A metaparadigm is a group of major philosophical worldviews of a profession that contain conceptual models and theories that help guide research, education, and practice. The nursing metaparadigm is a collection of “intellectual and social missions” of nursing that, in turn, place boundaries of the subject matter that the discipline must follow (McEwen & Wills, 2014, p.41). Many nursing theorists have discussed and examined the nursing metaparadigm in great depth to be able to understand it better and apply it to all forms of the nursing profession. For nursing frameworks and theories to qualify as a metaparadigm, they must develop central domains that are unique from other disciplines, “encompass all phenomena of interest to the discipline in a parsimonious manner” and be “perspective neutral,” as well as have a scope of practice that is global (McEwen & Wills, p.41). The nursing metaparadigm is developed at the center of the nursing profession values, and is used throughout clinical practice and the critical thinking aspects that are required of nurses.
Jacqueline Fawcett first started to develop the central concepts in nursing in 1978, and never formally announced the metaparadigm in nursing until 1984 (McEwen & Wills, p.41). The metaparadigm she developed consisted of four main components: Person, Environment, Health, and of course Nursing. In nursing practice, nurses are most distinguishable from other practices with their focus on the person. Before the 1970s, nursing was merely based on a “biomedical” approach, which viewed the patients more as objects than as humans with deteriorated health. Many models have moved away from this biomedical view and approached nursing as a holistic practice that encompasses not only the client’s illness/physical health, but also their overall mental, emotional, and spiritual well-being (Thorne, et al., 1998).
Clinical Nursing practice is centered around the idea that the patient is first, and that a therapeutic relationship with the nurse and their client is, “the foundation of nursing practice” (Marchuck, 2014). In an article, out of The Journal of Neonatal Nursing, Allison Marchuck discusses how the skill of IV initiation can affect the patient, and their family, positively and negatively. She explains how nurses need to understand how they affect patient because “every interaction a nurse has with a patient has an impact” (Marchuck, 2014). She goes on to explain that even though IV initiation is a skill that we learn, the way that the nurse interacts and approaches the patient and family will have a direct impact on how successful the intervention is, but will also depict the level of stress and anxiety experienced (Marchuck, 2014). It is very clear that the concept of the person in the metaparadigm is strongly linked and supported by clinical nursing practice.
Health, which was defined by the World Health Organization in 1948, is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (World Health Organization, n.d.) It is the duty of the clinically practicing nurse to advocate for their patient’s health and well-being. In more recent years, theorists have put a focus on the “quality of life” over the general concept of health. Nurses see first-hand the effects of certain illnesses, and they have a greater understanding than some professionals on the overall out come a patient may have in regard to quality of life (Thorne, et al., 1998). Whether nurses are assisting in a health-related problem, or a personal issue it is the responsibility of the caregiver to “nurse patients through illness to a satisfactory outcome, whether this is regaining health and function…or the ultimate transition of a peaceful death” (Levasseur, 1999). Health has been of central interest in the profession of nursing since its inception and will continue to be a primary focus of the clinically practicing nurse.
Nursing theorists have many different interpretations of what the term “environment” means. B. Neuman described the environment as “all internal and external factors of influence that surround the client…” while M. Leininger explained environment as being “the totality of an event, situation, or particular experience that gives meaning to human expression…in particular physical, ecologic, sociopolitical, and cultural settings” (McEwen & Wills, p.43). This concept allows the nursing profession to be able to interpret what they believe to be the “environment” in many different ways as well. A nurse manager may think of the environment to be the walls or unique look that a hospital unit has. While on the other hand, the bedside nurse may interpret the environment as a culture of the other nurses, general morale, as well as an environment that is suitable for the conduciveness of healing, development, and generalized well-being. This allows nurses to have autonomy in how they practice; for example, in a Neonatal Intensive Care Unit, one nurse may consider a healing environment as one where darkness is valued for effective sleep patterns, while another nurse may believe that natural light assists with healing and development. Nursing culture, layout, and overall environment is an essential part of how the bedside nurse practices and how successful a nurse will be.
Finally: Nursing. McEwen and Wills describe nursing as “a science, an art, and a practice discipline…” that involves caring for the well and the sick, assisting with self-care and helping patients attain their own “human potential” (McEwen & Wills, p.42). Nursing has been significantly affected over the past 50 years due to advances in communication and will continue to allow nurses to provide top-notch care to their patients (Metaparadigm Concepts in Nursing, 2016). Nursing is a profession that assists with the promotion of health, providing patients with an environment that is beneficial to the healing process, and ultimately, focuses on the person as a whole. Nursing ties all other aspects of the metaparadigm together and upholds the values of which we practice clinically.
As discussed, the main components of the nursing metaparadigm are completely intertwined with the values that are held by clinically practicing nurses. Nursing theorists, the metaparadigm of nursing, and the conceptual frameworks of nursing will allow the profession to grow and become stronger with the help of newer nurses advancing their education, and focusing on the ideals that were founded many years ago. Nurses integrate the ideals of person, health, environment, and nursing into their day-to-day practice, and this shows how important the development of conceptual frameworks is to the profession of nursing.