Metaparadigm concepts in nursing

Jacqueline Fawcett’s metaparadigm in nursing consists of four major components. The four nursing paradigm concepts are person, environment, health, and nursing. "Person" refers to the individual with whom the nurse interacts on a therapeutic level. These may be patients, families, or even an agency or an entire community. "Environment" refers to the internal and external factors affecting the treatment. "Health" refers to the person's well-being, including physical, psychological, emotional, and spiritual aspects. However, according to Fawcett's paradigm, what constitutes "health" must be defined by the patient, and nurses must allow themselves to be guided by what the person considers an acceptable level of health or standard of living. Health also includes the ability to access healthcare and other kinds of support. "Nursing" refers to the actions taken by the nurse, including applying professional knowledge, procedural and technical skills, and indirect and direct patient care. Per the American Nursing Association, nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations. Fawcett’s metaparadigm concepts were a framework for the development of models in the articulation of expert nursing.

Background

Until the mid-nineteenth century, nurses had haphazard or no formal training. They might be kind, but were not formally prepared to understand the nature of illness or injury. Florence Nightingale is acknowledged as the force behind nursing education and advocacy. She was the first nursing theorist and opened the first school of nursing at St. Thomas’ Hospital in London (1860). Two years later, her belief in advanced nursing education resulted in a school for midwives at King's College. Prior to those accomplishments, she had received a total of less than four months training at two institutes, which qualified her to be superintendent of a hospital. Nightingale is best known for her work as a nurse in the Crimean War, which appears to be the first time standards of care had been set at a military hospital. She saw to it that patients were bathed and fed regularly, their psychological needs were met, and that the patients had clean dressings and clothes, as well as activities to keep them occupied. The "Lady with the Lamp" was a keen observer and statistician, skills that have become ingrained in the practice of nursing.

Fawcett’s metaparadigms were already evident in Nightingale’s work. Nevertheless, nursing was considered a low-skilled, task-based vocation until the late twentieth century. As healthcare advanced, nursing required greater levels of professional knowledge and skill. Articulating precisely what a nurse should know and what skills a nurse must possess to be competent in the profession sparked debate within the nursing community and drove nursing education. The metaparadigm concepts provide a framework for more advanced concepts to be nurtured and developed.

Impact

Within nursing, there is a running controversy concerning the difference between nursing theory and conceptual models. Hesook Kim, a noted nursing scholar, stated: "The functions of metaparadigms are to summarize the intellectual and social missions of a discipline and place a boundary on the subject matter of that discipline." The profession of nursing continually changes, and so do the boundaries. Technologies may be state of the art today and obsolete in five years. An ICU nurse of fifty years ago would stand in awe of computerization. Communication, a major part of "person," has been facilitated by technology. Further, understanding of human behavior and physiology has changed considerably since the early days of professional nursing and continues to expand.

Concepts of "person" and "health" must be developed in order to integrate patient and family needs into care plans. For example, a patient may present with an injury or disease that needs direct care; the patient, however, is more than an injury or disease, and care requires attention to the entire patient, including alleviating discomfort, noting side effects or distress, and facilitating family participation in treatment. In some models, "person" may include other people who interact on behalf of the patient. In all models, caring for the physical and psychological needs of patients cannot be overstressed.

Environment, as Nightingale recognized, contributes to the continuum and quality of care. The concept of "environment" includes, for example, sanitary conditions—sterile equipment, a relatively germ-free facility, and keeping patients clean—as well as a culture of caring. Working (and convalescing) in a dismal physical environment is inconsistent with good physical or mental health for anyone. Further, in some cases, the ability to practice nursing optimally can be impaired by the culture rather than the building structure.

As the nature of nursing education has progressed, there has been discourse on the expanding role of nurses, along with additional opportunities to engage in independent practice beyond midwifery. The medical field has seen an increase in nurse practitioners. According to the Bureau of Labor Statistics (BLS) Occupational Outlook Handbook, nurse practitioners tied with wind turbine service technicians as the fastest-growing occupation for 2022 to 2032, with an estimated growth rate of 45 percent over the decade.

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