SEEKING OPENESS WITH MARGARET NEWMAN

Losses in every aspect of late life compel the elderly to expend profound physical and emotional energy grieving, adapting to the changes that result from loss, and recovering from the stresses inherent in these processes. The treatment goal of the nurse is to enable the elderly person to gain insight into the losses and recognize and activate restitution possibilities within the limits of the situation and individual personality. Environments that include social support are beneficial to the overall health of the elderly, because they provide the opportunity to process negative events through social interaction. Newman's Theory views on health and nursing provide a theoretical framework for working with the elderly. She describes human beings as open energy systems in constant interaction with the environment, which also is an open system. The only way for nurses to understand an individual's health status is to understand the individual's patterns of relating to the environment. Human beings are continually moving toward expanded consciousness. There are times in life when an individual becomes aware that the old ways of doing things no longer work and new answers must be sought. This discovery leads to disconnectedness and a sense of disorder. According to Newman, this sense of disorder is a precursor to transformation. She calls this time a "choice point" and believes the resolution can result in progression to a higher level of consciousness. Choice points create situations that bring the client to the attention of the nurse. To be effective, the nurse must give up the compulsion to fix things and restore the client to the nurse's definition of health. Rather, the nurse must enter into the process with the client and be present during the period of disorganization and disharmony. The nurse-client relationship helps the client and the nurse tolerate uncertainty and ambiguity until the new pattern becomes clearer. Nursing actions help the client cope with the choice point and strengthen the new choices. Newman (1994) describes nursing as a caring process that reflects the whole person and transforms all of us and all that we do. Her theory encourages client and nurse to let go, embrace the experience, and allow "expansion of consciousness to unfold." This is an especially important concept in psychiatric nursing. Newman's concept of caring permits the caregiver to take time to understand the client's unfolding pattern by entering into the disorder or disconnection with the client. Nursing actions are part of the process of being with the client, and are not oriented toward a preestablished goal determined by the nurse. The students engaged their clients in caring relationships that allowed the client's symptoms to be seen as part of an unsatisfying pattern. In each situation the student's interventions were based on an understanding of the client's pattern and of the losses that led to that particular choice point for that particular client. All four of these women suffered major losses that impaired their ability to feel valued and valuable. The students' interventions, aimed at both the cognitive and emotional response to loss, acknowledged and validated these losses. The interventions were designed to build on the women's strengths and unique characteristics, providing them with an opportunity to connect with another person in an emotionally satisfying way. The relationships themselves were effective in treating the loneliness, depression, and paranoid behavior.