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  1. Newman, Margaret A. RN, PhD, FAAN


Ken Wilber's philosophy of no boundaries provides a backdrop for letting go of boundaries between art and science, research and practice, and nursing theories. Major nursing concepts are cited from a variety of theoretical persuasions to illustrate a statement of a unified perspective of the discipline. The author calls for exploration of a world of no boundaries in the expansion of nursing knowledge and practice.


WE HAVE COME a long way since the introduction of the World Wide Web. The internet has diminished boundaries of physical space and time in a giant step toward a world of no boundaries. Views from outer space support this perspective. We experience nearly instantaneous communication in multiple directions around the world, without regard for time of day, and across barriers imposed by institutional structures. But these advances in globalization are not without ideological boundaries, in the world in general and in nursing in particular. The purpose of this article is to acknowledge the ways in which we create barriers to the understanding of nursing praxis and to recognize the connectedness of emerging nursing theories.


We have a tendency to dichotomize things. Even Florence Nightingale subtitled her classic treatise on nursing: What It Is and What It Is Not. 1 But Martha Rogers intuitively sensed the unitary nature of things. 2 Dialogue with her in the late sixties propelled consideration of health as a unitary concept. When she said that health and illness were simply expressions of the life process, my response was "oh, yes, opposite ends of the spectrum." No, she said. I contemplated her answer and with renewed fervor posed "then opposite sides of a coin." No, she said. Martha understood that opposites create boundaries and that there were no boundaries between health and illness. I had to give up my way of viewing things as opposites.


Ken Wilber led the way in pointing out that a world of opposites is a world of conflict and that a typical way of trying to solve the problem of opposites is to eradicate one of the opposites (eg, disease). 3 It is difficult to let go of the categories (boundaries) imposed on life, and health. Helpful, though, is the nature of rhythmic phenomena. It is possible to view body temperature, for instance, as fluctuating through highs and lows within a 24-hour period without labeling any of the measurements as pathological. The fluctuation represents a unitary pattern essential to life. Analogously one can begin to regard other so-called pathologies as fluctuations of the unitary process of health. Personal experience has taught me that health encompasses disease, and vice versa. It is strikingly clear that the old dichotomy between health and disease is no longer viable.


Wilber wrote:


[horizontal ellipsis] we create a persistent alienation from ourselves, from others, and from the world by fracturing our present experience into different parts, separated by boundaries [horizontal ellipsis] each boundary we construct in our experience results in a limitation of our consciousness-a fragmentation, a conflict, a battle. 3(Preface)


That was the feeling I had while participating in some of the early nursing theory conferences in the late seventies and early eighties, a feeling that we were constructing boundaries between nursing theories, encouraging nurses to choose one and build their curriculum and practice on it. A competitive arena was created. Little attention was paid to the links between the theories. It was as if each stood alone. Since then, I have decried the boundaries imposed on nursing knowledge by conferences, organizations, and books that separate and isolate theorists of one persuasion from theorists of another, and also, that separate theorists and researchers from practitioners. Masson, a particularly wise practitioner, once wrote about her desire to be involved in research, her foray into the world of research conferences and journals, and her disappointment in not finding some practical information that could be of immediate use to her in practice. 4 The separation between theory, research, and practice has gone on far too long. The question for us today is how to go beyond the artificial barriers that separate them.


Things that we usually consider irreconcilable-the opposites-are like the crest and trough of a single wave; reality is not in the crest or the trough alone, but in the unity of one inseparable activity. Dividing lines (not boundaries) join and unite as well as divide and distinguish. Like light and dark, one cannot exist without the other. 3 Perhaps this is what was meant by Parse in her inclusion of paradox as important to nursing knowledge. 5 A line becomes a boundary when we forget that the inside coexists with the outside. We create boundaries where there are none and "these illusory boundaries, with the opposites they create, have become our impassioned battles." 3(p27) A liberated person transcends opposites, like good and evil and life and death, moving to unity consciousness. According to Wilber, heaven is not all positives and no negatives, but no-opposites, ultimate reality as a union of opposites. At the highest level of consciousness, all opposites are reconciled. 6 Ultimate consciousness has been equated with love, which embraces all experience equally and unconditionally: pain as well as pleasure, failure as well as success, ugliness as well as beauty, disease as well as nondisease.


The convergence of various theories of nursing is becoming apparent. The crossover between theories of caring and the theory of health as expanding consciousness is remarkable. 7 Explication of the relationship between Watson's theory of caring and the science of unitary human beings has begun to illustrate the links between major perspectives of the discipline. 8 There is growing recognition that there are no real boundaries between nursing theories.


Within a unitary, transformative perspective, which Rogers introduced for nursing, 2 there are no boundaries. There are no boundaries between health and disease, between art and science, between research and practice, between nursing theory and nursing theory. In other fields, various approaches work under different circumstances, eg, ice packs to prevent swelling immediately after an injury, with heat later on to facilitate the healing process. The same is true for nursing theories: some have more immediate relevance; others enlighten and transform for the long term. So what is the transcendent unity of theories of nursing?


Before addressing that question directly, I will mention briefly 2 other dichotomies that pervade the nursing literature and bear noting. First, the question of art and science.