service from traditional health-care services (1999,
2004).
Exploring Pattern Recognition
as a Nursing Intervention
Emiko Endo (1998) explored HEC pattern recogni-
tion as a nursing intervention in Japan with women
living with ovarian cancer. She asked, “When a
person with cancer has an opportunity to share
meaning in the life process within the nurse-client
relationship, what changes may occur in the evolv-
ing pattern?” Attending to the flow of meaningful
thoughts for each participant and building on
the previous work of Litchfield (1993, 1997), Endo
found four common phases of the process of ex-
panding consciousness for all participants: client-
nurse mutual concern, pattern recognition, vision
and action potential, and transformation. Par-
ticipants differed in the pace of evolving movement
toward a turning point and in the characteristics of
personal growth at the turning point. The charac-
teristics of growth ranged from assertion of self, to
emancipation of self, to transcendence of self.
Reflecting on her experience, Endo (1998) put
forth that pattern recognition is “not intended to
fix clients’ problems from a medical diagnostic
standpoint, but to provide individuals with an op-
portunity to know themselves, to find meaning in
their current situation and life, and to gain insight
for the future.”
Endo, Nitta, Inayoshi, Saito, Takemura, et al.
(2000) carried out a similar study with Japanese
families in which the wife-mother was hospitalized
because of a cancer diagnosis. Families found
meaning in their patterns and reported increased
understanding of their present situation. In the
pattern-recognition process, most families recon-
figured from being a collection of separated indi-
viduals to trustful, caring relationships as a family
unit, showing more openness and connectedness.
The researchers concluded that pattern recognition
as a nursing intervention was a “meaning-making
transforming process in the family-nurse partner-
ship” (p. 604).
Early research emanating from Margaret
Newman’s HEC theoretical perspective added to
understanding the interrelatedness of time, move-
ment, space, and consciousness as manifestations
of health. These studies pointed to the need to look
at health as expanding consciousness using a re-
search methodology that acknowledges, under-
stands, and honors the undivided wholeness of the
human health experience. They pointed to a need
to step insideto view the whole from within. These
studies cleared away the murky waters so that what
previously appeared as separate islands became
clearly visible as mountaintops on one undivided
piece of land, newly emerged but always there as a
whole. As a result, a new generation of qualitative
HEC research has emerged, and a deeper under-
standing of health has surfaced.PRACTICE
Patricia Tommet (2003) used the HEC hermeneu-
tic dialectic methodology to explore the pattern of
nurse-parent interaction in families faced with
choosing an elementary school for their children
who were medically fragile. She found a pattern of
living in uncertaintyto exist for the families in the
intense period of disruption and disorganization
following the birth of their medically fragile child
through the first few years. After two to three years,
the families exhibited a pattern oforder in chaos
where they learned how to live in the present, let-
ting go of the way they lived in the past. Tommet
found that “families changed from being passive re-
cipients to active participants in the care of their
children” (p. 90) and that the “experience of their
children’s birth and life transformed these families
and through them, transformed systems of care”
(p. 86). Tommet demonstrated insights gained in
family pattern recognition and concluded that a
nurse-parent partnership could have had a more
profound impact on these families, and hence the
services they used, during the first three years of
their children’s lives.
Working with colleagues in New Zealand,
Litchfield undertook a pilot project that included
19 families in a predicament of strife (Litchfield &
Laws, 1999). The goal of the pilot project, which
built on Litchfield’s previous work (1993, 1999),
was to explore a model of nurse case management
incorporating the use of a family nurse trained in
HEC theory. In the context of a family–family
nurse partnership, the unfolding pattern of family
living was attended to. Family nurses shared their
stories of the families with the research group, who
reflected together on the families’ changing
predicaments and the whole picture of family living
in terms of how each family moved in time and
place. Subsequent visits with the families focusedCHAPTER 15 Margaret A. Newman’s Theory of Health as Expanding Consciousness and Its Applications 229