Abstract
It is important that nurses guide practice with crafted policies based in nursing knowledge that is distinctive and specific to the values and beliefs of all persons, such as humanbecoming. As policy crafters in nursing, a nursing theory or model must serve as the foundation in service to others. In this article, the author explores crafting policy with the Rainbow PRISM model (Cody, 2003; Ortiz, 2018), in light of Parse’s (2021a) humanbecoming paradigm, the humanbecoming community change concepts (Parse, 2003, 2021a), and Parse’s (1987, 2021a) principles of inquiry construction.
It is intriguing to think about the many artful ways in which health or nursing policies are developed. There are various traditional policy development processes that outline the steps in policy development. However, there are not many policy development processes that look to principles from art to develop or craft policies that are ontologically consistent with practice that emerges from nursing’s unique paradigms, such as humanbecoming. The purpose of this paper is to explore policy implications of the Rainbow PRISM Model (Cody, 2003), in light of Parse’s (2021a) humanbecoming paradigm, the humanbecoming community change concepts (Parse, 2003, 2021a), and Parse’s (1987, 2021a) principles of inquiry construction.
The Humanbecoming Paradigm and Policy Crafting
It is important that nursing policy-makers have a strong knowledge base in the paradigms, theories, and models of nursing, so that policies are reflective of nursing’s contribution within any healthcare organization or community. A unique nursing perspective is the humanbecoming paradigm (Parse, 2021a). This paradigm consists of the nature of existence (ontology), the investigative tradition (epistemology), sciencing (methods), and living the art (practice; Parse, 2021a). The humanbecoming nature of existence is rooted in humanuniverse as “indivisible, unpredictable, everchanging” (Parse, 2021a, p. 28). There are philosophical assumptions, ethos, postulates, and principles that comprise the humanbecoming nature of existence. There are three assumptions about humanuniverse, three focused on ethos, and three about living quality. The nine humanbecoming assumptions “mean humanuniverse is a cocreation that cannot be divided. It is not a static entity, but rather continuously moving in unrepeatable, unforeseeable ways without a wrinkle” (Parse, 2021a, p. 33). Parse (2021a) wrote that “the ethos of humanbecoming is the sentiment and straight thinking that informs the enduring truths of reverence, awe, betrayal, and shame, in venerating treasured presence” (p. 33). Living quality is “the all-at-onceness of the truth for the moment, which is all there is” (Parse, 2021a, p. 33).
The humanbecoming assumptions serve as the foundation for the principles of humanbecoming, which are:
Structuring meaning is the imaging and valuing of languaging.
Configuring rhythmical patterns is the revealing-concealing and enabling-limiting of connecting-separating.
Cotranscending with possibles is the powering and originating of transforming. (Parse, 2021a, p. 39)
With these principles, individuals shape preferred patterns that are known and not-known, while moving-on with each now moment with certainty-uncertainty about what may be. Individuals cocreate meaning with each choice, as choices unfold with more choices.
Policy Crafting With Humanbecoming
Humanbecoming has been used to guide the development of policies in a variety of settings. “Humanbecoming can be used as a guide to expand nurses’ involvement in health policy” (Poirier, 2012, p. 106). Nurses who are grounded in the humanbecoming paradigm as a guide to research, practice, leadership, and education approach the “making of” or the “development of” policy differently than the traditional approach to policy development that is often conceptualized as sequential parts or stages, such as problem emergence, agenda setting, consideration of policy options, decision-making, implementation, and evaluation (Walton, 2022). Humanbecoming nurses adhere to specific ontological beliefs. With these ontological beliefs, the crafting of policy would emerge with constituent communities (individual and groups) through the humanbecoming community change processes (Parse, 2021a). This means that humanbecoming nurses (or professionals) approach policy-making more like an artful craft because, like professionally educated and trained artisans, they have formal study (education) of the paradigm and experience in working with and utilizing (training) the paradigm’s assumptions, postulates, principles, and concepts. For humanbecoming nurses, it seems, then, that these nurses would be more appropriately named “policy crafters,” as opposed to nursing policy-makers or developers. A pertinent definition of crafting, from the Oxford English Dictionary (2023), is “the activity of skillfully creating something” and “making decorative objects with your hands” (para. 1 & 2). Moreover, Rosanne Cash (2018), the award-winning singer, song-writer, and producer, described crafting or a craft. She wrote that:
Craft is the dovetailing of discipline and imagination, dedication, and inspiration. When those spiral around each other, and serious attention is given over to that alchemy, then one’s craft can be realized. My particular craft uses notes and words, and sometimes they are difficult to wrangle into a pleasing shape, but no more difficult than thread and fabric, wood and knife, canvas and paint, flour, and butter. (para 10)
From these definitions, there is an artful way to create or make policies with skill and careful attention to detail, especially policies that weave in nursing values and beliefs that are embedded within the larger tapestry of the humanbecoming paradigm.
Utilizing elements of art and design (Sondheim, 2011), Parse (2021a) has written “principles of inquiry construction” when she developed modes of inquiry congruent with the humanbecoming paradigm (p. 67). These principles of inquiry construction may serve as the basis for the principles of crafting policies congruent with the humanbecoming paradigm, as outlined in Table 1: Principles of Inquiry Construction and Policy Crafting.
Principles of Inquiry Construction and Policy Crafting.
These principles of crafting policies guide the interlacing of humanbecoming into living the art (practice) through the skillful and attentive “crafting” of policies that flow from the humanbecoming paradigm.
Policy Crafting: Humanbecoming Community Change Concepts and the Rainbow PRISM Model
In light of the principles of crafting policies, it is essential to reflect on the ways the humanbecoming community change processes may shape the policies of healthcare organizations, centers, and communities, such as those health centers guided by the Rainbow PRISM Model (RPM; Cody, 2003; Ortiz, 2018). From a humanbecoming perspective, “when people come together as a group, the individual communities bring their histories to the emerging now, and this creates an entity of coevolving histories, which confirms individual as community and group as community” (Parse, 2021a, p. 151). This means that each person is community, and each group is community (Parse, 2003, 2012, 2021a). With this view of community, there are three community change concepts: moving-initiating, anchoring-shifting, and pondering-shaping (Parse, 2003, 2012, 2021a). These concepts are “rhythms [that] arise in all day-to-day relationships as new meanings unfold with shifting patterns in cocreating what is possible” (Parse, 2003, p. 23).
[The] becoming visible-invisible becoming of the emerging now is the living moment that brings to the fore the idea that meaning changes with each unfolding living experience incarnating the remembered with the prospected all-at-once. It is what is meant by the construct all-at-onceness. (Parse, 2012, p. 44)
By being grounded in the humanbecoming paradigm and the humanbecoming community model, nursing policy crafters cocreate policies that reflect nursing’s knowledge base, and the values and beliefs of all communities: individual and group.
In regard to utilizing the RPM with practice (living the art), Ortiz (2018) wrote about how each of the RPM’s constructs (PRISM: Presence, Respect, Information, Services, and Movement) are consistent with Parse’s (2021a) humanbecoming paradigm. Presence is being with the community, face-to-face, paying attention, being reliable, being with community, and staying with community over time (Cody, 2003). In living the art of humanbecoming, true presence is “a powerful humanuniverse whole-in-motion connection, a special way of being with others, attentive to moment-to-moment changes in meaning with the becoming visible-invisible becoming of the emerging now” (Parse, 2021a, p. 119). Parse (2021a) further explained that true presence is “bearing witness and being with others in their changing patterns preferences attuned to the rhythms, hopes, and dreams as shown in the sounds and silences, the visions and blindnesses available with the illimitable mystery of being human” (p. 119). In living the art of humanbecoming, being with others is grounded in the belief that people know their way, are mysteries, and are experts on their living quality. “Living quality can be described only by the individuals living life since it is the incarnation of meanings in their seamless symphony of becoming” (Parse, 2021a, p. 120).
Respect is profound veneration for human dignity, honored consistently, demonstrably, and without exception. This means that it is a community’s values, hopes, and dreams that determine the professional’s activities (Cody, 2003). Within the humanbecoming paradigm, human dignity is a tenet fundamental to the humanbecoming nature of existence, and has four tenets: reverence (solemn regard for humanuniverse presence), awe (beholding the unexplainable of humanuniverse existence), betrayal (violation of humanuniverse trust), and shame (humiliation with dishonoring humanuniverse worth; Parse, 2021a, p. 29). Professionals are with others in nonjudgmental ways that honors their wishes, needs, and wants.
Information is of two kinds: information about clients and information that clients want. The healthcare providers and staff listen first, last, and always, acknowledging clients’ freedom and responsibility to make their own choices in life (Cody, 2003). Within the RPM nursing practice model, professionals and staff make information available to clients that the clients say they want to support informed decision making. Parse (2021a) wrote that “humanbecoming professionals bear witness with individuals and groups as they choose living quality with the becoming visible-invisible becoming of the emerging now” (p. 160). This means that professionals, guided in practice by the RPM, provide information to others when it is asked for and not when the professional believes others may need or require it. By doing so, professionals honor the values of others in the moment, as directed by what is wanted, needed, or requested.
Services are helpful or useful acts on the part of healthcare providers and staff, directed toward clients, and are tangible, desirable, and meaningful from the perspective of the clients (Cody, 2003). This means that professionals guided by humanbecoming with the RPM model do not participate in routinized assessments based on algorithms of illness signs and symptoms or disease processes. Instead, professionals are “with individuals in the becoming visible-invisible becoming of the emerging now, and what surfaces is illuminating meaning, shifting rhythms, and inspiring anticipation” (Parse, 2021a, p. 120). That is, individuals share their story with professionals that uncovers “new insights and even surprises as situations are seen in the new light that arises with the true presence of those who bear witness without judging” (Parse, 2021a, p. 121). Professionals, then, are available to hear the perspective of what is important to others, as opposed to conducting a data-gathering assessment to gather information for professionals to provide input for the traditional therapeutic planning process.
Movement is change in a desired direction in the lives of individuals, families, and groups. Healthcare providers and staff encourage, support, and coparticipate in movement as determined by community (Cody, 2003). This means that professionals and staff, adhering to the RPM practice model, follow the lead of the people served and change activities as people change. In this light, Parse (2021a) wrote, “inspiring anticipation is moving with the becoming visible-invisible becoming of the emerging now. Moving with is propelling with envisioned possibles of transforming” (p. 121). This means that professionals move with others as they describe what they hope will be and the desires they work towards through their many choices. “Creative imagining, affirming personal becoming, and glimpsing the paradoxical are ways that can move individuals to change pattern preferences in living quality” (Parse, 2021a, p. 125).
Moving-Initiating Community Change
In moving-initiating change, “community (individual and group) is discarding-creating shown with the becoming visible-invisible becoming of the emerging now. The discarding and at-once creating refers to barriers that cannot be moved without erecting new ones” (Parse, 2021a, pp. 152–153). Moving-initiating processes arise with the “removal” of earlier or traditional ideas and create space for innovative approaches to policy crafting. The processes are tunneling, driving, laddering, boating, swimming, submarining, ballooning, motorflying, and swinging (Parse, 2021a, p. 152). These processes are “actions” of change as skilled and attentive “crafters” of a policy focusing on change at the organizational and practice levels. These moving-initiating processes are about introducing movement as change, such as through crafting policies that are consistent with the RPM’s practice constructs.
“Tunneling is digging under, piercing the depths in cocreating situations for deliberately earthing and unearthing ideas, objects, and events” (Parse, 2021a, p. 152). This is how pioneering practice approaches, like the RPM, are “uncovered,” while all-at-once covering-up longstanding practices of health centers, such as those with medicine-focused policies, which are not valued by constituents of nurse-led health centers. With tunneling, nursing policy crafters attend to humanbecoming ideas about the direction of an initiative or policy, such as: “nursing practice with individuals, families, and groups focuses on their desires and intentions” (Cody, 2003, p. 59). “Driving is forging directly with intensity in cocreating the shifting patterns of diversity” (Parse, 2021a, p. 152), and “laddering is climbing multidirectionally in planning and executing strategies” (Parse, 2021a, p. 152). Driving and laddering is crafting policies with strength and in unexpected ways; it is the ways in which humanbecoming policy crafters and constituents move and shape what they value from their unique knowledge bases. These values arise in the policies and projects that are chosen. With this, it is important that the nursing policy crafters are “cautiously moving on [which] may require engaging in open discussions about differences and negotiating with integrity, uncovering potential consequences of choosing to move in one direction or another” (Parse, 2021b, p. 345). A policy may be crafted that is focused on how “nursing practice is guided by community priorities with utmost respect for values” (Cody, 2003, p. 59).
“Boating is steering while navigating the calm-turbulence of shifting waves and wind, harnessing moments of buoyancy, yet always with ambiguity” (Parse, 2021a, p. 152), “swimming is gliding with diverse currents in keeping afloat with sureness-unsureness” (Parse, 2021a, p. 152), and “submarining is immersing in a high pressure enveloping at great depth with the shifting of what is known and not-yet known explicitly” (Parse, 2021a, p. 152). Boating, swimming, and submarining emerge with many composed occasions and pressures of crafting new policies amid the uncertainty that arises with inventive policies; one such crafted policy is that “nurses bear witness to desires, intentions, hopes, and dreams of community” (Cody, 2003, p. 59). Innovative policies are not often the only matters of concern to constituents. It is important then that the nurse policy crafters keep the mission driven nursing agenda “afloat,” while navigating with challenges and opportunities as they “float” up in creating something new with the RPM, such as a crafted policy that focuses on “nurses both bear witness to, and assist with, the clients’ activities in pursuing their desires, intentions, hopes, and dreams” (Cody, 2003, p. 59). Parse (2021b) wrote that “Unforeseen and unexpected insights may surface from the collective engaging of the members present in the situation” (p. 345).
“Ballooning is drifting vigilantly with the pattern of the whole in a buoyant surgence-release, while shifting winds cocreate the unexpected” (Parse, 2021a, p. 152), “motorflying is propelling persistently with the gravity of weaving winds” (Parse, 2021a, p. 152), and “swinging is soaring in undulating suspension with gusts of shifting winds in swingshifting to and fro in a bold leaping beyond” (Parse, 2021a, p. 152). Ballooning, motorflying, and swinging are the ways nursing policy crafters may thoughtfully identify the rise and falls of policy transformation, while advancing nursing policy crafting regardless of any sudden shifts that may happen with constituents. It is important to stay with the established values and beliefs of the RPM to ensure a health center’s policy agenda is consistent with a humanbecoming knowledge base; one such crafted policy would be: “we acknowledge individual freedom to choose direction in life and do not seek to influence or change persons’ choices” (Cody, 2003, p. 59). Parse (2021b) wrote that “surprises may surface as the constituents of a situation cocreate unexpected unfoldings. Designated leaders usually have agendas that the others present may not yet know” (p. 345).
Anchoring-Shifting Community Change
Parse (2021a) wrote that in anchoring-shifting change,
community (individual and group) is persisting-diversifying with the becoming visible-invisible becoming of the emerging now. Persisting-diversifying is anchoring with tradition and shifting with new experiences, and it is what ongoing change means in light of the pattern of the whole. (p. 154)
The processes of anchoring-shifting are savoring-sacrificing and revering-liberating. Parse (2021a) described these processes:
Savoring is delighting in something treasured while all-at-once forgoing it. It is relishing being with others, ideas, objects, or events that are appealing to community, whereas sacrificing is giving up something of worth. Savoring- sacrificing is shown as threads of constancy amid diversity become transparent in speech, silence, movement, and stillness. (p. 154)
“Savoring is delighting” is how policy crafters and constituents find contentment in new policies, while “savoring-sacrificing is shown as threads of constancy amid diversity” that arise as policy crafters and constituents accept what may be lost, as new policies shape and sometimes remove previous policies.
Parse (2021a) described revering-liberating as “honoring and respecting others and ideas while cocreating a buoyant freeing. The respecting is of the predecessors, contemporaries, and successors alive with the personal histories of the constituents, as they push and resist with the familiar-unfamiliar in anchoring-shifting” (p. 154). Revering-liberating is respect for others and their ideas; it is releasing constituents from ties to previous policies and values of traditional health centers. In light of the processes of anchoring-shifting, it is important that policy crafters are able to respect “differences with conviction” (Parse, 2021b, p. 345). “Regardless of the goal and the constituents, the leader living power with presence is engaging with prudence” (Parse, 2021a, p. 345). There are two crafted policies consistent with the processes of anchoring-shifting: “nurses are with community as values and intentions change over time” and “nurses offer their energies to contribute to the attainment of desired changes” (Cody, 2003, p. 59).
Pondering-Shaping Community Change
It is imperative that leaders think about change and form its direction based on values and beliefs. In pondering-shaping change, Parse (2021a) wrote that:
community (individual and group) is contemplating-configuring with the emerging now. Contemplating and at once configuring is with the imaged possibles present with the communities’ illimit-able experiences. Contemplating-configuring is humanuniverse connecting-separating in cocreating new meaning in deep thought as careful shapeshifting arises with certainties amid the inevitable uncertainties of choosing directions in the context of the becoming visible-invisible becoming of the emerging now. (p. 155)
The processes of pondering-shaping are considering-composing and dialoguing-listening. Parse (2021a) wrote that:
Considering-composing is concentrating with deliberate intent or deep meditation in all-at-once living creating anew with the becoming visible-invisible becoming of the emerging now. Considering is deliberately ruminating about others, ideas, objects, and events that are important with the everchanging becoming visible-invisible becoming of the emerging now. (p. 155)
“Considering-composing is concentrating with deliberate intent” is thinking about how beliefs and values shape the crafting of policies; what is chosen by policy crafters and constituents reflects the meaning of values and beliefs.
In 2003, Parse described dialoguing-listening as “unconditional witnessing with all-at-once speaking−being silent and moving−being still” (p. 39). She also wrote that:
Dialoguing with community in pondering-shaping arises with the discourse of comingling personal histories. Listening with pondering-shaping emerges with the solemn regard integral with coming to know something in depth for a clearer understanding yet knowing that all understanding is only for the moment as it is bridled with the mystery of that which cannot be known explicitly. (2021a, p. 155)
“Dialoguing-listening is unconditional witnessing” is about the ways in which constituents involved are able to offer their thoughts about what is important to them, as new policies are crafted; it is an opportunity for persons to express what is crucial and impact the crafting of the policies. There are two crafted policies consistent with the processes of pondering-shaping: “nurses listen and dialogue as community ponders and shapes the future” and “nurses ponder and shape resources at the nursing center to conform with community preferences” (Cody, 2003, p. 59).
Summary
It is important that nurses guide practice with crafted policies based in nursing knowledge that is distinctive and specific to the values and beliefs of all persons, such as humanbecoming. As policy crafters in nursing, a nursing theory or model must serve as the foundation in service to others. In this article, the author explored crafting policy implications with the Rainbow PRISM Model (Cody, 2003; Ortiz, 2018), in light of Parse’s (2021a) humanbecoming paradigm, the humanbecoming community change concepts (Parse, 2003, 2021a), and Parse’s (1987, 2021a) principles of inquiry construction. The crafting policy principles and implications further expand understanding of the ways in which humanbecoming may be “lived out” in practice through specific congruent policies.
