Each professional discipline has a responsibility to identify concepts that provide a general description of the discipline. It is these concepts that comprise the profession’s metaparadigm (Fawcett, 1984). Much of the philosophy and theory of nursing stems from the work of Florence Nightingale. The diaries, letters, and books that she left behind containing her statements and beliefs have been fundamental to the development of the concepts comprising the nursing metaparadigm (Selanders, 2010). Fawcett’s (1984) stated there was a general consensus among scholars that the concepts of nursing were person, environment, health, and nursing. Some researchers have suggested that other concepts should be added to the nursing metaparadigm. For example, some have cited caring or social justice as core concepts (Fawcett, 1996; Johnstone, 2011). Social justice is a concept that has gained general acceptance as the fifth metaparadigm. For example, promoting justice is included in the Canadian Nurses Association's (CNA) Code of Ethics, where it indicates that nurses should uphold the principles of justice by fostering human rights, guarding equality and fairness and promoting public good (CNA, 2008). Schim, Benkert, Bell, Walker, and Danford (2006) specifically defined social justice as “ensuring distribution of life resources in a way that benefits the marginalized and constrains the self-interest of the privileged” (p. 73). In this paper, I will discuss these five accepted metaparadigms of nursing and illustrate each using examples from my own nursing practice. Person
The concept of person refers to the patient. However, the concept encourages nurses to view the person as a whole or multidimensional and not just as a condition or diagnosis. Person may also include patient’s families or social groups that help shape and define them. In nursing theory, human beings are considered in terms of their physiological, psychological, social, spiritual, and cultural selves (Sarter, 1987). A person’s place in society, as well as their relationships to their family, community, and society as a whole, can affect their needs and how nursing can help meet those needs. In Nightingales era it was the physical component that was addressed by both medicine and nursing. Nightingale identified how addressing psychological and social components affected a person and produced better outcomes (Selanders, 2010). In my own practice I have often cared for individuals who because of their faith will not accept blood products. Patients with acute leukemia will usually have a drop in their hemoglobin and platelet count as a result of chemotherapy and require a transfusion to bring those levels up. As nurses we educate our patients about the effects treatment will have on their bodies and the consequences of those effects. If the patient still refuses blood products the nurse must support that patient through the therapy and respect their right to make that decision. Environment
Environment can be basically described as a person’s surroundings that may impact their recovery. This metaparadigm concept of nursing incorporates factors both internal (e.g., food, water, medications) and external (e.g., air, noise, temperature) that act on an individual (Selanders, 2010). A person's environment may refer to the significant others in their lives as well as their physical surroundings (Fawcett, 1996). Undoubtedly people who have a positive and caring environment will do better than those in an environment without. As an example, I recently cared for a Mennonite lady who was admitted with febrile neutropenia. After a couple days of antibiotics she was no longer febrile, however, I found her to be sleeping most of the day and not eating much. I completed a thorough assessment, where she denied feeling unwell; yet I felt there was something I was missing. On the second day I was her nurse, her family – all 15 of them – who lived in another town came to visit. A Little...
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