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Evolution of the Science of Unitary Human Beings: the conceptual system, theory development, and research and practice methodologies.

INTRODUCTION

The purpose of this paper, presented at the 2014 meeting of the Society of Rogerian Scholars, is to acknowledge the impressive evolution of the Science of Unitary Human Beings. I offer this paper in celebration of the 100th year since Martha E. Rogers' birth. Martha was born on May 12, 1914, the same month and day of Florence Nightingale's birthday; Martha died on March 13, 1994.

In 1966, Martha Rogers told us:

Nursing's story is a magnificent epic of service to [human beings]. It is about people: how they are born and live and die; in health and in sickness; in joy and in sorrow. Its mission is the translation of [nursing] knowledge into human service. Nursing is compassionate concern for human beings. It is the heart that understands and the hand that soothes. It is the intellect that synthesizes many learnings into meaningful [ministrations].

Martha's words serve as the organizing framework for my presentation. I will begin with nursing knowledge in the form of a discussion of highlights of the evolution of the conceptual system. I will continue with the intellectual synthesis of learnings in the form of evolution of theory development guided by the conceptual system. Then, I will discuss meaningful ministrations of the conceptual system, in the form of evolution of research and practice methodologies.

EVOLUTION OF THE CONCEPTUAL SYSTEM

Rogers was a pioneer in the development of unique nursing knowledge. Newman (1972) pointed out that Rogers was one of the first modern nurse scholars to explicitly identify man as the central phenomenon of interest to the discipline of nursing. Moreover, Rogers focused attention on the environment as an equally important phenomenon of study. Rogers (1978a, 1992a) traced the dual concern with people and their environments to Nightingale. In 1992(a), she explained, "Rogerian science of irreducible human beings provides a framework rooted in a new reality and directed toward moving us from what might be called a prescientific era to a scientific era. Certainly Nightingale laid a firm foundation for this kind of an approach to nursing knowledge and its use" (p. 61).

In 1978(a), Rogers stated that she directed her efforts "to evolve a conceptual system that would give identity to nursing as a knowledgeable endeavor." She added that she deliberately set out to develop a conceptual system when she realized that "there had to be a body of knowledge that was specific to and unique to nursing, or there was no need for higher education in nursing at all" (Rogers, 1978b). Rogers' recognition of the need for an organized body of unique nursing knowledge was evident in her early writings on nursing education, especially in her 1961 book, Educational Revolution in Nursing and her 1964 book, Reveille in Nursing.

As many, if not all, of us who know about the Science of Unitary Human Beings know that Rogers was never satisfied with her conceptual system and, therefore, revised the wording, if not the intent, many times. Rogers' conceptual system currently is referred to as the Science of Unitary Human Beings. She first presented her conceptual system, known then as the Life Process Model, in her 1970 book, An Introduction to the Theoretical Basis of Nursing. Further development and refinement of the conceptual system, then called the Science of Unitary Man, was presented by Rogers in 1978(a) at the Second Annual Nurse Educator Conference. That presentation, with additional refinements, was later published in Riehl and Roy's 1980 book, Conceptual Models for Nursing Practice (Rogers, 1980a). The latter two papers also introduced theoretical formulations derived from the conceptual model. In a series of 1980 audiotapes and videotapes, Rogers (1980b-g) presented an expanded explanation of the conceptual system, as well as a comprehensive discussion of three grand theories that she derived from the conceptual system. Further refinements in the conceptual system were published in a chapter in Malinski's 1986(a) book, Explorations on Martha Rogers' Science of Unitary Human Beings (Rogers, 1986). By 1986, the conceptual system was referred to as the Science of Unitary Human Beings. Still further refinements were published in a chapter in Barrett's 1990 book, Visions of Rogers' Science-Based Nursing (Rogers, 1990a), and in Rogers' 1992(b) journal article. Despite many refinements, the label for the conceptual system has not changed since 1986.

Several changes were made in the conceptual system as it evolved from the Life Process Model to the Science of Unitary Man to the Science of Unitary Human Beings. The term for human beings evolved from man (Rogers, 1970) to unitary man (Rogers, 1980a) and later to unitary human beings (Rogers, 1986). Furthermore, the word, development, was dropped inasmuch as this word tends to denote linearity (Rogers, as cited in Malinski, 1986b).

The concepts or basic building blocks of the Rogerian conceptual system evolved from energy field, wholeness, openness, unidirectional, pattern and organization, and sentience and thought (Rogers, 1970) to energy field, openness, pattern, and four-dimensional (Rogers, 1980a) to energy field, openness, pattern, and multidimensional (Rogers, 1990a), and finally to energy field, openness, pattern, and pandimensional (Rogers, 1992b).

Rogers eliminated the term unidirectional as it led to the false interpretation of human development as linear. Multidimensional replaced four-dimensional in an effort "to select words best suited to portray one's thought.... Multidimensional provides for an infinite domain without limit" (Rogers, 1990a, p. 7). Pandimensional replaced ultidimensional for the same reason. Rogers (1992b) explained that despite the changes in the actual word used, the definition has remained the same.

The principles of homeodynamics evolved from reciprocy, synchrony, helicy, and resonancy (Rogers, 1970) to helicy, resonancy, and complementarity (Rogers, 1980a) to helicy, resonancy, and integrality (Rogers, 1986). Reciprocy and synchrony were eliminated and complementarity was replaced by integrality inasmuch as the terms reciprocy, synchrony, and complementarity led to the false interpretation of separation between the human and environmental energy fields. Furthermore, the notion of mutual and simultaneous interaction (Rogers, 1970), with its false connotation of separate human and environmental fields, evolved into complementarity and then to integrality. A change also was made in the definition of helicy--the term, probabilistic, used in the definition was replaced by the term, unpredictable; as Rogers (1990a) explained, "the literature now points up that unpredictability transcends probability" (p. 7).

Moreover, Rogers (1983) and Fawcett (1975) both modified the conceptual system for the family. Furthermore, Leddy (2004) based her Human Energy Model on the basic ideas of Rogers' Science of Unitary Human Beings.

EVOLUTION OF THEORY DEVELOPMENT

Although the findings of all research and many "thought experiments" are theories (Fawcett & Downs, 1986, p. 61; Fawcett & Garity, 2009), most of us regard as theories only those formuations that are explicitly labeled as such. Thus, the starting point for evolution of theory development guided by the Science of Unitary Human Beings most likely is Rogers' three grand theories--the Theory of Accelerating Evolution (Rogers, 1980a, 1986, 1992b); the Theory of Rhythmical Correlates of Change (Rogers, 1980a, 1986, 1992b), which Butcher and Malinski (2010) called the Theory of Manifestations of Field Patterning in Unitary Human Beings; and the Theory of Paranormal Phenomena (Rogers, 1980a, 1986, 1992b), which Butcher and Malinski (2010) called the Theory of Emergence of Paranormal Phenomena.

Development of three other grand theories was grounded in the Science of Unitary Human Beings--Newman's (1986, 1994) Theory of Health as Expanding Consciousness (Newman, 1986, 1994); Parse's (1981, 1992, 1998, 2007, 2014) Theory of Humanbecoming; and Fitzpatrick's (1983, 1989) Life Perspective Rhythm Model.

Many explicit middle-range theories that have been derived from the Science of Unitary Human Beings. Those that I have identified are:

* Health Empowerment Theory (Shearer, 2009)

* Power as Knowing Participation in Change (Barrett, 1986; Caroselli & Barrett, 1998)

* Theory of Aging (Alligood & McGuire, 2000)

* Theory of Aging as Emerging Brilliance (Butcher, 2003)

* Theory of the Art of Professional Nursing (Alligood, 2002), also referred to as the Theory of the Art of Nursing (Alligood, 2010)

* Theory of Creativity, Actualization, and Empathy (Alligood, 1991)

* Theory of Diversity of Human Field Pattern (Hastings-Tolsma, 2006)

* Theory of Enfolding Health-as-Wholeness-and-Harmony (Barrett, Cowling, Carboni, & Butcher, 1997)

* Theory of Enlightenment (Hills & Hanchett, 2001)

* Theory of Healthiness (Leddy & Fawcett, 1997)

* Theory of Human Field Motion (Ference, 1986b, 1989)

* Theory of Intentionality (Zahourek, 2004, 2005)

* Theory of Kaleidoscoping in Life's Turbulence (Butcher, 1993)

* Theory of Pattern (Alligood, 2010; Alligood & Fawcett, 2004)

* Theory of Perceived Dissonance (Bultemeier, 1997a)

* Theory of Self-Transcendence (Reed, 1991, 1997, 2003)

* Theory of Sentience Evolution (Parker, 1989)

* Theory of Pandimensional Awareness-Integral Presence (Phillips, 2014)

Three other middle-range theories have been derived from Leddy (2004)--the Theory of Healthiness (Leddy & Fawcett, 1997), the Theory of Participation, and the Theory of Energetic Patterning.

At least one explicit situation-specific theory has been derived from the Science of Unitary Human Beings. Willis, DeSanto-Madeya, and Fawcett (2015) identified concepts and propositions of the Theory of Men's Healing from Childhood Maltreatment by means of a secondary analysis of data from Willis' study of childhood maltreatment.

EVOLUTION OF RESEARCH METHODOLOGIES

Much of the early research done by doctoral students who were interested in Rogerian science has been dismissed as not being consistent with the Science of Unitary Human Beings. Ference (1986a) claimed that Rawnsley's 1977 study was the first "true" Rogerian research, and that her own study of human field motion was the first investigation of correlates of unitary human development. Although I certainly acknowledge that there has been an impressive evolution in Rogerian research, I do not agree with Ference that earlier studies were not guided by the then-current version of Rogerian science. To her credit, Ference acknowledged that earlier studies had focused on "some of the variables ... [that] were relevant for study [of the Science of Unitary Human Beings]" (Ference, 1986a, p. 39).

The evolution of the research methodologies for the Science of Unitary Human Beings reflects modifications in what "counts" as Rogerian research based on evolution of Rogers' conceptual system. I constructed the current guidelines from ideas put forth by Reeder in 1984 and 1986; Cowling in 1986, 1997, and 1998; Fawcett and Downs in 1986; Rogers in 1987, 1990(b), 1992(b), 1994(a), and 1994(b); Phillips in 1989 and 1991; Rogers, Doyle, Racolin, and Walsh in 1990; Butcher in 1994, 1998, and 2001; Fawcett in 1994; Carboni in 1995; Barrett in 1996; Barrett, Cowling, Carboni, and Butcher in 1997; Bultemeier in 1997(b); Sherman in 1997; and Alligood and Fawcett in 1999. The current guidelines, which are published in Fawcett and DeSanto-Madeya's 2013 book, Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories, are:

The purpose of Science of Unitary Human Beings- based basic research is to develop new theoretical knowledge about unitary human energy fields in mutual process with environmental energy fields. The goal of basic nursing research is pattern seeing. The purpose of Science of Unitary Human Beings-based applied research is to test already available knowledge in practice situations. The term applied research is used instead of the term clinical research inasmuch as "clinical" refers to investigation of a disease in the living being by observation, or it refers to something done at the bedside. The term clinical research, therefore, is inappropriate and inadequate for the scope and purposes of Science of Unitary Human Beings-guided nursing research.

The phenomena to be studied are those that are central to nursing--irreducible unitary human beings and their environments. More specifically, the phenomena to be studied are manifestations of human and environmental energy field mutual process in the form of perceptions, expressions, and experiences. Nursing research should not focus on other fields of study or theories derived from other fields, nor should it focus on nurses and what they do.

The problems to be studied are the manifestations of human energy field patterns and environmental energy field patterns, especially pattern profiles, which are clusters of related pattern manifestations. Inasmuch as nursing is a service to all people, wherever they may be, virtually any human being or group in its natural setting would be appropriate for study, with the proviso that both human being or group and environment are taken into account.

A variety of qualitative and quantitative research designs currently are regarded as appropriate for Science of Unitary Human Beings-based research, although qualitative methods are more congruent with the Science of Unitary Human Beings than quantitative methods. Although descriptive and correlational designs are regarded as consistent with the Science of Unitary Human Beings, strict experimental designs are of questionable value due to Rogers' rejection of the notion of causality. Specific existing methodologies that are used across disciplines but currently are regarded as appropriate include Husserlian phenomenology; existentialism; rational interpretive hermeneutics; interpretive evaluation methods, such as Fourth Generation Evaluation; participatory action and cooperative inquiry; focus groups; ecological thinking; dialectical thinking; and historical inquiries; as well as methods that focus on the uniqueness of each human being, such as imagery, direct questioning, personal structural analysis, and the Q-sort.

Science of Unitary Human Beings-specific methodologies include the unitary pattern appreciation case method, unitary appreciative inquiry, the Rogerian process of inquiry method, the unitary field pattern portrait research method, and the photo-disclosure methodology.

Case studies and longitudinal research designs that focus on identification of manifestations of human and environmental energy field patterns are more appropriate than cross-sectional designs, given the emphasis in the Science of Unitary Human Beings on the uniqueness of the unitary human being. Hypotheses should not be stated in causal language, in recognition of the unitary nature of the problem to be studied and Rogers' rejection of the notion of causality. Purposive sampling is appropriate, so that study participants who manifest the phenomenon of interest may be included. Research instruments that are directly derived from the Science of Unitary Human Beings should be used. Researchers are the primary pattern-apprehending instrument, as they are the only instrument sensitive to and able to interpret and understand pandimensional potentialities in manifestations of human and environmental energy field patterns. The researcher may use tacit and mystical intuition and all forms of sensory knowing to apprehend pattern manifestations. Inclusion of study participants in the process of inquiry enhances mutual exploration, discovery, and knowing participation in change.

Synthesis rather than an analysis that separates parts is the goal of data analysis. Data analysis techniques must take the unitary nature of human beings and the integrality of the human and environmental energy fields into account. Consequently, the use of standard data analysis techniques that employ the components of variance model of statistics is precluded, as this statistical model is logically inconsistent with the assumption of holism stating that the whole is greater than the sum of parts. Multivariate analysis procedures, particularly canonical correlation, are useful techniques for generating a constellation of variables representing human field pattern properties. However, canonical correlation is a component of variance procedure, as are all parametric correlational techniques.

New data analysis techniques that permit examination of the integrality of human and environmental energy fields must be developed so that the ongoing testing of the Science of Unitary Human Beings does not have to be done through the logical empiricist criterion of meaning, testing the hypodeductive system for consistency, and then testing correspondence to the world. Data should be interpreted within the context of the concepts and propositions of the Science of Unitary Human Beings. Bracketing and objectivity are not possible given the integral nature of the researcher and the study participants as energy fields in mutual process.

Science of Unitary Human Beings-based research enhances understanding of the continuous mutual process of human and environmental energy fields and manifestations of changes in energy field patterns. Ultimately, Science of Unitary Human Beings-based research will yield a body of nursing-discipline specific knowledge.

Despite these guidelines, quantitative research continues. For example, since July 2012, seven experimental studies and two correlation studies have been published. Only one descriptive qualitative study has been published since that time.

EVOLUTION OF PRACTICE METHODOLOGIES

Similar to the evolution of research methodologies, the evolution of practice methodologies for the Science of Unitary Human Beings reflects modifications in what "counts" as Rogerian practice based on evolution of the conceptual system. The current guidelines evolved from Rogers' early ideas, which were published in her 1970 book and reflect the generic nursing process of assessment, planning based on goal setting, intervention, and evaluation, to ideas put forth by Malinski in 1986(c) and Rogers in 1992(b). The current guidelines, which are published in Fawcett and DeSanto-Madeya's (2013) book, are:

The primary purpose of Science of Unitary Human Beings-based nursing practice is to promote well-being for all human beings, wherever they are. Another purpose of Science of Unitary Human Beings-based nursing practice is to assist both client and nurse to increase their awareness of their own rhythms and to make choices among a range of options congruent with their perceptions of well-being.

Practice problems of interest are those manifestations of human and environmental field patterns that nursing as a discipline and society as a whole deem relevant for nursing. Nursing may be and has been practiced in any setting in which nurses encounter people, ranging from hospitals to the community, although we have not yet practiced in outer space. Legitimate participants in nursing practice encompass all people of all ages, both as individual human energy fields and as group energy fields.

Following Rogers' generic nursing process, Barrett (1988) and Cowling (1990) developed the pattern manifestations practice method. The three components are pattern manifestation appraisal-assessment, deliberative mutual patterning, and pattern manifestation appraisal-evaluation. The current nursing process for the Science of Unitary Human Beings is the Health Patterning Practice Method. The components of the method are pattern manifestation knowing and appreciation--assessment, voluntary mutual patterning, and pattern manifestation knowing and appreciation--evaluation (Fawcett & DeSanto-Madeya, 2013).

Science of Unitary Human Beings-based nursing practice contributes to human betterment, however that might be defined by a society. Furthermore, Science of Unitary Human Beings-based nursing practice leads to acceptance of diversity as the norm and of the integral connectedness of human beings and their environments, as well as to viewing change as positive.

CONCLUSION

In conclusion, I apologize to all Rogerian scholars whose wonderful contributions to the evolution of the Science of Unitary Human Beings I did not cite. I hope you agree that evolution of the Science of Unitary Human Beings has been impressive, and that the contributions to the advancement of nursing knowledge made by Rogers and by all Rogerian scholars who have translated the Science of Unitary Human Beings into service to human beings have been outstanding.

Martha would, I believe, be very disappointed if we did not continue to evolve the conceptual system, which we have been reluctant to do. Yet Martha insisted that the conceptual system must continue to be revised. She stated:

The development of a science of unitary human beings is a never-ending process. This abstract system first presented some years ago has continued to gain substance. Concomitantly, early errors have undergone correction; definitions have been revised for greater clarity and accuracy, and updating of content is ongoing (Rogers, 1992b, p. 28).

So much knowledge of human beings and the universe has been developed since Martha's death 20 years ago! How much of that knowledge might be relevant to the continued evolution of the Science of Unitary Human Beings?

In contrast, I believe that Martha would be very pleased with the evolution of the research and practice methodologies. However, we should not be satisfied with the current guidelines for research and practice. For example, we have not yet determined whether quantitative research should be accepted as "legitimate" for the Science of Unitary Human Beings. Furthermore, we have not yet identified all possible ways to practice from a unitary perspective. As Martha Alligood noted in 2004,

Martha Rogers' ideas have challenged nurses worldwide for many years. She challenged us to understand nursing as knowing rather than doing and as human service based on knowing rather than isolated functional activities. She challenged us to view nursing as understanding and caring for human beings in the wholeness and mutuality of the person-environment process rather than as isolated actions and responses in a limited cause and effect manner. (p. 8)

We have yet to meet those challenges in a completely satisfactory way. So much remains to be done. Are we willing to accept these and other challenges to facilitate the continued evolution of the conceptual system known as the Science of Unitary Human Beings and its associated research and practice methodologies?

In closing, I hope you will be as inspired as I am by Martha's words to nursing students, which I have revised slightly for all nurses: "[Ours] is a rich repository of far flung opportunities--around this planet and toward the further reaches of [our] explorations of new worlds and new ideas. [Ours] is the promise of deep satisfaction in a field long dedicated to serving the health needs of people" (Rogers, 1966).

Thank you very much for this opportunity to share the marvelous benchmarks in the evolution of the Science of Unitary Human Beings and its applications for theory development, research, and practice.

CONFLICT OF INTEREST

The author has declared no conflicts.

ACKNOWLEDGEMENTS

Footnote

(1) Portions of this paper are adapted from Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed., Chapter 9). Philadelphia, PA: F. A. Davis, with permission.

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Jacqueline Fawcett, PhD, ScD (hon), FAAN (a)

(a) Nursing Department, University of Massachusetts Boston, Boston, MA USA

Author's Note: Keynote address presented at the Annual Meeting of the Society of Rogerian Scholars: "Martha E. Rogers: Her Life, Her Science, Her Legacy Emerging." Knoxville, TN, October 8, 2014.

* Address correspondence to Dr. Jacqueline Fawcett at iacqueline.fawcett@umb.edu
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