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Progress in the explanatory power of the science of unitary human beings: frubes in a lull or surfing in the barrel of the wave.

Fifteen years ago Visions: The Journal of Rogerian Nursing Science was launched with Martha Rogers" stating, "the journal is a very significant step forward, and I'm delighted (1993, p. 3)." She went on to say that the debut of the Visions represented a significant step in the evolution of the Society of Rogerian Scholars and that the Journal can be a forum in "transmitting ideas, creating new ways of thinking, and making new knowledge readily available to more people" (1993, p. 3). The fact that the Journal continues to be the major vehicle in publishing conceptual, methodological, and practice advances specific to Rogerian Science is indeed an enduring testament to meeting the challenge of disseminating scientific innovation.

In that inaugural issue, Bramlett, Gueldner, and Boettcher's (1993) article "Reflections on the Science of Unitary Human Beings in Terms of Kuhn's Requirement for Explanatory Power" reprinted here stands out as an accurate and comprehensive representation of the status of the Science of Unitary Human Beings in 1993. Using Kuhn's historical account of how science undergoes revolutionary change, the authors discuss the advances in identifying phenomena of concern relevant to Rogerian informed approaches to inquiry. Bramlett, Gueldner, and Boettcher's (1993) employ Kuhn's (1962) idea of exemplars to examine the explanatory power the Science of Unitary Human Beings has toward solving puzzles relevant to nursing's primary concern. They end their article concluding, "remarkable progress made within the last decade gives evidence that this exciting, avant garde paradigm may hold potential to meet this challenge" (p.33). But, have the last 15 years since this publication been equally "remarkable?" The purpose of this paper is to reflect on the progress made in Rogerian Science since the publication of Bramlett, Gueldner, and Boettcher's (1993) landmark article, and like the authors, use of Kuhn's (1962) idea of progress in scientific revolutions point to future activities that will better situate Rogerian Science in the coming wave of scientific transformation.

An Expanding Phenomena of Focus

Conceptual frames of reference contribute to identifying concepts of concern. Concepts such as power (Larkin, 2006), pain (Lewandowski, 2004; MacNeil, 2006; Matas, 1997), time experience (Alligood & McGuire, 2000; Davis, 2006) identified by Bramlett, Gueldner, and Boettcher's (1993) continue to be a focus of Rogerian inquiry. Over the past 15 years, there is a clear broadening of concepts conceptualized within a unitary perspective including therapeutic touch (Malinski, 1993); spirituality (Hanchett, 1992; Hardin, 1997; Malinski, 1991, 1994; Smith, D. W., 1994; Reeder, 1997; Rush, 1997; Sarter, 1997), hope (Salerno, 2002), appreciation (Cowling, 1997), dispiritedness (Butcher, 1996), despair (Cowling, 2005), empowerment (Shearer & Reed, 2004), compassion (Butcher, 2002); caring (Smith, M.C., 1999), time (Davis, 2006), awareness (Schneider, 1995), risk taking (Hastings-Tolsma, 2006) and intentionality (Zahourek. 2005).

One marker of the emergence of a new science is the creation of new concepts along with ways to identify and/or measure these concepts in research contexts. A number of instruments used to measure unitary indices continue to be developed and used in Rogerian informed research. By far the most robust measure employed in Rogerian research is Barrett's (1984) Power as Knowing Participation in Change Tool (PKPCT), which has been used in a wide variety of research studies. Caroselli and Barrett (1998) reviewed 15 years of research using the PKPCT, which included 16 articles published between 1993 and 1998. Since 1998, the PKPCT continues to be used widely in Rogerian research (Hurley, 2005; Kim, 2001; Kim, Park, & Kim, 2008; Larkin, 2007; Lewandowski, 2004; Malinski, 1997; Siedliecki & Good, 2006; Smith, D. W., 1995; Smith, D.W., & Broida, 2007; Wall, 1999; Wright, 2004). Additional instruments specific to the Science of Unitary Human Beings developed after the publication of the 1993 journal include the Diversity of Human Field Pattern Tool (Hasting-Tolsma, 1992), Perceived Human Field Motion Tool (Yarcheski, Mahon, & Yarcheski, 2002; 2004), Human Field Image Metaphor Scale (Johnston, 1993, 1994) as a measure of awareness of the infinite wholeness of the human field; Mutual Exploration of the Healing Human Field--Environmental Field Relationship Creative Measurement Instrument (Carboni, 1992); Well-being Picture Scale (Gueldner, Bramlett, Liu, Johnston, Endo, Minegishi, & Carlyle, 2005), formally know as the Index of Field Energy (Gueldner, 1998); Assessment of Dream Experience Scale (Watson, 1999); and Person-Environment Participation Scale (Leddy, 1995).

Emergence and Testing of Unitary Patterning Modalities

Rogers (1988, 1992, 1994) repeatedly asserted that non-invasive patterning modalities are central to nursing and to the enhancement of human betterment and well-being. Increasingly, non-invasive modalities have continued to be a major focus of Rogerian research including the use of music (Siediecki & Good, 2006), Reiki (Ring, 2006), acupuncture (Walling, 2006), therapeutic touch (Denison, 2004; Smith, D.W., & Broida, 2007; Samarel, 1992; Samarel, Fawcett, Davis, & Ryan, 1998), guided imagery (Lewandowski, 2004), reminiscence (Bramlett, & Gueldner, 1993); magnetism (Kim, 2004), and support groups (Larkin, 2007). New patterning modalities such as, kaleidoscoping (Butcher, 1993) written expression (Butcher, 2004), and metaphoric unitary landscape narratives (Butcher, 2005a) have also been developed. Advances in Rogerian Theory Development

A second marker of the emerging explanatory power of an emerging science is the development of theories derived from the abstract system. Like the development of new concepts and measurement tools, the development and testing of theories developed from the Science of Unitary Human Beings is the work of a community of established and aspiring Rogerian scholars/scientists. Malinski (2006) reviewed key Rogerian Science-based nursing theories. Most having been developed since the publication of the Bramlett, Gueldner, and Boettcher's (1993) article including Reed's (1991) theory of transcendence; Butcher's (1993) theory of kaleidoscoping in life's turbulence; Bultemeier's (2006) theory of perceived dissonance; Hill and Hanchett's (2001) theory of enlightenment; Carboni's (1995a) Health-as-Unfolding-Wholeness; Shearer and Reed's (2004) theory of empowerment; Butcher's (2003) theory of aging as emerging brilliance; Zahourek's (2004, 2005) theory of intentionality in healing; and Smith's (1999) reconceptualization of caring within a unitary perspective. These are some of the key advances in Rogerian theory development over the past 15 years.

New Methodologies

A third marker of emerging explanatory power is the development of both research and practice methods that are consistent with the paradigm's ontological and epistemological assumptions. Rogers (1992), as well as a number of Rogerian scholars called for the development of research methodologies specific to the SUHB (Phillips, 1988; Rawnsley, 1990). Bramlett, Gueldner, and Boettcher (1993) were actually among the first to state "new and innovative research methodologies, consistent with the Rogerian conceptual system, need to be developed" (p. 33). At the time their article was published, there were no Rogerian specific research methodologies. A number of qualitative methods, all published within a close span of time, have been developed. Butcher (1994, 1998, 2005b) developed the Unitary Field Pattern Portrait research method; Carboni's (1995b) Rogerian Process Inquiry and Cowling's (1998) Unitary Case Inquiry as well as his Unitary Appreciative Inquiry (Cowling, 2001) have emerged since the first journal. All of the methods have been widely endorsed by the community of Rogerian Scholars (Phillips, 2000; Malinski, 2005; Malinski in Fawcett, 2003), yet there have been relatively few published studies using the methods.

Cowling (1993) expanded on the original Rogerian practice model in 1993. As early as 2001, Butcher (2001) began to synthesize Barrett's (1998) updated Rogerian practice model with Cowling's pattern appreciation practice constituients. Butcher's (2006a) continued to develop and refine the practice method and renamed it "unitary pattern-based praxis consisting of two nonlinear and simultaneous processes: pattern manifestation appreciation and knowing, and voluntary mutual patterning." The focus of nursing care guided by Rogers" nursing science is on recognizing manifestations of patterning through pattern manifestation knowing and appreciation and by facilitating the client's ability to participate knowingly in change, harmonizing person/environment integrality, and promoting healing potentialities and well-being through voluntary mutual patterning (Butcher & Malinski, in press).

Explications in the Philosophy of Rogerian Nursing Science

The last marker of explanatory power is the development of over-arching philosophical tenants that serve to further clarify the structure of the paradigm or disciplinary matrix. Phillips (1997) called for the elucidation and articulation of a philosophy of the Science of Unitary Human Beings. Sarter's (1988) philosophical inquiry into the ontology of Rogerian science stands out as a significant contribution previous to the Bramlett, Gueldner, and Boettcher's (1993) publication and after their publication, Todaro-Franceschi's (2001) inquiry into the nature of energy stands out as expanding our understanding. In addition, in a 2006 publication, Butcher (2006b) laid out a foundation and model for Rogerian cosmology, philosophy, and science. In this publication, Butcher described the basic tenets of a Rogerian ontology, epistemology, Rogerian-ethics (Butcher, 1999), and aesthetics to create a philosophical-scientific nexus of Rogerian-based knowledge designed to guide unitary pattern-based praxis in both research and practice contexts. The model is a "blueprint for further articulation of the linkages between Rogerian cosmology, science, and praxis" (Butcher, 2006b, p. 31). The value of the model is that it links together Rogers" postulates, principles, theories, and measurement tools to Rogerian cosmology and philosophy; and illustrates how together, Rogerian philosophy and science guide all aspects of Rogerian based practice and research.

Progress: From Outliers and to "Normal Science?"

I was fortunate to receive an advance copy of Malcolm Gladwell's new book Outliers: The Story of Success, which will be published by the time this article is in print. I was intrigued by the title since in the larger scheme of nursing science there may be little doubt that the Science of Unitary Human Beings is an "outlier." Gladwell (2008) defines outlier as "1: something that is situated away from or classed differently from a main or related body" (p. 3). It is interesting to note that in their landmark article Newman, Sime, and Corcoran-Perry (1991) placed emphasis on the distinctions among three competing nursing paradigms: particulate-deterministic, interactive-integrative, and unitary-transformative. While "multiple perspectives are appropriate for knowledge development in nursing, we are convinced that a unitary-transformative perspective is essential for full explication of the discipline" (p. 5). Rogers' Science of Unitary Human Beings is at the core of the unitary-transformative paradigm and in a follow-up to the 1991 article, Newman, Smith, Pharris, & Jones (2008) assert there is movement toward a unified whole transcending the limitations of each nursing paradigm. The authors go on to identify health (the intent of the relationship), caring (the nature of the relationship), consciousness (the informational pattern in the relationship), mutual process (the way in which the relationship unfolds), patterning (the evolving configuration of the relationship), presence (resonance of the relationship), and meaning (importance of the relationship) as central focal concepts. If the authors are correct, there has been a shift toward Rogers' unitary-transformative perspective with relationships emerging as the central focus of the discipline. However, the question remains, will Rogerian science remain intact as a distinct science within the unitary-transformative paradigm or will it become enmeshed with other unitary perspectives losing its distinctness as a science? How Rogerian science is situated in the unitary-transformative paradigm will be dependent on whether the Science of Unitary Human Beings continues to advance.

Rogerian science is still situated, according to Kuhn's theoretical historical account of the philosophy of science, in a "prenormal" phase of scientific development. While there is a movement towards synthesis in the unitary-transformative paradigm, the paradigm is far from reaching a "tipping point." According to Kuhn, and what is true about Rogerian science, is scientific schools of thought in the prenormal phase have only local or isolated acceptance of exemplary problem solutions. As with Rogerian science, conceptual schools of thought in the prenormal phase constantly have to explain and legitimatize the scientific and theoretical foundations of their own approach. Kuhn (1962) goes on to describe in detail how one scientific school vanishes in favor of another, thereby moving from a prenormal to a normal science. Often, the emerging "normal science" has produced an achievement so convincing that members of other scientific schools begin to defect and the emergings science begins to attract the next generation of scientists. Furthermore, scientific revolutions do not happen by just the mere accumulation of knowledge. Kuhn (1962) argues that progress through scientific revolutions depends on a number of factors. The new theory must be able to solve a large portion of the problems that the old theory cannot solve. The failure of the old theory to solve important problems of the discipline creates significant anomalies and eventually leads to a crisis. Not every anomaly leads to a crisis, nor will every member of a scientific community perceive a crisis. Capra (1982) in the Turning Point: Science, Society, and the Rising Culture, clearly demonstrated that we are in the midst of a major paradigmatic shift, from a mechanistic view of life grounded in the principles of Cartesian thought and Newtonian physics to an organic systems view of life informed by the philosophical and theoretical implications of a wide area of emerging theories including: quantum theory, relativity theory, and systems theory. The emerging paradigm is inherently holistic, ecological, and participatory. Rogers' Science of Unitary Human Beings is clearly situated in the emerging paradigm while the biomedical model represents the old theory. There is abundant evidence that the biomedical model is in a state of crisis. While transformation is taking place, the declining biomedical model in nursing culture refuses to change, clinging more rigidly to its outdated idea. Dominant social institutions will not relinquish their hold and leading role. As long as nursing attaches itself to the biomedical model, it too will "go down with the ship." Furthermore, Rogerian science is just one of a vast number of emerging theories across multiple disciplines that are positioning themselves to catch the coming wave of scientific revolution.

The critical question concerning the progress of Rogerian science is where is it situated in the coming scientific revolution? Will Rogerian science be positioned to ride the wave crest, or in the accelerating wave barrel as the scientific revolution breaks? Or will Rogerians be the equivalent of a "frube," never catching the wave, left treading water in the lulls and troughs, as the wave heads toward the impact zone? Will Rogerian science be at the center and leading the revolution in nursing it sparked, or will it be dormant, in hibernation, an outlier on the beach as the tide of transformation swells?

Getting Situated in the Line up Zone: Activities in a Time of Extraordinary Science

I spent some time in Surf City, North Carolina this past summer. Surf culture has developed its own form of language, basically excluding itself and its members from the wider society. I've used some of the surf language as a metaphor throughout this paper. The "line up zone" is that area where the surfers wait just outside the breaking waves for the next wave. But, in terms of scientific revolutions, passively waiting is not sufficient. Researchers, through their activity, participate in creating the waves. Research conducted during a time of crisis by a prenormal science is what Kuhn referred to as "extraordinary science." Kuhn (1962) described many activities or what he called "symptoms of extraordinary science," and what is central are the continuous attempts by members of the emerging science to solve the anomalies that triggered the scientific crisis. Indeed, progress in the development of the Science of Unitary Human Beings over the past 15 years has been remarkable, but the scientific revolution is far from complete. Rogers' vision is indeed a gift, and it is up to us as a community of scholars to seize the opportunity and advance the science.

Gladwell's (2008) central thesis in Outliers is that success is not simply the sum of decisions and efforts we make, but rather, success is a gift to those who have been given opportunities, and have the strength and presence of mind to seize them. Over the past 15 years, many nurses have participated in advancing nursing and Rogerian science, but there remains many more "opportunities to seize."

A critical feature in the tipping from one favored theory to the emerging theory is having a body of research solving a large portion of the problems that were solved by the old theory as well as solving the stubborn anomalies. Rogerian scholars need to significantly elevate both the quantity and quality of Rogerian science informed research. According to Kuhn's (1962) model of scientific revolutions, the choice of one theory over another occurs when one has faith the new paradigm will succeed, however, there needs to be a basis for having faith. The first adherents and supporters of the new theory must produce a "flushing out of the theory ... solve at least a large portion of problems solved by the older theory with comparable (or greater accuracy), and "predict phenomena that, from the perspective of the older theory, are unexpected" (Hoyningen-Huene, 1993, p. 240-241). While much progress has been made, the fact is, the amount of Rogerian research currently being conducted is miniscule compared to the research being conducted within the dominate paradigm. Furthermore, there is a pattern of declining published Rogerian research. Thus, if Kuhn is correct, considerably more Rogerian research is needed, especially research directed at problems that have been solved by the biomedical model and other nursing and non-nursing theories that are considered out-dated from the perspective of the new emerging theory. To solve large portions of problems solved by the older theories requires reconceptualizing phenomena relevant to nursing within a unitary perspective and demonstrating the efficacy of modalities already demonstrated to be successful as well as demonstrating the success of new modalities more consistent with Rogerian science that enhance well-being and human betterment. Significantly more Rogerian research needs to be directed at identifying, addressing, and solving the significant unsolved problems relevant to nursing and human well-being that are what Kuhn (1962) described as serious, meaningful, troublesome, especially compelling, admittedly fundamental, and crisis provoking (Hoyningen-Huene, 1993).

Engagement: Becoming the Wave

The work of scientific transformation does not occur simply by wading in the water. A remarkable finding in Gladwell's (2008) new book is that outliers are actually super-achievers and are the source of most major innovations. Gladwell (2008) believes that "success is dependent on the 10,000 hour rule, meaning that the path to success involves many hours of effort, commitment, and hard practice" (p. 41).

Gladwell's (2000) earlier book "The Tipping Point: How Little Things Can Make a Big Difference" describes how success in reaching a "tipping point" is in part determined by the law of the few in which people function as either connectors, mavens, or salesmen. The "tipping point," like Capra's "turning point," is that dramatic moment when a new idea, like a new theory, reaches critical mass and replaces an old idea. While most certainly the current Rogerian community must be more visible, more active in the activities of extraordinary science, and expand its critical mass by attracting many new members, Gladwell's (2000) "law of the few" illustrates how when relatively few people functioning intensely as connectors, mavens, or salesmen, they are the sources of "social epidemics" that lead to major transformations.

According to Gladwell (2000), connectors are those people who know many people and are linked to the broader social network. They commonly occupy many worlds, subcultures, and niches. Connectors bring people together, and because of their highly social nature, they are willing to meet and play host to a wide array of individuals. The connector has more acquaintances than most people, not just because they are more sociable, but rather they are better able to maintain these relationships than most people. Rogerians who have close ties to numerous academic settings, and at the same time have significant connections to funding agencies or multiple practice settings, can act as a connector. Editors of major journals, leaders of major nursing organizations, are often people who have multiple connections. People just naturally want to know and interact with connectors. Since connectors are the socialites who know a lot of people and automatically link them together, they can play a key role in spreading new ideas through many communities.

The word "Maven" comes from Yiddish and it means one who accumulates knowledge. Mavens are the gatherers of information in the social network. In terms of Rogerian science, mavens would be the ones who keep up with the advances in science from multiple disciplines that would be relevant to Rogerian science. Rogerian Mavens would have a depth of knowledge and understanding of the Science of Unitary Human Beings, be familiar with classic Rogerian publications, and would keep up with newly published material. Mavens, Gladwell (2000) states, are not persuaders. Rather, "Mavens are really information brokers, sharing and trading what they know" (p. 69). In other words, Mavens are the "thought" leaders and are well respected by their contacts for their knowledge and expertise.

While Mavens are the data banks and Connectors the social glue that spread the knowledge, Salesmen are those with persuasive skills who can convince the unconvinced. Often salesmen have a unique combination of energy, charm, passion, enthusiasm, and likeability that is both powerful and contagious. Some may be able to combine two of these unique roles. A person who has the connections and at the same time has the talent of a Salesman could have tremendous influence in spreading the idea of Rogerian science, as would someone who has a deep knowledge of Rogerian science as well as having many connections. For an idea like Rogerian science to explode in popularity, you need well respected Mavens to be the thought leaders and to be the knowledge experts, Salesmen to pitch it and sell it to his/her connections, and Connectors to pick up on it and spread it exponentially to their vast network.

Similar to the Gladwell's (2000) recent popular work, Everett M. Rogers (2003) has been studying the "diffusion of innovations" for over 50 years. Diffusion according to E. Rogers (2003) is a process in which a new innovation, such as a theory or new technology, is communicated through channels over time among members of a social system. Communication is the process participants create and the sharing of information with others to reach a mutual understanding. Diffusion can be spontaneous or planned. The success of the innovation reaching critical mass or "tipping point" is influenced by many factors. For example, the innovation needs to have a "relative advantage" over the idea that it supersedes. The innovation should have a period of trialability when it is tested to demonstrate its value and the innovation needs to be visible and observable to others. Demonstrating the relative advantage, testing, and making visible the work of Rogerian science is the work of Rogerian scholars and needs to be intensified for the Science of Unitary Human Beings to continue to progress. Journals, books, conferences, teaching students, the media, websites, and social networks are just some of the channels that must all be used to assure the diffusion of an innovation like the Science of Unitary Human Beings. According to the E. Rogers" (2003) theory, in order for the idea to spread, the adopter needs knowledge about the innovation, is persuaded by the evidence, then decides, implements, and confirms the value of the innovation. Five categories of adopters have been identified: innovators, early adopters, early majority, late majority, and laggards. As a community of Rogerians, we need to exponentially increase the number of "early adopters." E. Rogers (2003) describes in detail the role "opinion leaders" can play informally influencing others with relative frequency about the innovation and in how educated and professional change agents can influence and change attitudes. "Champions" are those charismatic persons who can throw their energy behind an idea in ways that "can help over come resistance so that the innovation can diffuse throughout an organization" (E. Rogers, 2003, p. 414).

In an earlier publication (Butcher, 2002), actions were laid out that need to be undertaken to assure the advancement of nursing science, as well as Rogerian science in particular. Rogerians "practicing hard" to advance the science can work collectively as Connectors, Mavens, and Salesmen to allow the movement of lulls into swells, and in turn, swells into ever increasing waves. In addition to significantly increasing the amount of Rogerian informed research activities in a time of extraordinary science, those committed to advancing the Science of Unitary Human Beings can: a) live the values of Rogers" science, in particular the values of courage, commitment, transformation, responsibility, optimism, and wisdom; b) attain positions of responsibility where one can facilitate the diffusion of Rogerian science; c) in teaching situations, create ways to incorporate nursing theory and specifically the Science of Unitary Human beings in every course you teach; d) nurse administrators can lead staff in implementing Rogerian informed practice modalities; e) support the advancement of Rogerian science by being actively involved in the Society of Rogerian Scholars; f) support Visions: The Journal of Rogerian Nursing Science by submitting work for publication as well as other significant journals; g) seize opportunities to tell stories to the public, health care professionals, and other nurses how Rogerian informed nursing care makes a difference distinct to nursing; and h) devote serious scholarship and effort toward making sure Rogers" original work remains easily accessible to educators, students, researchers, administrators, other health care professionals, and the public.

Frubes and Wavegens

Rather than frubes in the lull, for Rogerian science to advance, many more "wavegens" are needed. Wavegens are those who generate waves through their actions. Through active programs of Rogerian guided research, wavegens can enhance the explanatory power of the Science of Unitary Human Beings and propel the science toward reaching critical mass. Wavegens can play multiple roles: Connectors, Mavens, Salesmen, innovators, opinion leaders, change agents, and champions are all needed if the next 15 years to be more successful than the last 15.

Laird Hamilton (2008), the great surfer, explains in his new book that if you can"t swim, you can"t surf. Surfing, he says, "is like playing music. There can be endless variations on a song: infinite ways to make a melody. And likewise, everyone that rides a wave brings something unique to the process" (p. 180). "Surfing is motion, and its rhythm. We are all equal before the wave. The wind, the tides, the pulse of the swell, the rhythms of the ocean, all went into creating its power" (p. 180). Good waves make good surfers, so you need to be where the good waves are. If you want to become a better surfer, then get out there where the better surfers are so you can learn from them.

We are in a time of extraordinary research. The waves are swelling and a critical mass is approaching. The tipping point of scientific conversion to a unitary-transformative is on the horizon. Rogerian science must be well positioned if it is to "catch" the impending "barrel." A barrel is both a noun and a verb concerned with the hollow part of the wave formed by the top travelling faster than the bottom when a wave breaks over shallow water. As the wave swells and begins to peak, surfers stand up and direct their boards toward the impending barrel. The surfer becomes one with the wave and when surfing within the wave"s barrel or hollow tube, air, sound, and light, are all transformed. For surfers, riding the barrel is an ultimate, euphoric, and transcendent moment ending when one flies out of the gaping wave and into the bright sunlight.

The ocean is calling. Make waves!

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Howard Karl Butcher, RN; PhD, PMHCNS-BC

Associate Professor

The University of Iowa College of Nursing

http://rogeriannursingscience.wikispaces.com
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