Newman's HEC and Fowler's Faith Stages in Nursing Practice

Introduction

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, and alleviation of suffering through the diagnosis and treatment of human response (Vandemark, 2008). It is a valued and honorable occupation. There are many nursing theories that exist and that have useful application in the profession. This paper highlights the particular nursing theories and arguments of Margaret Newman and the faith-based, non-nursing theories of James Fowler that have found their way into modern nursing practice. While these two theorists differ somewhat in their overarching philosophies, they share a commonality — both focus on understanding others in a very holistic way, including physically, emotionally, and spiritually, for balanced health.

In Margaret Newman, the nursing practice can find a deeper meaning in patient interactions. A true nursing theorist, Newman believed that nurses should move beyond data collection, basic patient interviewing, and routine bed checks (Awa & Yamashita, 2008). Her theories are rooted in the idea of personal relationship building and an understanding of the greater patient consciousness, which is always at work and constantly evolving. Not only was she concerned with helping patients who suffered from curable diseases, disorders, and conditions, but also with the quality of health for those for whom recovery in the traditional sense was not an option (Weingourt, 1998). She proposed that nurses should look at life through a broader lens and focus on expanded definitions of helping and healing that center on connection facilitated through caring acts.

James Fowler's stages of faith development also hold weight for the nursing profession (Hart, 2008). While not a nursing theorist, his ideas offer much insight into the inner life of others — the spiritual and faith-based life that has been shown to aid the sick in recovery. In instances where patients must endure and cannot necessarily anticipate a recovery, faith may be the anchor for getting through each day. Fowler's six-stage faith development model is both heavily criticized and applauded (Jones, 2004). This paper explores the merits and limitations of both Newman's and Fowler's theories in the hopes of gaining an enhanced understanding of the diverse approaches that can be used in the field of nursing.

Margaret Newman and the Theory of Health as Expanding Consciousness

The crux of Newman's theory of health is that consciousness is 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 (Weingourt, 1998). According to Newman, nurses practicing within this theory find their own lives enhanced and transformed (Neill, 2002). Her beliefs and consciousness-centered approach were born from her early nursing experiences involving rehabilitation patients (Weingourt, 1998). She came to understand the altered connection between the concept of time for her patients and their limited mobility. 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 — an observation that 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.

Strengths and Weaknesses of Newman's HEC

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 interventions (Weingourt, 1998). 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, and for them many of Newman's ideas fall flat. In addition, understanding when or how to interject caring into practice can be confusing. Much of Newman's framework is purely qualitative, meaning that the application of expanded consciousness is subjective and depends on the nurse administering the care (Neill, 2002). Outcomes may therefore not be consistent across the board. This is confounded further when one considers 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.

Conclusion

Margaret Newman and James Fowler both focus their attention on the larger, more spiritual context of human experience and the implications this has for healing. There are commonalities that exist between the philosophies of both theorists: human reasoning, the ability to adopt another's perspective, social awareness, and the human formation of a worldview. Newman offers that the nurse-patient relationship can be enhanced if it is viewed as a caring partnership. HEC does not pretend to be a quick fix or a 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 may function 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 have implications for the practice of nursing. A theory, by definition, is a group of related concepts that propose action to guide practice. From Margaret Newman and non-nursing theorist James Fowler we see how using a systematic view of the interrelationships 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.

Annotated Bibliography

Awa, M., and M. Yamashita. (2008). "Persons' Experience of HIV/AIDS in Japan: Application of Margaret Newman's Theory." International Nursing Review, 55(4), 454–61.

This work explores the experience of persons living with HIV/AIDS in Japan through the lens of Margaret Newman's theory of health as expanding consciousness. Homosexual men afflicted with HIV/AIDS were interviewed and asked to share their personal experiences. Their narratives revealed patterns consistent with Newman's five stages: self-consciousness of their own sexual orientation, chaos, stagnation, a turning point, and regaining a new identity. This article illustrates how, after viewing their patterns, the expanding consciousness of these men becomes evident as they develop compassion for society's underserved and underprivileged and gain deeper levels of connectedness with family and friends. The article also includes recommendations and implications for nurses and those working in public health.

Fowler, James W. (2004). "Faith Development at 30: Naming the Challenges in a New Millennium." Religious Education, 99(4), 405–21.

Fowler shares personal accounts of the origins and emergence of his faith development research. He examines the ways in which religious educators have critically reflected on and adopted his faith development theory and what the implications have been for religion as a whole. Also included is a critical and constructive assessment of the theory, updates to religious education with an increased focus on faith formation and growth, and thoughts about some of the challenges on the subject that are yet to come.

Hart, C. W. (2008). J. Robert Oppenheimer: A faith development portrait. Journal of Religion and Health, 47(1), 118–28. doi:

This article is a review of Oppenheimer's life as a public figure in relation to Fowler's stages of faith. Oppenheimer's life and belief system was said to encompass many themes and ideas of a religious and ethical nature. Included is a full, detailed history of his life and legacy as well as an analysis of his stages of faith in the face of lung cancer after a lifelong addiction to smoking.

James, N. P. (1997). Faithful change: The personal and public challenges of postmodern life. Theology Today, 54(3), 435–436.

This work is a compilation piece in which Fowler examines the complexity of life and an ever-evolving sense of faith. Separated into three parts, it offers an update on his stages of faith, revealed through conversations with Daniel Stern and William James. Fowler also offers a detailed explanation of what he means by "healing or reconstructive change" and takes a closer look at the concept of shame and its impact on health. The third section is concerned mainly with debates regarding global postmodernism. This work addresses the personal issues of child development, injury, and healing, and offers a comprehensive theoretical framework to help religious leaders cope with a variety of situations that regularly occur in ministry.

Jones, T. P. (2004). The Basis of James W. Fowler's Understanding of Faith in the Research… Religious Education, 99(4), 345–357.

This work is a critical review of Wilfred Cantwell Smith's presentation of the nature of faith on James W. Fowler's faith-development paradigm. Weaknesses in Smith's original research are highlighted. The author contends that Christianity and Fowlerian stage-development are related, although the content and development of both remain essentially distinct.

Neill, J. (2002). "Transcendence and Transformation in the Life Patterns of Women Living with Rheumatoid Arthritis." ANS Advanced Nursing Science, 24(4), 27–47.

Margaret Newman's theory of Health as Expanding Consciousness is at the heart of this article. It is a detailed case study that explores the personal life patterns of three women with rheumatoid arthritis as a process of expanding consciousness. The women's stories reveal transcendence of self-boundaries and personal transformation as new ways of living — they find pleasure in simple things and learn to remain positive despite their circumstances. Reviewing illness stories as nursing relationships develop is useful to avoid overemphasizing the technical aspects of nursing and, as Newman contends, to focus on interjecting care and concern into the nurse-patient relationship. The article does caution that illness stories alone can exclude important information that allows people to be appreciated for their wholeness and uniqueness as human beings.

Weingourt, R. (1998). "Using Margaret A. Newman's Theory of Health with Elderly Nursing Home Residents." Perspectives in Psychiatric Care, 34(3), 25–30.

Weingourt reviews components of Newman's views and their applicability to health and nursing as a theoretical framework for working with the elderly. A full analysis is included of how human beings are in actuality open energy systems in constant interaction with the environment, which is itself an open system. The sum of Newman's philosophy for nurses is that to truly understand an individual's health status is to understand the individual's patterns of relating to the environment. To be effective, the nurse must give up the urge to fix things — or fix the patient — and instead enter the process as a caring partner with the client. The nurse-client relationship is enhanced if the nurse can tolerate uncertainty and ambiguity until the new pattern becomes clearer.

Vandemark, Lisa. (2008). "Awareness of Self and Expanding Consciousness: Using Nursing Theories to Prepare Nurse-Therapists." Issues in Mental Health Nursing, 27(6), 605–615.

This article offers insight for nurses, particularly about the role psychotherapy can play for advanced practice psychiatric nurses. Margaret Newman's theories and ideas offer guidance on the psychological and professional development of the nurse. This paper details Newman's Theory of Health as Expanding Consciousness and the concept of awareness of self. It suggests that nurses should be educated in such a way that they are better able to develop self-knowledge to facilitate the nurse-patient relationship and to improve patient care outcomes in psychotherapy.