"Here is a secret I never told Maybe you'll understand why I believe if I refuse to grow old I can be young till I die. " from Pippin, lyrics by Stephan Schwarte, Motown Records, 1972,
"The deterioration caused bysenescence is irreparable and we know that year by year it ts going to increase. It is perhaps this which is most piercingly sad about growing old - this feeling of irreversibility." 1
Two statements, two views, two models of aging. deBeauvoir presents just one example of the entropie view of aging. This view of man is one of regression and undifferenfiations, a state of being homogeneous, not heterogeneous. This theory presents aging as a uniform winding down process that is closed, one dimensional and in a progressive state of decline. Until recently, this data has had much influence on the various aspects of the aging process.2
In many nursing homes, this theory still prevails, since a more optimistic view of aging has not filtered down to the grassroots of gerontological nursing practice. If one walks through an extended care facility and observes the aged sitting in their chairs, one can see that the self-fulfilling prophecy of winding down has left its mark. The residents appear to be joyless - living, they want to die - they welcome death.
Another view of growing old is a negentropic model - a model of negative entropy. With this view of aging, man is defined as becoming more complex, increasing in diversity, increasing in heterogeniety, more enriched, not a winding down, but a speeding up.3 This view of aging presents a positive attitude to the developmental process of growing old. When a nurse perceives this view of the aged, the delivery of health care to the aged by the nurse will be geared to higher expectations of her client, and more positive interactions between the client and nurse.
The literature supporting the entropie, décrémentai model of aging is abundant in biological, psychological, sociological and health care services. Kastenbaum's "molecular manifesto" relates aging to irreversible cell mutation which eventually leads to senescence.4 Cummings' disengagement theory caused much stir in 1961 by stating that the aged gradually withdraw from society and society withdraws from the aged individual.5 Although this may be true of some aged, it is definitely not a universal phenomenon. Futrell and Jones stated health professionals have little respect for geriatrics.6 This negativism is due partly to society's attitude to the aged and the chronicity of their problems. In 1971, Campbell stated that the attitudes of health care workers toward the aged were those of dependency, inactivity and isolation.7
Supportive literature for the negentropic view of the aging process is becoming more abundant in nursing today. Since 1970, nursing theory has been trying to reconceptualize aging in accordance with a more positive way of thinking. Neugarten states "with the passage of time, life becomes more, not less, complex; it becomes enriched, not impoverished. "8 Strumpf writes that data utilizing the negentropic model of man should be interpreted, rather than following the entropie view.2 In this way, the negentropic model of continuous, creative development will weaken the entropie view of progressive decline. Eliopoulos states in her book that there is a growing awareness; concerning the unique needs and problems of the elderly which require specialized nursing attention.9 The gerontological nurse must possess skills that attest to these diversities and must recognize that aging is a highly individualized process with each individual having different outcomes.
Ebersole and Hess state "A new age is dawning for old age. " 10 The concept of aging shows unlimited growth potential and serves to challenge the mechanistic model that previously interpreted our world concerning the aging process. Carnivelli and Patrick say that a person does not become part of a homogeneous group at any given age. 11 Heterogeniety is prevalent in all ages and those working with the elderly especially must be reminded of this fact.11 In the past we have tried to collect all older people into a group with the term "aged," making generalizations and predictions about the group on that basis. This theory is not plausible because as man progresses along the life cycle there are various interactions with the environment, and these interactions become more complex as the individual ages. Human development becomes more, not less, differentiated.12
The conceptual framework in nursing practice that lends itself to the negentropic view of aging, was formulated by Martha Rogers. This model described unitary human beings as unified wholes, more than, and different from, the sum of their parts; identified by pattern and organization, continually exchanging energy with the environment.3 *Rogers' model deals with four building blocks: energy fields, open systems, pattern and organization, and four-dimensionality.
Field - The unifying concept in the model . It replaces the cell as the fundamental unit of living and non-living substance. The cell theory has lost precedence. Fields have no boundaries, only imaginary parameters as we assign them; define the boundaries, then study whatever you want.13 If you follow the field theory, then you can formulate arguments against Kastenbaum 's grim perspective of aging related to the dying of the cell.2
Open systems - a system that exchanges energy with the environment and all living organisms. It is a negative entropie system that does not run down , increases in complexity, and is a contradiction of steady state.
Pattern and organization - present always, always changing; you can predict with only a probability of being correct. Pattern and organization identify energy fields; human and environmental fields are characteristic of wave patterns that never are steady. They become more complex as the life process evolves.3
Four-dimensionality - this is Rogers' ultimate abstraction; it is characteristic of human field and environmental field. It is a domain that is non-linear without spatial or temporal qualities. The relative present is different for everyone.15 There is an explanation for paranormal events. Past, present and future are all in the fourth dimension. Rogers describes this concept as "a mad leap into the unknown."13
It is necessary to look at the principles of hemodynamics, which are derived from the four building blocks, in order to translate Rogers' model into nursing practice. These are representations of reality and can be tested to verify their usefulness.3
Reasonancy - the change in the man environment reaction takes place by means of wave phenomena. These increase in complexity and diversity. The developmental process of growth is an example of this principle.3
Helicy - the mutual, simultaneous interaction of man and the environment, never repeating, increasing in complexity. The process of negentropic evolution is part of this principle.3
Integrality** - it is inherent in helicy. The mutual, simultaneous interaction of man and environment is a continuous flow - one does not cause the other. Man and environment change together. There is no causality. 13
Aging is seen as a manifestation of these hemodynamic principles. It is viewed as a negentropic evolutionary emergence of man, which is totally different from the entropie model.2 Aging is a process of increased complexities, increased knowledge, and increased intelligence.13 The aged move through their developmental process in a unidirectional way. Man moves through developmental stages with one stage following the other with increased diversity.3 The pattern and organization of the aging client is a speeding up, not a winding down. There will be changes, but these are part of the structural development of the individual and repatterning must be encouraged to incorporate these changed into the unified whole. 13 The client will not take on the sick role, but one of continuous change as he/she reacts with the environment. These new patterns will progress forward, toward the realization of maximum health.3
Relation to Clinical Practice
Throughout my clinical practice in gerontology, I utilize Martha Rogers' framework of unitary human beings.
The human field of aging is more than the sum of its parts. The energy field is in mutual, simultaneous interaction with the energy field of the clinician - no one pattern identifies the aged field. Encased in entropie thought, the aged see themselves as parts, the bowels having priority. The clinician must extent her energy field into the human field of the aged and try to effect change within the pattern of the individual. Information is energy, and the repatterning of the aged field is accomplished through the exchange of this energy.
The patterning and repatterning of their lives to accommodate the changes that occur with aging are encouraged. They learn that it is alright to sleep less because, in many cases, the aged do not need as much sleep as the young. The patterns of the physicians also need reorganization. They prescribe hypnotics for the aged who awaken at night in a hospital. The name they give this pattern is "Sundowners Syndrome." The aged are then sedated and sleep through the day, only to awaken at 3 AM the next night. The entropie view of aging stilt prevails in both medicine and nursing. Education about the patterns of the elderly is necessary for nurses and physicians. The environment of the elderly must be assessed in a manner to encourage the repatterning in relation to their impairments. A client on massive diuretics was encouraged to remain upstairs in the morning while the diuretic is working. Anotherclient with diabetes loved to walk barefoot on the beach but this pattern had to be changed to prevent any injury to her foot. Nursing interventions are initiated for man/ environment interactions that stimulate repatterning and must be reevaluated due to the continuous change in man's pattern.
NURSING SCIENCE: A SCIENCE OF UNITARY HUMAN BEINGS
The emphasis on the uniqueness and differentiation of each aged individual must be stressed because one spouse will view their own aging in relation to the other spouse's. Each face their own aging in a manner manifested by their own pattern and organization and interaction with the environment.
By utilizing the Rogers' framework in nursing practice, one can focus on the new view of unitary human beings and have man as a composite of biological, physical, social and psychological components a relic of the past.
Martha Rogers' framework can be utilized in two ways: first, the aged of today can be encouraged to reorganize their world to better perceive new relationships (Rogers, 1970) and a more positive attitude toward the developmental process of aging. Secondly, it will institute a philosophical change, for the younger or middle aged adult in order to re-evaluate the process of growing old and facing this normal stage of development with a positive attitude.
Martha Rogers' conceptual system of nursing practice utilizes a completely different view of man and his environment; the nurse does not have to acquire new knowledge, but must view her knowledge in a different way. Disease can no longer be looked at as a separate entity, but must be regarded as part of the total pattern of the individual while in a continuous interaction with the environment.16
Nursing theory based on a negentropic view of man would change nursing practice; the attitude of health care workers toward the aged, and their own aging, would have to be re-evaluated and a new focus would have to be found. Much must be done if we are to lift most of the nursing profession out of the depths of entropie thought and move forward to a more positive view of aging and a more acceptable way of responding to our aged citizens. This can be done at the nursing education level through knowledgeable nursing instructors with a positive attitude toward the aging process. Nursing research can be more geared to the negentropic model of human beings, rather than the entropie view. Although man's potential for creative development is evident in many aged individuals, this is not apparent in much of the research today based on the declining theories.2 A positive view of the aging process will ensure the maximum quality of a meaningful life process, and a meaningful passage from life to death.3
- 1. deBeauvoir S: The Coming of Age. New York, GP Putnam's Sons, 1972.
- 2. Strumpf N: Aging - a progressive phenomenon, J Gerontol Nurs. March/ April, 1978; 17-21.
- 3. Rogers M: An introduction to the Theoretical Basis of Nursing. Philadelphia, FA Davis Co, 1970.
- 4. Kastenbaum R: Theories of human aging. Journal of Social Issues. 1965; 21-14.
- 5. Cummings E, Henry WE: Growing Old. New York, Basic Books, 1961.
- 6. Futrell M, Jones W: Attitudes of physicians, nurses, and social workers toward the elderly and health maintenance services for the aged: Implications for health manpower policy, J Gerontol Nurs. May/June, 1977; 42-46.
- 7. Campbell ME·. Study of the attitudes of nursing personnel toward the geriatric patient, Nursing Research. February, 1971; 147-151.
- 8. Neugarten B: Time, age and the life cycle, The American Journal of Psychiatry. July, 1979; 887-893.
- 9. Eliopoulos C: Gerontological Nursing. New York, Harper & Row, 1979.
- 10. Ebersole P, Hess P: Toward Healthy Aging Human Needs and Nursing Response. St. Louis, CV Mosby Co, 1981.
- 11 . Carnevali D, Patrick M: Nursing Management for the Elderly. Philadelphia, JB Lippincott, 1979.
- 12. Murray R: Current Practice in Gerontological Nursing. A Reinhardt, M Quinn eds., St. Louis, CV Mosby Co, 1979.
- 13. Rogers M: 2nd National Educator Conference. New York, December 4-6, 1978.
- 14. Hazzard M: An overview of systems theory, Nursing Clinics of North America. 1971;6 (3);385-393.
- 15. Rogers M: Science of Unitary Man; A Paradigm for Nursing. Paper presented at the International Congress of Applied Systems Research and Cybernetics, Acapulco, Mexico, December 12-16, 1980.
- 16. Newman MW: Theory Development in Nursing. Philadelphia, FA Davis Co, 1979.
NURSING SCIENCE: A SCIENCE OF UNITARY HUMAN BEINGS