Rosemary Parse's Human Becoming theory and nursing paradigms

Nursing Theorist: Rosemary Parse

BACKGROUND & INFLUENCING FACTORS

Rosemarie Rizzo Parse earned her BS in Nursing from Duquesne University, located in Pittsburg, and earned her Master's Degree in Nursing and PhD from the University of Pittsburg. In 1981, Parse "...presented a unique theory of nursing titled 'Man-Living Health'..." which was a synthesis of concepts and principles from the work of Roger (18970, 1984) as well as "concepts and tenets from existential phenomenology." (Hickman,

Rosemary Parse's theory on 'Human Becoming' holds that man is the combination of psychological, biological, sociological and spiritual factors in what is a 'totality paradigm' and that man is a unitary being in an ongoing interaction that is one of mutuality with the environment in what is called a 'simultaneity paradigm'. The three principles as stated by Rosemary Parse are as follows: (1) Meaning: (a) Man's reality is given meaning through lived experiences; and (b) Man and environment cocreate; (2) Rhythmicity: (a) Man and environment cocreate (imaging, valuing, language in) in rhythmical patterns; (3) Contranscendence: (a) reference to a reaching beyond the limits set by a person; and (b) One is constantly undergoing transformation. (Hagopian, 2001) Parse's 'Human Becoming' Theory holds that the 'person' is an 'open being who is more than and different from the sum of the parts' and that the environment is' everything in the person and his experiences' and is 'inseparable, complimentary to and evolving with." (Hagopian, 2001) Hagopian (2001) states that in the view of Rosemary Parse 'health' is an "open process of being and becoming and involves synthesis of values. In Rosemary Parse's view 'nursing' is a "human science and art that uses an abstract body of knowledge to serve people." (Hagopian, 2001)

The work of McKenna (1997) entitled: "Nursing Theories and Models" states that Parse (1987) serves as a reminder that "scientific discipline like nursing encompasses more than one paradigm with which to guide practice and research. Each paradigm or worldview...results in the formation of several theories, which are a reflection of the parent paradigm's belief and value system "so that the concepts and propositions within a theory are congruent with the views set forth in the paradigm. Therefore, the development of science occurs within the context of paradigms." (McKenna, 1997) Parse held that nursing science has historically been known to develop and continues the course of development "within two almost contradictory paradigms: (1) the totality paradigm; and (2) the simultaneity paradigm. (McKenna, 1997)

From the view of the 'totality paradigm' the individual is seen as a "...organism whose nature is a composite of bio-psycho-social and spiritual dimensions." (McKenna,

From this view, the environment stimuli that are both internal and external to the person and the individual may manipulate and interact with the environment for the purpose of goal achievement and health maintenance. Nursing goals of this paradigm have as their primary focus the promotion of health and the care and cure of those who are sick and finally disease prevention. The totality paradigm as posited by Parse is "the predominant paradigm in nursing..." And has its roots in "the mechanistic Newtonian and Cartesian view of science and dovetails completely with the philosophy inherent within the medical model." (McKenna, 1997) From this view, the theory of nursing is focused on assisting the adaptation of the sick individual for 'self-care, interaction, and attainment of health' and the central figure of authority is the nurse. The practice of nursing is stated to be guided "...by a linear nursing process approach whereby the patient's problems area assessed, a plan of care is drawn up, interventions are undertaken and the results are evaluated." (McKenna, 1997) McKenna states that the 'totality paradigm' "gives rise to research which is quantitative in nature and where causal and associative relationships are testable." (McKenna, 1197) the 'simultaneity' paradigm is different from the totality paradigm in three primary ways: (1) in it assumptions about the person and health; (2) in relation to the goal of nursing; and (3) in the implications for research and practice. (McKenna, 1997) the 'simultaneity; paradigms views the individual as a "unitary being who is in continuous and mutual simultaneous interaction with the environment. From this view health is viewed as "a process of becoming' as well as "a set of value priorities." (McKenna, 1997) the individual experiences health and only that individual can provide an accurate description for health since no "optimum health" exists but only "how one experiences personal living." (McKenna, 1997) Winkler (1983) states that Parse's assumptions come primarily from philosophical sources and secondarily from Rogers' theory and states that the original nine assumptions of Parse (1981) are those as follows:

Man is coexisting while coconstituting rhythmical patterns with the environment (based on pattern and organization, coconstitution, and coexistence;

Man is an open being, freely choosing meaning in situation, bearing responsibility for decisions (based on energy field, openness, and situated freedom).

Man is a living unity continuously coconstituting patterns of relating (based on energy field, pattern and organization, and coconstitution;

Man is transcending multidimensionally with the possibles (based on openness, four dimensionality, and situated freedom).

Health is an open process of becoming, experienced by man (based on openness, coconstitution, and situated freedom).

Health is a rhythmically coconstituting process of the man-environment interrelationship (based on pattern and organization, four dimensionality, and coconstitution).

Health is man's pattern of relating value priorities (based on openness, pattern and organization, and situated freedom).

Health is an intersubjective process of transcending with the possibles (based on openness, coexistence, and situated freedom).

Health is unitary man's negentropic unfolding (based on energy field, four dimensionality, and coexistence).

IV. OTHER KEY CONCEPTS and RELATIONSHIPS in the MODEL

The work of Morrison (2004) entitled: "Virtuous Nursing: More Caring Than Science and More Scientific Than Care" states that the contribution of Parse to theoretical nursing include two major contributions: (1) Parse categorized nursing theories into two groups: (a) those which rely on an understanding of the human body as a compete entity which is defined by the sum of its parts (totality paradigm) and (2) those which rely on an understanding of the human body as a dynamic entity which interact with the environment in ways that sometimes elute measurement ("Simultaneity Paradigm)."

V. COMPONENTS of the THEORY TESTED

Morrison (2004) states that the theory of Rosemary Parse is one that "reflects a commitment to nursing as a human science...[and]...describes nursing in terms that emphasize the human element in all that occurs in the activity of nursing." Morrison additionally relates that the nursing process is inclusive of five elements that make the provision needed by a nurse in a method of approaching patient care and are that in any encounter with a patient: (1) the nurse assess the patient situation; (2) makes a nursing diagnosis based on the assessment; (3) develops a plan of nursing care; (4) implements the plan of nursing care; and (5) evaluates the plan of nursing care. (2004)While the nursing process may appear to be one that is linear in nature, in reality "the stages of the process are 'dynamic and continuous'.

VI. MOCK CLINICAL CASE

In a mock clinical case the patient presents depressed and has recently lost his wife, and added to this has severe diabetes and the patient's sugar levels are extremely high on presentation. The nurse in this mock clinical case quizzes the patient and quickly learns that the patient does not cook for himself and has been eating many of the wrong foods for his condition. The nurse develops a plan by which the patient will be in receipt of 'meals-on-wheels' on a daily basis allowing his diet to stabilize his sugar levels. To ensure that this takes place, the nurse contacts the 'meals-on-wheels' committee herself and regularly checks with the patient to see that he still receiving this balance meal each day.