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.