The nursing metaparadigm is a group of statements that identifies phenomena and incorporates philosophical assumptions that guide the development of nursing theory (Fawcett, 1984). Nursing scholars have historically agreed that the central concepts of the nursing metaparadigm include person, health, environment and nursing. Recently, the inclusion of a fifth concept, social justice, has been discussed in the literature as part of the metaparadigm. This paper will outline the meaning of these five metaparadigm concepts illustrated through the author’s personal nursing practice. Throughout the paper the author refers to "person" as "she", but acknowledges that in practice, person includes both she and/or he. Person
The person is a complex and dynamic being with unique values, behaviours and attributes that must be considered through a holistic approach (Pender, 1990). As a nurse in the intensive care environment it can easily become commonplace to see the person laying in the bed as nothing more than a diagnosis with issues that require fixing based on scientific facts and technical competence (McCormack, 2003). From this perspective, the person’s dignity and values will be overlooked and the holistic needs of the person will not be met. McCormack (2003) presents a conceptual framework for person centered practice where a therapeutic narrative between nurse and person is built on mutual trust, understanding and sharing of information. Adopting this approach in the intensive care unit (ICU) enables the nurse to gain more understanding of who the patient is beyond the obvious indicators of gender, race, religion and geographical location. Due to the critical condition of ICU patients, involvement of the patient’s support system through open dialogue and organized family meetings is essential to gain a better understanding of the whole person. Environment
A person embodies both an internal and external environment. Biological, physiological, cultural and spiritual elements make up the internal environment, whereas the external environment is comprised of physical and socio-political elements (Schim et al., 2006). Collectively, these factors shape the person’s interpretation of the world and her decision making process. A change in the person’s external environment is easier to assess due to its concrete nature than that of the internal environment. However, a nurse must be cognizant of how both environments may alter the person’s behaviour and the healing process. A person is consulted to ICU due to critically significant changes to her internal environment. If her physiology is drastically altered and she (or her power of attorney) still desires to have life saving attempts made, an ICU admission follows. This admission alters her cultural environment. There is a specific culture in the ICU and this ill person is swept up into it. The patient along with her family must adapt to the rules, regulations and norms of the department. From experience, this is not always easy for the family members to achieve. Health
Health is an expression of the interactive process between a person and her environment. (Pender, 1990). This is a dynamic process along a continuum of wellness and illness. Each person will find a different place along this continuum as her point of optimal health. A person’s ability to adapt to her constantly changing environment, utilizing various coping mechanisms, will enable her to maintain or improve upon her place on the health continuum (Fawcett, 1984). When these coping mechanisms fail, the person begins a journey away from wellness. Nursing
Nursing functions as the connection between person, environment and health. Nursing facilitates the movement toward wellness on the health continuum. Litchfield & Jonsdottir (2008) state that nursing is rooted in the prevailing health paradigm of prevention, diagnosis and treatment of disease. In order to meet these needs, nursing has evolved to be both an art and a science. Science alone will not fulfill the needs of nursing, as according to Johnson (1994), it is a practice discipline. A practice discipline requires creativity and establishing connections to meet the person’s needs (Johnson, 1994). Social Justice
Social justice has recently been explored in the nursing literature as the fifth concept of the nursing metaparadigm. The Canadian Nurses Aassociation (2008)’s Code of Ethics outlines that nurses are to “uphold principles of justice by safeguarding human rights, equity and fairness and by promoting the public good (pg. 17).” Practicing social justice means that nurses do not discriminate a person based on their environment or health status. Social justice is impartial (Schim et al., 2006). It ensures distribution of health care resources in a way that benefits the marginalized and prevents the self-indulgent interest of the privileged (Schim et al., 2006).
Conclusion Nurses must apply principles of social justice to individuals interacting with their internal and external environments while experiencing changes along the continuum of health. These five concepts of the nursing metaparadigm: person, environment, health, nursing and social justice are well explored in the nursing literature and provide the phenomena required to further advance the discipline of nursing (Pender, 1990).