settling. There is risk in opening oneself to see
things in a new way. Discovery changes everything
in a cascading flow of understanding. Leaders can
invite and nurture discovery, but ultimately it is a
self-directed process that is lived by each person
considering and choosing or not choosing to
change.
Confirmingis a process of seeking personal and
organizational coherence with the values clarified
in the process of visioning. Nurses seek coherence
with cherished values in dialogue with others.
Confirming new values is facilitated in standards
of practice that specify expectations in the nurse-
person process. As members of a self-regulating
discipline, nurses have the authority to study and
define the knowledge that will guide their practice
and research activities. Standards make concrete
the values chosen to guide practice and clarify the
purpose of nursing in any organization.
Disclosinghappens through actions taken and
words spoken as staff integrate and share their new
realities in the context of day-to-day relationships
with patients and families. Disclosing is about pre-
senting self to colleagues and to patients and fami-
lies as a professional with intent and direction.
Disclosing also happens through storytelling as
staff members share their experiences with others.
Telling stories of changing realities in practice and
research perpetuates the living of new values and is
the primary way nurses and other professionals
propel the ongoing journey of change. The way
these processes get lived out in any community of
professionals will be unique, yet common patterns
are recognizable.
Common patterns include explicit commitment
and communication on the part of leaders in an or-
ganization where expectations are changing in the
direction of a new way that is consistent with the
human becoming school of thought. Patterns
emerge that reflect the pushing-resisting with the
central message from leaders and with the core
ideas of the human becoming theory. Professionals
can experience interest, anger, excitement, apathy,
and resistance to ideas expressed. As new ideas and
processes of care are described and explored, staff
begin to discourse about the possibilities. Leaders
are required in order to present the alternative views
that inspire reflection and creative tension as new
ideas about patient care are tossed about. Leaders
facilitate patterns of discovery in the pushing-
resisting of change (Bournes & DasGupta, 1997;
Linscott, Spee, Flint, & Fisher, 1999).
A necessary pattern to keep introducing into the
process of changes is the pattern of reality linked
with patients’/families’ lived experiences in health-
care systems. Patient and family experiences are
critical to sustaining the impetus for change.
Valuable video resources on the topic of patient ex-
periences include “Not My Home” (Deveaux &
Babin, 1994), “Real Stories” (Deveaux & Babin,
1996), “The Grief of Miscarriage” (Pilkington,
1987), and “Handle with Care” (Gray, 2000; Gray &
Sinding, 2002), to name several. Simply stated, peo-
ple want to be listened to, to be regarded as know-
ing participants, to be respected for their unique
lives and meanings, to have meaningful dialogue,
and to have their choices and wishes integrated in
plans of care. These basic requests are consistent
with what the human becoming theory offers pro-
fessional staff.
Patterns of thinking and acting, as well as pat-
terns of attitude and intention, are complex and
multidimensional. Nursing practice encompasses
multiple realms of responsibility, yet there is with
human becoming an identifiable coherence amid
the apparent dissonance of diverging paradigms.
Nurses who practice human becoming describe
being more vigilant and attentive to the medical
and technological responsibilities, because they are
concerned in a different way about the person as a
unitary human being who is illuminating meaning,
synchronizing rhythms, and mobilizing transcen-
dence. Leaders in large systems know that serious
mishaps can sometimes be avoided if professionals
truly listened to people and trusted their knowing
of potential or impending danger and concern.
Organizational structures and systems must
change if professional staff are to be supported to
practice in ways consistent with the human becom-
ing theory. For example, documentation of patient
care changes from a stance of observed interpreta-
tion of patient behavior to a representation of
the patient’s experience from the patient/family
perspective. This change in documentation is
dramatic. For instance, a record in the problem-
based, observed behavior model may include a no-
tation like, “Patient refusing to take medications;
confused, upset, and occasionally yelling out.” In a
culture in which patients are respected as leaders of
their care, the same occasion might prompt this206 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration