Transcript File - Kristen`s Professional Portfolio

Martha Rogers:
Science of Unitary
Human Beings
Ferris State University
Kristen Lintjer
Christine Maxim
Sara Potes
Martha Rogers: An
Introduction
 Martha Elizabeth Rogers
was born on May 12, 1914
 Nursing diploma in 1936,
Knoxville General Hospital
 Bachelor of Science degree
in Public Health Nursing in
1937, George Peabody
College in Nashville
 Public health nurse in rural
Michigan where she stayed
for 2 years before returning
to further study
Martha Rogers: An Introduction
 Master’s degree in 1945, Teacher’s College
Columbia University, New York
 Public health nurse in Hartford, CT, advancing from
staff nurse to acting Director of Education
 Established and eventually became the Executive
Director of the first Visiting Nurse Service in
Phoenix, AZ
 Doctorate degree in Science in 1954, John Hopkins
University
 Head of the Division of Nursing at New York
University in 1954
 Officially retired as Professor and Head of the
Division of Nursing in 1975 after 21 years of service
 1979 she became Professor Emeritus and continued
to have an active role in the development of
nursing and the SUHB until her death on March 13,
1994
History: Science of
Unitary Human Beings
Rogers directed her efforts “to evolve a
conceptual system that would give identity
to nursing as a knowledgeable endeavor.”
(Fawcett, 2005, p. 316)
 Deliberately set out to develop a conceptual
model when she realized that “there had to
be a body of knowledge that was specific to
and unique to nursing, or there was no need
for higher education in nursing at all.”
(Fawcett, 2005, p. 316)
Used a primarily deductive approach to
develop the Science of Unitary Human
Beings but also engaged in inductive
thinking. (Fawcett, 2005)
Phenomena of Interest
The phenomenon of central concern to
nursing is “the study of unitary, irreducible
human beings and their respective
environments.” (Fawcett, 2005, p. 319)
Concern with people and the world they live
in
World View
• Reflects the Simultaneous Action World View
• Philosophical threads are “holism, process,
•
•
•
•
[pan]dimensionality, evolution, energy fields, openness,
noncausality, and pattern” (Fawcett, 2005,p. 318)
Reflects a holistic view of human beings and
environment
Change is continuous, relative, and innovative
Human beings are always progressing, reaching toward
their potential (Fawcett, 2005)
Parse names Rogers as “the creator of a new paradigm
in the discipline of nursing, the simultaneity paradigm”
(Hektor, 1989, p. 63)
Science of Unitary Human
Beings:
The Concepts
Human
Beings &
Environment
•
•
•
•
•
Energy Field
Openness
Pattern
Pandimensionality
Homeodynamics
Health
• Well-Being
Nursing
• Independent
Science of
Nursing
• Art of Nursing
Practice
Nonrelational Propositions
Concept: Energy Field
Human Being
Energy Field
Environment
Energy Field
Concept: Energy Field
(continued)
 A means of perceiving people and their respective
environments as irreducible wholes
 Field…is a unifying concept and energy signifies
the dynamic nature of the field. Energy fields are
infinite and pandimensional; they are in
continuous motion
 Human Energy Field: an irreducible, indivisible,
pandimensional energy field identified by pattern
and manifesting characteristics that are specific to
the whole and which cannot be predicted from
knowledge of the parts
 Environmental Energy Field: an irreducible,
[indivisible] pandimensional energy field identified
by pattern and integral with the human [energy]
field
(Fawcett, 2005)
Concept: Openness
Energy fields are open, not a little bit
or sometimes, but continuously
Openness is nonvariant
(Fawcett, 2005)
Nursing
Assessment
• Rogerian nursing focuses
on concern for people
and the world in which
they live.
• Purpose of nursing is to
promote health and wellbeing for all persons.
• The art of nursing is the
creative use of the
science of nursing for
human betterment
(Rogers, 1994).
Professional
practice in nursing
seeks to promote
symphonic
interaction
between human
and environmental
fields
The patient is not
regarded in a
holistic view
(the sum of
parts). The
patient is more
than the sum of
his parts and
cannot be
divided.
Changes in the life process in human beings are
predicted to be inseparable from environmental
changes and to reflect the mutual and
simultaneous interaction between the two at any
point in space and time. Changes are irreversible
and nonrepeatable. They are rhythmical in
nature and evidence growing complexity of
pattern and organization. Change proceeds by
the continuous repatterning of both human
beings and environment by resonating waves.
Energy Field Nursing
Nurse
Harmony
Patient
Concept: Pattern
 The distinguishing characteristic of an energy
field perceived as a single wave
 Pattern is an abstraction, its nature changes
continuously, and it gives identity to the
field…Each human field pattern is unique and is
integral with its own unique environmental field
pattern
 Energy field patterns are not directly observable
 Manifestations of field patterning are observable
events in the real world. They are postulated to
emerge out of the human-environmental field
mutual process
(Fawcett, 2005)
Concept: Pattern
(continued)
 Manifestations of energy field pattern range
from the physical body to such rhythmical
phenomena as diversity in the experiences of
time passing, the speed of motion, and sleepwake cycles
 Rogers has stated that she considers “physical
bodies to be manifestations of field [pattern]”
(Fawcett, 2005, p. 321)
 The evolution of life and non-life is a dynamic,
irreducible, nonlinear process characterized by
increasing complexification of energy field
patterning. The nature of change is
unpredictable and increasingly diverse
(Fawcett, 2005)
Concept: Pandimensionality
A nonlinear domain without spatial or
temporal attributes
Best expresses the idea of a unitary whole
One does not move into or become
pandimensional. Rather, this is a way of
perceiving reality.
[All reality is pandimensional, and in such a
pandimensional world,] the relative nature
of change becomes explicit
(Fawcett, 2005)
Concept: Homeodynamics
There are three dimensions to the concept of
homeodynamics:
1. Resonancy
2. Helicy
3. Interality
The definitions of the three dimensions are
considered principles, explaining the nature
and process of change. (Wright, 2007)
Principle: Resonancy
“The continuous change from lower to
higher frequency wave patterns in human
and environmental fields.”
“Resonancy delineates the direction of
evolutionary change in energy field pattern.”
(Fawcett, 2005, p. 322)
Principle: Helicy
 “The continuous, innovative, unpredictable,
increasing diversity of human and environmental
field patterns.”
 “Helicy addresses the continuous change that
characterizes human and environmental field
patterns.”
(Fawcett, 2005, p. 322)
http://www.youtube.com/watch?v=bcZ06E
ZKxLs
Principle: Interality
“The continuous mutual human field and
environmental field process.”
“Integrality emphasizes the nature of the
relationship between the human and
environmental fields.”
(Fawcett, 2005, p. 322)
Concept: Well-Being
An expression of the life process
Well-being is a value, it is not an absolute
(Fawcett, 2005)
Concept: Nursing
 Independent Science of Nursing: An
organized body of abstract knowledge
arrived at by scientific research and
logical analysis. A body of knowledge
specific to nursing.
 Art of Nursing Practice: The creative
use of the science of nursing for
human betterment. [Nursing’s]
creative use of its knowledge [is] the
art of practice.
(Fawcett, 2005)
Relational Propositions
A. For nurses, [the] focus consists of a long-
established concern with people and the work
they live in. It is the natural forerunner of an
organized, abstract system encompassing
people and their environments.
B. [The nurse is] an environmental component
for the individual receiving services.
C. The primary focus of nursing is to promote
health
D.The purpose of nurses is to promote…wellbeing for all persons wherever they are.
(Fawcett, 2005, p.326)
Relational Propositions
(continued)
E. Nurses participate in the process of change,
to help people move toward what is deemed
better health
F. The purpose of nurses is to promote health
and well-being for all persons wherever they
are
G.The purpose of nursing is to promote human
betterment wherever people are, on planet
earth or in outer space
(Fawcett, 2005, p.326)
Generation of Theory:
Grand Theories
Theory of Accelerating Evolution (Rogers)
Theory of Rhythmical Correlates of Change
(Rogers)
Theory of Paranormal Phenomena (Rogers)
Theory of Health as Expanding
Consciousness (Newman)
Theory of Human Becoming (Parse)
Life Perspective Rhythm Model (Fitzpatrick)
Generation of Theory:
Middle-Range Theories
 Power as Knowing Participation in Change (Barrett)
 Theory of Human Field Motion (Ference)
 Theory of Sentience Evolution (Parker)
 Theory of Creativity, Actualization, and Empathy
(Alligood)
 Theory of Self-Transcendence (Reed)
 Theory of Kaleidoscoping in Life’s Turbulence
(Butcher)
 Theory of Enfolding Health-as-Wholeness-andHarmony (Barrett)
 Theory of Healthiness (Leddy & Fawcett)
 Theory of Perceived Dissonance (Bultemeier)
 Theory of Aging (Alligood & McGuire)
 Theory of Enlightenment (Hills & Hanchett)
 Theory of the Art of Professional Nursing (Alligood)
Application to Practice
Rogerian Cosmology and Philosophy. Retrieved from
http://rogeriannursingscience.wikispaces.com/
Comprehensiveness
• Fawcett describes the theory as:
– Sufficiently comprehensive in
depth and content
– Four metaparadigms are defined
and described in detail
– Depth in the description of the
relationship between unitary
human being and the environment
Depth of the Theory
• Model is based on science
• Nursing is an empirical science
• Continually translating theoretical knowledge
•
into human service
Always maintained the nursing practice
needs to be theory based
–
–
–
–
Flexible and creative
Individualized
Socially orientated
Compassionate and skillful
Validity of the Theory
• It provides direction for nursing practice
• In depth guidelines written for:
•
– Nursing research
– Nursing education
– Adminsitration of Nursing Services
– Nursing practice
Compatible with ethical standards for nursing
How Applicable is the
Theory?
• Covers any health related issue from birth to
•
death
Person
– Families, social groups, communities
• Can be used in a wide range of clinical areas
– Outer space?
Uses in Clinical
Practice
Nursing Interventions
Therapeutic Touch
Imagery and Meditation
Music, Color and Light
Therapy
A physical body does not
constitute a human being,
because the human field is
energy which extends
beyond the physical
boundary.
Vital energy is continuously circulated
through the body. The Chinese call these
pathways meridians and the Hindus refer
to them as chakras that provide energy to
the body. An interruption in the flow of
energy will cause ill health in the blocked
area because the body is seen as no longer
whole.
Treatment of blocked energy
involves acupuncture, acupressure,
massage, Yoga, therapeutic touch,
color, sound and crystal therapy,
which will redirect the flow of the
energy.
Examples of interventions to
help with the flow of energy
Color Therapy
• Colored lights are applied to the body.
• Red, yellow and orange are found to be
•
•
•
•
stimulating or building colors.
Green, turquoise and blue are repairing or
balancing.
Magenta is spiritual, emotional and
physically balancing.
Indigo, purple and violet are calming and
depress the activity of internal organs.
Scarlet is the most emotionally and
physically stimulating.
Crystal Therapy
• Crystals are used in the patients environment.
• Quartz absorbs negative energy currents, eliminating them from the
room as well as the body. This could be especially helpful in an ICU
environment where there is a lot of electrical equipment.
• Rock crystal maximizes physical and mental awareness and
encourages free circulation of life force.
• Crystals placed in a patients bedside water will prevent it from
getting stale, but should be placed in a clear water jug and exposed
to light.
Therapeutic Touch
Therapeutic touch is healing technique used to
relieve or eliminate emotional or physical
pain. It is a non-invasive, holistic approach to
healing that stimulates the recipients
recuperative powers. It is a modern day layingon-of-hands and is based on the theory of an
energy exchange between people.
We each have all the equipment
needed for therapeutic touch right
at our fingertips.
Therapeutic touch appears very simple, it
starts with simply laying hands on or close
to the body of an ill person for 10 to 15
minutes. It is actually much more complex
and involves the exchange and moving of
energy and must be done by a trained
practitioner.
Purpose of Therapeutic Touch
•Alleviate or cure
pain
•Relieve anxiety
•Speed up the
body’s natural
healing properties
•Decrease stress and
promote relaxation
Imagery
• Images live in the home of pandimensional
space,time and motion. There is no here and there,
in and out, up and down, no location, no
directionality in the nonlinear domain.
• Imagery is a knowing beyond words one can
enhance one’s power to create change.
• In imagery, we experience the principles of
homeodynamics that Rogers named helicy,
resonancy, and integrality.
• Imagery is a modality that allows people to more
fully participate in their health care by mobilizing
healing abilities using the power of the imagination.
“Imagination is more
important than
knowledge.
Knowledge is limited.
Imagination encircles
the world" (Einstein
as noted by Viereck,
1929).
Guided Imagery
Guided imagery is the use of the mind to arrive
at a relaxed state and to create mental
visualization in order to promote physical and
mental health. Guided imagery can be done
alone or it can be done through the direction of
another person.
Treatment of Chronic Pain Using
Guided Imagery
• The use of guided imagery to assist persons
•
•
•
experiencing pain as they evolve with the pain
experience is an effective evidence-based nursing
intervention.
Theory stresses the importance of a person being
capable of knowingly participating in the process of
change.
Assisting the person with chronic pain to be aware of
change as the pain evolves creates a sense of wellbeing.
Chronic pain is not an isolated event but a manifestation
of the whole. Therefore getting well involves resolving
issues in all aspects of the person’s life.
• First is an awareness of the issues. Physical awareness
of the pain is only a small part of human awareness.
• For many people guided imagery causes a
disappearance of time and space.
• Guided imagery should not be used in place of analgesic
medications but in adjunct with a pain regimen.
• Guided imagery techniques are used to relax, transform
sensory images of pain, and change thinking about pain.
Phase One of Guided Imagery
• Patient must be in a
•
•
deep, relaxed state.
Achieve this through deep
breathing exercises and
muscle relaxation while
utilizing calming sounds
or music.
Helpful to have patient
start with relaxing the
toes and slowly working
up to the head, body part
by body part.
Phase Two of Guided Imagery
• Phase two involves the actual
visualization itself.
• Several different types depending
on if treating pain, anxiety,
relaxation or healing.
• Pain control imagery involves
imagining the pain and
transforming that image into no
pain at all.
• An example would be imagining
your back pain as voltage and
then cutting off the current,
thereby cutting off the pain.
• No side effects except for some
sleepiness.
Nursing
Education
"education is for the
future, yesterday’s
methods will
not suffice for
tomorrow’s needs"
(Rogers, 1961).
Structure nursing education programs to
teach nursing as both a science and as a
learned profession.
Rogers’ model clearly articulates
beliefs and values about human
beings, health, nursing and the
educational process.
Rogers’ model has been used to
guide curriculum development
in all levels of nursing
education.
Rogers has said that nurses must
commit to lifelong learning. The
nature of the practice of nursing is
the use of knowledge for human
betterment.
Rogers advocated for separate licensure for
nurses prepared at the associate degree
and the baccalaureate prepared nurse.
Rogers acknowledged that there is a
difference between the technically oriented
nurse and the professional nurse.
The Professional Nurse
• The professional
nurse needs to be
well rounded.
• Education needs to
include the
humanities,
sciences and
nursing.
Bachelors Degree Nurses
Math
Political
Science
Computer
Science
Language
Ethics
Anthropology
Logic
Professional Nurse
Chemistry
Psychology
Microbiology
Art
Biology
Music
Sociology
Physics
• Rogers believed research was an important
component to nursing education.
• Students need to be able to:
Have tools
Of
Investigation
Identify
Problems
Be able to read
Literature
Intelligently
Masters prepared nurses need
to know how to perform
applied research.
Doctoral Programs
Doctoral programs will focus on
nursing as a learned field of endeavor
and will produce the fundamental
basic research and the theoretical
research.
Learning Clinical Skills
• Acquisition of technical skills may be
limited for the student in the hospital due
to severity of patients and the use of
technology.
• Manipulative technical skills can be
practiced and learned in practice labs,
clinics, home health agencies, homeless
shelters and senior centers.
Critical Case Study Using Rogerian
Conceptual Model
• Young woman admitted to psychiatric unit
with severe depression secondary to
ovarian malignancy.
• Accompanied by husband and one year
old child. Husband appears supportive
and attentive. He works as an
accountant.
• Diagnosis made two months ago. Had
surgery and is currently undergoing
Case Study (continued)
• She has been sitting lonely with
decreased ADL, repeated crying spells,
decreased talking, muttering to self,
decreased sleep, decreased appetite,
neglecting child, complains of severe pain.
• Three days ago attempted suicide by
ingesting rat poison.
Assessment
• Teary eyed young woman, ill kempt,
clinging to husband, looking perplexed,
not talking. When asked about condition,
cries inconsolably.
Nursing Care with Rogers Model
• Pattern appraisal
• Mutual patterning
• Evaluation
Pattern Appraisal
• Visable rhythmical pattern is a manifestation
•
•
•
of evolution to dissonance.
Has pattern manifestation of dissonance
…depression with suidical ideation, ovarian
malignancy, pain.
A pattern activity of healing is noted through
reports of a positive operative course.
Patterning has to be directed towards
reduction in perceived dissonance with her
personal and environmental field.
Pattern Appraisal (continued)
• Pain is a manifestation of perceived dissonance.
• Decreased environmental energy transfer is
•
•
visible by decreased talking and crying.
Manifestation of fear….her self knowledge links
her illness to her personal belief of being
punished for her past sins
Appraisal can be grouped into exchanging
patterns, communication patterns and relating
patterns.
Pattern Appraisal (continued)
• Time between nurse and patient is needed
to foster her healing.
• During the process the nurse must rely on
personal intuition and insight regarding
the emerging pattern.
• All this pattern forms the unitary pattern
of the patient.
Mutual Patterning
• The process is mutual between the nurse and
•
•
•
patient.
The surgery performed, medication she is
receiving are patterning modalities.
Patterning activities planned by the nurse are
therapeutic touch, humor, meditation and
imagery.
The patient needs to be assessed fully
regarding her ability to understand and agree
with different patterning modalities.
Mutual Patterning (continued)
• Therapeutic touch can be introduced.
• Touch is introduced and incorporated into the
•
•
management of pain, helps in energy
transmission for healing and helps in
developing trust in the nurse.
Teach her how to center the energy and
channel her energy to the area of pain.
Use humor for increasing socialization and
developing self confidence and developing
worthiness.
Mutual Patterning (continued)
• Human environmental patterning needs to
involve the other individuals who share
her environment including husband and
son.
• Options are introduced relating to increase
communication and hygiene patterns.
• The entire family is involved in power as
knowing participation in change.
Evaluation
• The evaluation process centers on the
•
•
•
perceptions of dissonance that exist after the
mutual pattern activities.
The appraisal process is repeated.
Manifestation of worry, pain, fear, sadness of
mood has to be appraised with family members.
A summary of the dissonance and/or harmony
that is perceived is then shared with the patient
and mutual patterning is modified or instituted
as indicated based on the evaluation.
Society of Rogerian Scholars
(SRS)
• Founded in 1986 in the living room of
Martha Rogers.
• Met twice a month during Martha Rogers
life to address ongoing inquiry into science
of unitary human beings (SUHB).
• Continues on today through collective
body of research and writing about the
SUHB. Gives assurance that the voice of
Martha Rogers has not been silenced.
SRS Continues Martha Rogers
Work
• Society does not undertake specific
projects.
• Members use SUHB to guide their
research or practice and to publish their
work in peer reviewed journals.
• In 1988 began publishing Nursing Science
News.
• In 1993 began publishing Visions: The
Journal of Rogerian Nursing Science.
Focus of SRS
• Education
• Research
• Practice in service to humankind
http://www.youtube.com/watch?v=tmmXl
MPhRyQ
References
• "Abstract Of Martha Rogers Video 0001." 20 Sept. 2009.
Web. 6 Mar. 2010.
• Fawcett, Jacqueline. 2nd ed. 2005. Print.
• "[email protected]." Message to the author. 4 Mar.
2010. E-mail.
• Welcome to the Society of Rogerian Scholars - Homepage.
22 Feb. 2010. Web. 06 Mar. 2010.
<http://societyofrogerianscholars.org>.
• Wright, Barbara W. "The Evolution of Rogers' Science of
Unitary Human Beings: 21st Century Reflections." Nursing
Science Quarterly 20.64 (2007). Print.
• YouTube - Broadcast Yourself. 11 July 2009. Web. 06 Mar.
2010. <http://youtube.com/watch?v=bcv06EZKxLS>.
References
•
Therapeutic Touch: The Imprimatur of Nursing
Dolores Krieger The American Journal of Nursing, Vol. 75, No. 5 (May, 1975), pp. 784-787
(article consists of 4 pages) Published by: Lippincott Williams & Wilkins Stable URL:
http://www.jstor.org/stable/3423456
•
Krieger, Dolores. Therapeutic Touch Inner Workbook. Santa Fe, NM: Bear & Company Publishing, 1996.
•
Pain Management Nursing Changes in the Meaning of Pain with the Use of Guided Imagery Wendy
Lewandowski, RN, PhD, CS; Marion Good, RN, PhD, FAAN; Claire Burke Draucker, RN, PhD, CSPosted:
07/14/2005; Pain Manag Nurs. 2005;6(2):58-67. © 2005
Energy Fields Nursing: An Exploration of New and Re-Discovered Boundaries for Practice.
by Francis C Biley RN PhD Lecturer in Nursing,University of Wales College of Nursing and
Catherine Jones RGN BN(Hons)
Post-graduate Student,University of Wales College of Nursing
•
•
eCAM Advance Access published online on February 2, 2008
eCAM, doi:10.1093/ecam/nen006
The Effect of Therapeutic Touch on Pain and Fatigue of Cancer Patients Undergoing Chemotherapy
Nahid Aghabati1, Eesa Mohammadi1 and Zahra Pour Esmaiel2