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ROSEMARIE PARSE'S HUMAN BECOMING THEORY

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Indie Kaur

on 21 November 2014

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Transcript of ROSEMARIE PARSE'S HUMAN BECOMING THEORY

HUMAN BECOMING

INTRODUCTION
Principles about human becoming
Based on major themes stemming from the 9 assumptions:
MEANING
RHYTHMICITY
TRANSCENDENCE
MEANING
Imaging
~refers to knowing explicitly and tacitly
~Explicit knowing is reflected upon critically
~Tacitly knowing is prearticulate and acritical
~Knowing explicitly and tacitly occur simultaneously
PARADIGMS unique to Parse's nursing theory:
Application of Parse's Nursing Theory
As Parse nurses, we do the following for our clients:
illuminate meaning
synchronize rhythms of the human-universe process
mobilize transcendence
ROSEMARIE PARSE'S HUMAN BECOMING THEORY
AGENDA

-Introduction
-About the theorist
-Assumptions, Principles and Postulates


-Paradigms
-Practical nursing
-Evaluation and critique
-Final evaluation and conclusion
ROSEMARIE PARSE'S NURSING THEORY

BY: CHINTAN, INDIE, ARIANNA, AND PRANAVAN

ABOUT THE THEORIST
Education: graduated from Duquesne University in Pittsburgh, and received master’s and doctorate from the University of Pittsburgh.
Inspiration: Rogers, existential phenomenological thought concepts
Work history: Fellow in the American Academy of Nursing, founder and current Editor of Nursing Science Quarterly, and President of Discovery International, Inc. She is also founder of the Institute of Humanbecoming.
Dr. Parse has also developed humanbecoming ethical tenets of human dignity, community, leading-following, teaching-learning, mentoring, and family models that are used internationally.

http://www.humanbecoming.org/rosemarie-rizzo-parse.php
RHYTHMICITY
TRANSCENDENCE
Health:
Sum of biological, psychological, sociological and spiritual
Lived experience: Own meaning
Manifests in values, beliefs and way of life
Continuously evolves with time
Open process of being and becoming
Nursing:
1) Finding the meaning: in person’s expressed values, beliefs and way of life (Imaging, Valuing, Languaging)
2) Finding the meaning: in inheritant patterns of person’s choices at the point of care and over time period (Receiving-Concealing, Connecting- Separating )
3)Non-judgemental acceptance: of person’s own meaning of health, disease and well-being
4) Resolving person’s ambiguity in finding meaning and highlighting future path (Powering , Originating and Transforming)
EVALUATION
Valuing
~one's choices reflects one's values
~gives meaning to multidimensional experiences to create one's reality
Languaging
~The way humans represent personal constructs of reality
~based on interconnectedness of humans and universe from all generations
Powering
empowerment of the client in their situation.
the client's own willpower/belief that there is an alternative out of an unfavourable situation
Originating
transcendent ideas emerge from the patient's consciousness with the help of the nurse, and through the healing process.
Transforming
the change that the client goes through with the progression of their situation
new thoughts and ideas are developed over the course of care.
4 POSTULATES
The themes and principles are permeated by four postulates:
Illimitibility
Paradox
Freedom
Mystery
Illimitibility:
is the indivisible unbounded knowing extended to infinity
Paradox:
an"intricate rhythm expressed as a pattern of reference."
paradoxes are not opposites to balance or obstacles to overcome, but living rhythms.
Background/Metaparadigm
Formerly called theory of man-living-health
Also called Human Becoming, which reflects the unity of man-living-health; none of these components are referenced separately within the theory.
based on Human Science in that Parse states humans cocreate health in participation with the universe.
Deviates from traditional problem-focused nursing.
Assumptions are written at the philosophical level, and principles at the theoretical level.
Philosophical Assumptions
Four main, developed from Rogers' and existential phenomenology:
Humans are open beings in mutual process with the universe
Humans cocreate patterns of relating with one another
Humans live at the multidimensional realms of the universe simultaneously
Humans freely choose ways of becoming by giving meaning to situations.
Five other assumptions
Health is a process of becoming
Health is experienced by the person
Health is a human-universe mutual process
Health is incarnated as patterns of relating value priorities
Becoming is an intersubjective transcending with possibles in the unfolding
We:
go along with the client as they make choices in changing their health priorties
listen carefully, answer questions and refer pt to other HCP when needed
teach when the client is ready to learn (by asking questions/indicating curiosity)
do not tell the client what to do
do not have a standardized teaching plan
Parse, R. R. (1999). Nursing science: The transformation of practice. Journal of Advanced Nursing, 30(6), 1383-1387.
The client reaches out beyond perceived limits and present circumstances. A bedridden patient can still be vivacious in spirit.
Ontology (what it is): a set of Assumptions, Postulates and Principles which contain concepts and paradoxes
Epistemology (it's origin): creation of concepts and formation of inquiry unique to human becoming.
Methodology (manners of practise): The Parse research model and the human-becoming hermeneutic model
Human beings construct a personal significance by choosing options from the various realms of the universe
The positive effects of Introducing Parse's nursing theory to a nursing unit

Critical review of R. R. Parse's The Human Becoming School of Thought. A Perspective for Nurses and Other Health Professionals

Advancing nursing practise: an evaluation study of Parse’s theory of human becoming by Legault F. and Ferguson-Pare, M. (1999):

This study introduced Parse’s theory of nursing to an acute care surgical setting and evaluated the changes in nursing practise and perspectives of the family/patients towards nursing care.

Presentation of findings:
Presentation of findings:
The nurses described major thematic changes to their nursing practise:


Cons
ongoing struggle presented by the difficult process of learning the language of Parse’s theory.
There was an increased sense of nurse-physician conflict
practising this theory presented problems in the continuity of care.
It was difficult to practise under this theory with increasing acuity of patients and decreased length of stays.
Nurses also faced continued resistance to change.
Pros:
-being with patients/families in a meaningful way instead of just doing tasks.
-affirmation and validation of nurses’ values and beliefs in that nurses felt comfortable knowing that their individual nursing practises were acceptable.
-developing enhanced nurse-person relationship with patients, families and peers by respecting individuality, moving beyond problems and suspending judgement.
-reflective and meaningful nursing practise
-personal growth by realizing the hopes for nursing and identifying personal strengths.
-supporting one another when nurses asked for extra time to sit down with their patients
-challenging and changing nursing practise traditions, such as allowing open visiting hours and not making all the beds at 8:00am especially when patients refused, and a shift from problem-focused charting to documentation that reflected the patients/families subjective experience.
viewed nursing care as more individualized and meaningful
described nurses as less task-oriented and took the time to talk and listen.
Patient/family perspectives:
Client-centered care
The concept of Client-centered Care:
Respect client’s own values, beliefs and way of life
Respect autonomy (choice) of client
Respect person’s own values and beliefs of health, disease and well-being
Provide meaningful nursing care that fits with client’s values, beliefs and way of life

1) Finding the meaning: in person’s expressed values, beliefs and way of life (Imaging, Valuing, Languaging)
2) Finding the meaning: in inheritant patterns of person’s choices at the point of care and over time period (Receiving-Concealing, Connecting- Separating )
3) Non-judgemental acceptance: of person’s own meaning of health, disease and well-being
4) Resolving person’s ambiguity in finding meaning and highlighting future path (Powering , Originating and Transforming)
Parse's theory closely matches with the concept of client-centered care.

Client-centered care takes the following form in Parse's nursing theory:
Totality Paradigm
Person as a whole unique human being
Defines Health, Disease and well-being as sum of biological, psychological sociological and spiritual
Simultaneity Paradigm
Consider person as a unitary being in continuous, mutual interaction with environment
Engaged with environment on the basis of own perception of time and space
Consider each moment as a unique live experience in relation to time and space
Unique Inheritent pattern in choice and live experience: each person’s interaction with environment is unique
Parse on Health, Nursing, Person and Environment:
Person:
Person as a whole unique human being (Biological, Psychological, Sociological and Spiritual).
Has unique values, beliefs and way of life
Has freedom in choice: Open, Freely chooses meaning of situation and Responsible for decision
Has unique rhythmical pattern of interaction with universe
Environment:
Internal: within the person
Inseparable
Continuously evolving with time
Forms lived experience
Freedom:
is contextually construed liberation
Humans are free and continuously choose ways of becoming with their situations.
Mystery:
"is the unexplainable, that which cannot be completely known unequivocally
it is the inconceivable, unutterable, unknowable nature of the indivisible, unpredictable, ever-changing human universe.
The nurse does not try to calm uneven rhythms but rather moves with the flow as the person/family discuss and recognize the struggles of the situation.
Enabling-limiting
a rhythmical pattern of relating
there are an infinite number of opportunities and limitations, and moving in one direction limits movement in another
there are inherent opportunities and limitations within the chosen direction all at once, thus one is enabled-limited by all choices
living with rhythms is like treading water; while one appears to remain in the same place. Different waves arise to create subtle movement and giant leaps.
Connecting-Separating:
a rhythmical process of moving together and moving apart.
in moving together, with one phenomenon, the indivdual moves away from other phenomena.
in moving together, there is both the closeness of togetherness and the distance of moving apart within the same phenomenon.
Synchronizing rhythm is lived as the nurse stays with the person/family while they describe the ups and downs, struggles, moment of joy and the the unevenness of day-to-day living in the moment.
Revealing-concealing
a paradoxical rhythm in the pattern of relating to others.
while revealing one simultaneously conceals.
Paradoxes within Rhythmicity:
These rhythmical patterns are not opposites; they are two sides of the same rhythm that coexists all at once.:
Case study:
Mrs P was a 93 year-old woman admitted with congestive heart failure. Four days after her admission Mrs P showed evident signs of depression. Reports indicated Mrs P spoke about wanting to die and that she frequently cried and resisted any attempts from nurses to comfort or reassure her. The nurses said Mrs P only spoke about losing her dignity and that she couldn't take care of herself.
Traditional nursing theories diagnosed Mrs P with ineffective coping related to loss of self care behaviours and loss of physical functioning and threatened dignity.
As a nurse guided by Parse theory:
Be truly present with her and help her with clarifying the meaning of her present life situation:
While Mrs P discussed her wanting to die as a result of her lost self-care behaviours, she had stated she would rather die than live without dignity.
Being in true presence with Mrs P, ask her what her dignity really means to her:
Dignity meant being able to go to the washroom alone and keep herself clean; that she can go places like church on Sundays. Dignity is knowing who she was and who she is now.
Mrs P spoke about dignity as it related to her life situation and the meaning it had for her.
Through Parse theory, a care plan to work with Mrs P and assist her with what dignity meant to her would ideally give her meaning.
Giving Mrs P assistance when needed to the washroom but giving her independence by allowing her to go to church on Sundays all worked to give her a sense of meaning through her lived experiences.
Edwards, S.D. (2000) identified four areas of criticism in his critical review of Parse's theory:
One can never claim that anyne is unhealthy given Parse's view on health. it is counterintuitive that even if a person feels terrible, they are still healthy
Parse's view on quality of life is subjectivist, hence there can be no question of a person who simply drinks beer, watches T.V. and eats junk food all day, everyday, and states that they have a good quality of life.
The complex language that Parse uses does not serve to increase clarity of lived experience, which could be taken at face value.
The idea of universals is questionable both in philosophical and nursing literature; it is doubtful that there is an aspect both unique to nursing and found in no other activity.
Final Evaluation/Conclusion
Evaluation model from Johnson, 1974:
Define the congruence of nursing practise with societal expectations of nursing decisions and actions:
Humanbecoming is not based on traditional problem-focused nursing and has complex terminology that may make it difficult to relate it to societal expectations
.

Clarify the social significance of nursing, or the impact of nursing on persons receiving nursing:
Practising Parse's theory has a profound impact on the client's experience while receiving care, as seen in the study that introduced the theory to an acute care surgical nursing unit.

Describe social utility, or usefulness of the theory in practise, research, and education.
The theory is useful in practise as observed in the presented case studies, and Parse has developed and written extensively on the Parse research method and the Human Becoming Hermeneutic Research Model. Parse has also developed teaching-learning and mentoring models based on human-becoming.
Struggling to change: from the traditional approach to Parse's theory-based prctise by Mitchell, G. (1990)
http://nuriscairo.blogspot.ca/2013/06/rosemarie-parses-human-becoming-theory.html
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