Nursing Metaparadigm

Nursings metaparadigm represents its scope

of practice and consists of four major
concepts:
Nursing
Health
Client/Person
Environment
 Concept of Nursing
Nursing as a process of well-being
Nurse, as described by Websters Dictionary, is
defined as the process of nourishing, of promoting
the development or progress of something.
Synonyms include to heal, to foster, to sustain
Nursing as a process is developmental,
progressive, and sustaining, all of which lead to
well-being
 Concept of Nursing
Dr. Pamela Reed ( 1997) describes nursing as:
An inherent human process of well-being that
is manifested by complexity and integration of
human systems
Nursing is the creative process to facilitate
the clients well being
 Concept of Nursing

The nature of nursing processes

Complexity
The different variables that can be identified in a
given situation
Integration
The synthesis and organization of the variables
Well-being
The innovative change required to maximize the
variables
The manifestation of complexity and integration in
the human open system
 Concept of Nursing
The inherent nursing process
Nursings understanding of the nursing process is
changing
Mechanical and external to patients (biomedical model)
More global and interrelated (nursing model)
Nursing existed long before nursing theory
Research and education mold the development of
the nursing process
Concept of Nursing
 Concept of Nursing
The art of nursing
Nurses must be able to:
Grasp the meaning of patient encounters
Establish a meaningful connection with patients
Skillfully perform nursing activities
Rationally determine an appropriate course of nursing
action
Morally conduct nursing practice (Johnson, 1999)
 The Concept of Health
As society evolves and quality of life improves,
our perceptions of health change
Health today is vastly different from health at
the turn of the 20th Century
The concept of health varies greatly between
cultures
The perception of health changes throughout
the life span
 The Concept of Health

Historically, illness, not health, has been the

primary concern of health professions
(Smith, 1981)
Terris (1975) identified the following illness-
related approaches to health assessment
Measurement of impairment
Assessment of physiological systems in relation
to established norms
Measurement of performance in the context of
potential decrements
 The Concept of Health
Is health such a complex human process that
it cannot be studied quantitatively or
qualitatively?
Can it only be assessed in the context of the
negative?
What is the impact of the concept of
adaptation to the meaning of health?
 Concept of Nursing
The evolution of the word Nursing
A series of tasks and technology (a subset of
medicine)
A broad, compassionate, and supportive human
service
A science of human health and behavior across
the life span
 The Concept of Health
In the past two decades, our focus in nursing
has shifted from how the illness affects the
person to how the person deals with the
illness
This is due to a continuing and evolving
holistic view within mainstream nursing that
has been described by many theorists
 The Concept of Health
Rogers (1970) said:
The unity of man is a reality. Man interacts with
his environment in his totality. Only as mans
wholeness is perceived does the study of man
begin to yield meaningful concepts and theories.
Only as mans oneness is apprehended is it
possible to identify mans distinctive attributes.
 The Concept of Health
Holistic
Health as a pattern
There is no single universal health pattern which
all people share
Persons shape their own health experiences to a
considerable extent as they make choices from
the options available to them (Parse, 1981)
 The Concept of Health

Affect
Sensation and emotion are fundamental
attributes of humanness that are expressions
of wholeness or unity
Emotions and feelings are subjectively
experienced
Emotional patterns can influence immune
function
Feelings and emotions have direct effect on the
quality of life and perception of health
 The Concept of Health
Attitude
Humans not only think in concepts and
relationships but give meanings to such
abstractions
It structures the way a person sees their world
Optimism vs. pessimism
 The Concept of Health
Activity
Active lifestyles can influence the concept of
health
We tend to look at health in the context of
mobility
Meaningful work
Energizing diversions influence health
 The Concept of Health
Aspirations
Humans are inherently purposeful
Persons evolve in light of the range of options they
perceive as available to them
The concept of self actualization
The effect of social contribution
 The Concept of Health
Accomplishments
These can be viewed as the payoffs for a life well
lived
Measures of worth vs. expressions of health
Enjoyment
Creativity
Transcendence
 The Concept of Health
Becoming healthier is a national obsession
If I could only:
Lose weight
Exercise regularly
Eat more healthy foods
Get more sleep
 The Concept of Health
Centrality of health in nursing
Conceptualized as a
State
A process of development
Positive adaptation
An actualization
An outcome
A lifestyle
 The Concept of Health
Strategies for the development of a contextual
conception of health
Most studies done on middle class white
population
Being healthy vs. becoming healthy
What does the concept health promotion really
mean?
 Concept of Client
Pluralistic knowledge in nursing (theory,
research findings)
Competing approaches
Confusion
Solution: Unite common and unique
perspectives (Kim)
 Concept of Client

Types of Conceptualization:
Holistic human-environment processes
Balance as human condition
Integration of structure and function of
humans
States revealed by aggregate parts
Experiencing = Human condition (health belief model)
Making sense and meaning
 Concept of Client
ANA 1980
Nursing: Treatment of human responses to
actual and potential health problems.

Focus is on states of clients

Time is discrete entity rather than continuum
or trajectory.
 Concept of Client
Economic Pressures:
Technological approaches
Assisting health care workers
Nurses do MD jobs

Nursing has not appreciated what matters

(Kitson, 1997)
 Concept of Client
Unifying Factors
FOCUS ON CLIENTS LIVING

Living of oneself (body, biological/material, symbolic/ cultural,

personhood, reflexes, consciousness, meaning).

Living with other (co-existing, communication, interaction)

Living in situations (context, relationship with environment)
 Concept of Client
NURSING
Diagnosing and treating must be oriented to
support ways of living.
Help clients find a way of living in their
situations.
Assist clients to live more creatively, wisely,
meaningfully, with control.
 Concept of Environment
HEALTH BELIEF MODEL
Patient weighs benefits and dangers
(avoidance or engagement).
Burden of action is on the individual.
Distorted perceptions cause non-compliance.
Nurses explore patients perceptions and
modify distorted perceptions advice is
accepted by the patients.
 Concept of Environment
Individually based interventions are futile
(Butterfield)
Economic, political, environmental factors
need to be included in care.
Clients social involvement is important.
Health belief model is inadequate.
Lack of theory addressing the environment.
 Concept of Environment
NEW IDEAS
Ecocentric paradigm grounded in the cosmos and including
the whole environment (in contrast to egocentric= What is best for the individual
is best for society; homocentric= Social justice, common good are key.

Milios framework of prevention-concepts of community

oriented,population focused care
Critical social theory-- Critical theory is a school of thought
that stresses the reflective assessment and critique of society
and culture by applying knowledge from the social sciences
and the humanities.
 Concept of Environment
ECOCENTRIC PARADIGM
Environment and all its elements are valued.
Humans are one with the environment
Theorists are influenced by Eastern philosophy
and Native American spirituality. E.g. Watson (unity
and integrality of humans and environment); Schuster (one cares for the
world in day-to-day living).
 Concept of Environment
RELATED CONCEPTS IN NURSING
Harmony
Open systemshttp://faculty.babson.edu/krollag/org_site/encyclop/open_system.html
lSelf-transcendencehttps://www.youtube.com/watch?v=t53wpeLphKg;
tps://faculty.unlv.edu/gulliver/SelfTranscendence/Theory of Self-Transcendence
Graphic.htm

Process (evolution of expanding consciousness)

Gaia hypothesis (net of jewels)-The Gaia hypothesis, also
known as Gaia theory or Gaia principle, proposes that
organisms interact with their inorganic surroundings on Earth
to form a self-regulating, complex system that contributes to
maintaining the conditions for life on the planet.
 Concept of Environment
NURSING
Address worldwide environmental problems.
Work together with professionals in other
nations.
Think globally, act locally (take environmental
history of patients).
The client becomes the environment.
 Concept of Environment
MILIOS FRAMEWORK OF PREVENTION

Health choices shaped by policy decisions

Health deficits due to imbalance between
health needs and resources. (Affluent societies have
diseases of excess).
 Concept of Environment
MILIOS FRAMEWORK OF PREVENTION
Individual Resources: Awareness, knowledge,
beliefs (incl. family, culture), money, time,
priorities.
Societal Resources: Health care system,
environmental protection, shelter, rewards
and penalties for choosing health options.
 Concept of Environment
Healthful choices should be cheaper and more
easily accessible.
Knowing does not lead to action.
Teaching does not work.
Nurses are counselors and environmental
activists.
 Concept of Environment
CRITICAL SOCIAL THEORY
Life is structured by social meanings
determined by social domination.
Social inequities prohibit people from
reaching their potential.
Truth is a social construction.
 Concept of Environment
CRITICAL SOCIAL THEORY
Nursing:
Expose power imbalances, ageism, sexism, etc.
Ameliorate social problems.
Be a social/political activist.
Problem: Emphasis on life-style puts the entire
Focus on the person and neglects the environment.