What is meaningful practice? How might we create a meaningful care environment? The Newman Theory/Research/Practice Society in Japan sent the Nursology.net team an update on their efforts to provide transformative nursing theory-guided care for patients in Japan, and a mutual action research process they created for nursing teams to reflect on meaningful practice and shape meaningful care environments.

This work began in the 1990s when Emiko Endo was a PhD student studying with nurse theorist, Margaret Newman, PhD, RN, FAAN.  Endo tested Newman’s theory of health as expanding consciousness in women with ovarian cancer in Japan. As a result of the caring partnership with Endo, who followed Newman’s theory and research method, the women reported finding greater meaning in their lives and experiencing personal growth and insight into the future.

Eager to share what she had learned, Endo returned to Japan and worked with a hospital-based nursing praxis team to incorporate Newman’s theory and research method into their nursing practice with women with cancer. Realizing the power of the process and the strain family members were experiencing, the nurses extended their attention to use Newman’s method with families of women with cancer. The praxis teams were expanded to include nurse educators, nursing graduate students, and clinical nurse specialists as co-researchers. On one unit, a head nurse assisted her staff to recognize their own patterns as they moved through the chaos of care with clients. The process of recognizing patterns of meaning expanded from the patients, to patients and families, and eventually to nursing care teams. It did not stop there.

Endo developed a process of Mutual Action Research and initiated monthly project meetings for the nurses to capture the meaning of their work as it unfolded. In these meetings, nurses recognized transformation in their caring partnerships with patients and families and visualized ways to improve the care environment. Nurses reflected on their pattern of relating to clients and others and how much more meaningful their practice was when rooted in nursing theory rather than simply in the medical model. The personal reflection and subsequent collective dialogue revealed the ways in which not only had they and their patients been transformed, but also the influence of their transformation on the entire interprofessional team and the care environment. Endo and colleagues realized a need to share what they had learned with nursing teams throughout Japan.

In 2016, the Newman Theory/ Research/ Practice Society was established as a Japanese Nonprofit Organization (NPO) to host national study meetings, dialogues, and seminars in Japan. The intent of the Society is to expend every effort for the development of nursing guided by Newman’s theory of health in Japanese society. Members of the society have been major contributors to international Newman Scholars Dialogues.

As you read the following entry that the Newman Theory/ Research/ Practice Society board members Emiko Endo, Mari Mitsugi, Tomoko Miyahara and Satoko Imaizumi submitted to Nursology.net, you will see that they ended with words from Margaret Newman’s foreword to the Japanese edition of her book, “Transforming Presence: The Difference that Nursing Makes.” The last word is “Satori!”

Satori embodies understanding, enlightenment, awakening to see into one’s true nature, comprehension.  In 2020, which the World Health Organization has declared the Year of the Nurse, and in light of Nursing being considered the most trusted profession for improving the U.S. healthcare system (The Commonwealth Fund, The New York Times, and Harvard T.H. Chan School of Public Health, October 2019, p. 17), the international nursing community looks to the wisdom of our colleagues in Japan for Satori.

Report from the Newman Theory/Research/Practice Society in Japan

Contributed by:*
Emiko Endo, Mari Mitsugi,
Tomoko Miyahara and Satoko Imaizumi

We are pleased to post the 2019 work of the Newman Theory/ Research/ Practice Society in Japan.

In memory of Dr. Margaret Newman, we are devoted to understanding the theory of health as expanding consciousness (HEC) and her life as a nursing theorist, researcher, and educator.

Emiko and Mari, today’s leader and sub-leader, are talking about HEC in the study meeting on June 2, 2019

At the first 2019 study meeting held on June 2, 54 participants gathered together. We read Dr. Newman’s 1994 theory book together chapter by chapter with a facilitator until Chapter Six, and had a dialogue within each small group. The second study meeting was the afternoon of October 19 followed by the annual HEC Dialogue Meeting on the next day. In the first half, we read some articles on Dr. Newman’s life and missed her. In the latter half, we read Chapter Seven (Practice: Order out of Chaos), connecting it with our own nursing practice within 7 small groups.

The participants are having dialogue in each small group about HEC and their nursing practice

The next day at the 13^th HEC Dialogue Meeting, the topic was “A challenge to develop an HEC study group at your clinical nursing unit or hospital.” Two presenters talked about their experiences. They noted that these experiences were not easy, because nurses were working in their irregular working time and mostly under the medical model. But they added, in having continued these meetings patiently, they realized that the nurses were enjoying the meetings and were moving toward the HEC model gradually. The last presenter spoke about a trial to introduce HEC theory into a practicing Chemotherapy Nursing Course. The next study meeting will be held in February, 2020, with the topic of “More efforts to develop study meetings at one’s own working place.”

The praxis research course on HEC and the pre-praxis research course to understand HEC theory are moving forward. Each time in the process, nurses reached a new realization in terms of HEC.

In the foreword for the translation of her 2008 book into Japanese, Dr. Newman wrote to us:

“… The search leads
in different directions
and along new paths
To unanticipated horizons.

Stay with the search.
Wait…
Understanding will come
Satori!”

          ( Margaret Newman, June 2009)

The following are two videos from the October 2019 meetings.

*About the contributors

Emiko Endo, PhD, RN
Chair, Board of Directors and Professor Emerita, Musashino University

Mari Mitsugi, PhD, RN
Vice-chair of the Board of Directors and Associate Professor, Musashino University, Faculty of Nursing

Tomoko Miyahara, PhD, RN, OCNS
Vice-chair of the Board of Directors and Chief of Outpatient Clinic Kanagawa Prefectural Ashigarakami Hospital

Satoko Imaizumi, PhD, RN
Secretary-general and Professor, Tokai University, School of Medicine, Faculty of Nursing