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Four Nursing Metaparadigms
HOLZWART TRAVIS & HINER, CHERYL DEAK, HALEY BRANCH, CHAD
Abstract
en11i- hea!t~ person,,of This paper focuses on the four nursing paradigms which are comprised
is essen- and the nursing process in role key Each metaparadigm plays a nursing.and ronment,
contrasts three nursing theorists' and The paper compares care. tial when providing patient
the four nursing metaparadigms. Jean Watson is a modern day of individual interpretations
Caring. Her focus is on the holistic approach Human of theorist who developed the Theory
is imperative to include it order for a person to be fully healed, in believes that and to healing
century nursing 1911 the soul. Florence Nightingale was a and the mind, body, of the healing
war experiences, her with Armed theorist who paved the way for the nursing profession today.
focused on the impor- and time her of innovative ideas most the of some Nightingale created
century nursing theorist who created a self. 2(Jh environment. Dorothea Orem was a of tance
their own health of the patient to take charge of duty was the it model. She believed that care
potential ailments. The information obtained from these theorists was used to createto prevent
the four nursing metaparadigms. These personal definitions of our own personal definitions
were then applied to a patient scenario to exemplify their applicability to the nursing process.
The nursing. and health, environment, person, nursing include of The four metaparadigms
care. This may encom- of the recipient is the patient who on focuses person of metaparadigm
pass things such as a person's spirituality, culture, family and friends or even their socioeco-
includes both internal and external factors relat- environment nomic status. The metaparadigm
ed to the patient. This may include the interactions patients have with visitors as well as their
the patient. It of refers to the quality and wellness health of surroundings. The metaparadigm
nursing the is also includes the access the patient has to health care. The fourth metaparadigm
component. This refers to the nurse and how he or she will apply their knowledge and skills
providing the care. is the nurse who of when caring for patients. It also refers to the attributes
essential for nurses to apply these four metaparadigms to the nursing process when caring is It
for patients in order to address patient care as a whole. Three nursing theorists who provide
these four metaparadigms are Jean Watson, Florence Night- of their individual interpretations
these of ingale, and Dorothea Orem. There are similarities and differences in their viewpoints
striving to achieve the best possible patient of metaparadigms, but all share the common goal
of aim is to examine these viewpoints in greater detail, use the framework Our care possible.
the four nursing metaparadigms, and use them of these theorists to create our own definition
in real-life scenario in order to demonstrate their significance and importance current-day
patient care practices.
As modern day medicine advances, some may be fearful that it could lead to a more
Ameri- an methodical and less altruistic approach in healthcare. With this fear, Jean Watson,
Caring. Watson's approach, views Human of can Nurse and Theorist, developed the Theory
a separate entity from curing. She believes that curing refers to more than the healing as caring
on an illness, but includes mental and spiritual healing as well. Rather than focusing solely of
a patient, nursing should also include of curative factors, those that address physical ailments
"carative" factors as well. Carative factors provide the guidelines for modern day nurses to use
factors of that they are able to practice healing through the mind, body, and soul. This set so
Caring and demonstrates the distinc- of provide the structural framework to Watson's Theory
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tion between nursing and medicine.
Watson's interpretation of the nursing metaparadigm, person, promotes the practice of satisfying human needs through human care. She believes that every individual has their own unique and unpredictable set of needs and it is imperative to accept and honor a person's needs, regardless of their wishes, customs, or beliefs. She also feels that in order for a person to be fully healed, a holistic approach which focuses on the mind, body, and soul, is imperative. She contests that omitting even one of these components, prevents the healing process from being fully achieved. Each individual patient needs to be valued and understood, with the nurse always being authentically present and each patient deserves the right to have their dig- nity maintained and protected at all times. For example, a patient who has suffered a chronic illness, may feel powerless and vulnerable. It is of upmost importance for the nurse to spend quality time with the patient in order to prevent these types of feelings from occurring. It has been indicated that Watson's Theory of Care impacts patients universally. A study in Saudi Arabia found that over ninety-seven percent of patients perceived the behavior of caring from nurses to patients as important (Suliman, 2009). The patients felt that a caring environment was a way to accelerate the healing process by making them feel safe and comfortable. This example demonstrates that Watson's Theory of Caring benefits not only people within the United States, but people all over the world.
Watson's interpretations of health is described as much more than simply curing an illness. She believes that although curing is imperative, it is much more than a physiological response. In order for health to be achieved, nurses must also take a holistic approach with patients, one which is structured around the mind, body, and soul. She states that in order for healing to be effective, that there needs to be a complete balance of person's physical, cognitive, and spiritual-self. It is essential for each of these components to be unified and functioning at their highest capacities to achieve health. Another important aspect of health involves nursing assessment. It is crucial to assess patients based on their individual needs in order to maintain optimal health. Patients in acute health care settings, for example, may require multiple as- sessments daily, while patients in other areas of the nursing field may require less observation. Watson stresses that if a person appears to be in good health, it does not necessarily equate to health being fully achieved. It is important to note, Watson's Theory stresses the equal impor- tance of illness prevention with total health. Through this ideology, it is important for nurses to implement care plans that are structured not only to treat current illnesses, but also to assess a patient's mental state and background, and prevent potential illnesses as well.
When describing her viewpoints on the metaparadigm of nursing, Watson believes that it is essential for nurses to establish relationships with their patients. She pinpoints that while medicine and science are crucial curative factors, that they are not always the most dominant factors. It is equally important for caring to be another essential component to the nursing process by focusing on the person as a whole and ensuring that nurses will provide care to patients physically, mentally, and spiritually. By establishing meaningful relationships, nurses can ensure that they feel safe and comfortable. Achieving this helps to strengthen the bond between the nurse and patient, curing and caring. Establishing relationships can ultimately lead to nurses gaining even more patient information, which helps to promote better healing. Watson stresses that it is imperative for nurses to educate and guide patients to restore optimal health. The nurse should be a leader who is able to teach patients ways to further promote the healing process. Many leaders and administrators in the nursing field have applied Watson's theories in hospitals around the country. Her theories are used as criteria for the nursing staff to apply the deepest levels of caring (Watson, 2009). Watson also believes that assessing and evaluating patients is crucial in preventing further illnesses from occurring.
Watson is also a firm believer that environment plays a huge role to the nursing process. 124
Although Nightingale's theory was built on environment, she specifically focused on the environment for the person or patient ..Without the person, you would have no need for an environment, medically speaking. "Nightingale's environmental theory can be viewed as a sys- tems model that focuses on the client in the center, surrounded by aspects of the environment all in balance" (Zborowsky, 2014). In this respect, the whole point of her theory is centered on supporting body, mind, and spirit of the patient. Through assessments and observations, Nightingale was able to notice what made people calm, what caused them to be more anxious, or what made them irritable. She would then implement whatever made that person calm or happy to other patients in order to see if the overall affect was the same.
Nursing was not known as a respected job title in the I800's. People believed nurses could be taught everything they needed to know in a month or two. During Nightingale's ca- reer, she was able to show that nursing is not just about doing what doctors order nurses to do, but is also about promoting health (Arnone and Vitzsimons, 2015). Thinking critically about a patient was a huge revolutionary change in the nursing career. This is when nurses began to start looking at the overall health of the patient, rather than just what the doctor might think is making the patient ill. Nightingale believed that becoming a nurse wasn't just a job title or a ca- reer, but a calling to help the patient's mental and physical health (Stichler, 2014). She believed that nursing is something that only certain people were capable of doing, to help take care of those who needed medical care and attention. Nightingale was able to demonstrate that nurs- ing is not just a career, but a professional calling that requires education and training to deal with almost all direct patient care (Stichler, 2014). Nurses must always be thinking critically to try and figure out the next best course of action for each individual patient, no matter what the situation. This is why the nursing profession is considered such a respected job, nurses are advocates for their patients.
Health, of course, is the primary factor in patient care. Nightingale's theory shows that through caring, cleanliness, preparedness, and other medical needs, nurses can improve indi- vidual's health substantially. The fact that her theory is based in the 19th century and she was able to decipher the importance of some basic medical needs, like clean water and food, in her era is inspirational (Stichler, 2014). Nightingale changed the way people thought about im- proving someone's health when they needed care. Prior to Nightingale's revelations, medical care consisted mainly of diagnosing the patient. Rather than just trying to fix a problem, she focused on maintaining their health, which as we know now, is just as important as diagnosis and treatment of person, health, environment, and nursing.
Dorothea Orem was a twentieth century nurse and theorist who developed the theory of self-care, which focuses on the metaparadigm of person. She received numerous accolades for her achievements and contributions to the nursing field, including honorary degrees from various universities. Her theory consists of three components: the theory of self-care, the self- care deficit theory, and the theory of nursing systems. Orem's main emphasis is to provide pa- tients with the education and tools in order to take control of their own health and well-being. Orem believes that nurses play a key role in this process by being leaders and teaching patients the proper strategies to achieve optimal self-care.
Many people with hypertension would rather take medications than change their daily exercise or change their diet just for the fact that it is easier. This is one of the reason's Doro- thea Orem created her theory of self-care. She believes that people should care for themselves as best as they can. If someone is extremely sick though there is no way that they can get better without taking some type of medication. There is an exception when it comes to the health of some individuals, but she believes the individuals that can take care of themselves should take care of themselves. She believes self-care is the essence to a greater life.
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Life expectancy in 1840 was around 40 years; today life expectancy has risen to almost
only physically, not themselves of years. People have come to better learn how to take care 80
self-care has helped to increase of but also mentally and emotionally. Dorothea Orem's theory
expectancy in the United States. She believes that people should do everything they can to life
promote good health. People have the ultimate decision about the way they live their life and
diagnosed with breast cancer they is someone If the things they choose to do with their lives.
with their life and do everything they can to treat it, or they on the decision to both move have
can sulk about it and not do anything for themselves.
on self-care for elderly patients who were on Orem's theory was applied to a study done
increasing in elders in the United States. Peritoneal dialysis is peritoneal dialysis. Renal failure
therapy of self-worth. This type on with their life and have a feeling on can help patients move
forces them to integrate self-care .into and their own on requires patients to be able to do things
integral in teaching patients to perform therapy at is their daily routine. Using Orem's theory
hospital of home (O'Shaughnessy, 2014). This therapy allows patients to decrease the number
their own. on stays and live more freely
of healthcare. Keeping this in mind, the metaparadigm of Nurses are the backbone
self-care, of Self-Care. Patients are the center of displayed through Orem's Theory is nursing
healing. of therapies, nurses are essential to the course and but when it comes to diseases
what to do in the healing pro- on Nurses are there to help their patients heal and instruct them
something is Most people don't automatically know how to do peritoneal dialysis. That cess.
the nurse has to teach them how to do. Nurses encourage self-care by teaching their patients
everything that they need to know. They realize that individuals are all different and require
care in order to teach them what they need to learn. of different types
the hospitals by of only in the hospitals, but also outside not Self-care is encouraged
if by stating that environment of friends, and coworkers. Orem stresses the importance family,
a family member with cancer, needs to be surrounded by supportive forces to remain healthy
and happy. Support systems keep patients from self-neglect by making sure loved ones are tak-
themselves the way they should. Self-care also includes staying away from things of ing care
that are detrimental to one's health. This includes substance abuse, smoking, unhealthy diets,
how they are affecting and that nature. People should learn about these topics of or anything
their lives and nurses can help educate them.
themselves of essential for anyone's life. Orem finds that people who take care is Health
typically live a happier and longer life than those who neglect caring for themselves. Her Theo-
unhealthy an ry of Self Care stresses that without self-care, health conditions plummet. Eating
diet, failing to identify and treat obesity or high blood pressure, or even letting a disease take
failed self-care. Self-care encourages people to of one's life are all examples of over all facets
and themselves of seek health care when they aren't feeling well. It pushes people to take care
their future health. Orem's theory sets concrete standards for of not let themselves lose sight
education and support from nurses for of nursing practices today and teaches the importance
healthy life. and their patients' well-lived
healthcare. Jean Watson, of the main focus and priority in the system is patient The
of the concept on slightly different takes had Florence Nightingale, and Dorothea Orem all
unique and thus is that each patient is those ideas of person but did share some ideas. One
individual. Orem recognized the fact that nurses care for all types an should be cared for as
the care for each will be different. Although she was a major advocate for and patients, of
her patients will have individual needs. of self-care, she acknowledged the notion that each
factors that affected her on Similarly, Nightingale furthered this idea by catering her care based
patient's emotions. Nightingale would individualize her care for patients by linking actions to
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include things such as spirit, mind, body, soul and much more. Watson argued that through
a on these aspects, health could be addressed. She also believed health should be addressed
a patient can vary drastically be- of day-to-day basis. This was due to the fact that the health
the other hand, argued that self-care is the driving on tween one moment and the next. Orem,
themselves of best for patient's to take care is a patient's health. She argued that it of factor
patients did this, should If effort to prevent health issues. an and embrace a healthy lifestyle in
they become ill, their situation would be less severe. This also makes providing care for the
health in her own of patient much easier and efficient. Nightingale addressed the paradigm
a patient can be improved by maintaining of well. Nightingale expressed that the health as way
cleanliness, being prepared to provide care, and utilizing the therapeutic resources available in
of one is her time. As we now know, cleanliness of the medical field. Nightingale was ahead
patients. Although they each shared of maintaining the health of the most important aspects
health, they all shared the same general of their own sentiments in regards to the paradigm
the patient can be accomplished through of intentions. Restoring and maintaining the health
many different avenues as proved by their differing approaches.
Definitions Our
unique, with is individual who an is person, the metaparadigm, of Our interpretation
ideologies. This person will also have their own and values, beliefs, of their own personal set
others. Because of cultural identity, which may not always coincide with the value system
open mind, setting aside any pre-conceived an very important for nurses to keep is of this, it
someone who deserves to is notions, biases, or judgments towards their patients. The patient
personal differences. Things such as a patient's religion, personal of be respected, regardless
beliefs or socioeconomic status should play no role in how they are treated. The patient also
able is the nurse If deserves for their privacy to always be maintained and never compromised.
to achieve these things, the patient will likely be more open and comfortable when providing
subjective data during assessments. This will result in a stronger rapport between the nurse
and the patient, resulting in better overall patient care. It is important for the nurse to build a
strong, trusting relationship with patients in order to improve the patient's experience. A pa-
tient who trusts their nurse will be more open and better outcomes will be achieved.
as a person's physical well-being and in order to achieve health of We often tend to think
illness does an peak health, that they should be free from injury or disease. Although treating
involve this physiological approach, we also feel that it should include much more. We be-
that the holistic and treated as a whole is that healing is not complete until the person lieve
only a person's not crucial. This should include treating and evaluating is approach to healing
a patient if physical health, but also their mental and spiritual health as well. For example,
of went through vigorous physical therapy sessions after a surgery and finally gained full range
motion, this would not necessarily indicate complete health. It's very possible that they could
in their life. on have emotional issues from either their injury or possibly something else going
the healing process, optimal health cannot be achieved. Anoth- of Without treating all aspects
health is that it should be routinely monitored and evaluated. Health of er important factor
this, it should never be of often changing. Because and always ongoing is something that is
ignored. Routine evaluations may play a huge role in health and may impede future illnesses
the best solution because it saves re- is illness from occurring an from occurring. Preventing
sources, time, and the patient from experiencing hardship.
someone who should not only is a nurse nursing, In regards to the metaparadigm,
illness when treating patients, but should an physiology behind and understand the science
others. Compassion and empathy should be an in- of also genuinely care for the well-being
nate quality within a nurse and he or she should be able to set aside any personal biases or
things such as race, religion or socioeconomic status. A nurse should of judgments, regardless
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exude professionalism at all times, whether or not he or she is at work. Nurses are one of the most respected professions and they are role models within their communities. A nurse should also be a leader as well as an educator, taking the time to work with patients to improve their quality of care. It is important that nurses take the time to show patients procedures and teach them essential habits to better their quality of life. Nurses should also not only treat existing ill- nesses, but take the initiative to do all that they can to prevent further illnesses from occurring. It is also essential that nurses never take any shortcuts to ensure that their patients are receiving the best possible care possible.
Another aspect of the healing process that may be more subtle, yet highly effective, is the environment. It is very important to create a therapeutic environment for the patient in order to promote healing. When creating this environment for the patient, a nurse should take into account a patient's individual needs. This environment should be a place where the patient feels safe and it should remind them of home. Sometimes subtle but meaningful changes can be made to promote comfort, such as opening a window to increase sunlight for patients. This may relieve feelings of stress, anxiety, or depression, which is harmful to the patient's immune system. It may also benefit certain patients to see nature, which may allow them to feel more calm and relaxed. A nurse could also take into consideration the colors in the room, adding flowers or plants or certain wall decor to help improve patient environment. When creating a therapeutic environment, the sense of smell is important to consider. Eliminating foul odors and incorporating pleasant smells may help promote patient health. It may be beneficial to use aromatherapy, which has been believed to stimulate brain function. Another factor which benefits the patient's environment includes having visitors such as friends or family to keep a patient's spirits lifted. Some patients may also benefit from animal therapy. It is important for nurses to create a patient's environment based on their own individual needs, whatever that may be, in order for the patient to feel safe, comfortable and happy.
Our Scenario
A scenario was created to personify what our interpretation of the four nursing metaparadigms, person, health, nursing, and environment. An RN named Jackie starts her shift at 0700 on the oncology floor. Today she has been assigned a new patient with the initials, T.J, who is a ten year old boy from Brazil, battling lung cancer and recently admitted to the hospital. As Jackie enters the room, she immediately begins her assessment and gathers some objective data. As she greets the patient, she immediately notices that the patient's airway is open as he verbally responds to his name. The nurse then notices that his breathing is unla- bored and he is not displaying any signs of cyanosis. She also notes that the patient does not appear to have any skin abnormalities, lesions, or ulcers. One thing that Jackie did notice was that T.J appeared to be a little distressed. She sees that the patient is making very minimal eye contact and is giving very short answers when answering questions. Jackie takes the patients vital signs and documents all of her findings on his chart.
Jackie then begins to collect subjective data from the patient. The first thing that the nurse learned was that T.J is from Brazil. Jackie then asks the patient to tell her a little about his culture. She learns that in his country, it is a sign of disrespect to make eye contact with an authority figure. Jackie quickly realizes that his lack of eye contact was simply a demon- stration of respectfulness according to his cultural belief system. The nurse makes sure that although the patient is from a foreign country and has a different value system that she will not display any judgments on the patient. Next Jackie inquires about T.J's pain status and the patient reveals that he currently is a four out of ten. The nurse does notice though that the pa- tient appears to be withdrawn and asks T.J if he has been feeling sad lately. The patient nods and Jackie asks him if he wants to talk about it. T.J then tells her that he feels very isolated in the hospital room and misses going outside and playing with his friends. Jackie tells him that 130
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References
Arnone, J.M. and Fitzsimons, V. (2015), Plato, Nightingale, and Nursing: Can You Hear Me Now?. International Journal of Nursing Knowledge, 26: 156-162. doi: 10.1111/2047-3095.
Biggst, A. (2008). Orem's Self-Care Deficit Nursing Theory: Update on the State of the Art and Sci- ence. Nursing Science Quarterly, 21(3), 200-206. doi:10.1177 /
Kay Hogan, B., & Cleary, E. M. (2013). Caring as a Scripted Discourse versus Caring as an Expres- sion of an Authentic Relationship between Self and Other. Issues in Mental Health Nursing, 34(5), 375-379. doi:10.3109/01612840.2013.
McDonald, L. (2014). Florence Nightingale, statistics and the Crimean War. Journal of the Royal Statis- tical Society: Series A (Statistics In Society), 177(3), 569-586. doi: 10.1111/rssa.
O'Shaughnessy, M. (2014). Application of Dorothea Orem's Theory of Self-Care to the Elderly Pa- tient on Peritoneal Dialysis. Nephrology Nursing Journal, 41(5), 495-498.
Stichler, J. F. (2014). An Ode to Florence. Health Environments Research & Design Journal, HERD, Ven- dome Group LLC, 7(4), 13-18.
Suliman, WA., Weimann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research (Taiwan Nurses Association), 17(4), 293-300.
Summerell, P.^ (2015). EB133 Jean Watson's Caritas Processes: A^ Model^ for Transforming the Nursing Practice Environment. Critical Care Nurse, 35(2), e66-e67.
Taylor, S. G. (2011, January). Dorothea Orem's Legacy. Nursing Science Quarterly. pp. 5-6. doi: 10.1177 /0894318410389064. Watson, J., & Watson, J. (2012). Human caring science: A Theory of Nursing (2nd ed.). Sudbury, MA: Jones & Bartlett Learning.
Watson, J. (2009). Caring Science and Human Caring Theory: Transforming Personal and Profession- al Practices of Nursing and Health Care. Journal of Health & Human Services Administration, 31(4), 466-482.
Zborowsky, T. (2014). The Legacy of Florence Nightingale's Environmental Theory: Nursing Re- search Focusing on the Impact of Healthcare Environments. Health Environments Research & Design Journal, HERD, Vendome Group LLC, 7( 4), 19-34.
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