Fut ure Refinement s
Jacqueline Fawcett, Ph.D.,
The central concepts and themes of t he
discipline of nursing are identified and formalized as nursing’s metaparadigm. Examples illustrate the direction provided by the metaparadigm for theory development. Refinements of the metaparadigm through conceptual models and programs of nursing research are proposed.
he discipline of nursing will advance only through continuous and systematic development and testing of nursing knowledge. Several recent reviews of the status of nursing theory development indicate that
nursing has n o established tradition of
scholarship. Reviewers have pointed
out that most work appears unfocused
and uncoordinated, as each scholar
moves quickly from one topic to another and as few scholars combine their efforts in circumscribed areas
(Chinn, 1983; Feldman, 1980; Hardy,
1983; Roy, 1983; Walker, 1983).
Broad areas for theory development’ are, however, beginning to be recognized. Analysis of past and present writings of nurse scholars indicates that theoretic and empirical work has
always centered on just a few global
concepts and has always dealt with
certain general themes. This paper
identifies these central concepts and
themes and formalizes them as nursing’s metaparadigm. Examples are given to illustrate the direction provided by the metaparadigm for theory development. The paper continues with a discussion o f refinements of t he
metaparadigm needed at the levels of
jacqueline Fawcett, Ph. D., F.A.A.N., i s
Associate Professor, and Section
Chairperson, Science and Role
Development, School of Nursing,
University of Pennsylvania,
disciplinary matrices and exemplars
and concludes with proposals for future work needed to advance to the discipline of nursing.
Present Status of the
Metaparadigm of Nursing
The metaparadigrn of any discipline
i s a statement or group of statements
identifying its relevant phenomena.
These statements spell out the phenomena of interest in a most global manner. No attempt i s made to be
specific or concrete at the metaparadigm level. Eckberg & Hill (1979) explained that the metaparadigm “acts as an encapsulating unit, or framework, within which the more restricted . . . structures develop” (p. 927). The Central Concepts of Nursing
Evidence supporting the existence
of a metaparadigm of nursing i s accumulating. A review of the literature on theory development in nursing reveals a consensus about the central concepts of the discipline-person,
environment, health, and nursing
(Fawcett, 1983; Flaskerud & Halloran,
1980). This consensus i s documented
by the following statements:
O ne may.
. . demarcate nursing in terms
of four subsets: 1 ) persons providing care,
2) persons with health problems receiving
care, 3) the environment in which care i s
given, and 4 ) an end-state, well-being.
(Walker, 1971, p. 429)
The major concepts identified (from an
analysis of the components, themes, topics, and threads of the conceptual frameworks of 50 baccalaureate nursing programs) were Man, Society, Health, and Nursing. (Yura &Torres, 1975, p. 22)
The units person, environment, health, and
nursing specify the phenomena of interest
to nursing science. (Fawcett, 1978, p. 25)
Nursing studies the wholeness or health of
humans, recognizing that humans are in
continuous interaction with their environments. (Donaldson & Crowley, 1978, p.
Image: The Journal of Nursing Scholarship
Nursing’s focus i s persons, their environments, their health and nursing itself. (Bush, 1979, p. 20)
Nursing elements are nursing acts, the p atient, and health. (Stevens, 1979, p. l l ) The foci of nursing are the individual in relation to health, the environment, and the change process, whether it be maturation,
adaptation, or coping. (Barnard, 1980, p.
Nursing i s defined as the...