February 5, 2012

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Critical Examination of Parse’s Theory of Humanbecoming

by misterhunt
Categories: misterhunt's NUHI Masters
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Historical Evolution: Development of the Theory

The ontology for the development of the Theory of Humanbecoming Likely came from a variety of sources. Parse grew up in a homestead setting where a good living was provided for her and her family through the hard, honest work and societal foundations laid down by her parents and grandparents. Parse speaks of her grandfather laying a solid foundation for the house where she grew up. Her father was known as ‘an institution’ in Parse’s hometown. Parse describes her mother as ‘a force in the community’. In later years, Parse eschewed one of the tenets of her upbringing as her understanding of the ‘Dignity of being human grew from family values’ (Fitne Inc., 1990).

After graduating from Duquesne University in Pittsburgh, Parse searched for a framework to guide her practice. She posed questions to herself like ‘why do people not follow health teachings and for those that do, why do they not get healthy?’  Parse viewed the medical model as limiting in terms of nursing practice. In her search for a guiding theory, Parse wanted her practice to reflect the idea that one nurse could make a difference in a person’s health (Fitne Inc., 1990).

Philosophical and Theoretical Antecedents

Parse built her Theory of Humanbecoming over many years and through gradual awakening and building of personal realizations (Parse, 1997a; Fawcett, 2001) of two things. First, Parse questioned the value of nurses following the medical model for providing nursing care to patients. Second, Parse became aware of the significance of the works of nurse theorist such as Peplau and Rogers. In her search for a nurse-specific epistemology, Parse used a combination of nursing theory and philosophical thought to construct her theoretical assumptions.

During that time Parse was reading the teachings of: Kierkegaard, ostensibly known as the ‘father of existentialism’ (McDonald, W., 2009); Heidegger, whose ideas seeded contemporary European philosophy (Wheeler, M., 2011); Dilthey, who explored the understanding of human life (Makkreel, R., 2011); Merleau-Ponty, a phenomenologist who put forth a philosophy tying the body and mind together as one entity (Maurice Merleau-Ponty, 2012); Gadamer, known for his development of the field of hermeneutics (Malpas, J., 2009); and Rogers, whose Unitary theory described the irreducible nature of the individual human (Rogers, M. E., 1994). Parse developed her theory from the roots of her reading (Fitne Inc., 1990).

Parse used various aspects of Heidegger and Gadamer’s philosophy in the hermeneutical base for the humanbecoming theory (Earle, 2010). Heidegger philosophized that people derive significance from personal experience. Heidegger believed that all people have the ability to understand themselves and ask questions about the meaning of their lives (McConnell-Henry, 2009). A nurse using Parse’s theory for practice or research will enter into a relationship with a person, and with expert knowledge and a back and forth sharing of ideas, become part of the person’s understanding of health. Phenomenological study has been thought of as peeling the layers of an onion to get to the core understanding of the person (phenomenon) being studied (Robertson‐Malt, 1999).  Rather than peeling layers away, Parse’s theory of nursing adds layers of understanding so that both nurse and patient develop a deeper understanding of the person’s health. This adding of layers and mutual exploration of ideas is called the hermeneutic circle (Earle, 2010). Gadamer’s contribution to Parse’s theory was that hermeneutic layers of understanding could be attained in two ways. First, dialogue is essential, and second, the opinion of the person being interviewed was highly important to the meaning of the dialogue (McConnell-Henry, 2009).

Changes to the Theory Since First Publication

Man-Living-Health: A Theory of Nursing was published in 1981 (Parse, 1981). At that time the definition of ‘man’ was genderless. When the dictionary definition changed, Parse renamed the theory to human becoming (Parse, 2010). The human becoming theory was expanded by Parse in 1987 to include more specifics about nursing practice methodology. This change also incorporated three research methodologies (Parse, 2010).  In 2007 Parse clarified some of the ontology and syntax of the theory. Parse used the method of joining words to create  discipline specific terminology. For example, she created the words humanbecoming and humanuniverse so the concept of the words is indivisible. This language is unique to the humanbecoming school of thought. Also unique to the theory is adding ‘ing’ to the ends of some words. These examples show that change is an important conceptual process in the theory (Parse, 2010).

Foundational Elements: Philosophical Statements and Principles of the Theory

Parse used the nine philosophical assumptions in Appendix A as a guide to form the theory (Parse, 1997a). The philosophical assumptions were fused from a combination of Rogers Science of Unitary Human Being and Parse’s other readings on existentialism (Parse, 2010). The three assumptions about humanbecoming, shown in Appendix B, were produced from the nine philosophical assumptions of which four are about the human, and five are about becoming (Parse, 2010). Reading the three assumptions of humanbecoming, Parse relates to human individuals as being indivisible co-creators of the ever changing universe, and experts in their own health and quality of life (Parse, 2010)

Parse (2007) elaborated on the three principles of the humanbecoming theory, shown in Appendix C. The fours postulates of illimitability, paradox, freedom, and mystery provide a foundation for all three principles but are never mentioned in the actual principles, ensuring the intactness of the theory (Parse, 2010). Humanbecoming illimitability describes the infinite, unbounded knowing that takes place with the unfolding of the moments in a human individual. Nurses, being co-creators of moments with individuals, are part of, and exist within, this indivisible moment. Humanbecoming paradoxes are the lived rhythm where choices are continually being made. Examples of humanbecoming paradoxes are revealing-concealing and conforming-not conforming. Humanbecoming freedom is that liberation for the human individual to make choices in the context of humanuniverse. Humanuniverse is the indivisible unfolding of human life and every environment. This postulate provides the understanding that every human has the right to choose their own path, and is free to make choices. This guides nurses to be co-creators of health. Humanbecoming mystery means that he humanuniverse is never completely knowable, that there will always be the unpredictable (Parse, 1997b; Parse, 2007; Parse, 2010).

The three principles, or concepts, of the theory reflect meaning, rhythmicity, and transcendence. In humanbecoming meaning is people partnered in the creation of their own reality and express this in the living within the context of their own values. Humanbecoming rhythmicity is how a person expresses choices in the opportunities and limitations that are presented to them. Humanbecoming transcendence is the moment where a person chooses to move on in an individual path from ambiguity (Cody, 2010).

Looking at the three principles of the theory, one can see how the three concepts, meaning, rhythmicity, and cotrascendance, are tightly integrated with each one, yet do not enter the language of the principle. This allows for clarity at different levels and allows the level of abstraction at the principle level to maintain simplicity. The economy of words in the principles allow for an uncluttered explanation of the theory (Shearer & Reed, 2012).

Semantic Integrity

Parse believed that a discipline should have it’s own terminology. She accomplished this with her humanbecoming theory from the beginning. Parse created new combinations of words and new words altogether, for example humanbecoming and enabling-limiting. The new words and word combinations have been used consistently through not only the assumptions and principles of the theory, but also in articles by other authors and reports by practitioners. This consistency in language gives the theory semantic integrity for the philosophy and definition of the principles and concepts (Shearer & Reed, 2012).

Paradigmatic Perspective

Parse delineates two major nursing paradigms, totality and simultaneity. The totality paradigm consists of beliefs where “the human being is a biopsychosocial spiritual being who interacts with an external environment, which the human being either adapts to or attempts to control’ (Cody, 1995, p. 144).  Health is viewed in totality paradigm as a fluctuating state of the physical, psychological, social, and spiritual nature of a human being. This paradigm places a high value on a person’s heath when being valued against societal norms (Cody, 1995). The beliefs of the simultaneity paradigm are ‘that the human being is more than and different from the sum of parts, and is, rather, an open being in mutual process with the universe who coparticipates in creating health through personal knowledge and choices based on personal values’ (Cody, 1995, p. 144). Human health is viewed in the simultaneity paradigm as something that is constantly evolving, and cannot be thought of as good or bad (Cody, 1995). It is an important distinction that Parse identified these two paradigms that they were based on nursing science and no other discipline. The theory of humanbecoming then, is based on a worldview of nursing science. Nursing science underpins every step of Parse’s theoretical ladder from the creation of a theory; it’s assumptions, principles, and guide for practice and research methodology. It’s beautiful.

Using the Theory for Guiding Research

Humanbecoming Theory has specific guidelines for nursing research, listed in Appendix D. Parse writes about inventing new research methodologies for the theory that takes into consideration basic assumptions and principles, and a method of construction from the writings of Kaplan and Sondheim (Parse, 1992). Parse underpins the humanbecoming research methodology with 5 assumptions: human beings are in a mutual process with the universe, the process is different for every individual, individuals describe their own health in ways that are meaningful to them, the researcher and the participant share the participants experience in true presence, and the researcher creates the structure of the lived experience in the framework of the theory (Parse, 1992).  Parse point out that this research methodology is ‘different from other qualitative methods’ and is ‘not an interview, but a way of “becoming with”’ (Parse, 1992, p. 42).

Using the Theory for Guiding Practice

Humanbecoming theory has clear levels of abstraction in the assumptions and principles allow for nursing practice where the nurse is a coauthor of the individual’s health.  The nurse does not try to change the individual’s personal view of what their health is or what the individual values as quality of life.  The humanbecoming theory has three aspects: illuminating, where the nurse invites the individual to share the meaning of the situation, and in so doing may bring an ‘aha’ moment to light; synchronizing rhythms, as the nurse, in true presence with the individual or family, goes with the ebb and flow of the relating process; and mobilizing transcendence, where the individual or family, in true presence with the nurse, move beyond the moment to a new illumination. “The Parse nurse lives the practice methodology through true presence with persons and families. True presence is a special way of “being with” in which the nurse bears witness to the person’s or family’s own living of value priorities.” (Parse, 1992, p. 40). The beauty of this is that the practice methods used by the humanbecoming nurse are based in pure nursing science as set out by Parse from the beginning development of her theory. Writing about what essentially is the art in the science of nursing, she states:

The nursing paradigm proposed in this book identifies unitary man as one who coparticipates with the environment in creating and becoming, and who is whole, open, and free to choose ways of living health. This is in contradistinction to a paradigm that views man as the sum of parts, acted upon and delimited by such terms as disease and pathology. (Parse, 1981, p. 7)

Humanbecoming has become a nursing school of thought. In the book Nursing Theories & Nursing Practice, Parse writes her own chapter, espousing her theory. The humanbecoming school of thought provides nurses with guidance for practice, leadership, education and research. Parse writes that the belief system is embraced across five continents in various educational programs and health centers. Parse specifically mentions Toronto, Canada, where Sunnybrook Health Science Center and the University Health Network work together to create health standards.

Humanbecoming theory guides practice in many parts of the world. Research from practice settings confirms the viability of using humanbecoming theory to guide practice. Parse acknowledges that shifting one’s practice to the art of humanbecoming is difficult requires a high level of commitment from one’s health care organization. A change in values across the institution is required to support a change to humanbecoming practice (Parse, 2010).

Potential for Advanced Practice Nursing

The humanbecoming school of thought is not without critics. Spenceley (2004) wrote that the paradigmatic split in nursing theory might be harming the discipline by limiting nurses, especially nurses who follow the simultaneity paradigm, by cutting them off from research and knowledge that is the mainstay of the totality paradigm. In an interview in 2001, Parse (Fawcett, 2001) states ‘I do not think that it is appropriate and fruitful to attempt a unified theory of nursing, but it is important to emphasize that both paradigms are nursing approaches’. In that interview, Parse states she believes the master’s level should be the entry level for nursing practice. The philosophy and theory at the master’s level would ensure nurses learned about nursing assumptions, paradigms and disciplines through education rather than through the medical model after graduation. It is expected that a theory will have critics, but Parse clearly believes that both simultaneity and totality paradigms are important to nursing. By acknowledging this, Parse does not criticize those who are immersed in the totality paradigm, but leads us to believe the theory of humanbecoming is the art in our practice we’ve been looking for.

Most health care systems in North America today follow the medical model. Nurses practicing in these systems also follow the medical model, albeit under a totality paradigm. Changing one’s practice from a totality paradigm to a simultaneity paradigm would be difficult if frameworks such as education and administrative support do not exist. The humanbecoming school of thought appears to be gathering more followers. If the theory doesn’t falter, the relatively small pockets of humanbecoming followers will be come larger groups. In some areas the larger groups will reach critical mass and system wide changes may then become possible. That is not today.

There is no question that for the advanced practice nurse, applying the nursing purity of humanbecoming theory would add many layers of depth to their nursing practice. The humanbecoming theory is more than a guide for nursing, it is a way of being a nurse. The question is, can humanbecoming be used in advanced practice nursing within a medical model? Not today.

 

References

Cody, W. K. (1995). About all those paradigms: Many in the universe, two in nursing. Nursing Science Quarterly, 8(4), 144-147. doi:10.1177/089431849500800402

Cody, W. K. (2010). Parse’s humanbecoming school of thought: A brief introduction. Retrieved February 1, 2012, from http://www.humanbecoming.org/human-becoming.php

Earle, V. (2010). Phenomenology as research method or substantive metaphysics? an overview of phenomenology’s uses in nursing. Nursing Philosophy : An International Journal for Healthcare Professionals, 11(4), 286-296. doi:10.1111/j.1466-769X.2010.00458.x

Fawcett, J. (2001). The nurse theorists: 21st-century updates–rosemarie rizzo parse. Nursing Science Quarterly, 14(2), 126-131. doi:10.1177/08943180122108319

Makkreel, R. (2011). Dilthey. In E. N. Zalta (Ed.), Stanford Encyclopedia of Philosophy. Retrieved January 21, 2012 from http://plato.stanford.edu/index.html

Malpas, J. (2009). Gadamer. In E. N. Zalta (Ed.), Stanford Encyclopedia of Philosophy. Retrieved January 21, 2012 from http://plato.stanford.edu/index.html

McConnell-Henry, T., Chapman, Y., & Francis, K. (2009). Husserl and heidegger: Exploring the disparity. International Journal of Nursing Practice, 15(1), 7-15. doi:10.1111/j.1440-172X.2008.01724.x

McDonald, W. (2009). Kierkegaard. In E. N. Zalta (Ed.), Stanford Encyclopedia of Philosophy. Retrieved January 21, 2012 from http://plato.stanford.edu/

Merleau-ponty. (2012). In Wikipedia, the free encyclopedia. Retrieved January 21, 2012, http://en.wikipedia.org/wiki/Merleau-ponty

Parse, R. R. (1981). Man-living-health: A theory of nursing.  (1st ed.). New York: John Wiley & Sons, Inc.

Parse, R. R. (1992). Human becoming: Parse’s theory of nursing. Nursing Science Quarterly, 5(1), 35-42. doi:10.1177/089431849200500109

Parse, R. R. (1997a). The human becoming theory: The was, is, and will be. Nursing Science Quarterly, 10(1), 32-38.

Parse, R. R. (1997b). Transforming research and practice with the human becoming theory. Nursing Science Quarterly, 10(4), 171-174. doi:10.1177/089431849701000409

Parse, R. R. (1999). Nursing science: The transformation of practice. Journal of Advanced Nursing, 30(6), 1383-1387. doi:10.1046/j.1365-2648.1999.01234.x

Parse, R. R. (2007). The humanbecoming school of thought in 2050. Nursing Science Quarterly, 20(4), 308-311. doi:10.1177/0894318407307160

Parse, R. R. (2010). Rosemarie Rizzo Parse’s Humanbecoming School of Thought. In M. E. Parker & M. C. Smith (Eds.), Nursing theories and nursing practice (3rd ed., pp. 227-289). Philadelphia: F. A. Davis.

Plummer, M., & Molzahn, A. E. (2009). Quality of life in contemporary nursing theory: A concept analysis: A concept analysis. Nursing Science Quarterly, 22(2), 134-140. doi:10.1177/0894318409332807

Robertson‐Malt, S. (1999). Listening to them and reading me: A hermeneutic approach to understanding the experience of illness. Journal of Advanced Nursing, 29(2), 290-297. doi:10.1046/j.1365-2648.1999.00830.x

Rogers, M. E. (1994). The science of unitary human beings: Current perspectives. Nursing Science Quarterly, 7(1), 33-35. doi:10.1177/089431849400700111

Shearer, B. C., & Reed, P. (2012). Parse’s criteria for evaluation of theory with a comparison of fawcett’s and parse’s approaches. In Perspectives on nursing theory (6th ed., pp. 358-360). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Spenceley, S. M. (2004). Out of fertile muck: The evolving narrative of nursing. Nursing Philosophy : An International Journal for Healthcare Professionals, 5(3), 201-207. doi:10.1111/j.1466-769X.2004.00187.x

Wang, C. H. (2008). Working with older adults: A nurse practitioner’s experience from a humanbecoming perspective. Nursing Science Quarterly, 21(3), 218-221. doi:10.1177/0894318408320150

Wheeler, M. (2011). Heidegger. In E. N. Zalta (Ed.), Stanford Encyclopedia of Philosophy. Retrieved January 21, 2012 from http://plato.stanford.edu/index.html

 

Appendix A

Parse’s Philosophical Assumptions
1. The human is coexisting while coconstituting rhythmical patterns with the universe.
2. The human is open, freely choosing meaning in situation, bearing responsibility for decisions.
3. The human is unitary continuously coconstituting patterns of relating.
4. The human is transcending multidimensionally with the possibles.
5. Becoming is unitary human living health.
6. Becoming is a rhythmically coconstituting human-universe process.
7. Becoming is the human patterns of relating value priorities.
8. Becoming is an intersubjective process of transcending with the possibles.
9. Becoming is unitary human evolving.
(Parse, 1997b)

 

Appendix B

Humanbecoming Assumptions
1. Human becoming is freely choosing personal meaning in situation in the intersubjective process of relating value priorities
2. Human becoming is cocreating rhythmical patterns of relating in mutual process with the universe.
3. Human becoming is cotranscending multidimensionally with the emerging possible.
(Parse, 1997b)

Appendix C

Humanbecoming Principles
1. Structuring meaning multidemensionally is cocreating reality through the language of valuing and imaging.
2. Cocreating rhythmical patterns of relating is living the paradoxical unity of revealing-concealing and enabling-limiting while connecting-separating.
3. Cotranscending with the possibles is powering unique ways of originating in the process of transforming.
(Parse, 1997b)

 

Appendix D

Parse’s Research Methodology
Phenomena
  • Phenomena for study in this method are universal human health experiences surfacing in the human-universe process reflecting being-becoming, value priorities, and quality of life.
  • Structure of the phenomenon to emerge through this method is the paradoxical living of the remembered, the now moment, and the not-yet, all-at-once.
Process of the method
  • Participant selection.
  • Dialogical engagement (a researcher-participant true presence, not an interview).
  • Extraction synthesis (dwelling with).
  • Extract and synthesize essences from transcribed and recorded descriptions in the participant’s language.
  • Synthesize and extract essences in the researcher’s language.
  • Formulate a proposition from each participant’s essences.
  • Extract and synthesize core concepts and from the formulated propositions of all participants.
  • Synthesize a structure of the living the living experience from the core concepts.
  • Heuristic interpretation.
  • Structural integration.
  • Conceptual interpretation
(Parse, 1997b)

 


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  6. ANNE RENDEIRO says:

    Why is there virtually NO CRITICISM of Parse theory? It is as if it simply does not exist! When one searches for it all that comes up is HER SPONSORED JOURNAL and that’s it! Kinda Orwellian creepy.

    • misterhunt says:

      When I first researched Parse’s theory of Humanbecoming, I saw she developed a way of thinking tangental to the nursing theory of the time. In many ways, Humanbecoming is even more at odds with western nursing today than when the theory developed: Nursing in the West is aligning with medicine—acute care nursing the most vulnerable. The more I study Nursing and Health Information Sciences, the more I see ALL clinicians—other than physicians—being left behind as technology is applied to everything in health care.

      Still, I do love the purity of the theory of humanbecoming. It is a lot easier to apply to nursing than medicine. Unlike the totality paradigm, the simultaneity paradigm perspective has a better fit for my view of what nursing should be.

      Unfortunately, Humanbecoming will not be able to sway nurses away from medicine in the time I have left to practice.

      There is plenty of criticism against Parse’s theory. In the world of academics, you’ll have to look at a few articles of each paradigm, understand what each stands for, and see how they mutually exclude each other in many ways. It’s the polite, academic, way to state your beliefs.

      You might try reading this.
      Spenceley, S. M. (2004). Out of fertile muck: The evolving narrative of nursing. Nursing Philosophy : An International Journal for Healthcare Professionals, 5(3), 201-207. doi: 10.1111/j.1466-769X.2004.00187.x

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