11 Epilogue: Sustaining Rogerian Nursing Science

The Science of Unitary Human Beings 2.0

Howard Butcher

 

The strength of a discipline is not how similar it is with other disciplines, but rather the value of its uniqueness (Butcher, 2002). The Science of Unitary Human Beings sets forth  a comprehensive philosophical, scientific, and theoretical foundation for nursing. Rogers’ abstract system is grounded in numerous contemporary scientific theores ranging from relativity theory, quantum theory, quantum cosmology, systems theory, chaos theory, and evolutionary theory; all enveloped in a humanistic philosophy. The focus on unitary human beings as pandimensional, irreducible wholes in mutual process with their environment provides a distinct focus for the nursing discipline.

Some nurses have suggested that since nurses will need to work more within a multidisciplinary, interdisciplinary, or even a transdisciplinary perspective, that nursing language and nursing theory limits interdisciplinary communication and collaboration and prevents the formation of interdisciplinary partnerships. However, The National Academies of Sciences, Engineering, and Medicine (2018) notes that “every field of study has its own epistemology that is learned through disciplinary preparation. The process of disciplinary education is characterized by certain conceptual gateways that are preconditions to any deep disciplinary understanding.” The National Academies of Sciences, Engineering, and Medicine goes on the define what multidisciplinary, interdisciplinary, and transdisciplanry mean, and note that each definition assets that each discipline enters the collaboration from their unique disciplinary perspective.

 

“Multidisciplinary methods, typically considered the least integrative of the three, have been defined in several ways, yet converge on the idea that multidisciplinarity involves the process by which investigators from more than one discipline work from their disciplinary-specific bases to solve a common problem, either at the same time or by sequentially applying ideas from multiple disciplines to the focal problem” (National Academies of Sciences, Engineering, and Medicine. 2018).

 

“Through interdisciplinary approaches, in contrast, scholars work jointly from their disciplinary perspectives to address a common problem. The use of interdisciplinary methods requires team members to integrate their disciplinary perspectives—including concepts, theories, and methods—in order to solve the complex problem at hand”(National Academies of Sciences, Engineering, and Medicine. 2018).

 

Transdisciplinary research strategies require “not only the integration of discipline-specific approaches, but also the extension of these approaches to generate fundamentally new conceptual frameworks, hypotheses, theories, models, and methodological applications that transcend their disciplinary origins, with the aim of accelerating innovation and advances in scientific knowledge”(National Academies of Sciences, Engineering, and Medicine. 2018).

 

Thus,  collaboration depends on the ability of each discipline to clearly communicate their professional focus and the nature and extent of their contribution to the common shared goal. If the nurse is using only knowledge derived from other disciplines such as medicine or psychology, the nurse would have little to contribute to the care of the patient distinct from what physicians and psychologists contribute. If nurses use a nursing theory to guide assessment, the nurse would have information distinct from any other member of the team and therefore contribute to a new understanding of the patient’s situation that likely is not otherwise addressed. Clearly Rogers’ nursing science provides nursing with knowledge about human beings and their health that is of great value in any nursing care situation.

What can assure that the science of unitary human beings becomes integral to the theoretical basis of nursing?

 

Declining Interest in Nursing Theory?

A number of nursing scholars (Cody, 1997; Fawcett, 1999; Levine, 1995; Mitchell, 1997; Rawnsley, 1999; Reed, 1998) have pointed out a decreasing emphasis on the application of unique nursing knowledge in nursing education and practice. DeKeyser and Medoff-Cooper (2002) commented that “over the decade of the 90s nursing theory seemed to take an increasingly smaller role in the content of schools of nursing” (p. 330) and “practicing nurses are continuing with their daily routines and are often unaware that the world of nursing theory is changing” (p. 329). The vast majority of published nursing research continues to be conceptualized from theories borrowed from other disciplines. More importantly, few nurses in practice use a nursing conceptual framework or nursing theory as the theoretical foundation for conceptualizing and guiding their work.

An entire generation of nursing students are being educated with minimal exposure to the value of nursing-theory guided education, research, and practice. Few students even learn about Rogers’ nursing science and worse, if nursing theory is taught at all, it is taught as having only historical value or taught in one isolated nursing theory course. In addition, confining nursing theory to graduate studies, which is the custom in many schools of nursing, conveys the false notion that theory is too esoteric and underestimates intelligence and abilities of undergraduate students in learning how to engage in theory-guided practice.

The lack of education grounded in nursing’s distinctive knowledge base may be a significant reason why there is a decreasing interest in Rogerian scholarship. With no tradition of educating the next generation of nurses in the traditions of nursing’s distinctive body of knowledge, the interest and flow of students into specific schools of nursing theory will become a mere trickle. How can we assure that in this world, the science of unitary human beings will continue.

 

Sustaining the Vision

Kotter (1996) outlined processes for creating major changes. First is the establishment of a sense of urgency. The decreasing emphasis on nursing theory-based education and practice is beyond urgency. It is a crisis. The very survival of nursing as an independent academic discipline rests solely on the development and use of a distinctive knowledge base. Secondly, Kotter states that a coalition of persons acting together like a team needs to be created to lead the change. This column is a call to action, a call for synchronization of energy of those devoted to theory based practice and those devoted more specifically to advancing Rogerian science.

Third, Kotter explains one needs to develop a vision and strategy to guide and direct the change effort. Visions are about possibilities, about desired futures. Visions are ideals, standards of excellence, expressions of optimism and hope. Visions communicate what makes us singular and unequaled and ideal reveal our higher order value preferences. Visions give focus to human energy (Kouzes & Posner, 1997).

Kotter’s fourth process of creating change is communicating the change vision. Butcher (2002) laid out a number of visions or what he called  “luminescent beacons” to provide direction in sustaining and advancing the Science of Unitary Human Beings. A beacon is usually a light used as a “signaling or guiding device” (American Heritage Dictionary, 2000, p. 155). While a number of visions addressed nursing theory-based practice more generally, any vision that is designed to enhance nursing theory-based practice as foundational to nursing contributes to actualizing the vision of sustaining and advancing Rogerian nursing science. Each vision was offered as a “beacon of light” signaling a fundamental change, transformation, and new direction guiding the advancement of nursing theory-based practice more generally and in many instances, Rogerian science specifically (Butcher, 2002).

 

Luminescent Beacons for Advancing Nursing/Rogerian Science

In the 2002 article Butcher (2002) highlighted 10 paths for advancing nursing and Rogerian-based practice, education, and  research. He referred to the paths as “luminescent beacons.”

The idea of beacons of light were inspired the notion of using a lighthouse as metaphor. I vividly recall seeing my first lighthouse. It was on a camping trip with my Boy Scout Troop 79 in Springfield, NJ to Sandy Hook, NJ. The Sandy Hook lighthouse is the oldest lighthouse that is in operation in the United States. The lighthouse was built in 1764 to aid mariners entering the southern end of New York Harbor.  Lighthouses serve as a beacons for ships at sea, showing the edge of the land.  Lighthouses as metaphor is replete with deep personal meaning. For me, the lighthouse can be a symbol of overcoming challenges and adversity and of guidance offering safe passage. Commonly the lighthouse metaphor is used to symbolize a way forward and help in navigating through the world. I am also struck of lighthouses have a spiral staircase, reminding me the Slinky helix metaphor of Rogerian Science. The journey to the top of the lighthouse is often challenging, circling around, one step at a time, until final you reach the top,  you have a sense of exhaustion, relief, and exhilaration when you look out at the endless expanse of sea and sky. Built to withstand time, hash seas and winds, set high on cliffs and rock, lighthouses can been understand as symbols of strength, and of hope. The following are paths for navigating nursing to toward overcoming the challenges that limit the actualization of nursing theory-based practice.

 

 

Sandy Hook Lighthouse

 

 

 

1) ANA standards of nursing practice needs to accurately reflect the scope and diversity of nursing practice. We must make it clear to the standard writers at ANA that nursing practice is not only guided by the nursing process, but the nursing process is guided by extant conceptual framework. More importantly, the standard need to acknowledge that nursing practice is guided by specific practice methodologies other than the nursing process that are derived from conceptual frameworks, such as Rogerian practice methodologies.

2) Accrediting organization of schools and colleges of nursing (AACN and NLN) need to assure that content on nursing philosophy, metaparadigm concepts, conceptual frameworks from both the simultaneity and totality paradigms, and practice methodologies derived from extant nursing theories are taught at all levels of the nursing curriculum. Most scholars agree that a unique body of knowledge is an essential quality of a profession (Styles, 1982). The use of nursing knowledge is a hallmark of nursing practice (Fawcett & Carino, 1989), distinguishes nursing as an autonomous health profession, and represents nursing’s unique contribution to the health care system (Parse, 1995). Nursing’s distinctive knowledge base is expressed in nursing’s metaparadigm concepts, philosophy, patterns of knowing, paradigms, conceptual frameworks and theories specific to nursing, and practice models. A unique body of knowledge is a foundation for attaining the respect, recognition, and power granted by society to a fully developed profession and scientific discipline (Butcher, 2004). The autonomy of a profession rests most firmly on the uniqueness, recognition, and recognized validity of the discipline’s theoretical knowledge.

Undergraduate nursing students expect to become knowledgeable, competent, ethical, and caring professionals who provide nursing care for promoting health and well-being. To meet this goal, it is essential that nurses acquire the knowledge, skills, values, meanings, and experience that are specific to nursing. Accrediting organizations have a tremendous impact on establishing what is considered “essential” content for the preparation of nurses. AACN and NLN need to explicitly identify nursing conceptual frameworks as the foundation of nursing education and make the integration of extant nursing frameworks a criterion for accreditation.

3) Extant nursing theories and their distinct practice and methods of inquiry form the core for organizing and structuring knowledge taught in nursing education at all levels. Nursing theory is integrated in all nursing courses. Specific nursing theories/models, including Rogers’ science of human beings, serves as a way of conceptualizing and organizing content in nursing courses. Nurse educators in the clinical setting need to teach, role model, and practice from a nursing theory base so that students can experience how nursing theory guides practice. Students are evaluated on their ability to conceptualize and base their practice on extant nursing theories/models.

4) Colleges of nursing recruit and retain faculty who are not only diverse in research interests but are diverse in terms of their paradigmatic and theoretical nursing perspectives. Balanced and healthy colleges of nursing not only have identified areas of excellence in scholarship but also have faculty with diverse educational, methodological, and theoretical expertise. In order for nurses to be educated within and across nursing paradigms, schools of nursing will need a faculty that embrace paradigmatic diversity as well as nurse scholars/educators/researchers who have expertise in a variety of nursing theories and research traditions. Students have most to gain when they are exposed to multiple theoretical perspectives.

5) All nursing students graduate with knowledge grounded in extant nursing frameworks, including Rogers’ Science of Unitary Human Beings. Students who major in any discipline graduate with a wealth of knowledge about the application of using theories and conceptual frameworks specific to their discipline. For example, psychology students graduate with knowledge of psychological theories that describe the nature of the mind, development, and personality. Should not all nursing students be educated in the knowledge specific to nursing? Knowledgeable nursing students graduate grounded in the application extant nursing theories, practice methodologies, and modes of inquiry in both the totality and simultaneity paradigms. Nursing students are prepared for professional nursing practice when they are able to apply a variety of nursing theories to guide patient care in any given nursing situation.

6) NCLEX exams and AACN certification exams for specialty and advanced nursing practice need to incorporate competency in the understanding the application of a variety of nursing theories. It’s time that licensing exams accurately incorporate and make nurses and nurse educators accountable for learning and teaching knowledge that is specific to nursing, including extant nursing conceptual frameworks, which are the essence of all nursing knowledge. Nurses can no longer afford to ignore this unique scientific knowledge base. Only when nurses everywhere use knowledge specific to nursing will the nursing discipline achieve parity with other scholarly disciplines. Members of a discipline have the obligation to concern themselves with the knowledge base of their discipline, participate in its development, guide its use, and evaluate the work of their colleagues on the basis of the work’s relation to the extant theory base of the specific discipline (Cody, 1994). Once nurses base their practice, education, and research on nursing theory, nursing’s unique contribution to human well-being will become visible in the world of science, health care, and society. Incorporating nursing knowledge on licensing and certification exams would assure nursing content is taught and learned.

7)  Major textbooks must move beyond including a chapter on nursing theories, which rarely addresses how the theory can be used in practice, toward integrating knowledge about the application of nursing theories. Just as frequently as nursing textbooks include knowledge about nursing diagnosis and the nursing process, alternative nursing practice methodologies need to be included and integrated throughout textbooks in order to present a more balanced perspective on the diversity of conceptualizing nursing phenomena.

8) JCAHO criteria for accrediting hospitals indicate the nursing practice must be guided by extant nursing theories. When hospitals realize quality care is grounded in theory-based practice, they will invest in implementing information systems, data collection tools, and documentation instruments that support nursing theory-based practice. All practicing nurses are expected to and are able to practice nursing from a nursing theory base. When interviewing for a position at a hospital, nurses are routinely asked what frameworks they use in practice and employee evaluation criteria include the ability to effectively use nursing theory-based practice.

9) National Institute of Nursing Research funds nurse researchers who conceptualize research within nursing’s extant theoretical frameworks. Currently, the mass majority of funded and published nursing research is conceptualized from theories borrowed from other disciplines. Having a unique body of knowledge is the very essence of a discipline. Donaldson and Crowley (1978) pointed out in their classic article, “a discipline is not global; it is characterized by a unique perspective, a distinct way of viewing all phenomena, which ultimately defines the limits and nature of its inquiry” (p. 113). Similarly, Meleis (1997) pointed out “a discipline provides a unique way of considering the phenomena that are of interest to its members” (p. 42). When conducting research there is nothing wrong with conceptualizing the research problem within a theory from another discipline. However, research conceptualized using non-nursing theories or borrowed theories from other disciplines does not advance nursing science nor does it advance the development of a unique body of disciplinary knowledge (Parse, 1994).

10) Independent nurse owned and managed centers abound and are places of excellence where nurses practice independently guided by extant nursing theories. Advanced practice nurses need to provide an alternative service promoting health and well-being that is complementary and not a substitute or surrogate for medical care. Extant conceptual frameworks provide the scientific foundation for providing unitary and holistic nursing care and are the foundation of independent advanced practice nursing.

A Call to Action

John Wheeler, who along with Steven Hawking is one of the most eminent physicists of our time, believes that we are not simply bystanders on a cosmic scale; rather we are shapers and creators living in a participatory universe (Folger, 2002). In being informed of the work by Pierre Telihard de Chardin, Henri Bergson, and Alfred North Whitehead, it is not surprising Rogers’ nursing science is evolutionary, participatory, and process in nature. The notion of participation is integral to Rogers’ Science of Unitary Human Beings. Specifically, integrality, mutual process, and knowing participation in change all speak to Rogers’ participatory epistemology (Butcher, 1994, 1997). Participation is an implicit aspect of a unitary ontology. Skolimowski (1994) explains that one cannot truly conceive of the nature of wholeness unless one grants that the meaning of wholeness implies that one must participate in it. Participation is the core of life, the song of joy in experience, the source of meaningfulness, the profound catalyst of an evolving universe, and the vehicle of transforming visions into actualities. Furthermore, Skolimowski (1994) asserts meaningful knowing participation in change includes responsibility for change. Understanding integrality, or unity of the living and non-living, knowing that everything is inseparable, implies we must take responsibility.

Those invested in the endurance and advancement of Rogerian nursing science and all have a responsibility to participate in transforming visions into actualities. Laszlo (2001) reminds us that visions of “the future cannot be predicted; they must be created . . . the world we create in reality depends on us” (pp. 210-211). Responsibility is an intrinsic value in Rogerian-ethics (Butcher, 1999). Rogers frequently linked the science of human beings to the fulfillment of nursing’s social responsibility for enhancing well-being and human betterment. Knowing participation in change includes responsibility. Like the transformation of energy creating the light that emanates from fireflies and stars, nurses devoted to advancing nursing and Rogerian science have a responsibility to collectively direct their energy to make the vision real.

 

Becoming a Beacon of Light

Stars, like the spinning beacon of lighthouse illuminate the darkness. As a star burns its nuclear fuel, energy in form of light is released into space (Lightman, 2018). But, “the cosmos is also within us, we’re made of star stuff,” Carl Sagan proclaimed in his original award-winning TV series “Cosmos,” All organic matter containing carbon was produced originally in stars. His statement sums up the fact that the carbon, nitrogen and oxygen atoms in our bodies, as well as atoms of all other heavy elements, were created in previous generations of stars over 4.5 billion years ago.  We are all “stars” and each of us has the capacity and responsibility to burn brightly. Meaningful, deliberate, knowing participation in change is the way in which humans bring forth a new world (Butcher, 1997). Those who are interesting in advancing Rogerian theory-based practice have a role to play.

1) Live the values of Rogers’ Science. Sustaining the vision of Rogerian science involves living the values inherent in Rogers’ life and her work. In an earlier work, Butcher (1999) identified a constellation of values inherent in Rogers life and her works. Living the values of courage, commitment, transformation, responsibility, optimism, and wisdom have particular relevance in devoting energy toward advancing Rogerian science. Living the values of Rogerian science can be a continual source of inspiration and energy.

2) Attain positions of responsibility and facilitate transformation. Kotter (1996) explains that in order for change to occur, broad-based action is needed. Obstacles such as systems or structures that undermine the change vision need to be overcome. Becoming a dean of a college of nursing; chairing curriculum committees; sitting on the boards of hospitals, state boards of nursing, and nursing organizations; being a hospital administrator or unit administrator; or sitting on a NINR review board that funds “nursing research” are some examples where Rogerian scholars can work in assuring the voice and value of nursing theory based education, research, and practice is heard and advanced. In becoming members on boards of organizations such as ANA, NLN, AACN, NINR research review boards, State Boards of Nursing we can move nursing toward formally recognizing nursing’s distinctive knowledge base in educational and practice settings.

3) If you are a nurse educator, create ways to incorporate nursing theory and the science of unitary human beings in every course you teach. It is an educator’s ethical responsibility to teach nursing’s substantive knowledge. The survival of any theoretical system depends on the investment of this generation of nurse educators to pass on the ideas, values, concepts, principles, research findings, and practice methods of the discipline’s theoretical systems and research traditions to the next generation. Any aspect of teaching nursing knowledge can be connected to and integrated with postulates and principles in Rogerian science.

4) Conceptualize your research in ways that serve to advance Rogerian science. Only a few Rogerian scholars have developed a program of research or a series of studies that build one on another. Until NINR becomes more receptive to Rogerian science, a couple of strategies can be used to further Rogerian research. For example, using theoretical triangulation, funded studies can be reconceptualized from a variety of theoretical perspectives. In addition, a Rogerian research study can “spin-off” of a larger, funded grant or use secondary analysis by taking some aspect of the data and re-examine it through the lens of Rogerian science. In addition, new concepts and tools need to be developed, old concepts reconceptualized, and Rogerian research methods tested and developed. Studies need to be replicated and expanded. Viable conceptual systems and research traditions need to have an active and growing community of scholars who are committed to advancing the science by conducting research and mentoring the next generation of research scientists.

5) Nurse administrators can lead their staff in implementing theory based nursing practice. Nurse administrators informed about Rogerian science can teach, role model, and formally implement the Rogerian practice methodology in their practice setting. There are numerous examples in the Rogerian science literature, and in the literature of other conceptual systems particularly Roy’s Adaptation Model, Parse’s theory of human becoming, Orem’s self-care deficit theory, and Neuman systems model, that describe successful implementations in various practice settings. The processes of implementation described in this literature can be useful in guiding the process of integration of Rogerian science in practice settings.

6) Support the advancement of Rogerian science by being actively involved in the Society of Rogerian Scholars. In laying the foundations for nursing, Nightingale (1893) declared, “no system can endure that does not march” (p. 198). Rogerian science has endured so far; however, the march toward the fulfillment of Rogers’ vision remains unfulfilled. A major catalyst in the movement of any science toward achieving wider recognition is the collective participation of its members in professional organizations. Without the active involvement of each member in the professional society, Rogerian science may languish in the shadows. The Society of Rogerian Scholars (SRS) is a major vehicle educating others about the science and promoting the advancement of Rogerian scholarship.  To march also means “proceed directly and purposely . . . to walk steadily and rhythmically forward in step with others” (American Heritage Dictionary, 2000, p. 1068).

7) Support Visions: The Journal of Rogerian Nursing Science by submitting work for publication in the Journal that is now published online at http://www.societyofrogerianscholars.org/author-guidelines.html. At the same time, Rogerian scholars need to publish work in other prestigious, referred journals so that a wider audience can become familiar with Rogerian science.

8) Seize opportunities to tell stories to the public, health care professionals, and other nurses of how nursing is distinct from medical science when guided by extant nursing conceptual frameworks. Buresh and Gordon (2000) explain in some detail how nurses can inform the public about the true nature of nursing by telling stories that illuminate the value of nursing’s contribution to health and human betterment. Similarly, Rogerian nurses can engage with and educate the public by telling stories that illuminate how Rogerian science makes a difference in everyday health situations.

9) Rogerians must devote serious scholarship and effort toward making sure Rogers’ original work remains easily accessible to educators, students, researchers, administrators, other health care professionals, and the public. New in-print or on-line primary sources are needed and must be made accessible to the next generation of Rogerian scholars.

 

Finding Energy in the Apparent Void

On typical Midwest summer nights, one can’t help but look up at the midnight sky and see the sky vibrating with stars. On other nights, yo may be shaken by thunderstorms that rattles and awaken you from your slumber. Torrents of lightening shatter the apparent void. The Midwest nighttime thunderstorms strike with sudden force and then recede quickly, revealing a night sky inky black. On summer evening starting in mid June, sitting on the screen in porch looking out into the dark night void crickets are chirping and fireflies flashing again while stars are blazing overhead reminding me that we are all enveloped in creative energy.

On that camping trip, me and my childhood best friend, left our campsite in the middle of night, and walked toward the Sandy Hook lighthouse, and the way, we ran across a huge bulge of earth, like a dune covered in grass, that actually was a old abandoned bunker, a relic from World War II, designed to protect the US shores from invasion. We climbed to to top of the bunker, and laid down in the grass and stared up at the star filled pitch black moonless midnight sky. As Jim and I contemplated our place in the universe, my experience was much like the one Alan Lightman (2018) described in “Searching for Stars on an Island in Maine.” My world begin to disappear as I felt myself dissolving into a vibrant star littered sky. I felt a deep connection not just to the stars, but to all that was around me, a merging with something larger than myself.

 

Now is the time for all to rise up; burn brightly, and illuminate the void in nursing. Now is the time to make Rogerian science visible to all.

 

 

 

 

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Epilogue: Sustaining Rogerian Nursing Science Copyright © 2018 by Howard Butcher. All Rights Reserved.

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