Integrated awareness: a key to the pattern of mutual process.
Abstract: Nursing science has entered into a phase of transition and revolution. Never before has there been such a flux of creative ideas to challenge nurse scholars' scientific visions and to create a more diverse horizon in which to integrate those phenomena. There exists a need for continued exploration into more abstract and complex phenomena. Even though these phenomena may be less amenable to empirical validation, such quests are crucial to the further evolution of nursing science. Martha Rogers' Science of Unitary Human Beings has provided a rich landscape in which to elucidate those concepts.

The focus of this theoretical exploration is directed toward analysis and elucidation of the concept, integrated awareness, and its salience to Rogers' principles of homeodynamics. Integrated awareness is postulated to give a sense of unity, direction, and power to one's life and is further proposed to be a crucial aspect of mutual human field process. Integrated awareness is envisioned as a concept with direct relevance to the nature of human to human mutual process, a phenomenon of critical importance to well-being.

Integrated awareness involves the creation of a matrix in which one is cognizant of a greater awareness of self and environment, including living and nonliving entities as well as the potential for mutual process to occur. Integrated awareness implies an abstract sense of connection or mystical transcendence wherein human and environmental energy fields evolve. It may be perceived as a unifying schema of inner peace, serenity, well-being, and power.

Because of the nature of the complex human phenomena that nursing must address, a conceptual system specific to nursing's area of concern is necessary to discover and refine issues for research. This delineation of the concept, integrated awareness, through concept analysis provides a valuable foundation for theory development as well as further inquiry and research into this specific and complex human phenomenon.

Key Words integrated awareness, M.E.Rogers, Science of Unitary Human Beings, nursing theory, concept analysis
Subject: Awareness (Analysis)
Nurses (Services)
Nursing (Methods)
Nursing (Forecasts and trends)
Authors: Phillips, Barbara Brinkley
Bramlett, Martha Hains
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: 360 Services information; 010 Forecasts, trends, outlooks Computer Subject: Market trend/market analysis
Product: Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners SIC Code: 8049 Offices of health practitioners, not elsewhere classified
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 198291196
Full Text: The discipline of nursing, by virtue of its existential being, continues to evolve. This evolution is inherent to the nature of knowledge and the process of science in transition. A plethora of questions continue to arise regarding the focus and direction of the discipline of nursing. Is nursing an art or is it a science? Is nursing's knowledge unique to the phenomena of its concern or has all knowledge possessed by nursing been acquired from other scientific disciplines then molded, sculpted, synthesized, and adapted for use in the practice of nursing? If so, is nursing a scholarly and academic realm or only a practice realm? To be considered a scholarly and academic discipline as well as a practice discipline, nursing must have a unique body of knowledge based on theories of nursing (Rogers, 1970, 1986). Theories provide direction for a science, determining both the questions to be asked and the manner of query appropriate to answer the questions (Kuhn, 1970). Nursing, as a newly evolving science, has often experienced confusion about its theoretical base and therefore the direction and manner of scholarly inquiry. This quandary and lack of direction has spurred continued rhetorical discourse and debate among nurse scholars who continue in their quest to refine nursing's unifying focus and the direction of nursing research and practice.

Science does not exist without the theoretical underpinnings upon which to structure the evolution of knowledge. The construction of theory, which will bear relevance to nursing as a scholarly discipline and a science, is the ultimate desired out-come of acquiring knowledge specific to nursing phenomena. If theory is to become critical to the structure of the discipline of nursing, then concepts that are relevant to nursing phenomena must be identified, explored, and explicated.

Scientific theory development depends on identification of natural phenomena that are of particular concern to scholars in any discipline. Schlotfeldt (1987) stated:

As in many disciplines, nursing is experiencing a paradigmatic diversity in which theorists such as Martha Rogers are striving to free nursing from an old worldview that is heavily rooted in empiricism. Instead, Rogers proposed a new worldview that paves the way for exploration of more abstract and elusive concepts that may enhance the evolution of nursing as a unique science. The new worldview and the vision of the future will generate knowledge specific to nursing's metaparadigm. With this vision, old concepts will be redefined and new concepts will emerge.

Walker and Avant (1988) consider concepts as one of the three basic elements of theory building. A concept is an idea or abstraction that provides knowledge about the essence of a phenomenon (King, 1988). Concept analysis clarifies the association of feelings, values, mental processes, and attitudes that accompany the internalization of word labels associated with those phenomena and is considered a steppingstone in the process of theory construction (Chinn & Jacobs, 1987). Integrated awareness, an emerging concept within the framework of the Science of Unitary Human Beings, is herein presented. The conceptual fit of integrated awareness with the Rogerian theoretical framework as well as practice and research applications are discussed.

Overview of the Science of Unitary Human Beings

In developing a concept, congruence with the scientific framework is crucial. Rogers revolutionized the evolution of nursing as a science with the publication of An Introduction to the Theoretical Basis of Nursing in 1970. She synthesized her thoughts about the natural world with the hard sciences of physics and biology. This explosion of creativity combined with her knowledge of Eastern philosophy, psychology, and the paranormal realm, encouraged Rogers to abandon the Cartesian dualism which had so plagued the discipline of nursing and to shift the focus of nursing's concern to the phenomenon of unitary human beings. Rogers' Science of Unitary Human Beings, which provides the conceptual underpinnings for integrated awareness, is based on four concepts and three principles. Rogers (1970, 1986) identified unitary human beings and their environments as the central focus of her conceptual system. Human beings and their environment are regarded as irreducible wholes which cannot be understood if reduced to their particulate components. Rogers (1992) defined the unitary human being as "an irreducible pandimensional energy field identified by pattern and manifesting characteristics that are different from those of the parts and cannot be predicted from knowledge of the parts" (p. 7). The environment was defined as "an irreducible, pandimensional energy field identified by pattern and manifesting characteristics different from those of the parts" (p. 7). The human and environmental fields change continually, mutually, and creatively, and are infinite and integral with one another (Rogers, 1986). The definitions of unitary human beings and their environments incorporate the four concepts of the Science of Unitary Human Beings: (1) energy fields, (2) openness, (3) pattern, and (4) pandimensionality.

Rogers (1990) defined energy fields as the fundamental unit of the living and the nonliving. Field is a unifying concept, and energy signifies the dynamic nature of the field. Energy fields are infinite and exist without boundaries. In conceptualizing openness, Rogers (1990) postulated that the universe is one of open systems. Openness signifies continuous and innovative change where causality is not an option. Pattern was defined as an abstraction which gives identity to the field. Each human field pattern is unique and is integral with its own unique environmental field pattern. The nature of the pattern changes continuously (Rogers, 1986). Rogers (1992) defined pandimensionality as: "a nonlinear domain without spatial or temporal attributes" (p 7). Pandimensionality encompasses the human and environmental fields.

The four concepts provide a base for the three homeodynamic principles under-pinning the Science of Unitary Human Beings: (1) resonancy, (2) integrality, and (3) helicy. These mutually exclusive principles state explicitly and concisely Rogers' ideas about the human and environmental field patterns. According to Rogers (1986) the key concept in the three principles is pattern; all three principles describe the pattern of unitary human beings as they evolve. The principle of resonancy is described as "the continuous change from lower to higher frequency wave patterns in human and environmental fields" (Rogers, 1990, p.8). Resonancy delineates evolutionary change in energy field patterns, both human and environmental. The principle of integrality is described as "the continuous mutual human field and environmental field process" (Rogers, 1990, p.8). Finally, the principle of helicy is defined as "the continuous, innovative, unpredictable increasing diversity of human and environmental field patterns characterized by nonrepeating rhythmicities" (Rogers, 1990, p.8). Helicy describes the nature of change and evolution.

The Concept of Integrated Awareness

The term "integrated awareness" does not appear as a unit in dictionaries. However, the individual words, "integrated" and "awareness," can be analyzed and then synthesized into a unitary construct. The word "integrated" stems from the root word integrate, which is defined in The American Heritage Dictionary (1985) as:

1. to make into a whole by bringing all parts together; unify.

2. to join with something else; unite. (p.667)

A related term, which also stems from the root word, "integrate," and also bears relevance to the definition of integrated, is the word "integral." Integral is defined in The American Heritage Dictionary (1985) as:

1. essential or necessary for completeness; constituent.

2. possessing everything essential; en-tire.

3. a complete unit; whole. (p.667)

"Awareness" stems from the root word, "aware," which is defined in The American Heritage Dictionary (1985, p.145) as:

1 Having knowledge or cognizance 2.conscious; recognition of something sensed or felt. 3. knowing; either by perception or by means of information 4. cognizant; sure knowledge and the recognition of it.

Integrated awareness, as a unitary construct, is envisioned as a concept with direct relevance to the nature of human to human mutual process, a complex phenomenon of critical importance to well-being. Integrated awareness is postulated to give a sense of unity, direction, and power to one's life.

A recurring theme, which is implied but not always explicitly stated throughout the literature related to the Science of Unitary Human Beings, is mutual process and its intimate relationship with human and environmental energy fields. Rogers has stated that pattern is a unifying manifestation of mutual process within human and environmental energy fields. She has suggested that inquiry be made into how to further illuminate the pattern inherent in mutual process (Personal Communication with Martha Rogers, Region 7 meetings of the Society of Rogerian Scholars, July, 1992). It is postulated that integrated awareness is the key to the pattern of mutual process. Mutual process entails an awareness of the creative processing of authentic power. Authentic power is present when one perceives meaningfulness and purpose in the events that occur in one's life (Zukav, 1989).

Integrated awareness involves the creation of a matrix in which one is cognizant of a heightened transcendence of self and environment, including living and nonliving entities as well as the potential for mutual process to occur. This potential exists in all human beings, but may vary in the level of intensity and pattern manifestation. Integrated awareness represents a dynamic, non-linear domain which is always present. The perception of manifestations of integrated awareness facilitates one in attending or listening to those human and environmental wave patterns that are meaningful. The perception of the moment of integration (mutual process) may be manifest as (1) a harmonious wave where the fields meet in a pattern of synchronicity, (2) a chaotic wave when fields meet in patterns of dissonance, or (3) where field wave patterns counterbalance to form a dampened wave form. Harmonious integrated awareness involves field patterns in which waves build on and complement each other and are increasingly high frequency and high amplitude (see figure 1). Integrated awareness may also exhibit a dissonance when energy fields meet in an asynchronous, chaotic or erratic pattern. This may be manifest as disharmony or field disconnection (see figure 2). Low intensity Integrated awareness can occur when counterbalancing field patterns meet and dampen each other (see figure 3). Low intensity integrated awareness does not negate that mutual process is occurring, but rather places the experience in a less recognizable con-text. While these vignettes of integrated awareness present three possible patterns, infinite pandimensional variations of these are possible.

[FIGURE 1 OMITTED]

[FIGURE 2 OMITTED]

[FIGURE 3 OMITTED]

Review of Related Literature

Science of Unitary Human Beings

Many of the concepts which are interspersed throughout the literature related to Rogers' Science of Unitary Human Beings express a commonality or relatedness to the concept of integrated awareness. These exemplars of Rogers' Science of Unitary Human Beings will be explored and their salience to integrated awareness will be elucidated.

Motion of energy fields. Ference (1986), investigating motion of the human field, postulated that the relationship of time experience, creativity, and differentiation were manifestations of human synergistic development and would be correlates of human field motion. She developed an instrument to measure human field motion in order to examine and support the principle of resonancy. The Human Field Motion Tool (HFMT) was specifically developed to measure motion as an index of human synergistic development and was the first tool re-ported in the literature that was solely developed as a measure in the Science of Unitary Human Beings. Findings from this study demonstrated a positive correlation between human synergistic development and human field motion.

Gueldner (1986) utilized the Human Field Motion Tool to study the relationship between imposed motion (rocking) and human field motion in elderly individuals living in nursing homes. She hypothesized that there would be a positive relationship between imposed motion and human field motion. She also hypothesized that there would be a positive relationship between perceived human field motion and the state of restedness in these individuals. Gueldner found no significant difference between those individuals who rocked versus those who did not rock; however, those individuals with higher human field motion scores re-ported feeling more rested. Testing difficulties in this population with Ference's Human Field Motion Tool prompted Gueldner (1993) to develop an alternative measure of motion of energy fields, the Index of Field Energy (1FE), that utilizes a pictorial semantic differential format. Thus visual metaphors are utilized to measure energy and motion of both human and environmental fields (Gueldner, 1993). Ference's HFMT as well as Gueldner's IFE, which attempts to measure energy characteristics of human and environmental fields, may well measure a phenomenon closely related to integrated awareness.

Both Gueldner and Ference studied a manifestation of pattern of the individual. Neither, however, addressed the manner in which patterns blend during mutual process between individuals, or between individuals and their larger environments. As the pattern of motion of an energy field changes, fluctuating in frequency and intensity, it is reasonable to hypothesize that the pattern of integrated awareness will also vary. Further investigation of the relationship between these patterns may prove quite fruitful.

Power. Barrett's (1983/84, 1986) concept of power as the ability to knowingly participate in change presents an-other related concept. Conceptualizing power within the Science of Unitary Human Beings, she studied the relationship of human field motion and power. Attributes of power include awareness, choices, freedom to act intentionally, and involvement in creating changes. According to Barrett (1983/84), "awareness and freedom to act intentionally may be the knowing which guides participation in choices and involvement in creating changes in one's own field and one's environmental field" (p. 27). Barrett utilized her concept of power to develop The Power-As-Knowing-Participation-in-Change Test (PKPCT). In her investigation of the relationship of human field motion and power, she found a significant correlation between the variables and concluded that the ability to participate knowingly in change increases as human field motion evolves.

Bramlett (1990/1991, 1993) investigated the pattern of change in power in older adults after participating in reminiscence activity. She found significant increases in power over the study period in both control and experimental groups. While reminiscence was not confirmed as a therapeutic modality, Bramlett concluded that power was a dynamic phenomenon, capable of exhibiting changing patterns.

Both power and integrated awareness incorporate the idea of awareness. Furthermore, both are dynamic and constantly changing as individuals evolve. Power is concerned with the pattern manifestations of individuals or groups. While pat-terns of power are integral with unitary human field and demonstrate an evolving synchrony with these fields, power is a manifestation of the field and only indirectly reflects the ongoing mutual process of the individual or group and the environment. Integrated awareness is purported to more directly address the mutual process.

Motion and Power. Rapacz (1991/1992) investigated the nature of chronic pain as a manifestation of patterning of human and environmental energy fields. Utilizing Ference's Human Field Motion Tool and Barrett's Power as Knowing Participation in Change Test, Rapacz found that people experiencing chronic pain demonstrated significantly lower human field motion and power than their counterparts who were not experiencing pain. She concluded that individuals with chronic pain have significantly lower frequency patterns than those per-sons who do not have pain. Thus, Rapacz explored the concepts of both human field motion and power and their relationship to field pattern manifestations. While she investigated the relationship between two field pattern manifestations, Rapacz did not address the relationship between the individual and environmental field patterns.

Mystical/paranormal Experiences. In an investigation of the principle of helicy, Cowling (1983) studied the relationship of mystical experience, differentiation, and creativity in college students. Cowling conceptualized and operationalized these three variables as characteristics that composed the unitary construct of field pattern. He emphasized that the transcendent nature of mystical experience indicated the diversity of human field pattern. He further described mystical experience as "behavior phenomenologically described as transcendent perceptual experience" (Cowling, 1983, p.5). He concluded that a relationship did exist between mystical experience, differentiation, and creativity in college students and thus supported the principle of helicy. Cowling (1986) further inferred that mystical experiences are also evidenced in other states which may be labeled as peak experiences, dreaming, meditation and near death experiences. Cowling (1986) emphasized that these experiences may occur in every-day life, and the potential they have for explaining human potential and field patterning have not been fully investigated.

McEvoy (1990) investigated the relationships among the experience of dying, the experience of paranormal events, and creativity in adults. In this study, she hypothesized that adults who are dying will experience more paranormal events and manifest more creativity that those adults who are not dying. She also hypothesized that adults who are dying would manifest an increase in paranormal events and creativity as the dying process proceeds. The findings of this longitudinal study indicated an in-crease in the incidence of paranormal experiences over time, yet no differences in creativity were seen. Paranormal experience is seen as a correlate of pandimensionality and is based on the principle of integrality.

These phenomena all suggest a process of heightened awareness which is deemed necessary in integrated awareness. Cowling and McEvoy both investigated mystical paranormal experiences as manifestations of individual pattern but did not address the pattern manifestations of mutual process. Integrated awareness is proposed to sometimes be perceived by the individual as having a mystical or paranormal quality reflecting the pattern of the mutual process of individuals and their environments. Thus, integrated awareness may have the potential to make the pattern inherent in mystical and peak experiences more recognizable.

Empathy. The concept of empathy, a term proposed to be closely related to integrated awareness, was presented by Alligood (1986). She investigated the relationship of creativity, actualization, and empathy in support of the principle of helicy. She postulated that creativity as innovative human field pattern and actualization as increasing diversity of human field pattern are associated with empathy. She defined empathy as "a human field pattern manifestation emerging from the mutual human being-environmental process" (p. 148) and considered it a field pattern manifestation of helicy. Alligood found a positive correlation between creativity and empathy as well as between actualization and empathy.

Thomas (1993), while working as a nurse practitioner to assess health promotion and disease prevention needs of clients, noticed that something unusual and unexplained was happening during her sessions. Both the nurse and the client sensed that the sessions were "life-changing experiences" (p.3) in that a sense of connectedness or continuous mutual process was occurring. In order to examine and delineate the pattern of this phenomenon, which she stated bore resemblance to the concept of empathy, she began a phenomenological investigation to explain why in some cases she felt that she and the client were empathically related and sometimes not. Results suggested that an empathic relationship exists when the nurse centers and focuses her energies with mutual intention to foster the client's well-being. Thomas acknowledged that one encounter occurred in which an empathic relationship existed without the benefit of the nurse focusing her energies. Data also suggested that when the investigator did not focus or center her energies, or the client was experiencing anxiety, the likelihood of an empathic nurse-client relationship was reduced.

Thomas and Alligood both addressed the concept of empathy within a Rogerian framework. Alligood's (1986) findings would suggest that if a relationship between creativity, a manifestation of human diversity, and empathy exists, then integrated awareness may be mutually patterned with human diversity. Thomas also addressed the relationship between empathy and the nature of the mutual process. However, the pattern manifestations of mutual process remain vague and undefined. The development of the concept "integrated awareness" is an attempt to address this ambiguity.

Field Image. Phillips (1990, 1991) presented the concept of human field image (HFI) and used the word 'interconnectedness" (i.e., bonding, attachment, love, couvade) as a manifestation of energy field perspectives. Johnston (1992, 1993a) expanded on the concept of HFI through the development of a scale using metaphors to measure human field image. Johnston (1993b) conceptualized field image as a "manifestation of the human and environmental patterning process which may be expressed as a perception of one's potential and an awareness of one's integrality" (p. 55). While viewing field image as a manifestation of human environmental field process, she interpreted this process in terms of the individual's perception of his or her own potential and integrality. Integrated awareness, which also ad-dresses the pattern of mutual process, addresses the nature of the mutual process itself.

Time Perception. Paletta (1990) investigated the relationship of temporal experience to human time. Temporal experience was defined as "the continuous mutual process of the human field with the movement of events in the environmental fields" (p. 240). Time awareness is a human-environmental mutual process which is subjectively perceived as time "racing," time "dragging," or as "timelessness." Temporal and time awareness are a unique blend of rhythmic subjective experience and may vary in the context of change and relationships.

Rawnsley's (1986) early 1977 study of the principle of helicy investigated the relationship between the perception of time and the process of dying. Rawnsley concluded that increasing field complexity, a natural process of evolution, occurs at an accelerated rate during the process of dying and because of this, the perception of the passage of time does not differ significantly from older to younger dying persons. Both perceive the passage of time as occurring at an accelerated rate.

Paletta and Rawnsley both investigated the perception of time, conceptualized as a marker of increasing field complexity. Integrated awareness may reflect the synchronicity of subjective experience (i.e. harmonious, chaotic, erratic) reflected in their conceptualizations of time. However, rather than addressing perception of a specific phenomenon such as time, integrated awareness addresses the actual pattern of the mutual process experienced by the individual.

Wave Pattern Perception. Numerous studies have been conducted within the Rogerian framework in order to investigate mutual process of the human and environmental fields. Most of these studies have reflected the relationship of the human field with light or wave patterns in the environment. McDonald (1986) conducted a study to determine the relationship between visible lightwaves and the experience of pain. She hypothesized that persons who were exposed to higher frequency (blue) visible lightwaves would experience less pain than those persons exposed to lower frequency (red) visible lightwaves. She further hypothesized that the longer exposures to blue lightwaves would yield greater likelihood of pain reduction. She reported that persons exposed to blue light experienced greater relief of pain, thus supporting the hypotheses.

Investigating the relationship between hyperactivity in children and perception of short wavelength light, Malinski (1986) hypothesized that hyperactive children would be able to visually perceive shorter wavelengths of light than their non-hyperactive counterparts and would also express preference for those shorter wavelengths. While noting a trend in the hypothesized direction, Malinski was unable to document statistically significant associations.

McDonald's use of light as wave patterns parallels conceptualization of integrated awareness as the mutual process of wave patterns presented herein. Further-more, Malinski's propositions regarding perception of wavelengths may be relevant in explicating the various manifestations of integrated awareness.

Other Literature

Intuition. Intuition is a phenomenon whereby knowledge is received in an immediate manner, perceived as a whole, and not arrived at through conscious linear processes (Rew, 1988); it allows us to experience the totality and underlying connections of pattern invisible to the senses. Rew has investigated the utility of intuition to guide the decision-making process of nurses. In-tuition and integrated awareness share a common theme in that they both involve a higher form of vision and a greater awareness of perception with meaningful intent. The intimate relationship between these phenomena presents a challenge to scholars for further inquiry.

Connected Knowing. Gilligan (1982) and Lyons (1983) used the terms separate and connected to describe two different conceptions or experiences of the self. Separate implies autonomy as in separate from others. The separate self experiences relationships in terms of reciprocity and mastery over or doing unto others as they have done to you. The connected self experiences relationships as "response to others in their terms" (Lyons, 1983, p. 34). Integrated awareness differs from connected in that connection implies a mutuality with a specific or static phenomenon, whereas mutual process is a dynamic phenomenon. Furthermore, connection infers at least two boundaried beings. Integrated awareness rejects the existence of boundaries and recognizes humans and environment as infinite, consistent with the assumptions underlying the Science of Unitary Human Beings.

Synchronicity. Synchronicity is a descriptive term used by the psychologist, Jung (1973), to describe the link between two events that are connected through their meaning, a link that cannot be explained by cause and effect. Synchronicity requires human participation, for it is a subjective experience in which the person gives meaning to coincidences. "Meaning" differentiates synchronicity from synchronous events (i.e., clocks chiming at the same time, airplanes departing or arriving at the same time). Synchronicity reflects on the subjective experience and subsequent meaning of coincidental events, whereas integrated awareness is focused on the mutual process that occurs during meaningful coincidences.

Summary.

Integrated awareness implies an abstract sense of connection or mystical transcendence wherein human and environmental energy fields evolve. It may be perceived as a unifying schema of inner peace, serenity, well-being, and power. However, it differs from the discussed concepts in that it addresses the pattern of the mutual process of individual and environment, including both other individuals and natural phenomena such as a sunset or a symphony.

Essential Attributes of Integrated Awareness

The concept of integrated awareness is an abstruse, complex, and pandimensional phenomenon. Based on a review of the literature and analysis of the concept, the following essential attributes are identified:

1. Authenticity--flows from the subjective experience of authentic power whereby one perceives meaningfulness and purpose in the patterns of one's life.

2. Transcendence--the perceptual nature of phenomena as independent of mere feeling or cognition.

3. Unity--perception of the self as an energy field, mutually exclusive from mind-body dualism and as integral with one's environment.

The following hypothetical cases will illustrate the essential attributes of integrated awareness.

Model Case.

A student sits in a classroom awaiting the guest speaker's arrival. When the guest speaker begins to lecture, the student's and the speaker's eyes meet. At that moment the student becomes aware that a mystical connection characterized by harmonizing of energy fields is occurring. The student knows that for whatever reason the speaker has become an integral facet in her life. She resists the urge to go to the speaker after the class because she knows the pattern manifestations will emerge. The speaker notices the student and experiences a similar sensation that the student has become integral to her life. The memory and the perceptual meaning of the experience remains with them forever.

The situation demonstrates authenticity, as the student perceives the meaningfulness of the encounter. She is highly aware of the experience and the transcendent nature of the meeting. She perceives a sense of unity and mutual process with the speaker.

Borderline Case

Patients who have been triaged are waiting to be brought back to an emergency treatment area. A nurse steps into the waiting area to call the next patient back. The nurse sees a young woman, who is pale and waxen, sitting in a wheelchair. The nurse immediately goes to her because she senses that something potentially life-threatening is occurring with the young woman. Subsequently, it is discovered that the young woman has a ruptured ectopic pregnancy.

This situation describes intuition, a related concept, rather than integrated awareness. While intuition merged with knowledge and experience contributed to resolution of the situation, these should not be confused with integrated awareness. While awareness is present, the sense of unity and mutuality are absent.

Contrary Case

Thirty-seven people are crowded into a train car of a metropolitan area subway. People enter and exit in a continuous stream as the train stops. No one can remember or recall the other people on the train. They traveled in a day dream, unaware of the existence of the others.

In this situation, authenticity is absent so no meaning is perceived. Transcendence is absent, and there is no perceived unity or intent. Therefore, this situation exhibits none of the essential attributes of integrated awareness.

Antecedents and Consequences

At first thought, antecedents and consequences might appear to infer the existence of linearity and causality and thus would be incongruent with the Rogerian conceptual system. However, more careful consideration of these terms reveals their potential to describe recognizable patterns within the process of pandimensional sequencing. This sequencing does not necessarily infer linearity, but may explicate the sense of mutual process that integrated awareness is purported to address.

Empirical Referents

Empirical referents are "classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself" (Walker & Avant, 1987, p. 43). Since Rogers first introduced her model in 1970, difficulties have arisen regarding the appropriate methodology for the empirical measurement of unitary constructs. The argument continues among nurse scholars regarding the use of both quantitative and qualitative methodologies and the validity of collecting data by qualitative methods, then quantifying that data to give static meaning to that phenomenon (Carboni, 1992).

Although instruments purporting to measure unitary constructs within the Science of Unitary Human Beings have been developed or are evolving (Barrett, 1986; Carboni, 1992; Ference, 1986; Gueldner, 1993; Johnston, 1993; Paletta, 1990), none of these instruments measure integrated awareness. Phenomenological methodology may prove to be the most useful tool for exploration of the phenomenon of integrated awareness as a human experience. Qualitative exploration of the concept of integrated awareness utilizing phenomenological methodology may provide further insights that could facilitate the future development of appropriate measurement methodologies.

Research and Practice Implications

Research within the framework of the Science of Unitary Human Beings continues to evolve and expand. More recent research studies have focused on clarifying the abstract conceptual system, further delineating human field patterning, and on therapeutic modalities, which may enhance the knowledge and practice of nursing. Carboni (1992) developed an instrument called the Mutual Exploration of the Human Field Environmental Field Relationship Tool, which is used to measure the unitary field pattern. The importance of this tool is that it allows for the open expression of human pattern in a holistic context. Butcher and Parker (1988) have explored the use of pleasant guided imagery as a relaxation technique nurses can utilize to assist patients in coping with stress and anxiety. Therapeutic Touch is a healing technique that dates back for centuries. It was developed for use as a nursing practice modality by Kreiger (1975) and has received increasing attention by nursing re-searchers ( Heidt, 1981; Meehan, 1985; Quinn, 1984,1989). Heidt (1981) and Quinn (1983) both investigated the relationship between Therapeutic Touch and anxiety and found that subjects experiencing Therapeutic Touch had decreased levels of anxiety. As anxiety is perceived to be a dissonant state, an investigation into the relationship of integrated awareness, Therapeutic Touch, and anxiety may be worthy of consideration. Heidt (1994) has further investigated Therapeutic Touch by conducting a grounded theory analysis of nurses' and patients' experiences of Therapeutic Touch. She identified categories of experience including: opening intent, opening sensitivity, and opening communication. As Therapeutic Touch is based on mutuality of energy fields, the congruence of these categories of experience with integrated awareness may serve as an area for further investigation.

Time perception presents a fruitful area for future research. In an extension of Rawnsley's (1986) work, a relationship between integrated awareness and the perception of the dying process may be worthy of investigation. With the increasing field complexity accompanying the dying process, does the pattern of integrated awareness also change?

Research examining the relationship between motion of energy fields and integrated awareness may also prove beneficial. Also, the relationship between intimacy, a potential contributor to quality of life (Seagraves, Bramlett, Gueldner, Moneyham & Guillory, 1993), and integrated awareness is worthy of investigation. Of course, all research on integrated awareness must first be predicated on further development of the concept through research, both qualitative and quantitative, that more fully illuminates the nuances of this evolving concept.

Reprinted from Volume 2 Number 1 1994

Received December, 1993 Accepted February, 1994

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Barbara Brinkley Phillips, RN;MSN Martha Hains Bramlett, RN,PhD

The authors would like to express their gratitude to Sarah Gueldner, RN;DSN; FAAN, of the Medical University of South Carolina, Patricia Lillis, RN;DSN, and Gloria Clayton, RN;EdD; FAAN of the Medical College of Georgia for their critiques of a draft of this manuscript.
The new knowledge ... frees us from the chains of a most narrow
   dungeon and sets us at liberty to rove in a more august empire ...
   of an infinite space, of so worthy a field, and of such beautiful
   worlds.

   Giordano Bruno as cited in LeShan (1984, p. 8).


It is the responsibility of nursing scholars to advance, clarify,
   verify, and organize knowledge of those phenomena [relevant to
   nursing] through promulgating and testing relevant and promising
   theoretical constructs. (p. 66)
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