NR 501 Week 3 Self-Transcendence Concept Analysis Example

Concept Analysis: Self-Transcendence at the End of Life, Separated From Hope, Resilience and Spirituality, With Attributes Written as Tests

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College of Nursing, Chamberlain University

NR 501: Theoretical Basis for Advanced Nursing Practice

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Month Day, Year

Concept Analysis: Self-Transcendence at the End of Life, Separated From Hope, Resilience and Spirituality, With Attributes Written as Tests

The Word It Is Not

The concept analyzed is self-transcendence, as it applies to adults in the last weeks of life. The analysis follows the steps described by Walker and Avant (2019): selecting the concept, identifying its uses, determining defining attributes, constructing cases, and identifying antecedents, consequences and empirical referents. Before any of that, it names the words self-transcendence is most often confused with, because on an oncology unit the four are used almost interchangeably.

Hope looks forward: it is an expectation that something good may still happen. Resilience is recovery: returning to function after adversity. Spirituality is a person's relationship with what they hold sacred, which may or may not involve religion. Self-transcendence is none of these exactly. It is an expansion of the boundaries of the self, inward, outward, across time and beyond the self, that can occur when recovery is not possible and when hope for a cure is gone. A dying patient can lose hope of recovery, show no resilience in the usual sense, have no religious faith, and still show self-transcendence. That is why the concept is worth separating.

Uses, Gathered Rather Than Asserted

The definition is built from published uses. Reed (1991) introduced self-transcendence as a nursing theory concept, developed by reformulating life-span developmental psychology within Rogers' framework, and proposed it for settings where well-being is compromised by end-of-life issues. Coward (1996), measuring self-transcendence with the Self-Transcendence Scale in a healthy adult population, found it strongly correlated with sense of coherence, self-esteem, hope and emotional well-being, which shows that the concept overlaps with hope and well-being in measurement without being identical to them. Teixeira (2008), in a concept analysis for nursing practice, described self-transcendence as a quality inherent in every human being and as a process of personal transformation that helps people find meaning and purpose, and that can serve as a way of coping with adversity.

Outside nursing, the idea has older roots in developmental and existential psychology, which Reed drew on. The analysis here stays with nursing uses, because the question is how the concept functions in nursing care.

Defining Attributes, Written as Tests

Each attribute is written so that an observer could say whether it is present:

1. Inward expansion: the person describes greater awareness of their own values, beliefs or what matters to them now. Test: can they say what is most important to them, and has it changed?

2. Outward expansion: the person reaches toward others, through reconciliation, new closeness or concern for others' futures. Test: are they initiating contact, giving, or expressing care for others?

3. Temporal integration: the person connects past and future to the present in a way that gives meaning. Test: do they speak of their life as a whole, and of what will continue after them?

4. Transpersonal connection: the person relates to something beyond themselves, whether religious, natural or human legacy. Test: do they describe a connection to something larger?

Self-transcendence is present when at least the first and one other attribute can be observed.

A Model Case

Mr. D., 61, a retired machinist with metastatic lung cancer, has stopped treatment and is expected to live a few weeks. He tells the nurse that he used to think his job defined him but now thinks his grandchildren do (inward). He has asked his estranged brother to visit and spent an afternoon with him (outward). He has been recording stories about his father for his grandchildren (temporal). He says he feels "part of something that keeps going" when he watches the birds at the feeder his granddaughter filled (transpersonal). All four attributes are present.

The Example Written to Fail

Mrs. K., 70, with advanced ovarian cancer, is hopeful. She is sure the next chemotherapy will work, talks about her garden next spring, and refuses to discuss her will. She is resilient: after each setback, she returns to her routines within days. She attends her church every week that she can. By the everyday use of the words, she is doing well. By the tests above, however, self-transcendence is not clearly present. She does not describe any change in what matters to her; she is not reaching toward others in new ways; her talk of the future is about continuing as before rather than integrating a life that is ending. Her hope, resilience and spirituality are real, and they are different concepts. This case fails the tests on purpose, to show that the attributes separate self-transcendence from its rivals.

A Borderline Case

Between the two sits Ms. T., 48, with metastatic breast cancer, who has entered hospice care at home. She has written letters to be opened by her teenage son on his birthdays until he turns 21, and she speaks often about what she wants him to remember of her. On the tests above, outward expansion and temporal integration are plainly present. Inward expansion is harder to judge: when asked what matters most to her now, she answers only about her son, and says her own feelings are "not the point." Nothing suggests a relationship with anything beyond her family.

Whether this is self-transcendence depends on how strictly the first attribute is read. The letters could be an expression of changed values, or they could be a way of avoiding her own fear by staying busy for someone else. The analysis does not settle this from outside; it tells the nurse what to ask next. A gentle question about how she herself is doing, asked more than once, would show whether the inward boundary has moved. Borderline cases like this one are useful because they show the attributes are workable questions rather than labels.

Antecedents, Consequences and One Thing Somebody Records

The main antecedent is vulnerability: an awareness of mortality, which serious illness makes hard to avoid. A second is enough cognitive and physical capacity to reflect and connect, which may be lost late in dying. The consequence the theory proposes is greater well-being, a sense of being whole in one's own terms, and some studies suggest lower depression and despair.

The empirical referent is what makes the concept usable in practice. Researchers use the Self-Transcendence Scale, as Coward (1996) did. At the bedside, the nurse can record the four tests above in plain words once a week, noting which attributes the patient shows and in what form. That record would let a team see whether self-transcendence is present, whether it changes, and whether nursing actions, such as arranging a family visit or a life-review conversation, are followed by a change.

A limitation of the analysis is its population. Coward's measurement work was done in healthy adults, and the tests here are proposed for people who are dying, many of whom tire quickly or drift in and out of alertness. A weekly record that depends on conversation will miss patients who cannot talk, and a nurse filling it in may read their own hopes into a patient's words. For that reason, the record should note who supplied each observation: the patient, a family member or the nurse.

References

Coward, D. D. (1996). Self-transcendence and correlates in a healthy population. Nursing Research, 45(2), 116-121. https://doi.org/10.1097/00006199-199603000-00011

Reed, P. G. (1991). Toward a nursing theory of self-transcendence: Deductive reformulation using developmental theories. Advances in Nursing Science, 13(4), 64-77. https://doi.org/10.1097/00012272-199106000-00008

Teixeira, M. E. (2008). Self-transcendence: A concept analysis for nursing praxis. Holistic Nursing Practice, 22(1), 25-31. https://doi.org/10.1097/01.HNP.0000306325.49332.ed

Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson.