Rogers’ Science of Unitary Human Beings in Nursing Practice

The theory proposed by Barrett (1986, 2010), Power as Knowing Participation in Change, emerges from the principle of helicy within the Rogerian model (see Figure 13-2). The theory proposes that as knowledge increases, so does the capacity to participate knowingly. Furthermore, the theory proposes the capacity of human beings to pattern their human/environmental fields. Barrett (2010) explains, “Following the testing and research of the theory and measurement instrument, a practice methodology was developed and the health patterning practice model was initiated” (p. 47). Patterning manifests via the nurse and client patterning process. Barrett (2000) describes power as being aware of what one is choosing to do, feeling free to do it, and doing it. She identifies power as a relative state characterized by the momentary continuously changing pattern. Power is a relative trait characterizedby “the more consistent organization of the human and environmental field pattern” (Barrett, 1986, p. 174). She specifies that as the person is knowledgeable of his or her pattern manifestations, meaningful participation in the patterning process occurs. Barrett’s theory is used widely by nurses around the world. And in 2010, the volume 23, number 1 issue of Nursing Science Quarterly celebrated Barrett’s power theory and Rogers’ SUHB. Barrett (2010) told her story of the development of her power theory in that special issue also pointing out “what’s new and what’s next” (p. 47).

The Theory of Self-Transcendence by Gulliver (2007) describes the process occurring at the end-of-life. The theory proposes continuously fluctuating imagery boundaries over past, present, and future. With self-transcendence the boundaries become less distinct. The theory further articulates the infinite possibilities for this transition.

Pattern appraisal requires the identification of pattern manifestations that reflect the whole. Pattern appraisal is integral to the provision of care to unitary human beings. Table 13-1 outlines the critical thinking of the nurse and the self-reflection by the client. Nursing within Rogers’ model focuses on the manifestations that emerge from the mutual human/environmental field process. The meeting of the art and science of nursing is vital to the entire process of caring for the client from a Rogerian framework. Pattern appraisal is a comprehensive assessment that incorporates cognitive input, sensory input, intuition, and language. Intuitive knowledge is gained from both the client and the nurse. The nurse accompanies the client in focusing on personal patterns and rhythms. Identification of emerging pattern manifestations throughout the provision of care allows for a departure from the linear cause-and-effect approach and uses an evolutionary approach. The nurse and client gain awareness of rhythmical fluctuations and their associated manifestations. A change in pattern of the human field and the environmental field is propagated by waves. The manifestations of field patterning that emerge are perceivable events (Rogers, 1992). The identification of patterns that characterize a phenomenon provides knowledge and understanding of the human experience and provides the basis for the care, which results (Rogers, 1970).

Patterning “is the dynamic or active process of the life of the human being” that is “accessible to the senses” (Alligood & Fawcett, 2004, p. 11). Pattern information encompasses “phenomena that are categorized as physical/psychological, mental/emotional, social/cultural, and spiritual/mystical” (Cowling, 2005, p. 95). Wholistic pattern appraisal tools are necessary for application of the Rogerian model to the provision of nursing care to the unitary human being.

The nurse incorporates information gained from traditional measurement tools used to care for patients into the wholistic pattern appraisal. All conventional information gained such as vital signs, lab results, biopsy reports, and radiographic reports are integrated into the pattern appraisal and acknowledged as manifestations of the whole. Nurses are asked to incorporate knowledge gained from the use of their senses for the wholistic pattern appraisal. Consequently sight, smell, touch, hearing, and taste all contribute information of emergent patterns. Knowledge gained is via cognitive, sensory, intuitive understanding as well as language. Pattern appraisal includes perceivable rhythms of sleep/wake, mood, pain, movement, and nutrition. Patterning activities are based on probabilistic outcomes as they emergefrom the appraisal of pattern evolution. Emergent human environmental rhythms and patterns are manifestations of the whole; that is, the mutual process of human beings and their environment.

Cowling (2005) provides direction for nurses to study unitary human phenomena such as he has developed for nursing of despairing women. His guidelines assist the assessment and care process. He contends that all pattern appreciation must include the features of being synoptic—viewing together what normally is viewed apart, participatory and collaborative and transformative or reaching for the essence. Butcher (1998) identified additional pattern appraisal methods that include Human Field Motion Tool, Index of Field Energy, Human Field Image Metaphor Scale, Person-Environment Participation Scale, Perceived Field Motion Scale, and the Human Field Rhythms scale.

An important component of the appraisal process involves the work of the client to center and reflect on his or her personal pattern and on the pattern of those with whom he or she shares life. Bultemeier (1997) introduced the use of photographs and written narrative to assist in pattern identification. Pattern appraisal includes multiple lifestyle rhythms, such as nutrition, work, exercise, pain, anger, depression, sleep-wake cycles, and safety. A method for categorizing rhythmicities is by the use of criteria developed by Kim and Moritz (1982). These rhythms include the following: (1) exchanging (eating, elimination, breathing, giving, and receiving); (2) communication (verbal and nonverbal); and (3) relating (spacing, touching, eye contact, belonging, and referencing). During the appraisal, special attention is given to rhythms of pain and discomfort or to areas about which the client is uncomfortable or concerned (Cowling, 1990). Wholistic pattern appraisal methods and practice applications such as the following continue to be developed and refined for human betterment:

The nurse integrates the feeling or sensing level of knowing, which is often described as intuitive or instinctual into the appraisal process. The intuitive knowledge is best realized through reflection, which assists in pattern appraisal. The nurse realizes that manifestations are not static but are partial perceptions of the synthesis of the past, present, and future. These perceptions provide the basis for reflection and intuitive knowing, which then further expands the appraisal. The manifestations, patterns, and rhythms are an indication of evolutionary emergence of the human field. Pattern appraisal, rhythm identification, and reflection provide the content for appraisal validation with the client. The emergent knowledge provides direction for nursing patterning activities. Maintenance and promotion of health,prevention of disease, nursing diagnosis, intervention, and rehabilitation comprise the scope of nursing (Rogers, 1970).

The unitary human being and the environment are one. Rogers’ theoretical model places an emphasis on “the essentials, potentials, and possibilities that exist within the wholeness of life” (Cowling, 2001, p. 37). Knowledge is used creatively for human betterment (Rogers, 1970). Nursing knowledge provides tools for emergent artistic application as the nurse cares for the unitary human being (Alligood, 2002; Rogers, 1992). Nursing is the creative use of nursing knowledge in the care of unitary human beings. Nursing practice accompanies unitary human beings in their health patterning. Therefore, clients define what health is for them and nurses assist their movement toward that goal.

Once the client and nurse have consensus with respect to the appraisal, nursing action centers on mutual patterning of the human/environmental field. “Voluntary mutual patterning” is defined as the continuous process whereby the nurse assists clients to freely choose, with awareness, ways to participate in their well-being” (Barrett, 1998, p. 136). The goal of nursing is promoting symphonic rhythms of the human and environmental field. This is done to “strengthen the coherence and integrity of the human field and to direct and redirect patterning of the human and environmental fields” (Rogers, 1970, p. 122). Patterning activities in practice may be focused on areas identified as dissonant and described as pain, discomfort, or anxiety. Through mutual patterning of the nurse and the client, manifestations of pattern awareness and power emerge, evidence of Barrett’s knowing participation in change theory.

Mutual patterning emerges from the pattern appraisal and relates to areas of mutually emerging goals. Barrett (1990a, 1998, 2010) identifies components of power that are fundamental to change in the patterning processes: awareness, choice, freedom, and involvement. From the inseparable components of power comes what Barrett (2010) calls a “Power Profile” (p. 49). The power profile indicates “the changing nature of the human and environmental field patterning” (p. 49) as follows:

Knowledge of the power profile and various options for patterning are shared with the client. The appraisal guides the knowledge shared, including specific information relating to options. The nurse ensures that the client has adequate knowledge of the appraisal and the various options for patterning. The sharing of the appraisal empowers client participation in the patterning process and choices. Various therapeutic patterning activities are discussed by the client and the nurse. Patterning activities instill hope and are individualized. Modifications are made as needed to accommodate patterning activities to the individual.

The client is empowered in the process of patterning (Barrett, 2010; Cowling, 2004). Power is characterized by continuously changing pattern. Power can be conceptualized as harmonious rhythmicity and as consistent integration of thehuman/environmental field pattern. Cowling (1990) proposes the “goal of patterning is substantive change in health dynamic and change in the direction of health as defined by the client” (p. 51). The nurse’s goal is to assist the client to reach the health potential and foster harmonious patterns, thereby reducing the perception of dissonance.

Barrett (2010) defines patterning as the continuous process whereby the nurse, with the client, patterns the environmental field to promote harmony related to the health event. Rogers (1970) contends that “change proceeds by the continuous patterning of both [person] and environment by resonating waves” (p. 102). Change is specific to energy fields and is perceived through manifestations. Increasing diversity of field patterning characterizes the process of change (Rogers, 1970). Each human possesses rhythmicities of individual uniqueness. The goal is harmonious rhythmicities and human betterment.

All treatments and interactions are patterning activities as they are integral to the human/environmental field process. Practice modalities concern human life patterning and reflect the wholeness of the unitary human being in “continuous innovative change with the universe” (Barrett, 1990b, p. 35). The health-related change modalities allow for change; they do not require it. Nurses currently assist clients in the use of meditation, music, art, imagery, visualization, and therapeutic touch with a primary focus of patterning of the human field. Additional practice modalities based on motion, sound, light and color, humor, relaxation, nutrition, affirmation, art and nature, bibliotherapy, and journal keeping are all potentials for patterning. The nurse remembers that the human/environmental field is one without boundaries. “Human energy fields are integral with environmental energy fields; both fields change together toward greater diversity in field patterning” (Yarcheski, Mahon, & Yarcheski, 2004, p. 73). Awareness centers on perception of the human field, as it manifests the human/environmental field process. Centering is vital to all modalities for the nurse and the client. With centering, the client focuses on his or her core or energy field. Centering may be perceivable as a harmonious field manifestation. All manifestations, including those called illness, emerge from the mutual human/environmental field process. Patterning activities assist the client to move to and focus on emergent patterns.

Manifestations emerge from the human/environmental field process. The environment, with its healing quality, or lack of dissonance, is a vital component of patterning. Wholeness implies concern with the totality of the human/environmental field manifestation. The key is integrality—energy patterns flowing through energy patterns. The nurse works with the client in the context of the client’s family, community, and cultural group. The nurse’s concern for unitary human beings incorporates other nurses and health care providers, as well as the family, in the patterning. The nurse recognizes that pattern manifestations as perceived in the attitudes, intentions, and feelings of those with whom the client works are integral to the person/environmental field manifestation. Color, light, sound, and smell are manifestations of the environmental field. Harmony of the fields proposes increased potential for change (Davidson, 2001).

Options regarding how her physical space is oriented, decorated, and located are explored in the patterning of Mary. She and her family are given latitude in bringing personal effects, artwork, children’s drawings, and photographs. The bed is turned to face the window at Mary’s request. A favorite rocker and a bright rug for the floor are brought into the room. Mary elects to place a beautiful cloth over her bedside table and has her small weaving loom placed in the room. The room radiates a sense of peace, and the feeling of the illness is lost. According to Rogers (1992), dying is moving beyond the pattern visible to human perception. Death is a transformation of energy (Rogers, 1970). At death, the human field ceases to exist and identity as a living human being is gone. The process of dying is a period of transition in which the integrity of the human field as such diminishes and dies (Rogers, 1970). As the pattern of cancer evolves for Mary, manifestations of pain increase and the reality of impending death emerges. Nursing care revolves around the introduction of modalities to assist Mary and her family as the human/environmental field evolves.