to the term “voluntary” emphasizes freedom, spon-
taneity, and choice of action. The nurse does not
invest in changing the client in a particular direc-
tion, but rather facilitates and mutually explores
with the client options and choices and provides in-
formation and resources so the client can make in-
formed decisions regarding his or her health and
well-being. Thus, clients feel free to choose with
awareness how they want to participate in their
own change process.
The two processes are continuous and nonlinear
and are therefore not necessarily sequential.
Patterning is continuous and occurs simultane-
ously with knowing. Control and predictability are
not consistent with Rogers’ postulate of pandimen-
sionality and principles of integrality and helicy.
Rather, acausality allows for freedom of choice and
means outcomes are unpredictable. The goal of
voluntary mutual patterning is the actualization of
potentialitiesfor well-being through knowing par-
ticipation in change.
COWLING’S ROGERIAN
PRACTICE CONSTITUENTS
Cowling (1990) proposed a template comprising 10
constituents for the development of Rogerian prac-
tice models. Cowling (1993b, 1997) refined the
template and proposed that “pattern appreciation”
was a method for unitary knowing in both
Rogerian nursing research and practice. Cowling
preferred the term “appreciation” rather than “as-
sessment” or “appraisal” because appraisalis associ-
ated with evaluation.Appreciation has broader
meaning, which includes “being full aware or sensi-
tive to or realizing; being thankful or grateful for;
and enjoying or understanding critically or emo-
tionally” (Cowling, 1997, p. 130). Pattern apprecia-
tion has a potential for deeper understanding.
The first constituent for unitary pattern appreci-
ation identifies the human energy field emerging
from the human/environment mutual process as
the basic referent. Pattern manifestations emerging
from the human/environment mutual process are
the focus of nursing care. Next, the person’s experi-
ences, perceptions, and expressions are unitary
manifestations of pattern and provide a focus for
pattern appreciation. Third, “pattern appreciation
requires an inclusive perspective of what counts as
pattern information (energetic manifestations)”
(Cowling, 1993b, p. 202). Thus, any information
gathered from and about the client, family, or com-
munity—including sensory information, feelings,
thoughts, values, introspective insights, intuitive
apprehensions, lab values, and physiological meas-
ures—are viewed as “energetic manifestations”
emerging from the human/environmental mutual
field process.
The fourth constituent is that the nurse uses
pandimensional modes of awareness when appreci-
ating pattern information. In other words, intu-
ition, tacit knowing, and other forms of awareness
beyond the five senses are ways of apprehending
manifestations of pattern. Fifth, all pattern infor-
mation has meaning only when conceptualized and
interpreted within a unitary context. Synopsis and
synthesis are requisites to unitary knowing.
Synopsisis a process of deliberately viewing to-
gether all aspects of a human experience (Cowling,
1997). Interpreting pattern information within a
unitary perspective means that all phenomena and
events are related nonlinearly. Also, phenomena
and events are not discrete or separate but rather
coevolve together in mutual process. Furthermore,
all pattern information is a reflection of the
human/environment mutual field process. The
human and environmental fields are inseparable.
Thus, any information from the client is also a re-
flection of his or her environment. Physiological
and other reductionistic measures have new mean-
ing when interpreted within a unitary context. For
example, a blood pressure measurement inter-
preted within a unitary context means the blood
pressure is a manifestation of pattern emerging
from the entire human/environmental field mutual
process rather than being simply a physiological
measure. Thus, any expression from the client is
unitary and not particular by reflecting the unitary
field from which it emanates (Cowling, 1993b).
The sixth constituent in Cowling’s practice
method describes the format for documenting and
presenting pattern information. Rather than stating
nursing diagnoses and reporting “assessment data”
in a format that is particularistic and reductionistic
by dividing the data into categories or parts, the
nurse constructs a “pattern profile.” Usually the pat-
tern profile is in the form of a narrative summa-
rizing the client’s experiences, perceptions, and
expression inferred from the pattern appreciation
process. The pattern profile tells the story of theCHAPTER 13 Applications of Rogers’ Science of Unitary Human Beings 169