Contributor – Jacqueline Fawcett
September 3, 2018
Updated by Margaret Dexheimer Pharris and Melody Waller
January 14, 2022
Dorothy Jones, Emiko Endo, Marlaine Smith, Jane Flanagan
March 11, 2022
UTHSC Margaret A. Newman Center for Nursing Theory
Author – Margaret A. Newman, RN, PhD, FAAN, LL (Living Legend)
Year First Published – 1979
- Transforming presence
- Mutual nurse-patient/family/community relationship
- Uncovering meaning through pattern recognition
- Gaining insight and discovering choices
- Unfolding awareness/expanding consciousness
- Undivided wholeness/boundarylessness
- Human-environment-health interaction
- Fluctuation of the life process
A grand theory of nursing.
The theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of their health status. 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—a 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.
Nurses practicing within this perspective experience the joy of participating in the expanding process of others and find that their own lives are enhanced and transformed. Pattern recognition is central to both research and practice, which reflects a hermeneutic, dialectic praxis approach. Disease is no longer the focus. Rather, the focus is on the person as an evolving whole, guided by “the necessity of unconditional love, which manifests itself in sensitivity to self, attention to others, and creativity.” [from Newman, M. A. (2008). Transforming presence: The difference that nursing makes. Philadelphia, PA: F. A. Davis.Kindle location 172]
The relevance of movement, time, and space was part of the original explication and has re-emerged in the evolving patterning of unfolding consciousness.
Overview of the Theory
The theory of health as expanding consciousness stems from Martha Roger’s theory of the science of unitary human beings. Rogers’ assumptions regarding patterning of persons in interaction with the environment are basic to the view that consciousness is a manifestation of the evolving pattern of person-environment interaction.
Consciousness is defined as the informational capacity of the system (in this case, human being); that is, the ability of the system to interact with the environment (Bentov, 1978). 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.
Rogers’ insistence that health and illness are simply manifestations of the rhythmic fluctuations of the life process is the foundation for viewing health and illness as a unitary process moving through variations in order-disorder. From this standpoint, one can no longer think of health and illness in the dichotomous way characterized in medical science; that is, health as an absence of disease or health as a continuum from wellness to illness. Health and the evolving pattern of consciousness are the same.
A person is identified by her or his pattern, which reflects the pattern of the person within the larger pattern of the environment. The pattern is evolving through permutations of order and disorder, including what in everyday language is called health and disease. Pattern recognition emerges from a process of uncovering meaning in a person’s life. Meaning is inherent in pattern, and vice versa.
A Paradigm Shift
To see health as the pattern of the whole, one needs to see disease not as a separate entity but as a manifestation of the evolving pattern of person-environment interaction. The paradigm shift is:
- From a focus on treatment of symptoms to a search for pattern
- From viewing disease and disruption as negative to viewing them as part of a self-organizing process of expanding consciousness.
- From viewing the nursing role as addressing the problems of disease to helping people to get in touch with their own pattern of expanding consciousness.
David Bohm’s theory of reality as undivided wholeness supports the view of health and illness as a unitary process (Bohm, 1980). Bohm posits an unseen, underlying pattern (called the implicate order) as the primary order of reality. All the tangential things of the world are explications of the implicate order. Disease (and all other observable manifestations of human functioning) can be seen as the explication of the implicate order. From this perspective, disease is considered a manifestation of the wholeness of the underlying pattern, not a separate entity. The view of health as the evolving pattern of the whole requires a nonfragmentary world view. Disease and non-disease are simply different points of view of a much larger reality. They cannot be separated from the whole, except in a fragmentary way of viewing them.
The situation that brings a person to the attention of a nurse represents a time in people’s lives when the old rules don’t work anymore, a time when one must make a choice. The task is to learn how things work, to discover the new rules, and to move on to a new level of being and understanding. Both Gregory Bateson (1979) and Arthur Young (1976) emphasized this task as the purpose of life. It is the crux of situations in which nursing can assist people in their search for understanding of the evolving pattern of their lives. A person moves through stages of consciousness involving the loss of freedom in the development of self-identity until a turning point is reached (Young, 1976). At this time, the things that worked in the past don’t work anymore. What was considered progress is no longer progress. It is at this stage that the task is to learn new rules. There is a realization of self-limitation that precedes new inner growth, bringing about the transformation that makes it possible to go beyond oneself in expanding consciousness. The mutuality of the nurse-client relationship facilitates this inner-growth and transformation.
The transformation that occurs at the turning point may be understood from the standpoint of Ilya Prigogine’s theory of change (Prigogine, Allen & Herman, 1977). Prigogine asserts that the usual fluctuations of deterministic processes interact through chance events to bring about a kind of giant fluctuation that propels the system on to another, higher level of organization and functioning. Disorder places a strain on existing structure and is resisted by the structure. If the force of the fluctuation is great enough, the structure is forced to change and moves through a temporarily chaotic situation to a new higher order. Transformation takes place as the system moves far from equilibrium. The action at the critical point of the fluctuation signals potential to go in a number of directions, and it is impossible to know which way it will go. At some point one direction takes over and a new order is established where new rules apply.
Movement through the period of disruption, disorganization and uncertainty is facilitated by the presence of a caring other. Current research documents the importance of a nurse’s supportive partnership with the client in allowing the process of expanding consciousness to unfold.
- Newman’s theory of health as expanding consciousness and persons with lower extremity chronic skin wounds
Newman, M. A. (1966). Identifying and meeting patients’ needs in short-span nurse-patient relationships. Nursing Forum, 5(1), 76–86.
Newman, M.A. (1971). Time estimation in relation to gait tempo. Perceptual and Motor Skills, 34, 359–366.
Newman, M. A. (1972). Nursing’s theoretical evolution. Nursing Outlook, 20(7), 449–453.
Newman, M. A. (1973). Identifying patient needs in short-span nurse-patient relationships. In M.E. Auld & L.H. Birum (Eds.), The challenge of nursing (pp. 98-103). St. Louis, MO: Mosby.
Newman, M. A. (1975). The professional doctorate in nursing: A position paper. Nursing Outlook, 23, 704-706.
Newman, M. A. (1976). Movement tempo and the experience of time. Nursing Research, 25, 173–179.
Newman, M. A. (1978). Nursing theory. (Audiotape of an address to the 2nd National Nurse Educator Conference in New York.) Chicago, IL: Teach’em, Inc.
Newman, M. A. (1979). Theory development in nursing. Philadelphia, PA: F. A. Davis.
Newman, M. A. (1982). Time as an index of expanding consciousness with age. Nursing Research, 31, 290-293.
Newman, M. A. (1982). What differentiates clinical research? Image, 14, 86-88.
Newman, M. A. (1983). Editorial. Advances in Nursing Science, 5(2), x-xi.
Newman, M. A. (1984). Nursing diagnosis: Looking at the whole. American Journal of Nursing, 84, 1496-1499.
Newman, M. A. (1986). Health as expanding consciousness. St. Louis, MO: C. V. Mosby.
Newman, M. A. (1987). Nursing’s emerging paradigm: The diagnosis of pattern. In A. M. McLane (Ed.), Classification of nursing diagnoses, Proceedings of the seventh conference of the North American Nursing Diagnosis Association (pp. 53-60). St. Louis: Mosby.
Newman, M. A. (1987). Aging as increasing complexity. Journal of Gerontological Nursing, 12, 16–18.
Newman, M. A. (1987). Patterning. In M. Duffy & N.J. Pender (Eds.), Conceptual Issues in Health Promotion. A report of proceedings of a Wingspread conference. Indianapolis: Sigma Theta Tau International.
Newman, M. A. (1989). The spirit of nursing. Holistic Nursing Practice, 3(3), 1-6.
Newman, M. A. (1990). Newman’s theory of health as praxis. Nursing Science Quarterly, 3, 37–41.
Newman, M. A. (1990). Toward an integrative model of professional practice. Journal of Professional Nursing, 6(3), 17-173.
Newman, M. A. (1991). Health conceptualizations. Annual Review of Nursing Research, 9(1), 221-243.
Newman, M. A. (1991). Commentary. Research as practice. Nursing Science Quarterly, 4(3), 100-101.
Newman, M. A., & Moch, S. D. (1991). Life patterns of persons with coronary heart disease. Nursing Science Quarterly, 4, 161–167.
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. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-14.
Newman, M. A. (1994). Health as expanding consciousness (2nd ed.). Sudbury, MA: Jones & Bartlett (NLN Press).
Newman, M. A. (1994). Into the 21st century. Nursing Science Quarterly, 7(1), 44-46.
Newman, M. A. (1994). Theory for nursing practice. Nursing Science Quarterly, 7(4), 153–157.
Newman, M. A. (1995). A developing discipline: Selected works of Margaret Newman. Sudbury, MA: Jones & Bartlett (NLN Press).
Newman, M. A. (1997). Evolution of the theory of health as expanding consciousness. Nursing Science Quarterly, 10(1), 22–25.
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. (2003). A world with no boundaries. Advances in Nursing Science, 26(4), 240–245.
Newman, M. A. (2005). Preface. In C. Picard & D. Jones (Eds.), Giving voice to what we know: Margaret Newman’s theory of health as expanding consciousness in research, theory, and practice (pp. xxiii–xxvi). Sudbury, MA: Jones & Bartlett.
Newman, M. A., & Jones, D. A. (2007). Experiencing the whole: Health as expanding consciousness (state of the art). In C. Roy & D. A. Jones (Eds.), Nursing knowledge development and clinical practice (pp. 119-128). New York, NY: Springer.
Newman, M. A. (2008). Transforming presence: The difference that nursing makes. Philadelphia, PA: F. A. Davis.
Newman, M. A. (2008). It’s about time. Nursing Science Quarterly, 21(3), 225–227.
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.
Margaret A. Newman (1933 – 2018 )
For more information about Dr. Newman, see “A Tribute to Margaret Ann Newman“
- New York University, New York; Nursing, PhD, 1971
- University of California, San Francisco, Nursing, MS, 1964
- University of Tennessee, Memphis; Nursing, BSN, 1962
- Baylor University, Waco, Texas; Home Economics, BS HE, 1954
- Professor Emeritus, University of Minnesota, 1996
- Professor, School of Nursing, University of Minnesota, Minneapolis, MN, 1984-1996
- Professor, Department of Nursing, College of Human Development, The Pennsylvania State University, University Park, PA, 1977-83
- Professor-in-Charge, Graduate Program and Research, Department of Nursing, College of Human Development, The Pennsylvania State University, University Park, PA, 1977-80
- Acting Director, PhD Program, Division of Nursing, School of Education, Health, Nursing, and Arts Professions, New York University, New York, NY, 1976-77
- Associate Professor, Division of Nursing, School of Education, Health, Nursing, and Arts Professions New York University, New York, NY, 1975-77
- Assistant Professor, Division of Nursing, School of Education, New York University, New York, NY, 1971-75
- Director of Nursing, Clinical Research Center, University of Tennessee, Memphis, TN, 1965-67
- Assistant Professor, College of Nursing, University of Tennessee, Memphis, TN, 1964-67
- Assistant Instructor, College of Nursing, University of Tennessee, Memphis, TN, 1962-63
Recognition and Awards
- Living Legend, American Academy of Nursing, 2008
- Who’s Who in America, 1996
- E. Louise Grant Award for Nursing Excellence, University of Minnesota, 1996
- Nurse Scholar Award, Saint Xavier University School of Nursing, 1994
- Sigma Theta Tau Founders Award, Elizabeth McWilliams Miller Award for Excellence in Research, 1993
- Distinguished Scholar in Nursing, New York University Division of Nursing, 1992
- Distinguished Resident, Westminster College, Salt Lake City, Utah, 1991
- Featured in videotape series, Nursing Theorists: Portraits of Excellence, sponsored by the Helene Fuld Health Trust, 1990
- Hall of Fame, University of Mississippi School of Nursing, Jackson, Mississippi, admitted 1988
- Distinguished Alumnus, Division of Nursing, New York University, New York, New York, 1984
- Outstanding Alumnus Award, College of Nursing Alumni Association, University of Tennessee Center for Health Sciences, Memphis, Tennessee, 1975; 2002.
- Who’s Who in American Women, 1983
- Travelling Fellow, New Zealand Nursing Education and Research Fund, October-November, 1985
- Distinguished Faculty, Seventh International Conference on Human Functioning, Wichita, Kansas, 1983
- American Journal of Nursing Scholar, awarded by American Nurses’ Foundation, 1979
- Founder, Nursing Theory Think Tank, Postdoctoral workshop initiated by the Department of Nursing, The Pennsylvania State University, University Park, Pennsylvania, October 5-6, 1978, with subsequent meetings in Indianapolis and Detroit, 1979; Minneapolis, 1980; Denver, 1981, Dallas, 1982; Cleveland, 1983; Minneapolis, 1984; Boston, 1985; Austin, 1986; Philadelphia, 1987; and Tucson, 1988.
- Latin American Teaching Fellow, Universidade Federal do Rio Grande do Sul, Porto Alegre, and Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, July-August 1976, January 1977
- Fellow, American Academy of Nursing, admitted 1976