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Discussion Question:
Newman pointed out that, “nurse client relationships often begin during periods of disruption, uncertainty, and unpredictability in patient’s lives” (Smith & Parker, 2015, p. 288). Page copied and pasted below. Statement highlighted below.
Explore what she means by this statement.
Then, reflect on a patient that you cared for that you could apply her theory to.
Provide details of the interaction and outcomes.
Posting should be 250 words
See below pg 288 content
Insights Occurring as Choice Points of Action Potential
The disruption of disease and other traumatic life events may be critical points in the expansion of consciousness. To explain this phenomenon, Newman (1994a, 1997b) drew on the work of Ilya Prigogine (1976), whose theory of dissipative structures asserts that a system fluctuates in an orderly manner until some disruption occurs, and the system moves in a seemingly random, chaotic, disorderly way until at some point it chooses to move into a higher level of organization (Newman, 1997b). Nurses see this all the time—the patient who is lost to his work and has no time for his family or himself, and then suddenly has a heart attack, which leaves him open to reflecting on how he has been using his energy. Insights gained through this reflection give rise to transformation and decisions about where energy will be spent; and his life becomes more creative, relational, and meaningful. Nurses also see this in people diagnosed with a terminal illness that causes them to reevaluate what is really important, attend to it, and then to state that for the first time they feel as though they are really living. The expansion of consciousness is an innate tendency of humans; however, some experiences and processes precipitate more rapid transformations. Nurse researchers working within the theory of HEC have clearly demonstrated how nurses can create a mutual partnership with their patients to reflect on their evolving pattern and the points of transformation.
Newman (1999) pointed out that nurse–client relationships often begin during periods of disruption, uncertainty, and unpredictability in patients’ lives. When patients are in a state of chaos because of disease, trauma, loss, or other causes, they often cannot see their past or future clearly. In the context of the nurse–patient partnership, which centers on the meaning the patient gives to the health predicament, insight for action arises, and it becomes clear to the patient how to get on with life (Jonsdottir et al., 2003, 2004; Litchfield, 1999; Newman, 1999). Litchfield (1993, 1999) explained this as experiencing an expanding present that connects to the past and creates an extended horizon of action potential for the future.
Endo (1998), in her work in Japan with women with cancer; Noveletsky-Rosenthal (1996), in her work in the United States with people with chronic obstructive pulmonary disease; and Pharris (2002), in her work with U.S. adolescents convicted of murder, found that it is when patients’ lives are in the greatest states of chaos, disorganization, and uncertainty that the HEC nursing partnership and pattern recognition process is perceived as most beneficial to patients.
Many nurses who encounter patients in times of chaos strive for stability; they feel they have to fix the situation, not realizing that this disorganized time in the patient’s life presents an opportunity for growth.
The disruption brought about by the presence of disease, illness, and traumatic or stressful events creates an opportunity for transformation to an expanded level of consciousness (Newman, 1997b, 1999) and represents a time when patients most need nurses who are attentive to that which is most meaningful. Newman (1999, p. 228) stated, “Nurses have a responsibility to stay in partnership with clients as their patterns are disturbed by illness or other disruptive events.” This disrupted state presents a choice point for the person to either continue going on as before, even though the old rules are not working, or to shift into a new way of being. To explain the concept of a choice point more clearly, Newman drew on Arthur Young’s (1976) theory of the evolution of consciousness.
Young suggested that there are seven stages of binding and unbinding, which begin with total freedom and unrestricted choice, followed by a series of losses of freedom. After these losses come a choice point and a reversal of the losses of freedom, ending with total freedom and unrestricted choice. These stages can be conceptualized as seven equidistant points on a V shape (Fig. 16-2). Beginning at the uppermost point on the left is the first stage, potential freedom. The next stage is binding. In this stage, the individual is sacrificed for the sake of the collective, with no need for initiative because everything is being regulated for the individual. The third stage, centering, involves the development of an individual identity, self-consciousness, and self-determination. “Individualism emerges in the self’s break with authority” (Newman, 1994b). The fourth stage, choice, is situated at the base of the V. In this stage, the individual learns that the old ways of being are no longer working. It is a stage of self-awareness, inner growth, and transformation. A new way of being becomes necessary. Newman (1994b) described the fifth stage, decentering, as being characterized by a shift from the development of self (individuation) to dedication to something greater than the individual self. The person experiences outstanding competence; his or her works have a life of their own beyond the creator. The task is transcendence of the ego. Form is transcended, and the energy becomes the dominant feature—in terms of animation, vitality, a quality that is somehow infinite. In this stage, the person experiences the power of unlimited growth and has learned how to build order against the trend of disorder

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