Situation specific theory evaluation

 For this discussion, you will be evaluating Willis, DeSanto-Madeya, & Fawcett (2015).

Moving Beyond Dwelling in Suffering: A Situation-Specific Theory of men’s Healing from Childhood Maltreatment (PDF)

. Nursing Science Quarterly, 28(1), 57–63.  article attached

Situation-Specific Theory Evaluation Criteria

Parsimony

1. Is the theory concise or wordy?

2. Provide examples.

3. Did this theory propose implications for practice and research, for patients suffering from effects of childhood abuse? Explain/cite examples

2 schorlary articles APA

Nursing Science Quarterly
2015, Vol. 28(1) 57 –63
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DOI: 10.1177/0894318414558606
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Article

Healing among men who have lived through various forms
of childhood maltreatment (CM), referred to by the general
public as child abuse, is not well understood. The phenome

–

non of healing represents a complex human situation central
to the focus of the discipline of nursing and in need of further
research and theorizing (Willis, Grace, & Roy, 2008).
Although Draucker and colleagues (2011) developed a stage-
based theoretical framework of healing from one form of
CM, childhood sexual abuse (CSA), using data from a sam-
ple of men and women, men’s exposure to CM and their
healing from all forms of CM, including neglect and physi-
cal, sexual, and emotional abuse, have not been adequately
studied. The purpose of this paper is to propose and describe
a situation-specific nursing theory of men’s healing from
CM interpreted within the context of Rogers’ science of uni-
tary human beings (SUHB). Given that the purpose of this
paper is to introduce a new theory, we did not include an in-
depth description of the entire hermeneutic phenomenologi-
cal research process–including the presentation of detailed
findings and participant quotes as an outcome–that served as
the starting point for our theory. Findings are comprehen-
sively discussed elsewhere (Willis et al., in press). The con-
tribution of this paper is the description of a situation-specific
theory that extends nursing theories of healing by focusing
on adult men survivors’ experiences of healing from all
forms of CM.

Rogers’ Science of Unitary Human
Beings

The SUHB is a very abstract and general conceptual model
of nursing that has been used to guide theory development
(Rogers, 1992). The four postulates of the SUHB are energy
field, openness, pandimensionality, and pattern. Human
beings and their environments, which are regarded as coex-
tensive energy fields, always are completely and continu-
ously open and pandimensional, that is, without any space or
time features. Energy field pattern is regarded as a non-
observable wave that is empirically observable only through
manifestations in the form of situations; events; reports of
perceptions; various forms of expression, such as oral and
written stories, dances, and works of art; reports of experi-
ences; and observations of ways of living and relating.

Human and environmental energy field patterns are char-
acterized by three mutually exclusive principles of homeo-
dynamics (Rogers, 1992). Resonancy refers to continuous
evolutionary change in human and environmental field pat-
terns from lower to higher frequency waves. Helicy refers to
continuous, innovative, and unpredictable changes in

558606 NSQXXX10.1177/0894318414558606Nursing Science QuarterlyWillis et al.
research-article2014

1Associate Professor, Boston College
2Associate Clinical Professor, Boston College
3Professor, University of Massachusetts-Boston

Moving Beyond Dwelling in Suffering:
A Situation-Specific Theory of Men’s
Healing from Childhood Maltreatment

Danny G. Willis, RN; DNS,1 Susan DeSanto-Madeya, RN; PhD,2
and Jacqueline Fawcett, RN; PhD; FAAN3

Abstract
The authors present an explanation of the development of a situation-specific theory of men’s healing from maltreatment
during childhood. Development of the theory was guided by Rogers’ science of unitary human beings (SUHB). The four
multidimensional concepts of the theory are interpreted within the context of the SUHB from themes discovered from
the findings of a hermeneutic phenomenological study of men who had been exposed to childhood maltreatment, including
neglect and abuse. The concepts are: moving beyond suffering, desiring release from suffering, dwelling in suffering, and
experiencing wellbeing. Moving beyond suffering is the process of healing from childhood maltreatment. Desiring release
from suffering is the facilitator of men’s life experiences that speeds up the rate of evolution from moving beyond suffering
to experiencing healing. Dwelling in suffering is the barrier in men’s life experiences that slows down the rate of evolution
from moving beyond suffering to experiencing wellbeing.

Keywords
Situation-specific theory, healing, childhood maltreatment

http://crossmark.crossref.org/dialog/?doi=10.1177%2F0894318414558606&domain=pdf&date_stamp=2014-12-17

58 Nursing Science Quarterly 28(1)

pattern. Integrality refers to continuous mutual human and
environmental energy field process. Although evolution of
human and environmental energy field patterns is continu-
ous, the rate of evolution may be interpreted as faster or
slower.

Related Literature

Survivors of CM are at risk for poor health and quality of life
(Corso, Edwards, Fang, & Mercy, 2008). Men with histories
of CSA demonstrate suicidal ideation (Easton, Renner, &
O’Leary, 2013), the psychiatric disorders of major affective
disorders, anxiety, personality disorders, and a range of other
illnesses (Spataro, Mullen, Burgess, Wells, & Moss, 2004).
Most published studies and theorizing about healing from
CM has been limited to a primary focus on survivors who
experienced sexual violence or CSA (Chouliara, Karatzias,
& Gullone, 2013; Draucker et al., 2011; Grossman, Sorsoli,
& Kia-Keating, 2006). Briere’s (1992) classic child abuse
trauma theory is laudable in that it addresses all forms of CM
experienced by both men and women. However, the focus of
that theory on psychopathological response patterns result-
ing from CM does not offer a parsimonious theory of healing
from CM that could be used to enhance healing professional
practices.

The SUHB has been used to guide generation and testing
of many middle-range theories (Fawcett & DeSanto-Madeya,
2013), including Barrett’s theory of power as knowing par-
ticipation in change (Barrett, 2010), Butcher’s theory of
dispiritedness in later life (Butcher, 1996), and Cowling’s
unitary praxis healing model for women’s experience of
despair (Cowling, 2006). The SUHB has not, to our knowl-
edge, been used to guide development of situation-specific
theories.

The Hermeneutic-Phenomenological
Study

The SUHB served as the conceptual model for interpreting
the findings of a federally-funded hermeneutic phenomeno-
logical study of community-dwelling adult male survivor’s
healing from maltreatment when they were children. The
research undergirding our situation-specific theory utilized a
hermeneutic phenomenological approach focused on under-
standing men’s descriptions of healing and the researchers’
interpretations of the men’s experience of healing.

Salient aspects of the research approach are briefly
described here and in more detail elsewhere (Willis, Rhodes,
Dionne-Odom, Lee, & Terreri, 2014b). University institu-
tional review board approval was obtained prior to conduct-
ing the research. Written informed consent was obtained
from a purposive sample of 52 adult men who perceived
themselves as having experienced healing from their own
CM and who were willing to be interviewed. They were
recruited through advertisements, flyers, and snow-ball

sampling within a northeastern city in the United States
(U.S.). The goal of the hermeneutic phenomenological
research approach used for the study (Cohen, Kahn, &
Steeves, 2000) was to obtain rich oral descriptions through
in-depth individual interviews, lasting from one to three
hours, focused on the phenomenon as well as the subsequent
interpretation of the meaning of the humanly lived experi-
ence. This hermeneutic phenomenological approach was not
grounded within the SUHB unlike Butcher’s (1996) unitary
pattern field portrait hermeneutic-phenomenological method
or Cowling’s (2004) unitary appreciative inquiry.

The interviewing process, conducted by a psychiatric
mental health nurse, began with an initial orienting question,
“Tell me about your experience of healing from childhood
maltreatment. What has healing been like for you?”
Interviewing processes to clarify and deepen participants’
reflections on their life of healing from CM followed the ini-
tial interview question.

Data analysis was an iterative process including examina-
tion of the audiotapes of the interviews and transcripts of
interview data. Multiple reviews of audiotapes, readings of
transcripts, and thoughtful reflection on excerpts from the
data by the research team facilitated the identification of
codes reflecting the meaning of healing. Through reflection
and immersion in the data of lived experience obtained in the
interviews, identification of codes, refining codes, and
research team discussions, themes were ultimately generated
to reflect the meaning of healing from CM. The themes of
the meaning of healing were validated through eight partici-
pants’ recognition of ‘healing’ during member checks.
Continuing within the hermeneutic circle of research inter-
pretation (Cohen et al., 2000), our situation-specific theory
of men’s healing from CM evolved as the findings were
interpreted in light of the SUHB. This interpretation further
illuminated the phenomenon of healing from CM within a
nursing discipline-specific context.

The Situation-Specific Theory

Meleis (2012) described situation-specific theory as a rela-
tively concrete theory that is developed for members of a
specific population who are exposed to a specific health-
related situation. The population of interest for our theory is
adult men survivors of CM. The specific health-related situ-
ation of interest is the pattern manifestations of CM.

Pattern Manifestations: The Situation

Within the context of the SUHB, and for the purposes of
development of our situation-specific theory of men’s healing
from CM, the energy field pattern manifestation of the situa-
tion is represented by societal understanding of male survi-
vors’ maltreatment during childhood. The World Health
Organization (2013) identified CM as a major worldwide
health problem for both boys and girls. However, scientific

Willis et al. 59

research and theory development regarding men’s experi-
ences of healing from CM does not parallel the substantial
advancements in theory pertaining to women’s experiences of
healing from CM. Over the past few decades, knowledge
development directed toward describing women’s experi-
ences has resulted in extensive recognition of sexual abuse
and violence against girls and women. This work has resulted
in garnering of female-specific resources and health services.
The emphasis only on females, although needed, is inconsis-
tent with similar rates of CM experienced by both females
(52%) and males (48%) residing in the U.S. (United States
Department of Health and Human Services, 2012).

Pattern Manifestations: The Events

Pattern manifestations of events are represented by the actual
instances of childhood maltreatment. All 52 participants
experienced CM before the age of 18 either within the con-
text of their families (mothers, fathers, siblings, other rela-
tives) or with non-familial others. Their ages ranged from 18
to 64 years of age at the time of the interview, with the major-
ity of the participants in their 40s and 50s. All reported hav-
ing experienced either childhood neglect and/or physical,
sexual, emotional abuse.

Our situation-specific theory evolved as we interpreted
the findings of the hermeneutic phenomenological study
within the context of the SUHB. We interpreted the themes
discovered in the data from the hermeneutic phenomenologi-
cal study as pattern manifestations that reflected the homeo-
dynamic principles.

Pattern Manifestations: Reports of
Perceptions and Forms of Expression

Moving Beyond Suffering

A pattern manifestation of reports of perceptions and forms
of expression is represented by our situation-specific theory
multidimensional concept of moving beyond suffering, which
reflects the homeodynamic principle of helicy. Moving
beyond suffering is the men’s reports of their perceptions of
and their expressions in narrative form of the process of heal-
ing from CM as a continuous, innovative, and unpredictable
liberating of the self from preoccupation with abuse, and
focusing instead on discovery, cultivation, and sustenance of
the authentic self capable of experiencing and maintaining a
sense of peace and wellbeing. The five dimensions of mov-
ing beyond suffering are breaking through the masculine
veneer, finding meaning, choosing to live well, caring for
self using diverse healing methods, and engaging in mutual
process perceived as humanizing (Willis, Rhodes, Dionne-
Odom, Lee, & Terreri, 2014b).

Breaking through the masculine veneer (BTMV) is that
dimension of moving beyond suffering in which the male sur-
vivor evolves in his sense of self by becoming aware of

society’s definition of masculinity and the self who has been
abused or neglected in childhood being regarded as damaged
goods and bad. BTMV involves experiencing and yielding to
the emergence and cultivation of a fuller sense of self. BTMV
represents a male-specific aspect of healing from CM that dif-
fers from female veneer as it specifically reflects men’s chal-
lenges with living as a male survivor of CM. Key aspects of
BTMV include recognizing CM, acknowledging the restric-
tion of masculine social norms on healing as a man and
accessing and expressing emotions beyond those emotions
socially prescribed as typical and appropriate for masculine
expression such as anger, revenge, or aggression. The authors
view BTMV as perceived and expressed by men to reflect
their lives of healing from CM within the societal context of
masculine norms and the evolution of the authentic self.

Finding meaning is that dimension of moving beyond suf-
fering in which the male survivor discovers purpose in his
experience of CM and life beyond CM that assimilates the
events of CM. Key features of finding meaning include
reframing the CM events to let go of perceived negativity
while remaining respectful of suffering, attributing CM to
the abuser(s) versus blaming self, focusing on an evolving
optimistic view of the self, practicing self-defined spiritual-
ity, appreciating life and the journey of healing, and gleaning
insight into emotions, behavior, and personal and spiritual
evolution. Thus, finding meaning continuously moved men
beyond perceiving their lives as constricted existence domi-
nated by rumination, negative thoughts, self-blame, anger,
and fear.

Choosing to live well is that dimension of moving beyond
suffering in which the survivor makes thoughtful deliberate
decisions and develops explicit action plans focused on actu-
alizing a more optimal authentic self capable of living well in
mutual process. Key features include believing in taking
charge of life, setting goals, making choices, taking action to
support a life of wellbeing, and being continuously deter-
mined to move beyond suffering. When men chose to live
well, they reinforce a newer, yet continuous, innovative, and
unpredictable liberating of the self from preoccupation with
abuse and instead perceive the self as healing.

Caring for the self using diverse healing methods is a
dimension of moving beyond suffering in which the survivor
looks beyond traditional Westernized medicine and incorpo-
rates complementary and alternative health approaches into
his life. The methods mentioned by the men who participated
in the hermeneutic phenomenological study include focused
breathing, listening to music, meditation, yoga, tai chi, drum-
ming, dancing, running, swimming, biking, massage, reiki,
acupuncture, qiqong, reading, and gardening. Experiencing
mutual process within calming environments and artistic cre-
ative expression eased pain, improved self-awareness, and
released emotions. When men participated in these healing
methods, they entered into a relaxed state and became aware
of what they expressed as a connection with nature and/or
others.

60 Nursing Science Quarterly 28(1)

Engaging in mutual process perceived as humanizing is
that dimension of moving beyond suffering in which the
male survivor perceives and expresses himself compassion-
ately in mutual process. Key features of the mutual process
include receiving and giving supportive, compassionate,
empathetic, validating, trusting affirmations with others,
including altruistic acts of helping others.

Desiring Release from Suffering

Another pattern manifestation of reports of perceptions and
forms of expression is represented by our situation-specific
theory multidimensional concept of desiring release from
suffering, which reflects the homeodynamic principle of res-
onancy. The concept of desiring release from suffering
reflects the men’s perceptions and expressions of how they
evolved from moving beyond suffering to experiencing well-
being, which may be interpreted within the SUHB as evolv-
ing from lower to higher frequency wave patterns and,
therefore, may be regarded as the facilitator of healing. The
five dimensions of desiring release from suffering are: open-
ness to change, mindfulness, intention, perseverance, and
optimism.

Openness to change is that dimension of desiring release
from suffering in which the survivor is amenable to altering
sense of self and ways of being. Openness to change is nec-
essary for awareness of transformation and evolution to
occur. Mindfulness is that dimension of desiring release from
suffering in which the survivor is aware of CM events and
simultaneously senses an innate yet undiscovered and/or
underdeveloped capacity for healing. Intention is that dimen-
sion of desiring release from suffering in which the survivor
deliberately and thoughtfully focuses on healing and purpo-
sively aims, plans, and acts to heal from CM. Perseverance is
that dimension of desiring release from suffering in which
the survivor endures many challenges in an attempt to expe-
rience healing from CM. Perseverance helps the survivor
maintain momentum through difficult times and diverse life
changes as he evolves to experiencing wellbeing. Optimism
is that dimension of desiring release from suffering that is
indicative of the survivor’s outlook and energy that facilitate
evolving from suffering to wellbeing.

Dwelling in Suffering

Still another pattern manifestation of reports of perceptions
and forms of expression is represented by our situation-
specific theory multidimensional concept of dwelling in
suffering, which also reflects the homeodynamic principle
of resonancy. The concept of dwelling in suffering is the
men’s perceptions and expressions of what slowed the rate
of their evolution to experiencing wellbeing, which may be
interpreted within the SUHB as a slower rate of evolving
from lower to higher frequency wave patterns than desiring
release from suffering and, therefore, may be regarded as

the barrier to healing. The seven dimensions of dwelling in
suffering are: hiding behind a masculine veneer, lack of
insight, being stuck in distress and escaping through behav-
iors regarded by society as dysfunctional, mistrust of oth-
ers, statements by therapists and others perceived as
unsupportive, being in environments perceived negatively,
and inadequate male resources for healing from CM (Willis
et al., 2014a).

Hiding behind a masculine veneer is that dimension of
dwelling in suffering in which the survivor conceals the self
for fear of exposing feelings of vulnerability and being
judged for not living up to stereotypical masculine social
norms. The self that is hidden from others includes percep-
tions of self as damaged or vulnerable, as well as perceptions
of self as loving and compassionate. Lack of insight is that
dimension of dwelling in suffering in which the survivor per-
ceives a deficiency in recognizing and understanding his suf-
fering. Being stuck in distress and escaping through behaviors
regarded by society as dysfunctional is that dimension of
dwelling in suffering in which the survivor feels trapped by
unpleasant thoughts and behaviors regarded by society as
dysfunctional. Mistrust of others is that dimension of dwell-
ing in suffering in which the survivor distances himself and
does not trust others to do no harm.

Statements by therapists and others perceived as unsup-
portive is that dimension of dwelling in suffering in which
the survivor hears what he perceives as negative and invali-
dating statements from professionals, family, friends, and
others. Invalidating statements by others send a message to
the survivor that his perceptions and expressions are not val-
ued, believed, or credible. This dimension also includes
interpreting communications with family members and oth-
ers as hurtful, being faced with unresolved CM-related issues
in the family, and perceiving abusive dynamics and dissatis-
faction in mutual process with romantic partners and indi-
viduals outside the family.

Being in environments perceived negatively is that dimen-
sion of dwelling in suffering in which the survivor remains in
toxic settings that were associated with exacerbated suffer-
ing. These settings include poverty; environments character-
ized by alcohol, drugs, and chaos; and being exposed to
community violence. The settings also include being embed-
ded in a masculine culture with much silence about male
CM, denial or non-acceptance of male survivors, and societal
expectations about what it means to be masculine. Within
this environment, the survivor may be terrified of denial,
stigma, and judgment.

Inadequate male resources for healing from CM are
within the dimension of dwelling in suffering in which the
male survivor faces a dearth of male-specific resources and
support for healing from CM. Not having access to high
quality resources and support tailored to the particulars of
men’s experiences and challenges limits the male survivor’s
ability to acquire knowledge and help for surmounting the
difficulties associated with the events of CM.

Willis et al. 61

Pattern Manifestations: Reports of
Experiences

Energy field pattern manifestations of reports of experiences
are represented by our situation-specific theory’s multidi-
mensional concept of experiencing wellbeing, which reflects
the homeodyamic principle of integrality. The concept of
experiencing wellbeing is the men’s experiences of healing,
which the authors interpreted as mutual human and environ-
mental energy field process that is experienced as the male
survivor evolves toward healing from CM. The four dimen-
sions of experiencing wellbeing include experiencing com-
passion, experiencing peace, experiencing meaning and
purpose in life, and experiencing mutual process.

Experiencing compassion is that dimension of experienc-
ing wellbeing whereby the survivor is aware of loving kind-
ness and acceptance of self and the suffering of others,
including understanding the suffering of the abuser(s).
Accepting and appreciating suffering with loving kindness,
recognizing others’ suffering and the need to help them, as
well as empathy for one’s abuser(s) is the basis for compas-
sion in experiencing wellbeing. Experiencing peace is that
dimension of experiencing wellbeing in which the survivor
feels harmonious and free from feeling trapped in abuse and
strife. Peace is a harmonious state of being that involves
calmness and serenity. Experiencing meaning and purpose in
life is that dimension of experiencing wellbeing whereby the
survivor experiences life as meaningful and purposeful.
Meaning and purpose in life are based on the survivor having
evolved beyond the CM events, experiencing integration of
all life events, and valuing his life. Experiencing mutual pro-
cess is that dimension of experiencing wellbeing whereby
the survivor is aware of the coextensive experience of self,
others, a higher being, and/or the universe.

Discussion

The conceptual-theoretical-empirical structure for our theory is
depicted in Figure 1, which displays the links of the pattern
manifestations and homeodynamic principles with the concepts
of situation-specific theory. Moving beyond suffering, espe-
cially the dimension of choosing to live well, desiring release
from suffering, and experiencing wellbeing resonate with
Barrett’s (2010) theory of power as knowing participation in
change. Dwelling in suffering reflects periods of suffering simi-
lar to despair as described by Cowling (2004, 2006) and dispir-
itedness as described by Butcher (1996). The non-relational
propositions of the situation-specific theory are the descriptions
of the concepts and their dimensions given in the previous sec-
tion of this paper. The relational proposition of the theory is: The
relation between moving beyond suffering and experiencing
wellbeing is moderated by desiring release from suffering and
dwelling in suffering, such that the stronger the desiring release
from suffering increases, the faster the rate of evolution of mov-
ing beyond suffering to experiencing wellbeing, and conversely,
the stronger the dwelling in suffering, the slower the rate of evo-
lution of moving beyond suffering to experiencing wellbeing
decreases or is perceived as not occurring (Figure 2).

The development of our situation-specific theory emerged
from a synthesis of our thinking about and interpreting the
findings from a hermeneutic phenomenological study of
men’s experiences of healing from CM with the context of
the SUHB. The next step in development of this theory is
empirical testing with sample drawn from the same popula-
tion of men as the sample for the hermeneutic phenomeno-
logical study. An examination of extant measurement tools
that may be congruent with the concepts of our theory must
be completed or, perhaps new tools need to be developed,
prior to empirical testing of our theory.

Rogers’ Science of Unitary Human Beings (SUHB)

–

Figure 1. Conceptual-theoretical-empirical structure for the situation- specific theory of men survivors’ healing from childhood
maltreatment.

62 Nursing Science Quarterly 28(1)

Implications for Nursing Practice

The concepts and propositions of the theory provide an orien-
tation to the complex evolving nature of healing as lived by
men suffering from CM. Applying this theory to practice
within the context of the SUHB, nurses and the men will
engage in the first step of the SUHB practice methodology:
pattern manifestation knowing and appreciation—assess-
ment (Fawcett & DeSanto-Madeya, 2013) to determine where
each man is in his evolution from moving beyond suffering to
experiencing wellbeing, and determine the strength of desir-
ing release from suffering and dwelling with suffering.

Then, nurses and the men will engage in the second step
of the SUHB practice methodology: voluntary mutual pat-
terning, as the men evolve toward experiencing well being.
During this step, “the nurse helps create an environment
where healing conditions are optimal and invites the client to
heal himself … as the nurse and the client participate in vari-
ous [non-invasive] health patterning modalities” (Fawcett &
DeSanto-Madeya, 2013, p. 239). Based on the findings of the
hermeneutical phenomenological study, the health pattering
modalities could include: meditation, guided imagery, rhyth-
mic movement, energy methods, leisure activities, calming
environments, and artistic creative expression.

As nurses and men participate in voluntary mutual pat-
terning, they also engage in the third step of the SUHB prac-
tice methodology: pattern manifestation knowing and
appreciation—evaluation. During this step, the pattern mani-
festations of evolving from moving from suffering to experi-
encing wellbeing are explored and decisions made about the
use of different non-invasive modalities.

Conclusion

The situation-specific theory of men’s healing from CM
focuses on an understudied phenomenon and widens the
scope and specificity of theory within the nursing discipline
to include men healing from all types of CM. The uniqueness
of men’s healing from CM as specified in the theory equips
nurses with knowledge to structure their practice of cre-
atively promoting “well-being for all human beings, wher-
ever they are” (Fawcett & DeSanto-Madeya, 2013, p. 242).

The situation-specific theory advances understanding of
men’s healing from CM and can be used to guide nursing
practice, education, and research endeavors within the con-
text of the SUHB. The theory is a comprehensive SUHB-
based theoretical rendering of men’s healing from CM. The
theory captures men’s perceptions, expressions, and experi-
ences of their healing from all forms of CM that are likely to
be applicable to many adult male survivors who are members
of the same population from which the sample of men for the
hermeneutical phenomenological study was drawn. Inasmuch
as the theory was developed from research with a purposive
and maximum variation sample of ethnically, racially, educa-
tionally, and socioeconomically diverse men in the north-
eastern region of the US, the authors recognize that a different
situation-specific theory could emerge from study of other
populations of men who were exposed to CM.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this editorial.

Funding

The first author received funding from the National Inssitutes of
Health/National Institute of Nursing Research for this research
[1RI5NR011353]

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