important others, including the person with
schizophrenia.
Carol Picard (2000) brought the HEC research
full circle to a place where movement is again ex-
plicitly central. Picard utilized the HEC hermeneu-
tic dialectic process with midlife women. Picard’s
research methodology was unique in that it ex-
panded the narrative/diagram pattern-recognition
process to include an intentional creative move-
ment group experience for each participant and a
piece of reflective art conceptualized by Picard to
illuminate the participant’s pattern. Participants
were asked to put the sequential patterns of mean-
ingful events to movement. Picard found congru-
ence between the narratives and the expressions of
creative movement. Participants revealed an inte-
grated embodiment of emotion when expressing
themselves in movement, which they had not pre-
viously experienced. Picard reports that partici-
pants expressed the awareness of the past within
the present and experienced a deep sense of healing
in their movement. Participants reported valuing:
being known, feeling accepted, not being diag-
nosed, and having enough time to tell their stories.
In another study, Picard (2004) utilized HEC to
understand the experience of parents of persons
with bipolar disorder. Picard met with each partic-
ipant for two interview/dialogue sessions and then
did one creative movement experience in which the
parents demonstrated a movement or gesture that
captured the essence of the meaning of their expe-
rience. In a presentation of this research, Picard did
a slide presentation of her study’s findings and then
performed a choreographed dance made up of the
combined movements of all of the parents in her
study (Jonsdottir, Litchfield, Pharris, & Picard,
2001). Participants at the session could feel on a
very deep level what the experience of being a par-
ent of a person with bipolar disorder might be like.
It was a different and deeper way of knowing the
experience from that gained by reading the com-
mon themes and quotes on the overhead screen.
In Australia, HEC nurse researcher, Jane Neill
conducted pattern recognition with women with
rheumatoid arthritis (2002a) and other chronic ill-
nesses (2002b). She followed the HEC protocol
outlined by Newman (1994a); in addition, when
she went back the second time with the diagram-
matic depiction of sequential patterns, she brought
a disposable camera and asked the women to take
photos as a continued reflection on what was mean-
ingful to them. She told them the images could be
symbolic or not. New interpretations evolved in the
dialogue as the women reviewed the photos with
Neill and reflected on what was most important to
them. Neill (2002b) concludes that pattern recogni-
tion and practicing from an HEC perspective is
essential even in short nurse-patient encounters,
stating, “I remain convinced that the exclusive
focus on technical work and practical nursing
knowledge fails to address the central concern of
nursing with the whole person and his or her envi-
ronment, and is ultimately unsatisfying” (p. 53).
Focusing on the Process of Health Patterning
and the Nurse-Patient Partnership
Merian Litchfield (1993), from New Zealand, was
the first HEC researcher to apply the HEC theory to
a nursing partnership with families. Litchfield
(1993, 1997, 1999, 2004) has led the way in focus-
ing on the process of the nursing partnership with
patients and families. In her first study, Litchfield
(1993) described health patterning as “a process of
nursing practice whereby, through dialogue, fami-
lies with researcher as practitioner, recognise pat-
tern in the life process providing opportunity for
insight as the potential for action; a process by
which there may be increased self-determination as
a feature of health” (p. 10). Litchfield (1993) de-
scribes HEC research as a “shared process of in-
quiry through which participants are empowered
to act to change their circumstances” (p. 20).
Through her research over several years with fami-
lies with complex health predicaments requiring
repeated hospitalizations, Litchfield (1993, 1999,
2004) found that she could not stand outside of the
process of recognizing pattern to observe a fixed
health pattern of the family. She sees the pattern as
continuously evolving dialectically in the dialogue
within the nursing partnership. The findings are
literally created in the participatory process of the
partnership (Litchfield, 1999). For this reason,
Litchfield did not use diagrams to reflect pattern, as
she thought they would imply that the pattern is
static rather than continually evolving. As the fam-
ily reflects on the pattern, insight into action may
involve a transformative process, with the same
events being seen in a new light. Family health is
seen as a function of the nurse-family relationship.
Many of the families in partnership with Litch-
field gained insight into their own predicaments in
such a way that they required less interaction and228 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration