A classification scheme is pro-
posed to organize existing
Proposed Metaparadigm for
Nursing Research and
Theory Development
An Analysis of Orem’s Self Care Theory
Mary Colette Smith, R.N. Ph.D.
Professor and Chairman
Graduate Program In Nursing
University of Southern Mississippi
Hattiesburg, Mississippi
A review of master’s theses and doc-
toral dissertations, current and emerg-
ing journals and newsletters, and a pro-
liferation of textbooks addressing
research and theory development in
nursing reveal a myriad of serious, but
discrete endeavors to explain and study
the phenomenon of nursing. Although
individual research reports reflect
systematic, orderly approaches to in-
vestigate variables of interest to the
researcher, the overview of extant
literature presents the state of the art as
disconnected, unstructured, and in-
coherent in explaining the practice of
nursing for the practitioner, educator, or
researcher.
Recent literature further reveals a
variety of scholarIy approaches to
theory development and research in
nursing, emphasizing the need for rela-
tionship to nursing practice (Chinn &
Jacobs, 1978; Fawcett, 1978; Hardy,
1 9 7 8 ) . Recommendations include
defining an area of concern, categoriz-
ing and structuring phenomena, and
connecting research to theory. The pro-
cess of categorization of unstructured
material however, requires the use of a
single classificatory principle, an ex-
haustive set, and mutual exclusivity
(Selltiz, Wrightsman, & Cook, 1976),
thereby assuming that classes of
variables have been identified.
October 1979, Vol. 11, No. 3
Scholarly approaches to the study of
theory development provide the guides,
roadmaps, “how-to” methods, and
perhaps criteria against which to check
an endeavor into the realm of theory
work. The primary decision in theory
construction, however, is in what to
observe (Wallace, 1971, p. 23), which
becomes the crucial question in apply-
ing the guides to phenomena for study.
Because health care can be humaniz-
ing or dehumanizing, Ashley and
O’Rourke (1978) suggest that decisions
regarding health care are not technical
questions nor those of values, but rather
a matter of ethics.
If a “nursing situation” is reducible to
a nurse interacting with a client regard-
ing a matter of health, a classificatory
scheme of variables for study should ac-
count for the “human self’ or “per-
sonhood” of each. The scheme pro-
posed in this paper suggests a set of
phenomena beginning with the “self’ of
both nurse and client, deriving from the
work of Orem (1971) and the Nursing
Development Conference Group
(1973). Such a scheme may serve as a
preliminary step in the formulation of a
taxonomy from which hypotheses may
be deduced for empirical validation.
Although literature urges that know-
ledge be structured, none has so far
specified or even suggested what
EEl/Image
research and set directions for
f u t u r e studies a n d theory
development in nursing. Orem’s
self-care approach to nursing
forms the basis of the scheme,
with the recommendation to
study the phenomena of the field
through a constructivist meth-
odology. Scholars, theorists, and
researchers are invited to par-
ticipate in examination and use of
the scheme from a variety of
perspectives.
variables might be studied in a struc-
tured format.
The present article, rather than a pro-
selytizing endeavor for Orem’s self-care
theory, is an invitation to scholars and
researchers to challenge the basic
premises, elaborate derivations for the
inherent theoretical bases and con-
structs proposed, substitute alternative
nursing frameworks, theories, or class-
ification systems, or try out the pro-
posed scheme. The thinking presented
here, is proposed as a preliminary step
to move out of redundant recommen-
dations into the rather risky and for-
midable task of organizing nursing
knowledge.
Purpose
The immediate purpose of this paper
is to propose a classification scheme to
structure the analysis of existing
research and the design of future
research in nursing. The ultimate pur-
pose in utilizing the scheme for analysis
and design is to formulate a cohesive,
organized body of knowledge for theory
building and development in nursing.
Theory building from already re-
ported research could begin with classi-
fying the elements into the categories of
the scheme in a manner not dissimilar to
work done by O’Connell and Duffey
(1976) in nursing, and Magoon (1977)
and Lockwood (1978) in educational
Page 75
Proposed Metaparadigm
research.
An analysis of research to date, from
a nursing framework, would make ex-
plicit: independent and dependent
variables studied; methods used; results
obtained; concepts, constructs, and
theoretical derivations of designs; con-
tributions of the results to expansion or
elaboration of the theoretical framework
of the study; unresolved questions; and
most important, inherent assumptions
of the studies.
The assumptions of particular interest
are those inherent in: selection of the
variables as relevant to the domain of
nursing; selection of methods as ap-
propriate to eliciting or measuring the
phenomena of the domain; operational
definitions of elusive terms such as pa-
tient, client, health, nurse, nursing; and
the outcome of the study as relevant to
advancing theory and the practice of
nursing based an a foundation of nurs-
ing science.
The proposed scheme of this paper
permits both a concurrent examination
of extant literature as a basis for theory
building and design for the conduct of
future studies for theory development.
The term “metaparadigm” is used for
the scheme in the sense that the format
suggests a guide to the researcher and
scholar for a perspective from which to
view phenomena of the field. Although
the proposed “metaparadigm” does not
reflect the consensus of contemporary
scientists in nursing, it can serve as a
way of organizing phenomena studied
to date, which is a step beyond the
preparadigm state as discussed -by
Hardy (1978).
Use of the proposed metaparadigm
sets the analysis of existing research and
the design of future research into a nurs-
ing framework for a critical assessment
of the state of the art as well as suggest-
ing directions for studies of the future.
Characteristics of the Metaparadigm.
The characteristics of the metaparadigm
admittedly reflect a set of personally
Page 76
biased assumptions regarding the sine
qua non of professional nursing prac-
tice. These are presented at the outset
as challengeable to contemporary
scholars in nursing.
I. A nursing situation consists of a nurse
and a client engaged in interaction
regarding health as it affects the life ac-
tivities of the client.
2. At its most fundamental level, the act
of nursing is humanizing for both care
giver and recipient.
3. The interaction between nurse and
client occurs and endures for a time-
limited period.
4. Human conduct is affected by values
and knowledge.
5. Human conduct requires decision-
making regarding courses o/ action or
no action.
6. Perception, based o n knowledge,
constitutes the reality within which a
person lives, acts, and responds, giu-
ing meaning to life’s choices.
7. “Experience” is a phenomenon
unique to an individual, not shared by
any other person at any other time in
history (See R.D. Laing, The Politics
of Experience, 1967).
Inherent in the above stated assump-
tions are theoretical formulations de-
rived from: interpersonal relations
h u m a n i s m , existentialism, p h e -
nomenology, axiology, praxiology ,
epistemology, and metaphysics. Con-
structs inherent in the assumptions in-
clude: communication, perception,
reality, temporality, judgment/know-
ing/certitude/learning, motivation,
autonomy/freedom/choice/responsi-
bility, and “self’ in all its dimensions.
Additional constructs which may be in-
herent include: field theory, stress,
adaption, life change events, social
learning, symbolic interaction, locus of
control, and purpose in life and/or the
seeking of noetic goais (Crumbaugh &
Maholick, 1964). The entire set of
theoretical and construct formulations
may be subsumed into General Systems
Theory, with a base of reality analagous
to Plato’s Allegory of the Caves (1952).
EEBl llmage
The metaparadigm, viewed as a
structuring devise, should provide a
framework to set the parameters of
legitimacy for nursing practice as distinct
from the practice of any other health-
related discipline (client, nurse, health-
related matter affecting the life activities
of the client). The internal elements
should account for the diversity of
theoretical and empirical interpretations
of health and illness. The framework
and elements therein must be useful,
and hold the potential for becoming a
taxonomy for validation by demon-
strating consistency between theoretical
propositions and research findings in
ordering the phenomena of the field.
The framework should provide a struc-
ture from which to view and study the
field, The premises and propositions of
any nursing theorist may be substituted
for the categories presented in this
paper, insofar as they provide a
cohesive structure for study.
The Metaparadigm.
The components of the metapara-
digm include three classes of variables:
focus, participants, and elements of
professional nursing as presented in
Figure 1. The classes are derived from
Orem’s work (1971) and that of The
Nursing Development Conference
Group (1973) with some elaboration by
this author.
Focus:
I. Individual
II.Famify
III. Group
A. Conglomerate ofpersons with no
identified common charac-
teristic
IV.Population
A. Conglomerate ofpersons with an
identified common charac-
teristic, e . g . , age, medical
diagnosis, receiving medical
therapy such as hemodialysis,
surgical intervention, etc.
Participants
A. Client
1. Actual
October 1979, Vol. 11, No. 3

2. Potential
B. Nurse
1. Graduate
a. Registered nurse by type
o f educational prepara-
tion
2. Student
a. By type of educational
preparation
C. Others
1. Family
a. Household
b. significant others: phys-
cian, dietition, rehabilita-
tion therapist, etc.
Elements
1.0 Conduct affected by . . .
2.0 Self-care (practices, assets, defi-
cits)
3.0 Universal self-care requirements
4.0 Health deviation care requirements
5.0 Health state
6.0 Health results sought
7 . 0 Determination o f therapeutic
self-care demand
8.0 Range o f self-care deficits
9.0 Determination o f nursing re-
quirements
10.0 Health focus
11 .O Type of nursing situation
12.0 Type of nursing system
13.0 Type o f nursing technology
14.0 Ways o f assisting
15.0 Outcomes o f nursing
The scheme presents a total of 83 ele-
ment variables, to be studied from five
different participant perspectives, for
four different focuses with potential for
1660 combinations of pairs a n d vast
possibilities for multivariate approaches.
It is also possible to substitute numerical
alterations for the present number
system to provide for computer analy-
sis. A total reduction to a numbering
system at this time was avoided to pre-
vent a mechanistic view of a human-
istic system.
The present classification allows for
assignment of variables reported in ex-
isting research in the following examples
of master’s theses a n d professional
papers of graduate students at the
October 1979, Vol. 11, No. 3
University of Southern Mississippi.
1. “Self-care practices identified in
folklore elicited from residents in a
selected area o f Mississippi” (Schmitt,
1976)
FOCUS:Population IV (residents shar-
ing common geographical area)
Participants: Clients (Potential) -- A,
Element: Self-Care Practices -- 2.1
Classification:IV, A,, 2.1
2. “Therapeutic sey-care demands of
residents of an institution for the men-
tally retarded as perceived by the
residents and by their direct care
givers” (Rachel, 1978)
Focus: Popularion - - IV
Participants: Clients - - A ,
Others (Care-gioers)-- C
Element: Therapeutic Self-care De-
mands -- 7.0
Classification: IV, A,, C, 7.0
3. “A description of self-care activities of
selected children in the elementary
schools of Tangipahoe, Louisiana”
(Whalen, 1976)
Focus: Population -- IV
Participants: Clients (Potential) - - A,
Nement: Self-care Activities - - 2.1
Classijlcation: IV,A,, 2.1
4. “Relationship between leader effec-
tiveness and personality traits among
head nurses” (White, 1977)
Focus: Population -- IV
Participants: Nurses -- B ,
Element(.$: Maturity (Personality
traits) and Performance Abilities -- 1.8
and 1.14
Classification: IV, B , , 1.8, 1.14
Findings as well as variables of
reported studies also can b e classified.
Wan and Livieratos (1977) found that
sex and race demonstrated more in-
fluence on “general well-being” scores
than other sociodemographic variables
for 6,931 noninstitutionalized adults. A
possible classification for the finding
might be: Group, clients (potential),
and characteristics (1.0) related to
health state (5.0),which was defined as
“general well being -- 111, A,, 1.2 a n d
1.7, 5.5. Scrupulous inter-rater reliabili-
ty checks, would, of course, have to be
instituted for classification.
A brief and cursory analysis of t h e 65
EBl /Image
Proposed Metaparadigm
graduate papers at the University of
Southern Mississippi revealed not only
focus, participants, a n d elements which
had been addressed, but put into stark
relief, those which have not. A matrix
could be designed to identify the gaps.
Such secondary analysis of research
reports could assist in formulation of
needed directions for nursing research.
Methodology for the Metaparadigm.
The complex and essential interaction
among theory, method, and data sug-
gests the need for decisions regarding
not only identification of important
phenomena of the field, but how to
study them. Cosminsky (1977) yielded
different sets of findings, studying illness
concepts in a Guatemalan community,
with the use of two different methods of
data collection.
Magoon (1977) suggests scrutiny of
the assumptions underlying research
methods. His case for a constructivist
methodology, in eliciting the construct
of the subject, rather than validating the
construct of the investigator, has
relevance to research in nursing.
Magoon suggests that the direct method
of inquiry to those closest to the
phenomena are the most appropriate
sources for data concerning themselves.
Data elicited directly from the subject
constitute “first degree” constructs.
Standardized instruments assume that
words have the same meaning for in-
vestigator and subject.
Williamson ( 1 9 7 8 ) discussed
methodologic problems in studying the
concept of patient needs. The list of pa-
tient needs was developed from a
literature review and interviews with
clinical nursing specialists, with revisions
made after a review by discharged pa-
tients, lay persons a n d registered
nurses. In order to obtain what Magoon
(1977) refers to as a “first-degree” con-
struct, the needs would have been
elicited first from the construct of the pa-
tients, rather than derived from sources
and constructs several degrees removed
Page 77
Proposed Metaparadigm
from the origin.
In a study of “patients’ perceptions”
(Passo, 1978), the subjects selected
responses from a list of topics those
reflective of their perceptions, attitudes,
and needs thus validating the construct
of the list creator, rather than eliciting a
“first degree” construct of the subject.
The subjective experience is often
relegated to a lesser position in the
hierarchy of values, yet Wan and
Livieratos (1977) found that the
variable “perceived health state” had
the strongest effect on “general well
being.” Given, Given and Simoni
(1978) found patient compliance close-
ly related to the degree to which pa-
tients believed therapeutic regimes were
beneficial. “Health” indexes often
measure levels of disability rather than
asking positive questions regarding
levels of health as in the work of
Klaukka (1977).The questions phrased
in terms of illness or health are reflective
of the frame of reference of the in-
vestigator.
Magoon (1977) proposes the use of
constructivist approaches based on the
assumptions of man as a knowing
being, whose knowledge has conse-
quences regarding behavior and action,
whose locus of control resides within
himself, and whose behavior is pur-
posive (pp. 651-652).
The methods of data collection in
nursing should be reconsidered in view
of assumptions made regarding the sub-
jects studied. The phenomena of in-
terest in the field should reveal the
world of the subject rather than the
shadowed images (of Plato’s cave) of
the investigator. Through the collection
of individual perceptions, clusters may
form so that collective statements can be
made regarding the phenomena of the
domain. The results of this grounded
theory approach (Strauss & Glaser,
1967), utilizing variations from Dickoff,
James and Wiedenbach (1968), with a
combination of subjective and objective
data (Wolfer, 19731, may yield a body
Page 78
of knowledge unique to the practice of
nursing
Summary.
A classification scheme is proposed,
reflective of Orem’s (1971) self-care ap-
proach to nursing, for the purposes of
analysis of extant research and setting
direction for nursing research in the
future. Methods for use of the meta-
paradigm are suggested as secon-
dary analysis and a constructivist ap-
proach as described by Magoon (1977).
The scheme is viewed as a first step to
organize existing research and design
future research studies from a nursing
framework. An invitation is extended to
scholars, theorists, and researchers to
challenge, elaborate, or substitute other
phenomena of interest, legitimizing their
relevance to the domain of nursing.
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October 1979, Vol. 11, No. 3
 1.O Conduct Affected 2.0 Self-care 6.0 Health Results
by Integrity of Sought
2.1 Practices
Man as
1.1 State of Growth - 2.2 Assets 6.1 Life
and Development 2.3 Deficits 6.2 Normal or Near
tive 1.2 Age 5.2 Agent Normal Function-
i 5.3 Symbolizer
re 1.3 Self-lmage 3.0 Universal Self-care ing
0 5.4 Object
1.4 Social Roles Requirements 6 . 3 Effective Living
1.5 Capacitv for 2 5.5 Person
3.1 Air I
Self-care\, 3.2 Fluids 10.0 Health Focus
1.6 Capacity for 3.3 Food
al Learning Therapeutic Self-care 10.1 Life Cycle
3.4 Elimination 10.2 Recovery
1.7 Culturaiy Derived 3.5 Activity
Goals Tl 10.3 Illness
1.8 State of Growth

If 3.6
3.7
3.8

Rest
Solitude
Interaction

7.1 Self-care Agency

7.2 Self-care Deficit
10.4 Developmental
10.5 Active Treatment
10.6 Restoration, Stabiliza-
tive 3.9 Being Normal 15.0 Outcomes of
and Development tion, Control of Inte-
g 1.9 Age 3.10Hazards to Life and 9.0 Determination of 1 grated Function
1.10 Self-Image Well-Being Nursing Require- 15.1 Elimination of
1.11 Concept of Nursing rnents Deficit
te 1.12 Knowledge
1.13 Interpersonal Skills
1.14 Performance Ability
Therapeutic Self-care
9.1 Therapeutic Self-
Care
9.2 Maximize Self-care

J 11.O Nursing Situations

11.1 Life Saving
11.2 Life Maintaining

15.2 Maintenance of
Abilities
15.3 Compensation
Care Deficits
Development 9.3 System Design 11.3 Life Sustaining 15.4 Increased Self-
4.2 Change in Health State 9.4 Role Performance 11.4 Health Promotion Agency for Pro
11.5 Disease Self-care Abili
+ Prevention Prevention of
tive 1.16 Influence Deficits
1.17 Value 9.0 Range of Self-care Deficits 12.2 Partly Compensatory
al ---e
Systems 12.3 Educative-Supportive-
1.18 Knowledge 8.1 No Deficit
8.2 Incorporate Practices Developmental 14.0 Ways of Assisting
1.19 Performance
Abilities 8.3 Suspend System +
ion 8.4 Assistance-Reversible 13.0 Nursing Technologies 14.1 Doing for/with
Deficit 14.2 Guiding
13.1 Communicating 14.3 Supporting
8.5 Assistance-Irreversible 13.2 Coordinating -c
Deficit 14.4 Developmental
13.3 Assisting Environment
8.6 N o Capacity for Deliberate 13.4 Creating Milieu for
Action 14.5 Teaching
Therapeutic Process -
13.5 Maintaining Life
: Variables for the Study of Nursing as a Practice Discipline Processes
13.6 Promoting Growth and