consciousness. To explain this phenomenon,
Newman (1994a, 1997b) draws on the work of Ilya
Prigogine (1976), whose theory of Dissipative
Structures asserts that a system fluctuates in an or-
derly manner until some disruption occurs, and the
system moves in a seemingly random, chaotic, dis-
orderly way until at some point it chooses to move
into a higher level of organization (Newman,
1997b). Nurses see this all the time—the patient
who is lost to his work and has no time for his fam-
ily or himself, and then suddenly has a heart attack,
an experience that leaves him open to reflecting on
how he has been using his energy. Insights gained
through this reflection give rise to transformation
of his life pattern, which becomes more creative, re-
lational, and meaningful. Nurses also see this in
people diagnosed with a terminal illness that causes
them to reevaluate what is really important, attend
to it, and then to state that for the first time they feel
as though they are really living. The expansion of
consciousness is an innate tendency of human be-
ings; however, some experiences and processes
precipitate more rapid transformations. Nurse re-
searchers operating out of the HEC theory have
clearly demonstrated how nurses can create a mu-
tual partnership with their patients to reflect on
their evolving pattern. The insights gained in this
process lead to an awakening and transformation to
a higher level of consciousness (Endo, 1998; Endo,
Minegishi, & Kubo, 2004; Endo, Nitta, Inayoshi,
Saito, Takemura, et al., 2000; Jonsdottir, 1998;
Jonsdottir, Litchfield, & Pharris, 2003; Kiser-Larson,
2002; Lamendola, 1998; Lamendola & Newman,
1994; Litchfield, 1993, 1999, 2004; Moch, 1990;
Neill, 2002a, 2002b; Newman, 1995; Newman &
Moch, 1991; Noveletsky-Rosenthal, 1996; Pharris,
2002, 2004; Picard, 2000, 2004; Tommet, 2003).
Newman (1999) points out that nurse-client re-
lationships often begin during periods of disrup-
tion, uncertainty, and unpredictability in patients’
lives. When patients are in a state of chaos because
of disease, trauma, loss, etc., they often cannot see
their past or future clearly. In the context of the
nurse-patient partnership, which centers on the
meaning the patient gives to the health predica-
ment, insight for action arises and it becomes clear
to the patient how to get on with life (Jonsdottir,
Litchfield, & Pharris, 2003, 2004; Litchfield, 1999;
Newman, 1999). Litchfield (1993, 1999) sees this as
experiencing an expanding present that connects toCHAPTER 15 Margaret A. Newman’s Theory of Health as Expanding Consciousness and Its Applications 221Each person exhibits a distinct pattern,
which is constantly unfolding and evolving
as the person interacts with the environ-
ment. Pattern is information that depicts
the whole of a person’s relationship with
the environment.interacts with the environment. Pattern is infor-
mation that depicts the whole of a person’s rela-
tionship with the environment and gives an
understanding of the meaning of the relationships
all at once (Endo, 1998; Newman, 1994a). Pattern is
a manifestation of consciousness, which Newman
(1994a) defines as the informational capacity of the
system to interact with its environment.
To describe the nature of pattern, Newman
draws on the work of David Bohm (1980) who said
that anything explicate(that which we can hear, see,
taste, smell, touch) is a manifestation of the impli-
cate(the unseen underlying pattern) (Newman,
1997b). In other words, there is information about
the underlying pattern of each person in all that we
sense about them, such as their movements, tone of
voice, interactions with others, activity level, ge-
netic pattern, vital signs. There is also information
about their underlying pattern in all that they tell
us about their experiences and perceptions, includ-
ing stories about their life, recounted dreams, and
portrayed meanings.
The HEC perspective sees disease, disorder,
disconnection, and violence as an explication of
the underlying implicate pattern of the person,
family, or community. Reflecting on the meaning of
these conditions can be part of the process of
expanding consciousness (Newman, 1994a, 1997a,
1997b).
Pattern recognition is a profound act of nurse
caring in that it focuses on knowingthe patient,
family, and/or community at a very deep level
(Newman, 2002b). Pattern recognition happens in
the context of a caring nurse partnership, which is
centered on exploring that which is considered
most meaningful.
INSIGHTS OCCURRING AS CHOICE
POINTS OF ACTION POTENTIAL
The disruption of disease and other traumatic life
events may be critical points in the expansion of