phenomenon of health, this unique view
has been used extensively in exploring and under- of health challenges nurses to make a difference in
standing the experience of health within illness, sup- nursing practice by the application of this theory. The
porting a basic premise of the theory, that disruptive volume and breadth of literature cited in this chapter
situations provide a catalytic effect and facilitate is evidence that Newman’s theory has stood the test of
movement to higher levels of consciousness. time with global importance.

Critique Summary
Clarity Although Newman started with a rational, empirical
Semantic clarity is evident in the definitions, de- approach that was both inductive and deductive, she
scriptions, and dimensions of the concepts of the found it restrictive and “not consistent with the para-
theory. digm from which the theory was drawn” (1997a,
p. 23). Little by little, she relinquished some of the
Simplicity experimental control, and her work evolved to a more
The deeper meaning of the theory of health as expand- interactive, integrative approach that continued to be
ing consciousness is complex. The theory as a whole objective and controlled. When that still did not
must be understood rather than isolating the concepts. work, she shifted from the scientific paradigm with its
As Newman advocated in the 1994 edition of her book, objectivity and control and allowed the principles of
Health As Expanding Consciousness, the holistic ap- her theoretical paradigm to guide her research. Then
proach of the hermeneutic dialectic method is consistent she began to see the core of pattern and process
with the theory and requires a high level of understand- as nursing practice. She saw the evolving pattern
ing of the theory on the part of the researcher to extend as meaning in process that required an approach
the theory in praxis research (M. Newman, personal of mutual process, not just objective observation.
communication, 1996). Patterns showed that expanding consciousness was
related to quality and connectedness of relationships.
Generality The nurse researcher’s creative presence was impor-
The concepts in Newman’s theory are broad in scope tant to the participant’s insight. Newman (1986) con-
because they all relate to health. The theory has been cluded that individuals experience a theory in living
applied in many cultures and is applicable across the it. She labeled her research as hermeneutic dialectic.
spectrum of nursing care situations (M. Newman, The theory of health as expanding consciousness,
personal communication, 2004). Application of the along with the research as praxis method, has been
theory is universal in nature. The broad scope pro- used extensively in nursing practice with a variety
vides a focus for middle-range theory development. of individuals, family and community situations,
nursing education, and practice models and nursing
Accessibility research in the United States and many other coun-
In the early stages of development, aspects of the tries. Newman continues to write, consult, and lec-
theory were tested with the traditional scientific ture, advancing her work.