Question:
summary of matha rogers nursing theory?
cajunnurse
18 years ago
summary of matha rogers nursing theory?
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researchtissue
18 years ago
An Introduction to Martha Rogers and the Science of Unitary Human Beings.

Nursing in Europe has, over the past twenty years or so, benefited from the influence of innovations that have arisen from North America. The nursing process, quality assurance, primary nursing and nursing models and theories are just a few of the topics that have gained wide application.



But there is at least one major area of study and practice that has been developed and is receiving considerable attention in North America which has yet to achieve anything more than a brief acknowledgment elsewhere. The work of Martha Rogers and other nurses who have based their practice, education and research on Rogers’ Science of Unitary Human Beings (1970, 1980a, 1983, 1986, 1990) has remained in a state of relative obscurity.



The Science of Unitary Human Beings provides a radical vision of nursing reality. It provides a framework for nursing practice, education and research that promises a move away from the previously predominant medical model approach to the delivery of nursing care. The framework provides an alternative to the traditional view of nursing which could be described as reductionistic, mechanistic and analytic. It has been said that it has "guided nursing out of a concrete, static, closed system world view" (Smith, 1989) and as a result has started to challenged many preconceived ideas about nursing. Indeed, when the theoretical framework was first published, it was "in clear contradiction to all the nursing theories in use at that time" (Sarter, 1988a).



Although the Science of Unitary Human Beings is hardly recognized outside North America, the scale of the influence of the framework on American nursing is significant. International conferences are held in order to disseminate the latest information. The Society of Rogerian Scholars exists in order to provide debate and to enable the exchange of ideas and views through local meetings and via the quarterly newsletter the "Rogerian Nursing Science News". Textbooks dedicated to Rogers’ work (notably Malinski, 1986a; Sarter, 1988a; Barrett, 1990a; Lutjens, 1991; Malinski and Barrett, 1994; Barrett and Malinski, 1994; Madrid and Barrett, 1994) have been published. In addition, there is a wealth of other published material, with articles frequently appearing in journals such as "Nursing Science Quarterly" and the Rogerian dedicated journal "Visions". There is also a growing body of research that is testing and otherwise exploring some of Rogers’ propositions.



Martha E. Rogers was born in 1914 and between 1931 and 1954 received a wide nursing and academic education. After working as a community health nurse she moved into higher education, spending 21 years as Professor and Head of the Division of Nurse Education at New York University. In 1975 she became Professor Emeritus in the same establishment (Falco and Lobo, 1985; Daily et al, 1994). A more detailed exploration of her life history can be found elsewhere (Hektor, 1989) and will also be given later. She died on 13 March 1994, at the age of 79.



Early development of the conceptual framework, the Science of Unitary Human Beings, was first seen in Reveille in Nursing, Rogers’ second book, which was published in 1964. Six years later, in 1970, Rogers published her major work which was entitled An Introduction to the Theoretical Basis of Nursing.



In the 20 years or so following the publication of An Introduction to the Theoretical Basis of Nursing, considerable changes have taken place within the conceptual framework to the Science of Unitary Human Beings (Rogers, 1980, 1983, 1986, 1990). It is beyond the scope of this section to chart these changes but it will give the reader the current definitions of the concepts subsumed under the Science of Unitary Human Beings, relating these to earlier definitions where appropriate.



The Science of Unitary Human Beings draws on a vast array of subjects that form its the theoretical underpinning for the conceptual framework. These include, amongst others, anthropology, astronomy, mathematics (Daily et al, 1989), Einsteinian (post-Newtonian) physics (Sarter, 1988a) and philosophy, including, for exampleamongst others, the work of Polanyi and de Chardin (Sarter, 1988b). Such subjects often use terminology in a very specific way and demand a knowledge and understanding of concepts that may be very alien to the European, and indeed American, nurse. It may be possible that this is the reason that the Science of Unitary Human Beings has received little emphasis in European nursing. It is certainly the reason why it has been called an "outrageous nursing theory" (Thompson, 1990), the complexity of which is "difficult to understand" (Daily et al, 1989). However, if an attempt is made to try to understand the Science of Unitary Human Beingsconceptual framework, readers will begin to realize why Rogers has been hailed by some as "a brilliant nurse theorist" and "one of the most original thinkers in nursing" (Daily et al, 1989), without whom it is "difficult to imagine what nursing would look like today" (Barrett, 1990b).



In 1970, Rogers formulated five basic assumptions that describe man and the life process in man (Rogers, 1970). These assumptions or "building blocks" underlay the conceptual framework and consist of the concepts of:



Wholeness - in which the human being is regarded as a unified whole which is more than and different from the sum of the parts.

Openness - where the individual and the environment are continuously exchanging matter and energy with each other.

Unidirectionality - where the life process exists along an irreversible space time continuum.

Pattern and Organization - which identifies individuals and reflects their innovative wholeness.

Sentience and Thought - which states that of all life, human beings are the only ones capable of abstraction and imagery, language and thought, sensation and emotion.



Over the ensuing years, four "critical elements" emerged (Cowling, 1990) that are "basic to the proposed system" (Rogers, 1986). These are energy fields, open systems, pattern and pandimensionality (Rogers, 1991). The final concept, pandimensionality, was previously known as multidimensionality and prior to that, four-dimensionality.



Energy fields are the "fundamental unit of the living and the non-living" (Rogers, 1986). They consist of the human energy field and the environment energy field. The human field is "an irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts" (Rogers, 1991). The environmental field is integral with the human field. Each environmental field is specific to its given human field.



Open systems (openness) describe the open nature of the fields, which allow for an interchange of energy and matter between the fields, the preferred terminology being that there is a "continuous process" without the mention of energy or matter (Daily et al, 1994). Pattern is the "distinguishing characteristic of the energy field perceived as a single wave" (Rogers, 1986), which gives identity to the field. Human behaviour can be regarded as manifestations of changing pattern (Alligood, 1989). The pattern is constantly changing and might be regarded as an indication of pain, illness or disease (Wright, 1987).



Pandimensionality describes "a nonlinear domain without spatial or temporal attributes" (Rogers, 1991), an "infinite domain without limit" (Daily et al, 1994).



Such a brief summary of the fundamental basis of the Science of Unitary Human Beings hardly does justice to the concepts outlined and does little to explain them. An outline is necessary however, in order to place in context the key to the conceptual framework, the Principles of Homeodynamics. These principles "postulate a way of perceiving unitary man" (Rogers, 1970) and arise from these previous statements, giving "fundamental guides to the practice of nursing" (Rogers, 1990).



The Principles of Homeodynamics, consist of the three principles of integrality, helicy and resonancy. It is these aspects of the Science of Unitary Human Beings that have had more direct relevance for nursing practice, research and education than the descriptions of man and the life process that has previously been outlined. Integrality, which will be described in greater detail further on, is a statement about the "continuous mutual human field and environmental field process" (Rogers, 1990), suggesting that energy fields pass through one another (Alligood, 1989). Helicy describes the "continuous innovative, unpredictable, increasing diversity of human and environmental field patterns" (Rogers, 1990), the "continuous creative development and evolution of the human-environmental fields" (Gueldner, 1989). Resonancy describes the "continuous change from lower to higher frequency wave patterns in human and environmental fields" (Rogers, 1990). In order to gain a greater understanding of these principles, it is useful to see how other authors have interpreted them in their research and practice.



The Principle of Integrality, where the human field is integral or at one with its environmental field (Schodt, 1989), was studied by McDonald (1986), who stated that if there is a continuous mutual human field and environmental process, changes in one field will bring about changes in the other. In other words, "researchers should be able to demonstrate a relationship between a nurse-initiated modification in a person’s environment and an alteration in that person’s state of being" (McDonald, 1986). In order to examine whether such nursing concepts concepts can be brought down the ladder of abstraction to an operational level (Smith, 1988), McDonald tested whether an alteration in the colour of light (the environmental field) could bring about a reduction in rheumatoid arthritis pain in the left hands of 60 female volunteers (human fields) and found that blue lightwaves were related to a reduction in the experience of pain. This comparitively early and rigorously designed study showed that a "practical nursing intervention can be derived from Rogers’ abstract system" (McDonald, 1986).



Such findings re-emphasise a whole new world of nursing practice possibilities. It has been suggested that other interventions, such as music (Smith, 1986), humour or meditation can be used by the nurse to promote positive human-environment field patterning (Malinski, 1986d).



The Principle of Helicy was explored by Floyd (1983) who made the prediction that the amount of wakefulness and the number of sleep-wakefulness cycles increase (in other words, there will be an increasing diversity of human and environmental field patterns) when "persons experience a deviation in the rhythmic relationship with their environment" (Floyd, 1983). Shift rotation and admission to hospital were two variables that were identified as possibly causing diversity in field patterning. Sixty shift workers and 35 hospital in-patients took part in the study which found that those with diversity in field patterning did indeed sleep less (0.3 hour and 1.0 hour less per cycle for shift workers and hospital in-patients respectively) than those without such diversity. The number of sleep-wakefulness cycles did not increase for hospital in-patients although it did increase for shift workers. Floyd (1983) indicates that this kind of information may be useful when planning "optimum systems for around-the-clock delivery of nursing". It also indicates that diversity in human and environmental field patterns occurs for individuals on admission to hospital and that nurses should take steps to promote positive human-environmental field re-patterning. In another study that examined the principle of helicy, Rawnsley (1986) found that perceptions of the speed of time was slower for those who were dying and that this could be an explanation for the lack of patience often experienced by the terminally ill.



The Principle of Resonancy, in which it is suggested that there is a continuous change from lower to higher frequency wave patterns in human and environmental field patterns, was studied, for example, by Butcher and Parker (1988). They postulated that the technique of guided imagery could promote resonancy and that the change from lower to higher frequency patterning could be a theoretical explanation for feelings such as relaxation and timelessness. Sixty adult subjects were assigned to an experimental group (who listened to a guided imagery tape) or a control group (who listened to an educational tape). The experimental group had a significantly lower score on the specially developed Time Metaphor Test than the control group, indicating a greater sense of timelessness or higher frequency wave pattering. Subjective opinions from both groups confirmed these results. The authors state that these results illustrate "the potential of the Science of Unitary Human Beings for providing a scientific rationale for the use of pleasant guided imagery in nursing practice" (Butcher and Parker, 1988) which can promote harmony, relaxation and well-being.



It has been stated that Rogers’ Science of Unitary Human Beings offers a view of nursing that is consistent with the current prevailing world view of holism and ecological concern (Cowling, 1986a) and in a sense was, and perhaps still is, ahead of its time. Using the Science of Unitary Human Beings with all its implications for nursing practice, education and research may be one way of firmly embracing the ideology of the ‘new age’ and to keeping abreast of these beliefs.



The above examples of empirical explorations of the principles of homeodynamics show how the Science of Unitary Human Beings can act as a potentially usefulprovide the philosophical framework for the development of research studies that may influence the development of nursing practice. But there are also other areas where the Science of Unitary Human Beings has had a direct application to nursing practice and education.



Many examples have been given of the direct application of the conceptual framework in nursing practice. In discussion and position papers and in those describing accounts of care delivery, Bradley (1987) and Hover-Kramer (1990) promote the importance of the concept of energy fields and its potential operationalization using techniques such as therapeutic touch (although the pioneering work of Dolores Krieger (1979), the foremost authority on therapeutic touch, should not be regarded as having directly evolved from the work of Rogers). Whelton (1979) presented a comprehensive and detailed but far from clear assessment and care plan based on the Science of Unitary Human Beings. It was shown to be useful in guiding nursing intervention and predicting outcomes in the examples given, that is, the care of a patient with decreased cardiac output, diabetes and hypertension and in the care of a patient with a recurrent meningioma. However, there is no evidence in the literature that this care plan has been used since it was first published. Another assessment tool to be used in nursing practice has been developed by Barrett (1988) who has also stated that nurses need to assess "pattern manifestation" and to promote "deliberative mutual patterning" (Barrett, 1990c). The nursing care of an adolescent with a "borderline personality disorder" has been described by Thompson (1990) who used the conceptual framework to describe the interpersonal processes of transference and counter-transference that existed. Further explorations of patient care scenarios using the Science of Unitary Human Beings are given by Meehan (1990) who described caring for a man with pain due to metastatic cancer, Madrid (1990) who gave a moving account of successful deliberative mutual patterning in the care of a patient who was in considerable discomfort due to pain, hospitalisation and gastrointestinal bleeding and Chapman (1994) who described an ICU incident.



This literature review is by no means fully comprehensive (more extensive reviews can be found in Barrett, 1990a; Daily et al, 1989 and later on in this work). However, in summary, the aforementioned literature provides initial evidence that points to the expanding adoption of the Science of Unitary Human Beings as a framework to guide nursing practice in both the relative present and the relative future.



Rogers wrote, over 30 years ago, that "education is for the future, yesterday’s methods will not suffice for tomorrow’s needs" (Rogers, 1961). If this statement can be accepted and if it is, If nursing education is to positively respond to the need to educate nurses for the future, to successfully adopt to the changing needs and demands of a new age, ecologically concerned society, then it could consider the possibililities that arise from the adoption of will need to adopt a framework such as that described here.



A Critique of the Science of Unitary Human Beings.

Such a brief description of the Science of Unitary Human Beings does not do justice to the considerable amount of work that has been performed in its development and exploration, nor does it critically analyse the logical or academic adequacy of the work. As it has been stated by Moody (1990), "a systematic approach to evaluation is needed in selecting or developing the theoretical perspective to guide research and advance theory". This is a particular consideration when using a framework in the United Kingdom that has been developed in North America.



In order to rectify this, a critical analysis of the Science of Unitary Human Beings will be performed. Prior to this, two issues need confirmation. Firstly, the purpose of the analysis or the reason why the analysis is being performed needs to be defined. Secondly, the level of abstraction of the Science of Unitary Human Beings needs to be confirmed. In other words, it has to be established whether the Science of Unitary Human Beings is a model, a theory or a philosophy for nursing practice. Both of these issues need confirmation in order to be able to define the criteria to be used to guide the analysis of the Science of Unitary Human Beings.



The Purpose of the Analysis.

Thibodeau (1983) stated that the "purpose or intent of the analysis in part determines the criteria for analysis" and that the purpose can either be to "compare and contrast the cognitive processes used by the creators of the models" or "to determine the acceptability of a model by the nursing profession". An analysis using an explicit framework can reduce the possibility of bias occurring in the evaluation process and "augments the potential for further theory refinement" (Moody, 1990). In addition, it is important to perform an analysis in order to establish whether the work, in this instance the Science of Unitary Human Beings, is a suitable framework to use as the philosophical basis for a major piece of research. When considering this suitability, a consideration needs to made not only of the degree of internal consistency and development but also of its applicability to nursing from a United Kingdom perspective.



A Philosophy, Model, or Theory?

A philosophy is a "statement of beliefs and values about human beings and their world" (Kim, 1989). It reflects values, goals or opinions (Keck, 1994), and is an "investigation of causes and laws underlying reality" based on logical inquiry (Morris, 1978; cited in Marriner-Tomey, 1994). As it can be seen from the previous section outlining the work of Martha Rogers and the Science of Unitary Human Beings, this does appear to meet these criteria of being a philosophy, however, it appears to be suggesting much more than being a philosophy.



According to Fawcett (1993) a model is defined as something that cannot be observed in the world, a general and abstract set of concepts and propositions that are not "amenable to direct empirical observation or test". This sounds like the Science of Unitary Human Beings, and indeed Fawcett does identify it as being a model (Fawcett, 1993), a thought echoed by Fitzpatrick (1986) and others (for example Malinski, 1986d).



A theory is less abstract than a model (Fawcett, 1993), with concepts being operationally defined and less abstract than the concepts described in a nursing model. They are "closely tied to particular individuals, groups, situations, or events" (Fawcett, 1993) and address "specific and concrete phenomena". A theory has been defined as "a set of interrelated concepts, definitions and propositions that presents a systematic view of phenomena by specifying relations among variables" (Thibodeau, 1983).



Even less clarity is achieved when considering Martha Rogers’ views on whether the Science of Unitary Human Beings is a philosophy, model or theory. Rogers used to reject all of these labels in favour of repeatedly calling the Science of Unitary Human Beings a conceptual framework or system (for example Rogers, 1986), without giving any clear indication in any of her writing why this should be the case. This is also a device that has been adopted by many academics when discussing the Science of Unitary Human Beings (for example Reeder, 1986). However, Fawcett (1993) recognises that conceptual models have also been called "Conceptual frameworks, conceptual systems, paradigms, and disciplinary matrices". This would seem to reinforce the idea that the Science of Unitary Human beings might be accurately called a model of nursing or nursing model.



Furthermore, in searching for an answer as to whether the Science of Unitary Human Beings is a philosophy, model or theory it became increasingly obvious that it was a question that could probably not be answered and may not even be a critical question. This is for two reasons. Firstly, if the only way to find out if the Science of Unitary Human Beings is a philosophy, model or theory is by performing a critical analysis using a framework designed to be either performed on a philosophy, model or theory then you have to be able to define whether you are analysing a philosophy, model or theory before the analysis is performed. In other words, in order to find out whether the Science of Unitary Human Beings is a philosophy, model or theory a congruent analysis needs to be performed. Secondly, although a claim has been made that frameworks for the analyses of nursing theories and nursing models are different (Fawcett, 1993) and that a framework for the analysis of a theory cannot be used on a model and vice versa, it would appear as though all of these frameworks are essentially similar (indeed, some metatheorists refer to all conceptualizations as theories), although in recent years they have developed an increasing degree of complexity (Moody, 1990). In order to come to this conclusion a number of frameworks for the analysis of nursing theories and frameworks were read (Barnum, 1990; Chinn and Kramer, 1991; Duffy and Muhlenkamp, 1974; Ellis, 1968; Fawcett, 1993; Hardy, 1978; Marriner-Tomey, 1994; Thibodeau, 1983; Torres, 1990) and the frequency of recurrent themes or criteria was noted. For example, many of the writers talk about the importance of establishing the degree of clarity obtained by the examined work (Barnum, 1990; Chinn and Kramer, 1991; Fawcett, 1993; Marriner-Tomey, 1994) or the degree of internal consistency (Barnum, 1990; Chinn and Kramer, 1991; Fawcett, 1993; Hardy, 1978; Torres, 1990). With these points in mind, a conclusion was made that the decision as to which framework for analysis should be chosen was an almost arbitrary one, perhaps based on personal preference, experience and degree of "fittingness", scope and detail.



The framework developed by Meleis (199189) was dismissed as being too detailed and complex, however those by Ellis (1968), Hardy (1978) and Marriner-Tomey (1994) were dismissed for exactly the opposite reasons; they suggested only seven, four and five major and broad criteria in their frameworks for analysis. Out of a number of remaining frameworks that were considered to supply a requisite degree of detail in the definition of criteria for analysis, the framework developed by Thibodeau (1983), based on the work of Fawcett (1980), was chosen. The framework for the analysis is presented in the Figure.



In summary, a critical analysis of the Science of Unitary Human Beings needs to be performed in order to:



a) judge how suitable the framework will be as a philosophical base or structure for the present research.

b) assess how well the Science of Unitary Human Beings meets criteria judging the internal suitability of the framework.

c) determine how applicable the Science of Unitary Human Beings might be for nursing in the United Kingdom.

d) clarify whether the framework is indeed a philosophy, model or theory.



It is hoped that some of these issues can be addressed and questions can be answered following the completion of the critical analysis, which follows in the next sections of this chapter.



1. People, Environment, Health and Nursing.

a) How is people defined and described?

b) How is environment defined and described?

c) How is health defined and described?

d) How is nursing defined and described?

i) Goal?

ii) Nursing Process?

e) Are statements about people, environment, health and nursing explicit or implicit?

f) What are the relationships between the concepts?

2. Origin of the Problem.

a) What was the stimulus for model development?

b) What is the origin of the problem?

i) Experiential base? Familiar areas?

ii) Esoteric or unfamiliar areas of knowledge?

c) What are the authors’ inherent values or biases? How did these influence problem selection?

3. Methodology.

a) What methods were used in model development?

i) Induction?

ii) Deduction?

iii) Synthesis?

b) Logical development?

i) Internal consistency?

ii) Empirical validity?

4. Generation of Theory.

a) Does the conceptual model generate theory?

b) What are examples of research questions generated?

c) On what level of abstraction is the theory?

d) What is the scope of the theory?

e) How widely applicable is the theory?

f) Is the theory complex or parsimonious?

5. Utility, Acceptance and Significance.

a) Social congruence?

b) Social significance?

c) Social utility?

d) Kuhn paradigm, paradigm, or paradigm variation?



Figure . Guidelines for the analysis and evaluation of conceptual models for nursing



developed by Thibodeau (1983), based on an original by Fawcett (1980).





The Science of Unitary Human Beings: A Critical Analysis and Evaluation.



As identified and outlined in the previous section, the framework for the analysis and evaluation of the Science of Unitary Human Beings that will be used here in order to examine the previously set questions is that developed by Thibodeau (1983).



There are four metaparadigms that Commonly, the topics that are usually addressed by nursing theorists; these are people, the environment, health and nursing. It is therefore a logical place to start an analysis and evaluation of the Science of Unitary Human Beings. Each of the definitions of people, environment, health and nursing, as well as statements about the relationship between these concepts will effect the nature of nursing as described by the Science of Unitary Human Beings.



People, Environment, Health and Nursing.

How is People Defined and Described?

The Science of Unitary Human Beings offers what might be considered a precise but perhaps, in nursing, a rather idiosyncratic is a precise definition and view of person. In Rogers’



early writings, person was called "man" (Rogers, 1970), but in the later work this was adjusted to person, or more precisely from unitary man to unitary human being, in an attempt to remove indications of gender (Rogers, 1983). Person is defined as "a unified being integral with the environment" (Daily et al, 1994) and in constant interaction with the environment, a unified whole that cannot be understood when divided into parts (Rogers, 1970) nor indeed can be divided into parts. A person is regarded as an open system in continuous interaction with the environment. In addition, there is only one person, characterized by a particular wave pattern manifestation, Rogers stated that all other people are part of, aspects of, or manifestations of pattern in the environment (Rogers, 1992).



Person has more precisely been defined as:



"an irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and cannot be predicted from the parts".

(Rogers, 1992)



This identifies Rogers’ definition of person as different from most other nurse theorists’ definitions as it should not be regarded as a holistic view (the sum of the parts), the view held by most of the latter, as Rogers has stated that the person is more than and different from the sum of the parts and cannot even be effectively divided.



A physical body does not constitute a human being (Sarter, 1988a) as the human field is energy which extends beyond the physical boundary. "This human field is synergistic; that is, it has characteristics that are derived from the whole and cannot be predicted from the parts" (Sarter, 1988a).



How is Environment Defined and Described?

As it has already been stated, Rogers defined the environment as being in constant interaction with the person, or human field pattern manifestation. Furthermore, it has been defined very simply as everything that is not of the human field pattern manifestation,. It has been defined as:



"an irreducible, pandimensional energy field identified by pattern and manifesting characteristics different from those of the parts. Each environment field is specific to its given human field. Both change continuously and creatively."

(Rogers, 1992)



The environment is a wave pattern manifestation, where pattern has been defined as:



"an abstraction. It gives identity to the field. The nature of the pattern changes continuously. Each human field pattern is unique and is integral with its own unique environmental field pattern."

(Rogers, 1986)



A further elaboration of the definition of the environment will be given later in the discussion of the Principle of Integrality.



How is Health Defined and Described?

In all of her writing, and in the writing of other Rogerian scholars, health receives little mention and then it occurs only occasionally without precisely defining the term (Daily et al, 1994), without it being addressed specifically (Falco and Lobo, 1985). Meleis (1991) has stated that Rogers believed that "labels of problems and illness are tentative and based on societal definitions" and this might be why health appears to receive such a low profile. Health and ill health havehas also been defined as particular manifestations of field pattern (Daily et al, 1994).



However, Phillips (1990a) has stated that there are two more recent definitions of health congruent with Rogers’ Science of Unitary Human Beings. These are that "health is participation in the life process by choosing and executing behaviours that lead to the optimum fulfillment of a persons’ potential" (Madrid and Winstead-Fry, 1986) and that "health is a rhythmic patterning of energy that is mutually enhancing and expresses full life potential" (Kim and Moritz, 1982). Additionally, Barrett (1990c) maintains a similar view and has stated that health "can be viewed as a process of actualising potentials for well-being by knowing participation in change".



How is Nursing Defined and Described?

In a similar way to health, Rogers appears to have omitted defining nursing, at least in the traditional sense. One of the most recent references to nursing can be found in one of her last writings, Nursing Science Evolves (Rogers, 1994). Rogers stated that nursing:



"as a science, designates the term nursing as a noun and signifies that nursing is an organized body of abstract knowledge. Traditionally, the term has been used as a verb. Nursing, the science-noun, indicates that there is a body of knowledge specific to nursing."

(Rogers, 1994)



So nursing as a science is using the word as a noun, but Rogers also stated that she believed that nursing is an art, and in that case the word should be used as a verb. This has been consistently reiterated throughout the history of the Science of Unitary Human Beings (Rogers. 1990). For example in 1970, it was stated that:



"Nursing seeks to promote symphonic interaction between the environment and man, to strengthen the coherence and integrity of the human beings, and to direct and redirect patterns of interaction between man and his environment for the realisation of maximum health potential".

(Rogers, 1970)



However this quote shows the inherent dangers of referring back to the older literature. Such is the dynamic nature of the Science of Unitary Human Beings that many of the ideas suggested in the above quote have now been superseded. For example, the use of the words strengthen, direct and redirect implies causality, an idea more recently repeatedly and rigorously rejected by Rogers.



For more precise definitions of nursing, the definitions of nursing as given by nurses who have based their work on Rogers’ Science of Unitary Human Beings needs to be explored. Two authors in particular have described the role of the nurse in considerable detail. Barrett (1990c) maintains that the role of nursing is "unique [because of its]...concern with unitary, irreducible human beings and their respective environments" and that this view helps nursing to distinguish itself from other professions. Nursing practice consists of two stages, pattern manifestation appraisal and deliberative mutual patterning (Barrett, 1988; 1990c). Pattern manifestation appraisal is where the nurse identifies the wave pattern manifestation of the individual and the environment and deliberative mutual patterning is where the nurse "facilitates the clients’ actualisation of potentials for health and well being" (Barrett, 1990c). Although such a process could be considered reductionist, Barrett stresses that this process is not linear, but that pattern manifestation appraisal and deliberative mutual patterning would occur at the same chronological time.



Cowling (1990) also stated that the "focus of nursing is unitary human beings in mutual process with their environment" and that nursing intervention would be to "create ways in which the client might become more aware of his or her field and collaborate with the nurse in proposing and using patterning strategies". Cowling developed a template for Rogerian nursing practice, outlining a number of constituents which were based on an extension of the earlier work of Barrett (1988, 1990c) but also included new elements.



The template developed by Cowling (1990) consists of the following:



Constituent 1. Nursing interventions should arise from an awareness of the mutual human-environment field pattern and should be pattern specific rather than age, disease or gender specific.



Constituent 2. Human field pattern appraisal should take place taking into account experience, perception and expression.



Constituent 3. All sources of appraisal should be regarded as valid, attending to "sensory information, thoughts, feelings, awareness, imagination, memory, introspective insights, intuitive apprehensions and more" (Cowling, 1990).



Constituent 4. Pattern recognition must involve multiple ways of knowing.



Constituent 5. Pattern information is constructed from a unitary perspective, which is unitary, specific, a constant mutual process, does not exist in separation from reality and is four-dimensional (with temporal characteristics).



Constituent 6. The pattern appraisal is communicated and this might include the use of single words, or pictures.



Constituent 7. The pattern appraisal is validated or otherwise, by the client.



Constituent 8. Meaningful interventions are initiated, based on the concept of knowing participation in change.



Constituent 9. Evaluation of the process, which is ongoing, takes place and consists of dialogue, journal keeping and re-evaluation of interventions.



A later publication, again by Cowling (1993), alters some of the terminology used, identifying that terms such as template, constituent, appraisal and intervention were incongruent with the Science of Unitary Human Beings. Template and constituent imply "a conglomeration of parts or components" and were substituted with "guiding assumptions for practice". Appraisal was substituted with appreciation and intervention which "implies coming in between" (Cowling 1993) was substituted with "purposive nursing strategies".



How is the Goal of Nursing and the Nursing Process Defined and Described?

Clarification has been obtained in the search for a Rogerian definition of nursing. But in addition, definitions of the two other criteria regarded as important by Thibodeau (1983), the goal of nursing and the nursing process have also been revealed.



The goal of nursing according to Rogers’ Science of Unitary Human Beings is to promote human-environment field patterning and the nursing process, according to the Science of Unitary Human Beings, has been described above by the Cowling (1990) Rogerian nursing practice template or methodology.



Are Statements about People, Environment, Health and Nursing Explicit or Implicit?

As can be seen from the description of these concepts above, the definition of person, or unitary human being is explicit, although the language used in that description cannot be regarded as simple, or even typical of general descriptions of person by other nursing theorists. The same can be said for the environment. Both of these concepts can be regarded as explicitly defined. Health however, is not explicitly defined, indeed, it might be considered that Rogers has avoided the use of the term at all and that it is not even implicitly defined. In the same sense, nursing was not defined by Rogers more than it being a noun rather than a verb. This is typical of the work of Rogers, who typically appears to do little more than subtly suggest ideas to nurses studying the Science of Unitary Human Beings and those nurses have then been in a position to further explore and develop the ideas, as it has been seen with the work of Barrett (1988, 1990c) and Cowling (1990, 1993). Despite this, it could still be considered that the terms that have been used could be described as "not being sufficiently operationalized to provide for a clear understanding" (Falco and Lobo, 1985). This is a statement that appears to have some contemporary significance.



What are the Relationships among the Four Concepts?

The relationships between some of the four concepts are explicit and have been dealt with at length by Rogers and other writers on the Science of Unitary Human Beings. As it can been seen from the previous definitions, the human-environment field relationship is explicit. The human field is in constant interaction with the environment field.



As health has not been defined and may even be regarded as an inappropriate label in Rogerian nursing science, the relationship between this concept and the others cannot be delineated unless it is accepted that a definition of health could be a positive human-environment field process. Similarly, nursing was not well defined by Rogers but subsequent Rogerian nursing scholars have been able to be more precise about the nature of nursing.



In summary, it is possible to state that the role of nursing is to pattern the human-environment field process in order to achieve maximum potential (health). If this definition is accepted, then it is possible to state that these concepts are closely linked, but that this relationship is not explicit and lacks clarity.



Origin of the Problem.

What was the Stimulus for Model Development?

It is difficult to supply an answer to this question. In reading through a wealth of literature about Martha Rogers and the Science of Unitary Human Beings, nobody seems to have found a direct answer to why the model was originally developed. This is perhaps best summarised by the following quote:



"Sometime during the 1960’s Rogers made a quantum leap from the road toward nursing science that the profession was traveling to a road less traveled...The earlier path of science ‘for’ nursing maintained that knowledge from the biological, physical and social sciences assumed "its own unique configuration" and was applied for social ends. The new direction on the road built by Rogers, where no other nurses were traveling at the time, was a basic science "of nursing".



(Malinski and Barrett, 1994)



There are however some hints at why the Science of Unitary Human Beings was originally developed. In an interview with Hektor (1989), when asked about when the Science of Unitary Human Beings began to be conceptualised, Rogers replied that:



"I started out when I was born - collecting more and more facts. New knowledge began to come out - there was the dawn of the Space Age. As for the framework, which comes first, the chicken or the egg? Knowledge doesn’t come out of the woodwork. There are new and old world views, ancient history and the Indian philosophies. Things fell into place and ideas grew".



Rogers was appointed to a position of Head of the Division of Nursing at New York University in 1954 and she expressed concern at the lack of nursing content in the nursing curriculum (Hektor, 1989). It is probable that it was this that was the original stimulus for the development of the Science of Unitary Human Beings when she realised that "the parameters of a unique body of knowledge had yet to be identified" (Meleis, 1991).



During the early 1960’s, the Science of Unitary Human Beings started to emerge, firstly in its earliest form in her second book Reveille in Nursing (Rogers, 1964) but more substantially in what has become to be known as the "purple book", entitled An Introduction to the Theoretical Basis of Nursing (Rogers, 1970).



In the introduction to this book, Rogers also gave a reason for the development of the Science of Unitary Human Beings, this being:



"motivated by a deep-seated conviction of the critical need for nursing practice to be underwritten by substantive knowledge so that human beings may benefit"



and that



"Escalating scientific and technological advances are forcing new explanations of man and his world. Nursing carries a signal responsibility in the great task of designing and implementing health and welfare services commensurate with changing times and human needs".

(Rogers, 1970)



The Origin of the Problem: Experiential Base, Familiar Areas?

Duffy and Muhlenkamp (1974; cited in Thibodeau, 1983) have stated that it is logical to ask if the problem has arisen out of the nurses’ own experience. For this reason, Rogers’ past professional history and work needs to be examined in addition to her own life history. This is well documented (Barrett and Malinski, 1994; Daily et al, 1994; Hektor, 1989; Madrid and Barrett, 1994) in a very detailed and precise way. Rogers grew up in a very supportive and comfortable family environment and began reading widely and extensively at a very young age. She was regarded as very bright and was jumping grades at school. She claims to have out read the library by the "fourth grade", knew the Greek alphabet by the age of 10 and had read all 20 volumes of The Child’s Book of Knowledge and had started on the Encyclopaedia Britannica (Hektor, 1989).



In 1931 she entered the University of Tennessee and stayed there for 2 years, studying science-medicine, which included such subjects such as psychology, French, zoology, genetics and embryology. But at that stage she had not decided what she wanted to do more than help people. She made the decision to go to nursing school in Knoxville General Hospital in 1933. Following the completion of nurse training she went to the George Peabody College to study for the degree of Bachelor of Science in Public Health Nursing which she obtained in 1937 (Hektor, 1989).



In the following few years she worked as a public health nurse, became an acting



Director of Nursing Education, established a visiting nurse service and in 1945 obtained a Masters degree from Teachers College, Columbia University in public health nursing supervision and a Masters degree in public health in 1952 from the same University. She obtained a Sc.D. in 1954 from Johns Hopkins University, following this, and in the same year, she was appointed Head of the Division of Nursing at New York University, a position she was to stay in until her retirement in 1975. She continued to be heavily involved in the School until her death on March 13, 1994 at the age of 79.



Although as a nurse educator, she would have obviously been concerned about the subjects taught in the Division of Nursing curriculum, there appears to be no explicit relationship with her clinical, practical and/or teaching experience and the nature of the Science of Unitary Human Beings. Again, the origins of the Science of Unitary Human Beings appears to be obscure.



It is obvious that Martha Rogers was highly academically qualified. However it is probably the depth and breadth of her reading that gave the Science of Unitary Human Beings such a unique perspective on the subject of nursing. This depth and breadth of reading is shown in the influences that are claimed to have been used in the development of the Science of Unitary Human Beings and will be outlined in the following section.



The Origin of the Problem: Esoteric or Unfamiliar Areas of Knowledge?

It has previously been mentioned that Rogers was concerned at the limited amount of nursing content in the nursing curriculum at the Division of Nursing in New York University. It was probably for this reason that she started to develop the Science of Unitary Human Beings. This appeared to develop almost spontaneously out of her own interests. Her own nursing education and career did not seem to bear direct relevance to the development of the Science of Unitary Human Beings, but it is interesting to examine the impact and influences of other theorists and disciplines in the development of the framework.



An examination of An Introduction to the Theoretical Basis of Nursing (Rogers, 1970) reveals, in only the first few pages, reference to Greek mythology, cosmology, archaeology, music, philosophy and prehistory, more specifically to the work of Harvey, Preistley, Kepler, Galileo, Newton, Bacon and Descartes.



Furthermore, her influences have "capitalised on the knowledge base gained from anthropology, sociology, astronomy, religion, philosophy, history, and mythology" (Falco and Lobo, 1985) and psychology, biology, physics, mathematics and literature (Daily et al, 1994), science fiction and futurology (Meleis, 1991) with evidence on derivation from the general systems theory of von Bertalanffy (Falco and Lobo, 1985), the work of Nightingale, Einstein, Burr and Northrop’s Electro-Dynamic Theory on Life (Daily et al, 1994), early Greek philosophers, and also de Chardin, Polanyi and Lewin (Meleis, 1991). It almost goes without saying that such broad subject areas of concern are not those usually studied by nurses, or at least they are not central to their study, and it is perhaps for this reason that the Science of Unitary Human Beings is regarded as a unique body of work. In direct answer to the originally posed question, the Science of Unitary Human Beings is almost entirely developed from a knowledge base that would usually be regarded as esoteric in the nursing profession.



What are the Authors Inherent Values and Biases?

To a great extent, this question has already been answered in the proceeding pages, and the values inherent in the Science of Unitary Human Beings that have been stated above are strong, appearing to be a reflection of the values and extensive knowledge base of Martha Rogers.



How did these Values and Biases Influence Problem Selection?

Rogers believed that there was a unique body of knowledge for nursing and she set out to develop that, based on the strong belief that a true picture of human beings cannot be obtained by looking at the parts, or even the sum of the parts, a traditional view widely known as holism. The knowledge base from which Rogers developed the Science of Unitary Human Beings was also somewhat idiosyncratic, in its depth and breadth.



Methodology.

What Methods were Used in Model Development? Induction, Deduction or Synthesis?

The Science of Unitary Human Beings was developed over a number of years and was created as a result of Martha Rogers’ vast reading, knowledge and experience. She drew on vast numbers of resources to create a model that was abstract and in the early years lacked empirical precision (Daily et al, 1989), a claim that could still be made. Whereas model generation by the inductive method would require that the model is grounded in an experiential base, and deductive generation would start with a specific idea and later validation (Thibodeau, 1983), as it has been seen above, Rogers’ appears to have used both methods in developing the Science of Unitary Human Beings. The model was therefore developed using the hypothetico-deductive method or synthesis. This requires the use of "inference and observation, induction and deduction" (Thibodeau, 1983).



Logical development?

The model appears to be in a state of constant development, with ever changing and developing concepts. This will be elaborated upon later. However, for this reason, it is not possible to state whether the development of the Science of Unitary Human Beings has been or will be logical. However, statements as to its logical development will also be made later.



Internal consistency?

During its development, a number of internal inconsistencies within the Science of Unitary Human Beings have surfaced, notably the problems associated with the rejection of the idea of linearity. Again, these will be elaborated upon later in this text.



Empirical validity?

In order to establish whether the Science of Unitary Human Beings is "just a product of the author’s belief system" or if it has empirical support, empirical validity has to be established (Thibodeau, 1983). According to Hardy (1978), the literature needs to be reviewed and an estimation of the methodological strengths and congruency needs to be made. This was achieved by examining a number of nursing theory textbooks that have already analysed and evaluated the Science of Unitary Human Beings to see if any conclusion as to the empirical validity had been made. Textbooks that were dedicated to exploring the Science of Unitary Human Beings and similar academic journal articles were then examined for further evidence of empirical support, or otherwise, were then explored. Lastly, time was spent in the repository for the New York University PhD dissertations, The Bobst Library, Washington Square, New York where most of the Science of Unitary Human Beings PhD dissertations are held.



Textbooks.

The Science of Unitary Human Beings frequently appears as a component of most textbooks on nursing theory and many make at least some estimation of its empirical validity. Falco and Lobo (1985) conclude that the empirical validity of the Science of Unitary Human Beings was limited at the time of writing their book chapter, when they stated that "the difficulty in understanding the principles, lack of operational definitions, and inadequate tools for measurement are the major limitations to the effective utilisation of this theory" and that "research done to support or verify the principles provides questionable results".



However, a somewhat later book (Fraser, 1990) begins to examine in some detail the research that has been performed that used the Science of Unitary Human Beings as a philosophical base or that explored some of the concepts contained within it. Fraser concluded that disappointing results had been obtained by some students examining the nature of waves but that Rogers had supervised many other students who had explored her work, concluding that "the number of studies found and the rigour of many of them is an unexpected but commendable feature of the acceptance or challenge that this model has created". No statement of the estimation of the overall empirical validity of the Science of Unitary Human Beings was made by Fraser (1990).



In a detailed section on validity, Meleis (1991) describes a number of studies that have been performed that have explored the Science of Unitary Human Beings but comes to no particular conclusions about validity. She does recognise however, that research work is increasing in frequency but comes to the critical conclusion that there are "still major gaps in our methodology for unitary human beings/unitary environments and their energy fields".



Daily et al (1994) make an explicit statement about the validity of the Science of Unitary Human Beings that expresses an indication of the contemporary and ongoing nature of the development of Science of Unitary Human Beings research. They stated that the:



"Principles of Homeodynamics are being studied. Investigation into the nature of field patterning and the search for indices of patterning have begun. The integral nature of the man-environment relationship and the growing complexity of life have been used in recent studies using Rogers’ model. Hypotheses are developed and theories are being devised from the systems being studied. Recent studies using Rogers’ conceptual system are numerous".



They also state that although in the early, years the model lacked empirical precision, this has more recently been greatly increased. The same authors made a selected list of doctoral dissertations that have been based on the Science of Unitary Human Beings and identified 15 that were published between 1977 and 1989. This indicates that there is at least some research being undertaken that explores the model. However, this list is far from complete and as it will be seen later Science of Unitary Human Beings research consists of many more pieces of research.



Specific Textbooks.

A number of textbooks have been published that specifically address the developments in the Science of Unitary Human Beings that have taken place since the first publication of An Introduction to the Theoretical Basis of Nursing (Rogers, 1970). Some of these talk about her life and work in general (Malinski and Barrett, 1994; Barrett and Malinski, 1994) whereas others (Barrett, 1990a; Madrid and Barrett, 1994; Malinski, 1986a; Sarter, 1988a) recount the research that has been performed.



The first of these to be published, Malinski’s Explorations on Martha Rogers’ Science of Unitary Human Beings (1986a) brought together for the first time eight "people who had conducted basic research within the Science of Unitary Human Beings" between 1976 and 1983. They covered the subjects of:



1. The relationship between the perception of the speed of time and the



process of dying.



2. The relationship of time experience, creativity traits, differentiation and human field motion.



3. The relationship between hyperactivity in children and perception of short wave light.



4. The relationship between visible lightwaves and experiences of pain.



5. The relationship of mystical experience, differentiation, and creativity in college students.



6. The relationship of creativity, actualisation, and empathy in unitary human development.



7. The relationship between imposed motion and human field motion in elderly individuals living in nursing homes



8. Investigation of the principle of helicy: the relationship of human field motion and power.



Some of these studies will be explored in detail later.



The Stream of Becoming: A Study of Martha Rogers’ Theory by Sarter (1988a) is a somewhat different book, based on her Ph.D. philosophical research study. After a detailed examination of the philosophical basis of the Science of Unitary Human Beings, a significant conclusion is reached that the model had a "lack of philosophical clarity and consistency" but that the "strengths of the model lie in its creativity and fertility as a generator of new approaches to nursing theory, and also in its potential impact on nursing practice" (emphasis added).



Two further texts that could be considered potentially influential in the development of the Science of Unitary Human Beings, Visions of Rogers’ Science-Based Nursing (Barrett, 1990a) and Rogers’ Scientific Art of Nursing Practice (Madrid and Barrett, 1994) record the proceeds of the 3rd and 4th Rogerian conferences held in New York in 1988 and 1992 respectively.



These texts describe in considerable detail the advances that have been made, not only in developing an empirical base for the Science of Unitary Human Beings, but also changes highlighting the ever developing nature of the framework.



In Visions Of Rogers’ Science-Based Nursing (Barrett, 1990a) there are explorations of Rogerian based topics as diverse as the experience of time (Rapacz, 1990), the experience of dying (Winstead-Fry, 1990), of dying and the experience of paranormal events (McEvoy, 1990), the development of unitary nursing practice (Cowling, 1990), education and nursing in space (Malinski, 1990), however not all of these topics are empirically based.



The more recent text Rogers’ Scientific Art of Nursing Practice (Madrid and Barrett, 1994) covers a wide variety of topics in a similar fashion, being a mix of position or discussion papers and research projects. Some of the subjects covered include storytelling (Griffin, 1994), Rogerian counseling (Tuyn, 1994) and the development of Rogerian research methods (Fawcett, 1994; Rawnsley, 1994a; Butcher, 1994a).



PhD dissertations and other journal articles.

In the same way that the Science of Unitary Human Beings has been developing over the past twenty five years or so, so has the research that has been based on either the Science of Unitary Human Beings or Rogers’ early ideas.



The history of the development of Rogerian research has been carefully recorded by Ference (1986). She stated that early dissertations submitted to New York University during the 1960’s showed the clear influence of the thinking of Martha Rogers and could be grouped into studies that explored holism, human development and early studies of man-environment interaction carried out by Mathwig (1967) and Felton (1968). A critical examination of these studies was not possible as they were not available for inspection.



Further studies of the impact of variations in the environment field on the human field were carried out in the early 1970’s (Ference, 1986). At this time several studies of body image were carried out that contributed to the development and understanding of four-dimensionality. This was followed by studies of the variable of time, locus of control and field independence. However, it was identified that these studies often had little direct relevance to the Science of Unitary Human Beings with only infrequent "reference to the framework, aside from a quote of an assumption or guiding principle" (Ference, 1986).



The first doctoral dissertation to be framed solely within the Science of Unitary Human Beings was by Rawnsley (1977) who studied the perception of the speed of time in those who were dying. Hypotheses were framed within the Science of Unitary Human Beings and findings related appropriately (Ference, 1986). One hundred and eight subjects were recruited into one of four categories; young, not dying; young dying; old, not dying; or old, dying. Responses to a time metaphor test, a time-opinion questionnaire and estimations of clock time revealed that the field boundaries of younger dying adults were similar to older non-dying adults, that is, they perceived time as passing faster than the other groups. Rawnsley (1986) considered that this had implications for the definition of a dying human field, being more differentiated than one of somebody not dying, and that a more "therapeutic milieu be fostered for persons moving toward the end of the life process". However, Rawnsley’s (1986) study has received criticism (Fitzpatrick, 1986; Ference, 1986), it being stated that the arguments were supported by general opinion rather than strong empirical data, that there was a lack of precision in the use of terms, that a refinement of the methodology was needed and that the categories of dying and non-dying could not be regarded as mutually exclusive.



Many studies followed this. Ference designed and tested the Human Field Motion Test (Ference, 1979), and many further dissertations, mostly doctoral, studied subjects such as sensation seeking (Lindley, 1981), imposed motion in the elderly (Gueldner, 1983), meditation (McCrae, 1982) and power (Barrett, 1983), all within the framework of the Science of Unitary Human Beings.



Dykeman and Loukissa (1993) performed a detailed analysis of explicitly Rogerian research that had been carried out between 1983 and 1991. Following the application of a strict inclusion criteria, which included that the study must be based on the analysis of data, that the results must have been published, exclusively use the Science of Unitary Human Beings as a framework and must have been written after Rogers had changed the number of principles of homeodynamics from four to three, 20 studies were found. These studies were then divided into two groups, those that studied one or more of the three principles of homeodynamics or that studied one of the theories (of accelerating change, rhythm or power) that have been generated by the Science of Unitary Human Beings.



Two studies were found that were based on the study of two principles and of the remaining studies, three were based on integrality, four on helicy and five on resonance (Dykeman and Loukissa, 1993). The six remaining studies examined the derived theories. In all of the studies it was found that 40 instruments had been used, but that only three had been specifically developed for use with the Science of Unitary Human Beings. These tools were the Human Field Motion Tool that has previously been mentioned (Ference, 1979), the Power as Knowing Participation in Change Test (Barrett, 1990d) and the Temporal Experience Scale (Paletta, 1990). Overall, the results "of the 20 studies indicate that the majority of the studies provide at least partial support for hypotheses derived from Rogers’ conceptual framework" but that "it would appear that more research is needed before any strong statements can be made as to the use of the framework or its affiliated theories in practice" and that "there is much work left to be done before the outcomes of Rogerian research will be relevant for nursing practice" (Dykeman and Loukissa, 1993). This is often simply because the authors of the individual research studies failed to identify the relevance of their work for the improvement or change in nursing practice. In addition, Dykeman and Loukissa (1993) state that there is a need to address the reliability and validity of new instruments that need to be developed in order to measure Rogerian constructs and that new methodologies might need to be developed. They conclude that rather than quantitative methods alone (which appear to have been more frequently used in these studies), a move towards qualitative methods or a combination of qualitative and quantitative methods might be more appropriate for the measurement and exploration of Science of Unitary Human Beings ideas and that the research that is exploring the framework must continue. But the literature review by Dykeman and Loukissa (1993) is incomplete. This is because of the insistence on only reviewing published papers rather than also including doctoral and other dissertations. A wealth of material is therefore missed. Also it should not be regarded as a contemporary view. Because of the very dynamic nature of the development of the Science of Unitary Human Beings, many studies have been completed since the publication, or at least submission in January 1992, of the paper.



A wider and more contemporary review of the literature would have revealed the work of Butcher (1994a, 1994b) who developed a Rogerian research methodology entitled "The Unitary Field Pattern Portrait Method", based upon the qualitative hermeneutic-dialectic circle (Guba and Lincoln, 1989) and used to develop an understanding of dispiritedness in later life from a Rogerian perspective. Also being developed was the Hastings-Tolsma Diversity of Human Field Pattern Scale (Hastings-Tolsma, 1994), that was used to examine diversifying human field pattern in risk takers, the Well-being Index and Health Synchrony Scale (Leddy, 1994b) and the Human Field Image Metaphor Scale (Johnson, 1993) that was developed in order to explore individuals awareness of their wholeness as a manifestation of field pattern. Repeated testing and use of these recently developed methods and tools will reveal how appropriate they might be in the future development of the Science of Unitary Human Beings.



Finally, a second qualitative research methodology that was not identified by Dykeman and Loukissa (1993) was developed by Carboni (1992; 1995), the Mutual Exploration of the Healing Human Field-Environment Field Relationship which "focuses on identifying experiences, expressions and perceptions of the human-environment healing relationship" and is currently being tested in a nursing home setting (Butcher, 1994a).



Furthermore, there has been a concerted move away from using quantitative approaches to the exploration of the Science of Unitary Human Beings towards the use of more qualitative methods since an earlier proclamation by Rawnsley (1990) who stated that "qualitative methods, which seem more congruent with the goal of understanding the nature and direction of patterning diversity characteristic of unbounded, integral four-dimensional, resonating human and environmental energy fields has not been addressed".



Lothian (1989) used grounded theory in order to explore the process of breast feeding, Heidt (1990) was the first person to explore therapeutic touch from a qualitative perspective finding a central concept of "opening" using a grounded theory approach to analyse the tape transcripts of 14 informants. A life history approach was used by Bramwell (1984) to explore the nature of pattern and health promotion needs in older women. Malinski (1991) explored the experience of laughing at oneself in 20 couples, being able to come to the conclusion that "laughing at oneself is an experience of evolving mutual field patterning that facilitates awareness of the harmonious mutual process". This study was based on a similar one performed sometime earlier by Reeder (1984) who used an Husserlian phenomenological approach to explore the meaning of the experience of laughing at oneself in older couples, finding that "recognition of the importance of knowing what to care about is foundational to balancing self-preservation activities and self-relational responsibilities" (Reeder, 1984).



In summarizing this section, it is obvious that a good deal of research has taken place, particularly since the beginning of the 1980’s, but that this research is currently struggling to come to terms with developing an understanding of nursing from a very new and different perspective. Researchers are beginning to appreciate that they have to find and develop new methodologies and tools that are congruent with the Science of Unitary Human Beings (Bramlett et al, 1993; Rawnsley, 1990) and are just starting to do this. The body of research is continuing to grow.



In direct answer to the original question that aimed to establish the empirical validity of the Science of Unitary Human Beings, it can only be safe to conclude that the empirical validity of the framework is growing or increasing but has yet to be confidently asserted. This is neatly summarised by Malinski (1986b) who stated that, in relation to all aspects of the Science of Unitary Human Beings:



"Perhaps it is becoming clear that there are no answers, in the sense of last word or final resolutions, within the system. The world view underlying the Science of Unitary Human Beings, one of total openness and continuous change fosters ongoing inquiry"



Generation of Theory.

Does the conceptual model generate theory?

If the Science of Unitary Human Beings is a conceptual model then it must be capable of generating theory. Three specific theories have been developed by Rogers from the Science of Unitary Human Beings, the Theory of Accelerating Change, the Theory of Paranormal Events and the Theory of Rhythmical Correlates of Change (Daily et al, 1994). However, it is not easy to find reference to these theories in much of the later literature, they seem to have been predominently superseded by explorations of the three principles of homeodynamics, mentioned earlier.



Rogers (1986) briefly mentions the Theory of Accelerating Evolution stating that the development of higher frequency wave patterns indicate the changing nature of health and that what was once a "norm" may now be outdated. In addition, the theory describes that there is greater diversity in the world (Malinski, 1986b) and "change is postulated to proceed in the direction of higher wave frequency field pattern and of organisation characterized by growing diversity" (Rogers, 1980). Two studies were found that explore the Theory of Accelerating Evolution. The first, by Malinski (1986c), explored the relationship between hyperactive children and their perception of short wave light. Data on hyperactivity was collected from 104 boys aged between 8 and 12, with hyperactivity being defined in the Science of Unitary Human Beings as a manifestation of accelerating rhythms. Malinski (1986c) hypothesised that there would be a preference for shorter wave length light in these hyperactive boys. Using a Pearson r computation, the hypotheses were not supported at a significance level of 0.05. It is concluded that "although lack of support for the hypotheses may be due to methodology rather than theory, the possibility that the theory is incorrect with respect to the postulated relationships must be acknowledged". However, the study propositions and their relationship to the Theory of Accelerating Evolution is not made clear and therefore must be regarded as offering inconclusive evidence in support of the latter.



The second study to explore the Theory of Accelerating Evolution was performed by Alligood (1991), who explored the relationships between creativity, actualisation and empathy in a small convenience sample of 47 people aged between 61 and 92. The hypothesis that there was a relationship between actualisation and empathy was supported, however a further two hypotheses were not. The potential implications of these findings were not further explicated.



Phillips (1990a) provided a theoretical exploration of the Theory of Paranormal Events explaining that "Rogers’ model provides a succinct explanation of the paranormal through the four-dimensional relative present that synthesises the past, present and future" and enables nurses to move towards an understanding of the infinite nature of the human-environment mutual field process that transcends space-time, offering possible explanations for the action of interventions such as therapeutic touch (Rogers, 1986), or can be used as a theoretical basis from which to explore states such as meditation, dreaming and solitude (Cowling. 1986b) or precognition, deja vu and clairvoyance (Rogers, 1980a). No reference to the empirical study of the Theory of Paranormal Events could be found in the literature. The Theory of Rhythmical Correlates of Change is almost equally absent from the literature. Although Rogers (1970) talked about rhythmicity and rhythmic phenomena, there is no explicit mention of the Theory in either that or any following publications. McDonald (1986) maintained that her study of the relationship between visible lightwaves and the experience of pain was based on "the rhythm theory component of Rogers’ model" but framed the study on one of the original principles of homeodynamics, complementarity. A partial explanation of the subject can be found in three brief paragraphs written by Rogers in 1980, who stated that unitary human field rhythms are not the same as biological rhythms but are manifestations of the whole. Rogers (1980) stated that living and dying are rhythmical processes, but finishes her section with perhaps one of the most obscure sentences in all of her writing that gives little or no clue as to the nature of the Theory of Rhythmical Correlates of Change, namely "Evolution from the pragmatic to the visionary bespeaks the fulfillment of new potentials and growing diversity" (Rogers, 1980).



Two studies were found that explored the "Theory of Interactive Rhythms", both carried out by Floyd in 1983 and 1984. The research, that examined the relationships between the rhythms of human and environment fields, resulted in only partially supported hypotheses but it was found, for example in the 1984 study, that a sample of 35 psychiatric inpatients had shorter faster sleep-wake rhythms than 35 matched outpatients. Again, the findings from this small study were not directly identifed as being potentially significant for nursing practice.



One further theory that has been developed from the Science of Unitary Human Beings and specifically the Principle of Helicy is the Theory of Power and Knowing Participation in Change (Barrett, 1986). Power is the capacity to participate knowingly in change which is the continuous patterning of the human-environment field manifest as awareness, choice, freedom to act intentionally and involvement in creating change. Barrett (1986) developed the Science of Unitary Human Beings to include the notion of power and specifically developed a tool (the Power and Knowing Participation in Change Tool, PKPCT) to measure the concept. As the PKPCT is used in the present study, a more detailed analysis of the tool and its use in existing studies will be given later.



In addition to these theories that have arisen directly from the Science of Unitary Human Beings, there are also a number of other theories that have their origins in the model but are less directly related to it. It is beyond the scope of this section to describe these theories in any detail, but it is generally recognized that the work of several major theorists have arisen from the Science of Unitary Human Beings. These theorists and theories are Watson and the Philosophy and Science of Caring (although the influence of Martha Rogers is rarely explicitly recognised or acknowledged here; Watson, 1992), Parse and the Theory of Human-Becoming (Parse, 1993), Fitzpatrick and the Life Perspective Rhythm Model (Pressler, 1983) and Newman and the Theory of Expanding Consciousness or Model of Health (1983).



In conclusion to this section, it has been shown that the model has directly generated four theories. Three were generated by Martha Rogers herself, whilst the fourth was developed by Barrett. However, examination of these theories reveals that they were often incompletely described, have little support in either the objective examination of the theories when used as a base for study, or in the more subjective discussion papers on the Science of Unitary Human Beings. There are also a number of very significant nursing theories that have been developed indirectly from the Science of Unitary Human Beings.



It is therefore possible to come to the conclusion that although theories have been generated by the Science of Unitary Human Beings, and because of the dynamic nature of the model it is probable that further theories will develop in the future, there has been hardly any work carried out to either clearly define or to empirically prove the theories that have directly arisen from the Science of Unitary Human Beings.



What is the level of the theory?

According to Thibodeau (1983) an estimation needs to be made of the level of the theory that has been generated by the model. The level of theory being defined by Dickoff and James (1968) as either factor isolating, factor relating, situation relating or situation producing theory. Once the level of the theory has been established then it should be possible to state how valuable and useful that theory will be in the development of nursing knowledge. Factor isolating theory is regarded as the lowest or first level of theory development and situation producing theory regarded as the highest or most advanced level of theory.



It is currently impossible to judge the levels of the theories of Accelerating Evolution,



Paranormal Events or Rhythmical Correlates of Change because of their incomplete



description. It is therefore impossible to state at this stage the impact that these theories might have on the development of nursing. However on estimating its current status it is not difficult to identify that the impact of these theories should be regarded as very limited. The Power and Knowing Participation in Change Theory has been left out of this discussion, but will be addressed later in the work.



What is the Scope of the Theory?

The scope of the theories is defined as their potential breadth or extent (Thibodeau 1983). Duffy and Muhlenkamp (1974; cited in Thibodeau, 1983) state that in order to establish the scope, it should be asked whether the theory is complete, with relationships between the propositions explicit, whether it can guide practice and whether it can be used as a body of knowledge.



As with trying to define the level of the theory in the previous section, the scope of the theory is difficult to define because of its incomplete nature. In reply to the questions asked by Duffy and Muhlenkamp (1974), the theory is incomplete, there appear to be no relationships between the propositions (or even explicit propositions), there is no clear indication that it might guide practice except perhaps in a limited way, and it does not seem to suggest any absolutely new knowledge. The scope of the theories must therefore be regarded as extremely limited.



If the same question is addressed to the Science of Unitary Human Beings then a different conclusion might be reached. Because of the dynamic developing nature of the Science of Unitary Human Beings it cannot be regarded as complete because the history of its development shows that it always appears to be changing and being refined. The relationships between some of the propositions are explicit and indeed appear in some instances to overlap, with for example the definitions of the environment and of person. However, it has been shown that other propositions are not clearly defined. In rare instances the theory does appear to have acted as a guide for practice although not in a prescriptive way, frameworks for practice have been developed by Cowling (1990, 1993) and others. In the early 1960’s Rogers began to define the body of knowledge and that is being, rather than has been, achieved. It is therefore possible to state that the Science of Unitary Human Beings at least partly addresses all of the questions asked by Duffy and Muhlenkamp (1974) and the answer as to determining the scope of the work is that it is broad and has a wide extent.



Is the Theory Complex or Parsimonious?

Complexity is regarded as the theory consisting of multiple variables, parsimony being that they are limited (Thibodeau, 1983). On first reading, the Science of Unitary Human Beings, with its terminology and propositions, appear to be complex. However on further examination, it can be parsimoniously summarised by the reiteration of its major constructs, the building blocks or founding principles and the three principles of homeodynamics. If the Science of Unitary Human Beings can be regarded as fulfilling its original aim, that is to define a body of knowledge specific to nursing and it has achieved this with so few major constructs, then the Science of Unitary Human Beings can be regarded as parsimonious.



Utility, Acceptance, Significance.

Social Congruence?

In order to establish social congruence "one determines the fit between the social expectations of society regarding nursing practice and the type of practice dictated by the model" (Thibodeau, 1983). In other words, is the style of nursing practice dictated by the Science of Unitary Human Beings acceptable to the general public? It is possible to tentatively suggest that the answer to this question is yes and may become increasingly so in the future. This is for the following reasons:



1. That Western society appears to recognise that Western medicine has not got all of the answers in treating disease and as a result there is a dissatisfaction with it and a move towards complementary and alternative methods of treatment. Such a move is supported by the Science of Unitary Human Beings.



2. That members of Western society appear to increasingly want to be involved in decision making about their treatment and care, want more health care information and are no longer willing to be passive recipients of medical treatment. Such an approach is supported by the Science of Unitary Human Beings, the Power Theory (Barrett, 1986), the Guiding Assumptions for Practice (Cowling, 1993) and other such Rogerian work.



Social Significance?

Social significance is a "measure of the value of the nursing actions proposed by the model of practice to the recipients of those actions" (Thibodeau, 1983). Although there is some current credence that suggests that the recipients of nursing practice value technical skill in nurses more than any other ability (Morrison, 1992), this is a view of nursing as dominated by a medical model approach and understanding of nursing from a Cartesian mind-body-spirit perspective. If the interests of society are moving towards taking a more wholistic viewpoint, with a greater interest in the person as a unitary whole, in complementary therapies and alternative methods of treatment and therapy, then the Science of Unitary Human Beings will gain increasing social significance.



Social Utility?

An estimation of the social utility of the Science of Unitary Human Beings is an estimation of the "value of the model to the nursing profession" (Thibodeau, 1983). As it has been seen by the partial summary of the research that has been performed using the Science of Unitary Human Beings as a philosophical base, it has guided some nursing research. The Science of Unitary Human Beings has guided the curriculum at New York University and other Universities in North America since the early 1970’s. A number of textbooks have been published that are dedicated to the work of Martha Rogers and to the Science of Unitary Human Beings. International conferences have been held every other year, with the fifth occurring in 1994, that relay the latest developments in the Science of Unitary Human Beings and a quarterly newsletter and annual Journal is distributed to the 300 or so members of the Society of Rogerian Scholars from all around the world. Rogers has received at least eight honorary doctorates in recognition of the contribution of her work to the development of nursing. It has been said that:



"A verbal portrait of Rogers might include such descriptive terms as stimulating, challenging, controversial, idealistic, visionary, prophetic, philosophic, academic, outspoken, humorous, blunt, and ethical. She has been widely recognised and honoured for her contribution and leadership in nursing. Her colleagues consider her one of the most original thinkers in nursing" (Daily et al, 1994)



She has been called brilliant and years ahead of her time (Daily et al, 1994), and it is "expected that its [the Science of Unitary Human Beings] contagiousness will increase more rapidly than ever anticipated in the decade ahead" (Meleis, 1991). However, this interest is largely confined to North America and particularly New York, with New York University being the academic centre for the study of the Science of Unitary Human Beings. All of the doctoral dissertations that have been completed were in North American Universities and only a few members of the Society of Rogerian Scholars exist outside of North America. This would indicate that although its appeal is significant in New York, the Science of Unitary Human Beings has had some success in North America but less so in the wider world community of nurses. One indication of this lack of success was found by McKenna (1994), who, when performing a Delphi study as part of a larger study of the impact of nursing models on quality of patient care, found that the response to the Science of Unitary Human Beings was poor, with only five respondents out of 87 stating that they were familiar with it and only one out of 95 stating that it would be their first choice of model. This was explained as being possible because Rogers’ "conceptualisation of nursing may be best described as nonconformist".



A Kuhn Paradigm?

One component of Thibodeau’s criteria for evaluation (1983) asks whether the model constitutes a Kuhn paradigm, which is defined as a "unique and radically different way of viewing the phenomenon", a paradigm, which "causes one to look at the phenomenon in a different light", or a paradigm variation, which "does not change the direction of the discipline...[but] fills in the knowledge gaps left by the prevailing paradigm" (Thibodeau, 1983).



This rather oversimplified interpretation of Kuhn’s (1970) work is rather difficult to interpret in relation to the Science of Unitary Human Beings, which might equally well be considered to be any one of the above paradigm types. It could be claimed that the Science of Unitary Human Beings views nursing in a unique and radically different way, thus making it a Kuhn paradigm. However, it cannot be regarded as "the general rules of thumb" (Thibodeau, 1983) that guides the profession at the present moment in time, nor in the immediate or longer term future. This is because at present it has been seen that the use of the Science of Unitary Human Beings remains limited to a very small group of nurses, mainly in North America. It might be safer to assume Hardy’s assertion of over 25 years ago (Hardy, 1978) that nursing is still at a pre-paradigmatic stage of development and the Science of Unitary Human Beings represents neither a Kuhn paradigm, paradigm or paradigm variation.



A Summary of the Critical Analysis and Evaluation of the Science of Unitary Human Beings.

At the beginning of this critical analysis and evaluation of the Science of Unitary Human Beings a number of issues were raised. The critical analysis and evaluation was performed in order to:



a) assess how well the Science of Unitary Human Beings meets criteria judging the internal suitability of the framework.



b) discover how applicable the Science of Unitary Human Beings might be for nursing in the United Kingdom.



c) consider whether the framework is indeed a philosophy, model or theory.



A summary of the critical analysis and evaluation of the Science of Unitary Human Beings reveals that the definitions of the major constructs within the model remain incomplete and poorly defined. Despite there being a growing body of research that has explored these aspects of the Science of Unitary Human Beings, it is often inconclusive, hypotheses derived from the model are not always supported and the research is infrequently related directly to the practice of nursing, leaving the reader to wonder how it can influence and increase the body of nursing specific knowledge. It therefore has questionable established empirical validity. Specifically designed tools that enable the testing of unitary concepts are at the very early stages of development and have yet to substantially contribute to the development of the Science of Unitary Human Beings. Theories that have arisen from the Science of Unitary Human Beings remain poorly defined with little or no empirical investigation in order to clarify their meaning.



The subjects that require understanding in order to be able to make sense of the Science of Unitary Human Beings are often not those that are addressed in typical contemporary nurse education and for this reason many nurses may be alienated by the model when trying to understand it’s somewhat esoteric terminology.



Finally, the social congruence, significance and utility is questionable. If the public are becoming more interested in complementary and alternative therapies and are rejecting Western medicine then it might grow as might the interest in Science of Unitary Human Beings for the nursing profession. However there is no indication that this interest by nursing has spread beyond North America, to for example the United Kingdom. This leads to some clarity in answering the above questions. In judging the internal suitability of the model and its suitability to act as a philosophical base for the present study, a recurrent theme that occurred throughout the critical analysis and evaluation revealed that it is currently in a dynamic state of development and is presently incomplete. It is possible to interpret this in two ways.



Firstly, the Science of Unitary Human Beings could be rejected as being internally invalid and an inappropriate philosophical base for the present study. Secondly, and on the other hand, whilst recognising its incomplete state, framing the present study within the Science of Unitary Human Beings gives the opportunity to participate in the future development of the model and the future development of knowledge for nursing. When exploring the third issue, about whether the Science of Unitary Human Beings is applicable in the United Kingdom, as far as the author is aware, there have been no studies completed in the United Kingdom that employ the conceptual framework. Although it was not mentioned in the critical analysis and evaluation, there have been very few papers published in the United Kingdom on the subject and all except one or two (Aggleton and Chalmers, 1984; Mason and Patterson, 1990) have been written by the present author (Biley, 1990; 1992a; 1992b; 1992c; 1993). However, in addition, several United Kingdom-authored nursing theory books do make reference to the Science of Unitary Human Beings (for example Fraser, 1990).



However, as it has been established that the Science of Unitary Human Beings appears to offer the potential to be wide in scope, it could be considered that this scope can encompass different cultures. In that case, it is probable that, given the existing difficulties with terminology that exist in North America, the Science of Unitary Human Beings is applicable in the United Kingdom.



The fourth issue also appears to remain largely unanswered or at least answered only with a degree of uncertainty. Many commentators on the Science of Unitary Human Beings use the term "model". Rogerian scientists and Rogers herself prefer to use the term conceptual framework or system. According to Fawcett (1993) these three terms can be used interchangeably. If this is the case then it seems as if all involved are calling the Science of Unitary Human Beings a model or an equivalent word. It appears to be less abstract than a philosophy and several theories have arisen from the Science of Unitary Human Beings. It could therefore be called a model.



Francis C. Biley. Posted on the Unitary Health Care web page in 2002, written during the early 1990s
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