Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 1210
  • Home
  • Print this page
  • Email this page

 Table of Contents  
Year : 2017  |  Volume : 4  |  Issue : 1  |  Page : 50-52

Margaret Newman's theory of health as expanding consciousness and a nursing intervention from a unitary perspective

The NPO Newman Theory/Research/Practice Study Society, Tokyo, Japan

Date of Submission07-Jul-2016
Date of Acceptance05-Oct-2016
Date of Web Publication27-Jan-2017

Correspondence Address:
Emiko Endo
Chairman of the Board of Directors, The NPO Newman Theory/Research/Practice Study Society, Tokyo
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2347-5625.199076

Rights and Permissions

This mini-review aims to introduce Margaret Newman's theory of health as expanding consciousness and caring partnership as a nursing intervention. Emanating from a unitary and transformative perspective of nursing, caring partnership enables nurses to identify with cancer patients as well as to help the patients find meaning in their situation and their lives. In genuine patient–nurse interactions, both patients and nurses experience higher levels of consciousness.

Keywords: Caring partnership, Margaret Newman, nursing intervention, theory-based practice

How to cite this article:
Endo E. Margaret Newman's theory of health as expanding consciousness and a nursing intervention from a unitary perspective. Asia Pac J Oncol Nurs 2017;4:50-2

How to cite this URL:
Endo E. Margaret Newman's theory of health as expanding consciousness and a nursing intervention from a unitary perspective. Asia Pac J Oncol Nurs [serial online] 2017 [cited 2022 Jan 25];4:50-2. Available from: https://www.apjon.org/text.asp?2017/4/1/50/199076

  Introduction Top

This review introduces Margaret Newman's theory of health as expanding consciousness (HEC),[1],[2],[3] which emanates from a unitary and transformative perspective of nursing. As medical technology advances, cancer patients have a great need of a caring connection with nurses. However, nurses often cannot establish those connections because of the demands of their time and energy for a treatment-focused care. Caring partnership, which is based on Newman's HEC theory, as a nursing intervention enables nurses to identify with cancer patients and to help the patients find meaning in their difficult situations and their lives. Consequently, both patients and nurses will grow even in extremely difficult situations.

  Evolution of Newman's Health as Expanding Consciousness Theory Top

Newman proposed a new concept of health in a dialectical manner, that is, “DISEASE fuses with its opposite, absence of disease, NON-DISEASE, and brings forth a new concept of HEALTH” she continues, “This synthesized view incorporates disease as a meaningful aspect of health.”[2] Nurses may be reluctant to accept this view, especially if they are committed to problem-solving care. However, once nurses understand how this innovative concept of health evolved in Newman's life, they will understand the core concept of the theory.

Newman was in her early twenties when she began taking care of her mother who was diagnosed with amyotrophic lateral sclerosis, a degenerative neurological disease that progressively diminishes the movement of all muscles except those of the eyes. Caring for her mother over a 5-year period was a transformative process. She learned to live day by day and was fully immersed in the present. She wrote,

I learned that my mother, though physically incapacitated, was a whole person, just like anybody else. I came to know her and to love her in a way I probably never would have taken the time to experience had she not been physically dependent. The 5 years I spent with her before she died were difficult, tiring, restrictive in some ways, but intense, loving, and expanding in other ways.[2]

Although her mother's life was confined by the disease, her life was not defined by it. The mother and daughter experienced “wholeness” and “health” together despite having a progressive disease.

After her mother's death, she decided to study nursing and worked as a nurse. While pursuing her doctoral studies in nursing at New York University, she studied with Martha Rogers. Rogers' Science of Unitary Human beings is a well-known nursing model because of the assumption about man; that is, “Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.”[4] Rogers viewed health and illness not as two separate realities but as a unitary and transformative process. This view is congruent with Newman's previous experience with her mother.

  Overview of Newman's Health as Expanding Consciousness Theory Top

Newman's theory embraces a unitary and transformative paradigm of nursing as “caring in the human health experience.”[5] Her first step as a theorist evolved around 1979.[6] After elaborating her idea, three books were published in order.[1],[2],[3] The basic assumptions of the theory are synthesized as follows:

  • Health is an evolving unitary pattern of the whole, including patterns of disease
  • Consciousness is the informational capacity of the whole and is revealed in the evolving pattern
  • Pattern identified the person–environment process and is characterized by meaning.[3]

The basic assumptions of the theory are focused on pattern. Pattern refers to “information that depicts the whole, understanding of the meaning of all the relationships at once.”[2] Wholeness is identified in pattern. Pattern is constantly evolving. Each observable pattern is time specific and contains information that was enfolded and will unfold. The evolution and transformation of pattern occurs through the patient–environment interaction, that is, the manner in which the patient relates with the environment. A pattern can be demonstrated retrospectively as sequential patterns over time. Sometimes, a patient's life is orderly; other times, the patient goes through a difficult life passage that is seen as chaos. Order and disorder in the patient's life are part of expansion of consciousness.

A nurse enters this process with the patient, particularly at a time when the patient is experiencing chaos. The key is that the nurse and the patient can engage in the mutual process of pattern recognition. Thus, both of them will evolve to higher levels of consciousness.[2]

A nursing intervention calls for action that evolves out of pattern recognition. That is, the recognition of pattern provides personal insight into the meaning of the pattern and reveals the potential for action. This nursing intervention that is based on Newman's theory was named “caring partnership” in a patient–nurse relationship.

  Caring Partnership in a Unitary Perspective Top

Newman's paradigmatic view shapes a new type of nursing intervention that focuses on the patient as a whole and finds meaning in the experience. She described this process as “HEC Praxis: The Process of Pattern Recognition.”[3] Praxis means a synthesis of theory, research, and practice. The elements of the research process are the same for practice; however, research usually requires recording of data.

  • Step 1: A mutual process of inquiry is established with a patient (patient and/or family)
  • Step 2: The patient is invited to talk about meaningful events and relationships in the patient's life. After the first meeting, the nurse transmutes the narrative to a simple diagram that illustrates the sequential configurations of relationships and events
  • Step 3. The diagram is shared with the patient and the dialogue resumes freely
  • Step 4. When the patient realizes the patient's pattern, partnership is terminated [Figure 1].
Figure 1: Process of caring partnership based on Newman's theory of health as expanding consciousness

Click here to view

Most nurses consider that a minimum of three meetings is needed. This process is not necessarily to “collect data” or obtain information through interviews. Rather, the aim is to interact genuinely with the patient. Through this authentic interaction, the patient and the nurse will experience higher levels of consciousness. This process was adopted as a nursing intervention for cancer patients,[7] families including patients,[8] and nurse students for cancer prevention [9] in a unitary perspective. This unitary approach for nursing patients with cancer was introduced into a practicing nurse group [10] and into an educational curriculum for an Oncology Certified Nurse Specialist in Master's Programs in Japan.[11] Praxis nature within Newman's theory was based on the aforementioned studies.[12] This article will be helpful for designing a nursing intervention from a unitary perspective.

  Relevance of Newman's Health as Expanding Consciousness Theory Across Cultures Top

Newman's theory has been used throughout the world, but it was quickly embraced and understood by nurses from the Eastern cultures. They are less bound by linear thought and a physical concept of health; they are immersed more in the metaphysical aspect of human existence.[13] The author recommends the practice of “caring partnership” to nurses who provide care to patients with cancer, especially those going through a difficult situation, such as a gear change or end-of-life period. A case report that is based on Newman's HEC theory will be presented in this issue.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Newman MA. Health as Expanding Consciousness. St. Louis, MO: C. V. Mosby; 1986.  Back to cited text no. 1
Newman MA. Health as Expanding Consciousness. 2nd ed. Boston: Jones and Bartlett (NLN Press); 1994.  Back to cited text no. 2
Newman MA. Transforming Presence: The Difference that Nursing Makes. Philadelphia: F.A. Davis; 2008.  Back to cited text no. 3
Rogers ME. An Introduction to the Theoretical Basis of Nursing. Philadelphia: F. A. Davis; 1970.  Back to cited text no. 4
Newman MA, Sime AM, Corcoran-Perry SA. The focus of the discipline of nursing. ANS Adv Nurs Sci 1991;14:1-6.  Back to cited text no. 5
Newman MA. Theory Development in Nursing. Philadelphia: F. A. Davis; 1979.  Back to cited text no. 6
Endo E. Pattern recognition as a nursing intervention with Japanese women with ovarian cancer. ANS Adv Nurs Sci 1998;20:49-61.  Back to cited text no. 7
Endo E, Nitta N, Inayoshi M, Saito R, Takemura K, Minegishi H, et al. Pattern recognition as a caring partnership in families with cancer. J Adv Nurs 2000;32:603-10.  Back to cited text no. 8
Endo E, Takaki M, Nitta N, Abe K, Terashima K. Identifying patterns in partnership with students who want to quit smoking. J Holist Nurs 2009;27:256-65.  Back to cited text no. 9
Endo E, Miyahara T, Suzuki S, Ohmasa T. Partnering of researcher and practicing nurses for transformative nursing. Nurs Sci Q 2005;18:138-45.  Back to cited text no. 10
Endo E, Takaki M, Miyahara T. A unitary perspective for cancer nursing. J Nurs Care 2014;3:1-5.  Back to cited text no. 11
Endo E. Nursing praxis within Margaret Newman's theory of health as expanding consciousness. Nurs Sci Q 2004;17:110-5.  Back to cited text no. 12
Pharris MD. Margaret Newman's theory of health as expanding consciousness. In: Parker ME, Smith MC, editors. Nursing Theories & Nursing Practice. 3rd ed. Philadelphia: F. A. Davis; 2010:290-313.  Back to cited text no. 13

  Authors Top

Emiko Endo


  [Figure 1]

This article has been cited by
1 Divinity in nursing: The complexities of adopting a spiritual basis for care
Bernie Garrett
Nursing Philosophy. 2021;
[Pubmed] | [DOI]
2 Caring Partnership within Newmanæs Theory of Health as Expanding Consciousness: Aiming for Patients to Find Meaning in Their Treatment Experiences
Satoko Imaizumi,Aya Honda,Yoshimi Fujiwara,Yukako Iio
Asia-Pacific Journal of Oncology Nursing. 2021; 8(6): 725
[Pubmed] | [DOI]
3 Awareness and sources of knowledge on men’s penile health in Lagos, Nigeria
Oscar Odiboh,Oladokun Omojola,Kehinde Oyesomi,Emmanuel O Amoo
Cogent Social Sciences. 2020; 6(1)
[Pubmed] | [DOI]
4 Apophenia, unconscious bias and reflexivity in nursing qualitative research
Stephen Buetow
International Journal of Nursing Studies. 2019; 89: 8
[Pubmed] | [DOI]
5 Growth: A Journey from Experience to Higher Perception Among Iranian Muslim CPR Survivors
Seyed Hamid Seyed Bagheri,Masoud Rayyani,Sedigheh Iranmanesh,Mahlagha Dehghan,Batool Tirgari,Seyed Habibollah Hosseini
Journal of Religion and Health. 2018;
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Evolution of New...
Overview of Newm...
Caring Partnersh...
Relevance of New...
Article Figures

 Article Access Statistics
    PDF Downloaded2270    
    Comments [Add]    
    Cited by others 5    

Recommend this journal