Thesis advisor: Dorothy A. Jones / The purpose of this qualitative research study was to answer the following questions: What is the life pattern manifested by individuals caring for spouses who have had coronary artery bypass surgery? What are the thematic expressions of life patterns among individuals caring for spouses who have had coronary artery bypass surgery? The theoretical framework guiding this study was Margaret Newman’s Health as Expanding Consciousness. The research method created by Newman facilitated the understanding of the individual participant’s experience, pattern identification, similarities in pattern across participants and the potential for expansion of consciousness. The study sample included ten women and two men whose spouses were recovering at home following cardiac surgery. These twelve spousal caregivers shared their life stories and their spousal caregiving experience in the first two weeks at home following their spouses discharge from the hospital. There were various levels of potential for expansion of consciousness for these spousal caregivers. Looking across participants six themes emerged from the data. First, disruption in the spousal caregivers’ roles and responsibilities impacts the relationship between the spousal caregivers and their spouses and shifts life patterns. Second, spousal caregivers face coping challenges with changes in lifestyle and response to illness. Third, Spousal caregivers experience vigilance in an effort to ease the uncertainty of the recovery process. Fourth, knowledge helps spousal caregivers gain a sense control in the face of uncertainty. Fifth, mutuality within the partnership of nurse and the spousal caregiver relationship impacts the potential for transformation. Sixth, Spousal caregivers’ awareness of their life pattern gives meaning and offers the caregivers a new perception on life they have left to live. Findings from this study have important implications for nursing theory, practice, research, education and health care policy. The study adds empirical support to Newman’s Theory of Health as Expanding Consciousness and provides a new way to examine spousal caregiving and the nurse-client relationship. / Thesis (PhD) — Boston College, 2008. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Jane . Flanagan / Purpose: The purpose of this hermeneutic, dialectic, phenomenological qualitative study was to describe among a sample of recently retired (within the past five years) United States military veterans, the experience of the transition to retirement at midlife from active duty (AD.) The secondary aim is to describe within this sample of recently retired military veteran’s, the meaning of health to their post military lifestyle. Background: The transition to retirement from AD military service to retirement is a unique transition occurring at midlife about which little is known. Veterans serving after 9/11/2001 are more likely to have deployed and to have deployed multiple times compared to other service eras, having unique effects on relationships, physical and mental health, and meaning of health. No research has been done to examine the experience and meaning of health of career AD veterans who served during eighteen years of continuous war. Method: This study was guided by Margaret Newman’s Health as Expanding Consciousness (HEC) to explore the meaning of the transition to retirement and health among AD military veterans at midlife. Newman’s HEC guided data collection and analysis. Fourteen participants were recruited through purposive, criterion snowball sampling. Participants were individually interviewed about meaningful people and events in the military retirement and meaning of health. Rigor and trustworthiness were ensured by taking measures to support credibility, confirmability, dependability, and transferability. The researcher developed a narrative and diagram of meaningful events and relationships which was shared with each participant and reflected together on life patterning. Results: Fourteen participants consisting of men (n=10) and women (n=4) representing all branches of the military as well as officer and enlisted ranks participated in this study. The difficulty of finding a sense of purpose in retirement was common among participants. Participants also described becoming aware of health conditions after distrust of the healthcare system during their military careers. The experience of war was found to have effects on the entire family. Conclusion: Through HEC, a more complete understanding of the meaning of health and transition to retirement among active duty veterans was formed. Future research should focus on the unique populations of veterans including of combat veteran and women veterans. / Thesis (PhD) — Boston College, 2019. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Dorothy Jones / A family's unique way of being, formulated through social, economic, environmental and political factors, becomes fractured during a loved one's critical illness. Family members experience burdensome physical and emotional symptoms as they transition through the marked uncertainty endemic to high acuity illness. For some, this burden results in long term psychiatric disturbances. Assessment tools and interventions have been proposed for family members experiencing a loved one's critical illness. However, ongoing suffering suggests inherent limitations within these reductionist approaches. The need for a more encompassing disciplinary perspective is suggested. Margaret Newman's (1986, 1994, 2008) theory of Health as Expanding Consciousness (HEC) and its praxis research method was employed to explore relationship based care among intensive care unit (ICU) family members and registered nurses. HEC retains person/environmental integrity through unfolding of unitary knowledge via exploration of meaning. Additionally, its holistic perspective aligns philosophically with the belief in nursing science as the study of caring in the human health experience, endorsing both the mutuality of the nurse/client relationship and pattern recognition's capacity to inspire transformational growth. The study was performed in an eighteen bed medical ICU in the northeast region of the United States. This unit's design includes an integrated critical/palliative care model. Exploration of the study's two research questions was accomplished using the practice and research components of HEC within a sample of eight family members and six registered nurses. Results demonstrated family members' capacity to achieve consciousness expansion within the context of a loved one's critical illness. Registered nurses revealed their ability to steadfastly partner with both patients and families. Repetitive elements distinguished as thematic commonalities were recognized among both family member and registered nurse participants. Additionally, thematic integration between family members and registered nurses was appreciated. HEC was found to offer unique insights into caring relationships between ICU family members and registered nurses. / Thesis (PhD) — Boston College, 2014. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Dorothy A. Jones / As the United States population ages, knowing and understanding the older adult couple’s experience living with chronic illness at home is significant to inform new strategies of care, and planning of resources for the improvement in the health and well-being for a potentially vulnerable population. The purpose of this qualitative study was to better understand the older adult couple’s experience while living with chronic illness at home by answering the following research questions: What is the life pattern manifested by an older adult couple living with chronic illness at home? Are there common themes across the life patterns of older adult couples living with chronic illness living at home? The theoretical framework guiding this study was Margaret Newman’s Health as Expanding Consciousness using a hermeneutic-dialectic phenomenology method. The study’s sample consisted of 14 married older adults (> 65 years of age) couples living together at home. The research method explored the experiences of the older adult couple through dialogue within the context of their social environment in all its complexity. This approach gave voice to the older adult couples’ experiences and their meaning from their perspective, which facilitated insights about each older adult couple as well as common themes across the older adult couples. Three themes emerged from the study, (1) an unfolding pattern of living meaningfully as an older adult couple with chronic illness while moving through life transitions, (2) couple interconnectedness strengthens the bonding within the older adult couple and promotes self-growth, and (3) a resonating process within the older adult couple promotes movement toward expanding consciousness. Conceptual models are proposed. The findings suggest older adult couples living with chronic illness at home strive to live meaningfully while experiencing multiple life transitions embedded in a resonating process that facilitates change. / Thesis (PhD) — Boston College, 2018. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Thesis advisor: Jane Flanagan / Background: Over the past decade, increasing numbers of emerging adults, defined as ages 18 to 22, have journeyed to the United States (US) from Guatemala, Honduras and El Salvador. Upon arrival to the US, many experience inequities in health and healthcare access. The inequities are shaped by US political practices and choices attributed to broad structural and systemic-level barriers within planetary, social, economic and necropolitical forces. Applying a critical framework of antiracism, anti-oppression and anticolonialism, nurses and other healthcare providers must seek to understand the health patterning and life experiences of emerging adult im/migrants from Guatemala, Honduras, and El Salvador so that their health and healthcare needs may be supported. Approach: This qualitative research project aimed to explore health patterning of emerging adult immigrants from Guatemala, Honduras, and El Salvador using the nursing specific research praxis of Health as Expanding Consciousness (HEC). The second aim explored themes across the group. Critical posthuman, feminist, and new materialist assumptions also informed the approach to the study. Between June 2021 to November 2022 thirteen emerging adult participants from Guatemala and Honduras were interviewed twice. Enrollment occurred through community-based recruitment and snowball sampling methods. Each person’s individual story was explored using the HEC praxis method. Results: Participants’ stories uncovered unique profiles with situated, context-specific individual health patterning. Four themes were identified across stories using the qualitative analytic method of Sort and Sift, Think and Shift: Family is Fundamental, The Journey Holds Meaning, Opportunities Exist Amidst Constraints, and Movement and Art are Healing. Conclusions: The discussion section reviews main implications for building critical nursing praxis; understanding intersections of health, nursing care and human mobility; advancing nursing policy for people excluded from care; advancing research using HEC praxis as a caring act of accompaniment; and transforming nursing education for social justice and radical possibility. Im/migration and asylum-seeking were viewed as fundamental human rights including critically advancing the right to health and safety for people in mobility contexts. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.