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582 UNIT V Middle Range Nursing Theories

beyond the concerns generated by physical and cogni- end of life represent some of the most vulnerable indi-
tive decline. Other scholars broadened the theory to viduals to whom nurses may provide care. Although
include younger adults with life-limiting conditions an abundance of lay literature exists about the devel-
that may make them vulnerable to spiritual disequilib- opmental and transcendent experiences of end of
rium and depression. Recent studies by Reed and others life and dying, there is a dearth of systematic research
have extended the scope of the theory to include addi- into this human experience. The Self-Transcendence
tional populations of adolescent and adult age groups, Theory guides the initial questions and may undergo
patients and nonpatients, who may have increased further refinement as this inquiry progresses.
awareness of personal mortality. Examples are Japanese Other forms of inquiry may occur in reference to the
hospitalized older adults (Hoshi & Reed, 2011), Korean theory, in view of Reed’s reconceptualization of nursing.
older adults and their family caregivers (Kim, Reed, Reed (1997a) has clarified a more foundational defini-
Hayward, et al., 2011), Amish adults in rural Ohio tion of nursing that shifts the source of nursing activity
(Sharpnack, Quinn-Griffin, Benders, et al., 2010, 2011), from that of external agent (i.e., the “nurse”) to a view of
caregivers of older adults with dementia (Kidd, nursing as an inner human process. Specifically, Reed
Zauszniewski, Morris, et al., 2011), low-income older defines nursing as a process of well-being that exists
adults (McCarthy, 2011), older adults patients in within and among human systems, characterized by
Norwegian nursing homes (Haugan, Rannestad, Garåsen, changing complexity and integration. From this, she
Hammervold, et al., 2011), Taiwanese nursing students proposed self-transcendence as a nursing process.
(Chen & Walsh, 2009), bullied middle-school boys Further explorations into mechanisms of changing
(Willis & Grace, 2011; Willis & Griffith, 2010), and complexity and integration should help achieve new
patients with progressive diseases such as multiple theoretical explanations about how self-transcendence
sclerosis and systemic lupus erythematosus (Iwamoto, emerges and functions in human lives.
Yamawaki, & Sato, 2011).
Diverse personal and contextual variables impact Critique
the relationship between self-transcendence and well-
being. Although a number of studies have associated Clarity
older age with increased self-transcendence, younger Clarity and consistency are key criteria in the descrip-
research participants have also report self-transcen- tion of and critical reflection on a theory (Chinn &
dence views and behaviors and score high on self- Kramer, 2011). Theory clarity is evaluated by seman-
transcendence measures. During a long or short period tic clarity and structural clarity. Semantic consistency
in one’s life, a variety of human experiences (e.g., child- evaluates how consistent concepts are used with their
birth and parenting, illness and disability, caregiving, definitions and the basic assumptions of the theory.
creating a work of art or literature, spiritual perspec- Structural consistency involves assessing congruency
tives) all may evoke the pandimensional views and among the assumptions, theory purpose, concept
behaviors indicative of self-transcendence. Continued definitions, and connections among the concepts.
research into these and other personal and contextual Theoretical sources for development of the theory
factors will increase understanding of the role they are described clearly in several publications (Reed,
play in the theoretical propositions (Reed, 2008). 1991b, 1996, 1997b, 2003). The definitions and as-
Continued development of the theory by Reed and sumptions about the concepts derived from Life Span
others includes further examination of points of inter- Developmental Theory and Rogers’ Science of Uni-
vention to facilitate self-transcendence perspectives tary Human Beings have sometimes been difficult for
and behaviors in persons who express a need for nurses to grasp. Attempting to clarify concepts such
increased sense of wholeness and well-being. As the as health and self-transcendence, Reed presented
Self-Transcendence Theory evolves, nurses learn more slightly varying definitions and numerous examples
about potentials for well-being over the life span. that, although theoretically consistent, may confuse
Reed received funding to study self-transcendence some readers. In terms of structural clarity, the rela-
as it relates to end-of-life decisions and well-being in tionships in the schematic model of the theory (see
patients and their family caregivers. People facing the Figure 29–1) are more fully defined and described in