Human Becoming Theory of Nursing by Rosemarie Rizzo Parse

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Rosemarie Rizzo Parse's Theory

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Patients admitted to hospitals often develop feelings of identity loss, frustration, and loss of control (Pedlar, Hornibrook & Haasen, 2001). Under the influence of these negative feelings, the outcomes of their hospital treatment may not meet medical professionals’ expectations. Patients’ emotional wellbeing is crucial to the success of their physical recovery in hospital settings. Nurses are expected to ”create a caring, dignified, and empowering environment in which patients truly direct the course of their care and call upon their inner resources to speed the healing process” (Pedlar et al., 2001, p. 16).

Patient-centered care is a relatively new concept that signifies the emergence of new health care philosophies which reflect the emerging concern for delivering quality care customized to the unique needs of individual patients. As of today, patient-centered care is claimed to be at the center of quality health care delivery. Parse’s Theory of Human Becoming remains one of the primary sources of knowledge about patient-centered care and, at the same time, a useful means to transform traditional patient-centered care models into human becoming-guided models of patient-focused care delivery. The purpose of the current paper is to reconsider the meaning and implications of the patient-centered care concept from the perspective of Parse’s Theory of Human Becoming.

The Perspective of Parse’s Theory of Human Becoming

The current theoretical and empirical nursing literature provides extensive information on Parse’s Theory of Human Becoming. Most nursing researchers seek to reconsider the value and practice implications of the three philosophic assumptions that shape the very basis of Parse’s theory. Many others apply these assumptions and principles to understand the meaning of patient-centered care in various nursing settings. As such, the concept of patient-centered care remains a theme that dominates the current knowledge of the theory.

Still, most nursing researchers begin with observing and interpreting the three basic assumptions within Parse’s theory. Hansen-Ketchum (2004) refers to it as a multifaceted approach to understanding the theoretical and practical processes inherent in inpatient and family care. In the view proposed by Hansen-Ketchum (2004), Parse’s theory offers a holistic vision of quality nursing care based on the patient’s potential for healing that comes from within and outside of the treatment reality. Based on the theory, the process of creating a healing environment is impossible without bringing together the patient’s self-work and nurses’ collaborative efforts with the patient, his/her family members, and the environment (Hansen-Ketchum, 2004). Such theoretical realities are further reiterated in the three philosophical assumptions synthesized by Parse (Hansen-Ketchum, 2004).

The Three Philosophic Assumptions of Parse’s Theory of Human Becoming

The three philosophic assumptions of Parse’s theory of human becoming create a theoretical basis for the analysis of various theory and practice-based concepts in nursing literature. For example, in the case of Pedlar et al. (2001), the assumptions were used to re-evaluate the meaning of patient-centered care. It is interesting to note that the wording used to interpret these theoretical assumptions varies across nursing studies. Yet, it is due to the richness of these theoretical and philosophic narratives that the meaning of human becoming and its implications for patient-focused care become much clearer. Pedlar et al. (2001) cite Parse’s words in the analysis of her theory and its basic principles. As such, the first principle sounds as ”structuring meaning multi-dimensionally is creating reality through the language of valuing and imaging” (p. 17).

Hansen-Ketchum (2004) reinterprets this principle as the freedom given to a patient in creating and reconstructing personal meanings. As such, Parse’s theory rests on the belief in the centrality of the patient’s individual experiences, while the process of illuminating their meaning is, in essence, the process of uncovering what was and is happening to the patient at any given moment (Hansen-Ketchum, 2004). Such a principle gives a rise to the second philosophic assumption, according to which patients constantly recreate themselves under the influence of the environment, in which they exist (Hansen-Ketchum, 2004). In the words of Parse, human becoming is synonymous with configuring human connections with the universe (McCarthy & Aquino-Russell, 2009).

However, like the meaning of human experiences changes, depending on the situation, so does the relationship between the human and the universe, turning human becoming into a dynamic and ever-changing process. The third principle articulated by Parse and cited widely in nursing literature is in a multidimensional reality as patients’ experiences unfold due to their choices (Hansen-Ketchum, 2004; McCarthy & Aquino-Russell, 2009). Such analysis gives rise to the discussion of patient-centered care.

Despite the relevance of the patient-centered care concept, the studies which reevaluate its meaning in the context of Parse’s theory are but few. One of the most interesting ones is the study by Pedlar et al. (2001), in which the researchers sought to look beyond the basic principles of therapeutic recreation and reaffirm the validity of patient-centered approaches based on Parse’s theory of human becoming. The meaning of human becoming-guided practice was also discussed by Bournes (2006).

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The results of his (2006) study indicate that, where nurses applied the principles of human becoming in practice, the care they provided to patients was more rewarding and professional, leading to greater patient satisfaction. In this sense, Mitchell, Bournes, and Hollett (2006) cite the nurse, who speaks of human becoming-guided practice as a direct way to capturing the hearts and minds of patients, who become particularly appreciative of nurses’ efforts about their treatment processes and outcomes.

One of the most problematic aspects in the study of patient-centered care, independently and about Parse’s theory, is that its meaning is often taken for granted. In other words, nursing researchers sometimes forget to include an explicit definition of the concept. The lack of clarity in how patient-centered care is defined raises the questions of its usability in practice settings. According to Mitchell, Closson, Coulis, Flint, and Gray (2000), the concept of patient-centered care cannot be universal, and each health care organization should invest in its meaning to make it workable. Operationally, patient-centered care entails decentralization and localization of nursing work (Mitchell et al., 2000).

The goal of such operational changes is to ensure that nursing care is delivered efficiently while keeping individual patients and their needs satisfied (Mitchell et al., 2000). More specifically, the patient-centered care concept can be used to simplify documentation processes, limit the number of hospital admissions, or reduce the waiting time (Mitchell et al., 2000). Philosophically, the concept of patient-centered care cannot be used without changing the values, actions, and principles of the nursing staff. As Mitchell et al. (2000) state, patient-centered care should be used to involve families in clinical decision-making, thus facilitating the discussion of care options.

The Concept of Patient-Centered Care Model

The concept of patient-centered care cannot be understood without understanding its key attributes. Morgan and Yoder (2011) suggest that attributes exemplify one of the central elements of any concept analysis. Morgan and Yoder (2011) performed a detailed analysis of the patient-centered care concept to conclude that its basic attributes were: holistic, respectful, individualized, and empowering. Among these, the notions of ”holistic” and ”individualized” are, probably, the most important ones. Patient-centered care is holistic in the sense that it is based on the recognition of every patient as a personality (Morgan & Yoder, 2011).

It means that nurses delivering patient-centered care try to evaluate the effects of their clinical decisions on the entire person and develop nursing interventions in ways that respond to patients’ true needs (Morgan & Yoder, 2011). The recognition of individuality and personal needs gives a rise to another attribute of patient-centered care – individualization. The concept of patient-centered care is always individualized since its essence is to consider the unique needs of every patient, understand their life situations, and empower them to control the course of their care in full (Morgan & Yoder, 2011).

Two model cases of human becoming-guided patient-centered care are described by McCarthy and Aquino-Russell (2009) and Hansen-Ketchum (2004). In McCarthy and Aquino-Russell (2009), a 15-year-old man is admitted to a hospital emergency department, with his nose and mouth bleeding and his right ear having the symptoms of cerebral spinal fluid. As the emergency procedures are taking place, the patient’s relatives seek advice and want to know as much as possible about what has happened and will happen to the young man. From the perspective of human becoming, the emergency room nurse decides to spend most of her time with the family, while medical professionals are taking care of the patient’s health needs (McCarthy & Aquino-Russell, 2009).

The case models the concept of true presence which, according to Parse (1997), facilitates a powerful connection between the person and the universe. Hansen-Ketchum (2009) discusses the case of 24-year-old Robin diagnosed with lupus. For years, the patient experienced difficulties with nurses, since the latter failed to understand her unique needs but, with the implementation of human being-guided frameworks, nurses have managed to see the situation from the patient’s perspective (Hansen-Ketchum, 2009). The case illustrates the multidimensionality of the patient’s perspective and the importance of seeing and understanding it among nurses.

Related cases of human becoming-guided patient-centered care can be found in the literature. Such cases are narrated by either nursing students involved in the provision of patient-centered initiatives or leaders, who guide the practices. Bournes (2006) describes students’ experiences and responses to human being-guided patient-centered care, according to which students were expected to spend 80 % of their time with patients and 20 % of the time developing and improving themselves. Being guided by the philosophic assumptions of Parse’s theory of human becoming, students exposed themselves to the value of true presence in the learning process, while being able to acquire and process new information in a non-judgmental manner and feeling comfortable enough to share their authentic feelings with others (Bournes, 2006).

Mitchell et al. (2000) offered a thorough analysis of Parse’s theory from several different perspectives, but the leader’s perspective is particularly interesting. Here, a human becoming-guided patient-centered care is viewed as a model for education and learning, allowing nurses to discuss both Parse’s theory and the concept of patient-centered care against their actual clinical experiences with patients (Mitchell et al., 2000).

The antecedents of patient-centered care always include commitment, vision, shared governance, and organizational behaviors (Morgan & Yoder, 2011). Vision and commitment as the integral elements of the care environment have the most considerable influences on patient-centered care (Morgan & Yoder, 2011). The organizational context and culture, the vision and commitment displayed by nurses have profound implications for the quality of care provided, and for patient-centered care to become a reality, the organizational culture should be based on the values of empowerment, respect, and patient autonomy (Morgan & Yoder, 2011).

The consequences of patient-centered care usually include enhanced quality of care, increased patient satisfaction, and improved health outcomes (Morgan & Yoder, 2011). The empirical referents related to the concept of patient-centered care are the Patient Satisfaction with Nursing Care Quality Questionnaire, the Person-Centered Climate Questionnaire, and others (Morgan & Yoder, 2011).

Conclusion

In conclusion, Parse’s theory of human becoming offers a wonderful perspective on the concept of patient-centered care. It is a promising approach to delivering quality nursing care, based on the holistic vision of the patient’s personality. Its consequences usually include improved quality of care and increased patient satisfaction. Certainly, the concept needs more clarity, especially in the context of human becoming which is the problem future researchers will need to solve.