For most of her patients, the day would seem to drag along despite the fact that their rehabilitation sessions were relatively short. Her conclusion was that these patients had an altered sense of reality. This eventually sparked her theory of Health as Expanding Consciousness (HEC). Looking at the practice of nursing through a more metaphysical lens, the HEC posits that there is a universal and expanding consciousness in which all humans participate -- the healthy, the recuperating, and the incurably ill. Newman believed this was a natural law just as real as the law of gravity -- an unseen energy system that is constantly and unceasingly interacting with everyone and everything in nature (Vandemark, 2008). For Newman, nursing is, at its core, a process of recognition of where patients are in their consciousness, evidenced by the patterns they demonstrate (Neill, 2002). Nurses must be able to identify where a patient is on the continuum of consciousness in relation to their physical environment. If attuned and creative, nurses are better able to help patients elevate their consciousness level to improve their health and abilities. In other words, nurses can use HEC to meet patients where they are, helping them use their personal power to overcome injury or disease through recovery or prevention.

There are strengths and weaknesses to Newman's HEC theory. It is strong in that it embeds a sense of caring and consideration for the patient into nursing inventions (Weingourt, 2008). Patients are viewed in a very holistic way that extends beyond their physical capabilities or limitations. Because of this, HEC can be considered applicable to nearly any health setting and for nearly every demographic. Critics, however, point out that the theory is very abstract (Vandemark, 2008). There are those who do not subscribe to metaphysics. For them, many of Newman's ideas fall flat. In addition, understanding and knowing when or how to interject caring into practice can be confusing. Much of Newman's ideas are purely qualitative. This means that the application of expanded consciousness is subjective depending on the nurse administering the treatment (Neill, 2002). This means that outcomes may not be consistent across the board. This is confounded even further when you consider that patient environments and willingness to participate will also vary. Nurses must understand HEC at a very deep level -- beyond isolated concepts -- to realize its full benefits.

James Fowler -- Faith Development

James Fowler's ideas regarding faith development have been highly examined, debated, and critiqued for nearly twenty years (James, 1997). The faith development theory and its associated stages expand the notion of what faith is. According to Fowler, all humans believe in something or someone (2004). The core of this belief is not religious; rather it is the way we make meaning of the world in which we live -- a way of thinking and being and understanding reality (Jones, 2004). As Fowler himself describes faith, it is:

…the composing or interpreting of an ultimate environment and as a way-of being in-relation to it. [it] must be seen as a central aspect of a person's life orientation. Faith is a primary motivating power in the journey of the self. It plays a central role in shaping the responses a person will make in and against the force-field of his or her life. Faith, then, is a core element in one's character or personality (2004).

For Fowler, faith is acknowledged as simple influential power -- a life-directing idea that guides us. He argues that the way people regard faith is through six distinct stages. Each is guided by specific ways of being. Progression between the stages often results in trauma or internal conflict as people leave the familiar, alter their patterns of thinking, relating and discerning the world and settle into new ways of experiencing life (Fowler, 2004).

Stage 1 is considered the Intuitive-Projective stage and is most common in small children. It is the stage at which basic thought forms about God are created based on lessons from parents or society at large (James, 1997). Stage 2 is referred to as Mythic-Literal and involves recognition of broader...

School-age children enter this stage when they begin to ponder questions about religion and larger concepts about life. Stage 3, Synthetic-Conventional, is common for teenagers who move in varying social circles and begin to form an all-encompassing belief system (Hart, 2008). This may or may not be reinforced by institutional religion and family tradition. This is a stage many enter and never leave; it becomes the cornerstone of their world-view and they come to reject any contradictory beliefs or challenges from outsiders.
Some do break from Stage 3 and enter an Individuative-Reflective stage which Fowler describes as "seeing outside the box" and realizing that other boxes also exist (Fowler, 2004). This stage involves a longing for deeper meaning and a very personal questioning of religion, religious leaders and authority, and definitions of truth. Fowler posits that this stage is often notably non-religious, and much more spiritual in nature. A critical examination of former faith and, at times, disillusionment is common at Stage 4. Coincidentally, Stage 3 thinkers believe that Stage 4 thinkers are lost or, in religious terms, backsliders. Fowler contends that Stage 4 individuals have simply evolved in their attitudes and thoughts about faith and crafted new independent definitions for themselves (2004).

Stages 5 and 6, Conjunctive Faith and Universalizing Faith respectively, refer a realization of the limits of logic and an acceptance of the paradoxes of life. Most people must reach mid-life before they fully enter this stage (James, 1997). They come to appreciate the mystery of life and the merits and value of earlier stages of faith. Faith at these stages is more community oriented and less focused on the individual. Fowler's theories were created from hundreds of personal interviews with every age group, yet they have been met with criticism by other researchers who question empirical support for his claims and also his blending of theology, education and psychological assumptions (Jones, 2004). Still, many educators and religious authorities agree with the underlying ideas behind Fowler's work. It has been used in pastoral counseling and education as well as in psychology and nursing (Hart, 2008).

Conclusion

Margaret Newman and James Fowler both focus their attention on the larger, more spiritual context of human experience and the implication this has in one's healing. There are commonalities that exist between the philosophies of both theorists: human reasoning, the ability to adopt to another's perspective, social awareness, and human formation of a world-view. Newman offers the nurse-patient relationship can be enhanced if it is viewed as a caring partnership. HEC does not really pretend to be a quick fix or direct nursing intervention; instead, it presents an opportunity to assist the sick by recognizing patterns and using this intelligence to expand a patient's consciousness, self-care, and comfort (Awa & Yamashita, 2008).

Fowler concerns himself more with faith as a lens through which we see the world. His ideas about faith over the span of one's lifetime can be particularly beneficial when working with elderly populations. Older, Stage 5 and 6 adults may begin to reincorporate earlier religious beliefs and traditions that were previously discarded (Fowler, 2004). This could be due to physical limitations or also used as a self-healing mechanism to avoid feelings of helplessness or abandonment. A nurse who is attentive can acknowledge this mature spirituality as being helpful to a patient attempting to find meaning in his or her illness.

In sum, both theories/frameworks have implications for the practice of nursing. A theory, by definition, is a group of related concepts that propose action that guide practice. From Margaret Newman and even non-nursing theorist James Fowler we see how using a systematic view of inter-relationships between concepts of spirituality, higher consciousness, caring and empathy can be useful for describing, explaining, predicting, and prescribing nursing interventions that make a difference in the lives of patients. Both philosophies offer insight that can create better nurses.