2.1 Nursing Theories for Mental Health Nursing

Martha E. Rogers’ Theory of Unitary Human Beings views nursing as both a science and an art. The uniqueness of nursing, like any other science, is in the phenomenon central to its focus. The purpose of nurses is to promote health and well-being for all persons wherever they are. The development of Rogers’ abstract system was strongly influenced by an early grounding in arts, as well as a background in science and interest in space. The science of unitary human beings began as a synthesis of ideas and facts.

The nursing theory provides a way to view the unitary human being, who is integral with the universe. The unitary human being and his or her environment are one. Nursing focuses on people and the manifestations that emerge from the mutual human-environmental field process. A change of pattern and organization of the human and environmental fields is transmitted by waves. The manifestations of the field patterning that emerge are observable events. By identifying the pattern, there can be a better understanding of human experience.

There are eight concepts in Rogers’ nursing theory: energy field, openness, pattern, pan-dimensionality, homeodynamic principles, resonance, helicy, and integrality.

The energy field is the fundamental unit of both the living and the non-living. It provides a way to view people and the environment as irreducible wholes. The energy fields continuously vary in intensity, density, and extent. There are no boundaries that stop energy flow between the human and environmental fields, which is the openness in Rogers’ theory.

Rogers defines pattern as the distinguishing characteristic of an energy field seen as a single wave. It is an abstraction, and gives identity to the field. Pan-dimensionality is defined as “non-linear domain without spatial or temporal attributes.” The parameters that humans use in language to describe events are arbitrary, and the present is relative; there is no temporal ordering of lives.

Homeodynamic principles postulate a way of viewing unitary human beings. The three principles of homeodynamics are resonancy, helicy, and integrality. Resonancy is an ordered arrangement of rhythm characterizing both the human and environmental fields that undergo continuous dynamic metamorphosis in the human environmental process. Helicy describes the unpredictable, nonlinear evolution of energy fields as seen in non-repeating rhythmicities, and postulates an ordering of the human evolutionary emergency. Integrality covers the mutual, continuous relationship of the human and environmental fields. Changes occur by the continuous repatterning of the human and environmental fields by resonance waves. The fields are integrated into each other, but are also unique.

In Rogers’ Theory of Unitary Human Beings, a person is defined as an indivisible, pan-dimensional energy field identified by pattern, and manifesting characteristics specific to the whole, and that can’t be predicted from knowledge of the parts. A person is also a unified whole, having its own distinct characteristics that can’t be viewed by looking at, describing, or summarizing the parts. Rogers also explains that people have the capacity to participate in the process of change. The environment is an “irreducible, pan-dimensional energy field identified by pattern and integral with the human field.” The two fields coexist and are integral to each other.

Rogers defines health as an expression of the life process. It is the characteristics and behavior coming from the mutual, simultaneous interaction of the human and environmental fields, and health and illness are part of the same continuum. The multiple events occurring during the life process show the extent to which a person is achieving his or her maximum health potential. The events vary in their expressions from greatest health to those conditions that are incompatible with the maintaining life process.

The nursing theory states that nursing encompasses two dimensions: nursing as art and nursing as science. From the science perspective, nursing is an organized body of knowledge specific to nursing, and arrived at by scientific research and logical analysis. The art of nursing is the creative use of science to better people, and the creative use of its knowledge is the art of its practice. Rogers claims that nursing exists to serve people, and the safe practice of nursing depends on the nature and amount of scientific nursing knowledge the nurse brings to his or her practice.

The nursing process has three steps in Rogers’ Theory of Unitary Human Beings: assessment, voluntary mutual patterning, and evaluation.

The areas of assessment are: the total pattern of events at any given point in space-time, simultaneous states of the patient and his or her environment, rhythms of the life process, supplementary data, categorical disease entities, subsystem pathology, and pattern appraisal. The assessment should be a comprehensive assessment of the human and environmental fields.

Mutual patterning of the human and environmental fields includes:

• sharing knowledge
• offering choices
• empowering the patient
• fostering patterning
• evaluation
• repeat pattern appraisal, which includes nutrition, work/leisure activities, wake/sleep cycles, relationships, pain, and fear/hopes
• identify dissonance and harmony
• validate appraisal with the patient
• self-reflection for the patient

To prepare nurses to practice Rogers’ model, the focus of nursing curriculum should be the transmission of the body of knowledge, teaching and practicing therapeutic touch, and conducting regular in-service education. Emphasis should be on developing self-awareness as a part of the patient’s environmental energy field, as well as the dynamic role of the nurse pattern manifestation on the patient. There should also be an emphasis on laboratory study in a variety of settings, and the importance of the use of media in education.