Presented By

Prof.Dr. Nefissa A. KaderProfessor of Psychiatric Mental Health Nursing

&Vice Dean for Education and Students Affairs

Objectives • Identify the historical evolution and origin

of the model.

• Be familiar with the author’s philosophical claims.

• Analyze the different influences on the author thinking.

• Differentiate between the model unique concepts.

• Define the model metaparadigm concepts.

Historical Evolution

• Born in Dallas, Texas, on May 12, 1914, Rogers was the eldest of four children.

• She received her nursing diploma in 1936 and her Bachelor of Science degree in Public Health Nursing in 1937.

• In 1945 she earned her master’s degree from Teacher’s College Columbia University, New York.

Historical Evolution

Cont’d.

• Rogers was appointed Head of the Division of Nursing at New York University in 1954.

• In 1963 Martha edited a journal called Nursing Science. In1970 she finished the publication of her third book An Introduction to the Theoretical Basis of Nursing) Rogers, 1970).

Origins of the Model

The basic concepts or building blocks of the Rogerian conceptual system evolved from energy field, wholeness, openness, unidirectional, pattern and organization, and science and thought (Rogers, 1970) to energy field, openness, pattern, and four-dimensional (Rogers, 1980a) to energy field, openness, pattern, and multidimensional (Rogers, 1980a) and now to energy filed, openness, pattern, and pandimensional (Rogers, 1992b).

Origins of the Model cont’d.

• Multidimensional replaced four-dimensional in an effort “to select words best suited to portray one's thought. Multidimensional provides for an infinite domain without limit” (Rogers, 1990a). Pandimensional replaced multidimensional for the same reason.

• Rogers (1992b) explained that despite the term name changes, its definition has remained the same.

Refinements Done to the Model

• Many refinements have been done to the model since 1970,1980, and 1990.

• In 1992 further refinements in Rogers Journal article and that was the last published refinements for the model.

Author’s Motivation

• Rogers was appointed to a position of head of the division of nursing at New York university 1954 and she expressed concern at the lack of nursing content in the nursing curriculum (Hektor, 1989).

• It is probable that it was the original stimulus for the development of the science of unitary Human Beings (Meleis, 1991).

Author’s Motivation• In her own book she wrote that, "I was motivated by

a deep-seated conviction of the critical need for nursing practice to be underwritten by substantive knowledge so that human beings may benefit“.

• And that "Escalating scientific and technological advances are forcing new explanations of man and his world. Nursing carries a signal responsibility in the great task of designing and implementing health and welfare services appropriate with changing times and human needs".(Rogers, 1970)

Philosophical Claims

• According to Levine, (1988) Roger’s view of human beings is a philosophic position of over-whelming importance to nursing.

• Her philosophical claim was the concept of holism.

• Roger focused on the individual as the center of the universe “early Greek philosophers”.

• Sellers(1991) mentioned that it’s “ miscellaneous synthesis of idealism, progressiveness, and humanism that moves away from rationalism and scientific realism.

Model Assumptions

• Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.

• Man and environment are continuously exchanging matter and energy with one another and that was evident in the concepts of (openness, integrality).

Model Assumptions cont’d.

• The life process evolves irreversibly and unidirectionally along a space-time continuum that was evident in in the principle of helicy.

• Pattern and organization identify man and reflect innovative wholeness (Roger,1970) and then was modified to be one concept which is pattren(1989).

• Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

Model Assumptions cont’d.

1. Nursing is a learned profession2. The explication of an organized body of

abstract knowledge specific to nursing is indispensable to nursing’s transition from science to science.

3. Nursing is both an empirical science and an art.

4. Nursing science is an organized body of abstract knowledge arrived at by scientific research and logical analysis.

5. The art of nursing is the utilization of scientific nursing knowledge for the betterment of people.

Model Assumptions cont’d.

6. People need knowledgeable nurse.7. The practice of nursing is the use of

nursing knowledge in human services.8. The descriptive, explanatory, and predictive

principles that direct nursing practice are derived from conceptual system.

9. Nursing’s long-established concern is with people and their world.

10. People have the capacity to participate knowingly and probabilistically in the process of change (Rogers, 1970, 1978a, 1978b, 1980a, 1986, 1992b)

Strategies for Knowledge Development

• Rogers (1992b) used a deductive approach to develop her conceptual system that yielded “a creative synthesis of facts and ideas… an emergent, a new product”.

Influences on the Author Thinking

The Science of Unitary Human Beings draws on a vast array of subjects that form the theoretical foundation for the conceptual framework, these include:

• Anthropology.

• Astronomy.

• Mathematics.

• Physics.

Influences on the Author Thinking cont’d.

Other influences such as:• Sociology, religion, history, and mythology".• Psychology, biology, and literature, science fiction and

futurology • With evidence on derivation from the general systems

theory and the work of Nightingale.• “Electro-Dynamic Theory on Life”, and early Greek

philosophers. • It is perhaps for this reason that the Science of Unitary

Human Beings is regarded as a unique body of work.

World Views• Organicism world view(Focuses on wholeness)

• Change that occurs between human and environmental energy fields continuously.

• Change is creative and innovative, always in the direction of increasing diversity.

• Rogers(1970) rejected the reaction world view tenet reductionism, with its focus on parts.

• Rogers stated that her conceptual system “is humanistic not mechanistic”.

Unique Focus of the Model

• The model is concerned with “people and their worlds in a pandimensional universal”

• The phenomenon of central concern is the “ study of unitary, irreducible human beings and their respective environments”.

• It reflects the characteristics of both systems and developmental models.

• The basic characteristic of systems model, integration of parts, was addressed in Rogers(1992) statements that unitary Human Beings and their environment are irreducible and indivisible energy fields “have their own identity and are not to be confused with parts”.

Unique Focus of the Model cont’d.

• The developmental model characteristics of growth, development, maturation, change and direction of change are addressed by principles of helicy and resonancy.

• Meleis(1991) regarded it as prominent example of the person-environment interaction category.

• Marriner-Tomey (1989) placed it as energy fields category.

• Barnum(1994) placed it as enhancement category of models.

Model Unique Concepts

• Wholeness

In which the human being is regarded as a unified whole which is more than and different from the sum of the parts.

• Openness

Where the individual and the environment are continuously exchanging matter and energy with each other.

• Unidirectionality

Where the life process exists along an irreversible space time continuum.

Model Unique Concepts

cont’d.

• Pattern and Organization

Which identifies individuals and reflects their innovative wholeness.

• Sentience and Thought

Human beings are the only ones capable of abstraction and imagery, language and thought, sensation and emotion.

Model Unique Concepts cont’d.

• Four "critical elements" emerged that are "basic to the proposed system" (Rogers, 1986).

• These are energy fields, open systems, pattern and pandimensionality (Rogers, 1991). The final concept, pandimensionality, was previously known as multidimensionality and prior to that, four-dimensionality.

• Energy fields Are the "fundamental units of the living and the non-

living" (Rogers, 1986). They consist of the human energy field and the environment energy field.

A-The human field Is "an irreducible, indivisible, pandimensional energy

field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from knowledge of the parts" (Rogers, 1991).

B-The environmental field Is integral with the human field. Each environmental

field is specific to its given human field.

Model Unique Concepts cont’d.

• Open systems (openness) Describe the open nature of the fields, which allow for

an interchange of energy and matter between the fields, the preferred terminology being that there is a "continuous process" without the mention of energy or matter (Daily et al., 1994).

• Pattern Is the "distinguishing characteristic of the energy field

perceived as a single wave" (Rogers, 1986), which gives identity to the field. Human behavior can be regarded as manifestations of changing pattern. The pattern is constantly changing and might be regarded as an indication of pain, illness or disease.

Model Unique Concepts cont’d.

Model Unique Concepts cont’d.

• Pandimensionality

Describes "a nonlinear domain without spatial or temporal attributes" (Rogers, 1991), an "infinite domain without limit" (Daily et al 1994, ).

Principles of Homeodynamics

• At the beginning Rogers introduced the principles of hemeodynamics with upcoming refinements:

1- Reciprocy,synchrony, helicy,and resonancy(1970)2- Helicy,resonancy,and complementarity (1980)3- Helicy,resonancy,and integrality (1986)

• Integrality

"Continuous, mutual, simultaneous interaction process between human field and environmental field " (Rogers, 1990), suggesting that energy fields pass through one another (Alligood, 1989(

Principles of Homeodynamics cont’d.

• The Principle of Integrality, where the human field is integral with its environmental field (Schodt, 1989), was studied by McDonald (1986), who stated that if there is a continuous mutual human field and environmental process, changes in one field will bring about changes in the other.

• In other words, "researchers should be able to

demonstrate a relationship between a nurse-initiated modification in a person’s environment and an alteration in that person’s state of being" (McDonald, 1986).

Principles of Homeodynamics cont’d.

Resonancy• The change in pattern and organization of human

beings and environments is presented by waves that move from lower frequency longer waves to higher frequency shorter waves.

• Describes the "continuous change from lower to higher frequency wave patterns in human and environmental fields" (Rogers, 1990).

• It is postulated that the change from lower to higher frequency patterning could be a theoretical explanation for feelings such as relaxation and timelessness to exert effort.

Principles of Homeodynamics cont’d.

Helicy • Describes the "continuous innovative,unpredictable,

increasing diversity of human and environmental field patterns" (Rogers, 1990), the "continuous creative development and evolution of the human-environmental fields" (Gueldner, 1989(.

• It states that the routine and direction of human and environmental changes are continuously innovative probabilistic and characterized by the increasing diversity of human field and is environmental field pattern and organization and manifest non-repeating rhythmicities.

Principles of Homeodynamics cont’d.

• The principles of hemeodynamics are the way of viewing human beings in their wholeness.

• Changes in the life process of humanity are irreversible, non-repeatable rhythmical in nature and evidence complexity of pattern and organization.

• Changes proceeds by continuous repatterning of both human and environmental fields by resonating oscillations of lower frequency longer waves to higher frequency shorter waves and reflects the mutual simultaneous interaction between the two fields at any given point in space time.

Principles of Homeodynamics cont’d.

• The Principle of Helicy was explored by Floyd (1983) who made the prediction that the amount of wakefulness and the number of sleep-wakefulness cycles increase.

• And they concluded that, this principle appears when "persons experience a deviation in the rhythmic relationship with their environment" (Floyd, 1983).

Interrelationships among Metaparadigm Concepts

Metaparadigm Concepts

Nursing:

• "As a science, designates the term nursing as a noun and signifies that nursing is an organized body of abstract knowledge. Traditionally, the term has been used as a verb. Nursing, the science-noun, indicates that there is a body of knowledge specific to nursing.“

(Rogers, 1994).

• She believed that nursing is an art, and in that case the word should be used as a verb. This has been consistently reiterated throughout the history of the Science of Unitary Human Beings (Rogers. 1990).

Metaparadigm Concepts cont’d.

Nursing:

"Nursing seeks to promote symphonic interaction between the environment and man, to strengthen the coherence and integrity of the human beings, and to direct and redirect patterns of interaction between man and his environment for the realization of maximum health potential“ (Rogers, 1970).

Nursing cont’d.

Two authors in particular have described the role of the nurse in considerable detail. Barrett (1990c) maintains that the role of nursing is "unique [because of its]...concern with unitary, irreducible human beings and their respective environments" and that this view helps nursing to distinguish itself from other professions.

Nursing practice consists of two stages, pattern manifestation appraisal and deliberative mutual patterning (Barrett, 1988; 1990c).

Nursing cont’d.

Pattern manifestation appraisal is where the nurse identifies the wave pattern manifestation of the individual and the environment and deliberative mutual patterning is where the nurse "facilitates the clients’ actualization of potentials for health and well being" (Barrett, 1990c).

Cowling (1990) also stated that the "focus of nursing is unitary human beings in mutual process with their environment" and that nursing intervention would be to "create ways in which the client might become more aware of his or her field and collaborate with the nurse in proposing and using patterning strategies".

The template developed by Cowling (1990) consists of the following:

• Constituent 1. Nursing interventions should arise from an

awareness of the mutual human-environment field pattern and should be pattern specific rather than age, disease or gender specific.

• Constituent 2. Human field pattern appraisal should take place, taking

into account experience, perception and expression.

. Constituent 3. All sources of appraisal should be regarded as valid,

attending to "sensory information, thoughts, feelings, awareness, imagination, memory, introspective insights, intuitive apprehensions and more" (Cowling, 1990(.

• Constituent 4.

Pattern recognition must involve multiple ways of knowing.

• Constituent 5.

Pattern information is constructed from a unitary perspective, which is unitary, specific, a constant mutual process, does not exist in separation from reality and is four-dimensional.

• Constituent 6.

The pattern appraisal is communicated and this might include the use of single words, or pictures.

• Constituent 7.

The pattern appraisal is validated by the nurse or otherwise, by the client.

• Constituent 8.

Meaningful interventions are initiated, based on the concept of knowing participation in change.

• Constituent 9.

Evaluation of the process, which is ongoing, takes place and consists of dialogue, journal keeping and re-evaluation of interventions.

Nursing cont’d. The goal of nursing: identified by Rogers is

predicated on a view of the practitioner as “an environmental component for the individual receiving services”

The goal of nursing focuses on the promotion of health and well-being and on the integral relationship between the human and environmental energy fields:

Nursing cont’d.• The primary focus of nursing is to promote health.

(Rogers, 1992a)

• The purpose of nurses is to promote health and well-being for all persons wherever they are. (Rogers, 1992b)

• The purpose of nursing is to promote human betterment wherever people are, on plant earth or in outer space. (Rogers, 1992b)

• Nurses participate in the process of change, to help people to move toward what is deemed better health. (Rogers, 1980g)

Nursing cont’d.

The nursing processAccording to Rogers (1970), follows from

the science of nursing. She explained:

• Broad principles are put together in novel ways to help explain a wide range of events and multiplicity of individuals differences. Action, based on predictions arising out of intellectual skill in the merging of scientific principles, becomes under written by intellectual judgments.

The nursing process cont’d.

• Rogers (1978) regarded the nursing process as a modality for implementation of nursing knowledge.

• She did not specify a particular nursing process format but did mention assessment, diagnosis, goal setting, intervention, and evaluation in her 1970 book.

• Rogers (1970) maintained that the nursing process must focus on the person as a unified whole. Moreover, Rogers has continuously emphasized the need for individualized nursing.

The nursing process cont’d

Assessment and diagnosis:

• Cowling (1990b) explained that human field pattern is appraised "through manifestations of the pattern in the form of experience, perception, and expressions".

• Relevant pattern information includes sensations, thoughts, feelings, awareness, imagination, memory, insights, nutrition, work, and play, exercise, sleep/wake cycles, safety, interpersonal networks, …etc.

• Rogers (1970) acknowledged the importance of technological tools and personal procedural activities as nursing interventions.

The nursing process cont’d

Intervention phase:• Nursing interventions are implemented in the

second phase of the Rogerian practice methodology, deliberative mutual pattering, "the continuous process whereby the nurse with the client patterns the environmental field to promote harmony related to the health events".

Evaluation • The outcomes of nursing intervention are evaluated

by means of a return to pattern manifestation appraisal. "Evaluation requires a return to the original appraisal format after monitoring and collecting additional pattern information as it unfolds during the implementation of nursing intervention strategies.

Metaparadigm Concepts cont’d.

Person:• Early writings, person was called "man" (Rogers, 1970),

but in the later work this was adjusted to person, or more precisely from unitary man to unitary human being, in an attempt to remove indications of gender (Rogers, 1983).

• Person is defined as "a unified being integral with the environment" (Daily et al, 1994) and in constant interaction with the environment, a unified whole that cannot be understood when divided into parts (Rogers, 1970).

A person is regarded as an open system in continuous interaction with the environment. In addition, there is only one person, characterized by a particular wave pattern manifestation, Rogers stated that all other people are part of, aspects of, or manifestations of pattern in the environment (Rogers, 1992).

Person cont’d.

Person cont’d.

• "An irreducible, indivisible, pandimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and cannot be predicted from the parts"(Rogers, 1992).

• A physical body does not constitute a human being (Sarter, 1988a) as the human field is energy which extends beyond the physical boundary. "This human field has characteristics that are derived from the whole and cannot be predicted from the parts" (Sarter, 1988a(.

Metaparadigm Concepts cont’d.

Environment:"An irreducible, pandimensional energy field

identified by pattern and manifesting characteristics different from those of the parts. Each environment field is specific to its given human field. Both change continuously and creatively."(Rogers, 1992)

Environment cont’d.

• The environment is a wave pattern manifestation, where pattern has been defined as:

• "An abstraction. It gives identity to the field. The nature of the pattern changes continuously. Each human field pattern is unique and is integral with its own unique environmental field pattern."(Rogers, 1986)

Person and Environment• The developmental model characteristics of growth,

development, maturation, change, and direction of change are addressed by the principles of helicy and reasonancy.

Rogers (1986) identified unitary human beings and their environments as the central focus of her conceptual system.

• The four basic concepts of the science of unitary human beings are:

• Energy fields, openness, pattern, and pandimensionality.

• Energy fields are infinite and pandimensional; they are in continuous motion.

Person and Environment cont’d.

• Human and environmental energy fields are open and have pattern.

• The pattern of an energy field is conceptualized as a wave phenomenon. Rogers (1970) noted, "a multiplicity of waves characterizes the universe. Light waves, sound waves, thermal waves, atomic waves, gravity waves flow in rhythmic patterns"

Person and Environment cont’d.

• Energy field patterns change continuously. The change, according to Rogers (1992b), is continuous, relative, innovative, increasingly diverse, and unpredictable.

• There is no repetition in human life no regression to former states or stages.

• Rogers (1992b) described human and environmental energy fields as pandimensional. "a nonlinear domain without spatial or temporal attributes". Rogers claims that pandimensional "best expresses the idea of a unitary whole"

Person and Environment cont’d.

Rogers (1992b) formulated three mutually exclusive principles of homeodynamics to explicitly and concisely state her ideas about human and environmental energy field patterns. The principles are equally applicable to individual and group fields:

• The principle of resonancy delineates the direction of evolutionary change in energy field pattern. Resonancy is the "continuous change from lower to higher frequency wave patterns in human and environmental fields.

• The principle of helicy is the continuous, innovative, unpredictable, increasing diversity of human and environmental field patterns.

• The principle of integrality emphasizes the nature of the relationship between the human and environmental fields. Is "continuous mutual human field and environmental field process: (Rogers, 1990a).

Metaparadigm Concepts cont’d.

Health:• Rogers (1970) defined health as an expression of

the life process. She referred to health and illness, ease and dis-ease, normal and pathological processes, and maximum well-being and sickness.

• Wellness and illness, then, are not differentiated within the context of the science of unitary human beings.

Health cont’d.

There are no absolute norms for health. There are patterns that emerge from the human process that may cause pain, happiness, illness or any behavior. Society labels some of these behaviors "sick". What behaviors a society accepts as sick or well varies with culture and history. Families also have their own definitions of sick or well … so there are no absolutes about what constitutes sickness or wellness.

Health cont’d.

• Phillips (1990a) has stated that there are two more recent definitions of health congruent with Rogers’ Science of Unitary Human Beings.

• Health is participation in the life process by

choosing and executing behaviors that lead to the optimum fulfillment of a persons’ potential" (Madrid and Winstead-Fry, 1986)

Health cont’d.

• Health is a rhythmic patterning of energy that is mutually enhancing and expresses full life potential" (Kim and Moritz, 1982).

• Additionally, Barrett (1990c) maintains a similar view and has stated that health "can be viewed as a process of actualizing potentials for well-being by knowing participation in change".

Health cont’d.

Health and illness are part of the same continuum. They are not dichotomous conditions. The multiple events taking place alone life's axis denote the extent to which man is achieving his maximum health potential and vary in their expressions from greatest health to those conditions which are incompatible with maintaining life processes.

Content of the model: propositions

• Rogers repeatedly linked the metaparadigm concepts person and environment. This linkage is most evident in the principle of integrity: "[the] continuous mutual human field and environmental field process" (Rogers, 1990a).

• Person, environment, and nursing are linked this statement: "for nurses, that focus consists of a long-established concern with people and the world they live in. it is the natural forerunner of an organized, abstract system encompassing people and their environments" (Rogers, 1992b).

Propositions cont’d .

• Person, health, and nursing are linked in this statement: "nurses participate in the process of change, to help people move toward what is deemed better health" (Rogers, 1980g)

• The linkage of all four metaparadigm concepts-person, environment, health, and nursing-is evident in the following statements:

Propositions cont’d.

• The purpose of nurses is to promote health and well-being for all persons wherever they are. (Rogers, 1992b).

• The purpose of nursing is to promote human betterment wherever people are, on planet earth or in outer space.

Relationship between Metaparadigm Concepts and Model Unique Concepts

Rogers Conceptual Model