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.

Margaret Newman and the Theory of Health as Expanding Consciousness

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.

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).