untitled

the past and creates an extended horizon of action
potential for the future.
Endo (1998) in her work in Japan with women
with cancer, Noveletsky-Rosenthal (1996) in her
work in the United States with people with chronic
obstructive pulmonary disease, and Pharris (2002)
in her work with U.S. adolescents convicted of
murder, found that it is when patient’s lives are in
the greatest states of chaos, disorganization, and
uncertainty that the HEC nursing partnership and
pattern-recognition process is perceived as most
beneficial to patients (Figure 15–1).
Many nurses who encounter patients in times of
chaos strive for stability; they feel they have to fix
the situation, not realizing that this disorganized
time in the patient’s life presents an opportunity for
growth. Newman (1999) states:

The “brokenness” of the situation... is only a point in

the process leading to a higher order. We need to join

in partnership with clients and dance their dance,

even though it appears arrhythmic, until order begins

to emerge out of chaos. We know, and we can help

clients know, that there is a basic, underlying pattern

evolving even though it might not be apparent at the

time. The pattern will be revealed at a higher level of

organization. (p. 228)

The disruption brought about by the presence of

disease, illness, and traumatic or stressful events

creates an opportunity for transformation to a

higher, expanded level of consciousness (Newman,

1997b, 1999) and represents a time when patients

most need nurses who are attentive to that which is

most meaningful. Newman (1999, p. 228) states,

“Nurses have a responsibility to stay in partnership

with clients as their patterns are disturbed by illness

or other disruptive events.” This disrupted state

presents a choice pointfor the person to either con-

tinue going on as before, even though the old rules

are not working, or to shift into a new way of being.

To explain the concept of a choice point more

clearly, Newman draws on Arthur Young’s (1976)

theory of the Evolution of Consciousness. Young

suggests that there are seven stages of binding and

unbinding, which begin with total freedom and un-

restricted choice, followed by a series of losses of

freedom. After these losses comes a choice point

222 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration

Emergence of new

order at higher level of

organization

Period of disorganization,

unpredictability,

uncertainty (response to

Normalpredictable disease, trauma, loss, etc.)

fluctuation

Giant

Fluctuation

Time when partnership with

an HEC nurse can be of

greatest benefit

FIGURE 15–1 Prigogine’s theory of dissipative structures applied to HEC nursing.