Integrated awareness: a commentary fifteen years later.
Subject: Nursing (Management)
Nursing (Forecasts and trends)
Nursing students (Services)
Author: Sharts-Hopko, Nancy
Pub Date: 07/01/2008
Publication: Name: Visions: The Journal of Rogerian Nursing Science Publisher: Society of Rogerian Scholars Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2008 Society of Rogerian Scholars ISSN: 1072-4532
Issue: Date: July, 2008 Source Volume: 15 Source Issue: 2
Topic: Event Code: 200 Management dynamics; 010 Forecasts, trends, outlooks; 360 Services information Computer Subject: Company business management; Market trend/market analysis
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 198291197
Full Text: It was a thrill to be invited to provide a commentary on Phillips and Bramlett's article, "Integrated Awareness: A Key to the Pattern of Mutual Process," which first appeared in Volume 2 of Visions. First, a disclaimer: I have never conducted research within the framework of the Science of Unitary Human Beings and I am not steeped in recent Rogerian research. But having studied with Dr. Rogers in the 1970s I have been profoundly, and I believe positively, influenced by

I that experience ever since. Moreover I am directly involved in various complementary and alternative modalities of healing and I can speak to exciting broad developments in at least Americans' world view that bear on the discipline of nursing from 1994, when they wrote the article, to now.

The postmodern shift continues. It was still the case when I was a graduate student in the 1970s and early 1980s that we spoke in terms of grand theories that could explain a whole discipline or even the totality of knowledge. It was the trend for nursing scholars to debate which conceptual framework should define the discipline of nursing, and Fawcett (1984) soon thereafter argued for what she termed the metaparadigm of nursing, the formalization as nursing's central disciplinary concepts person, health, nursing and environment. During my years in graduate school debates raged as to whether research "should" be inductive or deductive; whether or not knowledge could legitimately be borrowed from one discipline by another; and whether or not qualitative research methods were acceptable. Then, in the 1990s, these issues seemed to melt away. While it was true that the discipline was maturing, there had to be more going on. What happened?

One explanation that I share with my own graduate students is that the health professions were finally forced to acknowledge, if not embrace, the postmodern shift in world view that was first identified in the arts and humanities. Modernity, an era whose beginning can loosely be marked by the invention of the printing press, was characterized by such hallmarks as confidence in large bureaucratic structures, the embrace of capitalism as an economic system that would alleviate suffering on a large scale, the belief that democracy is a system that all nations should embrace, the industrialization of production as well as human services, the primacy of science and rationality, and the quest for a unified theory of knowledge.

The middle and later portion of the twentieth century brought major challenges to those broad-based assumptions of western culture. Examples are numerous, but some prominent ones include the Nazi holocaust that demonstrated that science and engineering are not value-free. The development of socially progressive governments in Western Europe that provided high standards of living to their populations led to questioning of other economic and political systems. The sun set on the British Empire as former colonies of long-standing became independent states. The Viet Nam war generated harsh criticism of the United States and the idea that American-style democracy could be exported. The Watergate scandal led Americans to question the benevolence of our government. The Civil Rights movement made people aware that there are numerous other perspectives on historic events than those of the dominant demographic in a given population. The critique of received wisdom and appreciation of relativism were ascendant.

What happened in the discipline of nursing with these changes? At least in the United States, value on the lived experiences of disparate segments of the population and non-western cultures particularly with regard to their health practices has grown over the past twenty years. Recognition of the failures of the United States' health system has occurred concurrently with growth in attention given to other ways of describing phenomena central to our discipline, including for example traditional Asian perspectives on health and illness. Nursing scholars have focused increasingly on examining other ways to promote healing and health, including health care delivery systems of other countries as well as complementary and alternative modalities of healing. The appreciation of relativism has grown concurrently with recognition that research designs that attended to individuals' stories have validity, and so nursing has seen tremendous growth in the use of qualitative research designs to describe previously ignored human experiences over the past twenty years.

Consciousness. What Phillips and Bramlett define as integrated awareness, many other sciences refer to as consciousness. In 2007 Princeton University announced the closing of its Princeton Engineering Anomalies Research (PEAR) program, which functioned for three decades under the aegis of the School of Engineering and Applied Science. With funding from the Department of Defense over the years of its existence, the PEAR program engaged in research on the interaction of human consciousness with physical devices, systems and processes. Still in business, the laboratory is now incorporated as a separate non-profit institution. Physicists have been attracted to explore issues of consciousness as characteristic of subatomic structures, the energy of consciousness, and the power of intention (Walker, 2000).

Synchronously with the ascendance of the postmodern paradigm in science, nursing and other health professions have paid increasing attention to the value of intentionality in health and illness. In the 1990s academic medical centers, for example Memorial Sloan-Kettering Cancer Center and the Harvard University School of Medicine provided leadership in adding departments of integrative medicine or mind-body medicine. At Harvard, Herbert Benson came into his work in mind-body medicine over the past thirty years from a background in cardiology with an interest in hypertension. Since that time contemplative healing modalities including prayer, energetic modes of healing, yoga and other breath and body work have grown in interest in health care practice and across various scientific disciplines.

Holism. It is interesting to reflect on how in the 1960s and 1970s the various conceptual frameworks in the discipline of nursing that competed for champions had in common a focus on the human being as an integrated and open system, interacting with other open systems within yet larger open systems. I recognize that the language is three-dimensional; but it is exactly my point that the major nursing theorists at the time besides Martha Rogers were aware of and trying to describe this essential fact. In recent years I have asked graduate students to consider what might have given rise to this interest at the time. One possible explanatory relationship is the coincidence of nurse theorists' awareness that human beings are open systems within larger open systems with the emergence of the field of cybernetics, an interdisciplinary field that emerged in the 1940s from, among other fields, engineering, logic, psychology, neuroscience, anthropology, and which is closely related to game theory and system theory. We know this field now as the study artificial intelligence. The late American quantum physicist David Bohm, whose career spanned The University of California at Berkeley, Princeton's Institute of Advanced Studies, and finally, Birkbeck College at the University of London, made an enormous contribution to wider understanding of the fundamental need to consider entities in their entirety; the concept that time and space do not really separate events or entities; and the realization that reality and thought are not distinctly separate.

These three issues, the postmodern shift, consciousness, and holism, are themselves integrally related. A postmodern paradigm recognizes that reality is perspectival; each person's reality is a valid experience and ultimate truth must take all perspectives into account. Perspective presumes consciousness and is a holistic manifestation. My proposal that these concepts have gained wide acceptance at least in America is substantiated by the popularity of two recent films that I strongly recommend to readers who may not have seen them: "What the Bleep do We Know," released in 2004, and "The Peaceful Warrior," released in 2006. "What the Bleep Do We Know" is the exploration of the intersection of quantum physics, neurology, molecular biology, spirituality and metaphysics through a fanciful story, while "The Peaceful Warrior," released in 2006, is the true story of Olympic-bound gymnast Dan Millman's recovery from a paralyzing injury after a stranger whom he meets working the night shift as a gas station attendant teaches him how to tap into his intentionality and energy.

As I admitted in the beginning, I am not a Rogerian scholar. But as a former student of Rogers, I believe that both of these films convey far better than any of us could have dreamed in 1994 how the concept of integrated awareness can manifest in our lives. I find the distance we have come from 1994 to now in our understanding of this and other related concepts and in public awareness of these ideas to be no less than thrilling. We do live in a world of infinite possibilities and we do have the power to contribute to creating our realities. Barbara Brinkley Phillips and Martha Hains Bramlett must be pleased.


Bohm, D. (1980). Wholeness and the implicate order. London: Routledge.

Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Journal of Nursing Scholarship, 16(3), 77-87.

The Peaceful Warrior Way. Accessed November 21, 2008 at

Walker, E.H. (2000). The quantum mind and the meaning of life. New York: HarperCollins Publishers.

What the Bleep Do We Know. Accessed November 21, 2008 at

Nancy Sharts-Hopko, RN, PhD, FAAN Professor and Director of Doctoral Program in Nursing Villanova University
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