Analysis and application of Rogers' Science of Unitary Human Beings.
ROGERS' SCIENCE OF UNITARY HUMAN BEINGS
Martha Rogers was a renowned theorist who developed the SUHB. Rogers was one of the first to identify human beings as the central phenomenon of interest to nursing (Newman, as cited in Fawcett, 2003). The SUHB is unique in that the phenomenon of central interest is what is "known" as opposed to what is done in practice (Rogers, as cited in Fawcett, 1995). Rogers was an innovative nurse theorist who inspired a new generation of theorists who are committed to carrying on her work.
In regards to the scope of the theory, there is disagreement among some academics as to how to classify the SUHB. In considering Rogers' views, there has been some debate as to whether the SUHB is a philosophy, model or theory. Fawcett (1993) differentiates between a theory and a model stating that a theory is less abstract than a model. She further states that a theory's concepts are operationally defined and less abstract than the concepts of a model. Rogers rejected the labels of philosophy, model and theory and referred to the SUHB as a conceptual framework or system, however she apparently did not clearly indicate in her writing as to her rationale (Biley, 2002).
Fawcett (1993) recognizes that conceptual models have also been called "conceptual frameworks, conceptual systems, paradigms, and disciplinary matrices" (p.12) suggesting that SUHB is accurately called a model of nursing or nursing model. Fawcett further states that SUHB a conceptual model rather than a grand theory because the concepts and propositions are more abstract and general than grand theories or middle-range theories (J. Fawcett, personal conversation, November 24, 2006). Further, conceptual models provide guidance for theory development and Gunther (2002) identifies the purpose of Rogers' work as "articulating a body of distinctive knowledge" (p.234), therefore reinforcing Fawcett's interpretation of SUHB being a conceptual model.
Different theories have emerged from Rogers' conceptual model because it provides a framework that stimulates and directs research and theory development for nursing science (Gunther, 2002; J.Fawcett, personal communication, November 24, 2006). Margaret Newman's Theory of Health as Expanding Consciousness and Parse's Human Becoming are examples of grand theories derived from Rogers' conceptual model. The Theory of Perceived Dissonance and the Theory of Interactive Rhythms are examples of middle-range theories derived from Rogers' conceptual model (Gunther, 2002). In addition to the development of grand theories, Rogerian researchers themselves have developed their own theories based on Rogers' science such as Barrett's Theory of Power where power is related to "participating knowingly in change" (Phillips, 2000, p.199).
The SUHB contains content that addresses the four metaparadigm concepts of human beings, environment, health, and nursing. By definition, all nursing conceptual models contain content about the four nursing metaparadigm concepts (J. Fawcett, personal communication, November 24, 2006). The emphasis of the SUHB is on the integrality of human environment field phenomena (Gunther, 2002). The concept of person is of a unitary human being, patterned, open, and pandimentional energy field. The concept of environment is a patterned, pandimensional energy field where health is seen as an expression of the life process and the goal of nursing is to facilitate well being through intentional mutual patterning including environmental patterning to promote helicy, integrality and resonancy (Fawcett, 1993).
The concepts of the SUHB are energy fields, openness, pattern, pandimensionality, and homeodynamics (resonancy, helicy, integrality). Energy fields are the "fundamental unit" for both the living and nonliving and are two types, human and environmental (Barrett, 2000; Eschiti, 2004; Gunther, 2002; Levin, 2006). These fields can not be divided or reduced and because there is no separation between the identified fields, they are considered as energy fields as opposed to having energy fields (Rogers, as cited in Eschiti, 2004). Rogers (1992) makes it explicit that humans are more than the sum of their parts and can not be understood by only having knowledge of their parts.
Rogers disagreed with the idea that dissecting something is the only way to attain knowledge or understanding it. For example, by dissecting a cat in a biology lab, we learn only how the individual parts work but there is much more to a cat than its individual parts. What we did not see was the cat's agility, its precision in estimating distance, its grace in movement and how it purrs. We did not look at the cat in the context of its whole self/living/life (V. Eschiti, personal communication, November 23, 2006).
Lastly, energy fields possess the qualities of infinity, unification and constant mutual change. Openness refers to the diversity of the energy fields and the freedom to knowingly participate in change. Pattern is that which distinguishes a particular energy field but is not directly observable. Having said this, the manifestations that emerge from the mutual process of human beings and their environments are observable (Barrett, 2000). Pandimensionality refers to a way of viewing reality where both time and space are conceptualized as nonlinear (Rogers cited in Barrett, 2000).
The principles of homeodynamics describe change within the SUHB. Phillips (as cited in Barrett, 2000) describes Rogers' principles of helicy as being the nature of change, integrality as being the process for change to take place, and resonancy as being how change takes place. The principles of homeodynamics and the manifestations of field patterning can be used to study concepts and experiences of people. The term "pattern profiles" is used as a way to understand the unitary nature of people and their environments (Phillips, 2000).
In terms of methodology, early basic research focused on one concept within Roger's science such as the human energy field. Through time and experience, Rogerian research has become more sophisticated where dual concepts such as hemodynamics and manifestations of field patterns are used to study people's experiences (Phillips, 2000). Rogers insists that research in nursing needs to look at unitary human beings as integral with their environment. Thus the intention of research should examine and understand phenomena and design patterning activities that will promote healing (Gunther, 2002).
One of the challenges of Rogerian research is choosing the correct methodology to "examine the person and the environment as health related phenomena" (Gunther, 2002, p.234). The methodology must be able to recognize the "unitary nature of the phenomena of interest" and "propose evidence of patterned mutual change among variables" (Gunther, 2002, p. 234). Both qualitative and quantitative approaches have been used to achieve this however there is disagreement amongst researchers as to the appropriateness of both. Rogers (1992) states that both qualitative and quantitative methods are appropriate, whereas, Gunther suggests that quantitative experiments and quasiexperimental designs are not appropriate, as their intent is to evaluate cause and effect relationships. Gunther further states that descriptive, explanatory designs are appropriate for investigating the complex nature of the variables of the SUHB.
What is agreed upon is that there must be ontological and epistemological congruence between the model and the approach and this needs to be reflected in the research question (Gunther, 2002). Several mid range theories have developed specific research methodologies based on the Rogerian model to recognize human-environmental phenomena, such as Cowlings' process of unitary pattern appreciation.
According to Phillips (2000), Rogerian researchers and theorists have made great progress in terms of the developing methodologies and instruments specifically for Rogerian science. Some examples of this are Butchers' unitary field pattern portrait research method, Carboni's pandimensional unitary process inquiry and Cowlings unitary pattern appreciation case study method (Phillips, 2000). Many Rogerian instruments have been developed to measure human-environment field phenomena. Prior to these developments, Rogerian researchers were depending on methodologies and instruments from other sciences.
The value for practice is significant as Rogers' work expanded the understanding of the healing processes that can happen with interacting with energy fields (Eschiti, 2004). Acceptance of the value of energy fields is evidenced by the fact that energy patterning nursing interventions now have an approved NANDA nursing diagnosis of Disturbed Energy Field (Leddy, 2004).
Healing is tied to emotions which are pattern manifestations, and being present and in the moment and connecting with another person's energy field is healing. Energy fields change and can bring about healing (S. Hardin, personal communication, November 23, 2006). When a connection occurs, one can feel a shift in the pattern manifestations (Gunter, 2002). I have experienced this shift both as a nurse and as a client. For instance, when I was a client receiving an amniocentesis, I was feeling anxious and fragile in anticipation. Prior to the doctor inserting the needle, the nurse held my foot and spoke to me. There was a shift in my pattern manifestation as my anxiety decreased, my anticipation of the pain decreased and procedure went well. Fawcett (1995) describes the focus of SUHB based nursing practice as creative use of nursing knowledge with the purpose of health promotion for individuals of various ages and diverse medical conditions.
Upon initial inquiry into Rogerian Science, one may find it complicated and abstract however it really is not that complicated. Gunter (2002) states, "with only three principles, a few major concepts and five assumptions, Rogers has explained the nature of man and life process" (p.236).
SUHB AND ADVANCED NURSING PRACTICE
In this section, I will discuss the usefulness of the SUHB as related to advanced nursing practice (ANP). The position statement on ANP from the College of Registered Nurses of British Columbia, (CNRBC), which has adapted elements of the Canadian Nurses Association's position, defines ANP as an umbrella term that is defined by assumptions that practice has flexible boundaries with the emphasis on advanced nursing knowledge as opposed performing additional functions (CNRBC, 2005).
Rogers (as cited in Barrett, 1998) describes nursing practice as "the creative and imaginative use of nursing knowledge" (p.136). The nurse working within the capacity of ANP could address this idea within all four domains of practice: clinical, education, research or administration (CRNBC, 2005). Rogers strongly believed that basic and applied research was necessary for the continuation of nursing's unique body of knowledge (Rogers, 1992). Research is an important component of ANP by developing and testing new knowledge and also the transmission of this knowledge (Rogers, 1992). The use of the broad principle of SUHB through ANP with its increased boundaries and nursing knowledge allows for many possibilities.
Lastly, Rogers SUHB provides the framework for nurses to be positive change agents in today's challenging health care system. It gives nurses a way of knowing nursing and new ways to perceive and care for clients. This knowledge could be considered a gift in the face of adversity within health care today with budget cuts and a nursing shortage all of which are challenges to providing quality client care.
The SUHB provides a theoretical basis, which informs practice for the delivery of nursing care. Theory is a set of concepts and relationships that are known to work in a certain fashion and are the scientific basis for practice. Rogers has been a dominant figure in the development of contemporary nursing theory and has contributed to the development of nursing's unique body of knowledge. Rogers' work is viewed by some as controversial, but the SUHB has served to guide practice and education for the nursing profession.
PERSONAL PRACTICE SCENARIO
Early in my career, I had an interesting experience. I had just taken a course on Therapeutic Touch (TT) and was working on an extended care ward. There was a man who had poorly controlled chronic pain. The man requested more analgesic, but he already received all the medication to relieve his pain that was ordered. I told him that I couldn't give him anything else but that I had been learning a technique that may help his pain. I was uneasy offering to do TT for this gentleman, as it was an unconventional intervention, especially for someone of his generation. To my surprise, he said he was willing to try anything.
I began to do the TT treatment first by holding his feet and imagining roots growing down towards the earth. I followed by working the whole body and then focused on the area over his legs where the pain was originating. Within a relatively short time, I could feel the difference in his energy as the pain subsided. I looked up at the man and he was asleep. I was completely surprised and I quietly left the room.
This man requested that I "do that thing" regularly and each subsequent time that I would do the TT for this man, the interval between starting TT and him falling asleep was getting shorter and shorter to where he would fall asleep. This was the first time that I intentionally and purposefully experienced working with energy fields. No one in the hospital was familiar with TT and this generated much discussion. Unfortunately, not all of the discussion was positive as one of my colleagues with a strong Christian background equated what I was doing to the supernatural. This nurse complained to our manager stating that I had no right to do to be dealing with spirits.
Viewing this practical situation from a Rogerian lens, TT is an integrative therapy that works with energy systems to clear blockages and restore balance. Rogers specifically lists TT as being consistent with human beings as energy fields and it is well- researched and documented to be effective in a number of situations (Eschiti, 2004). By offering this holistic intervention, I intentionally and purposefully used my focused awareness and that of the client's to promote harmony and diversity in the energy field for his maximum well being.
It is important to note that I did not cause the effect of the decreased pain as it is not the practitioner who heals the client, but the client heals himself/herself by resonating with the energy frequency (Leddy, 2004). I participated but it was the client who was the major participant in the interaction (Rogers cited in Gunther, 2002). The client's acceptance of my offer of TT demonstrated what Roger's (cited in Fawcett, 1995) referred to as the client's ability to "participate knowingly in the process of change" (p. 380). This example demonstrates acknowledgement of the client, myself, and the environment as an energy field which is open and in constant change. The energy field has patterns that are not observable but the manifestation of field patterning is the observable event more specifically, the pain. Rogers (1992) postulates that the observable event emerges out of the mutual process of the human-environmental field.
If you consider Rogers' views that energy fields are the fundamental unit for both the living and the nonliving and that these fields cannot be divided or reduced as there is not separation between the identified fields, then the negative dissonance from my peer affected the whole energy field of the living and nonliving. For example, had that coworker been receptive and used her energy to expand this intervention, one can only imagine how the energy of the whole hospital environment could have changed with 50 nurses providing TT. Looking at the hospital as an energy field with the living and nonliving one can start to examine the established dissonance within the energy field that disturbs the resonance of the healing environment such as a coworker's negativity to an obvious beneficial intervention with proven and observable efficacy. One can imagine that had there been a different reaction from my coworkers, the energy of the whole hospital could have evolved. This is similar to the analogy of the expanding ripples of a pebble thrown in a pond.
In this paper, the SUHB was examined in regards to nursing practice. Application to advanced nursing practice was presented and a personal practice scenario was examined through the theoretical lens of the SUHB. The SUHB was shown to be a valuable theoretical basis which informs practice for the delivery of nursing care.
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Levin, J. (2006). Unitary transformative nursing: Using metaphor and imagery for self reflection and theory infromed practice. Visions: The Journal of Rogerian Science, 14(1), 27-35.
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LISA BLUMENSCHEIN, BA, RN, BN
NURSE MANAGER OF AN INTERMEDIATE CARE FACILITY FOR SENIORS
STUDENT, NP PROGRAM U VICTORIA
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|Publication:||Visions: The Journal of Rogerian Nursing Science|
|Date:||Jan 1, 2009|
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