MARGARET A.

NEWMAN’S

HEALTH AS EXPANDING
CONSCIOUSNESS

By: MARK ERWIN C. TAGURAN, RN

January 30, 2010
 Objectives
Upon successful discussion of this theory,
colleagues will be able to:
• Describe the historical background of the development of
Newman’s Health as Expanding Consciousness

• Define Newman’s concepts and assumptions

– Expanding Consciousness
– Consciousness
– Movement
– Time
– Space
– Pattern
– Pattern Recognition
– Transformation

• Present the relationship between Health as Expanding

Consciousness and concepts in nursing’s metaparadigm

• Give an example of use of Health as Expanding

Consciousness in clinical practice
 Theorist

MARGARET A. NEWMAN, R.N, PhD, F.A.A.N

Birthday:
October 10, 1933 in Memphis, Tennessee

EDUCATION

1954 – Bachelor’s Degree in Home Economics and English at

Baylor University in Waco, Texas
1962 - Bachelor’s Degree in Nursing at University of
Tennessee in Memphis
1964 – Master’s Degree in Medical-Surgical Nursing and
Teaching at University of California, San Francisco
1971 – Doctorate of Nursing Science and Rehabilitation at New
York University
 Employment

Director of Nursing of the Clinical research center at the

University of Tennessee in Memphis

1971 to 1976- completed her graduate studies at New York

University. She also worked and taught alongside nursing
theorist Martha Rogers.

Rehabilitation Nursing stemmed her interest in health,

movement & time.

1977- Professor in charge of graduate study in nursing at

Pennsylvania State.

1984- Nurse theorist at the University of Minnesota.

1996- Retired from teaching.

 Achievements

Received Outstanding Alumnus Award from the University of

Tennessee College of Nursing in both 1975 and 2002
1976 – Newman was admitted into the American Academy of
Nurses
1979 – American Journal of Nursing scholar
Newman participated as a member of the nurse theorist task force
(1978-1982) with the North American Nursing Diagnosis
Association (NANDA)
1984 – Received the Distinguished Alumnus Award from the
Division of Nursing at New York University
1988 – Admitted into the hall of fame at the University Of
Mississippi School Of Nursing
1996 – Received the E. Louis Grant Award for
Nursing Excellence from the University of Minnesota
Newman is listed in the Who’s Who in American Women, Who’s
Who in America, and Who’s Who in American Nursing.

Published three books, and several journal articles

Theory Development in Nursing (July 1, 1979)

Health As Expanding Consciousness (1986 and 1994)

Developing Discipline: Selected Works of Margaret

Newman (1995)

Served on several editorial review panels

Currently a member of the advisory board of Advances in

Nursing Science
CALL TO NURSING
INTRODUCTION OF THEORY
Cared for mother with ALS
(Amyotrophic Lateral Sclerosis)
Amyotrophic lateral sclerosis (ALS), sometimes
called Lou Gehrig's disease, is a rapidly progressive,
invariably fatal neurological disease that attacks the
nerve cells (neurons) responsible for controlling
voluntary muscles.
 In ALS, both the upper motor neurons and the
lower motor neurons degenerate or die, ceasing to
send messages to muscles. Unable to function, the
muscles gradually weaken, waste away, and twitch.
Eventually the ability of the brain to start and control
voluntary movement is lost.
 Individuals with ALS lose their strength and the ability
to move their arms, legs, and body. When muscles in the
diaphragm and chest wall fail, individuals lose the ability to
breathe without ventilatory support. The disease does not
affect a person's ability to see, smell, taste, hear, or
recognize touch, and it does not usually impair a person’s
thinking or other cognitive abilities.
 However, several recent studies suggest that a small
percentage of patients may experience problems with
memory or decision-making, and there is growing
evidence that some may even develop a form of
dementia. The cause of ALS is not known, and
scientists do not yet know why ALS strikes some people
and not others.
REALIZATIONS
1. Simply having a disease does not
make you unhealthy
2. Time, movement, and space are in
some way interrelated with health
Both Newman and her mother experienced
1. Alterations in movement, time, space and
consciousness.
2. Greater sense of connectedness and increase
insight into the meaning of their experience and
into the meaning of health.
EARLY INFLUENCES
Martha Rogers
Theory of Unitary Human Beings
•Health and Illness are not two separate
realities, but rather as a unitary process.
•All of reality is a unitary whole and that
each human being exhibits a unique Dr. Newman with
pattern. Martha Rogers,
•Unitary human being is open and in teacher and mentor,
while in New York in
interaction with its environment. June 1992
•There are no real boundaries between
human and environment; pattern is an
identification of the wholeness.
•Life process as showing increasing
complexity.
David Bohm
Theory of Implicate Order

Supports Newman’s
“Disease is a manifestation
of the pattern of health” and
“Health as a pattern of the
whole with a normal
progression towards higher
levels of organization.”
Ilya Prigogine
Theory of Dissipative Structures

Newman incorporated
Prigogine’s theory as an
explanation for the timing of
nursing presence as the patient
fluctuates from one level of
organization to a higher level.
‘Normal’ Predictable Fluctuation Giant Period of disorganization, Emergence of new order at
Fluctuation unpredictability and uncertainty higher level of organization

Time when partnership with an

HEC nurse can be of great benefit

Figure 1. Prigogine’s Theory of Dissipative Structures applied to HEC nursing.

Arthur Young
Stages of Human Evolution

Discussion of the importance of

insight, pattern recognition, and choice
provided the impetus for the integration
of Newman’s basic concepts of
movement, space, time, and
consciousness into a dynamic portrayal
of health and life.
Figure 2. Parallel between Newman’s Theory of Expanding Consciousness
and Young’s Stages of Human Evolution.
 7 Stages of Human Evolution

Potential freedom – the capacity of the individual to evolve

Binding - the collective is primary

- the individual is not important
- everything is regulated and initiative
is not needed

Centering - Individual identity

- Self consciousness
- Self determination
- Develop as the person breaks with
authority
Choice – the turning point in which the individual learns the
“law”. The emphasis on choice is on science and a
search for laws with the new awareness of self
limitations.
- Human learns the law of the way things
work and make choices that ultimately
make human beyond space and time to a
state of absolute consciousness.
- The individual learns that the old ways of
being are no longer working and a new
way of being is necessary.
-Stage of Self awareness, inner growth,
and transformation.
Decentering – Emphasis shifts away from self–
development to something greater than the
individual.
- Energy is a dominant feature and one’s
works develop a life of their own; the
experience is one of unlimited growth.

Unbinding – Increasing freedom from time

Real Freedom – Complete freedom and unrestricted choice.

- Absolute consciousness which has been
equated with love.
Itzhak Bentov
“Life as a Process of Expanding Consciousness.”
•Consciousness as evolving and being
coextensive with the universe supports
Newman’s theory of “Health is the process
of expanding consciousness”.

•Defined consciousness as “a state in which

contrasting concepts become reconciled and
fused. Movement and rest fuse into one.
•Newman used Bentov’s conceptualization
of time as an index of consciousness to
demonstrate expanding consciousness
across life span.
Richard Moss
“Presentation of love as the
highest level of consciousness”

Affirming of Newman’s
views of the nature of health
and nursing.
Major Concepts and Definition of Terms

•Consciousness
•Expanding Consciousness
•Pattern
•Pattern Recognition
•Transformation
•Movement
•Time
•Space
 CONSCIOUSNESS

•The informational capacity of the system and

the ability of the system to interact with its
environment.
•Not only cognitive and affective awareness, but
also the “interconnectedness of the entire living
system which includes physiochemical
maintenance and growth processes as well as
the immune system.
•The person does not just possess
consciousness but is consciousness.
 CONSCIOUSNESS

•The highest level of consciousness is absolute

consciousness and is equated with love, where all
opposites are reconciled and experiences are all
accepted equally and unconditionally, such as love
and hate, pain and pleasure, and disease and
nondisease.
•All experiences are equal and unconditional.
•Transcendence is a process through which the
person reaches the highest level of
consciousness.
EXPANDING CONSCIOUSNESS

•A universal process of becoming

more of oneself, of finding greater
meaning in life, and of reaching
new dimensions of connectedness
with other people and the world.
 PATTERN

-Information that depicts the whole,

understanding of the meaning and relationships
at once. It is the fundamental attribute of all
there is and gives unity in diversity.
-Identifies the wholeness of the person
•unfolds in time and cannot be predicted
•dynamic (in constant movement)
•identified across space and time
Health is a pattern of the whole
 PATTERN

-Health assessment framework based on 9

patterns of person environment interactions
that guide a nurse in making holistic
observations consist of following dimensions:

-choosing, - moving
-communicating, - perceiving
-exchanging, - relating
-feeling, - and valuing
-knowing,
PATTERN RECOGNITION

– Becoming aware of the pattern of the

other person by becoming “in touch with
one’s own pattern.” Health professional
should focus on the pattern of other
person, acting as the reference beam in
a hologram.
 TRANSFORMATION

– a change that occurs all at once rather than

in a gradual and linear fashion. As more
information is obtained, the pattern evolves
unidirectionally and becomes more highly
organized.
MOVEMENT-SPACE-TIME

-Dimensions of merging patterns of

consciousness.

-Represent the person as a center of

consciousness.
 Movement

•A reflection of consciousness.
•An individual conveys his or her awareness of
self through the movement involved in language,
posture, and body movement.
•The rhythm and pattern which are reflected in
movement are an indication of internal
organization of the person and his perception of
the world.
•Provides a means of communication beyond
that which language can convey.
 Movement

•An essential property of matter needed to bring

about change.
•A pivotal choice point in the evolution of human
consciousness.
•The means whereby space and time become a
reality and, therefore, is a means of becoming
aware of self.
•Movement through space is integral to the
development of a concept of time in man and is
utilized by man as a measure of time.
 Time

•A function of movement
•A measurement of consciousness
•Centers primarily on time as perceived
duration or subjective time.
•Time and timing relate the rhythm of living
phenomena
 Space

•The unbounded three-dimensional expanse in

which all matter exists
•The region that lies beyond the atmosphere,
and all that it contains
•Distance or interval
•Holographic sense: “Each moment has an
explicate order and also enfolds all others,
meaning that each moment of our lives contains
all others of all time.”
 Time and Space

•Inextricably linked to each other and has a

complementary relationship. “When one’s
life space is decreased, as by either
physical or social immobility, one’s time is
increased.”
Theory Assumptions
Theory Assumptions
•Health encompasses conditions heretofore
described as illness or, in medical terms,
pathology.

•These ‘pathological’ conditions can be

considered a manifestation of the total pattern of
the individual.

•The pattern of the individual that eventually

manifests itself as pathology is primary and
exists prior to structural or functional changes.
Theory Assumptions
•Removal of the pathology in itself will not
change the pattern of the individual.

•If becoming ‘ill’ is the only way an individual’s

pattern can manifest itself, then that is health for
that person.

•Health is the expansion of consciousness.

Paradigm Shift

From: Instrumental View – linear, causal,

predictive, rational, controlling, dichotomous

1. Particulate – deterministic paradigm: Isolatable,

reducible entities with definable, measurable properties (i.e.,
A causes B, or atherosclerotic plaques causes heart attacks).

2. Interactive – integrative paradigm: Views reality as

multidimensional and contextual. Multiple antecedents and
probabilistic relationships are believed to bring about change
in the phenomenon. (i.e., A+B+C+D are interrelated in their
affect on heart attacks).
 Paradigm Shift

To: Relational View – pattern, emerging,

unpredictable, unitary, intuitive, and innovative.

3. Unitary – transformative paradigm: “Unitary, self-organizing

field embedded in a larger self – organizing field. It is identified
by pattern and by interaction with the larger whole.”
Paradigm Shift

•Searching for patterns instead of treating symptoms

•Perceiving pain and disease as information instead

of seeing them as totally negative

•Viewing the body as a dynamic field of energy that is

continuous with a larger field instead of a machine in
various states of repair and despair

•Seeing disease as a process rather than an entity

Metapardigm
 Person
“The human is unitary, that is cannot be divided into parts
and is inseparable from the larger unitary field”

•The person does not just possess consciousness but is

consciousness.

•Centers of consciousness within overall pattern of

expanding consciousness.

•Individual who is identified by a unique pattern. (Person

can be defined as family, group or community)

•A person is unique and each individual’s patterns should be

recognized as sequential over time.
Environment
•Larger whole which is beyond the consciousness of the
individual.

•The pattern of person-environment interactions shapes

health by evolving to higher levels of consciousness of
the self.

•Individuals patterns are embedded in family 

community  society

•In unison with human beings

 Health
•“Health is the pattern of the whole, and ... wholeness cannot
be gained or lost, in a way that becoming ill does not diminish
wholeness but wholeness takes on a new form.”

•A unitary pattern of the whole and encompasses both

disease and non-disease.

•Health is an outcome of the person’s interaction with the

environment

•Disease is part of the environment; hence becomes part of

person-environment interaction.

•The combination of disease and non-disease creates health

Nursing
“…the goal of nursing is not to make people well
or to prevent their getting sick, but to assist
people to utilize the power that is within them as
they evolve toward higher levels of
consciousness…”

Intervention is a form of nonintervention whereby

the nurse’s presence helps client get in touch with
the meaning of life by identifying their health
patterns. Nurses also help clients identify different
pattern of interactions.
Nursing
Pattern recognition: Becoming aware of the pattern of the
other person by becoming “in touch with one’s own pattern.”
Health professional should focus on the pattern of other
person, acting as the reference beam in a hologram.

PATIENT NURSE

Figure 3. Interaction pattern of two persons

– A holographic model of intervention.
Nursing
•Nurse-client interaction: A mutual process of
attending to that which is meaningful to the patient as
well as the nurse.

•Partnership demands that nurses develop tolerance

for uncertainty, disorganization, and dissonance, even
though it may be quite uncomfortable. It is in the state
of disequilibrium that the potential growth exists.

•Newman states, “The rhythmic relating of nurse with

client at this critical boundary is a window of
opportunity for transformation in the health
experience.”
Nursing
Nursing out of HEC perspective involves being fully
present to the patient without judgments, goals, or
intervention strategies.

It involves working with the client, and not doing for

the client. It is caring in its deepest, most respectful
sense.

The nurse works together with the client through these

critical choice points, when change takes place.
Application
CASE STUDY: Max Armstrong
Is a 57-year-old white, married man lives in New
Liskeard with his stay-at-home wife Elsie. They have three
grown children who live nearby. Mr. Armstrong is a smoker
and has had angina on and off for the last few years. He is a
long haul transport truck driver and is off for the week after a
one week trip out west.
It is mid-January and a heavy snowfall warning is in
effect. 15 centimetres of snow have already fallen. Elsie
decides to make a hot stew to warm up and needs to get to
the grocery store. She asks Max to shovel the driveway.
Max, being a loving husband, states “No problem,
honey. Lord knows I love stew! I’ll be finished in a jiffy!”
 While Max was shovelling he began to feel tightness
in his chest. He soon discovered it was harder and harder
to breathe and this time, his pain radiated to his arm and
jaw. Before he knew it, he was on the snow covered
ground in the driveway. His wife Elsie saw him collapse
through the window and called 911.
After waking up after his MI in the ICU with Elsie by
his side, Max explained he thought he was dead. He
described his life flashing before his eyes and said he saw
himself getting married, his children being born, and his
granddaughter on the first day of school all over again. He
described being pulled toward a bright light at the end of a
tunnel and experiencing a sense of serenity and freedom.
 Max had hit a “Choice Point” and in order to support
Max while he is evaluating his life, the nurse would provide
appropriate information regarding nutrition and smoking
cessation and work with him to develop appropriate changes.
HEC Approach
Nurses who form relationships with their clients can help them identify
problematic patterns, move to a choice point, then to a higher level of
consciousness, resulting in a reduction in problematic patterns of
behaviour.

Assess
The nurse assists the client to recognize that his life patterns no longer
function as they currently are and new ways of relating to his environment
are necessary.
Max : 57 year old, white male, Hx of angina,
Smoker, Trucker, Sedentary lifestyle,
Poor eating habits, Poor sleeping patterns,
Married with 3 grown children, Lives in New Liskeard (rural area),
Recent MI caused a near death experience
 Plan

While respecting the client's choices, the nurse assists the

client in exploring resources for transformation.

Discuss with client possible changes to identified health

patterns that are no longer functioning and discuss possible
new ways of relating them or creating new health patterns.

Work with client not decide for client

Implement

The client integrates health strategies into his lifestyle.

Client will demonstrate improved nutrition habits.
Client will demonstrate increased physical activity by exercising
20 minutes each day.
Client will demonstrate improved sleeping habits by sleeping at
least 7h/night.
Client will demonstrate appropriate use of Nitro-glycerin by
having an unexpired bottle at hand at all times
Client will begin smoking cessation measures.
 Evaluate
The nurse examines the client's transformed relationship
and how the interactions overcome the health challenge
Client has demonstrated improved nutrition habits.
Client has increased physical activity.
Client has demonstrated improved sleeping habits.
Client has demonstrated appropriate use of Nitro-
glycerin.
Client has begun a smoking cessation program
A new understanding has developed on how his
environment relates to his health
The MI and near death experience had a great impact on
Max. He re-evaluated his life and decided he had some big
changes to make. Max started exercising; eating healthier
and he even decided to quit smoking. Max cut down on the
long distance runs he took so that he could get better
sleep more often.

Elsie wanted to support Max’s lifestyle change so she

started looking up healthier choices for his favourite
recipes and even got a part-time job to help with the
finances, and she always made sure Max had his Nitro-
glycerine on him in case he has chest pain.
THANK YOU!