Theory of Human Becoming in nursing ecology: applying Meleis´s evaluation method

Abstracts

Objetivou-se realizar uma reflexão acerca da Teoria de Tornar-se Humano de Rosemarie Rizzo Parse, bem como, desenhar uma estrutura teórica aplicada ao processo de cuidar no âmbito da enfermagem ecológica. Trata-se de uma reflexão crítico-interpretativa, que utilizou o método de avaliação proposto por Meleis, restringindo-se à etapa de descrição, que considera a identificação de componentes estruturais e funcionais. Essa estratégia permitiu subsidiar a reflexão interpretativa da Teoria de Tornar-se Humano no contexto da enfermagem ecológica. Assim, foi possível dirigir a atenção aos significados de saúde e a qualidade de vida do indivíduo, para a priorização de valores e cuidados na área de enfermagem ecológica.

Teoria de enfermagem; Enfermagem do trabalho; Saúde ambiental; Enfermagem

REFLECTION

Theory of Human Becoming in nursing ecology: applying Meleis' evaluation method

Teoría de los Derechos Humanos convertirse en ecología de enfermería: aplicación del método de evaluación de Meleis

Glauce Araújo Ideião Lins^I; Marinez Kellermann Armendaris^II; Diana Lúcia Moura Pinho^III; Ivone Kamada^IV; Cristine Alves Costa de Jesus^V; Paula Elaine Diniz dos Reis^VI

^IM.Sc. in Nursing. Environmental Surveillance Manager of Non-Biological Factors. Board of Environmental Surveillance in Health. Federal District State Health Secretary. Distrito Federal, Brazil. E-mail: [e-mail]

^IIM.Sc. in Nursing. Nursing Supervisor, Outpatient/Imaging Unit, Instituto de Cardiologia do Distrito Federal. Distrito Federal, Brazil. E-mail: [e-mail]

^IIIPh.D. in Psychology. Adjunct Professor, Universidade de Brasília (UnB). Distrito Federal, Brazil. E-mail: [e-mail]

^IVPh.D. in Fundamental Nursing. Adjunct Professor, UnB. Distrito Federal, Brazil. E-mail: [e-mail]

^VPh.D. in Nursing. Adjunct Professor, UnB. Distrito Federal, Brazil. E-mail: [e-mail]

^VIPh.D. in Fundamental Nursing. Adjunct Professor, UnB. Distrito Federal, Brazil. E-mail: [e-mail]

Correspondence

ABSTRACT

The objective was to conduct a reflection on the Theory of Human Becoming Rosemarie Rizzo Parse, as well as designing a theoretical framework applied to the process of caring in nursing ecological. It is a research and interpretative critical reflection, which used the evaluation method proposed by Meleis, restricted to the stage of description, which considers the identification of structural and functional components. This strategy allowed us to subsidize the reflection of the interpretive theory of Becoming Human Ecology in the context of nursing. Thus, it was possible to direct attention to the meanings of health and quality of life of the individual, the prioritization of values and nursing care in the area of ecology.

Descriptors: Nursing theory. Occupational health nursing. Environmental health. Nursing.

RESUMEN

El objetivo fue llevar a cabo una reflexión sobre la Teoría de Convertirse Humano de Rosemarie Rizzo Parse, así como el diseño de un marco teórico aplicado al proceso de cuidar en enfermería ecológica. Es una reflexión crítica interpretativa, en que se utilizó el método de evaluación propuesto por Meleis, limitada a la etapa de descripción, que considera la identificación de los componentes estructurales y funcionales. Esta estrategia nos ha permitido subsidiar el reflejo de la teoría interpretativa de convertirse Humano en el contexto de la enfermería ecológica. Por lo tanto, ha sido posible dirigir la atención a los significados de la salud y la calidad de vida de la persona, para la priorización de los valores y los cuidados de enfermería en el área de ecología.

Descriptores: Teoría de enfermería. Enfermería del trabajo. Salud ambiental. Enfermería.

INTRODUCTION

Care actions should be linked with the reality people experience, as a fundamental tool to outline health interventions. These should picture the different manifestations of risk, including the environmental risks deriving from the destruction of ecosystems, the increasing contamination of the atmosphere, soil and water, as well as global warming, resulting from human activities in the environment, besides occupational risks, mainly due to the harmful conditions present in the work environment, which affect the health of workers, their relatives and populations living in the production units' area of influence.

Considering the environment as directly related with the health-disease process, health workers, including nursing professionals, should integrate this dimension into their practices, assuming the possibility of developing and consolidating actions within a socio-environmental focus, with a view to adapting different health actions based on comprehensive strategies to improve people's quality of life and the sustainability of natural and social biota.¹

This gives rise to a new care attitude, called ecological care, which drives actions in defense of the environment, at home, at the workplace and everywhere, permeating the relations, interactions and associations among human beings and other beings in nature.² Thus, understanding human beings in their different relational environments in the focus of nursing actions and knowledge, demanding further attention to environmental issues as components of their knowledge.¹

In that sense, theoretical models have contributed when they are used as a reference framework to structure care, adapted to the needs/particularities of patients and social and environmental contexts. Nursing theories are foundations elaborated based on a broad and complex view of reality, considered as fundamental epistemological contributions to the construction of knowledge and professional practice, supporting the development of the triad nursing theory, research and practice.³

Allied with human health experiences, the theories attempt to explicitly formulate the complexity and multiple nature of the phenomena present in health and nursing, with a view to describing, explaining, foreseeing or prescribing nursing care.^3-4

With a view to the evolution and enhancement of theoretical-scientific knowledge in nursing, its professionals should develop philosophical and methodological reflections about existing theoretical proposals, as a profession that does not acknowledge the importance of its own currents of thought ends up detaching the knowledge on how to do from that on how to think, thus compromising the development of its science.⁴ Thus, nursing theories support professional practice and permit expressing the proposals, contexts, variables, theoretical explanations, empirical evidence and the use of new approaches in practice, which determine the nature of the phenomena's descriptive elements.⁵

Hence, the definition of a nursing method based on a theoretical framework is a process that involves thinking, doing and feeling, turning the implementation of care into a grounded, complex and continuous process. This study is justified by the relevance of discussing nursing ecology based on Parse's Theory, which proposes an innovative theoretical structure to approach human beings and the environment, emphasizing nursing activities within the perspective of health promotion and quality of life.

Departing from Heidegger's perspective, which addresses care based on the ontological determinations of the human condition, assuming its existence and limitations,⁶ one may ask: can the Theory of Human Becoming be assessed, taking into account the complexity and abstraction of the proposed care forms? How can its theoretical-philosophical contents be applied in occupational and environmental health nursing? Therefore, the following objectives were set: to reflect on Rosemarie Rizzo Parse's Theory of Human Becoming, as well as to design a theoretical structure applied to the care process in the context of nursing ecology.

METHOD

As the assessment of nursing theories represents an essential component with a view to the testability, applicability and refinement of different care areas, this study permitted a critical-interpretative reflection, based on Meleis' evaluation method.⁷ This assessment method can be used as a whole or partially and consists of five segments, which are: description, analysis, criticism, test and theoretical support.⁸

For the sake of this study, the descriptive phase was chosen, as it was developed as part of a graduate subject in nursing, considering the identification of structural (premises, concepts and proposals) and functional components (includes elements focused on in the theory and how it addresses the patient nursing, health environment, nurse-client interactions, nursing problems and nursing therapeutics).^7-8

Although the Theory of Human Becoming cannot be submitted to experiments, as it is neither predictive, nor based on a cause-effect perspective, it can actually be tested, as it identifies phenomena experienced based on the interrelations among man, universe and health.^5,9

This strategy granted support for an interpretative reflection on the Theory of Human Becoming in the context of nursing ecology, through a deductive logical correlation between Parse's concepts, principles and theoretical structure and the premises of occupational and environmental health, culminating in the elaboration of a distinct theoretical structure and applied to this nursing area.

DISCUSSION

Description of the Theory of Human Becoming

Next, the theoretician's history and perspectives on care are highlighted, which significantly influenced the construction process of a nursing theory.

Rosemarie Rizzo Parse is one of the most recent nursing theoreticians. In 1981, she published the book Nursing Fundamentals, in which she presented her ideas, proposing the nursing subject based on human sciences.⁵ She obtained an M.Sc. and Ph.D. from the University of Pittsburgh and is currently serving as a lecturer at Loyola University in Chicago; she is the founder and editor of Nursing Science Quarterly and the president of Discovery International and the Institute of Human Becoming. Also, she has authored eight books and different papers.¹⁰

Parse inserted two paradigms into the discussion of nursing theories, the totality paradigm, in which man is the sum of system and considered as a bio-psycho-social-spiritual being, who interacts with the environment through internal and external stimuli. The second is the simultaneity paradigm, in which man is a "unitary being in a mutual inter-relationship with the environment, and health is the negentropic development",^9:267 considered as a reactive process to obtain energy reserves in order to stop the entropic process.^8-9,11

The Theory of Human Becoming, formerly called the Theory of Man-Living-Health, is classified among the main theories of the unitary process, as its theoretical framework is complex and described at a philosophical and highly abstract level.⁸ It was constructed based on the principles and concepts of Martha E. Rogers and borrowed its three main principles of integrality, resonancy and helicy from this model, as well as its four main concepts energy field, openness, pattern and pandimensionality.^9-11 The theoretician also received influence from the existential-phenomenological ideas of Heidegger, Sartre and Merleau-Ponty, synthetizing the principles of intentionality, human subjectivity, co-constitution, coexistence and freedom to choose. In view of the inter-relation among these concepts, Parse defined the human being as a vital unit, within the simultaneity paradigm.⁹ The research method is characterized as a hermeneutical-phenomenological method, which directly emerges from the ontology and epistemology of the Theory of Human Becoming, which comprise the following processes: dialectical engagement, extraction of synthesis of becoming human and heuristic interpretation, based on structural transposition, emergence of phrases in poetic language and artistic expressions of the human meaning attributed to experiences.¹²

According to the theory assessment method,⁵ the descriptive phase of the theory comprises structural and functional components.

The theoretician believes that the human being, the environment and health are closely linked, making it difficult to characterize their premises individually.⁵ Initially, nine premises were presented, which were revised in 1995 and summarized in three main premises, described as follows: 1) Becoming human means freely choosing the personal meaning of the situation in the intersubjective process of the experience of value priorities; 2) Becoming human means co-creating rhythmic patterns of relationship in the mutual process with the universe; and 3) Becoming human means co-transcending with possible emerging patterns in multidimensional terms.

Her premises originated in philosophical sources and Rogers' concepts but, in that context, Parse sees men as multidimensional beings, as opposed to Rogers' idea of four dimensions. Her interpretation is reached at a complex philosophical level.⁹ In the first premise, becoming human is considered as a subject-subject and subject-universe exchange, in which the meanings attributed to experiences reflect their personal values. Concerning the second premises, becoming human is considered as an open exchange in combination with the universe, that is, one participates in the creation of the other. In the third premise, the human being is capable of moving beyond the self at all levels of the universe.^9,11

Departing from the theme that emerges from the three main premises and their inter-relations based on the concept of meaning, rhythmicity and co-transcendence, the theoretician takes us to three fundamental principles that inter-relate three concepts each and are described as follows.^5,9,12

1^st Principle: structure the meaning, in multidimensional terms, means cooperating in the creation of reality through the expression of values and images. This principle inter-relates three concepts: image, valuation and language, and establishes that the human being finds meaning for the situation that is happening based on experiences. According to this principle, co-creation refers to the mutual participation man-environment. Language reflects the images values through signs and movements, which take place at multidimensional levels. Image refers to knowledge, which includes both explicit and tactic knowledge.

In this sense, clarifying the meaning is identified as the practical dimension of nursing care, in which the nurses guide individuals and families to relate the meanings of a situation and make them more explicit, based on each person's experiences.⁹

2^nd Principle: cooperate in the creation of rhythmic patterns of relationships means living the paradoxical unit of revealing/concealing, enabling/limiting and, at the same time, joining/separating. The importance of rhythmicity is observed, in which rhythmic patterns of man's relation with the universe are experienced through paradoxes that are not opposed, but will determine choices across the lifetime, experienced in multiple dimensions and simultaneously. The principle explains that, by experiencing the paradoxes, the person reveals a bit of him/herself and, at the same time, hides other parts, that is, the human being gradually reveals him/herself in the transformation process.

For the practical dimension of nursing care, the synchrony of rhythms is identified, in which the nurse, through bonds with the individual/family/community, attempts to harmonize the subjects' relation with the universe, in each context, thus facilitating the understanding of the meanings.⁹

3^rd Principle: co-transcending the possibilities means seems unique ways to start the transformation process. It inter-relates the concepts of strengthening, originating and transforming. The change that takes place in the reality experienced and its possibilities is the transformation process, culminating in the creation/origin of new patterns and personal values.

In this principle, the importance of nursing care is underlined, in the sense of mobilizing the transcendence, driving the individual to move beyond. The nurse helps the person in the process of planning changes in the health patterns that are experienced.⁹

The concepts are the most important components of the theory, as they define an idea or complex mental image of a phenomenon.⁵ This theory proposes, within a simultaneity perspective, a new nursing paradigm that is focused on the human being. This fact can be better understood based on the description of the four meta-paradigms of nursing science:

- the concept of human being/universe is considered as an open being, in a mutual process with the universe, co-creating relationship patterns with the others; it is an active and reflexive being of dialogue, capable of learning, relearning and teaching, and of freely choosing health patterns; it is a unique being, bringing beliefs, values, culture, a way of seeing and living in the world, as part of a collective environment and capable of transforming itself.^9,11

- the concept of environment is inseparable from and complementary to the human being, which together create life experiences reciprocally and mutually exchange energy to create what exists in the world.⁸

- health is defined as a process of becoming a person in the individual's experience, co-constituted to the extent that (s)he interacts in the universe and gains experience, thus reflecting the paradoxical nature of the person's relations in the world as part of a rhythmic process.^8,9

- nursing is understood as science and art, creative and humanistic and responsible for orienting individuals, families and communities in making choices among different possibilities in the multidimensional process of the human being-universe.⁹

The consequences of the Theory of Human Becoming are declared subjectively, as its principles describe a complex and realistic picture of human becoming, and the image corresponds to a significant structure to understand the inter-relation among man, the universe and health, resulting in the promotion of health and quality of life, based on the person's perspective.^5,9

Describing the purpose of the theory is important, in the attempt to explain why the theory was formulates and specifies the context and situations in which it is to be applied.⁸ The theory of Human Becoming is explanatory, as it mutually relates the concepts and describes and specifies their inter-relations. The theory originated in Parse's experiences in nursing practice, although its foundations started in childhood, through the values she received from her parents regarding respect for human beings.¹⁰

The theory, addressed in this theoretical reflection, is mainly focused on the human being, according to a phenomenological attitude, to the extent that nurses get closer to the patients, showing interest in the meaning of their experiences, moving together with them, without labeling or indicating a solution for the situation, thus respecting individual co-participation in the creation of the experience of living and understanding cure as a gradual process of human becoming.^9,13

The Theory of Human Becoming is applied in crisis and/or change situations individuals/families and communities go through. Countless researchers have validated it, developing perspectives on the human science of nursing.⁸ Thus, the application of the theory in research has been demonstrated through its comprehensive use by the nursing community in practice, research and teaching.⁵

Through the use of Parse's Theory, nurses, as agents of change to improve the quality of life based on individual perspectives, attempt to understand the nursing problems in the process of being with the person instead of doing by the person, turning these professionals into facilitators in the implementation process of the practical dimensions.

Its theoretical structure rests on three practical dimensions: strengthening (to reveal and conceal the image), originating (as a manifestation of value limitations) and transforming (unfolds into connection and separation).⁵

Concerning the therapeutics, it is relevant to understand the meaning of the nursing process the theoretician proposes, which is clearly described as a problem-solving method that is not exclusive to nursing, understanding people as co-authors of their health condition. An innovative, creative, solidary and distinguished care method is proposed, permitting discoveries and a better understanding of people's meanings and needs, as care is individualized.¹¹

Used as an appropriate guide for professionals who want to create respectful partnerships with people seeking healthcare, nursing practice involves all individuals and families, ignoring social designations of the health-disease condition and thus attempting to modify health patterns.^5,9

Applicability in nursing ecology

Parse's theoretical structure addresses three principles that are inter-related with nine concepts of human becoming: transmission through language, valuation, formation of images, revelation/dissimulation, permission, limitation, connection-separation, energizing, originating and transforming,⁵ as described in figure 1.

The theoretical structure, described above, does not refer to a model, in view of its concepts, principles and inter-relations are defined at a highly abstract level, which can further, in the research context, the creation of structures that demonstrate the relations between the theoretical constructs to understand the specific phenomena in a given context.⁵ In that perspective, this theoretical reflection permitted the design of a theoretical structure and its interrelations between the concepts and principles applied to nursing ecology.

With a view to protecting and promoting human health and collaborating to protect the environment, through integrated actions aimed at coping with socio-environmental determinants and preventing problems deriving from human exposure to adverse environments, so as to contribute to improve the population's quality of life in a sustainability framework, the World Health Organization defines environmental health, as presented in the "Sofia Declaration", as all aspects of human health, including quality of life, determined by physical, chemical, biological, social and psychological factors in the environment, besides referring to the theory and practice of valuing, correcting, controlling and avoiding environmental factors that can harm the health of current and future generations.¹⁴ The occupational health concept, on the other hand, has been described in the Organic Health Law as a set of actions aimed at occupational health promotion and protection, as well as at the recovery and rehabilitation of workers submitted to risks and problems deriving from work conditions.¹⁵

In that sense, health promotion tightens its relation with the theory of Human Becoming, to the extent that it represents a singular manner to face health and provide insights about how individuals create and choose to live freely, among paradoxical ways of being.⁸

Therefore, based on the theoretical structure of Human Becoming, its concepts and theoretical principles could be related with the definitions proposed by environmental and occupational health, describing the specific phenomena in this area, according to figure 2.

Departing from the first principle, it is considered that the co-creation of health patterns through the expression of reality, representativeness and perception of environmental and occupational risks give rise to the multidimensional structure of meaning. As regards the second principle, co-creating the rhythmic nature of relationships paradoxically means acknowledging/not-acknowledging and giving opportunities or not, as the nurse's interaction with the client, with a view to the construction of ecological care based on an innovative nursing process that enhances individuals' quality of life. Finally, what the third principle is concerned, co-transcendence is driven by the motivation to establish quality of life deriving from a mobilization process, to the extent that it stimulates and facilitates the change in life habits and standards adopted in the individual sphere of the human being-environment.

Consequently, environmental and occupational nursing practice converge in their focus on the promotion of quality of life, which covers many meanings based on objectivity, subjectivity and multidimensionality, varying according to each human being's worldview.

CONCLUSION

Based on the adopted method, the concepts and principles of the theory could be correlated in a logical theoretical structure, with a view to focusing on the meanings of individual health and quality of life, so as to prioritize nursing ecology values and care. Although the theoretical structure outlined, in this study, was described at a theoretical and abstract level, it can serve as a reference framework for application in other qualitative studies, using the hermeneutic method to validate the applicability of occupational and environmental nursing actions.

In that context, Parse's Theory represents a significant structure to understand the inter-relationship human-universe-health, to the extent that it accelerates the transformation process of the mechanical approach to health care towards a new individual care model.

It should be highlighted that, in the development of Parse's Theory, Carper's four knowledge patterns (empirical, esthetic, ethical and personal knowledge) are articulated, particularly the esthetic pattern, which reveals the interaction that reflects the nature of care. Thus, emphasizing human beings and their experiences, humanistic nursing attempts to facilitate the change process in individuals' unitary health perception.

Therefore, this study has contributed to drive a reflexive and interpretative process, based on the theoretical structure, structural and functional components proposed in Rosemarie Rizzo Parse's Theory of Human Becoming and its relation with nursing ecology, departing from the three classes that are focused on in care: the first emphasizes the environment, the second the interaction process between nurse and individual, and the third related to health promotion and quality of life; all three are based, respectively, on the three principles of the Theory of Human Becoming, and on the ultimate goals of environmental and occupational health.

REFERENCES

• 1. Cezar-Vaz MR, Soares MCF, Martins SR, Sena J, Santos LR, Rubira LT, et al. Saber ambiental: instrumento interdisciplinar para a produção de saúde. Texto Contexto Enferm. 2005 Jul-Set; 14(3):391-7.
• 2. Backes MTS, Erdmann AL, Backes DS. Cuidado ecológico: o significado para os profissionais de um hospital geral. Acta Paul Enferm. 2009; 22(2): 83-91.
• 3. Shaurich D, Crossetti MGO. Produção do conhecimento sobre teorias de enfermagem: análise de periódicos da área, 1998-2007. Esc Anna Nery Rev Enferm. 2010 Jan-Mar; 14(1):182-8.
• 4. Rosa LM, Sebold LF, Arzuaga MA, Santos VEP, Randuz V. Referenciais de enfermagem e produção do conhecimento científico. Rev Enferm UERJ. 2010 Jan-Mar; 18(1):120-5.
• 5. Tomey AM, Alligood MR. Teóricas de enfermagem e a sua obra: modelos e teorias de enfermagem. 5ª ed. Loures (PT): Lusociências; 2004.
• 6. Silva IJ, Oliveira MFV, Silva SED, Palaro SHI, Radunz V, Santos EKA, et al. Cuidado, autocuidado e cuidado de si: uma compreensão paradigmática para o cuidado de enfermagem. Rev Esc Enferm. 2009 Set; 43(3):697-703.
• 7. Rodrigues DP, Pagliuca LMF, Silva RM. Modelo de Roy na enfermagem obstétrica: análise sob a óptica de Meleis. Rev Gaúcha Enferm. 2004 Ago; 25(2):165-75.
• 8. Mcewen M, Wills EM. Bases teóricas para enfermagem. 2ª ed. Porto Alegre (RS): Artmed; 2009.
• 9. Coelho RCHA. Cuidando da mulher gestante com HIV fundamentado na Teoria de Parse: um novo referencial para a prática da enfermagem [dissertação]. Florianópolis (SC): Universidade Federal de Santa Catarina, Programa de Pós-Graduação em Enfermagem; 2001.
• 10. Vicente FR, Campregher G. Gerência do cuidado de enfermagem nos programas de saúde na Unidade Local de Saúde da Trindade [monografia]. Florianópolis (SC): Universidade Federal de Santa Catarina, Departamento de Enfermagem; 2007.
• 11. George J. Teorias de enfermagem: os fundamentos à prática profissional. 4ª ed. Porto Alegre (RS): Artes Médicas Sul; 2000.
• 12. Naef R, Bourns D. The lived experience of waiting: a parse method study. Nurs Sci Q. 2009 Apr; 22(2):141-53.
• 13. Ketchum PH. Parse's Theory in practice: an interpretive analysis. J Holist Nurs. 2004 Mar; 22(1):57-72.
• 14. Ministério da Saúde (BR). Subsídios para construção da Política Nacional de Saúde Ambiental, Conselho Nacional de Saúde. Brasília (DF): MS; 2007.
• ¹⁵
  Brasil. Lei n. 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União, 19 Set 1990.

Publication Dates

• Publication in this collection
  06 Feb 2014
• Date of issue
  Dec 2013

History

• Received
  26 Aug 2011
• Accepted
  10 Oct 2013