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Revolution in the Nursing Paradigm1-Caring & the Christian Story… 2-Revolution in the Nursing Paradigm… 3-A Christian Worldview for Nursing. CARING & THE CHRISTIAN STORY Purpose: To examine the relationship between faith and nursingObjectives: After reading this chapter and completing the exercises, youshould be able to:1.Describe the historical relationship between Christian faith and nursing2.Deﬁne Christian nursing3.Identify your motivation for being a nurse4.Describe the relationship between personal faith and nursing careKeywords: worldview, story, narrative, historyChristine, an emergency-department staff nurse in an innercity hospital, sawtwo little boys running out of the men’s room shouting, “Someone’s lying on theﬂoor in there!” Rushing in to investigate, she found a leather-coated man ofabout thirty lying face down on the ﬂoor, cyanotic. She felt a pulse but nobreath. Christine knew he was most likely an overdosed intravenous drug userand HIV-positive, but when help seemed long in coming, she began mouth-to-mouth resuscitation in spite of her fears. Afterward her colleagues said shehad been irresponsible. But all Christine could think about was, if Jesus lived to-day, would he sit among the HIV-positive and love them?1Rosene, a nurse in an extended-care facility, felt repulsed at ﬁrst by the“concentrated assemblage of helpless humanity” who surrounded her. Butthen she prayerfully determined that she would get to know her patients andsee in each one the image of God. She gradually began to enjoy the peoplein her care.21Christine Ann Grem, “Cameo of Caring: George,” Journal of Christian Nursing, summer 1995,p. 9.2Rosene M. Dunkle, “Beyond Appearances: Caring in the Land of the Living Dead,” Journal ofChristian Nursing, summer 1995, pp. 4-6. 14CALLED TO CAREMarsha, caring for an obscenity-shouting, combative drug abuser, looked into his eyes and saw a person whom God loved.3Mother Teresa saw Jesus in the sick and dying of Calcutta and took them into comfort and care for them.Joy, an American nurse living in Turkey, saw starving babies in an orphanageand organized an ongoing project to provide them with nourishing formula.4What common thread weaves throughout these stories? Each of the nursesresponded to her patients from a theological commitment. She saw those inher care as valuable human beings who reﬂected the image of God. She sawhope in the midst of hopeless situations. She viewed health as a holistic con-cept that radiates from a vital relationship with God and includes physical integrity, emotional stability and participation in the life of the community. Shewas motivated by the desire to share the love of God, which she had person-ally experienced, and she saw nursing as compassionate service to God andher neighbors.How does what we believe affect the health care we provide? Is there a re-lationship between the way a society understands the nature of God and thetype of health care that develops in that society? We will argue that there is adirect relationship and that if the faith perspective changes, health care practiceswill change. In fact, we are living in the midst of such changes in North Americaright now.Nursing developed out of a Christian worldview. It is important to see thatthe changes we are experiencing stem from a growing paradigm shift in our cul-ture. To fully appreciate this shift, we must ﬁrst look at who we are and hownursing developed in the ﬁrst place.How Did We Get Here?Optimism ran high in mid-nineteenth-century England. With the rise of empiri-cism, in which all knowledge is derived from experience, science blossomedand gave rise to high hopes for conquering drudgery and disease. FlorenceNightingale went to the Crimea, and by applying good principles of sanitationshe made a major difference in the death rate of British soldiers (from 42 percentto 2 percent). But the spectacular success of science and high hopes of the phi-losophers had an unsettling effect on the common people—and that troubledNightingale. She wrote to her friend John Stuart Mill, “Many years ago, I had a3Marsha Niven, “Somebody’s Son: A Patient Only a Mother Could Love,” Journal of ChristianNursing, spring 1995, pp. 28-30.4Joy Sterling, “The American Milk Mama,” Journal of Christian Nursing, winter 1996, pp. 28-3 Caring & the Christian Story15large and very curious acquaintance among the artisans of the North of Englandand of London. I learned that they were without any religion whatever— thoughdiligently seeking after one, principally in Comte and his school. Any return towhat is called Christianity appeared impossible.”5 The people were turning toempiricism and becoming atheists.At the same time, corruption and controversy ﬁlled the Church of England.While the church could be rigid in its outward requirements, it tended to be elit-ist and hypocritical in practice. In the light of the positivism of science and phi-losophy and the negativism of the church, many of the common people becamedisillusioned and simply dropped out.Florence Nightingale seemed most concerned about the ethical implicationsof religious belief. In her book Suggestions for Thought she attempted to de-velop an alternative concept of God that would appeal to the disenchanted “ar-tisans” (merchants and craftsmen) so they would have a basis for morality. Hertheology was far from orthodox—she dismissed the incarnation, the Trinity andthe atonement as “abortions of a comprehension of God’s plan.”6 However, sheconsidered herself a Christian and her work a “call from God.”7The Enlightenment brought major changes in science, beginning with RenéDescartes (1596-1650) and his elevation of human reason. The move towardmodern science began with British physicist Isaac Newton’s Mathematical Prin-ciples of Natural Philosophy (1687), in which he postulated that mathematicalphysics could explain the whole of the physical universe (the “mechanicalworld”). John Locke (1632-1704) and George Berkeley (1685-1753) continuedthis move to empiricism, retaining a somewhat Christian ﬂavor that resulted intheological deism.The twentieth century brought another set of philosophical and theologicalinﬂuences into nursing. New philosophers built on the foundations laid by empiricism, then began tearing them down. The results were nihilism, existential-ism and eventually postmodernism. This philosophical ferment laid the founda-tion for the tension we face in nursing today.Do the philosophical and theological underpinnings of nursing really matter?Absolutely! For just as Florence Nightingale observed that the common peoplein her day were becoming atheists and thereby losing their basis for ethical be-havior, nurses today are affected by the philosophies of our time. The spirit of5Florence Nightingale, quoted in Michael D. Calabria and Janet A. Macrae, Suggestions forThought by Florence Nightingale (Philadelphia: University of Pennsylvania Press, 1994), p. ix.6Ibid., p. 13.7JoAnn G. Widerquist, “Florence Nightingale’s Calling,” Second Opinion, January 1992, pp.108-21. 16CALLED TO CAREservice and compassion that once motivated nurses has evolved into a profes-sionalism that demands power, status and appropriate compensation.8 We seethe effects in a health care system controlled by the bottom line.What Is Nursing?In recent history, nursing has been closely associated with medicine and oftenconfused with the medical profession; however, nursing and medicine are twodistinct professions with very different histories. Western medicine developedout of a Greek, and later Cartesian, body-mind dualism that viewed the body asobject.9 The role of the nurse, however, grew out of a Christian understandingof the human person as created in the image of God and viewed the body as aliving unity and the “temple of the Holy Spirit” (1 Cor 3:16).Medicine has traditionally focused on the scientiﬁc dimension of the humanbody, relegating the spiritual and psychosocial dimensions to religion and psychology. The uniqueness of nursing is its emphasis on caring for the whole per-son as embodied. It is deﬁned as both an art and a science. Anne Bishop andJohn Scudder insist that nursing is neither an art nor a science but a practice thatdraws on both the arts and sciences.10 Nursing, even in our most scientiﬁcallyoriented periods, has always been concerned with the whole person. Nurse the-orist Patricia Benner asserts, Nurses deal with not only normality and pathophysiology but also withthe lived social and skilled body in promoting health, growth, and devel-opment and in caring for the sick and dying.11In other words, nurses work from an understanding of the self as embodied andare concerned with how we relate to one another and function in the worldthrough our bodies.The classic deﬁnition of nursing, developed by theorist Virginia Hendersonand adopted by the International Council of Nurses, states,The unique function of the nurse is to assist the individual, sick or well,8Suzanne Gordon and Sioban Nelson, “An End to Angels: Moving Away from the Virtue ScriptToward a Knowledge-Based Identity for Nurses,” American Journal of Nursing 105, no. 5(2005): 62-69.9Bonnie Bullough and Vern L. Bullough, “Our Roots: What We Should Know About Nursing’sChristian Pioneers,” Journal of Christian Nursing, winter 1987, p. 12.10Anne H. Bishop and John R. Scudder, “Nursing as a Practice Rather Than an Art or Science,”Nursing Outlook, March-April 1997, pp. 82-85.11Patricia Benner, ed., Interpretive Phenomenology: Embodiment, Caring, and Ethics in Healthand Illness (Thousand Oaks, Calif.: Sage, 1994), p. xvii. Caring & the Christian Story17in the performance of those activities contributing to health or his recov-ery (or to peaceful death) that he would perform unaided if he had thenecessary strength, will or knowledge. And to do this in such a way as tohelp him gain independence as rapidly as possible.12Henderson further elaborates by listing fourteen activities that a nurse assistspatients to perform.13 Eight of these activities pertain directly to bodily functions.The remaining six relate to safety and ﬁnding meaning and purpose in life—enabling the embodied person to function in relation to other people and theenvironment in a healthy way.More recent deﬁnitions, while not completely denying the need for physicalcare, reﬂect a growing paradigm shift by focusing more on the psychosocial as-pects of care and less on the physical. For example, Martha Rogers states, “Professional practice in nursing seeks to promote symphonic interaction betweenman and environment, to strengthen the coherence and integrity of the humanﬁeld and to direct and redirect patterning of the human and environmentalﬁelds for the realization of maximum health potential.”14Jean Watson asserts, “At its most basic level nursing is a human, caring, rela-tional profession. . . . Caring in nursing is a ‘human mode of being’; caring is abasic way of ‘being-inthe-world’ and creates both self and world.”15Rosemarie Rizzo Parse further expands this approach to nursing: “The nursecenters with the universe, prepares, and approaches the other, attending in-tensely to the meaning of the moment being lived by the person or family.”16With the present tumultuous change in the health care system, nursing strug-gles to redeﬁne itself. While theorists move toward the psychosocial and ethe-real, practitioners are positioning themselves for professional survival. Both tee-ter on a precipice, in peril of losing the true essence of nursing entirely. Theformer are looking more like shamans and the latter like physician-technicians.Neither embraces the full concept of nurse that grew out of the Christian gospel.We will deﬁne Christian nursing as a ministry of compassionate care for thewhole person, in response to God’s grace toward a sinful world, which aims to12Virginia A. Henderson, The Nature of Nursing: Reﬂections After 25 Years (New York: NationalLeague for Nursing Press, 1991), p. 21.13Ibid., pp. 22-23.14Martha E. Rogers, An Introduction to the Theoretical Basis of Nursing (Philadelphia: F. A.Davis, 1970), p. 122.15Jean Watson, “Nursing’s Caring-Healing Paradigm as Exemplar for Alternative Medicine?” Al-ternative Therapies, July 1995, p. 67.16Rosemarie Rizzo Parse, Illuminations: The Human Becoming Theory in Practice and Research(New York: National League for Nursing Press, 1995), p. 82. 18CALLED TO CAREfoster optimum health (shalom) and bring comfort in suffering and death foranyone in need.A Brief History of NursingAlthough some forms of health care were provided in ancient cultures,17 nursehistorian Patricia Donahue states, “The history of nursing ﬁrst becomes contin- uous with the beginning of Christianity.”18 Nurse historians Dolan, Fitzpatrickand Herrmann state,The teachings and example of Jesus Christ had a profound inﬂuence onthe emergence of gifted nurse leadership as well as on the expansion ofthe role of nurses. Christ stressed the need to love God and one’s neigh-bor. The ﬁrst organized group of nurses was established as a direct re-sponse to His example and challenge.19The impetus for this movement came when the ﬁrstcentury Christians beganto teach that all believers were ministers who were to care for the poor, the sickand the disenfranchised (e.g., Mt 25:31-46; Heb 13:1-3; Jas 1:27). As the churchesgrew, they appointed deacons to care for the needy within the church.20 Even-tually, more men and women were added to the roll of deacons, and their des-ignated responsibilities grew to include caring for the sick.21 Phoebe, the deaconmentioned in Romans 16:1-2, is often considered the ﬁrst visiting nurse.22By the third century, organized groups of deaconesses were caring for thesick, insane and lepers in the community.23 In the fourth century the church be-gan establishing hospitals. Most of these hospitals did not have a physician; theywere staffed by nurses. There were several periods when the early church didnot condone the practice of medicine, which they viewed as a pagan art.24 Nursehistorians Lavinia Dock and Isabel Stewart state,17These health care providers included midwives, shamans and wise women, but none of theseroles meet the criteria for professional nursing as deﬁned in this chapter.18Patricia Donahue, Nursing: The Finest Art—An Illustrated History (St. Louis, Mo.: Mosby,1985), p. 93.19Josephine Dolan, M. Louise Fitzpatrick and Eleanor Krohn Herrmann, Nursing in Society: AHistorical Perspective, 15th ed. (Philadelphia: W. B. Saunders, 1983), p. 43.20James Monroe Barnett, The Diaconate: A Full and Equal Order (Valley Forge, Penn.: TrinityPress, 1995), pp. 28-42.21David Zersen, “Parish Nursing: 20th-Century Fad?” Journal of Christian Nursing, spring 1994,pp. 19-21, 45.22Dolan et al., Nursing in Society, p. 45.23Mary Haazig, “Historical Presence of the Nurse in the Church,” in Oneness in Purpose—Diversity in Practice (Park Ridge, Ill.: National Parish Nurse Resource Center, 1989), p. 3.24Bullough and Bullough, “Our Roots,” pp. 11-12. Caring & the Christian Story19The age-old custom of hospitality . . . was practiced with religious fervorby the early Christians. . . . Their houses were opened wide to every afﬂicted applicant and, not satisﬁed with receiving needy ones, the deacons,men and women alike, went out to search and bring them in.25Nursing in the Middle Ages centered in monasteries. Women who wanted toserve God and care for the sick joined together in monastic orders. In the lateMiddle Ages, the Knights Hospitallers of St. John, a military nursing order, builta hospital in Jerusalem, as well as others along the route of the Crusades. Whilethe original intent was to care for pilgrims to Jerusalem, they also cared for Mus-lims, Jews and Christian crusaders.26The Renaissance through the eighteenth century brought a dark period in thehistory of nursing. As Catholic religious orders were disbanded or suppressedin Protestant countries, hospitals deteriorated. Nursing ceased to be a publicrole; it moved out of the church and into the home. However, some religiousorders in southern Europe continued providing nursing care, including those es-tablished by St. Francis of Sales (1567-1622) and St. Vincent de Paul (15811660).27However, care deteriorated even among the religious orders as nuns were notallowed to touch any part of the human body except the head and extremitiesand were often forced to work twenty-four-hour days.28By the nineteenth century, except for a few nursing orders of nuns, nursing wasdisorganized and corrupt. Dolan, Fitzpatrick and Herrmann describe hospitals inPhiladelphia in 1884:Hospital patients were penniless folk, usually homeless and friendless. In mostof the city hospitals the nursing was done by inmates usually over 50 yearsold, many being 70 or 80. . . . There was practically no night nursing, exceptfor the “night watchers” provided for women in childbirth and the dying.29Charles Dickens portrayed nineteenth-century nursing in the character of SaireyGamp in his novel Martin Chuzzlewit.30 A self-seeking alcoholic, Gamp has be-come the symbol of nursing at its worst. Dickens focused public attention on25Lavinia L. Dock and Isabel Maitland Stewart, A Short History of Nursing, From the EarliestTimes to the Present Day (New York: Putnam, 1931), p. 51.26Verna Benner Carson, Spiritual Dimensions of Nursing Practice (Philadelphia: W. B. Saunders,1989), p. 57.27Ibid., pp. 59-60.28Dock and Stewart, A Short History of Nursing, p. 99.29Dolan et al., Nursing in Society, p. 137.30Charles Dickens, Martin Chuzzlewit (New York: Books, Inc., 1868). Sairey Gamp is intro-duced in chapter 19 and continues as a key ﬁgure for the remainder of the book. 20CALLED TO CAREthe nursing care being provided by alcoholics, prostitutes and women whowere uncaring and immoral.Reform again came through the work of the Christian church. Elizabeth Setonestablished the Widow’s Society, a Protestant mission in New York, to care forpoor women in their homes—to nurse and comfort them. She later joined theCatholic church and eventually established the Sisters of Charity at Emmitsburg,Maryland. Mother Mary Catherine McAuley founded the Sisters of Mercy, whoministered to the poor and sick in Dublin, Ireland, and eventually spread toother countries, including the United States. Elizabeth Fry, an American Quakerin London, began a campaign of prison reform that eventually developed intothe Society of Protestant Sisters of Charity, whose primary objective was to sup-ply nurses for the sick of all classes in their homes.31Fry had a strong inﬂuence on a German Lutheran pastor, Theodor Fliedner,and his wife, Frederika. Seeing the pressing needs of the poor and the sick intheir community, the Fliedners decided that the church must care for these peo-ple. They turned a little garden house into a home for outcast girls and eventu-ally organized a community of deaconesses to visit and nurse the sick in theirhomes. That experiment quickly grew into the Kaiserswerth Institute for theTraining of Deaconesses, with a huge complex of buildings, including a hospi-tal, and educational programs for nurses and teachers.32About the same time, a young woman in England, Florence Nightingale, feltGod calling her to future service. She responded to that call by becoming anurse, studying ﬁrst at the Kaiserswerth Institute, then at Catholic hospitals inParis. Nightingale went on to single-handedly reform nursing, bringing it backto its Christian roots and setting high educational and practice standards.33 How-ever, her theological inﬂuence also set the stage for an ongoing struggle be-tween those of her followers who wanted to be viewed as “professional” (sec-ular) and those who understood nursing as a calling from God—a conﬂictNightingale herself did not envision.About this same period, churches in Europe and the United States began es-tablishing hospitals with schools of nursing. William Passavant, a Lutheran pas-tor and pioneer in hospital development, visited Kaiserswerth. He brought dea-conesses to Pittsburgh, Pennsylvania, to staff his ﬁrst hospital and teach in thenursing school, rather than choosing secular nurses. Passavant described the31Dolan et al., Nursing in Society, pp. 137-39.32Abdel Ross Wentz, Fliedner the Faithful (Philadelphia: Board of Publication of the UnitedLutheran Church in America, 1936), pp. 55-83.33Mary Lewis Coakley, “Florence Nightingale: A One-Woman Revolution,” Journal of ChristianNursing, winter 1989, pp. 20-25. Caring & the Christian Story21tension that he observed between Christian service and professionalism in anaddress given in 1899:The deaconess has a Biblical ofﬁce, the nurse a worldly vocation. The oneserves through love; the other for her support. In the one case we havean exercise of charity as wide in extent as the sufferings and misery ofmankind; in the other, a usefulness circumscribed by the narrow circle ofobedient help given to the physicians and surgeons. Above all, the dea-coness cares for the body in order to reach the soul. She works for eter-nity. The trained nurse, like the man whose vocation brings him to thesickbed, is, as a rule, quite content to pass by unnoticed the possibilitiesof an eternal future in the demands of the present welfare of the patient.34Inﬂuential nursing leaders at theturn of the century railed againstthe idea of nursing as a religiouscalling for several reasons.35 Britishempiricism left many thinking peo-ple of the time disillusioned withthe church and placing their hopesin science. Also most nurses in thereligious orders and deaconesscommunities worked under op-pressive conditions, resulting inchronic fatigue and a high mortal-ity rate among nurses.36At the same time, the Americansocial context included a strongsense of progress and an assump-tion that freedom and democracywould eventually create a pure,rational society. But rapid indus-trialization had left society with aloss of community and large populations of disenfranchised poor.34William Passavant, quoted in C. Golder, The History of the Deaconess Movement (Cincinnati:Jennings and Pye, 1903), p. 585. 35See, for example, Diane Hamilton, “Constructing the Mind of Nursing,” Nursing History Re-view 2 (1994): 3-28; and Dock and Stewart, A Short History of Nursing, pp. 241-83.36Dock and Stewart, A Short History of Nursing, pp. 256-57.Roles of a Deaconess and a Nurse 1899—William PassavantDeaconessBiblical ofﬁceServes through loveExercise of charity as wide assufferingCares for the body to reach the soulWorks for eternityNurseWorldly vocationServes for her ﬁnancial remunerationUsefulness circumscribed by thesystemConcerned for present welfare of the patientUnconcerned with eternal future 22CALLED TO CAREUpper-middleclass women, as keepers of the culture’s mores and unable tohold paying jobs, became social reformers. Out of these developments, publichealth nursing arose. Nurse historian Diane Hamilton comments about thesenurse reformers (“inventors”):Thus, both nursing and religion, if pursued compassionately, healedwounded minds, bodies, and spirits. Although the nurse inventors in-tended an unyielding boundary between religion and nursing, the kindredmissions of religion and nursing rendered the boundary translucent. Theyenvisioned that secular nursing would emulate the values of the religioussisters without accepting their rules, regulations, and cloistered life. Com-passion, once associated with God’s authority, would, according to thenurse inventors, be replaced with compassion based on commitment tothe authority of humanity and its social progress.37Other nursing leaders during the same period insisted that the intimacy inherent in nursing practice required religious goodness, credulity, discipline andobedience. Charlotte Aikens, in a 1924 nursing ethics text, acknowledged “reli-gion” (deﬁned as “the relation which an individual ﬁxes between his soul andhis God”) as the basis for nursing ethics.38 Rebecca McNeill wrote in the Amer-ican Journal of Nursing in 1910 that the “ideal nurse” must be a Christian.39Adding to the tension between the secular and religious inﬂuences in nursingwas the common practice of deaconess hospitals’ establishing schools of nurs-ing based on the Nightingale system, so that, until the establishment of bacca-laureate nursing programs, the two philosophies—service and professional-ism—developed side by side. As a baccalaureate nursing student in the earlysixties, I (Judy) felt caught in the middle of this tension. When I wrote a classpaper for a course in nursing leadership, I chose to defend the idea of service.In the process, I raised the ire of my instructor.At the end of the nineteenth century and beginning of the twentieth, theevangelical missionary movement developed. Early missionaries went to Asiaand Africa, communicating the gospel primarily through education and healthcare. Florence Nightingale also sent out “missioners” to all English-speakingcountries.40 Although they determined to be secular, most drew their motivationfrom Christian faith and often worked through religious orders or mission hos-37Hamilton, “Constructing the Mind of Nursing,” pp. 21-22.38Charlotte A. Aikens, Studies in Ethics for Nurses (Philadelphia: W. A. Saunders, 1924), pp.51-52.39Rebecca H. McNeill, “The Ideal Nurse,” American Journal of Nursing 10, no. 3 (1910): 393. Caring & the Christian Story23pitals. As missionary activity spread around the world, nursing worldwide couldtrace its roots to both Florence Nightingale and a Christian worldview.Nursing TodayWith the current rise of alternative spiritualities among nursing leaders, revision-ist approaches to nursing history have attempted to bypass the Christian rootsof nursing. More recent nursing histories look instead to animistic “medicinemen and women” and shamans, Greek and Roman goddesses, Egyptian priest-esses, Ayurvedic medicine, and healing traditions based on chi energy.41The practical result of these approaches seems to be a move away from thephysical care of the body.42 Increasingly, nursing as practiced by advocates ofalternative healing occurs more in the mind and less with hands-on physicalcare. While “caring” is taught, it is more of a detached presence than a doing ofthose things that communicate compassion.43At the same time nursing is facing a major restructuring and redeﬁnitionbased on bottom-line economics. American Nurses Association research has indicated that the reduction of registered nurses in hospitals is causing unsafe con-ditions for some patients. The most frequently reported explanations for thenurse cutbacks were economic reasons.44Not only does the health care industry want to streamline the work force tosave money, but some nurses themselves seem to be more motivated by eco-nomic considerations. Nurse educator Susan Stocker writes,I’m seeing an increasing number of students who are not entering nursingfor the same reasons you and I did. They don’t have a caring attitude.They have a goal and that goal is to get a job that pays a decent wage.The end. What impact will that have on the professional organization andthe profession?45Why are we in nursing? Is it only to earn a decent wage? Are we hoping togain power and prestige or academic status? While nurses have traditionally en-tered nursing to serve God and care for the sick, those motivations seem to berapidly changing. Too many nurses start lining up at the time clock to punch41See, for example, Lynn Keegan, The Nurse as Healer (Albany, N.Y.: Delmar, 1994), pp. 18288.42Margaret J. Dunlop, in Patricia Benner, Interpretive Phenomenology (Thousand Oaks, Calif.:Sage, 1994), p. 31.43Verna Carson, “Caring: The Rediscovery of Our Nursing Roots,” Perspectives in PsychiatricCare, April-June 1994, pp. 4-6.44American Nurses Association, Summary of the Lewin-VHI, Inc., Report: Nursing Report Cardfor Acute Care Settings (Washington, D.C.: American Nurses Association, 1995).45Susan Stocker, “Pretty Scary Stuff,” The American Nurse, September 1995, p. 6. 24CALLED TO CAREout while patient call lights ﬂash. Others retreat to academia to avoid the un-pleasant tasks of staff nursing.Tanya, a senior in a nursing program where students were allowed to choosetheir clinical areas, smugly related that she had managed to arrange all of herclinical experience in psychiatric settings. She had never done any physical care.When asked how she hoped to function as a graduate nurse, she adamantlystated, “I didn’t go into nursing to carry bedpans.”Jesus Christ has called us to a different vision for nursing. He touched lepers(Lk 5). He applied mud compresses (Jn 9:6). He washed feet (Jn 13). Jesusclearly proclaimed, “Whoever wishes to become great among you must be yourservant, and whoever wishes to be ﬁrst among you must be slave of all. For theSon of Man came not to be served but to serve, and to give his life a ransom formany” (Mk 10:4345).As Jesus began his ministry he proclaimed,The Spirit of the Lord is upon me,because he has anointed meto bring good news to the poor.He has sent me to proclaim release to the captivesand recovery of sight to the blind,to let the oppressed go free,to proclaim the year of the Lord’s favor. (Lk 4:18-19)Throughout the Gospels, physical healing was intimately linked with the proclamation of the gospel. Jesus sent his followers out with instructions to heal thesick and to tell them, “The kingdom of God has come near to you” (Lk 10:9).He underlined our responsibility to provide physical care by explaining in Mat-thew 25:35-36, 40:I was hungry and you gave me food, I was thirsty and you gave me some-thing to drink, I was a stranger and you welcomed me, I was naked andyou gave me clothing, I was sick and you took care of me. . . . Truly I tellyou, just as you did it to one of the least of these who are members of myfamily, you did it to me. However, he did not stop there. Throughout the Gospels we see how the ulti-mate purpose for physical healing was to restore people to a vital relationshipwith God and the community.If that is the case, nursing cannot work toward the goal of health without in-cluding the clear proclamation of the gospel, as well as providing physical carewith a servant attitude. Nursing as a vocation, or calling, from God, must return Caring & the Christian Story25to its roots in the church and Christian faith in order to work toward the goal oftrue health. Furthermore, if we hope to maintain a strong Christian worldviewin nursing, our faith must be nurtured in a Christian community and informedby a clear theology. True nursing cannot be divorced from the Christian story.For Further Thinking1.What motivated you to become a nurse?2.What did you learn about nursing history as a nursing student? How doesthat knowledge shape the way you view nursing?Theological ReﬂectionRead Matthew 25:31-46, Hebrews 13:1-3, James 1:27 and 1 Peter 2:9.1.What does each passage say about the relationship between faith and caringfor others?2.To whom should we direct our compassion? For what reasons?3.How do these passages describe the environment in which we care?4.What is the nature of health—the goal of our caring?5.What is involved in providing care?CASE STUDY: Amy & FloraAmy, a junior nursing student, was assigned to care for Flora, an eighty-ﬁve-year-old woman with bilateral gangrene of the lower extremities secondary todiabetes mellitus. Flora’s treatment regimen included maggot therapy. She wason strict contact isolation due to methicillin resistant staph aureus (MRSA). Amy came to clinical well prepared but with some obvious apprehension asshe began her day. She donned a gown, gloves and mask before entering Flora’sroom for an initial nursing assessment. The usual morning care followed: break-fast, medication administration, bathing and tedious dressing changes. Flora was hearing impaired, so Amy leaned close to her and spoke clearly inher ear. Flora chewed her food slowly, but Amy very deliberately helped hertake each bite of breakfast, a process that took over thirty minutes. Flora wasafraid and in pain, so Amy touched her gently and combed her hair carefully,gave good skin care and held her hand.Flora said she couldn’t remember when her family last visited, so Amy readeach of her greeting cards to her and listened as Flora reminisced about family.Amy opened the curtains to let Flora feel the warmth of the sun and see theactivities outside her window. 26CALLED TO CAREFlora was confused, due to sleep deprivation, so Amy developed a plan fora soothing bedtime routine. When Flora refused to take her medications, Amyhelped her with each pill, calling pharmacy to get liquid meds where possible.Flora dreaded the painful dressing changes to her lower extremities, but Amycarefully explained each step in the process and used strategies to minimize thepain Flora experienced. When a wandering maggot escaped from under theedge of the dressing, Amy unobtrusively removed it.Amy was weary as she came out of the room after morning care, sweat mat-ting the hair around her face as she sat down for the ﬁrst time in two hours todo her charting. When her instructor returned later, she found Amy back in iso-lation gear, sitting in Flora’s room, holding her hand. When her instructor askedAmy why she returned to Flora’s bedside, she replied, “I saw Jesus going backinto that isolation room to bring comfort to a lonely woman, but I knew Florawould not be able to see him, so I went instead.” (Adapted from Carol Bence, “I Went Instead,” Journal of Christian Nursing,spring 2003, pp. 45.)Discussion Questions1.In what ways does Amy’s care for Flora illustrate the principles given in theBible passages above? 2.How did Amy’s personal faith affect her nursing care?3.What did Amy’s care for Flora imply about the way she viewed her patient?4.How did Amy alter Flora’s environment to enhance her care? What seemedto enable Amy to endure the discomfort in her environment?5.What seemed to be the goal of Amy’s care for Flora? How do you think sheviewed health?6.Describe one of your most difﬁcult patients. How could you apply similarapproaches in your nursing care for this person? 2 REVOLUTION INTHE NURSING PARADIGM Purpose: To examine the relationship between shifting worldviews andthe changes occurring in nursing practiceObjectives: After reading this chapter and completing the exercises, youshould be able to:1.Describe a worldview 2.Deﬁne the four major concepts of the nursing metaparadigm accord-ing to the modern, postmodern and biblical worldviews3.Describe how this struggle between worldviews affects your nursingpractice4.Identify the worldview reﬂected in a nursing theoryKeywords: paradigm, worldview, nursing theory, modern, postmodern,biblicalSonja faced a dilemma. Working on a large aids unit over several years, shegrew to care deeply for the men and women who were frequently readmittedas a result of their immunosuppression. She grieved when they died, and sherecommitted herself to making the lives of other patients as comfortable as pos-sible during their last days. Her sense of being called by the Lord gave herstrength for what was often exhausting work.Increasingly, however, Sonja began to think that the option of physician-assisted suicide made sense for her patients. Many on her unit were seeking thehelp of organizations encouraging “the right to die” as a way of ending theirprolonged suffering. Some of her colleagues argued that helping these patientsend their lives was an act of compassion. Sonja felt confused. According to herChristian worldview, she could not deliberately end the life of anyone in her 28CALLED TO CAREthem contact someone for information about suicide as an option. Although thisalternative violated all that she had learned in nursing school about care for thedying, recent articles in nursing journals argued for the right of patients to con-trol their own deaths, dying when they chose to do so. Was Sonja’s Christianunderstanding too narrow?Maria, on the other hand, faced a different dilemma when she returned toschool for a master’s degree and took a required course in nursing theory. Likemany of her fellow classmates in undergraduate school, she had viewed nursingtheory as one of the subjects to be endured on the way to “real nursing.” Now,however, she was trying to see some practical implications in it.The changes in how nurses thought about nursing over the years intriguedher. Florence Nightingale focused on natural laws and the environment; thenVirginia Henderson saw nurses acting as substitutes to meet patients’ needswhen they could not do it themselves. Martha Rogers began to view patients asenergy ﬁelds within larger energy ﬁelds. Because Maria was a deeply committedChristian, she wondered about the connection between the theories she wasstudying and her faith.One professor suggested that she read the creation story in Genesis, substi-tuting the word energy for God. Upon trying it she realized that it underminedher understanding of the Christian God, who reveals himself as personal andloving. Over and over throughout the Scriptures, God speaks of wanting todwell with his people, of wanting to be their God and to have them belong tohim. This was the language of love and commitment. Energy, the language ofphysics, was so impersonal. Was Maria taking the Bible too literally? Karen, a junior nursing student at a large university, faced yet another di-lemma. One of her favorite instructors was teaching a popular elective coursein alternative healing, so Karen enthusiastically signed up for it. She hoped tolearn new ways to comfort patients. As the weeks went by, however, she beganto feel uncomfortable with what she was learning. For example, the professortold the class that she considered herself a witch and that some of the healingmethods she taught were “white witchcraft.” She encouraged students to chantformulas and burn candles as part of the healing process. She also taught thatthe Christian church had persecuted witches in order to retain its power overwomen. During a ﬁeld trip to a center for therapeutic touch, the instructor encouraged students to take off their clothes as a way to break down barriers be-tween themselves. Karen felt confused but decided not to participate. Was shebeing too rigid?11The three stories are composites of situations the writers have encountered. Revolution in the Nursing Paradigm29Sonja, Maria and Karen are not alone in their struggles. Nursing—reﬂectingchanges in the larger Western culture—is undergoing major shifts in its thinkingand practice. The foundations of nursing itself are being questioned. What isnursing about? What should be the goals of nursing? What is science in nursing?How can these questions be answered?The Beginnings of Nursing TheoryUntil nursing education moved from hospital-based apprentice programs to theacademic setting, there was little formal analysis of such matters. Nightingale’sconcern for a well-ordered environment was taken for granted, and much ofnursing focused on keeping things clean. During the early 1900s, hospitals werestaffed by nursing students who worked long hours and studied when theycould. After graduation, nurses went into either private-duty or public healthnursing. Most women in nursing were motivated by Christian values of compas-sion and service. Nurses saw themselves, for the most part, as assistants to phy-sicians. There was little time or inclination to develop concepts and philoso-phies of nursing.As nursing education moved into academia, the need developed to establisha body of knowledge unique to nursing. Because nursing entered the academythrough science departments, such knowledge was to be based on research. Sci-entiﬁc research required theories. Serious efforts in theory development beganin the 1950s and proliferated in the 1960s and 1970s. Virginia Henderson artic-ulated her famous deﬁnition of nursing in 1961 in a pamphlet published by theInternational Council of Nurses.2Because nursing entered the university through the door of natural science,nursing theories took on characteristics of naturalism. They were couched incause-and-effect language, often with elaborate diagrams showing complex re-lationships between concepts. Many theorists of this era were psychiatricnurses, so their theories focused on the nurse-patient relationship.3 Even thesewere framed in naturalistic language of analysis and cause and effect, althoughin a more personal tone.Early nursing theories reﬂect the positivistic philosophy of science prevalent 30CALLED TO CAREin the university.4 According to positivism, it is possible to gain true knowledgeof reality (what actually exists) through the processes of theory developmentand testing. The scientiﬁc community accepts theories insofar as they seem tocorrespond with reality. Nurses hoped that through this process of theory testingand reﬁnement they would progressivelybuild the body of knowledge needed forboth patient care and academic credibility.Early in this era (1952), the journal Nurs-ing Research began to disseminate theﬁndings of researchers. Great optimismamong nurses in academia characterizedthis period.Meanwhile nurses practicing at thebedside felt little actual impact from either nursing theories or nursing research.They did, however, experience the impact of new medical technology in the de-velopment of critical care units, advances in surgery and new approaches toemergency treatment. But these practicing nurses always knew that there wasmore to nursing than technology. They were often in awe of the inner strengthof their patients as they struggled with overwhelming illnesses, sometimes re-covering, sometimes dying. Nurses understood the power of their relationshipswith patients to encourage and give hope.Then in 1962 Thomas Kuhn published The Structure of Scientiﬁc Revolutions,in which he challenged the prevailing assumption that science was value-free.Kuhn is often misread as implying that reality exists only in human perception.What he does say is that while our perception and values shape our understand-ing of reality, eventually “reality ﬁghts back,” telling us that our theories are incorrect. In other words the facts no longer ﬁt the theory.5 A new paradigm, orway of interpreting experience, is sought. He denies, however, that progress inscience means drawing us closer to “some goal set by nature in advance.”64Positivist science is characterized by three features: presuppositionless objectivity, being em-pirically testable by experiments, and rationality. Bruce R. Reichenbach and V. Elving Ander-son, On Behalf of God: A Christian Ethic for Biology (Grand Rapids, Mich.: Eerdmans, 1995),p. 16.5Thomas S. Kuhn, The Structure of Scientiﬁc Revolutions, 2nd ed. (Chicago: University of Chi-cago Press, 1970). Kuhn assumes that nature exists, and it is when the facts of nature no longerseem to ﬁt within the prevailing theories that scientists are pushed to adopt new paradigms,ways of thinking about the part of nature they are studying. “Nature itself must ﬁrst undermineprofessional security by making prior achievements seem problematic” (p. 169). However,when scientists are operating on the basis of differing paradigms, they see reality differently(p. 150).6Ibid., pp. 170-72.A life devoid of the knowledge that theorizing brings us is a poor and paltry thing, short of what God meant our lives to be. NICHOLAS WOLTERSTORFF, EDUCATING FOR SHALOM Revolution in the Nursing Paradigm31Since Kuhn published his book, nurse thinkers, along with many in the socialand natural sciences, have wrestled with questions about the nature of scienceitself. Nursing theory textbooks now include chapters on the philosophy of sci-ence,7 asking questions such as What is truth? What is theory? They are also ask-ing even more basic questions such as Does reality exist beyond our perceptions,and, if it does, can we know anything at all about it? What is the scientiﬁcmethod? The debate rages in every ﬁeld of study. Nurses have an advantage thatmany others are not given—the patients we face every time we work. If the factsdo not ﬁt our theories, we get rapid feedback.However, the other side of Kuhn’s argument is that changing our thinkingdoes not come to us easily, either as individuals or as a community of thinkersand practitioners. He likens such changesto a conversion, something that one ex-periences. They are not brought about bylogical argument. The old ways of inter-preting our experiences with patientscontinue to guide us until we suddenlysee the facts in a new way.Conversion to a New ParadigmNursing is currently undergoing such aconversion experience. For many yearsnurses have known intuitively that therewas more about our patients and our-selves than could be explained withinnaturalistic scientiﬁc theories.8 Every daywe experience life, death, tragedy, birthand suffering. Often patients press uswith questions. “Why did my baby die?”“How can I live with a body that can’tmove or feel?” How often have we stooddumb before these cries? Our theories were impotent to help us. The naturalisticscientiﬁc theories told us about physiology and pathology. The psychosocialnursing theories told us to listen, to feel with, to support and encourage our pa-7See the chapter by Sue Marquis Bishop, “History and Philosophy of Science,” in Nursing The-orists and Their Work, ed. Ann Marriner-Tomey, 3rd ed. (St. Louis, Mo.: Mosby, 1994), pp.27-36.8Naturalistic theories assume that reality is only empirical, natural. There is no account of Godor spirit in these theories.A paradigm is the ﬁlter or grid through which we understand the world; an orientation of mind that determines how we think about the world. “For example a religious paradigm is a model of understanding that sees life as governed by God or some principle that is the ultimate cause of everything. A materialist paradigm is a model of understanding that sees life as the interaction of physical objects with no god principle at work.” HERBERT KOHL, FROM ARCHETYPETO ZEITGEIST 32CALLED TO CAREtients. But we found ourselves powerless in the end. Many of us turned to ourfaith to help us, and for most nurses that was Christian faith.Then in 1970 Martha Rogers published her little text An Introduction to the The-oretical Basis of Nursing.9 Because her work was so radically different, many dis-missed both the book and Rogers herself. Few understood what she was saying,and even fewer grasped the signiﬁcance of what she was doing for nursing.10What she did was open possibilities for new ways of thinking about nursing. Rog-ers continued using the impersonal language of physics—energy, ﬁeld theory, si-multaneity—to describe the intangible in nursing, but she assigned these wordsnew meaning. Other nursing theorists who followed began to explore new ap-proaches to nursing theory and science, such as phenomenology and existential-ism, and to use the language of spirit, consciousness and goddess.11In the 1994 edition of her textbook on nursing theory, Barbara Stevens Bar-num notes the polarity between the older and the newer nursing theories. Theolder nursing process theories are associated with taxonomies and quantitativemeasures, whereas the new holistic theories use more qualitative measures andsofter phenomena.12Both nursing education and practice are feeling the impact of the shift from theold to the new approaches. This shift—or revolution, according to Kuhn—is whatSonja, Maria and Karen, who were introduced at the beginning of this chapter, areexperiencing. The shift affects not merely our thinking about nursing but also ournursing interventions and the way we make ethical decisions.The polarity Barnum notes is particularly wide when it comes to how we de-velop nursing knowledge. Two opposing and irreconcilable ontologies (viewsof reality) underlie the old and the new paradigms: realism and conceptualism.13Barnum writes,9Martha A. Rogers, An Introduction to the Theoretical Basis of Nursing (Philadelphia: F. A.Davis, 1970).10Rogers’s book for nursing is comparable to Kuhn’s for the larger scientiﬁc community in thatboth formulated a new way to approach the work of their respective disciplines.11Jean Watson, Human Science and Human Care (New York: National League for Nursing,1988); Margaret A. Newman, Health as Expanding Consciousness, 2nd ed. (New York: Na-tional League for Nursing, 1994).12Barbara J. Stevens Barnum, Nursing Theory: Analysis, Application, Evaluation, 4th ed. (Phil-adelphia: Lippincott, 1994), pp. 25152.13Ontology is the study of being, of what exists, of ultimate reality. Its investigations concern Revolution in the Nursing Paradigm33In realism, one believes that the world exists “out there,” independentof the knower. Research and theory seek to discover and explain thenature of that external reality. . . . In conceptualism, reality does notexist independent of the knower. Invention, rather than discovery, isthe dominant mode of knowing reality. The two concepts are the extreme poles, with all sorts of variations on the continuum that spansthem.14Barnum, like many other nurse thinkers, advocates a live-and-let-live ap-proach between these two paradigms in nursing, arguing that both have some-thing to contribute. If Kuhn is correct in his analysis, however, conversation be-tween those using different paradigms is not possible. The struggle betweenthem will continue until the new paradigm succeeds the old.15Some nurse thinkers debate the question at the level of philosophy andscience.16 Margretta Styles sees the need for nursing to be guided by a unity ofscience based on philosophy, to clarify “what we should be and to include inprofessionalization such themes as commitment, personal motivation, and selfactualization as well as scientiﬁc discovery.”17While we agree that naturalistic theories alone are much too narrow for nurs-ing, we also think that there are serious problems with many of the newer ap-proaches. We agree with Styles that the issue is much more fundamental. It lieswith our ultimate view of life, the philosophy of nursing. We appreciate the newopenness to spirituality—but we believe that there is a far deeper concern thanmerely adding religion and spirituality, as if they were the missing parts that willslack the hunger for meaning not addressed in naturalistic theories. What is hap-pening in nursing (and in our larger culture) is a major shift from one worldviewto another. The new theories in nursing reﬂect this shift. It is at the worldviewlevel that we must begin.14Ibid., p. 269.15We think that Kuhn is correct if we operate as he does from a naturalistic understanding ofreality. We think that there is a way to bring about conversation. It is based on an understand-ing that reality is the creation of God and that God has revealed to us a way to think aboutreality.16June F. Kikuchi and Helen Simmons, eds., Philosophic Inquiry in Nursing (Newbury Park, Ca- 34CALLED TO CAREBeginning with WorldviewsUntil recently the term worldview was part of the technical language of philosophers and anthropologists. Philosophers refer to worldview when they meanthe basic assumptions that underlie a system of thought. Anthropologists use theterm in a broader way to identify not only the wellsprings of our thinking butour way of life as well. “It shapes and integrates our various ﬁelds of knowledgefrom theology, anthropology, and missions to physics and the culinary arts.Worldview governs everyday behavior” (Mt 6:8; 7:11; Lk 12:32).18 “Worldviews18Paul G. Hiebert, Anthropological Reﬂections on Missiological Issues (Grand Rapids, Mich.:Baker, 1994), pp. 11-12.Seven Basic Worldview QuestionsJames Sire deﬁnes a worldview as “a commitment, a fundamentalorientation of the heart, that can be expressed as a story or in a set ofpresuppositions (assumptions which may be true, partially true or entirelyfalse) which we hold (consciously or subconsciously, consistently orinconsistently) about the basic constitution of reality, and that provides thefoundation on which we live and move and have our being.”* He assertsthat to understand the concept of worldview, we must answer thefollowing questions:•What is prime reality?•What is the nature of the world around us?•What is a human being?•What happens to a person at death?•Why is it possible to know anything at all?•How do we know what is right and wrong?•What is the meaning of human history?**For the Christian nurse, the answers to these questions come from thestories, themes and patterns found in the Bible. This careful study ofScripture reveals to us the nature of persons, the context in which we liveand practice, the meaning of health and the impetus for nursing care. ForChristians, prime reality is God, who created and sustains all things. Thus,this worldview is derived from a Christian theology of nursing.*James W. Sire, Naming the Elephant: Worldview as Concept (Downers Grove, Ill.: Inter-Varsity Press, 2004), p. 122.**Ibid., p. 20. Revolution in the Nursing Paradigm35are the most fundamental and encompassing views of reality shared by a peoplein a culture. A worldview incorporates assumptions about the nature of things—about the ‘givens’ of reality” (Heb 4:15).19 “They are made up of the categories,values, and assumptions we use to examine our world.”20 Worldviews providethe cultural lenses that shape how we see the world, and they give meaning tolife, both personally and for humanity as a whole.Because a worldview is so overarching, it can integrate many theories fromdifferent aspects of life and help us see how they may complement each other.But when theories reﬂect very different worldviews, they will conﬂict with oneanother. Ultimately, differing worldviews cannot be reconciled; either one or theother gives us a truer picture of reality.The Modern Western WorldviewDualism, one of the themes inﬂuencing the modern Western worldview can betraced to the Indo-European culture of the third millennium B.C. According to an-thropologist Paul Hiebert, this worldview in its various forms undergirded the re-ligions of Babylon, Sumer, Canaan, Greece, India and Germany, among others.In this worldview good and evil are two independent entities locked ineternal conﬂict. In this battle, the ultimate good is order and freedom, andto achieve this one side or the other must gain control. The ultimate evilis chaos and enslavement. Given this dualism, all reality is divided intotwo camps and the line between them is sharp. We see this in our Amer-ican tendency to categorize in opposites: good-bad, big-small, sweet-sour,successfailure, and truth-falsehood.21This dualistic thinking inﬂuenced some early and medieval Christian schol-ars, who tended to draw a sharp line between spirit and matter. Many Christianssaw matter and the world as inherently evil, spirit and heaven as good. Theydrew a sharp distinction between the natural and the supernatural and focusedmore on the supernatural realm. During the Renaissance (beginning about the ﬁfteenth century), thinkers re-acted against the supernatural focus of dualism. They turned, instead, to the nat-ural world of humans, animals, plants and matter. They began to see the worldas autonomous, operating according to natural laws. Their hope was that thenewly developing science would enable them to understand these laws and use 36CALLED TO CAREthem to solve practical human problems.22 While most early scientists saw theworld as an orderly creation dependent on God for its existence, eventuallypeople began thinking of God as distant. They saw themselves created for theirown destiny. This view led to modern secularism, which effectively eliminatedGod from public life but retained the sharp divisions of dualistic thinking.While the modern worldview retains the dualism inherited from the ancientIndo-Europeans and Greeks, Hebrew and Christian thinking have also inﬂu-enced it. The Bible has given the Western world its strong emphasis on the valueof the individual person who is not to be lost within the group. The biblicalteaching that life has its source in God and that humans are created with thecapacity to relate to God in a personal way has supported our respect for eachperson. The creation story undergirds our belief that creation is orderly and thatthe “laws” of nature can be discerned by science. Westerners retain the idea ofhistory moving to a climax, rather than in endless natural cycles, from the bib-lical story of God acting in history and ﬁnally bringing it to a conclusion. Biblicalvalues of love and justice have shaped Western ethics.Today many are dismissing the modern worldview as having been tried andfound wanting, seeing it as causing alienation from the world of the spirit. Somesee Christianity as part of the problem because it has become so intertwinedwith the modern worldview. Nevertheless, its themes are still powerful in ourculture even though they are reinterpreted on a secular basis. Both Christianityand Indo-European and Greek dualism have undergirded the rise of modern sci-ence and the concept of progress associated with it.The Postmodern WorldviewMany writers argue that we now live in a postmodern world.23 Despite the pow-22Bruce R. Reichenbach and V. Elving Anderson, On Behalf of God: A Christian Ethic for Biology(Grand Rapids, Mich.: Eerdmans, 1995), p. 11. English philosopher Francis Bacon (1561-1626)called himself the “trumpeter of his times.” He sought to reform science, which until then hadbeen inﬂuenced by Aristotle’s search for essences. He advocated empirical science instead.“For Bacon, the function of science ultimately was to control nature for human beneﬁt.” Hebelieved that science was a form of power. To exercise power over nature we must understand nature and its causes or principles.23For those who want to read more about the development called postmodernism, we recom-mend the following: Albert Borgmann, Crossing the Postmodern Divide (Chicago: Universityof Chicago Press, 1992); Stanley J. Grenz, A Primer on Postmodernism (Grand Rapids, Mich.:Eerdmans, 1996); Dennis McCallum, ed., The Death of Truth (Minneapolis: Bethany House,1996); Pauline Marie Rosenau, Post-Modernism and the Social Sciences (Princeton, N.J.:Princeton University Press, 1992); Gene Edward Veith, Postmodern Times: A Christian Guideto Contemporary Thought and Culture (Wheaton, Ill.: Crossway, 1994); Nicholas Wolterstorff,“Does Truth Still Matter? Reﬂections on the Crisis of the Postmodern University,” CRUX, Sep-tember 1995, pp. 17-28. Revolution in the Nursing Paradigm37erful beneﬁts of science, there is increasing recognition that science cannot givemeaning to life. Many scientists are themselves rejecting the dualism that divorcesspiritual from material realities and separates values from scientiﬁc objectivity.Social scientists and health care professionals are calling for a more holistic viewthat brings humans into harmony with their environment. Others, rejecting hier-archy and competition, are calling for more inclusive global cooperation.The newer theorists of nursing reﬂect this postmodern worldview: Joyce Fitzpatrick, Margaret Newman, Rosemarie Rizzo Parse, Martha E. Rogers and JeanWatson. Each of these thinkers is quite different in her approach, but each iscalling for something beyond the mechanistic, natural-science approach to nurs-ing. A new nursing paradigm is needed.Postmodern theories reﬂect what Kuhn calls a new paradigm. They often as-sume that the world is made up of energy that can be manipulated and con-trolled.24 Although this energy is claimed to be nonreligious, in practice it fre-quently becomes a “channeling” or manipulation of spirits. These theories drawfrom various sources in Eastern philosophy, Theosophy and traditional reli-gions, including shamanism, Native American spirituality and Wicca.25 From a scientiﬁc perspective, proponents of energy-based theories vacillatebetween two extremes. Some advocates dismiss science entirely and claim theeffectiveness of the associated modalities through anecdotal evidence. Othershave attempted to use both quantitative and qualitative research methods toprove they work. Results, however, remain inconclusive.26 Some have attemptedto blend modern physics with Eastern mysticism27 but have made quantumleaps in logic and reality in the process.28Pagan Religions RevivedSome nurses—theorists, educators and practitioners—are afﬁrming pagan reli-gions as a source of new creativity and power. The natural world of pagan re-ligions, like that of traditional religions, is alive. “Not only humans, but also an-24Dora Kunz and Erik Peper, “Fields and Their Clinical Implications,” in Spiritual Aspects of theHealing Arts, ed. Dora Kunz (Wheaton, Ill.: Theosophical Publishing House, 1985), pp.213-61. Also see Rochelle B. Mackey, “Discover the Healing Power of Therapeutic Touch,”American Journal of Nursing, April 1995, pp. 27-31.25Barbara Blattner, Holistic Nursing (Englewood Cliffs, N.J.: Prentice-Hall, 1981), pp. 7-16; andLynn Keegan, The Nurse as Healer (Albany, N.Y.: Delmar, 1994), pp. 4-6.26Sharon Fish, “Therapeutic Touch: Can We Trust the Data?” Journal of Christian Nursing, sum-mer 1993, pp. 6-7.27One of the most quoted is Fritjof Capra, The Tao of Physics (Boulder, Colo.: Shambhala, 1975).28Nobel Prize-winning physicist Leon Lederman, The God Particle (New York: Bantam Double-day Dell, 1993), provides an entertaining exposé in his chapter “The Dancing Moo-Shu Mas-ters,” pp. 189-98. 38CALLED TO CAREimals, plants, and even rocks, sand, and water are thought to have personalities,wills, and life forces.”29 Most Western advocates of these religions hold a romantic view of them, seeing them as bringing mystery and harmony into human life.Christian critics of these worldviews recognize that the fortunes of adherents areleft to the mercy of capricious, invisible ancestors; of demons, witches andghosts; and even of impersonal forces. In the pagan worldview a supreme god is distant and unconcerned about thedaily problems of life: sickness, death, bad luck and accidents. The only defensefor humans is to gain power over these capricious spirits and forces that cause theirproblems. “Power, not truth, is the central human concern in this worldview.”30Today, accounts of fertility rites, white witchcraft, divination, palmistry, for-tune-telling and astrology are gaining credibility and acceptance. Many bookstores have large sections devoted to Wicca and the occult. Tabloids carry storiesof ghosts, witchcraft, evil-eye curses and fulﬁlled prophecies. Nurse researcherSharon Fish has documented the close ties between some of the energy thera-pies being advocated by nurses who call themselves healers and Theosophy, anadmittedly occult philosophy.31Such beliefs, suppressed during the reign of science, have never fully left theWestern mind. Underneath the veneer of orthodox Christianity an assortment offolk religious beliefs persists, handed down by word of mouth, despite the oppo-sition of church leaders and the ridicule of scientists.32 At the center of these folkreligions are the shaman and the practice of magic. Historian of religion Mircea Eli-ade characterizes the shaman as one who communicates with the spirits in an ec-static trance. He or she performs miraculous cures and predicts future events. Sha-mans serve as mediators between ordinary people and the spirit world.33Shamanism is gaining credibility among some nurses today.34 Some even re-29Hiebert, Anthropological Reﬂections, p. 196.30Ibid., p. 224.31Sharon Fish, “Therapeutic Touch: Healing Science or Metaphysical Fraud?” and “A Brief His-tory of Theosophy,” Journal of Christian Nursing, summer 1996, pp. 4-13.32Hiebert, Anthropological Reﬂections, p. 224.33Mircea Eliade, Shamanism: Archaic Techniques of Ecstasy, trans. W. R. Trask (Princeton, N.J.:Princeton University Press, 1972), pp. 3-8.34An example is the work by Jeanne Achterberg, who teaches and is involved in rehabilitationresearch at the University of Texas Health Science Center in Dallas. Her 1985 book Imagery inHealing: Shamanism and Modern Medicine is often cited in reference lists of nurses who writeabout holistic health. In this book she attempts to explain the power of shamans to heal by thescience of psychoneuroimmunology. In her 1994 Rituals of Healing, written with nurses BarbaraDossey and Leslie Kolkmeier, she refers to crosscultural studies of shamanic and other ritualsthat have led to her conclusions. In February 1996 Dr. Larry Dossey appeared on the TV pro-gram Unsolved Mysteries, supporting the use of shamanistic practices in modern health care. Revolution in the Nursing Paradigm39fer to themselves as shamans. The healer in energy-based therapies like thera-peutic touch ﬁlls the role of the shaman when manipulating and directing “lifeenergy” by hand and body movements, mental concentration or both.35 Eventhe Christian practice of praying for the sick is sometimes interpreted in the lan-guage of shamanism.36Shamanism is associated with magic, the attempt to inﬂuence people andevents by supernatural or occult means. Black magic attempts to produce evilresults through such methods as curses, spells, destruction of models of one’senemy and alliance with evil spirits. White magic tries to undo curses and spellsand to use occult forces for the good of oneself and others.37 The magician triesto compel a spirit to work for him or her or follows a pattern of occult practicesto bend psychic forces to do the magician’s will. Magic is carried out by speciﬁcrituals and methods known only to those who are initiates into the practice.Healers who practice these rituals often refer to themselves as white witches.38So far in this chapter we have presented the worldviews that have shapedand are shaping nursing theory—the modern worldview and the postmodernworldview. We agree that theories of nursing based on the modern mechanisticworldview are not adequate to undergird the practice of nursing. Theories thatreduce people by materialistic explanations and ignore the spiritual realm cannever satisfactorily encompass the richness of nursing: caring for people in lifeand death, in times of high joy and crushing sorrow.However, we challenge the idea that theories based on pagan religions arethe answer. Returning to shamanism and spiritism where we must appease spir-its, or to magic where we seek to dominate reality for our own ends through35In May 1993 one of the authors, Arlene, attended a workshop at Harrisburg Area CommunityCollege taught by Janet Quinn, wellknown teacher of Therapeutic Touch. Dr. Quinn said thatthe hand movements of TT were for the beneﬁt of the healer and eventually could be dis-pensed with. The clear implication was that healing would occur by mental concentrationonly.36One writer interprets James 5:13-17 as afﬁrming the innate power of people to heal: TomCountryman, “Energy-Based Healing Arts and Christian Teaching,” in Beginnings: The OfﬁcialNewsletter of the American Holistic Nurses Association, January 1996, p. 9. He fails to say that 40CALLED TO CARErituals and formulas, will lead to dehumanization, disillusionment and spiritualoppression. These worldviews undermine the practices and ways of thinkingthat face Sonja, Maria and Karen; the worldviews promise much but offer onlyillusions. Instead, we believe that nurses need to reexamine the view of realityportrayed in the Bible. We turn to that worldview in the next chapter.For Further Thinking1.What major changes have you encountered since you ﬁrst entered nursing?2.What evidence have you seen that worldviews in nursing are shifting?3.How would you describe your own worldview?Theological ReﬂectionRead Acts 8:4-24.1.Compare the ministry of Philip to that of Simon. 2.What outcomes did each of them seek?3.What motivated each? 4.Describe the worldview of each based on the information given about them.5.Why did Peter and John judge Simon so harshly?6.What resulted?CASE STUDY: Rachel and the Class She Couldn’t TakeAs a junior nursing student, Rachael was required to attend a weekly student-led seminar. During one class session, several students presented TherapeuticTouch (TT) as an alternative pain management technique. Rachael knew noth-ing about TT but felt uneasy about it. Later she learned that TT would be cov-ered more thoroughly in an upcoming nursing lab.Rachael began to discuss her concerns with several other students and toseek more information about TT. After reading articles in the Journal of Chris-tian Nursing about the occult and Eastern religious roots of TT, she became Revolution in the Nursing Paradigm41instructor. Rachael explained what she had discovered in her research and of-fered to write a letter to the faculty about her concerns. The instructor urged herto do so.Rachael’s letter elaborated the points she had brought up in the postconfer-ence, but also discussed the negative effects of TT (which were not mentionedin the lab) and the ethical issues regarding informed consent. She gave the letterto her instructor, who presented it to the faculty curriculum committee. The fac-ulty complimented Rachael on her work. They decided to discontinue the laband set restrictions on the way TT could be presented to students in the future. (Adapted from Rachael Foster, “The Class I Couldn’t Take,” Journal of Chris-tian Nursing, winter 1998, p. 8.)Discussion Questions1.Why do you think Rachael felt troubled by the presentation on TherapeuticTouch?2.Describe your own experience with TT and other alternative therapies. Whattroubles you? What intrigues you?3.How has your school or work situation addressed alternative therapies? Howhave you responded?4.Examine Rachael’s responses. What did she do well? 5.Worldviews not only affect spiritual issues but also ethics, economics, phys-ical care and interpersonal relationships. How do you see this reﬂected inyour own nursing environment? 3 A CHRISTIAN WORLDVIEWFOR NURSING Purpose: To determine the characteristics of a Christian worldview innursingObjectives: After reading this chapter and completing the exercises, youshould be able to: 1.Deﬁne theology of nursing 2.Deﬁne truth according to biblical, modern and postmodern worldviews3.Describe each concept of the nursing metaparadigm according to abiblical worldview (person, environment, health, nursing)4.Describe the implications of your own worldview on your nursingpracticeKeywords: theology, truth, worldview, Christian, Bible, Creator, Re-deemer, Holy Spirit, modern, postmodern, metaparadigm, person, environ-ment, health, nursingThe beginnings of organized nursing in Norway illustrate a common pattern forhow nursing became established around the world. Ingeborg Gjersvik tells the story:Around 1850 Norway experienced a spiritual awakening which motivatedan important social awakening. People began to see the need to care forthe sick and the poor. The very thought of women caring for sick peopleoutside of their own families, and furthermore establishing a trainingcourse to do so, was unheard of and unacceptable in Norwegian societyat that time. However, many prayer groups were formed, asking for God’sguidance in this matter.11Ingeborg Gjersvik, “A Heart of Compassion: How Nursing Started in Norway,” Journal ofChristian Nursing, spring 1997, p. 12. A Christian Worldview for Nursing43The answer to their prayers came through Cathinka Guldberg, a pastor’sdaughter who used to make home visits to the sick with her father. One nightCathinka discovered that a homeless woman, who had been going from doorto door begging for shelter, had been found frozen to death in the snow. Deeplyconvicted, Cathinka prayed about how she could make a difference. Soon after-ward, she found a leaﬂet about the Kaiserswerth deaconess community andconsidered it an answer to her prayers. She studied nursing in Kaiserswerth,then returned to begin a nurses’ training program for deaconesses. The schoolexpanded to include lay nurses. Then additional nursing schools were estab-lished, and nursing spread throughout Norway.The beginning of nursing in Norway continues a long tradition of care for thesick that began in the early Christian church. This was a radical change from thepre-Christian society. Second-century theologian Tertullian noted,It is our care of the helpless, our practice of loving-kindness that brandsus in the eyes of many of our opponents. “Only look,” they say, “how theylove one another! Look how they are prepared to die for one another.”2During a devastating third-century plague, historian Eusebius of Caesarea recorded,The Christians were the only people who amid such terrible ills, showedtheir fellowfeelings and humanity by their actions. Day by day somewould busy themselves by attending to the dead and burying them; othersgathered in one spot all who were afﬂicted by hunger throughout thewhole city and give them bread.3Nursing grew out of a Christian worldview, in response to Jesus’ teaching andexample of caring for the sick. What was it about the Christian worldview thatmotivated the early church to reach out to the poor, the sick and the marginalized?While other worldviews of the time focused on gaining control of the phys-ical elements and spiritual powers, the early Christians looked instead to Godas one who deserved love and obedience and who inspired loving service toothers. As we have seen, that tradition of caring for others in the form of nursinghas continued throughout church history.2Quoted in Josephine Dolan, M. Louise Fitzpatrick and Eleanor Krohn Herrmann, Nursing inSociety: A Historical Perspective, 15th ed. (Philadelphia: W. B. Saunders, 1983), p. 43.3Ibid. 44CALLED TO CAREWorldviews in Nursing TheoriesNursing theories provide a conceptual framework for directing and organizingour work. Theories guide nursing science but they also reﬂect theorists’ view ofscience. Although at times it is implicit, each theory assumes an underlyingworldview. Theories also reﬂect shifts in the worldview of the larger society.The worldview evaluation of theories in table 3.1 provides beginning examplesof how Christian nurses can examine worldviews as they relate to individualtheories. We suggested that the three worldviews underlying current nursing theoriesinclude modern Western, postmodern, and revived pagan. It would be a mistaketo label a nursing theory as purely one or the other of these worldviews. Mostcontain elements from several worldviews, often leading to contradictionswithin the theory.The impact on nursing from the general systems theory (GST) must also beconsidered in evaluating a theory. According to the GST, propounded by biol-ogist Ludwig von Bertalanffy, all sciences operate according to the same funda-mental principles.4 Often associated with GST were attributions of teleology, theidea that system processes are directed toward more fully developed and efﬁ-cient entities.5 Systems theory provides a way for nurses to deal with complexinteractions between persons and the many aspects of their environment as wellas interactions within the individual.Holism, a related concept in biology, holds that an organism is an irreduciblewhole that cannot be condensed to its component parts. Holism explains partsin terms of qualities displayed by the whole organism as opposed to analyzingparts to explain the whole.6 In other words the whole of anything is containedin each of its parts. This contrasts with the traditional understanding of sciencethat subdivides an organism or substance into smaller parts for analysis.We ﬁnd two meanings of holism in nursing theories. In the ﬁrst, holism is acomprehensive approach to anything, considering all parts or dimensions of aperson or object. The second meaning equates holism as a philosophy thatmakes no distinction between the whole and the parts. 4Ludwig von Bertalanffy, General Systems Theory: Foundations, Development, Applications(New York: G. Braziller, 1968).5General systems theory does not necessarily include a goal of increasing development andefﬁciency. However, many theorists who use it take an optimistic view of things, usuallybased on philosophical evolution. In this way they view systems as always improving onthemselves. A Christian Worldview for Nursing45Table 3.1. Worldview Concepts in Selected Theories (Classiﬁcation of theories based on Ann MarrinerTomey, Nursing Theorists and TheirWork, 3rd ed. [St. Louis: Mosby, 1994].)Betty Neuman: Neuman Systems Modela (Conceptual Model: Grand Theory)aBetty Neuman, The Neuman Systems Model, 3rd ed. (Stamford, Conn.: Appleton & Lange, 1995), pp. 4548.GODENVIRONMENTPERSONHEALTHNURSINGSource of human spirit or soul. Holy Spirit is a gift that combines with the human spirit; the spirit controls the mind that controls the body.“Consists of both internal and external forces surrounding the client, inﬂuencing and being inﬂuenced by the client at any point in time, as an open system. The created environment is an uncon-sciously developed protective environment that binds sys-tem energy and encompasses both the internal and external client environments.” “Stressors; Environmental fac-tors, intra-, inter-, and extra personal in nature, that have potential for disrupting system stability. A stressor is any phe-nomenon that might penetrate both the ﬂexile and normal lines of defense, resulting in either a positive or negative outcome.”“Client/Client System; A composite of variables (physiological, psychological, socio-cultural, developmental and spir-itual), each of which is a subpart of all parts, forms the whole of the client. The client as a system is composed of a core or basic structure of survival fac-tors and surrounding protective con-centric rings. The rings are composed of similar factors yet serve varied and different purposes in either retention, attainment, or maintenance of system stability and integrity or a combination of these. The client is considered an open system in total interface with the environment. The client is viewed as a system, and the terms can be used interchangeably with the client/client system.”“Basic Structure; The basic structure consists of common client survival fac-tors, as well as unique individual char-acteristics. It represents the basis sys-tem energy resources.”“Boundary Lines; The ﬂexible line of defense is the outer boundary of the client system. All relevant variables must be taken into account, as the whole is greater than the sum of the parts; a change in one part affects all other system parts.”“A continuum of wellness to ill-ness, dynamic in nature, that is constantly subject to change. Optimal wellness or stability indicates that total system needs are being met. A reduced state of wellness is the result of unmet systemic needs. The cli-ent is in a dynamic state of either wellness or illness, in varying degrees, at any given point in time.”“Stability; A state of balance or harmony requiring energy exchange as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health, thus preserving system integrity.”“Lines of Resistance; Protective factors activated when stressors have penetrated the normal line of defense, causing a reaction symptomatology. The resistance lines ideally protect the basic structure and facilitate reconsti-tution toward wellness during and following treatment, as stressor reaction is decreased and client resistance is increased.”“A unique profession con-cerned with all variables affect-ing clients in their environment.”“Prevention as intervention; Intervention typology or modes for nursing action and determinants for entry of both client and nurse into the health care system. Primary preven-tion: before a reaction to stres-sors occurs. Secondary preven-tion: treatment of symptoms following a reaction to stres-sors. Tertiary prevention: maintenance of optimal well-ness following treatment.”“Goal; The system goal is sta-bility for the purpose of client survival and optimal wellness.” 46CALLED TO CAREDorthea Orem: Self-Care Deﬁcit Theorya (Conceptual Model: Grand Theory)GODENVIRONMENTPERSONHEALTHNURSINGNot identiﬁed. Relevant only to the patient’s understand-ing.Physical, chemical, biological and social (family, community) fea-tures with which the person inter-acts. Contributes to the person’s development. Human beings are:1. Persons moving toward person-alization (maturation & achieve-ment of human potential) while liv-ing a life of faith in respect of things hoped for & to perfect themselves as responsible human beings who raise questions, seek answers, reﬂect and become aware of the relationship between knowl-edge and behavior.2. A unity of structures and func-tions that actively maintains self-care and/or dependent-care agency by regulating factors affect-ing life, health or well-being. Seek health care for self-care or depen-dent-care deﬁciencies.A state of being structurally and functionally whole or sound; psychologically, biologically and socially. It includes the individ-ual’s view of self as a self-care or dependent-careb agent and the freedom with which the individ-ual acts with responsibility in matters of self-care or depen-dent-care. Nurses help patients meet or develop their self-care agency—or their dependent care agency. Includes (1) doing for, (2) guiding, (3) teaching, (4) supporting, (5) providing a developmental environment.Nursing care is therapeutic in sustaining life and health, in recovering from disease or injury, or in coping with their effects (primary, secondary, and tertiary prevention). It contributes to personal develop-ment and maturation. aDorthea E. Orem, Nursing Concepts of Practice, 3rd ed. (New York: McGraw Hill, 1985), pp. 55, 136-43, 176-83.bCare of children or others for whom the person is responsible.Madeline Leininger: Culture Care Theorya (Middle Range Theory)aMadeleine M. Leininger, “The Theory,” in Culture Care Diversity & Universality: A Theory of Nursing, ed. Madeleine M. Leininger (New York: National League for Nursing, 1991), pp. 5-68.GODENVIRONMENTPERSONHEALTHNURSINGDeﬁned by the culture.Technology, religion, kinship and society, values and traditions, pol-itics and law, economy, educa-tion, language and history of the culture.Individuals, families, communities as deﬁned by the culture.Well-being: Culturally deﬁned and reﬂects the ability of individ-uals or groups to perform their daily activities according to their culture.Directed toward assisting, supporting or enabling an individ-ual or group with evident or anticipated needs to maintain A Christian Worldview for Nursing47Sr. Callista Roy: Adaptation Modela (Conceptual Model: Grand Theory)aCarolyn L. Blue et. al., “Adaptation Model,” in Nursing Theorists and Their Work, ed. Ann Marriner-Tomey, 3rd ed. (St. Louis: Mosby, 1994), pp. 24668.GODENVIRONMENTPERSONHEALTHNURSINGGod is intimately revealed in the diversity of creation and is the common destiny of creation.All conditions and inﬂuences surrounding & affecting the develop-ment & behavior of persons or groups. Persons must adapt to positive & negative factors in environment.• All conditions, circumstances and inﬂuences surrounding and affecting the development and behavior of persons and groups with particular consideration of mutuality of person and earth resources.• Three kinds of stimuli: focal, contextual and residual. • Signiﬁcant stimuli in all human adaptation include stage of development, family and culture.bbCallista Roy, Boston College Nurse Theorist Web Site, accessed February 3, 2004 . A biopsychosocial being in con-stant interaction with a changing environment. A living, complex, adaptive system. A whole made of parts or subsystems that function as a unity for some purpose.• An adaptive system with coping processes.• Described as a whole comprised of parts.• Functions as a unity for some purpose.• Includes people as individuals or in groups (families, organizations, communities, nations and society as a whole).• An adaptive system with cogna-tor and regulator subsystems acting to maintain adaptation in the four adaptive modes: physiologic-phys-ical, self-concept-group identity, role function and interdepen-dence.• Health: a state and process of being and becoming integrated and whole that reﬂects person and environmental mutuality.• Adaptation: the process and outcome whereby thinking and feeling persons, as individuals and in groups, use conscious awareness and choice to create human and environmental inte-gration.• Adaptive Responses: responses that promote integrity in terms of the goals of the human system, that is, survival, growth, repro-duction, mastery, and personal and environmental transforma-tion.• Ineffective Responses: re-sponses that do not contribute to integrity in terms of the goals of the human system.• Adaptation levels: represent the condition of the life pro-cesses described on three differ-ent levels: integrated, compensa-tory and compromised.Helping persons to adapt to changes in their physiological needs, self-concept, role func-tion, and interdependent func-tions during health & illness.• Nursing is the science and practice that expands adaptive abilities and enhances person and environment transforma-tion.• Nursing goals are to promote adaptation for individuals and groups in the four adaptive modes, thus contributing to health, quality of life and dying with dignity. • This is done by assessing behavior and factors that inﬂu-ence adaptive abilities and by intervening to expand those abilities and to enhance envi-ronmental interactions. 48CALLED TO CAREMartha Rogers: Science of Unitary Human Beingsa (Conceptual Model: Grand Theory)aMartha E. Rogers, An Introduction to the Theoretical Basis of Nursing (Philadelphia: F. A. Davis, 1970); Joann Sebastian Daily et al., “Unitary Human Beings,” in Nursing Theorists and Their Work, ed. Ann Marriner-Tomey, 3rd ed. (St. Louis: Mosby, 1994), pp. 211-30; Martha E. Rogers, “Science of Unitary Human Beings,” in Explorations on Martha Rogers’ Science of Unitary Human Beings, ed. Violet M. Malinski (Norwalk, Conn.: AppletonCentury-Crofts, 1986).GODENVIRONMENTPERSONHEALTHNURSINGNot identiﬁed as a distinct being(s). All reality is pan-dimensional, inﬁnite energy ﬁelds, char-acteristics usually associated with God.Energy ﬁeld: the fundamental unit of the living and non-living; unifying concept. Energy signi-ﬁes dynamic nature of ﬁelds; ﬁelds are inﬁnite.b Two energy ﬁelds are identiﬁed, human and environmental. Energy ﬁelds are open ﬁelds; causality is invalid; change is continuously innovative.c “Fields are coextensive with the universe, thus without boundaries, everything is interconnected through energy pattern-ing.”dPattern is the distinguishing characteristic of an energy ﬁeld perceived as a single wave; an abstraction; gives identity to the ﬁeld; changes continuously.e Four-dimensionality/pan-dimensionality: a non-linear domain without spatial or temporal attributes; characteristic of all reality; relative nature of change; a way of perceiving human beings and their world.fbRogers, “Science of Unitary,” pp. 4-5.cIbid., p. 5dViolet M. Malinski, “Nursing Practice Within the Science of Unitary Human Beings,” in Explorations on Martha Rogers’ Science of Unitary Human Beings, ed. Violet M. Malinski (Norwalk, Conn.: Appleton-Century-Crofts, 1986), p. 26.eIbid.fIbid.An irreducible, pan dimensional energy ﬁeld identiﬁed by pat-tern, manifesting characteristics of the whole and integral with the human ﬁeld.g Each environ-mental ﬁeld is speciﬁc to its given human ﬁeld. Both change continuously, mutually and cre-atively.h The patterns of human and envi-ronmental ﬁelds are character-ized by: Resonance—the contin-uous change from lower to higher frequency wave patterns; Helicy—the continuous innova-tive, unpredictable, increasing diversity of the patterns. Inte-grality—the continuous mutual human ﬁeld and environmental ﬁeld process.igDaily et al., “Unitary Human Beings,” p.230.hRogers, “Science of Unitary,” p. 5.iDaily et al., “Unitary Human Beings,” p. 215.The unitary human being (human ﬁeld) is an irreducible, indivisible, four-dimensional/pan-dimensional, energy ﬁeld identiﬁed by pattern; manifesting characteristics that are different from those of the parts (spe-ciﬁc to the whole) and cannot be pre-dicted from knowledge of the parts.j In continuous mutual total process with the environment.k Capacity for thought, imagination and emotion.lParanormal and mystical experiences derived from openness, pan-dimen-sionality and patterning of human and environmental ﬁelds.mBecause there are no boundaries, persons extend beyond their skin.njRogers, “Science of Unitary,” p. 5.kDaily et al., “Unitary Human Beings,” 216.lRogers, Introduction, pp. 67-73.mW. Richard Cowling, “The Relationship of Mystical Experience, Differentiation, and Creativity in College Students,” in Explorations on Martha Rogers’ Science of Unitary Human Beings, ed. Violet M. Malinski (Norwalk, Conn.: Appleton-Century-Crofts, 1986), pp. 131-39.nMalinski, “Nursing Practice,” p. 26.Passive health symbolizes wellness and absence of disease. Positive health is rhythmic consistency. oThe life process evolves irreversibly onward along the space-time continuum that may continue after death. pHealth is a value term deﬁned by the culture or individual. “Health and ill-ness are manifestations of pattern and are considered ‘to denote behaviors that are of high value and low value.’ Events manifested in the life process indicate the extent to which man achieves max-imum health according to some value system.”qoDaily et al., “Unitary Human Beings,” p. 216.pMalinski, “Nursing Practice,” p. 29.qDaily et al., “Unitary Human Beings,” p. 216.A science and an art.Promotes sym-phonic interac-tion between the environment and man, to strengthen the coherence and integrity of the human being and to direct and redirect patterns of interaction between man and his environ-ment for the real-ization of maxi-mum health potential.r A Christian Worldview for Nursing49Jean Watson: Philosophy and Science of Caringa (Philosophy)aSee Jean Watson, Postmodern Nursing (Edinburgh: Churchill Livingstone, 1999), p. 147, accessed February 3, 2004 .GODENVIRONMENTPERSONHEALTH NURSINGThe sacred unconscious, the universal mind. A deeper higher energy source. The universe is alive, conscious, intelligent and compassionate.Caring consciousness as energy within the human environment ﬁeld of a caring moment.Mind-body-spirit oneness; personnature-universe as oneness. Transpersonal, transcendent, evolving consciousness.Consciousness as energy.Embodied spirit.Health is consciousness; human-environmental energy ﬁeld. Phenomenal ﬁeld/unitary con-sciousness: unbroken wholeness and connectedness of all.“Clinical Caritas (Love) Process.”Nursing is a transpersonal car-ing relationship.Transpersonal caring is con-sciousness. Aims to facilitate individuals gaining ‘a higher degree of harmony within the mind, body and soul, which generates self-knowledge, self-reverence, self-healing and self-care processes while allowing increasing diversity.Rosemarie Parse: The Human Becoming Theorya (Middle Range Theory)aRosemarie Rizzo Parse, ed., The Human Becoming Theory in Practice and Research (New York: National League for Nursing Press, 1995), pp. 5-8, 81-83, and Rickard E. Lee et al., “Man-Living-Health,” in Nursing Theorists and Their Work, ed. Ann MarrinerTomey, 3rd ed. (St. Louis: Mosby, 1994), pp. 44559.GODENVIRONMENTPERSONHEALTHNURSINGNot clearly identiﬁed.“The universe” seems to ful-ﬁll the role of higher power.“The universe.”A pattern and organization of energy. Man and environment interchange energy to create what is in the world.Humans construct what is real for them from choices made from many realms of the universe.The human is: 1. coexisting while coconstituting, rhythmical patterns with the uni-verse. 2. an open being, freely choosing meaning in situation, bearing responsibility for decisions.3. a living unity continuously coconstituting, patterns of relating.4. transcending multi-dimension-ally with the possibles.Health is a synthesis of values, a way of living. A process of being and becoming.Becoming is:1. an open process, experienced by the human.2. a rhythmically coconstituting human universe process.3. the human’s pattern of relat-ing value priorities.4. an intersubjective process of transcending with the possibles.5. human evolving.Directed toward illuminating and mobilizing family interrela-tionships in light of the mean-ing given to health.“True presence,” including:1. Illuminating meaning.2. Synchronizing rhythyms.3. Mobilizing transcendence. 50CALLED TO CAREBetty Neuman’s systems model is an example of the inﬂuence of both GSTand the concept of holism on nursing theory. She ﬁrst published her theory in1972, four years after von Bertalanffy published his book. In Neuman’s theory,holism is viewed comprehensively. A person is viewed as a whole, and all di-mensions—psychological and social—are attended to in care. Neuman added aspiritual dimension in the second edition of her book.7The theories of Betty Neuman, Dorthea Orem and Sr. Callista Roy representthe inﬂuence of GST and the comprehensive sense of holism. Each of thesetheories presents a rational modern approach to nursing and science. Eachtheory directs nurses to attend to all aspects of the patient in caregiving andprovides an organizing framework for nursing care. Neuman and Roy ac-knowledge God in some way, while Orem recognizes patients’ understandingof God. Although each of these theories is basically secular, we can see thestrong inﬂuence of biblical views in the concepts of person, health, environ-ment and nursing. The philosophical meaning of holism undergirds more recent theories, eventhose that do not use the term itself. Holism in these postmodern theories is theidea that all things are interconnected and that the larger environment is con-tained within the individual, even the smallest aspects of the person. In principlethese theories reject a systems approach. Hence, analyses of the bio-psychosocial dimensions are not stressed. What is emphasized is the spiritual nature ofthe whole person, and nursing care often involves helping patients move alongin their spiritual development. The most common interventions advocated by philosophical holism includeenergy therapies of various kinds, guided imagery and other mental therapies,and different forms of spiritism including channeling and shamanistic rituals.Prayer may or may not be addressed to a god separate and distinct from the onewho prays. If it is directed to a god, the individual deﬁnes that god. Often prayeris seen as merely good intentions on the part of the nurse healer toward the illperson.Martha Rogers’s postmodern theory, science of unitary human beings, isbased on philosophical holism. Her deﬁnitions for person, health, environ-ment and nursing all read pretty much the same. If any concept stands forgod it would be energy ﬁeld. All dimensions of reality make up everythingthat exists, from the microcosm to the macrocosm, and there are no boundaries between them. Rogers uses the impersonal language of physics but re-deﬁnes it.7Betty Neuman, The Neuman Systems Model, 2nd ed. (Norwalk, Conn.: Appleton L A Christian Worldview for Nursing51Rogers opened the door to the mystical and the paranormal in her theory.Nurse educator Francis Biley suggests that Rogers’s ideas were strongly inﬂu-enced by the cultural changes taking place in Greenwich Village in New YorkCity in the 1940s and 1950s. Authors and artists were creating new movementsin writing and art, attempting to move beyond the rational way to knowledge.Many sought an altered consciousness and an experience with the loss ofboundaries through drugs.8Jean Watson’s philosophy of science and caring reﬂects Rogers’s thinking andlanguage but goes beyond it. Philosophical holism in Watson’s postmodern the-ory moves toward a revived paganism. She freely uses personal and religiousterms like “sacred unconscious,” “universal mind” and “spirit.” All reality is spir-itual with personal qualities of consciousness, intelligence and compassion. Attimes Watson seems to make distinctions between aspects of reality (for exam-ple, a deeper higher energy source and increasing diversity), but she also seemsto suggest that obliterating boundaries leads to harmony. Her language often re-ﬂects Christian inﬂuence, but it also opens the door to the spirit world Christiansare warned against in Scripture.Rosemarie Parse’s postmodern Human Being Becoming theory reﬂects inﬂu-ences of Rogers and humanistic psychology based on existentialism. Shades ofGST are seen in her deﬁnitions in that they are not all the same. The holism un-derlying her theory mixes both comprehensive and philosophical uses of theterm. The human being becoming is human-centered. Persons with the powerto choose create their own reality—thus replacing God. The responsibility formaking good choices is consistent with Scripture, but Parse’s humanistic psy-chology goes too far by eliminating the need for God.Madeline Leininger’s culture care theory takes a different approach from theother postmodern theories discussed. It is postmodern in the sense that she seestruth as deﬁned by each culture, not by a transcultural reality or God. If anythingstands above culture, it would be health, but even that is deﬁned by the culture.In another sense Leininger’s theory is modern in that she uses anthropologicallanguage and tools. She uses the terms person, health, environment and nurs-ing, but allows each culture to deﬁne them differently. Leininger’s theory is use-ful for nurses in crosscultural nursing, especially for learning about the differ-ences in their own and other cultures. But she does not give us transculturaltruth for evaluating them. 8F. Biley, “The Impact of the Beat Generation and Popular Culture on the Development of Mar-tha Rogers’s Theory of the Science of Unitary Beings,” International History of Nursing Jour-nal, winter 1999, p. 5. 52CALLED TO CARENursing from a Christian WorldviewWhat we believe about God shapes our understanding of human persons andthe environment in which we ﬁnd ourselves. That, in turn, informs our conceptof health and directs us to the means by which we nurture one another towardhealth and healing (see ﬁgure 3.1). So as Christians, we begin with a theologyof nursing more than a philosophy or theory. If we truly believe what we saywe believe about God, we cannot help but act in obedience to him, whichmeans communicating the good news of salvation, health and healing throughword and deed.The Christian worldview afﬁrms good empirical science and the appropriateuse of technology. They are gifts from God to be used for the beneﬁt of creation.The methods of science give us knowledge of the physical aspects o…
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