The Metaparadigm of Nursing: Present Status and
Fut ure Refinement s
Jacqueline Fawcett, Ph.D., F.A.A.N.
Abstract
The central concepts and themes of the
discipline of nursing are identified and for-
malized as nursing’s metaparadigm. Exam-
ples illustrate the direction provided by the
metaparadigm for theory development. Re-
finements of the metaparadigm through
conceptual models and programs of nurs-
ing research are proposed.
T he discipline of nursing will ad-
vance only through continuous
and systematic development and test-
ing of nursing knowledge. Several re-
cent reviews of the status of nursing
theory development indicate that
nursing has no established tradition of
scholarship. Reviewers have pointed
out that most work appears unfocused
and uncoordinated, as each scholar
moves quickly from one topic to an-
other and as few scholars combine
their efforts in circumscribed areas
(Chinn, 1983; Feldman, 1980; Hardy,
1983; Roy, 1983; Walker, 1983).
Broad areas for theory develop-
ment’ are, however, beginning to be
recognized. Analysis of past and pres-
ent writings of nurse scholars indicates
that theoretic and empirical work has
always centered on just a few global
concepts and has always dealt with
certain general themes. This paper
identifies these central concepts and
themes and formalizes them as nurs-
ing’s metaparadigm. Examples are giv-
en to illustrate the direction provided
by the metaparadigm for theory devel-
opment. The paper continues with a
discussion o f refinements of the
metaparadigm needed at the levels of
jacqueline Fawcett, Ph. D., F.A.A.N., is
Associate Professor, and Section
Chairperson, Science and Role
Development, School of Nursing,
University of Pennsylvania,
Philadelphia.
Page 84
disciplinary matrices and exemplars
and concludes with proposals for fu-
ture work needed to advance to the
discipline of nursing.
Present Status of the
Metaparadigm of Nursing
The metaparadigrn of any discipline
is a statement or group of statements
identifying its relevant phenomena.
These statements spell out the phe-
nomena of interest in a most global
manner. No attempt i s made to be
specific or concrete at the metapar-
adigm level. Eckberg & Hill (1979) ex-
plained that the metaparadigm “acts
as an encapsulating unit, or frame-
work, within which the more restrict-
ed . . . structures develop” (p. 927).
The Central Concepts of Nursing
Evidence supporting the existence
of a metaparadigm of nursing is accu-
mulating. A review of the literature
on theory development in nursing re-
veals a consensus about the central
concepts of the discipline-person,
environment, health, and nursing
(Fawcett, 1983; Flaskerud & Halloran,
1980). This consensus is documented
by the following statements:
One may. . . demarcate nursing in terms
of four subsets: 1) persons providing care,
2) persons with health problems receiving
care, 3) the environment in which care is
given, and 4) an end-state, well-being.
(Walker, 1971, p. 429)
The major concepts identified (from an
analysis of the components, themes, top-
ics, and threads of the conceptual frame-
works of 50 baccalaureate nursing pro-
grams) were Man, Society, Health, and
Nursing. (Yura &Torres, 1975, p. 22)
The units person, environment, health, and
nursing specify the phenomena of interest
to nursing science. (Fawcett, 1978, p. 25)
Nursing studies the wholeness or health of
humans, recognizing that humans are in
continuous interaction with their environ-
ments. (Donaldson & Crowley, 1978, p.
119)
Image: The Journal of Nursing Scholarship
Nursing’s focus is persons, their environ-
ments, their health and nursing itself.
(Bush, 1979, p. 20)
Nursing elements are nursing acts, the pa-
tient, and health. (Stevens, 1979, p. l l )
The foci of nursing are the individual in re-
lation to health, the environment, and the
change process, whether it be maturation,
adaptation, or coping. (Barnard, 1980, p.
208)
Nursing is defined as the diagnosis and
treatment of human responses to actual or
potential health problems. (American
Nurses‘ Association, 1980, p. 9)
The four conceptual areas of nursing are:
the person receiving nursing; the environ-
ment within which the person exists; the
health-illness continuum within which the
person falls at the time of the interaction
with the nurse; and finally, nursing actions
themselves. (Flaskerud, cited in Brink,
1980, p. 665)
The domain of nursing has always included
the nurse, the patient, the situation in
which they find themselves, and the pur-
pose of their being together, or the health
of the patient. In more formalized terms,
. . . the major components of the nursing
[metalparadigm are nursing (as an action),
client (human being), environment (of the
client and of the nurse-client), and health.
(Newman, 1983, p. 388)
There is general agreement that the central
concepts of the discipline of nursing are
the nature of nursing, the individual who
received nursing care, society-environ-
ment, and health. (Chinn, 1983, p. 396)
These statements indicate that there i s
considerable agreement among schol-
ars as to the concepts central to the
discipline of nursing. In fact, a review
of the literature revealed no contradic-
tory statements.
RecurringThemes
The relationships between and
among the concepts-person, envi-
ronment, health, nursing-are elabo-
rated in recurring themes found in
works of nurse scholars since Nightin-
gale (1859). These themes are listed in
Table 1.
Summer, 1984, Volumo XVI, blo. 3

TABLE 1
THEMES OF THE YETAPARAWW OF NURSING
1. The principles and laws that govern the life-process,
well-being. and optimum function of human beings,
sick or well.
2. The patterning of human behavior in interaction with
the environment in normal life events and critical life
situations.
3. The process by which positive changes in health
status are elfected.
(Donaldson& Crowley, 1978, p. 113; Gortner, 1980, p.
180)
The four central concepts and three
recurring themes identify the phenom-
ena central to the discipline of nursing
in an abstract, global manner. They
represent the metaparadigm. As such,
they have provided some direction for
nursing theory development. As New-
man (1983) explained:
It is within the context of these four major
components and their interrelationships
that theory development in nursing has
proceeded. Theoretical differences relate
to the emphasis placed on one or more of
the components and to the way in which
their relationships are viewed. (p. 388)
The relationship between the con-
cepts “person” and “health” is con-
sidered in the first theme. Theories ad-
dressing this theme describe, explain,
or predict individuals‘ behavior during
periods of wellness and illness. New-
man’s (1979) theory of health is one
example. This theory includes the
concepts of movement, time, space,
and consciousness. Newman propos-
es that “the expansion of conscious-
ness is what life, and therefore health,
i s all about” (p. 66).
Another example is Orem’s (1980)
theory of self-care, which maintains
that “self-care and care of dependent
family members are learned behaviors
that purposely regulate human struc-
tural integrity, functioning, and human
development” (p. 28). Still another ex-
ample is Orern’s theory of self-care
deficits. This theory maintains that in-
dividuals “are subject t o health-
related or health-derived limitations
that render them incapable of continu-
ous selftare or dependent care or that
result in ineffective or incomplete
care” (p. 27).
The relationships among the con-
cepts ”person,“ ”environment,” and
“health” are considered in the second
theme. Theories addressing this theme
Summer, 1B84, Volume XVI, No. 3
describe, explain, or predict individu-
als’ behavioral patterns as they are in-
fluenced by environmental factors
during periods of wellness and illness.
Such theories place the individuals
within the context of their surrounding
environment rather than considering
them in isolation, as in the first theme.
Roy and Roberts’ (1981) theory of the
person as an adaptive system is an ex-
ample. This theory proposes that the
person is a system that adapts to a
constantly changing environment. Ad-
aptation i s accomplished through the
action of coping mechanisms called
the “regulator” and the “cognator.”
The relationships among the “per-
son,’’ “health,” and “nursing” are
considered in the third theme. Envi-
ronment may also be taken into ac-
count here. This theme is addressed
by theories about nursing practice.
These theories describe or explain
nursing processes or predict the ef-
fects of nursing actions. King‘s (1981)
theory of goal attainment is one exam-
ple. King explains:
. . . nurse and client interactions are char-
acterized by verbal and nonverbal com-
munication, in which information is ex-
changed and interpreted; by transactions,
in which values, needs, and wants of each
member of the dyad are shared; by percep-
tions of nurse and client and the situation;
by self in role of client and self in role of
nurse; and by stressors influencing each
person and the situation in time and space.
(p. 144)
Orem’s (1 980) theory of nursing sys-
tems is another example. This theory
maintains that ”nursing systems are
formed when nurses use their abilities
to prescribe, design, and provide nurs-
ing for legitimate patients (as individu-
als or groups) by performing discrete
actions and systems of actions” (p.
29).
Refinement of the
Metaparadigm
Identification of the metaparadigm i s
an important step i n the evolution of a
scholarly tradition for nursing. The
n e x t step i s refinement o f t h e
metaparadigm concepts and themes,
which occurs at the level of the para-
digm or disciplinary matrix, rather
than at that of the metaparadigm.
The Disciplinary Matrix
Eckberg and Hill (1979) explained
Image: The Journal of Nursing Scholarship
Metaparadigm of Nursing
that a paradigm, or disciplinary matrix,
is more restrictive than a metapara-
digm, and that it “represents the
shared commitments of any disciplin-
ary community, including symbolic
generalizations, beliefs, values, and a
host of other elements” (p. 926). The
authors went on to say,
A disciplinary matrix may be seen as the
special subculture of a community. It does
not refer to the beliefs of an entire disci-
pline (e.g. biology), but more correctly to
those beliefs of a specialized community
(e.g. phage workers in biology). (p. 926)
Most disciplines have more than
one disciplinary matrix. Each one rep-
resents a distinctive frame of reference
within which the metaparadigm phe-
nomena are viewed. Furthermore,
each disciplinary matrix reflects a par-
ticular research tradition by identify-
ing the phenomena that are within its
domain of inquiry, the methods that
are to be used to investigate these
phenomena, how theories about these
phenomena are to be tested, and how
data are to be collected (Laudan,
1981, p. 151). More specifically, the
- research tradition of each disciplinary
matrix includes six rules that encom-
pass all phases of an investigation. The
first rule identifies the precise nature
of the problem to be studied, the pur-
poses to be fulfilled by the investiga-
tion, or both. The second rule identi-
fies the phenomena that are to be
studied. The third rule identifies the
research techniques that are to be em-
ployed and the research tools that are
to be used. The fourth rule identifies
the settings in which data are to be
gathered and the subjects who are to
provide the data. The fifth rule identi-
fies the methods to be employed in re-
ducing and analyzing the data. The
sixth rule identifies the nature of con-
tributions that the research will make
to the advancement of knowledge.
(Schlotfeldt, 1975, p. 7)
In nursing, disciplinary matrices are
most clearly exemplified by such con-
ceptual models as Johnson‘s (1980)
Behavioral System Model, King’s
(1981) Open Systems Model, Levine’s
(1973) Conservation Model,
Neuman’s (1982) Systems Model,
Orem’s (1980) Self-care Model, Rog-
ers’ (1980) Life Process Model, and
Roy’s (1984) Adaptation Model. Each
Page 85
Metaparadigm of Nursing
of these nursing models puts forth a
distinctive frame of reference within
which the metaparadigm phenomena
are viewed. Each provides needed re-
finement of the metaparadigm by serv-
ing as a focus-”ruling some things in
as relevent, and ruling others out due
to their lesser importance” (Williams,
1979, p. 96).
Conceptual models of nursing are
beginning to make major contribu-
tions to the development of nursing
theory. Theories derived directly from
King’s model and from Orem’s model
were identified earlier. A considerable
amount of empirical work designed to
test unique nursing theories as well as
theories borrowed from other disci-
plines is now being guided by nursing
models. Some of the studies are listed
in Table 2.
TABLE 2
Examples of Research Derived From Conceptual Models
of Nursing
Oorothy Johnson’s BehavioralSystem Model
-An instrument for theory and research development
using the behavioral systems model for nursing: The
cancer patient. Part I (Derdiarian, 1983).
-An instrument for theory and research development
using the behavioral systems model for nursing: The
cancer patient. Part II (Derdiarian & Forsythe, 1983).
-Achievement behavior in chronically ill children
(Holaday, 1974)
-Maternal response to their chronically ill infants’ at-
tachment behavior of crying (Holaday, 1981)
-Maternal conceptual set development: Identifyingpat-
terns of maternal response to chronically ill infant
crying (Holaday, 1982)
-Development of a research tool: Patient indicators of
nursing care (Majesky, Brester, & Nishio, 1978)
Myra Levine’s Conservation Model
-Effects of lifting techniques on energy expenditure: A
preliminary investigation (Geden, 1982)
-A comparision of two bearing-downtechniques during
the second stage of labor (Yeates & Roberts, 1984)
Betty Neuman’s Systems Model
-Effects of information on postsurgical coping (Ziemer.
1983)
Dorothea Orem’s Self-care Model
-Application of Orem’s theoretical constructs to self-
care medication behaviors in the elderly (Harper,
1984)
-Development of an instrument to measure exercise of
self-care agency (Kearney & Fleischer, 1979)
Martha Roger’s Life Process Model
-The relationship between identification and patterns
of change in spouses’ body images during and after
pregnancy (Fawcett, 1977)
-Patients’ perceptions of time: Current research (Fitz-
patrick, 1980)
-Reciprocy and helicy used to relate mEGF and wound
healing (Gill & Atwood, 1981)
-Therapeutic touch as energy exchange: Testing the
theory (Ouinn, 1984)
Callista Roy’s Adaptation Model
-Needs of cesarean birth parents (Fawcett, 1981)
-An exploratory study of antenatal preparation for ce-
Page 86
sarean birth (Fawcett & Burritt, in press)
-Clinical tool development for adult chemotherapy pa-
tients: Process and content (Lewis, Firsich. & Parsell,
1979)
-Content analysis of interviews using a nursing model:
A look at parents adapting to the impact of childhood
cancer (Smith, Garvis, & Martinson, 1983)
Despite the contributions already
made by nursing models to theory de-
velopment, much more work is need-
ed. In particular, rules addressing
methodology and instrumentation
must be specified. Moreover, pro-
grams of research emanating from
each model must be conducted to
refute or validate nursing theories.
Programmatic research probably is
carried out most expediently by com-
munities of scientists. Hardy (1983)
explained that each community of
scientists i s
. . . a group of persons w h o are aware of
their uniqueness and the separate identity
of their group. The have a special coher-
ence which separates them from neighbor-
ing groups, and this special bond means
they have a shared set of values and a
common commitment which operates as
they work together t o achieve a common
goal. Coordination of their activities may
include interaction among the coordina-
tion of institutions, organizations, groups,
and individuals. Such coordinated groups
hold a common perspective, common val-
ues and common bonds, and they have
common sets of activities and functions
which they carry out to achieve a common
outcome. (p. 430)
Each community of scientists, then,
represents a distinctive subculture, or
disciplinary matrix, of the parent disci-
pline.
It can be argued that communities
of scientists may be formed outside
the organizing framework of nursing
models. However, it also can be ar-
gued that conceptual models of nurs-
ing, like the disciplinary matrices of
other disciplines, are the most logical
nuclei for communities of scientists.
This argument is supported by three
facts. First, the curricula of most
schools of nursing now are based on
conceptual models. Second, most
graduate programs and many under-
graduate programs offer courses deal-
ing with the content and uses of
nursing models. And third, clinical
agencies are beginning to organize the
delivery of nursing care according to
the tenets of conceptual ‘models.
image: The Journal of Nursing Scholarship
Collectively, these facts mean that
academicians, students, clinicians,
and administrators are thinking about
nursing theory, nursing research, and
nursing practice within the context of
explicit conceptual models.
It is probable, then, that eventually
the development of all nursing theory
will be directed by nursing models. It
may even by possible to categorize
seemingly isolated past and current
work according to conceptual models.
This should provide more organiza-
tion for extant nursing knowledge and
should identify gaps and needed areas
of inquiry more readily than is possi-
ble now. Moreover, such an endeavor
should identify members of different
communities of scientists to each oth-
er as well as to the larger scientific
community.
Exemplars
Still further refinement of the
metaparadigm i s needed at the most
restrictive level-that of the exemplar.
Eckberg and Hill (1979) identified the
function of an exemplar as permitting
“a way of seeing one’s subject matter
on a concrete level, thereby allowing
puzzle solving to take place” (p. 927).
They went on to explain:
For a discipline to be a science it must en-
gage in puzzle-solving activity; but puzzle
solving can only be carried out if a com-
munity shares concrete puzzle solutions,
or exemplars. It is the exemplar that is im-
portant, not merely the disciplinary matrix,
and certainly not merely the general pre-
suppositions of the community [i.e., the
metaparadigm]. The latter may be impor-
tant, but they do not direct ongoing, day-
to-day research. (p. 927)
There is some evidence of exem-
plars in nursing. This includes but is
not limited to Fitzpatrick’s (1980) pro-
grammatic research on time percep-
tion; studies of effects of information
about a threatening procedure on a
patient’s responses to the procedure
(e.g., Hartfied, Cason, & Cason, 1982;
Johnson, Fuller, Endress, & Rice, 1978;
Ziemer, 19831, and investigations of
factors contributing to the outcomes
of social support (Barnard, Brandt,
Raff, & Carroll, 1984 in press).
These researchers are beginning to
solve some of the major puzzles of
nursing. However, more work is need-
ed to identify other puzzles and to de-
velop methods for their solutions.
Summer, 1984, Volume XVI, No. 3

Conclusion
It is time to formally accept the cen-
tral concepts and themes of nursing as
the metaparadigm of the discipline. It
is also time to direct efforts toward fur-
ther refinement of this metaparadigm
by developing specific rules for the
empirical work needed to generate
and test nursing theories within the
context of conceptual ‘models. The
metaparadigm must be refined still fur-
ther through the developing of new
puzzle-solving activities that will pro-
vide answers to the most pressing
problems encountered by nurse clini-
cians, educators, and ddministrators.
Any one of these activities would in it-
self make a significant contribution to
the discipline; all three could quite
possibly be the major accomplish-
ments of the decade.
‘As used here, theory development reft.r\ to generation
and testing of theory. and encornpasiei ”ivory tow-
er” theorizing as well as empirical rewarch.
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Page 87