The lived experience of moving forward for clients with spinal cord injury: a Parse research method study.
ABSTRACT Most people with spinal cord injuries take a long time to recover and return to their previous life activities. Moving forward is connected with the choices people make about what is important, what to do, and how to live life in ways they value. Parse's Theory of Humanbecoming is a human science theory, and its overall aims are to improve the quality of life for clients and their families.
The Parse research method was used to explore the lived experience of moving forward for 15 clients with spinal cord injuries recruited from two Spinal Injury Associations in Taiwan in 2007. Data were collected and analysed through the processes of participant selection, dialogical engagement, extraction-synthesis and heuristic interpretation, as proposed by Parse.
The core concepts found were confronting difficulties, going on and finding self-value and confidence, and co-creating successes amid opportunities and restrictions. Thus, the structure of the lived experience of moving forward is confronting difficulties, going on and finding self-value and confidence to affirm one's self while co-creating successes amid opportunities and restrictions.
This study contributes to nursing theory-guided knowledge development from a humanbecoming perspective on the experience of moving forward among clients with spinal cord injury, and informs rehabilitation nurses who use the Humanbecoming theory as a guide to practice to promote moving forward.
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ABSTRACT: To examine quality-of-life (QOL) factors and change in mobility in individuals with traumatic spinal cord injury (SCI) 1 year after injury. Retrospective case study of National SCI Database data. SCI Model Systems (SCIMS) sites (N=18). Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility data for both assessments. Not applicable. Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire, Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores. Of the sample, 55 individuals transitioned from walking to wheelchair use within 1 year of discharge. This group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001). Individuals with SCI who transitioned from walking at discharge to wheelchair use within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair, rather than primary ambulation during acute inpatient rehabilitation.Archives of physical medicine and rehabilitation 07/2011; 92(7):1027-33. · 2.18 Impact Factor
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ABSTRACT: The purpose of this study was to integrate and evaluate the spinal cord injury rehabilitation nursing theory named Super-Link System Theory using participatory action research. Data were collected from October 2007 to September 2008 in a rehabilitation hospital by means of interviews, participant observations, documentary resources, case conferences and reports, and participants' self-reflective inquiries. The Super-Link System Theory was introduced to 31 rehabilitation nurses. The nurses selected a key reference group including the researcher to facilitate the participatory action research process to implement and evaluate the theory. Data were analyzed using content analysis. The findings shows that several key concepts were clarified and specific nursing interventions were identified. Furthermore, an integrated link system from the hospital to the community through both rehabilitation nurses and discharge planners was established. The study demonstrated an evidence base for an evolving theory of care, and empowered nurses to make sustainable changes to their practice.Rehabilitation nursing: the official journal of the Association of Rehabilitation Nurses 05/2012; 37(3):119-27. · 0.85 Impact Factor
The lived experience of moving forward for clients with spinal cord
injury: a Parse research method study
Accepted for publication 18 December 2009
Correspondence to H.-Y. Chen: e-mail:
Hsiao-Yu Chen MSc PhD RN
Associate Professor of Nursing
Department of Nursing, National Taichung
Nursing College, Taiwan
CHEN H.-Y. (2010)CHEN H.-Y. (2010)
spinal cord injury: a Parse research method study. Journal of Advanced Nursing
The lived experience of moving forward for clients with
Title. The lived experience of moving forward for clients with spinal cord injury:
a Parse research method study.
Aim. This study is a report of a theory of Humanbecoming-guided study of the lived
experience of moving forward among people with spinal cord injury.
Background. Most people with spinal cord injuries take a long time to recover and
return to their previous life activities. Moving forward is connected with the choices
people make about what is important, what to do, and how to live life in ways they
value. Parse’s Theory of Humanbecoming is a human science theory, and its overall
aims are to improve the quality of life for clients and their families.
Method. The Parse research method was used to explore the lived experience of
moving forward for 15 clients with spinal cord injuries recruited from two Spinal
Injury Associations in Taiwan in 2007. Data were collected and analysed through
the processes of participant selection, dialogical engagement, extraction-synthesis
and heuristic interpretation, as proposed by Parse.
Findings. The core concepts found were confronting difficulties, going on and
finding self-value and confidence, and co-creating successes amid opportunities and
restrictions. Thus, the structure of the lived experience of moving forward is con-
fronting difficulties, going on and finding self-value and confidence to affirm one’s
self while co-creating successes amid opportunities and restrictions.
Conclusion. This study contributes to nursing theory-guided knowledge develop-
ment from a humanbecoming perspective on the experience of moving forward
among clients with spinal cord injury, and informs rehabilitation nurses who use the
Humanbecoming theory as a guide to practice to promote moving forward.
Keywords: human becoming, lived experience, moving forward, nursing, Parse,
spinal cord injury
? 2010 Blackwell Publishing Ltd
JOURNAL OF ADVANCED NURSING
The phenomenon of moving forward is a universal lived
experience of health that is significant to quality of life. All
people experience moving forward at some time in their lives,
possibly in relation to overcoming traumatic life events (such
as traffic accidents, burns, cancer or others), confronting life’s
struggles, living with a condition not of their choice or
carrying on after losing self worth (Shiau 2002, Lane 2005,
Tang et al. 2008, Teixeira 2008). Moving forward is a
human experience intertwined with all life events, embracing
ideals and values, desires and dreams, relationships and
plans, hope and uncertainty. It is a particularly vivid
experience for persons who have had to find ways to go on
with their lives amid the challenges inherent with successful
living after spinal cord injuries (Holicky 2005, Chen & Boore
The Spinal Injuries Association first used ‘moving forward’
on the title page of their guide for living with spinal cord
injury titled ‘moving forward: the guide to living with spinal
cord injury’ (Gatehouse 1995). DeSanto-Madeya (2006a)
stated that spinal cord injury imposed multiple challenges to
adaptation for clients with spinal cord injuries and their
family members. Moving forward was defined as a new way
of life, reflecting families’ learning to see life differently, and
coming to terms with life after injury as a necessary process of
moving forward in new ways of living (DeSanto-Madeya
2006b, Chen & Boore 2008, Lin & Chen 2008).
Parse’s Theory of Humanbecoming is a human science
theory. Human science focuses on the human being’s partic-
ipative experience with the world. The aim of human science
is to understand the connectedness of life itself, which can
never become wholly accessible to complete understanding.
Humanuniverse experiences are connected uniquely to giving
meaning to an individual’s life (Parse 1992).
Moving forward emphasizes leading as full and indepen-
dent a life as possible after a disastrous injury, such as a
spinal cord injury. For such persons, independence does not
mean doing everything for one’s self, but rather, it means
having control over and making the key decisions that affect
life (Gatehouse 1995, Holicky 2005, Chen & Boore 2007).
This independence is very important to those who suffer such
trauma, to enable them and their family members to accept
their reality as a disabled person, and to understand how to
adapt their life again (Liao 2004, DeSanto-Madeya 2009).
Moving forward is associated with courage and triumph over
tragedy, going on with the rest of life after a catastrophic life
event, and confronting challenges (Bournes 2002, Reeve
2003, DeSanto-Madeya 2006b, Chen & Boore 2007, 2008).
‘Moving’ is about acting towards some goal or the arousing
of emotions, and ‘forward’ relates to the future or the
progression of something (Collins Dictionary & Thesaurus,
2002). Much has been written about people suffering and
finding their way to move on or living with their chronic
illness and towards a good result from various disciplines
(Lee et al. 2004, Liao & Lin 2008), yet none of the literature
focuses on the lived experience of moving forward from a
human science perspective for any group, especially those
with spinal cord injury. Therefore, the view of existing
research and literature supports the need for further study of
the phenomenon of moving forward from the perspective of
those who are experiencing it, and particularly, for people
with spinal cord injury. Knowledge of the process of moving
forward is useful for developing a deeper understanding of
the human experience of moving forward, consistent with the
theoretical literature on ‘moving’ and ‘forward’ and ‘moving
forward’. Promoting understanding about what it is like to
move forward gives healthcare professionals a better under-
standing of how these persons find ways to persevere and go
on living day by day, amid their personal difficulties,
disabilities and challenges.
Parse’s Theory of Humanbecoming was first published as
‘man-living-health’ in 1981 (Parse 1981). The theory was
renamed ‘the human becoming theory’ officially in 1992
(Parse 1992) and in 2007, Parse joined the words to create
the Humanbecoming theory (Parse 2007a). Humanbecoming
theory is derived from human science and is based on the
belief that the human is an indivisible, unpredictable, ever-
changing, open being and free to choose meaning in situation
(Parse 1998, 2007b). Parse (1981, 1998) describes humans
co-creating patterns of relating in interchange with the
environment. Human structure means multidimensionally
co-creating rhythmical patterns while cotranscending with
There are three principles in this theory, with concepts and
paradoxes (Parse 1998, 2007a): the first principle of human-
becoming stipulates how humans structuring meaning is the
imaging and valuing of languaging (Parse 2007a, p. 309). In
light of this principle, moving forward is viewed as a process
of structuring meaning while co-creating reality, which
involves explicit-tacit knowing (imaging); choosing meaning
from among imaged options and integrating the meaning
with one’s personal world view (valuing), through speaking
and silence, movement and stillness (languaging).
JAN: ORIGINAL RESEARCH
Moving forward and spinal cord injury
? 2010 Blackwell Publishing Ltd
The second principle of humanbecoming specifies the
paradoxical unity of configuring rhythmical patterns of
relating is the revealing-concealing and enabling-limiting of
connecting-separating (Parse 2007a, p. 309). Accordingly,
moving forward is connected with the paradoxical processes
of humanuniverse relating that entails simultaneously dis-
closing and not disclosing one’s reality (revealing-concealing)
and connecting with, while also separating from persons,
ideas and events (connecting-separating). Additionally, the
experience of moving forward presents both opportunities
and limitations for ways of becoming (enabling–limiting).
The third principle of humanbecoming posits the human-
universe process of cotranscending with possibles is the
powering and originating of transforming (Parse 2007a,
p. 309). When viewed through the lens of this principle,
moving forward entails moving beyond the now moment
with the pushing-resisting force that propels human life
(powering), while carving out one’s path ‘in the certainty–
uncertainty of living’ (originating) and shifting one’s view of
the ‘familiar–unfamiliar (transforming).
In approaching this study, I viewed moving forward as an
experience for clients with spinal cord injuries affecting
health and quality of life in which one recognizes the
possibility of nonbeing. The theoretical perspective guiding
the research was Parse’s (1981, 1998, 2007a) Theory of
Humanbecoming. Central to this perspective are the ideas
that the humanuniverse process is mutual (rather than linear
and causal), and that the human is pan-dimensional, indivis-
ible, unpredictable and ever-changing (Parse 2002, p. 48).
Health is viewed as quality of life from the person’s
perspective – that is, one’s living experience of what life is
like (Parse 1994). The underpinning assumptions and the
three principles of the theory focus on the themes of meaning,
rhythmicity and transcendence. To shed light on how moving
forward shapes health and quality of life, the lived experience
of moving forward was conceptualized in light of the
assumptions, principles and their constituent concepts.
The aim of this study was to describe the lived experience of
moving forward among people with spinal cord injuries.
The Parse research method was employed in this study, which
was designed to be congruent with the ontology of Human-
becoming theory. The Parse research method is different from
other qualitative methods. It is a phenomenological-herme-
neutic method in that the universal experiences described by
participants who lived them are the source of information,
and participants’ descriptions are interpreted in light of the
Humanbecoming theory (Parse 1998). This process of com-
ing to know is the art of sciencing to enhance the knowledge
base of the discipline of nursing, thus, adding to the general
knowledge about phenomena from a particular worldview
(Parse 1997). Clients with spinal cord injuries are respected
as the experts in their own health and the meaning of the
lived experience of moving forward. The processes of the
Parse research method are dialogical engagement, extraction-
synthesis and heuristic interpretation (Parse 2005).
Participants and setting
There are 23 Spinal Injury Associations (SIA) in Taiwan,
which are patient support groups. The number of participants
was determined by the process of heuristic interpretation that
moved the discourse of the structure to the discourse of the
theory. Fifteen participants were recruited from two SIA
located in central Taiwan. Participant selection involved
inviting persons to participate who were moving forward
from spinal cord injuries and who were willing to share with
me symbols, pictures, music, poems or metaphors that were
expressions of their lived experience of moving forward.
Participants were included if they: (i) had a diagnosis of
spinal cord injury by a physician, (ii) were a member of an
SIA who personally perceived moving forward, (iii) were
aged 18 years or more, (iv) had verbal fluency in Chinese or
Taiwanese (other dialects were excluded) and (v) were willing
to participate in dialogical engagement and give informed
consent to participate.
Data were collected in 2007. Data collection involved
dialogical engagement, in which the true presence of the
researcher was with the participant. This was not an
interview, but a focus on the phenomenon under study as
described by the participants (Parse 2005, p. 298). True
presence, described by Parse (1981, 1998, 2007b), is a special
way of being with someone; it is genuine, non-mechanical,
non-routinized attentiveness to the others, an intentional
reflective love, and an interpersonal art grounded in a strong
knowledge base, and honours the beliefs that individuals
know the way and live personal value priorities. Dialogues
were audiorecorded and, when possible, videotaped. I cen-
tred prior to engagement with each participant. The centring
was still-time when I gentled down to be available to be with
? 2010 Blackwell Publishing Ltd
the participant in true presence. After the appropriate consent
form for the protection of participants was signed, and the
trust relationship was built, I opened the dialogue.
I conducted dialogical engagement, and asked participants
to bring and describe personal symbols, pictures, music,
poems or metaphors of moving forward during their response
to the statement, ‘Please tell me about your experience of
moving forward’. I then attended to, and went with the flow
of the behavioural description. No other questions were
asked – although participants were encouraged to say more
about some things, go on, or to speak about how something
they said related to their experience of moving forward. The
dialogues were 30 to 60 minutes in length and were
transcribed verbatim for the extraction-synthesis process.
This study was approved by an institutional review board and
informed consent was obtained from all participants prior to
the study. In 13 cases, the consent form was signed by the
participant. For the two who were unable to write their
signatures, oral consent was obtained and digitally recorded.
Extraction-synthesis is the process of moving descriptions
from the language of the participants across several levels of
abstraction to the language of science (Parse 1998, 2001). In
deep concentration with the transcribed, audiotaped and
videotaped dialogues, the meanings of participants’ experi-
ences were elicited, and invented expressions were created
through abiding with logic and adhering to semantic consis-
tency (Parse 2006). The extraction-synthesis process involved
the following (Parse 2005, p. 298):
• Synthesizing a story that captures the core ideas about the
phenomenon of concern from each participant’s dialogue.
• Extracting-synthesizing essences in the participant’s lan-
guage from recorded and transcribed descriptions. The
essences are succinct expressions of the core ideas about
the phenomenon of concern as described by the partici-
• Synthesizing-extracting essences in the researcher’s lan-
guage. These essences are expressions of the core ideas
conceptualized by the researcher at a higher level of
• Formulating the language-art from each participant’s
essences. Language-art is an aesthetic statement concep-
tualized by the researcher synthesizing the core ideas from
the essences in the researcher’s language. The essences arise
directly from the participants’ descriptions.
• Extracting-synthesizing core concepts from the language-
art of all participants. Core concepts are ideas, written in
phrases that capture the central meaning of the language-
art from all participants.
• Synthesizing a structure of the lived experience from the
core concepts. A structure is a statement conceptualized by
the researcher synthesizing the core concepts. The structure
as evolved answers the research question.
In this study, the constructed stories that captured the core
ideas about moving forward shared by participants were
extracted and their essences synthesized from the transcribed
descriptions in the participants’ language. I then conceptu-
alized the essence in my own language, synthesizing a
language-art from the essences of each participant’s descrip-
tion. I extracted and integrated the core concepts and
synthesized a structure for the lived experience of moving
Heuristic interpretation is the process of ‘weaving the
structure of the lived experience with the principles of
humanbecoming and beyond to enhance the knowledge base
and create ideas for further research’ (Parse 1998, p. 65).
Heuristic interpretation involved two processes: structural
transposition and conceptual integration (Parse 1998). The
structure of the lived experience of moving forward was
created through structural transpositions to moving forward
as overcoming changes and obstacles, having to move beyond
their current physical, emotional and spiritual limitations,
during periods of certainty–uncertainty, while inventing new
possibilities. These activities evolved as the researcher abided
with the structure of moving forward in light of Humanbe-
coming theory. Heuristic interpretation brings forth new
Attention was paid to maintaining trustworthiness between
the participants and the researcher throughout the research
process. I immersed myself in the data, taking time to listen to
the tapes, read the transcripts, think, interpret, understand
and formulate the core ideas. The core ideas were discussed
and shared with all participants during the analysis. In
addition, I asked two experts in qualitative research and
Parse’s theory and research method to conduct expert reviews
and to decide on the core ideas. The experts suggested
conceptual shifts in the levels of abstraction of the descrip-
tions; consequently, the core concepts were identified and
presented in a clear, semantically consistent fashion. All
participants also validated the core concepts identified,
confirming that they were vivid and precise concerning their
lived experience of moving forward.
JAN: ORIGINAL RESEARCH
Moving forward and spinal cord injury
? 2010 Blackwell Publishing Ltd
Fifteen clients with spinal cord injuries agree to participate in
this study. Thirteen resided in their own homes, while the
other two lived in a community residential setting. They
ranged in age from 18 to 55 years. The male: female ratio
was 13:2. The leading causes of spinal cord injuries were
traffic accidents (six), falls (six) and other causes (three).
Seven clients had cervical injuries, six had thoracic injuries
and two had lumbar injuries. The time since injury varied
from 6 to 324 months (27 years), with an average of
133 months (11 years).
From the dialogues, 15 stories were created from which the
essences in both the participants’ languages and my language
were extracted, and language-art for each participant
emerged. Examples of the stories for two participants follow.
Hsiung is 42 years old. He has a complete T12-L1 spinal cord
injury and has been paralysed for 24 years. He says, ‘Spinal
cord injury affects me very much. I am bothered by all
activities of daily living, including bathing, clothing, accom-
modation and transportation. I have to confront and over-
come every challenge. I believe everything will be achieved, if
you do your best. Through group power and confidence-
building, people with spinal cord injury help each other. We
accept the truth of our handicap. God closes a window, and
will open another one for us. Computer technology brings us
hope; we can learn and go back to work; it is not impossible.
We have to seize the chance and create our future ourselves’.
Essences: Hsiung’s language
• Moving forward is confronting and overcoming challenges,
through group discussion and facing the limitations,
additionally to rebuild self-confidence.
• High-tech computer knowledge brings hope to seize a
chance, create a better future, and goback to study or work.
Essences: researcher’s language
• Moving forward is confronting and overcoming difficulties,
arising with finding self-confidence.
• Moving forward is moving beyond and keeping hope amid
personal limitations and chances, and getting back to
Moving forward is confronting difficulties, going on and
keeping hope, and rebuilding self-confidence amid personal
opportunities and restrictions.
Jin is 23 years old. She has a complete C4-6 spinal cord injury
and has been injured for 6 months. She says: ‘At the
beginning of my injury, I felt so inconvenienced by my
activities of daily living; I had problems urinating and
defecating. I know that I have to be independent. My
family’s support is very important to me. I am also concerned
about what other people think about me. However, if I can
transition my thoughts, and open my mind, although I lost a
lot, I still own some control. I have to learn a lot, but I am
confident to confront it. I prepare myself and do my best.
Although, I lost control of my body, I can control my mind.
I am still valuable and I will never ever give up’.
Essences: Jin’s language
• Moving forward is confronting and overcoming changes
and obstacles, doing one’s best to be independent.
• Moving forward is transitional thoughts, open mind and
understanding body limitations; life is still valuable and
Essences: researcher’s language
• Moving forward is overcoming obstacles and exerting all
the endeavours in one’s power.
• Moving forward is going on to affirm self-value, amid the
limitations inherent with successful living, although the
body is limited, the mind is not.
Moving forward is confronting difficulties through transi-
tional thoughts, going on to affirm self-value, creating suc-
cessful living amid opportunities and limitations.
I extracted-synthesized core concepts from the language-art
of all participants (see Table 1). Three core concepts were
extracted and synthesized from all of the participants’
language-arts. The core concepts are confronting difficulties,
going on and finding self-value and confidence, and co-
creating successes amid opportunities and restrictions. Thus,
the structure of the living experience of moving forward is
confronting difficulties, going on and finding self-value and
confidence in order to affirm one’s self, while co-creating
successes amid opportunities and restrictions. The structural
transposition is ‘moving forward is confronting difficulties,
going on and finding self-value and confidence, with cer-
tainty–uncertainty while inventing possibilities. The concep-
tual integration with the theory of humanbecoming is
? 2010 Blackwell Publishing Ltd