man, 1994), the early HEC pattern-recognition
studies sought to identify similarities and varia-
tions of pattern among individuals with the same
medical disease diagnosis or with similar life cir-
cumstances (Newman, 1994). HEC researchers re-
ported common themes of experiences and
transformation in the quality and connectedness of
relationships. More recent HEC research focuses on
the process of pattern recognition and the evolving
nature of the nurse-patient partnership.
Moch (1990) found U.S. women with breast
cancer to experience changes in relatedness with
significant others and to identify meaning in their
experience of living with cancer, which added new
perspectives about health as expanding conscious-
ness. In discussing the implications her research
holds for nursing practice, Moch stressed that in-
corporating a “health-within-illness experience”
view has the potential to drastically change the way
nurses practice as they would shift their focus from
simply fighting illness to helping patients learn
about themselves through the illness experience.
Moch later collaborated with Newman (New-
man & Moch, 1991) to look at the person-
environment pattern of people with coronary heart
disease. They found three common themes: the
need to excel,the need to please others,and feelings of
being alone. These findings were consistent with the
literature on coronary artery disease and personal-
ity type. When applying Young’s (1976) theory to
the participants, they found that most participants
were caught in a repetitive cycle characteristic of
the centering stage. Blocks to movement along the
spectrum were seen as being mirrored by the blocks
in the disease process. Newman and Moch (1991)
concluded, “If they reached the choice point early
enough and still had enough resources to confront
their pattern and allow the meaning of their pattern
to unfold, they had the potential of transcending
the physical limitations and moving beyond them-
selves to a higher level of consciousness. If they had
reached the limits of their resources, death was the
‘transformative door’ to higher consciousness”
(Moss, 1981, p. 101, 166). Newman and Moch stress
that nurses could help patients get in touch with
their pattern and express themselves more fully.
Newman (1995) further demonstrated the im-
portance of nurses being fully present, seeking to
know about the most meaningful experiences in
patients’ lives, mirroring the story so that insights
can be gained into the evolving pattern, and being
sensitive to the fact that thoughts and feelings that
arise within the nurse are manifestations of their
interpenetration of the nurse-patient field. In ad-
dressing long-term implications of this study,
Newman pointed to the increasing societal need for
connectedness and nurturing as manifested by
heightening rates of homelessness and poverty. She
posed the challenge that “people should not have to
wait until the manifestation of disease brings them
to the attention of ‘caring and concerned help’ ”
(p. 169).
Helga Jonsdottir (1998) conducted a study with
people in Iceland with chronic obstructive pul-
monary disease (COPD). She characterized the
overall pattern to be one of isolation and being
closed inbecause participants isolated themselves
from situations they were unable to deal with and
avoided any stimuli that could threaten their pul-
monary status. Jonsdottir (1998) maintained that
for people with COPD, the threatened exchange of
essential elements between the human body and
the environment resembles “the participants’ diffi-
culty in open interactions between themselves and
other people, in finding effective approaches to
facing adversities, in their mental and physical
activity restrictions, and in their inability to pur-
sue what they need and want” (p. 164). Noveletsky-
Rosenthal (1996) conducted a similar study in the
United States and found a relationship between
pattern recognition and evolving consciousness to
be related to a sense of connectedness, with the par-
ticipants who manifested a sense of connectedness
being able to utilize pattern recognition to tran-
scend their illness. She found timing of the nurse-
patient partnership to be an important aspect of
potential for transformation, with greater insight
gained immediately after diagnosis as opposed to
after years of living with COPD.
Yamashita (1998, 1999) studied caregivers of
people with schizophrenia in Japan and in Canada.
She (Yamashita, 1999) described a process whereby
caregivers moved through struggling aloneand feel-
ing alienated from those around them as the schiz-
ophrenia was first manifested, and feeling a lack of
connectedness,particularly with health-care profes-
sionals. Yamashita reported that in the process of
pattern recognition, participants were able to rec-
ognize turning points in their lives and discover
new rules as they started to move beyond the
binding stage in Young’s spectrum of conscious-
ness. They eventually deepened connections withCHAPTER 15 Margaret A. Newman’s Theory of Health as Expanding Consciousness and Its Applications 227