on recognition of pattern and potential for action.
The family nurse mobilized relief services if neces-
sary and orchestrated services as needs emerged in
the process of pattern recognition. The research
group found that families became more open and
spontaneous through the process of pattern recog-
nition, and their interactions evidenced more
focus, purposefulness, and cooperation. In analyz-
ing costs of medical care for one participating fam-
ily, it was estimated that a 3 to 13 percent savings
could be seen by employing the model of family
nursing, with greater savings being possible when
family nurses are available immediately after a fam-
ily disruption takes place. Based on Litchfield’s
work with families with complex health predica-
ments, the government has funded a large demon-
stration project where family nurses are employed
to nurse from an HEC perspective and partner with
families without having predetermined goals and
outcomes that the families and nurses must
achieve. These nurses are free to focus on family
health as defined and experienced by the families
themselves.
Endo and colleagues (Endo, Minegishi, & Kubo,
2004; Endo, Miyahara, Suzuki, & Ohmasa, 2004) in
Japan have expanded their work to incorporate
the pattern-recognition process at the hospital
nursing unit level. After engaging the professional
nursing staff in reading and dialogue about the
HEC theory, nurses are encouraged to incorporate
the exploration of meaningful events and people
into their practice with their patients. Nurses keep
journals and come together to reflect on the expe-
rience of expanding consciousness in their patients
and in themselves. Endo, Miyahara, Suzuki, and
Ohmasa (2004) conclude: “Retrospectively it was
found through dialogue in the research/project
meetings that in the usual nurse-client relation-
ships, nurses were bound by their responsibilities
within the medical model to help clients get well,
but in letting go of the ‘old rules,’ they encountered
an amazing experience with clients’ transforma-
tions. The nurses’ transformation occurred con-
comitantly, and they were free to follow the clients’
paths and incorporate all realms of nursing inter-
ventions in everyday practice into the unitary
perspective.”
Jane Flanagan (2004) transformed the practice
of presurgical nursing by developing the pre-
admission nursing practice model, which is based
on HEC. The nursing practice model shifted from a
disease focus to a process focus, with attention
being given to the nurses knowing their patients
and that which is meaningful to them, so that the
surgery experience could be put in proper context
and appropriate care provided. Nursing presurgical
visits were emphasized. Flanagan reported that the
nursing staff was exuberant to be free to be a nurse
once again, and patients frequently stopped by to
comment on their preoperative experience and
evolving life changes.
Similarly, Susan Ruka (2004) made HEC pattern
recognition the foundation of care at a long-term-
care nursing facility, transforming the nursing
practice and the sense of connectedness among
staff, families, and residents—each became more
peaceful, relaxed, and loving.
Application of HEC
at the Community Level
Pharris (2002, 2004) attempted to understand a
community pattern of rising youth homicide rates
by conducting a study with incarcerated teens con-
victed of murder participating as coinvestigators.
When the experiences of meaningful events and
relationships were compared across participants,
the pattern of disconnection with the community
became evident and various aspects of the commu-
nity (youth workers, juvenile detention staff, emer-
gency hospital staff, pediatric nurses and physicians,
social workers, educators, etc.) were engaged in
dialogues reflecting on the youths’ stories and the
community pattern. Insights transformed commu-
nity responses to youths at risk for violent per-
petration. The youth in the study reported the
pattern-recognition process to be transformative,
and expanding consciousness was visible in changed
behaviors, increased connectedness, and more
loving attention to meaningful relationships.
Alterations in movement, time, and space inherent
in the jail system can intensify the process of
expanding consciousness. Pharris (2004) and
colleagues are extending the community pattern-
recognition process in a partnership with a multi-
ethnic community interested in understanding
and transforming patterns of racism and health
disparities.
Pharris (1999) gives the example of a 16-year-
old young man placed in an adult correctional fa-
cility after a murder conviction. This young man
was constantly getting into fights and generally
feeling lost. As he and the nurse researcher met over230 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration