Volume One Issue Two
TABLE OF CONTENTS
President's Message - W. Richard Cowling III, RN; PhD; CS
Editor's Corner - The Bear's Lair - Thomas Cox
Introduction by John Phillips of Elizabeth Ann Manhart Barrett, RN; PhD; FAAN -
New York University - Martha E. Rogers Center for the Study of Nursing
Science - 2001 Visiting Scholar
Remembrances of Martha E. Rogers - Fran Reeder
Remembrances of Martha E. Rogers - Linda W. Johnston
Research Questions - Poetry by Darlene Sredl
'Broken into Wholeness': Life Patterns of Women Living with Multiple Sclerosis and Rheumatoid Arthritis - Jane Neill
Womanheart - Poetry by Brenda Talley
The Rogers' Homepage: An Evolutionary Emergent - Francis Biley
Windvoices - Poetry by Brenda Talley
Music Review - Anna Biley
Thoughts on Science and Approximation - Thomas Cox
FEEDBACK & EMAIL
We encourage communication in all forms. Letters to the editor are encouraged and welcome and will, if desired, be published in the Newsletter.
Send letters, comments by email to
Thomas Cox - Newsletter Editor
President’s Message by W. Richard Cowling
We have finally entered the cyberspace territory with our newsletter. This was a recommendation made by membership at the 2000 Annual Meeting in New York.
Thanks to Tom Cox, we now have the reality of this newsletter reaching all those who care to seek information about Rogerian nursing science as well as our members. If you are a member, know that your dues support the ability of the organization to bring information to a wider audience. The SRS Board appreciates this commitment to nursing science.
The SRS Board of Directors made a decision to offer a Fall Conference in Richmond, Virginia. The dates of the conference are October 12 & 13, 2002 at the Richmond Marriott. The conference theme is Rogerian Nursing Science: Celebrating the Accomplishments. A call for abstracts is available at our site and there will also be mailings. We welcome everyone’s participation in this event.
Dr. Joanne King Griffin has also agreed to serve as the Director of the Martha E. Rogers Center at New York University for the coming year. Due to her leadership and the efforts of Dr. John Phillips, there will be a Dialogue 2002. The arrangements are in progress and you will be alerted to the details as soon as possible.
The Board of Directors is now seeking applications from interested persons for the position or positions associated with editorship of Visions: The Journal of Rogerian Nursing Science. If you are interested, please see the announcement posted on the listserv or simply send me a message via e-mail (firstname.lastname@example.org) stating your interest and your background. The Board wishes to select an editor or co-editors to facilitate the ongoing work of producing and promoting the publication of unitary scholarship. We are indebted for the 10 years of work, time, and effort as well as the supreme commitment of Drs. Shelia Cheema and Violet Malinski who created and sustained the journal. The 10th volume is forthcoming dependent on manuscript submissions. Please consider this journal as a venue for publication of unitary work.
Beyond the news of our organization, I wanted to address a comment made to me recently about how the Society of Rogerian Scholars is viewed in some circles. The comment was that we are viewed as elitist and unwilling to accept diverse views concerning the interpretation and expansion of unitary science. My first reaction to hearing this, from a very loyal and dedicated member, was to be defensive and to view this perception as inaccurate and unfair. I attributed it to those who cannot see why we so strongly hold to our views and are cautious about “false” interpretations. I decided to give some time for reflection before I developed any further ideas about this report that I was ready to dismiss. I recalled a few messages from some sincere folks over the years who wondered if they should really apply to join SRS because they did not view themselves as scholars. I recall times when people have talked to me about how afraid they were to give an opinion on the listserv or state an opinion at an SRS gathering because they felt fear of being admonished for not having the “correct” perception of what unitary science is really all about. I also remembered conversations with people who felt hurt or angry or dismissed because of encounters with other unitary scholars. Now my experience of involvement in SRS is generally not this. I think we are a pretty collegial group and that we are pretty open with and toward one another. I also know of newcomers who have described being welcomed. Finally, I know that there are many valid versions of reality that may co-exist simultaneously. Yet I know there are many who I saw for the first time who never returned. I know there are many who have not shown up who really would find a high degree of resonance with unitary thinking. So I am making a plea for all of us to think about the idea of being welcoming of new people and expanded ideas. I am not advocating that anyone not stand up and speak their truth. I am suggesting that there is a time for speaking and listening and reflecting and welcoming. I am not sure we are guilty of the perception, but I am sure that I want to listen and be aware of how I might let my enthusiasm about my ideas drown out the voices of new possibilities.
Congratulations to all whom work day-by-day to make a positive difference in our world through unitary nursing science and practice. We are all scholars!!!
Editor's Corner - The Bear's Lair
In a recent post to the Martha E. Rogers listserver, I suggested that there is not so much a shortage of nurses as a shortage of adequate demand for highly skilled, efficient, and caring professional caregivers. This humble Bear finds it hard to understand why it is that nursing leaders, professional nursing organizations, and rank and file nurses do not work to correct, rather than reinforce, the errant perceptions of nursing supply and demand issues. It is clear to me that major health care corporations, administrators of large, for profit, health care institutions and even political leaders would like to avoid focusing on issues of caring, quality, presence, and expertise but unfathomable that nurses, themselves are complicit. A review of the elementary rules of market economics may seem antithetical in a Rogerian publication, but this Bear believes that understandings of wholeness cannot be accomplished by intentional inattention to manifestations in parts. Wholeness requires appreciation not just of foreground but of background and the background of critical issues in healthcare includes issues of market economics because, like butterfly wings in the Amazon, they affect the patterns in which care is rendered and received by unitary human beings.
The most fundamental rules of economics suggest that supply and demand are related to cost, that as the supply increases or the demand decreases, the cost of a good, whether widgets or nursing service and expertise, decreases. In the last days before unionization of American workers, the equations reflected primarily demand. Industry leaders set wages that were often insufficient for workers to live on. However, because there were few alternatives available to most workers, they often stayed at those jobs, worked overtime if available, or worked second jobs to make ends meet. If it sounds like a well known cyclical pattern in nursing, it is because it is.
During the last few years there has been an increase in nursing salaries, more attention to attracting excellent nurses to facilities, bonus plans and increased participation by nurses in management decision-making affecting policies in health care institutions. These increases in attention to nurses' needs and expertise and better compensation plans for nurses reflect the costs of high quality caregiving in an advanced technological society. Excellent work demands excellent pay. Nurses, as 24/7 caregivers are the actors/actresses that truly are 'in charge'. If your shift nurse doesn't determine that you are in crisis, your doctor simply will not know until they come back to the institution. If your nurse doesn't first respond to your pain, your doctor will never know that your pain is intense at 3 AM. When I view the healthcare arena what I see is a black box with nurses feeding inputs and taking outputs, but the cycle starts and ends with nurses. Maybe it is my engineering background, maybe it is my tendency toward particularity, but what I see is that nurses are the ones in charge and other healthcare professionals cluster around nurses. Doctors, respiratory therapists, and administrators initiate few 3 AM phone calls to inform nurses about the well-being and needs of their patients. While extant laws and regulations require nurses to get approval before acting in so many routine areas, the reality is that nurses are better informed, more up to date, more observant, and generally know exactly what another health professional is going to recommend. at 3 AM a nurse is awake, alert, and able to make an informed decision about a patient's needs and treatment. This is rarely true for the person that the nurse has to call to proceed with timely, focused, and appropriate care.
What is the cost for having access to quality nursing? Are there any of us in nursing , or anyone among the public that would choose to have a nursing assistant care for them, their parent or child in preference to a skilled, experienced nurse? The cost of quality nursing is high. By all rights, given the importance and centrality of nursing in the health care arena, the cost of nursing is and should be a major cost factor. However, nursing is also the major income factor in health care organizations. Would any of us ever go to a hospital without nurses? The harsh reality is that the only reason that patients enter a hospital is for the nursing care, not the sporadic medical care. Hospitals, absent nurses, would have little or no income. Nobody goes to a hospital because the CEO is paid $500,000 per annum, they go to the hospital because the nursing care is the best they can get at the time they go.
In order for nurses salaries and opportunities to stabilize, market forces must be allowed to operate. If nursing salaries are too low to attract new, and retain experienced nurses, then salaries must rise to make nursing attractive vis-a-vis other career opportunities. Efforts to avoid this most fundamental reality by increasing the supply of nurses through recruitment, subsidization of for-profit healthcare organizations, sign-on bonuses and loan forgiveness programs, tend to destabilize the profession and 'cause' the supply of nurses to exhibit erratic fluctuations. We face the most significant opportunity to determine the future of nursing at this juncture. If we act to oversupply the healthcare industry with under-trained, undereducated nurses, we will establish a pattern of decreased salaries and decreased respect that will harm nursing for decades to come. If we bite the bullet now and acknowledge that increasing the supply of nurses is a societal, not a nursing profession obligation, we will strive to maintain the extant standards for educational preparation and the standards for licensing until such time as market forces encourage more highly educated, caring people, to enter the field.
The shortage of healthcare providers that is most severe, is a shortage of caring, compassionate, dedicated, and skilled professionals, working in communities, rural areas, inner cities and communities of color, poverty, and inequality. Despite decades of acknowledgment that there are insufficiently many medical doctors working in such areas, medicine qua profession, has done little to increase the supply of physicians where they are needed. As well, there is little effort on the part of administrators of healthcare enterprises to replace themselves with cheaper workers. It is neither nursing's duty, nor responsibility to attract people to nursing as a career. It is society's responsibility, through environmental change, compensation, and working conditions, to encourage people to enter the nursing profession. To do anything else merely replicates a banal history of undersupply and under-demand for excellence in nursing.
SUPPORTING THE NEWSLETTER AND THE SOCIETY OF ROGERIAN SCHOLARS
The online version of the Newsletter is free. However, there are costs associated with its production and the way to support the Newsletter is to become a member of the Society of Rogerian Scholars.
Membership in the Society of Rogerian Scholars is open to all people interested in the evolution and promotion of the thought of Martha E. Rogers, the Science of Unitary Human Beings, and Unitary Health Care. While nursing is the primary beneficiary of the wisdom of Martha E. Rogers, the ideas advanced by her are relevant to many different disciplines. The Society encourages membership from non-nursing health disciplines as well as non-health disciplines.
Print off and forward the following Membership Application Form to:
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I would like to maximize the use of e-mail notifications to encourage wide access to the Rogerian Nursing Science News Online. To accomplish this task I would like to develop mailing lists for nursing school faculty, Deans, students, libraries, and other nursing organizations. If you have mailing lists please that will help reach an ever wider, deeper, more diverse population please send them to me:
Research Questions by Darlene Sredl RN, MA, MSN
Society of Rogerian Scholars
Since its advent as a profession heralded by the work of Nightingale, nursing has been responsible for the development of a body of scientific knowledge specific to nursing and for the imaginative and creative use of this knowledge in the art of practice. The nurturance of human beings is the ever-present and age-old concern of the nursing profession.
The Science of Unitary Human Beings provides a distinctive nursing frame of reference for viewing human beings, the mutual human-environmental process, and nursing practice. Nurses who are concerned with the Science of Unitary Human Beings are challenged to contribute to its conceptual, theoretical and practical development. Nurses are responsible for the logical analysis of the framework and the generation and testing of theories.
How nurses use knowledge derived from the framework to provide a service to society is as important as the knowledge itself. The thoughtful synthesis of the science and art of nursing is essential if the framework is to contribute to the fulfillment of the profession's mandate to provide nursing service to society. All nurses concerned with the development and use of the framework are responsible for engaging in open communication of ideas, questions, challenges, and refutations generated by the framework, and reporting scholarly work and practice in the nursing literaure.
The Society of Rogerian Scholars is committed to fostering the development of the Science of Unitary Human Beings by providing a formal, organized structure for the stimulation, development, and exchange of ideas. The formation of the Society is predicated upon the belief that all nurses around the world should have a forum where questions, ideas, insights, and opinions related to the framework's concepts, theories, and use in practice are discussed.
The Society provides a structure to ensure open and speedy communication of current work and thinking within the framework and the most recent developments and revisions of its concepts, principles, and theories. The fulfillment of the mission and purposes of the Society will help to advance nursing as a science and thereby contribute significantly to the knowledgeable nursing of human beings.
- Advance nursing as a basic science.
- Explore the meaning of a philosophy of wholeness for nursing.
- Foster the understanding and the use of the Science of Unitary Human Beings as a basis for theory development, research, education, and practice.
- Provide avenues for dissemination of information related to the Science of Unitary Human Beings.
- Create forums for scholarly debate.
- Provide educational forums on the Science of Unitary Human Beings.
The mission of the Society of Rogerian Scholars, Inc., is to advance nursing science through an emphasis on the Science of Unitary Human Beings. The focus of the Society is education, research, and practice in service to humankind.
Remembrances of Martha E. Rogers by Fran Reeder
Let me tell you a personal story about a grand theorist by the name of Martha E. Rogers. As a graduate student at the University of Utah, College of Nursing, I met many of the established nursing theorists during a special Welcome week to the world of Nursing Knowledge Development. We had begun reading their books, but now we would be in the same room, facing these famous, intelligent leaders, and expected to talk with them on a personal level! Awesome! My knees were shaking! I had taken Martha Rogers primary book known as the "purple book" entitled An Introduction to the Theoretical Foundation of Nursing, and read it cover to cover over the weekend! I couldn't put it down. Someone had put into words what i had been experiencing in the world with a love of the human-environment relationship that went beyond a mechanical view of how things function, to a focus on how life process unfolded in an evolutionary way. I could see the big picture without being blinded by the boundaries creates by an education that had emphasized the body as physical, and illness as disease. Here was a scholar talking about the use of the imagination to create possibilities in the intuitive, creative realm of knowledge about humans in the environment. Meeting Martha Rogers in person I learned how warm and down to earth she was, how she had a cat named Susie, and how she loved to tell stories that woke people up or made them feel at ease, what ever was called for. She was first a public health nurse in Arizona before going on a courageous journey of revolutionizing nursing education, challenging nursing to be all that it could be.
She gave me license to be optimistic and to begin using my whole self in the learning process, not just my logic and intellect. She firmly believed Nursing had knowledge that was unique and that as a discipline we were to "participate knowingly" in the compassionate service to all people. Most of all Martha wanted to wake nursing up and desired that nurses "think" and know why they live and work as they do. Martha had a vision and it has led her down a courageous path of scholarship for the benefit of the Discipline and the Profession. Talking over punch and cookies in her home in the years I have enjoyed knowing her as a friend as well as a colleague, Martha spoke about the uniqueness of new emergent expressions of life. Diversity was a new emergent in the unfolding of life to be cherished, and celebrated with compassion. Nursing above all, had the social mandate to foster the creative potential of all people. I loved a quote by Martha that expresses the heart of her view of nursing, and I leave it with you to ponder again and again...
Nursing's story is a magnificent epic of service to mankind. It is about people: how they are born, and live and die; in health and in sickness, in joy and in sorrow. It's mission is the translation of knowledge into human service.
Nursing is compassionate concern for human beings. It is the heart that understands and the hand that soothes. It is the intellect that synthesizes many learnings into meaningful ministrations.
(I loved what she had to say to students!)
For students of nursing the future is a rich repository of far-flung opportunities around this planet and toward the further reaches of human explorations of new worlds and new ideas. Theirs is the promise of deep satisfaction in a field long dedicated to serving the health needs of people. (1978) Dream Big!!
Course Instructor: Fran Reeder
University of Colorado School of Nursing
Remembrances of Martha E. Rogers by Linda W. Johnston
My memories of Martha are not so much one narrative story as a whole collection of "memory bytes":
I remember Martha......
At a breakfast meeting in Augusta, Georgia when she deftly laid aside my carefully crafted idea for my doctoral dissertation and somehow got me to commit to doing instrument development instead.
Glancing at the result of a year's labor, a twenty five item instrument that used statements, and saying "This is quite nice, but wouldn't metaphors be much better"?
Giving my final instrument, the Human Field Image Metaphor Scale, her enthusiastic approval.
I remember Martha......
In Pigeon Forge at Corn Pone Cottage. How she loved that place.
Sitting at her kitchen table late one night, listening to me read to her from nursing journals until she fell asleep with her head on her arms.
At Fernandino Beach, standing on a balcony with the ocean in the background, wearing roller blades and a pair of stuffed "love arms" around her neck.
At Fernandino Beach, sitting at a kitchen table, wearing her cap that proclaimed "Just Visiting This Planet".
At the Outer Banks at the History of Flight Museum, celebrating past, present, and future in one all encompassing joyous stance of outflung arms that embraced it all.
In Philadelphia at her 80th birthday party given by Rosemarie Parse in her honor. Of her pleasure when Martha Bramlett picked out Happy Birthday and her admirers all sang. Her pleasure at a picture I took of her that showed her in triplicate.
I remember Martha......
At the end of her life, surrounded by her "two families" who were together for the first time to celebrate her life and mourn her death. Her "birth family" and her "academic family" sharing memories at the top of the mart at the joyous celebration after her funeral. The sharing of stories from both families, each learning from the other of glimpses of a Martha that they had not known.
I remember Martha......
Whose contributions to both her families will never be forgotten. Whose contributions to the advancement of nursing science will never be surpassed. Whose continuing influence will remain through the work of those who embrace her Science of Unitary Human Beings.
Yes, I do remember Martha.
Linda W. Johnston, RN, PhD USC Aiken School of Nursing
NEW YORK UNIVERSITY
MARTHA E. ROGERS CENTER FOR THE STUDY OF NURSING SCIENCE
2001 VISITING SCHOLAR
Elizabeth Ann Manhart Barrett, RN; PhD; FAAN
I'm John Phillips, a faculty member in the Division of Nursing at New York University.
It is my honor to introduce Dr. Elizabeth Manhart Barrett, who is the 2001 Visiting Scholar of the Martha E. Rogers Center for the Study of Nursing Science. Dr. Barrett is one of the founders of the Society of Rogerian Scholars and served as its first president. She is an elected fellow in the American Academy of Nursing, commonly known as FAAN. She serves on several editorial boards and has many publications in refereed journals and is editor of several Rogerian books. Dr. Barrett is the recipient of many distinguished awards, including the 1995 Distinguished Researcher Award from the Foundation of the New York State Nurses Association. Dr. Barrett is a distinguished professor of Hunter College, The City University of New York. Dr. Barrett is a world-renown administrator, educator, and researcher.
She is one of nursing's distinguished scholars, particularly a Rogerian scholar who has been instrumental in the advancement of Rogers' science of unitary human beings. Dr. Barrett is one of the first persons to create a theory derived from Rogers' science. Her Power as Knowing Participation in Change Tool has been translated into other languages. Recently, Dr. Barrett reported in Nursing Science Quarterly that over 30 research studies have been conducted using her power theory and instrument.
Dr. Barrett has a private practice where she uses Rogers' science and integrative modalities to help people to actualize their potentials. She serves as a consultant to institutions and individuals using Rogers' science-guided nursing in research and practice.
Dr. Barrett is a dear and respected friend and colleague to many of us. She is living essence of Rogers' science. Dr. Barrett manifests reverent spirituality. During the many years I've known Dr. Barrett I have never heard her gossip or say unkind things about any person. Dr. Barrett is truly a beautiful energy field, always manifesting love and compassion for people and their predicaments.
Dr. Barrett is probably wondering what the red roses represent. They are from her dear friend, Thomas Cox, known as "Bear," who lives in Richmond, Virginia. He could not be here tonight, so he sent the flowers to signify his love and admiration of Dr. Barrett.
Tonight, Dr. Barrett will illuminate "Health Patterning: Rogers' Science-Guided Nursing Practice." Let's welcome Dr. Barrett, a doctoral alumna of NYU, who brings distinction to New York University and the profession of nursing.
CALL FOR MANUSCRIPTS
Submission of manuscripts for publication in the Newsletter are encouraged. There are two categories of manuscripts in particular: Student manuscripts and Advanced manuscripts. These are not mutually exclusive classes. Anyone can submit a manuscript in either category but the editorial standards for the student manuscripts will be more lenient.
The manuscripts sought are not intended to be competitive with manuscripts that would be submitted to Visions. The official journal of the Society of Rogerian Scholars continues to be Visions and manuscripts for Visions should be sent to the editors of Visions rather than to the Newsletter.
The intent of these manuscripts is to provide a timely environment for exchanges of thought on the interpretation, explication, and development of the work of Martha E. Rogers and the Science of Unitary Human Beings. Any short manuscripts that will help others understand Martha's contributions to nursing and humanity are appreciated. Part of the reason for the page limitation is to keep these articles accessible to newcomers.
All manuscripts are limited to five pages of double spaced, 12 point font. As well, all manuscripts must be submitted in one of the four following formats to keep the editor from going totally crazy:
MS-Word 97 or MS-Word 2000
While we do not want to discourage submissions of paper manuscripts, there really is nobody available to type from a paper submission - on a good day, a bear can type about 1 page per hour and the bear gets increasingly hostile after just a few minutes. Hence, paper submissions are likely to encounter longer delays between submission and publication than electronic submissions. The preferred mode of submission is as an attached file through email to the editor: The kinds of things we publish in the newsletter are contributions in the form of brief articles, abstracts, case studies, clinical vignettes, and letters to the editor. Also, please send brief announcements about completed unitary dissertations, publications, and theses and other noteworthy items and events.
Echoes of fallen leaves now damp and rotting beneath my feet merge with primal rhythms within me. Ancient passions arise with the morning sun.
This new sun shares life illusion with the frail beige residue of tall fennel weeds and for a moment, dry still limbs are soft golden fire. I stand in magic flame. I am the flame. My hands against cool rough bark, feel the vibrations, the movement within, and my breath slows. I close my eyes and a thousand births whisper to me. My womanheart is encircled with this ancient newness,
immersed in fluid passion, and is reborn. Brenda Talley
The Rogers' Homepage: An Evolutionary Emergent by Francis Biley
It is with great pleasure and enthusiasm, and not much skill, that I continue to be webmaster for the best (because it is the only substantive) Rogers site on the internet. I remember the first version, that was little more than a couple of reading lists and a email discussion group archive, that went live in about 1994 or 5 on the UK Government sponsored Mailbase site, which also hosted the first Rogers discussion group, "nurse-rogers".
What can only be described as painful html programming and a steep learning curve (actually its not all that bad) produced the first incarnation of a real Rogers homepage, with loud, and I mean LOUD graphics and backgrounds and more than one too many animated gifs. Still, it was getting a lot of hits, 3 or 4 hundred a month, and that can't be bad for Rogerian science! Then I saw sense, and with the discovery of Frontpage I was able to design something a little more refined. That something stayed online from about 1997 until the beginning of 2002. Infrequently updated, it served a purpose I suppose, and I got many messages of thanks from students who also wanted to know if there was anything I could tell them about the SUHB that could help them with their class project. "Where did you want me to start" I used to reply, thinking about the last 15 years (or more) of my professional life (I know, I'm only a beginner), and my crammed filing cabinet full of SUHB miscellanea. But I always tried my best to help if I could.
I purchased a copy of the latest Frontpage so I could gain access to the site again, I hadn't been able to for almost a year. As soon as I bought Frontpage 2000 I was told that the newer version was available (isn't that always the case), but cracked on and in the last week in January gave myself a month to redesign the existing page, hoping to achive a greater aesthetic sense, more content, quicker download times & etc. So I loaded up Frontpage at home, put the papers I was writing (three I think, on haiku, problem-based learning, and medical iatrogenesis, no four, I'm doing something about what it was like to work with Martha), and for that matter, the family on the back burner, and knocked the latest version of the webpage together in four days, it went live on 29 January 2002. As ever, it is not, nor will it ever be, in a finished state, and there will always be stuff wrong with it (perhaps if I buy the latest version of Frontpage...).
Plans for the future may include a nice Flash graphic or two, if I ever manage to get the hang of Dreamweaver; perhaps a nice interactive "Anfy" graphic like on Richard's site, rare stuff, new photos, guestbooks. In fact I would be getting on with that now if I wasn't writing this for Bear's newsletter.
Fran Biley RN PhD likes trees and chickens, lives for his family, and enjoys being part of the Rogerian community. In his spare time he runs MSc programs.
The wind voices are soft and sleepy
at the dawn time.
In hunting for the day
I have become a leaf
on the flowering plum tree. Molecules of air brush
against my surface as I turn slightly
seeking the sun's light, ah this craving... I am met as a lover seeking comfort in the before day.
Vivid purple-redness overcomes me,
soaks into me, is me.
Fine vibrations of earth's voyage
flow with the fluids in my veins
and the rhythms of the stars and planets
echo in this building of my life being.
The wind spirits are amused
at the one
My joyous peace is not tempered by this tiny laughter.
My reward, I think, for not knowing so much.
Their knowing is reflected as a mirror reflected
in a mirror
and becomes too small and too large
for me to see.
A black beetle the size of a grain of sand
explores the ruffles of
pale gray green lichen.
The dew dries.
'Broken into Wholeness': Life Patterns of Women Living with Multiple Sclerosis and Rheumatoid Arthritis by Jane Neill
In spite of the suffering, uncertainty, and complexity of living with a chronic illness, it is clear that some people experience health within illness through a focus on what is most meaningful in their lives. Margaret Newman's theory of 'Health as Expanding Consciousness' which regards health and illness as a unitary process, was used in this study to discover what was most meaningful to women with Multiple Sclerosis or Rheumatoid Arthritis, by understanding their lives as patterns unfolding over time. There have been no previous Newmanian studies of life patterns among people with these chronic auto-immune diseases. Since both diseases are more prevalent among women and there is evidence that women's experiences of chronic illness and disability are different to those of men, the privileging of women's stories for their own sake was important in this study.
Seven midlife and older women who had lived with a diagnosis of Multiple Sclerosis or Rheumatoid Arthritis for between five and forty years volunteered to share their life stories. An adaptation of Newman's methodology was used to identify their life patterns. The research method involved five interviews: establishing a mutual partnership; a natural conversation about the most important people and events in their lives; sharing the recognition of life patterns; discussing meaningful photographs taken during a period of reflection; reflection on the study and closure. Attention was given throughout the study to ethical issues arising from the vulnerability expressed by the women. Trustworthiness was established by returning copies of interview transcripts, sharing pattern analyses and discussing with each woman a reconstructed life story incorporating recognized patterns. Life patterns and time patterns were identified by arranging the narratives in chronological order, while underlying patterns were identified as recurring themes through all the interviews as the whole pattern of each woman was contemplated.
The life patterns of women with Multiple Sclerosis and Rheumatoid Arthritis revealed turning points, choice points, pattern shifts and underlying patterns that support the theory of 'Health as Expanding Consciousness'. The most important finding from this study was the identification of six underlying patterns arising from the collective life stories, including two shared patterns that were expressed as dialectics of 'energy~fatigue' and 'giving~receiving'. These patterns reflect the complexities of women's lives and concern fluctuating rhythms in the way work is done, help is given, rest is accomplished and rewards are gained, but they tended to give their energy almost exclusively to others without caring about themselves. The shock and chaos of illness forced the women to recognize this pattern and after a choice point they moved towards restoring balance to their lives. All the women found new ways to live with chronic illness that was seen as transformation of the self. Transformation was compared to being 'broken' by the experience of illness but reconstituting a sense of 'wholeness' in a process of expanding consciousness. Even though the study occurred after they had reached a choice point in their lives, the women experienced the pattern recognition process and reflection as empowering in ways that were not anticipated.
This study provides evidence that Multiple Sclerosis and Rheumatoid Arthritis are manifestations of the same underlying patterns of 'energy~fatigue' and 'giving~receiving'. Underlying patterns have not been identified previously in dialectical terms. Furthermore, this study suggests that 'choice point' is a distinct concept and should be differentiated from 'turning point' in research using the theory of 'Health as Expanding Consciousness'. In keeping with the caring, healing and unitary mandate of nursing, a metaphor of energy processes that could substitute for metaphors of warfare in personal understandings of auto-immune disease, is offered.
The empowering nature of pattern recognition indicates that it should be an activity integral to nursing and could replace the emphasis on technical work and the nursing process. Consistent with the theory of 'Health as Expanding Consciousness', the research was experienced as transforming for the researcher as well as for the women who were her research partners.
Jane Neill, RN, DipAppSc, BSc, BNg, PhD, FRCNA
School of Nursing and Midwifery Flinders University GPO Box 2100 Adelaide, SA 5001 AUSTRALIA
E-mail: email@example.com Ph. +61 8 82013428
Music Review by Anna Biley Recently I was lucky enough to be asked to review a selection of CD’s from the ‘Seventh Wave Music’ company, based in Devon, England. The CD’s are all written and performed by Nigel Shaw and all offer the listener something special. ‘Echoes of the Ancient Forest’ (co-written and performed by Carolyn Hillyer) features over one hour of music created by oak, yew, pine holly and rosewood flutes and reed pipes blended with beautiful and haunting vocals. The four tracks on this CD pay homage to the ancient wisdoms of the Willow,Birch Oak and Holly as the music awakens the senses to the smell of the damp, earthiness of the forest floor and the sound of bird song. This CD is almost prayer like and brings the healing energies of the forest a little closer. In ‘The River’ in the second of Nigel Shaw’s compositions, flutes, Tibetan bowls, bells and cymbals combine with natural river sounds and bird song, gathered from Dartmoor, Devon. The music invites the listener to embark upon the river’s healing journey through forest and moor land. This hour long CD is both gentle and refreshing and like ‘Echoes of the Ancient Forest’ is ideal for using in imagery work, meditation of just for pure enjoyment. Finally ‘Requiem – Well of Souls’ follows a traditional framework for a Requiem composition in that the 10 tracks on this CD progress from the ‘Kyrie’ to the ‘Agnus Dei’ and finally the ‘In Paradisium’. However, unlike traditional, classical ‘Requiems’, the focus of ‘Well of Souls’ is upon a celebration of life and evokes hope and love. Although very gentle in nature, this music is also very deep, sombre and thought provoking. It is an extremely spiritual collection, which would help to create a peaceful ambiance for any ritual or healing session. Of these three CD’s by Nigel Shaw it is impossible to differentiate a favourite. At a time when the market is swamped with ‘New Age’ Music, which is often shallow and contrived, the ‘Seventh Wave Music Company’ has managed to create something that is truly new and special. All of these compositions are sincere, spiritual and inspired and all are reasonably priced. They can be purchased directly from Seventh Wave Music, PO Box 1, Totnes, Devon, UK. TQ9 6UQ. In addition it is certainly worth taking the time to browse the catalogue of other recordings that are available from this company as they really do offer something special that is also value for money. The catalogue is available on line at www.seventhwavemusic.co.uk
Anna Biley RN DipN MSc Health promotion Specialist
Thoughts on Science and Approximation
by Thomas Cox
As many people know, I came into nursing fairly late in life. I had already turned 50 when the oft-neglected impulse to 'be a nurse' struck with full force. One of the things that attracted me, immediately, to Martha E. Rogers was her interest in and grasp of other scientific disciplines. My early training and orientation was in electrical engineering, physics, and ultimately mathematics. There was, during my college years, a split between students who were interested in 'pure' mathematics and those who soiled their hands in what was called 'applied' mathematics. To be sure, this was more an arrogance of youthful naiveté than it was a reflection of reasoned maturity. In fact, some of the greatest mathematicians of the twentieth century, and for all time, contributed to both fields. The reasoning behind those of us who considered ourselves 'purists' holds very little water but it is interesting, and perhaps informative for those of us who seek communication with other scientists.
Applied mathematicians tended to work with computers and in endeavors that lacked the elegance of definitive mathematical proofs. In language similar to our own, we might think of them as working with parts and approximations, seeking to understand systems based on fragments. Pure mathematicians, on the other hand, wanted deep understandings and 'proofs'. Pure mathematicians, so we thought, played games with axioms, propositions, and rules of inference that were, quite likely and quite acceptably, unrelated to any real world phenomena. In the 1960s computing power was still relatively limited and the approximations to reality, of applied mathematicians, especially those with limited resources, were often tedious and time consuming. Among the most boring mathematics classes I ever took was the lone undergraduate 'applied mathematics' class. I put it in quotes because the truth was that many of my classes used ideas similar to those in that class but they did it with somewhat greater elegance and certainly far better teaching.
But the split between pure mathematics and applied mathematics is very much like the difference between unitary and non-unitary approaches to nursing. In the final analysis, of course, all we ever know about circles, in the real world, is that they do not exist. We can 'imagine' circles. We have formulae for circles. But we have no 'circles' in the real world. Certainly we have an abundance of round objects that approach circles. We have tires on our cars, CDs to carry our presentations around and store our critical files on, and we have balls, hoops, balloons all around us. But we don't have circles.
In the earliest days of civilization, many of the enduring ideas of Geometry were 'discovered'. Interestingly, many of those geometric laws were based on approximations. So we have a formula for the circumference of a circle and we have a formula for the area of a circle, and we think nothing of using these, even though we have no circle to apply them to. But how did early mathematicians come to discern these relationships? They did it by approximating the length or the area of 'almost circles' by using either short series of lines, or squares (as in the picture below - pic to follow), or triangles.
By successively better and better approximating the 'circles' they were able to make with shorter and shorter lines, or smaller squares or triangles, they developed a theory of underlying principles for the Platonic Ideal Forms that they believed to exist. As they strove to more closely approximate the ideals, even with their finite representations, they were able to uncover the forms that underlie much of modern mathematics, engineering, and physics, as well as more recent branches of study such as bio-mathematics and bio-engineering. They did not confuse their approximations with the ideals, nor did they confuse the physical circles they made with the ideals, just the way none of us confuse vital signs with the person on whom they are measured. Vital signs may be necessary conditions for appreciating a person in a health care encounter but they are not sufficient. Applied mathematics really came into its own with the advances in computer processing speed during the last 20 years. As computer memory and speed increased, what used to be very poor approximations have become very fine. Some experts in cognitive processing suggest that we humans reach overload trying to grasp the meaning of nine chunks of information. Modern computers on the other hand are capable of juggling hundreds of thousands of chunks of information, particularly when there is some information available about what is wanted - such as modeling seemingly chaotic fluid flow in a coronary artery or thermal transfers between two stellar bodies.
Where once upon a time the exact solutions to mathematical problems seemed to hold the most promise for science and engineering, applied mathematics and techniques such as finite element analysis are now ascendant. So too, in nursing, without sacrificing ideals perhaps we need to better define just what it is that is critically important when it comes to approximating human beings. We are always engaged in approximations: we see someone for a brief period, we see only a facet of their being, we see them perhaps as their pattern manifests in health or in illness, when concerned for themselves or for a loved one. What we clearly never really appreciate, but always strive for, is their wholeness, their 'Ideal Form' that underlies all the manifestations that are really just context dependent manifestations to which we respond with our seasoned efforts at approximation. Not only do we not achieve that, we likely never will or could. But, that should not and does not stop us from trying. It makes a difference whether we assume that our perceptions of manifestations are themselves real, or if we acknowledge that our perceptions are approximations.
So a question that keeps occurring to me is: how much do i really have to know to appreciate someone? What is necessary, and what is sufficient? Can I communicate it to someone else or must it remain unvoiced. Keep in mind that I do not think of this as a substitution of a particularistic approach - I know that my representations, whether qualitative or quantitative are far more reductionistic than acceptable. But I am also pretty sure that more direction is possible and that the clearer we are the more likely we are to prevail in political conflicts about what is and what is not essential to nursing. I am pretty certain that in working with most clients - remembering the name of their cat would facilitate the relationship far more than being able to recite their blood pressure from two years ago. Likewise, the success of modern applied mathematics is not based simply on the reduction of complex systems to finite elements, but the quality of the finite representations used to model the whole... In nursing, we have not even remotely begun to tap the power of computers in service to our worldview.
As editor, I'd be happy to have other people share their ideas. Either in response to this piece or to share their own views of the way things work around this planet... Remember, we are all 'just visiting..."
W. Richard Cowling III, RN; PhD; CS
President: Society of Rogerian Scholars
Thomas Cox, RN; MS, MSW, MS
Editor: Rogerian Nursing Science News Online
Copyright 2002 Society of Rogerian Scholars, Inc. This material may not be reproduced without prior written permission See Society of Rogerian Scholars Newsletter Service or contact the editor for more details on using Newsletter articles.