Guest Editorial : Advances in Nursing Science

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Guest Editorial

Guest Editorial

Editor(s): Cowling, W. Richard III PhD, RN, AHN-BC, APRN-BC, FAAN

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doi: 10.1097/ANS.0000000000000056
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The phrase “patterns of health behavior” is a broad term that has been used to define a wide array of phenomena that are associated with health. It is applied to behaviors related to health in individuals, families, communities, and populations. It has been conceptualized and used as a broader reference point for describing and understanding health. Advocates of studying patterns of health behavior implicitly or explicitly consider the focus on behaviors a more direct and useful indicator of the health of the person or population. In addition, exploration and analysis the patterns of behavior provide a more comprehensive approach to understanding health than a diagnostic approach. It is clear that research specifically and scholarship broadly, that focus on patterns of behavior associated with health, have yielded useful knowledge that can be applied in clinical practice. Nursing scholarship grounded in a variety of conceptualizations of patterns of health behavior has advanced our understandings of health beyond disease and diagnostic perspectives alone.

Conceptualization and contextualization of phenomena is central to how they are applied to the human condition as in nursing. A unitary-emancipatory-transformative perspective sheds new light on patterns of health behavior. The primary elements of such a conceptualization follow and are derived from unitary nursing science and unitary appreciative praxis1–3:

  • Unitary: Patterns of health behavior are expressions of life patterning that provide clues to the wholeness of individuals, families, communities, and populations.
  • Emancipatory: The use of patterns of health behavior as a focus of research or practice as unitary expressions of wholeness offers possibilities for participants to develop approaches to their health and well-being that are liberating in nature and in line with their own wishes and desires.
  • Transformative: Considering health patterns as expressions of wholeness and focusing research or practice on liberating potentials of the participants generates knowledge that can evoke transformation.

The unitary perspective provides a context for exploring health patterns of behavior as expressions of wholeness. The long evolving conceptual theme of human wholeness suggests that relying on data or information in reductionist ways fails to capture the fullest understanding and appreciation of the human experience. The value of this contextualization of health behaviors is that it avoids the fragmentation of human experience. This requires a synoptic orientation to health behavior patterns in which data are considered contextually. In some ways, this might extend beyond patterns of health behavior embracing other aspects of the human experience in which information is explored relationally. Human wholeness is reflected in a variety of phenomena, including health behavior, that provide information about the whole but cannot singularly represent fully the nature of the whole. These phenomena include those labeled as physical/physiological, mental/emotional, social/cultural, and spiritual/mystical. A synoptic lens as an alternative to an analytic lens on these phenomena allows for the exploration of the interrelatedness of the health behavior within patterns extending beyond to additional phenomena and creating more expansive knowledge. For instance, patterns of health behaviors of women who were abused as children might be brought into the eye of the narrative of each woman's abuse. Doing this might create a richer and deeper understanding of what is happening in the lives of the women relating health behaviors to abuse narratives. The goal would be to create a more meaningful understanding of the life pattern of women abused in childhood inclusive of health behaviors. This understanding may suggest approaches to enhance health and well-being that are more enduring.

The unitary contextualization of patterns of health behaviors described opens the doors to a greater array of possibilities for improving health conditions through mobilizing personal power in a variety of forms. Novel knowledge of patterns of health behavior are generated that may create the capacity for mobilizing inherent personal power to create desired changes. These are the power of knowledge and of awareness. The methodology associated with the praxis of unitary appreciation applied to patterns of health behavior would be participatory in nature. This provides for the power of cooperative understanding that evolves from mutual exploration of patterns and their relationship to larger forces and factors of the person, family, community, or population. Cooperative development of strategies to improve health and well-being would be a goal of this kind of praxis for research or practice purposes. The culmination of these 3 powers would lead to the power of liberation. This involves the development of competencies and skills that allow for enhancement of daily life aligned with dreams and desires. Returning to the example of women who were abused as children, this approach would enable the women to use these sources of power (knowledge, awareness, cooperation, and liberation) to improve the conditions of their lives. Focusing on patterns of health behavior would provide a trigger for broader exploration and focus on development of strategies and competencies to enhance health within the context of life as a whole.

Seeing health patterns as expressions of wholeness and focusing research or practice on emancipating potentials of the participants generates knowledge that can arouse transformative possibilities. The type of holistic understanding that emerges from the process clarifies and explicates health behavior patterns. The meaning of patterns of health behaviors is expanded in making connections with other phenomena of life. As noted previously, one of the outcomes of using the unitary contextualization of patterns of health behaviors is the development of competencies to improve health and well-being through knowledge, awareness, cooperation, and liberation. The transformative potential resides in the capacity of the research or practice to support the participants in developing themselves as instruments of change. The aim is toward seeing and appreciating patterns of health behavior in this broader more inclusive light relevant to the wholeness of the participants. This in turn suggests expanded potentials and possibilities for action. Returning once again to the example of women who were abused as children, patterns of health behavior incorporated into the abuse narrative reveal ways of approaching health that go beyond treatments of symptoms or disease. Emphasis is placed on potentials and possibilities that might not have been considered with a health behavior perspective alone.

The advancement of science focused on patterns of health behaviors is impressive and has significant relevance for nursing extending our understanding beyond a disease or symptom-focused model of care and treatment. The ongoing contributions to persons, families, communities, and populations based on previous inquiry and practice offer the possibility for improving health conditions in accord with the focus. The unitary-emancipatory-transformative contextualization of patterns of health behaviors suggests potentially broader and richer appreciation of human wholeness and healing. Acknowledging the need for extensive development of this perspective to become relevant, this perspective is shared to evoke thinking about novel ways to approach nursing's role in promoting health and well-being and the betterment of the human condition generally.

W. Richard Cowling III, PhD, RN,


Vice President of Academic Affairs

Chamberlain College of Nursing


1. Rogers ME. Nursing science and the space age. Nurs Sci Q. 1992;5:27–33.
2. Cowling WR. Unitary appreciative inquiry. Adv Nurs Sci. 2001;23(4):32–48.
3. Cowling WR, Repede E. Unitary appreciative inquiry: evolution and refinement. Adv Nurs Sci. 2010;33(1):64–77.
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