Health: A Personal Commitment ROSEMARIE Rizzo PARSE, RN; PHD* ; FAAN Health as a personal commitment is a view that evolves from Parse’s of man-living-health. This article describes different models of human nature and explains health from the perspectives of each, describes a view of health from the man-living-health theory supported by other contemporary works, and posits some implications for nursing practice and research related to this view of health. The author elaborates on ways human beings move beyond the moment to change patterns of health through creative imagining, affirming self, and spontaneous glimpsing of the paradoxical. The meaning of true presence is discussed as well as some basic suggestions for the study of phenomena using the Parse research methodology.
theory
An
85-year-old
Peter, was admitted to a for medical treatment of an
ual, incarnating his
man,
teaching hospital
obstruction. He believed that he was dying, but no one would listen. When his elderly roommate, suffering from heart disease, was unsuccessfully resuscitated and left lying in a pool of excretions, Peter frantically implored the doctors and nurses: &dquo;Please, don’t ever do that to me. Promise that you won’t ever do that to me.&dquo; Three days later Peter developed congestive heart failure, and an efficient nurse and technician intubated him and placed him on a ventilator. During the first night on the ventilator. Peter was found dead in bed. He had awakened, reached over, and switched off the ventilator. On the bedside table, the nurse found a scribbled note: &dquo;Death is not the enemy, nurse, inhumanity is&dquo; (Le Shan, 1982, p. 32).
his way of living a personal commitment. It is the author’s belief that to posit health as a personal commitment is a way of focusing on the human experience, thus, emphasizing the humanity in health
Peter’s action
was
care.
As the 21 st century approaches and the world rapidly changes, there is a strong movement among health scientists and society to identify health as a personal commitment. To do so is to specify health as a process of living or unfolding rather than the absence of disease or a dynamic state of physical, psychological, social and spiritual well-being. Health as a personal commitment means that an individual’s way of being is cocreated by that individ-
Key Words: Parse’s theory, Man-living-health, True presence, Health
*
Hunter
College of CUNY.
New York, NY.
or
her
own
value priori-
ties. The purpose of this article is threefold: (a) to describe different models of human nature and explain health from the perspective of each, (b) to describe a view of health from the
man-living-health theory supported by other contemporary works, and (c) to posit some implications for nursing practice and research related to this view of health. -
Views of Seminal to
a
Being
discussion
Human on
health is
a
de-
scription of various perspectives about human nature. Many persons, from a variety of discihave written about human nature. These include de Chardin, 1959; Dubos, 1979;
plines,
Ferkiss, 1969; Freud, 1930; Friedman, 1974; Fromm, 1968; Heidegger, 1962; Lovejoy, 1961; Marcel, 1978; Marcuse, 1964; Matson, 1964; May, 1967; Merleau-Ponty, 1963; Morris, 1968; Sartre, 1966; Skinner, 1953; van Kaam, 1974, and others. Different perspectives of human nature are presented by these authors,
basically their ideas can be divided into two views of the human being. One view is the human being as a mechanistic organism, and the other is the human as creative author. The first view sets forth the idea of the human being as a mechanistic organism. It reflects the belief that humans function as wellorganized machines. The machine-human is expected to perform certain tasks and duties and is rewarded when the expectations are met. If something doesn’t function, it can be fixed. The environment can be manipulated to make the machine work. Thus, it is a &dquo;fix it&dquo; model in which the person as object has things done to him or her, like Peter in the story. It is grounded in the belief that one adjusts to happenings in the environment and, thus, control but
136 Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
over
the environment is
a
highly sought after
goal. The second view of human nature is that the human is a creative author. This view posits the human as a free agent and is profoundly different from the mechanical &dquo;fix it&dquo; view. The creative author view reflects a belief that human existence is freely chosen in coconstitution with the universe, not predetermined. It specifies the human in open encounter with the world. A person is a living being making choices-not an object functioning to complete tasks. Humans live the power to choose a stand toward the universe; to reach beyond to what might be. The creative-author human creates a personal world with spirit, compassion, and honor. This view of the human shuns the idea of control, fixing, and manipulation. It is grounded in the belief that one is responsible for personal choices, has dignity, and the capacity to love, fear, be in pain, be angry, and express joy and wonder.
Perspectives of Health These two views of being human, mechanistic and creative author, incarnate beliefs that lead to very different perspectives of health. Health for the mechanistic organism is a wellfunctioning machine composed of the body-
mind-soul
system; this system, functioning
well, represents the health of the person. Illness and disease occur when one of the as-
pects of the body-mind-soul system has difficulty functioning and is considered out of control. Health can be restored by fixing the &dquo;machine&dquo; and carrying out maintenance strategies to regain control. Health can be maintained by initiating preventive measures. But, health for the creative author is a process of unfolding. Humans assume responsibility for health, which is cocreated in the humanenvironment interrelationship. Health is not static: it is a flowing process which incarnates the different ways of being of an individual. These perspectives of health, then, are distinct, and clearly evolve from different belief systems that lead to different health care
strategies. Health in Parse’s
less (Parse, 1981). It is just the way the human is! Health is cocreated through the human-environment interrelationship, and it is lived in rhythmical patterns of relating that incarnate the meaning that the human being gives to situations. How ever one is, is the meaning given to the situation. Health is a synthesis of values, a way of living (Parse, 1981). One is the source of his or her own health experiences (Pa.rse 1981). Thus, health is a personal responsibility in that it is chosen. The person participates in choosing from options at all levels of the universe, thus making clear value priorities, that is the personal commitment. Health as personal commitment, then, means that health is one’s own unfolding in interconnectedness with the world. It does not imply that one’s health is an entity, lived in a vacuum without connectedness with others and environment. The belief is that one cocreates health with others and the world in mutual interrelationship and that cocreation of health is the set of choices the person with world makes from all levels of the universe, not just from the explicit level. The person is responsible for the outcomes of choices in that the choices themselves incarnate the person’s unique was, is, and will be. The belief system underlying this view is clearly articulated in the principles of man-living-health, (Parse, 1981, p. 69). The view of health presented here was substantiated in a phenomenological research study on health completed by Parse (Parse, Coyne, and Smith 1985), in which 400 subjects between the ages of 7 and 93 were asked to describe a situation in which they experienced a feeling of health. The hypothetical definition, abstracted from the subjects’ descriptions, is health is a harmony sparked by energy leading to plentitude. This study concluded that the lived experience of health as described by people living it is much more than the absence of disease and more than a dynamic state of well-being, and that health as becoming is an active cocreating by a person with others and the environment. That the person participates in creating his or her own health confirms the idea that health is a personal commitment. more or
Theory
Health as a personal commitment reflects the perspective of health from the creative author view of the human. The beliefs about humans in the creator-view are consistent with the beliefs articulated in the man-livinghealth nursing theory, which posits health as a process of becoming, experienced by the person (Parse, 1981). It is an unfolding that cannot be prescribed or described by societal norms, only by the person living the health (Parse 1981). Health itself is a nonlinear entity, which cannot be described as good or bad,
Not
Congruent Contemporary Authors exactly the same, but generally
con-
gruent with Parse’s view of health and the findings of the research study on health is Ferguson’s (1980) view of an emergent paradigm of health, the assumptions of which include health as a view of the whole person with an emphasis on human values and caring. Ferguson (1980) says that health originates in an attitude. It includes accepting responsibility for self and relationships, and de137
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
veloping a sense of purpose in life. Dossey (1982) suggests a space-time model of health in which health is viewed as a shared phenomenon, not an individual affair. More specifically, health is a reflection of human connectivity (Dossey, 1982). Health then is cocreated by the person in connection with the environment and others. Disease is considered a pat- tern of health, and death is a movement, &dquo;a relentless shuttle between the worlds of form and nonform&dquo; (Dossey, 1982, p. 146). Newman (1986) concurs and explains health as a process of evolution toward expanding consciousness and disease as a pattern of health. Also consistent with the view of health as specified in the man-living-health theory is LeShan, (1982) who says that health is related to the whole person and the healing process is related to the total of the person’s life. He says, to believe that each disease has a cure that fits it is a fantasy with no grounding in fact (Le-
Shan, 1982, p. 14). Serge King (1981) goes further and actually says that individuals have only the limitations they agree to have and that health is a choice. This is highly consistent with Parse’s view as is Borysenko’s (1987), which talks about the science of healing. Borysenko believes that healing is connected to values that are most important in life, such as openness to love, an attitude of forgiveness toward self and others, and peacefulness. Although these authors’ views are from other disciplines and their views are not exactly like Parse’s, there is congruence among them and they reflect an evergrowing body of scientists who view health as a process of becoming.
Changing
Personal Commitment
More explicitly from Parse’s view, the personal commitment is lived through abiding with the struggles and joys of everydayness in a way that incarnates one’s quality of life. This way of abiding with joys and struggles of everydayness is the choosing of meaning in situations. The choosing is, all at once, at both the reflective and prereflective levels of being. When one becomes reflectively aware of the meaning of a situation, a light is shed on the
personal commitment.
One
choose to stay change the commitcan
with the commitment or ment by changing the meaning of a situation, thus, changing health. Changing health happens in rhythmically moving through the moment. Some ways the author posits as moving oneself through the moment in changing a commitment include creative imagining, affirming se f, and spontaneous glimpsing of the paradoxical.
Through
creatiue
imagining
one can
pic-
ture, that is, see, hear, and feel what a situation &dquo;might be like&dquo; if lived in a particular way. Imagining is structuring a scenario in which a
is already made, &dquo;trying it on,&dquo; getting feel for it, seeing what a change might be like through anticipatory projecting; for example, structuring a scenario around what a move to a different job would be like, or different living arrangements, or walking erect if
change
a
has been immobile. Creative imagining, when seriously approached as a way of moving through the moment, immerses the person in the structured situation. This whole-self immersion is a way of experiencing a change and learning about self and environment while unfolding with the imaged possibles. This insight was clearly illuminated through a study by Parse (1990, p. 16) on hope using the man-living-health methodology with 10 one
participants
on
hemodialysis. Findings
re-
vealed that the structure of &dquo;hope is the persistent picturing of possibles while incarnating opportunities and limitations all at once which unfolds in viewing the familiar in a new light. In dialogical engagement with the researcher, participants revealed that persistent picturing of possibles, such as having a
kidney transplant, seeing a daughter graduate from college, and traveling to another county to visit family, moved them beyond the moment and changed their experience of health. The persistent picturing of something that was not-yet moved these persons to another experience. Creative imagining is the persistent picturing of something that is not-yet and is a way of changing meaning, thus changing the .personal commitment. Affirming self is another way of moving beyond the moment. Affirming self is explicitlytacitly living patterns that incarnate the who one is becoming. In critically thinking about how or who one is, one uncovers personal patterns of preference. These patterns of preference affirm self in becoming a certain way. To persist in living these patterns of preference confirms specific values. For example, a person who believes he or she is &dquo;unhappy&dquo; will live a set of values that perpetuates this belief. To change the living &dquo;unhappy&dquo; to &dquo;happy&dquo; the person changes the beliefs and values to affirm &dquo;happy&dquo; living. New persistent patterns consistent with &dquo;happy&dquo; are willfully created. The &dquo;I will&dquo; and &dquo;I can&dquo; attitude toward a given desire for change creates it and affirms self in a different way, thus, changing health.
Spontaneous glimpsing of the paradoxical, way of moving beyond the moment, is looking at the incongruence in a situation as the opposites inevitably surface. The recognition of apparent incongruence may lead to laughter, which sheds a different light and changes a
the view of something. This insight was clarified through a phenomenological study by Parse (1987b) in which 30 persons over 65 were asked to describe a situation in which they experienced &dquo;laughing your heart out.&dquo; The structural description emerged as laugh-
138
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
ing is a buoyant immersion in the presence of unanticipated glimpsings unfolding a sense of harmonious integrity which surfaces anew in contempiative visioning. This definition is closely related to the one uncovered in Parse’s phenomenological study on health (Parse et ,al., 1985). It was shown that laughing unfolds, in the context of glimpsing the paradoxical, as a sense of harmony, a feeling of energy, and a sense of plentitude, the feeling of health as described by the subjects in the health study. The spontaneous glimpsing of the paradoxical, then, is a way of moving beyond the moment in changing patterns of health. For example, persons who glimpse some of the incongruities of a serious situation and laugh, change the view of the situation. This moves them beyond the moment and changes the emerging patterns of health. Creative imagining affirming self, and spontaneous glimpsing of the paradoxical are ways that can move one beyond to change patterns of health. The new patterns are incarnated with the personal commitment. This view of health and these ways of changing
dreams. The author believes that intentional reflective love is an interpersonal art grounded in a strong knowledge base reflecting the belief that each person knows &dquo;the way&dquo; somewhere within self. Each human lives a way, his or her own way, which is both alike and different from the &dquo;ways&dquo; of others. It is Like that of others in that it is a personal way of being; each individual has a personal way of being. It is different from others in that it is one’s own. It is like a fingerprint in that it belongs to only one human being and while others coexist in the large journey of life, each lives his or her own way on the journey. One’s own explicit and tacit knowing is the well-spring of moving along the way. True presence is in the sphere of the interhuman and this is where the nurse enters the person’s world with an openness, a self-giving, and a strong knowledge base reflecting the theory of man-living-health. The dimensions of Parse’s theory in practice focus on illuminating meaning, synchronizing rhythms, and mobilizing transcendence with the person (Parse, 1987a). It is with the true presence of the nurse that the person may be called to the meaning of a situation and dwell with the rhythmical patterns of relating that mobilize movement beyond the moment. As mentioned earlier, this movement beyond may happen in the presence of the nurse through creative
patterns of health, then, emerging from the
nursing theory, man-living-health, can guide nursing practice and research in ways different from the traditional.
Nursing Practice Implications Nursing practice from the man-living-health view is guided by the theoretical foundation that espouses the human as free agent and meaning giver, choosing rhythmical patterns of relating while reaching for personal hopes and dreams. These beliefs about the human and health lead the nurse to approach the person and family as a nurturing gardener rather than a &dquo;fix it&dquo; mechanic. To approach a person as gardener, not mechanic, believing that each person lives value priorities is to be truly present to the person as the person changes patterns of health. Nursing practice from this view is &dquo;not offering professional advice and opinions stemming from the nurse’s own lived value system. It is not a canned approach to care. It is a subject-tosubject interrelationship, a loving, true presence with the other to enhance the quality of life&dquo; (Parse, 1987a, p. 169). The true presence of the nurse is a nonroutinized, nonmechanical way of &dquo;being with&dquo; in which the nurse is authentic and attentive to moment-to-moment changes in meaning for the person or group. These changes in meaning lead to changes in commitment, and may occur through the creative imagining, affirming self, and glimpsing the paradoxical as the nurse is present to the person. True presence surfaces as an intentional reflective love (Orage, 1987) which the nurse shares with the other as the other blossoms according to personal desires and
imagining (anticipatory projecting), affirming .
self (I will and I can), and glimpsing the paradoxical (laughing). Living a true presence with a person is placing the emphasis on the human-to-human interrelationship with the nurse valuing the person as coauthor freely choosing health. Peter, in the story that began this article, called for humane care and did not receive it. He knew that health is a personal commitment. But the health care givers, who did not agree with his view, imposed their views on him and moved to make him a well-functioning machine. But he ultimately made the choice. Peter did not experience a nurse’s true presence. Nursing practice based on the beliefs of man-living-health frees people from enslavement by others’ values and enhances quality of life while reflecting the view that health is a personal commitment. This is how nursing is practiced if one believes that health is a personal commitment.
Nursing Research Implications The research on health from the man-livinghealth perspective, like the practice, is different from the traditional. The mode of inquiry to uncover lived experiences of health is qualitative in nature. This view of health can be studied by using qualitative methods such as
phenomenological, ethnographic, exploratory, or case
methods borrowed from other disci139
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
et al., 1985) or the man-livinghealth research methodology (Parse, 1987a). The latter is an emerging method that includes the processes of dialogical engagement (re-
plines (Parse
searcher-person dialogues), extraction-synthesis (transforming the data across levels of abstraction to the level of science), and heuristic interpretation (specifying the findings in light of the man-living-health theory and integrating them into the language of the theory) (Parse, 1987a). The entities for study in this method are lived experiences of health. Phenomena investigated through the manliving-health methodology all relate to health a personal commitment. For example, laughter and health in elders (Parse, in process), taking life day by day in later life (Mitchell, 1990), struggling through a difficult time for unemployed persons (Smith, 1990), living on the edge for persons with cardiac by-pass surgery (Liehr, 1988), caring about self with relentless runners (Santopinto, 1989), struggling to make a decision in a critical life situas
ation for persons who are HIV positive (Beauchamp, 1990), and grieving a personal loss (Cody, 1988). The findings of these studies shed light on the meaning of health, enhanced the theory, and refined the method, thus expanding the knowledge base of nursing. If one believes health is a personal commitment, a coconstituted unfolding, this type of research is appropriate. Both nursing practice and research from this worldview incarnate beliefs about the human being and health that are different from the traditional. In Reflection Health is a personal commitment-only I know me. Health is my own living of values. I constitute my health with my mutual interconnectedness with the world. The nurse’s true presence with me calls me to learn the meaning I give to situations but in me and my world is &dquo;the way&dquo;-I know it in my tacit-explicit-I know it at all levels of my universe, in ways I cannot say and that no others know. Health is how I live my life-my own personal commitment to being the who that I am becoming.... Listen to me nurse, when I tell you how I am, and what I will do-since that is how I am going to be me.
Peter said, &dquo;Please don’t do that to me-don’t beat on my chest and leave me lying in excretions&dquo;-but they did. Then he turned off the ventilator and died and said again zn his way &dquo;You can’t do that to me-death, people, is not the enemy, inhumanity is. I am no thing!&dquo;
References
Beauchamp, C. J. (1990). Struggling to make a decision in a critical life situation. Unpublished doctoral dissertation, University of Miami, Florida. , mending the Borysenko, J. (1987). Minding the boay mind. Reading, MA: Addison-Wesley. Cody, W. K. (1988). Grieving a personal loss: A preliminary investigation of Parse’s man-living-health meth-
odology. Unpublished master’s thesis, Hunter College. The City University of New York. NY. de Chardin, P. T. (1959). The phenomenon of man (p. 53). New York: Harper. Dossey, L. (1982). Space, time, and medicine. Boulder, CO: Shambhala. Dubos, R. (1979). Medicine evolving. In D. S. Sobel (Ed.). Ways of health (pp. 42-43). New York: Harcourt Brace Jovanovich. Ferguson, M. (1980). The Aquarian conspiracy: Personal and social transformation in the 1980s. Los Angeles: J. P. Tarcher. Ferkiss. V. C. (1969). Technological man. New York: Braziller. Freud, S. (1930). Civilization and its discontents. London : Hogarth. Friedman. M. (1974). The hidden human image. New York: Delacorte. Fromm, E. (1968). The revolution of hope. New York: Bantam. Heidegger, M. (1962). Being and time. New York: Harper & Row. King, S. (1981). Imagineering for health. Wheaton, IL: The Theosophical Publishing House. LeShan, L. (1982). The mechanic and the gardener. New York: Holt, Rinehart, & Winston. Liehr, P. (1988, December). A study of the experience of "living on the edge." Research study presented at the Southern Council on Collegiate Education for Nursing, Atlanta, GA. Lovejoy. A. O. (1961). Reflections on human nature. Baltimore : Johns Hopkins Press. Marcel, G. (1978). Mystery of being: Reflection and mystery (Vol. 1 ). South Bend, IN: Gateway Editions. Marcuse, H. (1964). One-dimensional man. Boston: Beacon.
Matson, F. W. ( 1964). The broken image. New York: Braziller. R. (1967). Man’s search for himself. New York: Norton. Merleau-Ponty, M. (1963). The structure of behavior. Boston: Beacon. Mitchell, G. J. (1990). The lived experience of taking life day-by-day in later life: Research guided by Parse’s emergent method. Nursing Science Quarterly 3, 29-
May,
36. Morris, D. Hill.
(1968).
The naked ape. New York: McGraw-
Newman, M. A. (1986). Health
as expanding consciousMosby (2). 32-50. Orage, A. R. (1987). On love. Parabola, 12 Parse, R. R. (1981). Man-living-health. A theory of nursing. New York: Wiley. Parse, R. R. (1987a). Nursing science: Major paradigms. theories, and critiques. Philadelphia: Saunders. Parse, R. R. (1987b). The lived experience of laughing in persons over 65. Research study presented at the Coun-
ness.
St. Louis:
cil of Nurse Reseachers. International Conference, Arlington, VA. Parse, R. R. (1990). Parse’s research methodology with an illustration of the lived experience of hope. Nursing Science Quarterly. 3, 9-17. Parse, R. R. (in process). The lived experience of laughter and health. Research study funded by the Research Foundation of CUNY. Parse. R. R., Coyne, A. B., & Smith, M. J. (1985). Nursing research: Qualitative methods. Bowie, MD: Brady. Santopinto, M. (1989. May). Caring about self. Research study presented at the International Sigma Theta Tau Research Congress, Taiwan. Sartre, J.P. (1966). Being and nothingness. New York: Washington Square Press. Skinner, B. F. (1953). Science and human behavior. New York: Macmillan. Smith, M. C. (1990). Struggling through a difficult time for unemployed persons. Nursing Science Quarterly 3, 1828. van Kaam. A. (May 1974). Existential crisis and human development. Humanitas, 10, 109-110.
140
Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
theory
An
85-year-old
Peter, was admitted to a for medical treatment of an
ual, incarnating his
man,
teaching hospital
obstruction. He believed that he was dying, but no one would listen. When his elderly roommate, suffering from heart disease, was unsuccessfully resuscitated and left lying in a pool of excretions, Peter frantically implored the doctors and nurses: &dquo;Please, don’t ever do that to me. Promise that you won’t ever do that to me.&dquo; Three days later Peter developed congestive heart failure, and an efficient nurse and technician intubated him and placed him on a ventilator. During the first night on the ventilator. Peter was found dead in bed. He had awakened, reached over, and switched off the ventilator. On the bedside table, the nurse found a scribbled note: &dquo;Death is not the enemy, nurse, inhumanity is&dquo; (Le Shan, 1982, p. 32).
his way of living a personal commitment. It is the author’s belief that to posit health as a personal commitment is a way of focusing on the human experience, thus, emphasizing the humanity in health
Peter’s action
was
care.
As the 21 st century approaches and the world rapidly changes, there is a strong movement among health scientists and society to identify health as a personal commitment. To do so is to specify health as a process of living or unfolding rather than the absence of disease or a dynamic state of physical, psychological, social and spiritual well-being. Health as a personal commitment means that an individual’s way of being is cocreated by that individ-
Key Words: Parse’s theory, Man-living-health, True presence, Health
*
Hunter
College of CUNY.
New York, NY.
or
her
own
value priori-
ties. The purpose of this article is threefold: (a) to describe different models of human nature and explain health from the perspective of each, (b) to describe a view of health from the
man-living-health theory supported by other contemporary works, and (c) to posit some implications for nursing practice and research related to this view of health. -
Views of Seminal to
a
Being
discussion
Human on
health is
a
de-
scription of various perspectives about human nature. Many persons, from a variety of discihave written about human nature. These include de Chardin, 1959; Dubos, 1979;
plines,
Ferkiss, 1969; Freud, 1930; Friedman, 1974; Fromm, 1968; Heidegger, 1962; Lovejoy, 1961; Marcel, 1978; Marcuse, 1964; Matson, 1964; May, 1967; Merleau-Ponty, 1963; Morris, 1968; Sartre, 1966; Skinner, 1953; van Kaam, 1974, and others. Different perspectives of human nature are presented by these authors,
basically their ideas can be divided into two views of the human being. One view is the human being as a mechanistic organism, and the other is the human as creative author. The first view sets forth the idea of the human being as a mechanistic organism. It reflects the belief that humans function as wellorganized machines. The machine-human is expected to perform certain tasks and duties and is rewarded when the expectations are met. If something doesn’t function, it can be fixed. The environment can be manipulated to make the machine work. Thus, it is a &dquo;fix it&dquo; model in which the person as object has things done to him or her, like Peter in the story. It is grounded in the belief that one adjusts to happenings in the environment and, thus, control but
136 Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
over
the environment is
a
highly sought after
goal. The second view of human nature is that the human is a creative author. This view posits the human as a free agent and is profoundly different from the mechanical &dquo;fix it&dquo; view. The creative author view reflects a belief that human existence is freely chosen in coconstitution with the universe, not predetermined. It specifies the human in open encounter with the world. A person is a living being making choices-not an object functioning to complete tasks. Humans live the power to choose a stand toward the universe; to reach beyond to what might be. The creative-author human creates a personal world with spirit, compassion, and honor. This view of the human shuns the idea of control, fixing, and manipulation. It is grounded in the belief that one is responsible for personal choices, has dignity, and the capacity to love, fear, be in pain, be angry, and express joy and wonder.
Perspectives of Health These two views of being human, mechanistic and creative author, incarnate beliefs that lead to very different perspectives of health. Health for the mechanistic organism is a wellfunctioning machine composed of the body-
mind-soul
system; this system, functioning
well, represents the health of the person. Illness and disease occur when one of the as-
pects of the body-mind-soul system has difficulty functioning and is considered out of control. Health can be restored by fixing the &dquo;machine&dquo; and carrying out maintenance strategies to regain control. Health can be maintained by initiating preventive measures. But, health for the creative author is a process of unfolding. Humans assume responsibility for health, which is cocreated in the humanenvironment interrelationship. Health is not static: it is a flowing process which incarnates the different ways of being of an individual. These perspectives of health, then, are distinct, and clearly evolve from different belief systems that lead to different health care
strategies. Health in Parse’s
less (Parse, 1981). It is just the way the human is! Health is cocreated through the human-environment interrelationship, and it is lived in rhythmical patterns of relating that incarnate the meaning that the human being gives to situations. How ever one is, is the meaning given to the situation. Health is a synthesis of values, a way of living (Parse, 1981). One is the source of his or her own health experiences (Pa.rse 1981). Thus, health is a personal responsibility in that it is chosen. The person participates in choosing from options at all levels of the universe, thus making clear value priorities, that is the personal commitment. Health as personal commitment, then, means that health is one’s own unfolding in interconnectedness with the world. It does not imply that one’s health is an entity, lived in a vacuum without connectedness with others and environment. The belief is that one cocreates health with others and the world in mutual interrelationship and that cocreation of health is the set of choices the person with world makes from all levels of the universe, not just from the explicit level. The person is responsible for the outcomes of choices in that the choices themselves incarnate the person’s unique was, is, and will be. The belief system underlying this view is clearly articulated in the principles of man-living-health, (Parse, 1981, p. 69). The view of health presented here was substantiated in a phenomenological research study on health completed by Parse (Parse, Coyne, and Smith 1985), in which 400 subjects between the ages of 7 and 93 were asked to describe a situation in which they experienced a feeling of health. The hypothetical definition, abstracted from the subjects’ descriptions, is health is a harmony sparked by energy leading to plentitude. This study concluded that the lived experience of health as described by people living it is much more than the absence of disease and more than a dynamic state of well-being, and that health as becoming is an active cocreating by a person with others and the environment. That the person participates in creating his or her own health confirms the idea that health is a personal commitment. more or
Theory
Health as a personal commitment reflects the perspective of health from the creative author view of the human. The beliefs about humans in the creator-view are consistent with the beliefs articulated in the man-livinghealth nursing theory, which posits health as a process of becoming, experienced by the person (Parse, 1981). It is an unfolding that cannot be prescribed or described by societal norms, only by the person living the health (Parse 1981). Health itself is a nonlinear entity, which cannot be described as good or bad,
Not
Congruent Contemporary Authors exactly the same, but generally
con-
gruent with Parse’s view of health and the findings of the research study on health is Ferguson’s (1980) view of an emergent paradigm of health, the assumptions of which include health as a view of the whole person with an emphasis on human values and caring. Ferguson (1980) says that health originates in an attitude. It includes accepting responsibility for self and relationships, and de137
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veloping a sense of purpose in life. Dossey (1982) suggests a space-time model of health in which health is viewed as a shared phenomenon, not an individual affair. More specifically, health is a reflection of human connectivity (Dossey, 1982). Health then is cocreated by the person in connection with the environment and others. Disease is considered a pat- tern of health, and death is a movement, &dquo;a relentless shuttle between the worlds of form and nonform&dquo; (Dossey, 1982, p. 146). Newman (1986) concurs and explains health as a process of evolution toward expanding consciousness and disease as a pattern of health. Also consistent with the view of health as specified in the man-living-health theory is LeShan, (1982) who says that health is related to the whole person and the healing process is related to the total of the person’s life. He says, to believe that each disease has a cure that fits it is a fantasy with no grounding in fact (Le-
Shan, 1982, p. 14). Serge King (1981) goes further and actually says that individuals have only the limitations they agree to have and that health is a choice. This is highly consistent with Parse’s view as is Borysenko’s (1987), which talks about the science of healing. Borysenko believes that healing is connected to values that are most important in life, such as openness to love, an attitude of forgiveness toward self and others, and peacefulness. Although these authors’ views are from other disciplines and their views are not exactly like Parse’s, there is congruence among them and they reflect an evergrowing body of scientists who view health as a process of becoming.
Changing
Personal Commitment
More explicitly from Parse’s view, the personal commitment is lived through abiding with the struggles and joys of everydayness in a way that incarnates one’s quality of life. This way of abiding with joys and struggles of everydayness is the choosing of meaning in situations. The choosing is, all at once, at both the reflective and prereflective levels of being. When one becomes reflectively aware of the meaning of a situation, a light is shed on the
personal commitment.
One
choose to stay change the commitcan
with the commitment or ment by changing the meaning of a situation, thus, changing health. Changing health happens in rhythmically moving through the moment. Some ways the author posits as moving oneself through the moment in changing a commitment include creative imagining, affirming se f, and spontaneous glimpsing of the paradoxical.
Through
creatiue
imagining
one can
pic-
ture, that is, see, hear, and feel what a situation &dquo;might be like&dquo; if lived in a particular way. Imagining is structuring a scenario in which a
is already made, &dquo;trying it on,&dquo; getting feel for it, seeing what a change might be like through anticipatory projecting; for example, structuring a scenario around what a move to a different job would be like, or different living arrangements, or walking erect if
change
a
has been immobile. Creative imagining, when seriously approached as a way of moving through the moment, immerses the person in the structured situation. This whole-self immersion is a way of experiencing a change and learning about self and environment while unfolding with the imaged possibles. This insight was clearly illuminated through a study by Parse (1990, p. 16) on hope using the man-living-health methodology with 10 one
participants
on
hemodialysis. Findings
re-
vealed that the structure of &dquo;hope is the persistent picturing of possibles while incarnating opportunities and limitations all at once which unfolds in viewing the familiar in a new light. In dialogical engagement with the researcher, participants revealed that persistent picturing of possibles, such as having a
kidney transplant, seeing a daughter graduate from college, and traveling to another county to visit family, moved them beyond the moment and changed their experience of health. The persistent picturing of something that was not-yet moved these persons to another experience. Creative imagining is the persistent picturing of something that is not-yet and is a way of changing meaning, thus changing the .personal commitment. Affirming self is another way of moving beyond the moment. Affirming self is explicitlytacitly living patterns that incarnate the who one is becoming. In critically thinking about how or who one is, one uncovers personal patterns of preference. These patterns of preference affirm self in becoming a certain way. To persist in living these patterns of preference confirms specific values. For example, a person who believes he or she is &dquo;unhappy&dquo; will live a set of values that perpetuates this belief. To change the living &dquo;unhappy&dquo; to &dquo;happy&dquo; the person changes the beliefs and values to affirm &dquo;happy&dquo; living. New persistent patterns consistent with &dquo;happy&dquo; are willfully created. The &dquo;I will&dquo; and &dquo;I can&dquo; attitude toward a given desire for change creates it and affirms self in a different way, thus, changing health.
Spontaneous glimpsing of the paradoxical, way of moving beyond the moment, is looking at the incongruence in a situation as the opposites inevitably surface. The recognition of apparent incongruence may lead to laughter, which sheds a different light and changes a
the view of something. This insight was clarified through a phenomenological study by Parse (1987b) in which 30 persons over 65 were asked to describe a situation in which they experienced &dquo;laughing your heart out.&dquo; The structural description emerged as laugh-
138
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ing is a buoyant immersion in the presence of unanticipated glimpsings unfolding a sense of harmonious integrity which surfaces anew in contempiative visioning. This definition is closely related to the one uncovered in Parse’s phenomenological study on health (Parse et ,al., 1985). It was shown that laughing unfolds, in the context of glimpsing the paradoxical, as a sense of harmony, a feeling of energy, and a sense of plentitude, the feeling of health as described by the subjects in the health study. The spontaneous glimpsing of the paradoxical, then, is a way of moving beyond the moment in changing patterns of health. For example, persons who glimpse some of the incongruities of a serious situation and laugh, change the view of the situation. This moves them beyond the moment and changes the emerging patterns of health. Creative imagining affirming self, and spontaneous glimpsing of the paradoxical are ways that can move one beyond to change patterns of health. The new patterns are incarnated with the personal commitment. This view of health and these ways of changing
dreams. The author believes that intentional reflective love is an interpersonal art grounded in a strong knowledge base reflecting the belief that each person knows &dquo;the way&dquo; somewhere within self. Each human lives a way, his or her own way, which is both alike and different from the &dquo;ways&dquo; of others. It is Like that of others in that it is a personal way of being; each individual has a personal way of being. It is different from others in that it is one’s own. It is like a fingerprint in that it belongs to only one human being and while others coexist in the large journey of life, each lives his or her own way on the journey. One’s own explicit and tacit knowing is the well-spring of moving along the way. True presence is in the sphere of the interhuman and this is where the nurse enters the person’s world with an openness, a self-giving, and a strong knowledge base reflecting the theory of man-living-health. The dimensions of Parse’s theory in practice focus on illuminating meaning, synchronizing rhythms, and mobilizing transcendence with the person (Parse, 1987a). It is with the true presence of the nurse that the person may be called to the meaning of a situation and dwell with the rhythmical patterns of relating that mobilize movement beyond the moment. As mentioned earlier, this movement beyond may happen in the presence of the nurse through creative
patterns of health, then, emerging from the
nursing theory, man-living-health, can guide nursing practice and research in ways different from the traditional.
Nursing Practice Implications Nursing practice from the man-living-health view is guided by the theoretical foundation that espouses the human as free agent and meaning giver, choosing rhythmical patterns of relating while reaching for personal hopes and dreams. These beliefs about the human and health lead the nurse to approach the person and family as a nurturing gardener rather than a &dquo;fix it&dquo; mechanic. To approach a person as gardener, not mechanic, believing that each person lives value priorities is to be truly present to the person as the person changes patterns of health. Nursing practice from this view is &dquo;not offering professional advice and opinions stemming from the nurse’s own lived value system. It is not a canned approach to care. It is a subject-tosubject interrelationship, a loving, true presence with the other to enhance the quality of life&dquo; (Parse, 1987a, p. 169). The true presence of the nurse is a nonroutinized, nonmechanical way of &dquo;being with&dquo; in which the nurse is authentic and attentive to moment-to-moment changes in meaning for the person or group. These changes in meaning lead to changes in commitment, and may occur through the creative imagining, affirming self, and glimpsing the paradoxical as the nurse is present to the person. True presence surfaces as an intentional reflective love (Orage, 1987) which the nurse shares with the other as the other blossoms according to personal desires and
imagining (anticipatory projecting), affirming .
self (I will and I can), and glimpsing the paradoxical (laughing). Living a true presence with a person is placing the emphasis on the human-to-human interrelationship with the nurse valuing the person as coauthor freely choosing health. Peter, in the story that began this article, called for humane care and did not receive it. He knew that health is a personal commitment. But the health care givers, who did not agree with his view, imposed their views on him and moved to make him a well-functioning machine. But he ultimately made the choice. Peter did not experience a nurse’s true presence. Nursing practice based on the beliefs of man-living-health frees people from enslavement by others’ values and enhances quality of life while reflecting the view that health is a personal commitment. This is how nursing is practiced if one believes that health is a personal commitment.
Nursing Research Implications The research on health from the man-livinghealth perspective, like the practice, is different from the traditional. The mode of inquiry to uncover lived experiences of health is qualitative in nature. This view of health can be studied by using qualitative methods such as
phenomenological, ethnographic, exploratory, or case
methods borrowed from other disci139
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et al., 1985) or the man-livinghealth research methodology (Parse, 1987a). The latter is an emerging method that includes the processes of dialogical engagement (re-
plines (Parse
searcher-person dialogues), extraction-synthesis (transforming the data across levels of abstraction to the level of science), and heuristic interpretation (specifying the findings in light of the man-living-health theory and integrating them into the language of the theory) (Parse, 1987a). The entities for study in this method are lived experiences of health. Phenomena investigated through the manliving-health methodology all relate to health a personal commitment. For example, laughter and health in elders (Parse, in process), taking life day by day in later life (Mitchell, 1990), struggling through a difficult time for unemployed persons (Smith, 1990), living on the edge for persons with cardiac by-pass surgery (Liehr, 1988), caring about self with relentless runners (Santopinto, 1989), struggling to make a decision in a critical life situas
ation for persons who are HIV positive (Beauchamp, 1990), and grieving a personal loss (Cody, 1988). The findings of these studies shed light on the meaning of health, enhanced the theory, and refined the method, thus expanding the knowledge base of nursing. If one believes health is a personal commitment, a coconstituted unfolding, this type of research is appropriate. Both nursing practice and research from this worldview incarnate beliefs about the human being and health that are different from the traditional. In Reflection Health is a personal commitment-only I know me. Health is my own living of values. I constitute my health with my mutual interconnectedness with the world. The nurse’s true presence with me calls me to learn the meaning I give to situations but in me and my world is &dquo;the way&dquo;-I know it in my tacit-explicit-I know it at all levels of my universe, in ways I cannot say and that no others know. Health is how I live my life-my own personal commitment to being the who that I am becoming.... Listen to me nurse, when I tell you how I am, and what I will do-since that is how I am going to be me.
Peter said, &dquo;Please don’t do that to me-don’t beat on my chest and leave me lying in excretions&dquo;-but they did. Then he turned off the ventilator and died and said again zn his way &dquo;You can’t do that to me-death, people, is not the enemy, inhumanity is. I am no thing!&dquo;
References
Beauchamp, C. J. (1990). Struggling to make a decision in a critical life situation. Unpublished doctoral dissertation, University of Miami, Florida. , mending the Borysenko, J. (1987). Minding the boay mind. Reading, MA: Addison-Wesley. Cody, W. K. (1988). Grieving a personal loss: A preliminary investigation of Parse’s man-living-health meth-
odology. Unpublished master’s thesis, Hunter College. The City University of New York. NY. de Chardin, P. T. (1959). The phenomenon of man (p. 53). New York: Harper. Dossey, L. (1982). Space, time, and medicine. Boulder, CO: Shambhala. Dubos, R. (1979). Medicine evolving. In D. S. Sobel (Ed.). Ways of health (pp. 42-43). New York: Harcourt Brace Jovanovich. Ferguson, M. (1980). The Aquarian conspiracy: Personal and social transformation in the 1980s. Los Angeles: J. P. Tarcher. Ferkiss. V. C. (1969). Technological man. New York: Braziller. Freud, S. (1930). Civilization and its discontents. London : Hogarth. Friedman. M. (1974). The hidden human image. New York: Delacorte. Fromm, E. (1968). The revolution of hope. New York: Bantam. Heidegger, M. (1962). Being and time. New York: Harper & Row. King, S. (1981). Imagineering for health. Wheaton, IL: The Theosophical Publishing House. LeShan, L. (1982). The mechanic and the gardener. New York: Holt, Rinehart, & Winston. Liehr, P. (1988, December). A study of the experience of "living on the edge." Research study presented at the Southern Council on Collegiate Education for Nursing, Atlanta, GA. Lovejoy. A. O. (1961). Reflections on human nature. Baltimore : Johns Hopkins Press. Marcel, G. (1978). Mystery of being: Reflection and mystery (Vol. 1 ). South Bend, IN: Gateway Editions. Marcuse, H. (1964). One-dimensional man. Boston: Beacon.
Matson, F. W. ( 1964). The broken image. New York: Braziller. R. (1967). Man’s search for himself. New York: Norton. Merleau-Ponty, M. (1963). The structure of behavior. Boston: Beacon. Mitchell, G. J. (1990). The lived experience of taking life day-by-day in later life: Research guided by Parse’s emergent method. Nursing Science Quarterly 3, 29-
May,
36. Morris, D. Hill.
(1968).
The naked ape. New York: McGraw-
Newman, M. A. (1986). Health
as expanding consciousMosby (2). 32-50. Orage, A. R. (1987). On love. Parabola, 12 Parse, R. R. (1981). Man-living-health. A theory of nursing. New York: Wiley. Parse, R. R. (1987a). Nursing science: Major paradigms. theories, and critiques. Philadelphia: Saunders. Parse, R. R. (1987b). The lived experience of laughing in persons over 65. Research study presented at the Coun-
ness.
St. Louis:
cil of Nurse Reseachers. International Conference, Arlington, VA. Parse, R. R. (1990). Parse’s research methodology with an illustration of the lived experience of hope. Nursing Science Quarterly. 3, 9-17. Parse, R. R. (in process). The lived experience of laughter and health. Research study funded by the Research Foundation of CUNY. Parse. R. R., Coyne, A. B., & Smith, M. J. (1985). Nursing research: Qualitative methods. Bowie, MD: Brady. Santopinto, M. (1989. May). Caring about self. Research study presented at the International Sigma Theta Tau Research Congress, Taiwan. Sartre, J.P. (1966). Being and nothingness. New York: Washington Square Press. Skinner, B. F. (1953). Science and human behavior. New York: Macmillan. Smith, M. C. (1990). Struggling through a difficult time for unemployed persons. Nursing Science Quarterly 3, 1828. van Kaam. A. (May 1974). Existential crisis and human development. Humanitas, 10, 109-110.
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Downloaded from nsq.sagepub.com at NORTH CAROLINA STATE UNIV on March 16, 2015
