Satori – Japanese Nurses Visualize a Path to Meaningful Practice: Report from the Newman Theory/Research/Practice Society in Japan

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 13th 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

A Tribute to Margaret Ann Newman, PhD, FAAN (October 10, 1933 – December 18, 2018)

newmancelebration

Go to Health as Expanding Consciousness (HEC) Theory Page
Download Newman HEC Reference List
Go to 2016 Newman Scholars Dialogue
Newman Theory/Research/Practice Society in Japan
Memorial Speech by Marlaine Smith
Memorial Speech by Dorothy Jones

Margaret Newman receiving Living Legend award

Dr. Margaret Ann Newman expanded the nursology horizon over the past 40 years with her thought-provoking work. She advanced the knowledge of the discipline of nursing and her wisdom continues to expand through the work of people inspired by her presence and written works. Margaret Newman’s transforming presence extends beyond boundaries of time and space.

As Margaret’s time in her body was narrowing, her niece, Donna Jean Mehr, asked me to help her write Margaret’s obituary for the Memphis newspaper. That obituary contains the chronological details of Margaret Newman’s life and work. In this tribute for the Nursology.net community, I would like to focus on the ways in which Margaret expanded our understanding of health, nursing theory, and nursing practice; embraced and advanced a paradigm of wholeness; and exemplified a spirit of generosity.

Margaret Newman Expanded our Understanding of Health, Nursing Theory, and Nursing Practice 

After graduating from Baylor University at the age of 21, Margaret returned home to Memphis to work and care for her mother who had been diagnosed with amyotrophic lateral sclerosis (ALS). The process of caring for her mother was transformative. Not knowing the trajectory of the disease, Newman learned to live day by day, fully immersed in the present (Newman, 2008a). She (2008b) recounted learning that “each day is precious and that the time of one’s life is contained in the present” (p. 225). This realization permeated Margaret’s philosophy of nursing and her writing throughout her life. She came to realize that simply having a disease does not make a person unhealthy. Although Margaret’s mother’s life was confined by the disease, her life was not defined by the disease. In other words, Margaret’s mother could experience health and wholeness in the midst of having a chronic and progressive disease.

When her mother died, Margaret entered nursing school at the University of Tennessee in Memphis. In her studies, she read Dorothy Johnson’s article “The Significance of Nursing Care,” which asserted that nursing was different from medicine, and “therefore the underlying knowledge was different,” which in 1961 was a “revolutionary” claim (Newman, 1994a, p. 153).  Newman described Johnson’s article as “a bolt of light piercing the darkness and confusion” as she was trying to apply the mostly medical knowledge she was learning at UT College of Nursing to her nursing practice (p. 153). From that point forward, describing the body of knowledge that characterized nursing as its own discipline became Margaret’s career-long odyssey (1994a). Drawn by Johnson’s work, Newman entered the MS in medical-surgical nursing program at the University of California, San Francisco. During her master’s studies, Margaret published a manuscript titled “Identifying and Meeting Patient’s Needs in Short-Span Nurse-Patient Relationships” (Newman, 1966). Her focus on nursing presence to that which is meaningful in the life of the patient was taking root. 

After graduating from UCSF in 1964, the medical director of the Clinical Research Center at Bowld Hospital recruited Margaret back to Memphis to become the Clinical Research Center Director. The Research Center was affiliated with the U of TN and thus the unit on which it was housed was independent of the hospital. Newman began by educating the medical director on the nature of nursing practice so that he would not expect the nursing staff to do things that physicians could do for themselves, or which staff from other departments could do. She gave each nurse one day a week in the library for scholarly development so that the nurses could enrich their nursing knowledge base. Newman was increasingly convinced that nurses who are fully present with patients while doing the tasks of nursing can comprehend in a holistic sense what patients need to achieve a greater sense of health. The writings of nurse theorist Martha Rogers drew Newman’s attention in, as Rogers was articulating a new paradigm of health that expanded the nature of nursing practice. Rogers’ science of unitary human beings resonated with Newman’s conceptualization of health and nursing, and enhanced her ability to see the whole by concentrating on pattern. Newman knew she wanted to pursue a PhD in nursing and went to NYU to study with Rogers. After receiving her PhD in 1971, she joined Martha Rogers on the NYU nursing faculty. While at NYU, Newman (1972) published a seminal work on Nursing’s theoretical evolution and conducted postdoctoral workshops on nursing theory development. She spent the summer of 1976 consulting with nurses in Brazil on the development of the knowledge of the discipline of nursing. In 1977, Margaret took a position as the professor-in-charge of graduate studies at Penn State University, where she published the first primer on Theory Development in Nursing (Newman, 1979) and initiated nursing theory think tanks (see Peggy Chinn’s November 13 Blog). 

Newman introduced her theory of health as expanding consciousness at a nursing theory conference in New York in 1978. In her talk, she asserted that illness and health are a unitary process moving through varying degrees of organization and disorganization and manifest as pattern and meaning in people’s lives. She stressed that the responsibility of the nurse is to help people recognize the power within them to move to higher levels of consciousness, with consciousness defined as the information of the systems—the capacity of the system to interact with the environment (Newman, 1994b, p. 33).  The manifestation of disease is an explication of the underlying pattern of the person. In a mutual relationship, the nurse and patient focus on the meaning of the pattern, knowing that new insights will arise into how to move forward. Disease may bring the greatest insight into meaning and pattern—into expanding consciousness, and thus into health. Perhaps of consolation to those of us who are deeply mourning the loss of Margaret’s physical presence in our lives is what she wrote in the introduction to the 1994 edition of her Health as Expanding Consciousness book: “The expansion of consciousness is unending. In this way we can embrace aging and death. There is peace and meaning in suffering. We are free from all the things we have feared—loss, death, dependency. We can let go of fear” (Newman, 1994b, pp. xxiii-xxiv).

With an expanded philosophy of health, so too comes an expanded view of nursing. Readers are encouraged to delve into the writing of Margaret Newman and savor the rich banquet of nursing ideas laid before them in her published works, particularly the 1994 Health as Expanding Consciousness and 2008 Transforming Presence: The Difference that Nursing Makes books.

On the note of nursing presence, one of my favorite Margaret Newman stories to tell new nursing students involves Margaret and her NYU and UMN colleague, Ellen Eagan. After they retired as Nursing Professors from the UMN School of Nursing, Margaret and Ellen lived in the same building in downtown St. Paul, Minnesota. Margaret had a cat named Punk, whom she cherished. Punk was sick and needed an injection, so Margaret called Ellen to come over and help her. They were preparing to give Punk his shot. Margaret was lovingly holding Punk in her arms. Ellen took the syringe with the medication, approached Margaret and Punk, stopped, and asked Margaret, “Would you rather be the nurse?” Margaret smiled and replied, “I am being the nurse!”

Margaret Newman Embraced a Paradigm of Wholeness

Newman called nurses to see the whole of the patterns of people’s lives in relationship to their environment and to respond to what is meaningful. Newman (2002) proposed that “attention to pattern constitutes the unitary grasp of knowledge the discipline seeks” and thus takes nursing knowledge to a higher level, transcending what is currently known and understood (p. 2). She taught us that it is very difficult to comprehend the enormity of wholeness, cautioning that the linear words of the academic world limit our understanding. She called attention to relationships, stressing that the “holistic mode of consciousness is nonlinear, simultaneous, intuitive, and concerned with relationships rather than the elements that are related” (Newman, 2008, p. 39). Newman gave the example of focusing on the elements of salt—sodium and chlorine, which can be seen, while not seeing the bond between them, which makes them salt. Strain to see and comprehend the relationships, the ties that bind. Comprehending the whole involves intuition and simultaneous appreciation for that which is seen and that which is perceived in other ways (2008). Strive to see the pattern of interactions. Pattern is a characteristic of wholeness. Wholeness is not something that can be achieved in that it is already there. Wholeness is “the bedrock of our reality”—one cannot lose or gain it (Newman, 1999, p. 228).

During her years as nurse theorist and professor at the University of Minnesota, Margaret strove to eliminate the confusion related to the nature of the discipline of nursing; she wanted to clearly articulate its focus. Margaret’s work was completely rooted in the unitary paradigm of nursing, first articulated by Martha Rogers (1970), yet it was clear that other nurses’ work was rooted in different paradigms. She collaborated with colleagues Marilyn Sime, who was involved in lab research, and Sheila Corcoran-Perry, whose nursing research focused on family systems. Together they (Newman, Sime, & Corcoran-Perry, 1991) determined that the overarching focus of the nursing discipline was “caring in the human health experience” under which fell three unique paradigms of nursing research and practice: the particulate-deterministic, the interactive-integrative, and the unitary-transformative (with the first word indicating the nature of reality and the second word indicating the nature of change in each paradigm). Newman subsequently articulated that the unitary-transformative paradigm was inclusive of the knowledge and perspectives of the other two paradigms (Newman, 2002).

Margaret Newman continued to write and speak about the unitary transformative nature of nursing praxis and further explicated the concept of wholeness, which was a major theme in the Newman Scholars’ Dialogues that were held every few years in Memphis or Boston. In 2008, Newman, Smith, Pharris, and Jones published “The Focus of the Discipline Revisited” in Advances in Nursing Science to clearly articulate nursing practice as a unified whole and to exhort nurses to embrace a shared meaning to bring coherence to nursing practice. Newman et al. (2008) proposed seven concepts that are central to the discipline of nursing: a) health, the intent of the relationship; b) caring, the nature of the relationship; c) consciousness, the informational pattern of the relationship; d) mutual process, the way in which the relationship unfolds; e) patterning, the evolving configuration of the relationship; f) presence, the resonance of the relationship; and g) meaning, the importance of the relationship.

Margaret Newman Exemplified Generosity of Spirit

When working with students, Margaret did not control, but rather sought to understand through dialogue. She hosted frequent dialogues with her students and colleagues. She encouraged her students to explore the theory of health as expanding consciousness in the context of their own work and culture. She took joy and expressed deep interest as students reached new insights. The nature of Margaret’s theory compelled her to recognize and appreciate the evolving pattern of her theoretical propositions. A poem Margaret wrote in 1985 describes her approach to relationships:

I don’t like controlling, manipulating other people.
I don’t like deceiving, withholding, or treating people as subjects or objects.
I don’t like acting as an objective non-person.
I do like interacting authentically, listening, understanding, communicating freely.
I do like knowing and expressing myself in mutual relationships.
                                 —Margaret Newman

Margaret Newman did not need to, nor did she seek, to insert herself or her theory into the work of others. She delighted in watching patterns unfold. She knew we were all one unified whole and she did not need to do anything but be fully present to what was before her. Dottie Jones and I had the great honor of being with Margaret in June, facilitating the American Academy of Nursing’s Nursing Theory-Guided Practice expert panel meeting from her bedside. Margaret listened intently to the dialogue. She said one last sentence to the group: “Don’t forget about the philosophical foundation of nursing knowledge and what is embedded in that.”

Memorial Service

A memorial service to celebrate Margaret Ann Newman’s life will take place in the Chapel of Trezevant Manor in Memphis, Tennessee on Thursday January 10 beginning at 1 p.m., followed by a reception. Marlaine Smith and Dottie Jones will be offering reflections at the memorial service. In lieu of flowers, those who are able can donate to the Margaret Newman Endowed Chair at the UT College of Nursing.

Reflections on the Transforming Presence of Margaret Ann Newman:

The following reflections come from the American Academy of Nurses’ Nursing Theory-Guided Practice Expert Panel dialogue section and from emails and cards:

Sometimes a person enters our lives and it changes us forever. Margaret was one of those people for me and for many. Her contribution to the nursing discipline lives on.
In gratitude,
    – Elizabeth Ann Manhart Barrett

 I am sad about the Earth now missing Margaret, such a great treasure. Her writing always included “breakthroughs” and that will continue to inspire and enlighten. Her Spirit will be near.
     – Dr. Patricia Chrisham, Professor Emerita, University of MN School of Nursing

I feel now as if all were a miracle which happened to me;  I met Dr. Margaret Newman at the University of Minnesota; she accepted me as her doctoral student; I worked  with her and learned a lot in a new nursing paradigm together with my classmates; and, I earned the degree of PhD at U of M.  I came back to Japan and had a lot of opportunities to teach health as expanding consciousness to graduate students of OCNS and others and worked with them and clients with cancer; and I with fellows who love HEC created the Non-profit Organization Corporation: Newman Theory/Research/Practice in Japan and are working with supporters very interestingly. I think this is really a kind of divine gift to me. I cannot write well in English. It is too much. I am standing in awe.
    – Dr. Emiko Endo*, Japan

[*It is important to note that Emiko Endo traveled from Japan to Memphis in November to be with Margaret. On November 16, Emiko, Donna Jean Mehr (Margaret’s niece), Katheryn Skinner (Margaret’s friend), and Carolyn Graff (UT Memphis College of Nursing Professor), had the last theoretical dialogue with Margaret: At this meeting, Emiko “truly appreciated that Margaret’s assertion, ‘Vulnerability, suffering, disease, death do not diminish us’ is really true.”]

Margaret taught me SO much about theory development when I was a student in her doctoral course at NYU–I am forever grateful to her for that, which catalyzed my interest in the relation of theory and research. I am confident that Margaret’s contributions to nursology will live on forever. Her thoughts, her voice, and her publications are a continuing inspiration to all of us! She already is missed. I am so glad that she was honored as an AAN Living Legend.
   – Jacqui Fawcett

Of course, I knew this day was coming, but the moment holds its own meaning. Since I read your message, I’ve been in another world, flooded with memories and very distracted in trying to “do Christmas”. Years ago, I was with Margaret when she got the phone call with the news that Martha Rogers had died. We went on with our discussion but Margaret was ‘spaced out’. I knew the depth of feelings there, so personal and vital, yet there we were carrying on with the day. I feel like this now – surreal. How our lives are interconnected! I’m glad I had my visit to her when she was still in her apartment. She took me right into the midst of her world in Memphis, which was so precious.  Now, Margaret’s going brings the time to remember, reflect and make sense of the deeply moving phase of my life when I went to study with her at UMIN. Not that her part in my life can disappear! How vital it was, including being the catalyst for so many of my special friendships! That dialogue doesn’t release us, does it? It just keeps unfolding, taking each of us with it! My decade as a student with her at UMN (1988-1998) involved so many memorable activities as well as the intense dialogue. Always at Christmas now I remember the Christmas day she cooked a special festive dinner when I was so far from home (she was a very good cook). We laughed a lot and went walking in the snow. When I stayed with her in Tucson she drove me across the border into Mexico. In Tucson we walked in snow blanketing the magnificent cacti in the desert. Memories are flooding in!
   – Dr. Merian Litchfield, Wellington, New Zealand

Margaret made such an important impact on nursing. I think she’d see this as a last step in expanding consciousness.
   – Anastasia Pharris-Ciurej, PhD, MSN, Stockholm, Sweden

 Our nursing society lost a truly inspiring person who will be remembered. With her work she was and will be present for ever also among Slovene nurses and nursing students. Her legacy will also in future link us in join effort on improving the discipline and science of nursing care.
She will be missed.

     – Majda Pajnkihar, PhD, RN, FAAN, Professor and Dean, University of Maribor

Margaret taught me theory development in the doctoral program at NYU.  I’ve used what she taught in my theoretical thinking.  She also helped me with the concept of time, which was one of the concepts for my dissertation.  Certainly an intelligent person who was caring and giving of her knowledge.  She still lives in many ways in the pandimensional universe integral with the energy/spirit of many people.
   –  John Phillips, 2018

 Margaret was a gift to us all who study nursing and are committed to it as a discipline. Her light will shine on into the future as she laid the foundation for us all toward an evolving consciousness for nursing and our world. A heart opening Wonder Woman.
   – Jean Watson

We invite your comments on the ways in which Margaret Newman inspired you.

References

Johnson, D.E. (1961). The significance of nursing care. American Journal of Nursing, 61(11), 63-66.

Newman, M. A. (1966). Identifying and meeting patients’ needs in short-span nurse-patient relationships. Nursing Forum, 5(1), 76–86.

Newman, M. A. (1979). Theory development in nursing. Philadelphia, PA: F.A. Davis. Newman, M. A. (1994a). Theory for nursing practice. Nursing Science Quarterly, 7(4), 153–157.

Newman, M. A. (1994b). Health as expanding consciousness (2nd ed.). Boston: Jones and Bartlett (NLN Press).

Newman, M. A. (1997).  Experiencing the whole. Advances in Nursing Science, 20(1), 34-39.

Newman, M. A. (1999). The rhythm of relating in a paradigm of wholeness. Image: Journal of Nursing Scholarship, 31(3), 227–230.

Newman, M. A. (2002). The pattern that connects. Advances in Nursing Science, 24(3), 1–7.

Newman, M.A. (2008a). Transforming presence: The difference that nursing makes. Philadelphia: F.A. Davis.

Newman, M.A. (2008b). It’s about time. Nursing Science Quarterly, 21(3), 225-227.

Newman, M. A., Sime, A. M., & Corcoran-Perry, S. A. (1991). The focus of the discipline of nursing. Advances in Nursing Science, 14(1), 1–6.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. (2008). The focus of the discipline revisited. Advances in Nursing Science, 31(1), E16–E27.

Rogers, M. (1970). An introduction to the theoretical basis of nursing. Philadelphia, PA: F. A. Davis.

For more information about Margaret’s life, see the Memphis Funeral Home obituary

In lieu of flowers, contributions can be made to the fund for the Margaret Newman Endowed Chair

At an AAN meeting – From Left to Right: Dorothy Jones, Margaret Newman (center) and former students and Newman Scholars Dr. Jacqueline Somerville and Dr. Angeline Peters-Lewis

from left to right: Margaret Pharris, Dorothy Jones, Margaret Newman, and Marlaine Smith. Taken in 2008 after the Newman Scholars Dialogue, Boston,MA

Margaret with advisees

Margaret, Maggie Pharris, Ellen Egan

Celebrating Margaret’s 81st birthday

Margaret with Richard Cowling

Gigi Oaks, Susan Drummon, Rebecca Meyer with Margaret

Pharris, Litchfield, Newman Lamendola,Jones

Margaret Newman and Martha Alligood, taken at the University of Tennessee Knoxville in spring 1995. Photo by Sandra Thomas

 

Margaret Newman young

Margaret Newman young adult

Margaret Newman child