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The nursing role is rapidly changing and evolving as we are taking care of a wider health
care responsibilities. The public perception of nurses just at bedside has changed
drastically and now we see nurses involved and collaborating in scientific research,
pursuing advanced specializations, involved in changing health care policies, or in the
media raising awareness about health and illnesses.
The independence, flexibility, and authority to treat patients and to be the link between
the patients and primary care providers are some of the many incentives that continue to
motivate numerous nurses to pursue this career nowadays.

Despite all these changes in the healthcare system throughout the years, one thing has
remained constant: The positive impact that nursing theorists and theories have in our
Theories provide a framework to guide our profession and provide patient care that is
culturally specific and empathetic. As nursing students we studied Florence Nightingales
theory of () manipulation and the environment for the benefit of the patient
(George, 2010 page. 9 ).

It is necessary, in order to comprehend these theories, to review the elements used

to generate these theories and the definitions of the concepts.

Nursing theories are composed of concepts (and their definitions) and propositions
that explain the relationships between the concepts. For example, Nightingale
proposed a beneficial relationship between fresh air and health. Theories are based
on stated assumptions that are presented as givens (George, 2010. p. 3)

The term metaparadigm is defined as the core content of a discipline, stated in the most
global or abstract of terms. () the metaparadigm of the discipline of nursing consisted
of four major concepts: person, health, environment, and nursing. (George, 2010. p. 3)
Person may represent an individual, a family, a community, or all humankind.
Health represents a state of well being
Environment represents the persons physical surroundings, the community, or the
universe and all it contains.
Nursing is the practice of the science and art of the discipline. (George, 2010. p. 3)

Jen Watson theory of Transpersonal Care promoting healing while preserving the dignity
of the patient or one of my favorites theorists Madeleine M. Leininger and her theory of
Transcultural Nursing, recognizing that the concept of caring was elemental in our
nursing profession.
Leininger defined Culture care as the synthesized and culturally constituted assistive,
supportive and, facilitative, caring act towards self or others focused on evident or
anticipated needs for the clients health or well being or to face disabilities, death, or
other human conditions (Leininger and McFarland, 2002, p.47)

Leiningers theory of culture, care, and diversity is useful as it calls on healthcare

providers to take a different approach to health care delivery. Nurses strive to deliver
quality health services when handling patients. Similarly, patients intend to receive quality
patient care and recover from the illness.
The theory thus advocates for the development of an effective nurse-patient relationship
that is driven by the desire to design an effect treatment or management plan in the face
of ill-health.

Nursing theories enhance professional nursing practice in the roles of advocate, provider,
teacher, manager, researcher, and leader.
Nursing theories not only educate the novice nurse but also gives them the opportunity to
shape the doctrines that will help evaluate patient care and develop the nursing interventions
based on the evaluation findings.
They serve to guide the nursing process and to stablish criteria to evaluate the quality of
nursing care rendered.
They have helped our profession to become more autonomous by clearly defining its
independent functions.
It is easier to apply a nursing theory to a specific cultural group or patient, but when it
comes to a hospital, a nursing home, or any other facility in the healthcare system, I always
wondered how these institutions could adapt it and take it successfully into practice.
While working at University of Miami Hospital I realized these theories, concepts and
metaparadigms are flexible and adaptable to any healthcare arena. In this institution not one
but three nursing theorists form part of the the hospital mission and vision:
Florence Nightingale
Dorothea Dix and
Lillian Wald.
In the words of the hospitals CNO: At UMH we are leading our nurses to follow in the
steps of Florence Nightingale, Dorothea Dix and Lillian Wald. These nursing icons responded
to a health care delivery system need- for soldiers on the battlefield (Nightingale), for the
mentally ill (Dix) and for immigrants coming to New York City (Wald). At UMH nurses have
the opportunity to follow in the path of Nightingale, Dix and Wald as we rethink our nursing
care delivery system
What is the role of a nurse? Whether the nurse approaches each patient with a caring
attitude (Jean Watson), puts them in the best environment for healing to occur (Florence
Nightingale), or modifies the stimuli to facilitate their successful adaptation to their
physiological and social challenges (Sr. Calista Roy) at UMH, we believe the nurse is practicing
a time honored art and science. (University of Miami Hospital , 2017)

As nursing students these theories gave us a structure and helped us identify and
eventually form our own beliefs about nursing and values regarding patient care.
I believe it is crucial to clarify our beliefs because these are the ones that are going to
guide our professional choices and how we care for our patients on our daily practice.
Creating a nursing philosophy and metaparadigms are difficult since Im still trying to
understand the complexities of nursing profession, and at the same time creating my own
philosophy and beliefs.

When I asked my coworkers about their nursing philosophy and values they all mention
Florence Nightingale as an inspiration but they couldn't offer a clear statement of what their
personal philosophy is.
Some nurses are more aware than others of the beliefs and values that influences their
actions. Even though many of my coworkers stated that nursing interventions, patient care,
nursing skills and hands on experience is what nursing is all about in a hospital setting. That
there is no time in between doctors calls, tests, social services meetings and patient care for
philosophy, these set of actions is the philosophy that currently guides them.
Even they recognize it or not, this is a philosophy as well. I would say action over reflection is
what guides their profession at this moment.

There is no right or wrong while developing a nursing philosophy and metaparadigm

Based on my 6 month nursing experience at UMH, and according to the patients cultural
group, I feel more identified with Madeleine M. Leiningers Theory of Culture Care
Diversity and Universality.
Madeleine Leininger's Theory of Culture Care Diversity and Universality is more relevant
today than ever. Her concepts about patients, their family and the community cultural
needs are testable and applicable in all the different healthcare settings. The core of our
job consists on being sensitive to patients cultural needs in order to provide excellent
customer care and improve patient health outcomes.

George, J. B. (2010). Historical Perspective. In J. B. George, Nursing Theories: The Base for
Professional Nursing Practice. (6th ed., p. 9). Fullerton , CA: Pearson.
Leininger, M., and McFarland, M. R. (2002). Transcultural nursing: Concepts, theories,
research and practice (3rd ed., p. 47). New York: McGraw-Hill.
University of Miami Hospital . (2017). University of Miami Hospital . Retrieved 2017, from
Nursing at University of Miami Hospital: http://www.umiamihospital.com/nursing