Margaret A. Newman and Her Theory Live in Our Nursing Practice

The Newman Theory/Research/Practice Society, a nonprofit organization (NPO) in Japan, was established in August 2016. Its origins date back to 2006, when 15 nursing educators and practicing nurses with an interest in Newman’s theory and practice participated in the Newman Dialogue held at the University of Tennessee College of Nursing. The Newman Dialogue is a meeting convened every 1 to 2 years in the United States, where Newman scholars gather to engage in dialogue centered on Margaret Newman’s work, with the aim of advancing the theory and practice of Health as Expanding Consciousness (HEC). Inspired by the enriching experience of being welcomed into Dr. Newman’s home, our Japanese participants established the Newman Theory/Research/Practice Study Group the following year, with the aim of “pursuing the science and art of caring.” Under the auspices of this study group, we have held study sessions three times a year and one dialogue meeting annually. After reaching the 10th year of these activities, and with a desire to contribute more broadly to nursing practice, we took the step of establishing an NPO. Therefore, the year 2026 marks both the 20th anniversary of the study group’s founding and the 10th anniversary of the NPO’s establishment. Current membership is approximately 120 nurses.

Hoping for continued sustainability and future development, we celebrate this year as a year of blessing. Below, we describe how Japanese nurses first encountered Margaret Newman’s theory, formed a group, developed an understanding of the theory, and integrated it into everyday nursing practice.

The journey began with an initial encounter with Newman’s theory. This occurred when one of the authors, Endo (hereafter referred to as “I”), met Margaret Newman at the University of Minnesota. The meeting took place in a course titled “The Phenomenon of Health,” which was open to all graduate nursing students and attended by approximately 20 students. The course was already two or three sessions underway, and the topic that day focused on the explanation of “patterns.” Newman illustrated patterns by drawing shapes on the whiteboard, saying things such as, “A pattern might look something like this,” while sketching trapezoids or jagged figures. At the time, I did not understand any of it. Nevertheless, by the end of the class, I felt as though I had been struck by lightning. A powerful conviction arose within me: I wanted this professor to be my doctoral dissertation advisor. Within the next few days, I resolved to act, visited Newman’s office, and asked her directly to supervise my dissertation. She looked at me with a surprised expression and said something like, “Show me your paper.” I returned with a literature review on cancer patients titled “Cancer Patients Become Whole Through Cancer.” Upon seeing the title, Newman stated, “Human beings are unitary beings, whether they develop cancer or not,” and fixed her gaze on me (personal communication, fall 1992). Needless to say, I was startled. However, before long, I found myself attending her seminar, reading texts on new science, and engaging in dialogue during class.

Since then, I have struggled to come to terms with what is called New Science (Bentov, 1977; Bohm, 1980; Prigogine & Stengers, 1984). In Newman’s office, the Japanese word “satori” (enlightenment), written in brush calligraphy, was displayed. Satori is a Buddhist term, and it is widely recognized that Buddhist thought and New Science share common foundations (Capra, 2025; Wilber, 2001). At that time, however, I had no knowledge about either. In fact, my purpose in going to the United States was to rigorously study scientific research methods in nursing science, which made this coincidence a genuine “encounter.” Within the framework of Newman’s theory, it was an encounter with the environment—an encounter between nurse and client. In Buddhist terms, it was truly the reception of “fateful connection.” I was filled with deep gratitude, and I became firmly resolved to share this encounter broadly with Japanese practicing nurses.

Newman asked the two or three students from East Asia what “satori” meant. We responded as best we could within our limited understanding. Ultimately, Newman came to interpret “satori” as “liberation and freedom accompanying pattern recognition” in parallel with Young’s theory (Newman, 1994, p. 42; Young, 1976, p. 181). This expression represents the very core of Newman’s theory. Through this process, human beings move toward higher levels of consciousness (Newman, 1994).

In her contribution to the Japanese edition of HEC, Newman wrote, “It seems my theory is connected to your spiritual heritage.” This observation is likely accurate. We hold deep affection for Margaret Newman and her theory, resonate strongly with its principles, and continue our activities with the hope of disseminating this theory more widely among Japanese practicing nurses.

Below, members of our society have selected meaningful passages related to “pattern recognition” from Newman’s theoretical works. We then sought to relate their meanings to nursing practice through careful reflection and in-depth examination. Through this process, we confirm that Newman and her theory are indeed alive within our nursing praxis (Newman, 2008, p. 21), and we describe these revelations here.

Satori: Liberation and Freedom Through Pattern Recognition Revealed in the Experience of Margaret’s Mother With ALS and Her Daughter

What I do want to share is my realization that life had to be lived in the present, and that if one were to be happy, it had to come one day at a time. I learned that my mother, though physically incapacitated, was a whole person, just like anybody else. I came to know her and to love her in a way I probably never would have taken the time to experience had she not been physically dependent. The five years I spent with her before she died were difficult, tiring, restrictive in some ways, but intense, loving, and expanding in other ways. (Newman, 1994, p. xxii)

We believe this insight—the liberation and freedom that accompany pattern recognition—is most clearly expressed in the passage above, which describes Newman’s experience with her mother, who developed amyotrophic lateral sclerosis (ALS). This experience later became the foundation for her theory of HEC. The ALS diagnosis disclosed to her mother was apparently shared with Margaret around the time Margaret entered university. However, preoccupied with university life, Margaret appears to have paid little attention to it. After graduating and returning home, however, she was confronted with the undeniable reality that her mother had become dependent on others. Together with the rest of the family, mother and daughter searched for ways to restore her mother’s physical functions, but without success. Reflecting on that period, Newman wrote: “Eventually, it became painfully clear that she and our family just had to learn to live with her losses. My experience was one of learning to live day by day. There was no past or future” (Newman, 2008, p. 1).

How many times have we read this passage, seeking to deepen our understanding of Newman’s experience? And how often have we shared it with nursing students and practicing nurses, engaging in dialogue to connect more closely with Newman’s insights?

We imagined that Margaret and her mother—who had loved dance and music—must have repeatedly lamented and grieved over why their movement was constricted, reminiscing about the days when they were doing well. Yet, we wondered why, in such difficult circumstances, Margaret came to understand and love her mother so profoundly. We then realized that Margaret, as the caregiver, must have recognized her own pattern of care—that is, she was focused on the disease ALS itself and on the symptom of physical immobility. By acknowledging this caregiving pattern, she was able to grasp its meaning and gain deeper insights. Newman wrote, “I learned that my mother, though physically incapacitated, was a whole person, just like anybody else” (Newman, 1994, p. xxii).

Her perspective on her mother changed, which in turn transformed the meaning of living in the present and altered her feelings toward her mother as well as the way she cared for her. In other words, we understand that both daughter and mother recognized their shared pattern of being trapped by the harrowing experience of ALS. They were able to reframe this experience from a new perspective and accept it as a different, meaningful experience. This is the essence of Newman’s theory—namely “pattern recognition.” Medically, the mother was indeed ill; however, from the nursing perspective, Newman asserts that she was, in fact, truly “healthy.”

2. A Nurse’s Recognition of Her Own Care Pattern Brings About Differences in Her Nursing Practice

The way in which nursing theory is applied is by virtue of the transformation that is taking place in the person of the nurse. The transformation constitutes the nurse’s field and through the interpenetration of the nurse–client field, it becomes the client’s field. Whatever transforms you, transforms your practice. (Newman, 1994, p. 116)

The citation above emphasizes that to effectively apply HEC in nursing practice, it is not enough to simply acquire knowledge; the nurse must undergo a personal transformation. For this to happen, nurses need opportunities to recognize their own care patterns, which requires an “experience” in which nurses themselves undergo transformation. This process allows nurses to move beyond their previous ways of practicing, deliver more meaningful care to clients, and consequently make differences in those clients. In other words, the nurse’s transformation becomes her own field, which then extends into the client’s field through the mutual interconnection of the nurse–client relationship.

One of the authors, Ikeda (hereafter referred to as “I”), developed a deep understanding of this through her own experience of significantly transforming her nursing practice by recognizing her own care pattern. I will first describe my personal experience. Subsequently, I will share examples of how practicing nurses new to HEC have undergone similar processes, resulting in changes in their care.

Part 1: Transformation in My Own Care Pattern Through Learning HEC and the Differences It Created Within Patients

I am a Certified Nurse Specialist (CNS) in Japan, working at a cancer consultation support center in a general hospital. While caring for a patient who repeatedly confided, “Why must I alone suffer so much?” I feared that exploring anguish might only deepen her pain. Consequently, I had been practicing what is commonly called active listening and empathy for a few years. However, after learning Newman’s assertion mentioned earlier, I deeply desired meaningful change for my practice and my patient. Simply acquiring knowledge, though, did not transform my nursing practice, and the patient continued to express her suffering repeatedly. Determined to improve, I resolved to document and reflect on my nursing practice, using it as material for dialogue with colleagues. Through this process, I came to recognize my own care pattern: “My interactions with patients remained limited to momentary responses, failing to conduct HEC care that supports patients taking a step forward.” This realization ignited a strong desire to move toward caring that more deeply supports patients’ essential needs.

After this experience, I encountered a male patient in his 50s who was preparing to be transferred to a hospital with a palliative care unit. He spoke of unfinished business, saying, “Before I die, I want to express my gratitude to those around me,” while also expressing loneliness in the face of death. As the transfer date approached, he became increasingly agitated, complaining of severe pain and refusing to be transferred. The staff were uncertain how to handle his distress.

When I visited the patient at the staff’s request, he firmly stated, “I don’t want to transfer.” I recognized this as a message rooted in deeper emotional turmoil. Offering sincere concern, I honestly shared my feelings: “Are you afraid because death seems to be approaching?” He snapped back, “Yes!” In that, I realized that I had touched his core need—a profound insight that I likely would have missed before. The underlying thought in my previous care pattern—“If I push further, the patient’s suffering will only increase, so I should avoid it”—was gone. I also clearly recognized my own care pattern: “My intuition is right! This is why I always stopped, unable to move forward!” Guided by HEC, I chose to trust the patient’s inner strength and take a courageous step forward. I said, “I feel you are not your true self right now. You mentioned having unfinished business. I believe you have the strength to address it.” After a moment of silence, the patient groaned, then shouted, “That’s right!” He reached out with both hands for a handshake, tears streaming down his face, and immediately agreed to transfer to the other hospital.

This moment was a genuine turning point for both the patient and me. It can be understood as the interaction of the patient’s field and my own, progressing together toward a higher level of awareness. In other words, it exemplifies the practice Newman describes in the citation above: when the nurse undergoes personal transformation, her field changes, and through this transformed field, the patient’s field is transformed as well.

Part 2: Transformations Through Recognition of Their Own Care Patterns by Practicing Nurses Learning HEC and the Differences Brought to Patients

The Newman Theory/Research/Practice Society (NPO) offers a six-session course consisting of 2-hour study meetings held every two months that are designed as an introduction for practicing nurses to understand this theory. Under the guidance of experienced leaders, participants engage in reading and reflecting on excerpts from HEC and participate in group dialogue. In the final session, each participant, within the limits of their own circumstance, practices the dialogue as “caring partnership” with a partner as proposed by Newman and then shares each experience within the group.

These reports demonstrate how, after recognizing their own care pattern, each nurse’s practice was transformed, how relationships with clients changed, and how a difference subsequently emerged within each client and their environment. Below are case reports from five participants.

Case 1: The Transformation of a Nurse Who Recognized Her Own Care Pattern, “Prioritizing What She Believes as Right Care,” and the Differences Brought to the Client and Nursing Team

A female client in her 50s, living with her husband who has schizophrenia, was hospitalized due to a rib fracture and was undergoing rehabilitation in preparation for discharge. When the client requested, “Please give me water,” Nurse A encouraged her to sit up to improve her activities of daily living. However, at that moment, both the client and her husband reacted with intense anger toward Nurse A, shouting, “I can’t get up yet!”

Nurse A hesitated briefly but then recalled what she learned from HEC. She attempted to focus on the meaning of their pattern manifested as anger and empathize with the couple’s experience. Simultaneously, she recognized her own care pattern: “prioritizing what she believes as right care.” She realized the importance of genuinely explaining the intent and necessity of care. Nurse A sincerely told the client, “To help you maintain your strength, let’s practice moving together.” The client then understood the need for rehabilitation and was able to explain her underlying anxiety: “Actually, my diabetic cataracts suddenly worsened, causing me to lose vision, and I fell down and fractured my bone. That’s why I was afraid of moving my body.”

Nurse A reframed the couple’s anger as anxiety about the impending discharge and shared her perspective within the nursing team. As a result, the entire team began to empathize with the couple’s situation and provided coordinated support for discharge. This enabled the couple to prepare for discharge with greater peace of mind.

Case 2: The Transformation of a Nurse Who Learned a New Nursing Approach, “Trusting the Client’s Inherent Strength of Self-Organization” and the Difference Brought to an Alcoholic Client

A male client in his 40s, who had been hospitalized repeatedly for alcoholic pancreatitis, expressed despairing words such as, “I don’t care what happens anymore” and “I want to die soon.” Nurse B sensed that this attitude represented a clear departure from his usual demeanor. She recalled an idea learned during an HEC study session: the nursing approach of “supporting clients in utilizing their inherent strength.” However, at that moment, she was unable to take a step forward and instead remained by his side while feeling inadequate.

On the day the client was scheduled to transfer to another facility to commit to abstaining from alcohol, he was completely sober, and Nurse B felt that it was an appropriate time to engage in dialogue with him. Summoning her courage to “trust the power within the client for self-organization,” as emphasized in HEC, Nurse B asked, “I believe now is a turning point in your life. What do you want truly?” After a moment of silence, the client replied, “I certainly want to change myself, but I don’t know how.” He continued, “I have friends who deliberately encourage me to drink, and I can’t refuse them.” As she listened, Nurse B became confident in the client’s inner strength. With a touch of humor, Nurse B conveyed, “I’m on your side. Just say to them, ‘I don’t want to get yelled at by that scary nurse.’ You can do it.” The client then exclaimed, “Oh, right!” as if suddenly recognizing his own power, and broke into a smile. The following day, he was transferred as planned, and since then, the nursing staff have not encountered any readmission.

Case 3: The Transformation of a Nurse Who Understood the Meaning of Accompanying Holistic Care Beyond Verbal Communication, and the Differences Brought to the Client and Nursing Team

An elderly male client in his 80s with dementia, who was unable to understand the reason for his hospitalization for aspiration pneumonia, occasionally removed his IV line by himself. One day, Nurse C witnessed a colleague restraining him as he repeatedly attempted to stand up on his own. Noticing the client’s sorrowful expression, Nurse C asked, “What’s wrong?” The client replied, “The nurse looked very busy, so I thought I’d help her.” At that moment, Nurse C realized the profound truth expressed in HEC: “It is possible to come to know another without words―someone, perhaps, who cannot speak” (Newman, 2008, p. 56).

Previously, Nurse C had believed that HEC-based nursing practice was not feasible with clients who had difficulty with verbal communication. However, this encounter with the elderly man led her to clearly recognize her own care pattern: “I hadn’t deeply understood the meaning of interaction with a client as a whole being.” She immediately grasped the importance of nursing practice that does not rely solely on words, but instead elicits the client’s wholeness through actions and expressions as patterns, while attending to the meaning.

After the client stood up, Nurse C, attuned to his feelings, asked, “Would you like to walk with me?” The client brightened and smiled with joy, sensing that his whole-body communication had been understood. He then began to move his wheelchair by himself. Witnessing this interaction, the ward nurses gradually began to adopt HEC-based approaches in their own practice as well.

Teaching-Learning Cases

HEC was also applied to mentoring junior nurses and nursing students. Nurse D, who had been struggling with mentoring junior nurses, recognized her own teaching-learning pattern: “I believed I had to solve problems entirely on my own without relying on anyone else.” This realization gave her the courage to consult her supervisor and colleagues. As a result, she felt relieved and adopted a more open approach in mentoring. Consequently, the junior nurses—who had previously feared connecting with clients’ true feelings—also transformed their practice, providing more compassionate care that was free from fear.

Furthermore, a nurse instructor, E, reflected on her tendency to focus solely on an explanation during student guidance. She recognized her own teaching-learning pattern: “My desire to guide students correctly takes precedence, leading me to instruct them unilaterally.” This left little room for interaction between instructors and students. This realization prompted her to intentionally soften her approach, trusting in the students’ abilities while guiding them. This shift in the instructor’s stance was reflected in the students themselves, who began to engage in two-way interactions with clients and support them in taking actions to improve their lifestyle habits.

Discussions

The various practices described above support Newman’s assertion that nurses’ transformative experiences, achieved through pattern recognition, can foster pattern recognition in clients and others. Nurses who studied HEC, while reflecting on their own practice, began to recognize their existing care patterns, such as problem-solving-oriented thinking, “should” thinking, and even forms of care that hesitate to approach the whole person as a means of self-protection. Once nurses began to let go of these constraints, they experienced liberation and freedom—that is, “satori.” Through this process, each nurse shifted from focusing on the client’s “part” to perceiving the whole person as a “pattern.” As Newman explains (Newman, 1994, p. 105), the waves radiating from each person interact with one another, forming an interference pattern that becomes part of each person’s pattern. These findings clarify Newman’s claim that merely acquiring knowledge is insufficient to put HEC into practice; rather, the nurse’s own transformative experience is the essential key.

3. Even Within Busy, Limited Time Frames, Focusing on “Pattern Recognition” Enables Care Guided by Newman’s Theory

The shift is from treatment of symptoms of disease to search for patterns; from viewing pain and disease as wholly negative to viewing them as information about the pattern of the whole; from seeing the body as a machine in good or bad repair to seeing the person as a dynamic field continuous with the larger environmental field; from seeing disease as a separate entity to seeing it as a unitary process. (Newman, 2008, pp. 11-12)

Our research group has recently focused on how Newman’s theory can be applied within busy clinical settings. Newman’s process of pattern recognition (Newman, 2008, pp. 89-91), referred to as a caring partnership, recommends repeated dialogue and is indeed caring valued by patients and families (Endo, 1998; Imaizumi et al., 2021; Mitsugi, 2019). However, applying this process directly within the constraints of brief, routine client–nurse interactions proved challenging, which led us to continue our exploration. What we ultimately discovered is that by focusing on “pattern recognition,” even very limited time can allow for Newman-guided accompaniment. In other words, we came to deeply appreciate the significance of Newman’s opening message, which proves particularly crucial amid the complexities of clinical practice. Below, we present several examples from our practice.

Case 1: Supporting an Outpatient and Family in Distress After Receiving News of Surgery Postponement Following Cancer Diagnosis

Mr. A was a single man in his 40s who had a panic disorder and was living with his parents. After being diagnosed with esophageal cancer and having a surgery date scheduled, the procedure was postponed for 2 weeks due to hospital circumstances, and this change was communicated to Mr. A. A few days later, Mr. A called the outpatient clinic.

Mr. A:

I’m panicking, worried about what happens if my condition worsens. My body won’t stop shaking, and even my meds aren’t helping. Could I die if I took a lot of sleeping pills? I’m at my limit!

Sensing that Mr. A and his parents remained unsettled despite the physician’s explanation, the nurse approached them. Mr. A explained that he had mentally prepared himself for the surgery and that the postponement had intensified his anxiety and sense of distrust. The nurse recognized that Mr. A had been making a desperate effort to face his illness despite being deeply shaken by the cancer diagnosis, and she conveyed this understanding to them. In response, his father, with tears in his eyes, said to Mr. A, “Should we talk about that, too?” In that instant, the tense atmosphere softened, and a sense of calm filled the room.

Mr. A:

A few years ago, after separating from my wife, I lost contact with my son. I fell into despair and started living recklessly. When the cancer was found, I researched and tried to change my lifestyle. I lost weight after cutting carbs, so now I’m working hard at strength training. I want to do whatever I can to beat this cancer.

Nurse:

So, you’ve been trying to rebuild your life in a very disciplined way.

Mr. A:

Looking back, I think I’ve always overthought everything and pushed myself too hard. I want to be a father my son isn’t ashamed of. I still want to live.

His parents nodded tearfully, and in that moment, everyone became one. Although the conversation lasted only approximately 10 minutes, Mr. A was able to release his relentless striving and, within his family, reaffirm that he could move forward with peace of mind. Later, Mr. A underwent surgery safely.

The nurse focused on perceiving the meaning behind Mr. A’s reactions that emerged when his surgery was postponed. Recognizing his pattern of “charging recklessly down the path he believes in,” she responded with a simple phrase, “You pushed yourself stoically.” This helped Mr. A recognize his pattern, gain insight, and take steps toward a hopeful future. This brief but timely interaction supported his pattern recognition precisely when he was in distress, connecting past struggles to opening new possibilities. Even in a short encounter, it exemplified Newman’s process of accompaniment.

Case 2: Accompanying a Terminally Ill Patient and Their Family Facing the Progression of Cancer and Experiencing Shock

Mr. B was an octogenarian living with his wife, who had Alzheimer’s disease, for whom he had been the primary caregiver. A year earlier, he had been diagnosed with pancreatic cancer and undergone treatment; however, the therapy was unsuccessful. He was now experiencing symptoms such as shortness of breath and ascites. Following his doctor’s advice, Mr. B visited the palliative care clinic with his wife and their son, who lived nearby.

Though confined to a wheelchair, Mr. B sat upright and stated, “I want to know what I can eat to regain my strength, even if it’s just a little. I don’t need hospitalization. I can move around on my hands and knees, so I don’t need a nursing bed.” When asked who supported him, he replied firmly, “I’ve been supporting my wife.” His wife murmured, “Oh dear,” with a forced smile, while their son quietly observed his parents.

The CNS quickly identified the patterns within Mr. B’s family—both individual and collective. Mr. B was driven by a strong sense of responsibility to protect his family; his wife was bewildered by the change in the husband she had always relied on; and their son was concerned about his parents’ condition. This pattern revealed a family dynamic centered around Mr. B. Yet, faced with the severity of his illness, Mr. B was wavering, erecting barriers against receiving care from others. The CNS also recognized how Mr. B’s wavering was rippling through the entire family. Believing that helping them recognize this pattern could be beneficial, CNS said to Mr. B:

CNS:

You’ve been searching for something to eat, even just a bite, that would give you energy for your family, haven’t you?

Mr. B:

I’ve been the one holding this family together. But . . ..

Mr. B held back tears, his back trembling. Sensing that Mr. B was recognizing his pattern and striving to overcome this difficult phase, the CNS conveyed his honest feelings back to him.

CNS:

You have a very strong son.

The son approached Mr. B and gently placed a hand on his shoulder. Mr. B’s tense expression softened, and the two exchanged glances and nodded. Turning to his wife, who had seemed restless, she responded to the look of relief, resolve, and trust reflected in their expressions with a smile. All of this unfolded in approximately 10 minutes.

Afterward, Mr. B shifted from forcefully leading the family to entrusting them. His wife interacted with him calmly, and their son took on a central role within the family. The family’s overall pattern evolved from a Mr. B-centered relationship to one of shared living. A few weeks later, Mr. B passed away peacefully.

In Case 2, the CNS consciously observed both individual and family interaction patterns within the limited time available. Trusting in the family’s power within, the CNS conveyed Mr. B’s words reflecting the suffering of “no longer being able to protect my family as its center.” This allowed Mr. B to recognize his own pattern and to find his potential actions. He turned his attention toward his remarkably grown son, and found the direction to entrust his role to him. Mr. B’s realization enabled the entire family to evolve into a new relationship. Mr. B’s transformation rippled through the entire family vividly, which embodied the essence of Newman’s theory: the part reflects the whole, and conversely, the whole reflects the part.

Case 3: Support for a Woman Who Lost a Child in the Hospital as She Faced Her Own Cancer Treatment

Ms. C was a woman who had lost her infant child, who had died in the hospital. When she herself required cancer treatment, seeing medical equipment triggered painful memories of her child, causing her to hyperventilate. Although the CNS offered support from the medical team, Ms. C expressed distrust, stating, “I distrust hospitals and medical professionals. Please don’t make a fuss if I hyperventilate. It’s sad that the body I shared with my child is gone, but it can’t be helped.” The CNS immediately recognized a pattern: Ms. C was guarding herself against confronting her loss, enduring anxiety to receive treatment. Wanting to understand Ms. C as a whole person, the CNS gently invited her to share her concerns. Ms. C then spoke about her past hospital experiences, her feelings for her child, and her feelings toward medical professionals, at times using taboo words. She later said, “Thank you for considering this. I trust the medical team that you as a CNS trust,” accepting the support. It was a moment that felt like Ms. C firmly grasping the hand the CNS had extended.

The CNS shared Ms. C’s patterns with the medical team and collaboratively discussed the care approach from admission to surgery. Within the team, a shared commitment to support Ms. C—who had experienced the loss of a child—spread like ripples. Although the CNS did not directly engage with Ms. C throughout her hospitalization, team members provided compassionate support in the operating room and on the ward. They spoke gently to the child’s photo and ensured that the surgery proceeded safely. Each of these acts of care required only approximately 10 minutes and were integrated into routine care. During a post-discharge outpatient visit, Ms. C spoke with the CNS; her expression was calm and relaxed.

Ms. C:

There wasn’t a single unpleasant thing during my hospitalization. Everyone said my child’s photo was cute, and that made me happy. It added to my good memories of the hospital.

CNS:

It seems you can move forward from here.

Ms. C:

I believe the surgery was necessary for me. I have no regrets. I feel like I’ve been reborn.

The CNS in Case 3 recognized Ms. C’s pattern: despite experiencing panic-inducing anxiety rooted in the grief of losing her child, she struggled to trust healthcare providers and closed herself off to endure the pain. When the CNS offered deep, compassionate care, Ms. C recognized her own pattern, opened up, and accepted the support of the medical team. Having endured the loss of her child, faced her own surgery, and gained insights into the meaning of that experience, Ms. C underwent the process of expanding consciousness and discovering profound meaning in life.

Discussions

In all three cases, within a limited timeframe, the nurses focused their interactions on facilitating pattern recognition in patients and families, accompanying them on the journey toward a higher level of consciousness. From the perspective of Newman’s wholeness-based theory, the phenomena we observe are not isolated entities but the unfolding of meaningful patterns. As Newman asserted, “If we’re looking for pathology, we see pathology; if we’re looking for patterns, we see pattern” (Newman, 2008, p. 45). The nurses’ interactions exemplified the practice of shifting perspective to a paradigm of wholeness and focusing on patterns.

As described in Part 2, in Japan, we have advanced the practice of HEC by developing a process of intentional study of HEC theory. This process brings nurses who are studying the theory together to reflect on their care pattern and to dialogue with other nurses on how HEC is embodied in their practice. Then in Part 3, through dialogue rooted in such nursing practice within our study group, we liberated ourselves from the belief that Newman’s theory-based practice is impossible in busy clinical settings. We clearly recognized that what matters is not the length of time spent with patients and families, but whether the theory is alive within the nurses’ presence. Moreover, we confirmed that precisely because practice occurs within busy, limited time frames, it is even more essential that the theory be deeply internalized by the nurse. Indeed, theory lives within practice, and practice gives life to theory, and vice versa.

Closing Reflections

Newman stated that nursing demands the utmost intelligence and the highest degree of humanity. Through her undergraduate and graduate studies and her encounter with Martha Rogers who had led New Science in nursing (Rogers, 1970), Newman’s thinking further evolved, leading to the proposition that “health is expanding consciousness.” She asserted that understanding this means “illness and disease lose their power to confuse human beings” (Newman, 1994, p. xxiii). She continues to call to us, proclaiming that nursing is an activity that creates difference, and the driving force behind this difference is the client’s own inner power. The transformation arises in the context of the nurse’s presence.

Newman herself must still be evolving as an expanding consciousness. Expanded consciousness is equivalent to deep love. Having been blessed with the opportunity to encounter Newman’s theory, we feel this love every time we interact with a client, and we sense it expanding within ourselves in the same way. We are grateful for this profound fulfillment and aspire to further integrate it into nursing practice.