Unitary Appreciative Nursing Praxis

Abstract

The purposes of this article encompass describing the development of unitary appreciative nursing praxis since the conception of a unitary pattern-based nursing practice over 30 years ago; explicating unitary appreciative nursing praxis in its current state; and clarifying the elements and dimensions of a unitary appreciative nursing praxis model. The body of this work is linked to a greater call for nursing care that transcends the fragmentation and medicalization of the human experience and advocates for nursing that liberates rather than manipulates those who are most vulnerable. Further exploration of praxiological knowing and refinement in conceptual-theoretical development is advocated.

NOW, more than ever, the world calls for a deeper and richer understanding of the nature of health and wellness to guide human betterment. We have yet to discover and mobilize the forces that support individual, family, community, and global healing. The advent of unitary appreciative nursing stems from a commitment to advance the science and praxis of nursing through the lens of the science of unitary human beings.¹ Arising from the intrigue that emerged during a PhD course taught by Martha E. Rogers in the summer of 1979, this evolved into a lifelong journey taking many paths and directions and has culminated in this current praxis model of unitary appreciative nursing. The purpose of this article is threefold: (1) to describe the evolution of unitary appreciative nursing and its grounding in the science of unitary human beings; (2) to explicate the unitary appreciative nursing in its current state; and (3) to clarify the elements and dimensions of unitary appreciative nursing in the form of a praxis model.

EVOLUTION OF UNITARY APPRECIATIVE NURSING

Unitary appreciative nursing evolved from adopting the lens of a science of unitary human beings' perspective and applying it to inquiry and practice through a series of iterations of methods and ideas. The primary genesis of unitary appreciative nursing arose from thinking and theorizing around the ideas of healing as appreciating wholeness,² a unitary participatory vision of nursing knowledge,³ a unitary appreciative inquiry method,^4,5 unitary appreciative praxis that integrates inquiry and practice,^6–9 and wholeness and life patterning as foundations for healing.⁹ The purpose of this article is to describe the evolution and current state of development of a unitary appreciative nursing praxis model. Praxis is conceptualized in this model aligned with the notions of “praxis as the integrated expression of all knowing patterns,”^10(p5) praxis generally “interpreted as a meeting and melding of theory and practice,”^11(p62) and the alignment of praxis shaped by uniqueness of context, persons, and situations using reflexivity.¹² “The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection.”^13(p116) Consistent with the functions of praxis, it should be noted that in the case of unitary appreciative nursing as praxis theorizing occurred during episodes of implementation and theories were being generated, which have yet to be fully explicated. There is a core theory emerging of healing as appreciating wholeness that requires illumination and clarification. Connor argues that “The theories, values, and beliefs, which constitute a particular philosophy, and which shape the expression of praxis is known as praxiology.”^11(p55) She argues for making the distinctions of praxiology clear contextually in terms of these characteristics. Connor¹¹ calls out emancipatory praxis as an exemplar explicit praxiology. It is the intent of this article to clarify the praxiology that underlies unitary appreciative nursing, which Connor described as “a praxiology methodology focused on healing through attention to the unitary pattern of the whole.”^11(pp63-64) The unitary worldview embraces the ideologies associated with emancipatory knowing.^14,15

Statements of Significance

What is known or assumed to be true about this topic?

Currently, there is a vast body of knowledge that has been generated grounded in the science of unitary human beings. In 1990, I published the first work articulating what was called a unitary pattern-based practice that I thought was essential as one tool for further meaningful and practical used of unitary science in practice. Pattern and eventually patterning were selected as central concepts because within unitary patterning, there are expressions of wholeness, which is a distinguishing feature of unitary science. Appreciation was chosen as a means of capturing wholeness through its patterning manifestations because of its conceptual defining features that are more compatible with a unitary perspective rather than terms such as appraisal and assessment. Unitary appreciative nursing praxis evolved from unitary pattern-based practice, unitary appreciative inquiry, and an overarching vision of a unitary participatory vision of nursing knowledge. There is a foundation of scholarly articles that I have published articulating these evolving developments toward a unitary appreciative nursing praxis.

What this article adds:

The major contribution I wish to make by offering this article is to finally clarify that the nature of unitary appreciative nursing is essentially a praxis model and to describe in precise detail what the praxiological knowing is that underpins this model. This article provides a systematic, detailed, and synoptic view of unitary appreciative nursing praxis. The narrative of the article addresses the conceptual and theoretical grounding of this form of praxis, the key conceptual elements that are at the heart of unitary appreciative nursing praxis, a figurative representation of the praxis, a description of the process and correlates of the praxis, a table representing the full integration of 4 forms of knowing and expressions in praxis and ends with several implications for the future. This is the most elaborate and explicit presentation of unitary appreciative nursing to date building upon decades of development and positioning the model for potential applications in nursing.

The core concepts that serve as the base for unitary appreciative nursing praxis are:

1. Patterning as a means of knowing the wholeness of unitary human beings in mutuality with their environments and providing the focus for viewing and understanding the uniqueness of human experiences and existence.
2. Wholeness as the nature of human existence being inherent in all living things.
3. Appreciation as the process by which nurses come to know patterning and wholeness providing a reference point for the direction of participatory caring in a healing context.

Patterning

The concept of pattern as representation of the unitary nature of life is 1 of 5 key postulates that underpin the science of defined by Rogers as “the distinguishing characteristic of an energy field perceived as a single wave.”^1(p29) Rogers explicated the concept of pattern as an abstraction whose nature changes constantly and gives meaning to the field. “Moreover, each human field pattern is unique and is integral with its own unique environmental field pattern.”^1(p30) Rogers went on to specify that while human field pattern is not directly observable, patterning manifestations are observable in the real world. The critical import of this statement is that it demonstrates the movement from an abstraction of pattern to observable patterning manifestations. Patterning emerges out of a human-environmental field mutual process.^1(p31) Based on a review and analysis of unitary writings, Alligood and Fawcett¹⁶ concluded that patterning was more coherent term or concept for representing the unitary field characteristic of pattern. Patterning is conceptualized in unitary appreciative nursing because it implies the constant changing nature of unitary human field pattern. In the unitary appreciative nursing perspective, unitary patterning is viewed as an expression of the wholeness and uniqueness of individuals, families, and communities. Further, the term life patterning is adopted for the unitary appreciative nursing praxis model to provide a greater sense of connection to the human experience moving from the more abstract to the experiential and practical. Further, it acknowledges life as form of knowledge.¹⁷

It was this grounding idea of pattern as a unitary human field postulate and statements regarding the capacity to observe patterning manifestations that was the core perspective that guided the development and evolution of unitary pattern appreciation. While one of the major criticisms of the science of unitary human beings is its abstractness, this was intentional on the part of Rogers.¹ She refers to this science a set of “abstract concepts and a corresponding language of specificity.”^1(p29) “Scientific language evolves out of the general language”^1(p29) while terms are defined specifically “for clarity, precision, and communication so that rigorous research can be pursued and replicated.”^1(p29) Rogers described the path to scientific advancement in terms of theory development and suggested several emerging theories grounded in the science of human beings in her final publication. Further, patterning has been identified as one of key concepts relevant to the focus of the discipline.¹⁸ Patterning is described as “characteristic of wholeness and gives insight into life meaning”^18(pE21) as well as providing “deep insight and understanding of the whole, and detailed comprehension of the uniqueness of the life process.”^18(ppE21-22)

Wholeness

The science of unitary human beings posits that human beings are whole and cannot be reduced to the sum of their parts. In the unitary appreciative nursing praxis model, wholeness is inherent in persons, families, groups, communities, and cultures. This conceptualization of inherent wholeness is consistent with the unitary science view of unitary energy fields.¹ Further, the unitary science view implies that pattern is an identifier of human wholeness and uniqueness and is observable through patterning manifestations. The major challenges and struggles that face researchers and practitioners who understand that humans are whole, is how to capture and respond to that wholeness, avoiding reductionism. The concept of patterning as a manifestation reflecting the core pattern of human wholeness and uniqueness provides the window to avoid reductionism in its many forms. Patterning as a manifestation of wholeness and uniqueness provides access to inherent wholeness in persons, families, groups, and communities. This view is consistent with a variety of theoretical perspectives in nursing.^18–21 Consequently, it was important to align the research and practice related to unitary appreciative nursing, as it evolved over many years with a view of inherent wholeness.

The view of inherent wholeness in humans is an antidote to the tendency toward fragmentation of human experience. While many espouse the notion of healing as a journey toward wholeness, unitary appreciative nursing posits healing as appreciating inherent wholeness.² Health and illness experiences have been so closely aligned with clinical, medical definitions, that nurses and other health care providers have missed the essential wholeness, unity, and uniqueness that underlies all human experiences. Leaning into the “clinicalization” of human experience has led to overreliance on reducing all experience to a physical cause and denial of the possibilities within approaches that are more holistic in nature. For instance, Cogan suggests that “the expression of emotion contributes to the growth of consciousness by providing a process wherein consciousness can recognize and reclaim its inherent wholeness, and thereby overcome fragmentation.”^22(p207) Kemmis²³ notes the historical understanding of communities as inherently whole like any other organism that forms a foundation for determining the health of a city. An ethnographic study of a Filipino community revealed that the participants saw illness and disease as insults to the inherent wholeness of individuals and society.²⁴

One of nursing's foremost concerns is the wholeness of human beings, according to several nursing scholars. Cody²⁵ asserts a discipline-wide focus and central concern on the wholeness of human beings. Further, he claims that nursing has a mandate to address wholeness in the care of human beings. Swanson and Wojnar²⁶ strongly suggest that nursing's goal is the healing of the whole person. Newman²⁷ exquisitely conceptualizes a paradigm of unbroken wholeness that underlies nursing and the care of human beings. Building on this paradigm, Rew²⁸ calls attention to nursing's dominant embrace of a biomedical model in an advanced nursing education and practice, rather than using advanced nursing to address human wholeness.

Appreciation

To understand human life patterning within the context of wholeness, appreciation was chosen as the process for understanding and contextualizing it for each person, family, community, and culture. Appreciation was chosen as an alternative to assessment because of its defining features as articulated in healing as appreciating wholeness.^2,29 These characteristics are further refined here from their original description:

1. Knowing that wholeness is revealed through life patterning, the nurse seeks to perceive and understand its fullness by considering the ways in which it might be manifested by an individual, family, group, or community.
2. The nurse develops sensitivity and sensibility to the manifestations conveying uniqueness of the patterning through perfecting requisite knowledge and competencies.
3. The requisite knowledge and competencies involve perceiving, recognizing, and attending to a variety of ways of knowing that can be used to reveal the patterning that may be underdeveloped, refined, or innovative in the nurse.
4. The nurse accepts and allows for a wide array of experiences including physical/physiological, emotional/expressive, intellectual/perceptual, spiritual/mystical, and social/cultural as sources of patterning information.
5. Acceptance and allowing involves a benevolent recognition by the nurse of the wholeness of human life expressed in the patterning regardless of the nature of revealed experiences.
6. The nurse translates what is known from patterning information into a meaningful profile for the person, family, group, or community that is validated through participatory knowing.
7. The goal of patterning appreciation is to provide the fullest and richest portrayal of the wholeness of patterning into a profile that illuminates the potentials for positive change within the context of the presenting concern of the people involved.

Appreciation is a process that is responsive, receptive, and creative that supports and nourishes human flourishing. Appreciating patterning has been described as a process that promotes healing by acknowledging and understanding inherent wholeness that leads to identifying opportunities for improving well-being that is not evident in a more fragmented view.² Knowing through appreciation can be distinguished from other forms of knowing.⁹ The focus of appreciative knowing is depicting and expressing the uniqueness of life patterning in the most meaningful way that deepens reflection and understanding through the lens of wholeness. It is represented in the information that is generated from an appreciative posture contextualized to the specific individual or group described further as appreciative knowing.

UNITARY APPRECIATIVE NURSING MODEL

The unitary appreciative nursing praxis model is presented in the Figure. It is comprised of the following elements:

• The central focus of unitary appreciative nursing is knowing human wholeness revealed in forms/manifestations that are
• physical/physiological
• intellectual/perceptual
• emotional/expressive
• spiritual/mystical
• social/cultural
• The process of appreciating wholeness requires unitary appreciative knowing, which involves appreciative knowing, synoptic thinking, participatory consciousness, and transformative aspiration.
• Unitary appreciative knowing is the capturing of life patterning represented in a variety of forms that encompass
• stories and numbers
• action and theory
• sense and soul
• universality and uniqueness
• Appreciating wholeness through life patterning manifestations leads to correlating changes that enhance, expand, and deepen understanding and appreciation of human health conditions and challenges.
• The goal of unitary appreciative nursing is to mobilize new understandings and appreciations that can help persons, families, and communities that can be leveraged to create more liberating and transformative experiences that guide health care and healing unique to those participating in the process.

Figure.: Unitary Appreciative Nursing Praxis. This figure is available in color online (www.advancesinnursingscience.com).

Unitary appreciative nursing process

There are 4 essential facets of the unitary appreciative nursing process evolving from unitary appreciative inquiry.⁴ The process is guided by the concept of appreciative knowing; uses synoptic thinking as a means of translating patterning information; employs participatory consciousness as a mode of participating knowingly in change; and is moved by transformative aspiration. Appreciation is conceptualized as a way of knowing that illuminates the wholeness of human existence through a focus on the life patterning expressed and manifested in multiple forms. The focus on wholeness and life patterning differentiates unitary appreciative knowing from appreciative inquiry focused on the life of organizations and institutions.³⁰ The target of unitary appreciative knowing is individual, family, group, and community life. It seeks to explore and represent the fullness and richness of life within these contexts to inform nursing practice and nursing science.

Appreciative knowing is the keystone of unitary appreciative nursing, which grew out of unitary appreciative inquiry. Cooperrider and Srivastva³⁰ are the originators of appreciative inquiry for organizations. Unitary appreciative nursing regards appreciative knowing similarly as the practitioner has a reverence for life in its wholeness. “Serious consideration and reflection on the ultimate mystery of being engenders a reverence for life that draws the [practitioner] to inquire beyond superficial appearances to deeper levels of life generating essentials and potentials.”^30(p131) Unitary appreciative knowing assumes a stance of seeking the mysteriousness of life, which is something that one is caught up in, rather than the problem-solving perspective, which assumes a barrier or block.³¹ In Cooperrider's³² reflection on 30 years since the original article on appreciative inquiry, he bemoaned the reluctance of scientists and scholars to be drawn toward mysticism. “I still cannot help but puzzle over how far we've drifted from amazement and enchanted experience of our world.”^32(p89) He advocates for “a kind of appreciative literacy for finding value in our ordinary daily lives.”^32(p89)

In some sense, Smith³³ addresses this concern in her sophisticated and detailed concept analysis process applied to caring within the science of unitary human beings by first summarizing the issues surrounding caring as a focus of nursing. The findings of this analysis revealed 5 constitutive meanings emerging around caring. One of those meanings is appreciating pattern further specified by 11 semantic expressions of caring. She concluded that “pattern appreciation is a theoretical niche within SUHB that exquisitely captures the meaning of a cluster of semantic expressions of caring.”^33(p23) Smith outlines 12 semantic expressions of caring in the form of appreciating pattern.

Synoptic thinking is the second element of the unitary appreciative nursing process that guides how nurses conceive and interpret patterning information as it presents itself experientially, expressively, perceptually, or in other forms. This includes all forms of information as detailed in the model across the entire spectrum of human experiences individually and socially. It is taken from the notion of synoptic empiricism³⁴ employed by Murphy³⁵ in his research on human transformation. “Synopsis is the deliberate viewing together of aspects of human experience which for one reason or another, are generally kept apart by the plain man and even by the professional scientist or scholar.”^34(p8) It is critical not to segregate information in categories but to search for the interplay and relations among the information that reveals the patterning of the whole. In the clinical the world of health care, it is typical for aspects of human experience to be separated by specialization and even in nursing health assessment formats a great deal of effort is spent on differentiating the information by body systems.³⁶ It is important to note that, while the diagram refers to a broad spectrum of phenomena within each category, there may be as yet unnamed and unidentified phenomena that do not fit perfectly within these categories. Further, information regarding human experience is relegated to objective and subjective.

Synoptic thinking calls for a heavy emphasis on an inclusive stance regarding the manifestations of human experience, elevating all information regardless of labels of subjective or objective as relevant. In the Figure, the various forms of human experience that are labeled in categories are seen as interwoven in the lemniscate symbol for infinity to demonstrate lack of boundaries among these various aspects and expressions of human experience as well as the infinite nature of patterning. Synoptic thinking sets the stage for revealing connections among these expressions of human experience manifesting life patterning of an individual, family, group, or community. Synoptic thinking does not give precedence to one form of information expressed as more valid than another. It is common to use only, or primarily, physical/physiological data/information as more relevant than others in clinical assessments and is often the sole focus of treatment approaches. It is also the common perception in the clinical and research world to consider observable information as the only pertinent data source. Inclusiveness of forms of data/information allows for openness to expanding possibilities of understanding “findings.” All data/information is valuable, but one form cannot be reduced to other forms. The focus of this praxis is finding the patterning within the various expressions of life represented in data/information that can lead to a more comprehensive understanding and appreciation, grounded in wholeness. Rogers¹ suggested that the field pattern can reveal itself through a variety of often seemingly disparate manifestations. This ensemble of manifestations is referred to as life patterning in unitary appreciative nursing praxis. It appears as an ensemble of information conveying a singularity of expression, in unitary appreciative nursing known as life patterning. The purpose of synoptic thinking is to achieve this as an indispensable component of the unitary appreciative nursing process.

Adopting the mode of participatory consciousness is the third element of the unitary appreciative nursing process.⁴ The science of unitary human beings, the overarching conceptual framework that supports unitary appreciative nursing, adheres to Rogers' postulate of “people's capacity to participate knowingly in the process of change.”^1(p28) The intent of unitary appreciative nursing is to mobilize this capacity in individuals, families, groups, and communities to promote human betterment as defined by those being served. Participatory consciousness within a unitary perspective explicitly acknowledges that the nature of our world is participatory, and we have no choice whether to participate in it or not—we have a choice of how we participate, knowingly or unknowingly.⁶

A mode of participatory consciousness was the term used by Heshusius³⁷ to describe an epistemological shift away from research agendas determined by the dominant culture rather than accounting for the experiences and voices of those participating in research acknowledging the participatory nature of knowing itself. The praxis of unitary appreciative nursing calls upon researchers and practitioners to consciously develop participatory consciousness as a partnership or kinship with the people involved that provides an attitude of profound openness and receptivity coupled with a heightened feeling of aliveness and awareness.^37(p16) The participatory worldview posits that “our world does not consist of separate things but relationships that we co-author.”^38(p6)

Unitary appreciative inquiry borrows from the participatory inquiry paradigm of Heron and Reason,³⁹ which grew from a critique of the constructivist position that fails to account for experiential knowing. A participatory worldview is grounded upon a subjective-objective ontology and “an extended epistemology of experiential, presentational, propositional, and practical knowing.”^39(p274) Heron and Reason³⁹ advocate for a cooperative methodology that culminates in practical knowing as having primary value. Unitary appreciative nursing praxis is the methodology promoted for an extended epistemology that leverages experiential, presentational, propositional, and practical knowing that culminates with unitary knowing or the knowledge of the patterning of the whole. Experiential knowing entails “direct encounter, face-to-face meeting: feeling and imaging the presence of some energy, entity, person, place, process, or thing.”^{39(pp280-281)} Presentational knowing is grounded in and emerges from experiential knowing. “It is evident in an intuitive grasp of the significance of our resonance with and imaging of our world as this grasp is symbolized in graphic, plastic, musical, vocal, and verbal forms.”^39(p281) Propositional knowing is conceptual and descriptive in nature related to some energy, entity, person, place, process, or thing. “It is expressed in statements and theories that comes with the mastery of concepts and classes that language bestows.”^39(p281) In unitary appreciative nursing, propositional knowing is considered as theorizing that transcends the dominant Western science and culture paradigms and calls for a greater creative, transformative, generative, and liberatory approach to this endeavor. “Practical knowing is knowing how to do something, demonstrated in a skill or competency.”^39(p281) “It presupposes a conceptual grasp of principles and standards of practice, presentational elegance, and experiential grounding in the situation within which the action occurs.”^39(p281) In unitary appreciative nursing this aligns with the very essence of praxis and its goal of human betterment.

Participatory consciousness is grounded in the unitary concept of a universe in which humans and their environments are irreducible and in mutual process. In unitary appreciative nursing, this takes the form of developing collaborative relationships with those served by nursing care, and awareness of the centrality of choice by those being served in determining courses of action. The participatory aspect of unitary appreciative nursing stems directly from the unitary ideal espoused by Rogers¹ of the capacity of people to participate knowingly in change and the purpose of nursing “to promote human betterment wherever people are ...”^1(p33) The participatory mode of consciousness is synonymous with the power to participate knowingly in change. Barrett⁴⁰ proposed a middle-range theory of power as knowing participation in change that consisted of the development of a practice methodology and creation of health patterning modalities. Barrett termed the practice methodology “pattern manifestation knowing and appreciation and voluntary mutual patterning.”^40(p49)

Transformative aspiration is the fourth component of the unitary appreciative nursing process. It positions the nurse in collaboration with those served in the direction of what is aspired and is guided by the type of transformation that aligns with self-determined human betterment. The potential for transformation resides in:

1. the way in which it seeks to expand and deepen the understanding of the human condition in the context of wholeness and life patterning through appreciative knowing
2. the capacity for heightened awareness guided by synoptic thinking and participatory consciousness that uncovers new potentials for change
3. the creation of new knowledge and practical skills that allow for unlocking the emancipatory capacities within healing as appreciating wholeness^2,9

Unitary appreciative inquiry, a forerunner of unitary appreciative nursing, yielded transformative potentials in the participants who were women experiencing despair with a history of traumatic childhood experiences.^7,41 Transformative potentials arose from the unitary appreciative responsiveness and the participatory frame of reference. The unitary appreciative responsiveness incorporated strategies to represent the uniqueness, wholeness, and perceptual and expressive manifestations of despair as experienced within a life patterning perspective. “The unitary appreciative practitioner is attracted to affirm and illuminate the factors and forces within individuals and groups that serve to nourish human living and well-being.”^7(pp95-96)

The mode of participatory consciousness surrenders power to persons and groups to have a say in the decisions that impact them through democratic relationships. “Unitary appreciative nursing is founded on the proposition that individuals and groups are capable of understanding and exploring approaches for their well-being that make sense in their world and serve them in some way.”^7(p96) In the case of the despairing women project, the women individually and in groups mobilized their power for change identifying ways in which they sought to improve their lives and those of other women who were experiencing despair. In many cases, the women were overwhelmed by the despair and found that through sharing their stories, creating narratives and art, and reflecting on the meaning of these expressions they were able to see avenues for action unseen previously. These action strategies ranged from self-reflective to collective enterprises with other women to shape different futures for themselves and others.

UNITARY APPRECIATIVE NURSING DIALECTICAL FORMS OF KNOWLEDGE

Unitary appreciative nursing encapsulates a variety of forms of dialectical knowledge as sources for representing the wholeness and unitary nature of persons, families, groups, and communities. In the praxis model, these are incorporated into praxis modalities. There are a set of identified dialectical dimensions of knowledge used to shape the content and advancement of unitary appreciative nursing knowledge development, which guides theory development, research, and practice. These dialectics are universal and unique; action and theory; stories and numbers; and sense and soul.⁴²

Universal and unique

The universal-unique knowledge dialectic refers to the need for practice knowledge that can be shared across persons and groups in similar situations as well as the need for knowledge unique to an individual case. The broad theoretical framework of the science of unitary human beings¹ provides a universal context of human wholeness, the mutual human-environment process, and the nature of change, including trends in human development. Unitary appreciative nursing draws attention to the unique expressions of the universal in the life patterning of individuals, families, groups, and communities; however, the field of praxis is delineated. Therefore, knowledge discovered and generated in unitary appreciative nursing employs a dialectic that attends to the aims of practice or research. This dialectic allows for appreciation of the phenomenon of concern in its deepest sense.

Action and theory

Unitary appreciative nursing “offers a bridge for the dialectic of theory and action in its ability to be action-oriented and theory-generative.”^4(p41) Unitary appreciative nursing is shaped around the ideals of praxis in which theory informs action and action informs theory cyclically. Theoretical accounts in unitary appreciative nursing are not judged on their predictive capacity but on their generative capacity consistent with appreciative knowing and participatory consciousness.³⁰ Generative theorizing nurtures the dialectic of theory and action, generating new possibilities for action, hopefully provocative ones that alter both theorizing and acting.⁴

Stories and numbers

Unitary appreciative nursing embraces the relevance of both stories and numbers critical to knowledge development and advancement. Stories and numbers are sources of evidence consistent with the ideals of appreciative knowing, synoptic thinking, and a mode of participatory consciousness. Important questions that guide choice of methods in research and practice are:

1. In what ways might numbers or stories illuminate the wholeness, uniqueness, and life patterning of the individual, family, group, or community?
2. Can stories and numbers serve the purpose of evaluating whether methods are fragmentary or responsive to the wholeness expressed in life patterning?
3. In what ways, if any, could stories and numbers inform the value of actions consistent with transformation?
4. Are there ways in which a combination of stories and numbers enhance appreciative knowing?
5. In what ways do stories and numbers have meaning for those involved in unitary appreciative nursing that could shed light on new transformative potentials/possibilities?

For example, in the research previously noted,^7,41 research participants used both stories in the former of their own narratives and consider the prevalence and incidence of their experiences in relation to society. All the questions noted above were used as a way of enhancing the quality, meaningfulness, and relevance of the findings of the project.

Sense and soul

Unitary appreciative nursing requires that there be attention on all realms of data, sensory and soul, to capture the complexity and comprehensiveness of unitary life patterning and the underlying wholeness. Additionally, the integral nature of the mutual human-environmental process necessitates exploration of all aspects of experience that can inform patterning appreciation. Disregarding or denying the existence of experiential information that has been labeled physical/physiological, intellectual/perceptual, emotional/expressive, spiritual/mystical, or social/cultural diminishes the capacity to appreciate the wholeness of human life. A recent text, The Shape of the Soul,⁴³ offers a sophisticated and detailed synopsis and analysis of the ways in which mystical experiences expand and enhance knowledge derived through the senses. The focus of unitary appreciative nursing is to use synoptic thinking to unify forms of data and knowing to represent the fullness of life patterning of each person, family, group, or community most richly.

CORRELATES OF UNITARY APPRECIATIVE NURSING

There are 6 general correlates of unitary appreciative nursing that are tailored to the context and focus of the situation. These are more explicitly driven by the focus and concern of those being served.

1. Realizing a deeper and richer appreciation of life patterning and human wholeness that underlies the condition and situation for which help is sought. This takes the form of revelation in which connections and relationships of elements of experience are linked together and illuminate deeper meanings and understandings for both the participants and the nurse. An example of this with despairing women was an emerging appreciation of the connection between the despair and experiences of abuse and other traumatic events. It was as if the despair, while still overwhelming, made some sense that made it more meaningful albeit less painful.
2. Discovering greater possibilities for clarity, freedom, power, and positive energy to transition situations and conditions that have previously functioned as barriers for health and well-being as defined by those being served. By looking at the situation through an appreciative lens, people will more deeply understand the complexity of the situation while not being overwhelmed by it. Appreciative presence by the nurse creates the conditions for the discovery process that occurs. Clarity comes with the meaningfulness of the appreciative knowing. Freedom occurs as a response to this heightened sense of awareness of the complexity, dimensions, and elements of the presenting experience that is viewed as problematic. Power evolves as a sense of possibilities that the situation and condition can be mediated and improved through the appreciation of the existing and changing life patterning. Positive energy is the feeling sensation that occurs with the new form of knowingness that has been revealed coupled with the awareness of alternative paths toward aspired health and well-being.
3. Exploring the array of manifestations of human patterning that are often segregated by systems through synoptic thinking in partnership with the people involved in the unitary appreciative enterprise. This is a process whereby the nurse is creating an environment in which previously undisclosed information can be revealed. Oftentimes, there are areas of experiential information that are viewed by people as unacceptable to share in a clinical context. An example might be in the realm of spiritual/mystical experiences that are not shared because of typical judgmental responses of dismissal or illegitimacy portrayed by clinicians and researchers. In many cases, people do not see the relevance of some nonphysical experiential data when their presenting problem is physical/physiological in nature. These can be within the realm of intellectual/perceptual and emotional/expressive. In addition, social/cultural information other than identification of racial and ethnic representation is not considered as significant but may be relevant to appreciating the wholeness underlying a situation or condition. Being open and affirming of the relevance of a wide array of experiential information is the precursor to synoptic thinking. Creating the environment to achieve this correlate is a competency critical to successful and meaningful unitary appreciative nursing. The correlate itself is the sense of affirmation and appreciation experienced by participants who share experiences and discover the connections to other experiences and see them in a profile of life patterning reflecting wholeness.
4. Leveraging appreciative knowing through the mode of participatory consciousness to consider potential paths and actions that can be linked to transformational aspirations. The person, family, group, or community participating in a unitary appreciative nursing endeavor develops an action strategy plan that builds off what is learned from the appreciative knowing, the synoptic thinking, and mode of participatory consciousness. The action strategy plan is derived from the aspirations of the person or people involved using what is learned through the unitary appreciative nursing process. Consistent with the unitary paradigm, strategies are considered, evaluated, and adopted by the participants who take advantage of such phenomena as unitive consciousness and pandimensional awareness, such as those spiritual or mystical in nature as well as what are considered more concrete strategies.^43–47 The participatory mode of consciousness and transformational aspirations determine what is chosen.
5. Providing guiding consultation and affirming support for the chosen action strategies of the clients. The nurse acts in the capacity of consultant to the participants in providing affirming support for the paths chosen moving forward. Appreciating the life pattern of the individual, family, group, or community and acknowledging that the participants are the primary source of validation of that appreciation is the basis for affirming support. Examples of ways in which affirming support might be experienced are described below:
1. Physical/physiological. Changes that accommodate physical and physiological conditions that improve results oftentimes, which can be measured, observed, or described
2. Intellectual/perceptual. Acute awareness to the possibilities for change and clarity in how to move forward confidently
3. Emotional/expressive. Creation of narrative and aesthetic representations of the evolving journey and path forward
4. Spiritual/mystical. Meditative and mindfulness practices that enhance and heighten soothing and enlivenment for pathways chosen
5. Social/cultural. Activation of social support and cultural practices or community engagement projects that shifts directions toward greater sense of connection
6. Transcendent experiences. Sensation of knowing the unity and relationship of all things, which generates a sense of power and positive energy
6. Cocreating an evaluation and reframing process aimed at assessing the value of the action plan with a focus on the capacity for transformation and emancipation. This correlate involves reassurance through the unitary appreciative nursing process that the participants may engage in a cycle of appreciation, allowing, and valuation that fosters self-direction and self-determination that drives the process. Possibilities in appreciating wholeness are the embodiment of healing exemplified in a deep sense of emancipation. The emancipation embedded in this form of healing with its emphasis on wholeness transcends current conceptualizations of gender, age, ableism, race, and class providing new understandings and knowledge (Table).

Table. - Unitary Appreciative Nursing Praxis Model

Integration of	Concepts of Praxis	Forms of Praxis	Representations of Praxis
Appreciative knowing	Nurse positioned in appreciative attitude to be fully open, nonjudgmental, and sympathetic regarding the experiences of participants grounded in sensitivity to and sensibility to life patterning manifestations	Suspending anticipation and showing willingness and openness to explore a variety of experiences and perceptions Seeking to capture what is being shared overcoming a tendency to fragment experiences by systems or specialization areas Reaching for the fullest expression of what it is like to live with and experience the conditions and situations being shared Demonstrating nonjudgmental and unquestioning attentiveness to what is shared	Creating a relational and positional arrangement with the participant that acknowledges free expression and an affirming presence open to all forms of knowing. Journaling notes that include informational sources and storylines that are shared between the nurse and participants. Collecting artifacts or materials that participants share regarding their experiences. Creating a profile using modalities associated knowing that is experiential, presentational, propositional, and practical.
Synoptic thinking	Nurse identifies an emergent life patterning reflective of the multitude of experiential information across all realms	Recognition of some enduring life patterning that underlies the multiplicity and variability of experiential information Using alternative forms of capturing the wholeness within the information such as narrative, music, and imagery Cyclical review of spiral of information that emerges using both intense reflection and relaxed imagining	Creating a life patterning profile using experiential information reflecting realms of phenomena with physical/physiological; intellectual/perceptual; emotional/expressive; spiritual/mystical; and social/cultural. Critical that the profile demonstrates underlying wholeness, avoiding tendency for fragmentation. Selecting the best form(s) of representation of life patterning that include narrative, storylines, music, art, photography, drama, cinema, dance, etc that comport with unique unitary wholeness.
Participatory consciousness	Nurse encourages participants to exploit participatory consciousness to discover the wholeness underlying the flow of information emerging from patterning manifestations	Nurse first and foremost placing themselves in a collaborative relationship seeing the participant as the expert of their own experience Valuing the perspective of the participants in making sense and meaning of any representation of the experiential information Realizing and remembering that all knowledge is participatory in nature and allowing for the time and space for the exploration wanted to uncover the fullest story of life patterning	As the life patterning is revealed to the nurse through appreciative knowing and synoptic thinking, constructing ways in which the participants can confirm perceptions, impressions, and representations Allowing for exchange and dialogue necessary to actively engage in participatory consciousness Making notes of and journaling about the dialogical engagement that can be used in framing the richest depiction of the unique life patterning context of participants
Transformative aspirations	Nurse provides opportunities for reimagining what is possible given a new sense of appreciative knowing grounded in synoptic thinking and a mode of participatory consciousness reflecting the wholeness of life	Exploiting the expertise of the participants to foster discovery and revelation regarding potentials for action supporting healing, health, and well-being Having a broad understanding of what counts as meaningful action and encompassing as many strategies as possible and approaches that are deemed to be important to the participants' aspirations for healing and well-being Sharing unitary nursing knowledge that can be useful in shaping the approaches chosen for realizing transformative aspirations	Designing creative strategies that are meaningful to the participant for realizing aspirations Considering and choosing ways in which the value of the strategies can be weighed in relation to what is desired Allowing for in-the-moment reflection and reimagining of ways to enhance desired patterning evolution Offering cooperative and engaging presence to support the emerging changes as they unfold

SUMMARY

The purpose of this article is to provide a clarification of the unitary appreciative nursing model, which has been developed since the first description of unitary pattern-based nursing practice in 1990.⁴⁸ It has gone through many iterations that were characterized as an inquiry method and eventually described as a praxis. Unitary appreciative inquiry was used in 5 studies exploring the nature of despair and healing that led to the overall evolution and development of the unitary appreciative nursing model. Findings and experiences using unitary appreciative inquiry led to a deepened understanding that praxis reflects the integration of forms of knowledge grounded in unitary thinking and grasping the whole through appreciation of life patterning. While this model of nursing praxis has had limited application, the potential for future applications exists within persons, families, groups, and communities in line with the ideology and values of “A Nursing Manifesto: A Call to Conscience and Action.”⁴⁹ Unitary appreciative nursing reflects and expresses these specific ideals and principles in action:

• “The concept of wholeness is something we fully embrace. Our notion of wholeness involves a commitment to the inherent oneness of all beings. We seek to recognize, appreciate, celebrate, and exploit this individual and universal wholeness in order to create health.”⁴⁹
• “It is our firm conviction that there is a body of knowledge that is specific, if not unique, to nursing's concerns and interests. We think that this knowledge is grounded in appreciation of wholeness, concern for human well being, and ways in which we accommodate healing through the art and science of nursing. We value theoretical and practical plurality with the centrality of nursing knowledge at the forefront of practice and knowledge development.”⁴⁹

Some critical elements for the advancement of unitary appreciative nursing as praxis will require attention. Effective means are needed to assist and guide nurses in the development of appreciative literacy specific to the integrated ways of knowing inherent in unitary appreciative nursing.³² Further exploration of praxiological knowing that would help nurses go beyond the ascendancy of technical discourse in health care systems where nurses practice and live will hopefully generate strategies for changing care practices for human betterment. Connor¹¹ refers to this as significant to moral practice and which Watson²¹ might think of as a moral imperative. Expanding the nursing discourse on the importance of praxis as liberation is profoundly needed given the dominant tendency for prescribed care management that comports primarily with a focus solely on measurable outcomes. This is not in any way meant to deny the importance of documenting correlates of unitary appreciative nursing as a means of offering both general and idiographic information generated from styles and strategies of praxis. Finally, the next stage in the development of unitary appreciative nursing might be work in the arena of conceptual-theoretical-empirical structuring eloquently outlined by Fawcett.⁵⁰ The specific focus of further work in this arena would be the elaboration of the theory of healing as appreciating wholeness in explicit terms.

Unitary appreciative nursing praxis exemplifies the 2 types of nursing praxis, outward and inward.¹⁰ Outward praxis serves to examine itself in relation to the society in which in exists. For example, unitary appreciative nursing changes the discourse and the focus on what it means to provide care in a system grounded in fragmentation. Outward praxis also considers the political context in which nursing knowledge is developed and in which nursing is practiced. Unitary appreciative nursing pushes for nursing-specific knowledge elevating the role of nurses in practice and research. Inward praxis “critically examines the methods used when developing and using nursing knowledge”^10(p13) while it “critically reflects and acts in relation to the development of nursing knowledge.”^10(p13) Applying the inward strands of practice, unitary appreciative nursing can be seen to contribute to development of nursing knowledge from a viewpoint of wholeness and examining methods developing and using nursing knowledge that is compatible with healing as appreciating wholeness.

If ever there was a need for innovative praxis models, it is now. The people, families, groups, and communities we care for need models that demonstrate how nurses can more effectively meet anger with compassion, loneliness with love, fragmentation with wholeness, and despair with aspiration. Unitary appreciative nursing is not a remedy for all of these, but it provides the possibility for nurses and people they care for to mutually engage in this journey borne out of fear and desperation in our daily personal and societal lives using appreciation as a means for recognizing and embracing the wholeness and oneness available to us all.