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576 UNIT V Middle Range Nursing Theories

MAJOR CONCEPTS & DEFINITIONS
Vulnerability may possibly be added to describe the capacities for
Vulnerability is one’s awareness of personal mortality boundary expansion (P. Reed, personal communica-
(Reed, 2003). In Reed’s earlier work, the phrase tion, June 17, 2004).
“awareness of one’s personal mortality” was the con- Well-Being
text for development or maturation in later adult-
hood or at the end of life. The concept of vulnerability Well-being is “the sense of feeling whole and healthy,
broadens the awareness of personal mortality situa- in accord with one’s own criteria for wholeness and
tions to include life crises such as disability, chronic well-being” (Reed, 2003, p. 148). In her earlier work,
illness, childbirth, and parenting. Self-transcendence Reed did not explicitly define well-being but linked
was a pattern associated with advanced development the concept to mental health, which was dependent
within that context (Reed, 1991b). on salient issues of development within a given
phase of life (Reed, 1989, 1991b). In an article
Self-Transcendence in Nursing Science Quarterly, Reed described the
Self-transcendence, initially defined by Reed (1991a) underlying mechanisms of well-being in “Nursing:
as “expansion of self-conceptual boundaries multi- The Ontology of the Discipline” and proposed nurs-
dimensionally: inwardly (e.g., through introspective ing to be “the study of the nursing processes of well-
experiences), outwardly (e.g., by reaching out to being” (Reed, 1997a, p. 76). Well-being as a nursing
others), and temporally (whereby past and future process is described in terms of a synthesis of two
are integrated into the present)” (p. 71), was later kinds of change: changes in complexity in a life (i.e.,
defined more comprehensively (Reed , 1997b) as the increasing frailness of advanced aging or the loss
follows: of a beloved spouse) tempered by changes in inte-
Self-transcendence refers to fluctuation of perceived gration (i.e., constructing meaning from such life
events).
boundaries that extend the person (or self) beyond
the immediate and constricted views of self and the Moderating-Mediating Factors
world. This fluctuation is pandimensional, that is, A variety of personal and contextual variables and
outward (toward others and the environment), their interactions may influence the process of
inward (toward greater awareness of one’s own self-transcendence as it contributes to well-being.
beliefs, values, and dreams), and temporal (toward Examples are age, gender, cognitive ability, life
integration of past and future in a way that experiences, spiritual perspectives, social environ-
enhances the relative present) (p. 192). ment, and historical events. These variables may
In 2003, the pattern of boundary expansion was strengthen or weaken relationships between vul-
incorporated so that self-transcendence included the nerability and self-transcendence and between
capacity to expand one’s self-boundaries “transper- self-transcendence and well-being (Reed, 2003).
sonally (to connect with dimensions beyond the typi- Nursing activities may be based on facilitating the
cally discernible world)” (Reed, 2003, p. 147). As self- mediating factor of self-transcendence.
transcendence is pandimensional, other dimensions

Use of Empirical Evidence in theory building was conducted with older adults
Self-Transcendence Theory was grounded in belief in (1986b, 1989, 1991b).
the developmental nature of older adults and the ne- In the first study, Reed (1986b) examined pat-
cessity of continued development to maintain mental terns of developmental resources and depression
health and a sense of well-being during the process of over time in 28 mentally healthy and 28 clinically
aging (Reed, 1983). Therefore, Reed’s initial research depressed older adults (mean age, 67.4 years). Levels