Newman’s theory of health as expanding consciousness and persons with lower extremity chronic skin wounds

Contributor: Katherine C. Rosa
October 24, 2018

Research/Theory Exemplar (Health as Expanding Consciousness)

Rosa, K. C. (2004). Newman’s research as praxis: Health as expanding consciousness and living with lower extremity chronic skin wounds. PhD Dissertation, Boston College, ProQuest Information and Learning Company.
Rosa, K. (2006). A process model of personal healing and transformation in
persons with chronic skin wounds. Nursing Science Quarterly, 19(4),
349- 358.
Rosa, K. (2011). The process of healing transformations: A model for holistic
practice. Journal of Holistic Nursing, 29(4), 322-337.
Investigator – Katherine C. Rosa, PhD, CNP
Project dates – 2002-2004
Location – Massachusetts General Hospital
Theoretical framework

This research study was grounded in Newman’s Theory of Health as Expanding Consciousness. Newman synthesized ideas from Roger’s Science of Unitary Human Beings on the nature of person (Rogers, 1970), quantum reality (Bohm, 1980), consciousness (Bentov, 1977), evolution of consciousness (Young, 1976 ), and dissipative structures (Prigogine, 1984) to develop her theory of health as expanding consciousness. Newman’s ideas that supported this study are:

  •  Humans are known by pattern, manifested by behavior, and reflective of a mutual interaction with their environment. Examples of pattern manifestations are found in the rhythm of a person’s walk, cadence of voice, openness, emotions, imaginings, memories, verbal responses, and behavioral responses.
  • Change is a process that is continuous and innovative manifested in behaviors and responses. Over a lifetime, individuals continually communicate with the environment, evolving in a more ordered and increasingly complex way.
  • Human patterning is an evolving whole moving through a process of transformation initially, in which personal choices are bound by parental rule or traditions until circumstances disrupt ease of movement. Changes brought by disease or life transition disturb a person’s previous pattern and becomes an opportunity to expand awareness of self and others. Within this moment, there is an opportunity to make new choices, expanding awareness, and fostering patterns of increasing complexity and integration to emerge.
  • Expanding consciousness is manifested by choice and movement toward a new order and increasing complexity.
  • For Newman it is in the process of expanding consciousness within which health is revealed. A brief presentation of the theory and research method can be found here .
Summary of the research

Chronic skin wounds (CSW) are a complex and prevalent worldwide problem that is predicted to rise particularly as the number of elders and those living with vascular diseases increase. Lifestyle behaviors such as smoking, physical activity, diet, and foot care contribute to the development, recovery, and healing of CSW. Adults living with CSW experience pain and uncertainty associated with wound healing. They report alterations in usual daily activities including dressing, grooming, work and often avoid socially pleasurable activities, fearing wound odors and unsightly dressings will offend others. Patients with re-occurring wounds encounter the possibility of limb amputations and/or life threatening systemic infections during the course of their healing.

Although treatment advances have improved recovery rates, chronic skin wounds remain a prevalent national health problem. Evidence exists on wound characteristics, treatment options, models of care, and rates of healing. A thorough review of the literature yielded a scarcity of research on CSW studied from the science of nursology. Newman’s hermeneutic-dialogic praxis research approach guided the development of the research questions, methodology, and analysis of data for this study.

The purpose of this study was to gain understanding of persons living with CSW during a moment focused on healing their wounds. Two research questions were asked: 1)What is the life pattern manifested by an adult living with a chronic skin wound and 2) What are the themes expressed by life pattern manifestations across participants? Newman’s method was extended to include an intentional creative self- expressive drawing as an expression of wholeness and to provide a visual expression used to enhance understanding. Data collection and analysis followed Newman’s praxis approach. Data collection occurred over a three to five week period for each participant and conducted over a nine-month period. Interviews lasted on average 60-90 minutes.


The sample consisted of eight women and ten men, whose ages ranged from 49-98 years, lived with a CSW from six months to 13 years, and often with co-morbid conditions. Pattern and change in relation to behavior were discussed with participants and provided insight into their unique pattern at that moment in time.

An exemplar of one narrative summary is included.

Although Steve was the youngest of six, he experienced a lonely childhood. Steve joined the armed services. He enjoyed these years. Afterwards, he started a career as a campus police officer, married, and fathered two children. He was proud of his ability to bounce back from work related injuries such as fractures and a stabbing. At 50, he had a heart attack. Later his life upended when he developed diabetes, divorced, and moved all within five years. Recently his life was very restricted by his foot wound. He drew himself having an oversized foot with a hole. He knew he was careless with his health and took steps to change. Reviewing his pattern appraisal, Steve reflected, “If people listen to the instructions that they are getting which I don’t do too well, that it would probably get better faster.” His pattern of the whole emerged as “Choosing to police himself.”  (see the figures below – all figures originally published in Dr. Rosa’s dissertation, cited above)

Theoretical Implications

Analysis across participants revealed five patterns:

a) Childhood environments reflected personhood lost in the crowd,

b) forging ahead even in the face of pain and suffering while minimizing personal threats to health,

c) a significant life event preceded the manifestation of CSW,

d) personal knowledge fostered a new awareness, insight, change, and integration of the wound experience and

e) support from nurse wound care specialist and others enabled people to get through difficult times.

A process model of wholistic healing and personal transformations emerged from the data.

Exemplar of HEC Praxis Method – Steve’s Life Diagram

Exemplar of HEC Praxis Method – Steve’s Narrative Diagram

Exemplar of an Extension of HEC Praxis Method – Steve’s Drawing

About  Katherine C. Rosa, PhD, CNP

While in my masters program, Martha E. Roger’s Science of Unitary Human Beings captured my imagination. Later during my doctoral program, Carol Picard presented her research on, Pattern of expanding consciousness in midlife women, igniting a spark within me! I quickly changed my research question from a focus on Therapeutic Touch to use Newman’s theory of health as expanding consciousness with persons living with chronic skin wounds. I discovered the beauty of engaging in mutual discovery through dialogue surpassed the communication style I’d honed over years as a nurse practitioner. From this research, a Process Model of Healing and Personal Transformation emerged. This work received the Young Investigator’s award from the Association for the Advancement of Wound Care, an international multidisciplinary organization.

Building upon this work, I conducted an exploratory study to further understand pregnant Cambodian American women’s responses to life challenges. Findings from these two works suggested the phenomenon of appreciating meaning was a pivotal component of the nurse patient praxis relationship. With support from the Yvonne L. Munn Center for Nursing Research’s Connell Nursing Research Scholar’s Award at Massachusetts General Hospital, I conducted an integrative review on the nurse patient relationship. Twenty years of research using Newman’s theory of health as expanding consciousness praxis approach with persons with chronic illness was reviewed to examine the use of the nurse-patient relationship and its seven dimensions of health, caring, consciousness, mutual process, patterning, presence and meaning. An article reporting these results was published in Nursing Science Quarterly. Presently, my scholarly work is focused on developing a tool to measure patients’ perceptions of their nurse-patient relationship facilitating healing. I have presented papers at international conferences, published in scholarly journals, and am a member of the Society of Rogerian Scholars, Sigma Theta Tau International, International Association of Human Caring, and Therapeutic Touch International Association. I work at the Benson Henry Institute of Mind Body Medicine at Massachusetts General Hospital as a nurse practitioner.