THEORY OF HEALTH AS EXPANDING
Unitary Human Beings was the main
CONSCIOUSNESS
MARGARET NEWMAN
Margaret Newman's History and Background
MARGARET A. NEWMAN, RN,PHD
 Born on October 10, 1933, in Memphis,
Tennessee.
 1954-Bachelor's degree in home
economics and English from Baylor
University in Waco, Texas.
 1962-Bachelor's Degree in nursing from
the University of Tennessee in
Memphis.
 1964- Master's Degree in Medical-
Surgical and teaching is from the
University of California
 1971-Doctorate in nursing science and
rehabilitation nursing in New York
University.
 She has worked in-university of
Tennessee, New York University,
Pennsylvania State University of
Minnesota.
 She died on December 18, 2018
INTRODUCTION
 The theory of health as expanding
consciousness stimulated by concern for
those for whom health as the absence of
disease or disability is not possible,
(Newman, 2010).
 The theory has progressed to include the
health of all persons regardless of the
presence or absence of disease,
(Newman, 2010).
 The theory asserts that every person in
every situation, no matter how
disordered and hopeless it may seem, is
part of the universal process of
expanding consciousness, (Newman,
2010).
THEORETICAL SOURCES
1) Martha Rogers-Martha Roger's theory of
basis of the development of her theory,
Health as Expanding Consciousness.
2) Itzhak Bentov. The concept of evolution
of consciousness.
3) Arthur Young- The theory of process.
4) David Bohm- The theory of implicate.
5) Prigogine-Theory of Dissipative
Structure
MAJOR CONCEPTS
1) HEALTH
 In Newman's theory, health is an
expansion of consciousness defined
as the informational capacity of the
system and seen as the ability of the
person to interact with the
environment (Newman, 1994).
According to Newman (1999),
"Health is the pattern of the whole,
and wholeness is one cannot lose it
or gain
2) CONSCIOUSNESS
 Consciousness includes not only the
cognitive and affective awareness
normally associated with
consciousness, but also the
interconnectedness of the entire
living system, which includes
physiochemical maintenance and
growth processes as well as the
immune system. This pattern of
information, which is the
consciousness of the system, is part
of a larger, undivided pattern of an
expanding universe.
3) PATTERN
 Pattern characterized by "movement
diversity, and rhythm" and is
described as a "design, or
framework as is seen in person-
environment interactions"
  Pattern recognition is the “insight or
recognition of a principle, realization of
a truth, or reconciliation of a duality”
and is “key to the process of evolving to
a higher level of consciousness
MAJOR CONCEPTS
1) Health encompasses conditions
heretofore described as illness.
2) These pathological conditions can be
considered a manifestation of the total
pattern of the individual.
3) The pattern of the individual that
eventually manifests itself as pathology
is primary and exists before structural or
functional changes.
4) Removal of the pathology will not
change the pattern of the individual.
5) If becoming “ill” is the only way an
individual’s pattern can manifest itself,
then that is health for that person.
NURSING METAPARADIGM
HEALTH
 “Health and illness are synthesized as
health-the fusion on one state of being
(disease) with its opposite (non-disease)
results in what can be regarded as
health”.
NURSING
 Nursing is “caring in the human health
experience”
 Nursing is seen as a partnership between
the nurse and client, with both grow in
the “sense of higher levels of
consciousness”.
PERSON/HUMAN
 The human is unitary, that is cannot be
divided into parts, and is inseparable
from the larger unitary field
 “Persons as individuals and human
beings as a species are identified by
their patterns of consciousness”
 Persons are “centers of consciousness”
within an overall pattern of expanding
consciousness
ENVIRONMENT
Environment is described as a “universe of open
systems”
Parallel between Newman’s theory of
expanding consciousness and
Young’s stages of human evolution
ACCEPTANCE BY THE NURSING
COMMUNITY
PRACTICE
Newman’s believes that research within the
theory of health as expanding conscious as
praxis, which she defines as a “mutual process
between nurse and client with the intent to help”.
Further, this process focuses
”on transformation from one point to another
and incorporates the guidance of an a priori
theory”.
EDUCATION
Newman stated that ideally, a new role is needed
for the nurse to function in the paradigm of the
evolving consciousness of the
whole. “Nurses need to be free to relate to
patients in an ongoing partnership that is not
limited to a particular place or time”.
RESEARCH
Newman's theory was useful in the practice of
nursing because it contained the concepts of
movement and time that are used by the nursing
profession and intrinsic to nursing interventions
such as range of motion and ambulation.
HEALTH AS EXPANDING
CONSCIOUSNESS-WEAKNESSES
What are the weaknesses of this theory?
 Concepts are challenging to grasp
initially (Draper, P. 1994p.204)
 Neither long-term research nor
quantitative research has been
conducted yet using this theory-
variables in the theory are difficult to
define. (Rothlyn, 2006 p, 88)
 Seems overwhelming to practice the
theory at the beside due to time
constraints.
HEALTH AS EXPANDING
CONSCIOUSNESS-RELEVANCY
How is this relevant in today’s nursing
setting?
 Used in over 30 research studies
internationally related to nursing (smith,
2011, p. 257).
 Has been used to improve nursing
protocols and practice Musker & Kagan
(2011).
 Provides guidelines and potential for
nurses to practice more holistic care.
 May be possible to use in long term care
facilities or other practice where nurse
has more extended periods of time with
patients.
HEALTH AS EXPANDING
CONSCIOUSNESS-IMPLEMENTATION
 Be present with your patients.
 Ask open-ended questions.
 Practice Holistically
CRITIQUE
CLARITY
 Semantic clarity is evident in the
definitions, descriptions, and dimensions
of the concepts of the theory.
SIMPLICITY
 The deeper meaning of the theory of
health as expending consciousness is
complex.
 The theory as a whole must be
understood, not just the isolated
concepts
GENERALITY
 The theory has been applied in several
different cultures
 It is applicable across the spectrum of
nursing care situations.
ACCESSIBILITY
 The theory is used with individuals as
well as with groups to influence health
policy development, practice, and
research.
IMPORTANCE
 The focus of Newman’s theory of health
as expanding consciousness provides an
evolving guide for all health-related
disciplines.
CONCLUSION
 A grand theory of nursing.
 Humans cannot be divided into parts.
 Health is central to the theory and is
seen “and is seen as a process of
developing awareness. of self and in the
environment”.
 “Consciousness is a manifestation of an
evolving pattern of person-environment
interaction”.
THEORY OF HUMANBECOMING
ROSEMARIE RIZZO PARSE
 Born: July 28, 1938
 Graduated from Duquesne University in
Pittsburgh and received her master's
degree.
 Dean of nursing school at Duquesne
University.
  Founder of the Institute of Human person sets, and that one constantly transforms.
becoming, and the president of
Discovery International. These three themes are permeated by four
 The theory of human becoming, arising postulates: illimitability, paradox, freedom,
from the simultaneity paradigm in and mystery.
nursing, is a theory originating in the
human sciences. ILLIMITABILITY
 Rosemarie Rizzo Parse first published The indivisible unbounded knowing extended to
the theory in 1981 as the “Man-living- infinity, the all-at-once remembering and
health” theory, and the name was prospecting with the moment.
changed to the “human becoming
theory” in 1992. PARADOX
 It was developed as a human science “An intricate rhythm expressed as a pattern
nursing theory, and the assumptions preference," Paradoxes are not "opposites to be
underpinning the theory come from the reconciled or dilemmas to be overcome but,
works of Heidegger, Sartre, as well as rather, lived rhythms.
Martha Rogers
FREEDOM
HUMANBECOMING THEORY “Contextually construed liberation." People are
Parse's Humanbecoming Theory guides the free to continuously choose ways of being with
practice of nurses to focus on quality of life as it their situations.
is described and lived. The Humanbecoming
Theory of nursing presents an alternative to both MYSTERY
the conventional biomedical approach as well as "The unexplainable, that which cannot be
the bio-psycho-soc spiritual theories. It focused completely known.”
on quality of life based on each person's own
perspective as the goal of the nursing practice. The theory makes assumptions about man and
becoming, as well as three major assumptions
The theory is structured around three abiding about humanbecoming:
themes: meaning, rhythmicity, and
transcendence NO. 1
The human is coexistent with rhythmical
MEANING patterns constituting with the universe.
Humanbecoming is freely choosing personal
meaning in different situations and priorities in NO. 2
life. Man's reality is given meaning through The human is open, freely choosing meaning in
lived experiences. situation and bears responsibility for their
decisions.
RHYTHMICITY NO. 3
Humanbecoming is co-creating rhythmical The human is transcending multi-dimensionally
patterns of relating in mutual process with the with different possibilities.
universe. Man and environment co-create in
rhythmical patterns. The humanbecoming theory makes the
following assumptions about becoming:
TRANSCENDENCE
Humanbecoming is co-transcending multi- NO. 1
dimensionally with emerging possibilities. It Becoming is unitary human's emerging.
refers to reaching out and beyond the limits a
NO. 2 experiences. The environment is inseparable
Becoming is the human's patterns of relating from the person, as well as complementary to
value priorities. and evolving with the person.

NO. 3
Becoming is a rhythmic activity constituting
human-universe process.

The theory provides a transformative approach

to all levels of nursing. It is different from
traditional nursing process which aims to solve
client's problem. Rather, this model gives the
nurse the ability to see the client's perspective.

Therefore, it allows the nurse to be see and

experience things based on how the client sees
and experiences them. This enables the nurse to
guide the client towards health goals. The nurse-
client relationship co-creates changing health
patterns. Nurses live the art of human becoming
in presence with the unfolding of meaning,
synchronizing rhythms, and transcendence.

Humanbecoming Theory includes the Totality

Paradigm, which states that man is a
combination of biological, psychological,
sociological, and spiritual factors. It also
includes the Simultaneity Paradigm, which
states that man is a unitary being in continuous,
mutual interaction with the environment.

NURSING METAPARADIGM

NURSING
For Parse, Nursing is a human science and art MASLOW’S HIERARCHY OF NEEDS
that uses an abstract body of knowledge to help
people.
ROSEMARIE RIZZO PARSE
PERSON
 Born: April 1, 1908, Brooklyn, New
The theory defines the person which referred to
"man" in this theory as an open being who is York, United States
more than and different from the sum of the  Died: June 8, 1970, Menlo Park,
parts. California, United States
 Influenced by: Carl Jung, Alfred Adler,
HEALTH Henry Murray, Kurt Lewin, Kurt
The open process of being and becoming, and Goldstein
involves the synthesis of values  Parents: Samuel Maslow, Rose Maslow
 Education: Cornell University, Boys'
ENVIRONMENT High School, The City College of New
Refers to everything in the person and his or her York
  Children: Ann Maslow Kaplan, Ellen
Maslow
 Abraham Maslow Was Best Known For:
 Hierarchy of needs
 Founder of humanistic
psychology
 Peak experiences
 Self-actualization
Selected Publications:
 A Theory of Human Motivation,
1943
 Motivation and Personality,
1954
 Toward a Psychology of Being,
1962
 The Farther Reaches of Human
Nature, 1971
According to Maslow (1943, 1954), human
needs were arranged in a hierarchy, with
physiological (survival) needs at the bottom, and
the more creative and intellectually oriented
‘self-actualization’ needs at the top. The higher
up the hierarchy, the more difficult it is to satisfy
the needs associated with that stage, because of
the interpersonal and environmental barriers that
inevitably frustrate us. Higher needs become
increasingly psychological and long-term rather
than physiological and short-term, as in the
lower survival-related needs.
Maslow's Hierarchy of Needs Theory
THE FIRST STAGE OF HIERARCHY OF
NEEDS- THE PHYSIOLOGICAL STAGE
The first stage of the hierarchy is the
physiological stage - the stage required to
sustain life. It includes breathing, excretion and
the desire for food, water, sex, sleep and
homeostasis. These are considered to be the
'basic' needs of human life.
THE SECOND STAGE OF HIERARCHY
OF NEEDS- THE SAFETY STAGE
Once physiological needs have been met,
attention and desire turns to safety and security,
in order to be free from the threat of
psychological and physical harm. Such needs
may be fulfilled by:
 Living in a safe area
 Financial reserves
 Job security
 Good health
THE THIRD STAGE OF HIERARCHY OF
NEEDS- THE LOVE/BELONGING STAGE
Once a person has met the lower physiological
and safety needs, the higher needs can be
addressed. This begins with the love/belonging
stage, which can also be referred to as the 'social
needs stage'. These are the needs related with
interaction and can include family, friendship
and sexual intimacy.
THE FOURTH STAGE OF HIERARCHY
OF NEEDS- THE ESTEEM STAGE
Once a person feels like they belong, the need to
be important can arise. Esteem needs can be
classified as external or internal. Internal esteem
needs are related to self-esteem, such as the need
to respect yourself and achieve. External esteem
needs are those such as social status, reputation
and recognition.
THE FIFTH STAGE OF HIERARCHY OF
NEEDS- THE SELF- ACTUALIZATION
STAGE
Self-actualization is the summit of Maslow's
hierarchy of needs. It can be defined as the quest
of reaching your full potential. People in this
stage tend to have needs such as: morality,
creativity, spontaneity, problem solving, lack of
prejudice, acceptance of facts, truth, justice,
wisdom and meaning.
DIFFERENT TYPE OF NEEDS
Maslow's hierarchy of needs can be separated
into two types of needs: deficiency needs and
growth needs.
Deficiency Needs
Physiological, security, social, and esteem needs
are deficiency needs, which arise due to
deprivation. Satisfying these lower-level needs
is important to avoid unpleasant feelings or
consequences.
Growth Needs
Maslow called the needs at the top of the
pyramid growth needs. These needs don't stem
from a lack of something, but rather from a
desire to grow as a person.
The Expanded Hierarchy of Needs
In 1970, Maslow built upon his original
hierarchy to include three additional needs at the
top of his pyramid, for a total of eight:
Cognitive Needs
This centers on knowledge. People generally
want to learn and know things about their world
and their places in it.
Aesthetic Needs
It is stated hierarchy that human need beautiful
imagery or something new and aesthetically
pleasing to continue up towards self-
actualization.
Transcendence Needs
Maslow believed that humans are driven to look
beyond the physical self in search of meaning.
Helping others, practicing spirituality, and
connecting with nature are a few ways we might
meet this need.
Relationship to the Nursing Metaparadigm
Relating Maslow’s hierarchy of needs to
the nursing metaparadigm, the application of
Maslow’s theory to their practice of patient care
may be efficient to their profession
Person – the nurse is able to identify the level of
care that the patient needs or is required.
Health – patient communication evaluation
can help to determine what needs are not being
met by the patient; body language also helps.
Environment - the nurse may have to adjust
their behavior towards their patients to show the
acknowledgment of the needs, like expressing
concern to
BHHJgrumpy patients and speaking respectfully
to those patients who indicate a desire for
respect
Nursing – there must be a bond between a
patient and a nurse, as these patients will benefit
from bonding with their caretakers.
Applications & Examples
Workplace organizations and employee
motivation
The theory is applicable to organizational
structures and the motivation of employees. To
enhance performance, the organizational culture
and HR strategies must address and fulfill the
needs of employees.
HR strategies, including compensation, benefits,
job design, training, cultural development, and
performance evaluations, can be tailored to cater
to Maslow's hierarchy of needs (Jerome, 2013).
TRANSACTIONAL ANALYSIS
HERBERT STACK SULLIVAN
LIFE STORY
 Born February 21, 1892 Norwich, New
York, United States
 Died January 14, 1949 , Paris, France
 Nationality: AMERICAN
 was an American Neo-Freudian
psychiatrist and psychoanalyst who held
that "personality can never be isolated
from the complex interpersonal
relationships in which person lives" and
that he field of psychiatry is the field of
interpersonal relations under any and all
circumstances in which relations
exist".Having studied therapists
Sigmund Freud, Adolf Meyer, and
William Alanson White, he devoted
years of clinical and research work to
helping people with psychotic illness.
 Sullivan was a child of Irish immigrants
and grew up in the then anti-Catholic
town of Norwich, New York resulting in
a social isolation which may have
inspired his later interest in psychiatry
 He attended the Smyrna Union School,
then spent two years at Cornell
University from 1909, receiving his
medical degree in Chicago College of
Medicine and Surgery in 1917.
 He developed a theory of psychiatry
based on interpersonal relationships
where cultural forces are largely
responsible for mental illnesses (see also
social psychiatry). In his words, one
must pay attention to the "interactional",
not the "intrapsychic".
 In 1927, he reviewed the controversial,
anonymously published The Invert and
his Social Adjustment and in 1929
called it "a remarkable document by a
homosexual man of refinement;
intended primarily as a guide to the
unfortunate sufferers of sexual
inversion, and much less open to
criticism than anything else of the kind
so far published.
 He was one of the founders of the
William Alanson White Institute,
considered by many to be the world's
leading independent psychoanalytic
institute, and of the journal Psychiatry in
1937. He headed the Washington, D.C.,
School of Psychiatry from 1936 to 1947.
 In 1940, he and colleague Winfred
Overholser, serving on the American
Psychiatric Society's committee on
Military Mobilization, formulated
guidelines for the psychological
screening of inductees to the United
States military. He believed, writes one
historian, "that sexuality played a
minimal role in causing mental disorders
and that adult homosexuals should be
accepted and left alone." Despite his
best efforts, others included
homosexuality as a disqualification for
military service.
 Beginning on December 5, 1940,
Sullivan served as psychiatric adviser to
Selective Service director Clarence A.
Dykstra, but resigned in November 1941
after Gen. Lewis B. Hershey, who was
hostile to psychiatry, became the
director. Sullivan then took part in
establishing the Office of War
Information in 1942.
The following works are in Special Collections
(MSA SC 5547) at the Maryland State Archives
in Annapolis:
 Conceptions of Modern Psychiatry,
Soundscriber Transcriptions (Feb. 1945-
May 1945)
 Lectures 1-97 (begins Oct. 2, 1942)
 Georgetown University Medical School
Lectures (1939);
 Personal Psychopathology (1929–1933);
The Psychiatry of Character and its Deviations-
undated notes.
His writings include:
1. The Interpersonal Theory of Psychiatry
(1953)
2. "The Psychiatric Interview" (1954)
3. Conceptions of Modern Psychiatry
(1947/1966)
4. Schizophrenia as a Human Process (1962)
Theoretical Concept
The ego plays an important role in human
behavior, people interact with each other in
terms of psychological position or behavioral
patterns known ego state. Ego's states are
person's way of thinking, feeling and behaving
at any time.
Transactional Analysis theory supports
understanding 3 ego states:
 Parent Ego State - Behaviors, thoughts
and feelings copied from parents or
parent figures.
 Adult Ego State - Behaviors, thoughts
and feelings which are direct responses
to the here and now.
 Child Ego State - Behaviors, thoughts
and feelings replayed from childhood.
Which give a deep understanding into one’s
behaviors. This helps to decode communication
patterns to resolve emotional problems to bring
a change within while improving
communication with self and our understanding
of the world. A person of any age have these ego
state varying degree and a healthy person is able
to move from one ego to another.
Major Concepts
The theory further states that the purpose of all
behavior is to get needs met through
interpersonal interactions and to decrease or
avoid anxiety.
The theory identifies six developmental stages
called “epochs” or “heuristic stages in
development.”
They are:
• Infancy
• Childhood
• Juuvenile era
• Pre-adolescence
• Early adolescence
• Late adolescence
• Adulthood
 Infancy, which takes place from birth to
18 months, focuses on the gratification
of needs.
 Childhood occurs between 18 months
and six years. The main characteristic of
this stage is delayed gratification.
 Juvenile Era is between six and nine
years, and is characterized by the
formation of a peer group.
 Preadolescence, which takes place
between the ages of nine and 12 years
old, is characterized by developing
relationships within the same gender.
 Early adolescence is from 12 to 14
years old, and during this stage, people
develop individual identities.
 Late adolescence takes place between
14 and 21 years. The main characteristic
of this stage is the formation of lasting,
intimate relationships.
 Adulthood takes place at the age of 21
and above, The primary struggles of
adulthood include family, financial
security, and a rewarding career.
Socialization continues to play a role in
adult development.
Stack-Sullivan explains three types of self: the
“good me,” the “bad me,” and the “not me.”
The “good me” versus the “bad me” is based on
social appraisal and the anxiety that results from
negative feedback. The “not me” refers to the
unknown, repressed aspect of the self.
In terms of anxiety, self-system, and self-
esteem, the theory explains that security
operations are the measures that the individual
employs to reduce anxiety and
enhance security. The self-system is all of the
security operations an individual uses to defend
against anxiety and ensure self-esteem.
This theory provides the theoretical basis for
interpersonal psychotherapy to treat patients
with depression and schizophrenia. Interpersonal
theory proposes that, most often, depression
develops in the context of adverse events.
Particularly, it develops in instances of
interpersonal loss. The theory also addresses
techniques and approaches on psychiatric
interviews.
Application to Nursing
V ED RYD EYEERDSullivan's transactional
analysis is a psychoanalytic theory and method
of therapy where in social interactions (or
"transactions") are analyzed to determine the
ego state of the communicator (wether parent-
like,childlike,or adult-like)as a basis for
understanding behavior.
Transactional analysis was applied to nursing as
a way to understand early development of
patients sexuality and mental function
specifically with psychiatric nursing practices.
Psychiatric nurses use many concepts of
psychoanalytic theories in their practice,such as
interpersonal relations, defense mechanisms,
transference,countertransference and empathy.
Metaparadigm
Person:
The person gradually develops a "good feeling"
towards others and a sense of goodness. towards
himself or herself. He/she learns how to avoid
anxiety and correct distorted perceptions of
others, learns to verify his/her ideas through
consensual validation, and seeks to achieve
effective interpersonal relationships on a mature
level.
Health:
People that have functional disability, cognitive-
perceptual changes, orientation disorders,
changes in thought content and vice versa, can
have difficulty making the
right decision for themselves.
Environment:
Interpersonal relations are responsible for both
positive and negative characteristics in people.
Sullivan believed that all psychological
disorders have an interpersonal origin and can be
understood only with reference to the patient's
social environment.
Nursing:
Helps nurses to have a better understanding of
how their reactions and behaviours have impact
on the patients, and quality increase in patient
care.
Critique
CLARITY
Sullivan’s Transactional analysis define
the clear process and development of every
individual towards their behavior within their
ego state and developmental stages
SIMPLICITY
The theory can be comprehensible and
is not complex in any ways. The theory provides
a process and development towards individuals
that makes it more comprehensible
GENERALITY
The theory can be applied to any field
because each and every one is connected to the
process of developmental stage and has their ego
state which makes everyone involved because of
our unique behaviors.
ACCESSIBILITY
The theory is used to every individuals
especially to patients who need an extra
attention to their unusual behavior.
IMPORTANCE
It is essential to methods of theraphy
since the theory is seeking for the development
of a person’s behavior, thoughts and feelings.
CONCLUSION
In conclusion, Harry Sullivan’s transactional
analysis has made significant contributions to
the development of nursing theories. His focus
on interpersonal relationships, communication,
and understanding human behavior has enriched
the nursing profession, leading to more
comprehensive and patient-centered care. His
ideas towards the psychoanalytic process or
method for theraphy to prychiatric patients
offers a more understandable explanation to
their condition.