Exemplars of HEC Nursing Practice

One of the most frequently asked questions (FAQ) is, “How do nurses practice from the health as expanding consciousness (HEC) theoretical perspective?”

HEC practice is not focused on simply treating disease, but rather on attending to how the current situation fits into the patient’s evolving pattern of interaction with that which is meaningful to her or him, and how the patient chooses to move forward. It attends to the whole of a person’s experience and being. It centers on recognizing life patterns. HEC practice gives insight not only to individual life patterns, but also to the pattern of the community interacting with the individual. Caring in the HEC perspective is nonjudgmental, noninterventionist, and involves being with rather than just doing for. It is caring in its deepest, most respectful sense.

From Margaret Dexheimer Pharris, Minneapolis, Minnesota, USA:

Newman’s HEC theory has been the basis of my nursing practice over the past decade. It has served as a basis for my interactions with my BSN and graduate nursing students. It has shaped my nursing care of adolescents experiencing violence, survivors of sexual assault and abuse, and people presenting to the local trauma center for emergent care. I have found its greatest power in working with people who have been labeled with the diagnosis of borderline personality disorder, in that the process of pattern recognition focuses on the interaction between the person and her or his environment. As pattern recognition unfolds, the person is able to see what was a manifestation of who they are at the core of their being, and what was a manifestation of their environment, the people around them as they were growing up. This insight is often transformative, pointing to a different way of interacting with others.

The exemplar I would like to offer is from the emergency room setting. Nurses often think that HEC practice can only happen in “nontraditional” nursing settings where the nurse has more time to interact with clients. This is not so. In every interaction nurses are providing patients with a reflection of themselves, whether it is intentional or not. Nurses in the US have been consistently found by national polls to be the most trusted of all professions. The public comes to us in a spirit of trust.

The setting is a major emergency department of a trauma center. It is a very busy day with ambulances pulling in. I am responsible for the care of the patients in three high-acuity rooms. My newest patient is brought in by ambulance. She comes to the emergency department for treatment of severe dehydration related to nausea and vomiting secondary to her AIDS infection. She has fear in her eyes. As I enter my patients’ rooms, I try to concentrate on being present in a way that the patient feels respected and regarded as a whole person. I try to be open to that which is important to the patient and realize that the patient’s only concern is not just what is happening to her physically. I realize that every encounter will be enfolded into the pattern of the patient’s evolving life interactions, and it could be a point of transformation. I try to care in a spirit that honors that reality. I use my body and my words to attend to creating a space in which the patient can reflect on that which is meaningful. As I perform emergent tasks, such as starting the IV, I try to ask a question to acknowledge the entirety of the patient’s experience, like, “How have you been getting on at home?” or “What else are you concerned about?” The question is not as important as the intent to be open to the concerns of the patient. My patient tells me she has five children and she is their sole parent. Tears well up as she reflects on issues surrounding facing her own death and how depleting it is to try to care for her teenaged children while she is sick herself. She reveals that she is isolated from any real support and has no one to talk with besides the children’s social worker. I reflected back to her, “It sounds like things have been going along smoothly for you and your children up until this point, and that the care of your children has been most important to you. But now you feel isolated, especially as you reflect on facing your own death, and trying to care for yourself and your children.” My patient nodded “yes” and wept. We reflected on how she could change the constellation of people surrounding her and how she wanted to focus her energy in this stage of her life. I was able to offer her resources that could be helpful at this transformative time in her life. I believe that in attending to the whole of my patients’ experiences/being and the possibility of transformation, I can reflect that it is not just the physical body that is important. In this realization, the patient feels less limited by and focused on her physical condition. If all I did was start her IV, give her antiemetics, monitor hypotension, etc., I am reinforcing that the physical is all-important. In our brief interaction, what became obvious to my patient and to me, was that this point in her life was not just one of physical deterioration, but also a time of potential spiritual growth for her and her family. Health took on new meaning. Spending only a few more minutes, nurses are able to take the initiative to promote health, not just treat the problems caused by disease.