The practice of nursing evolves daily
from theories and philosophies that are proven by researchers, resulting in
growth of the medical profession and advanced evidence-based knowledge.

Philosophies

According
to Alligood (2014b), philosophies are specific theories that focus on one or
more metaparadigm concepts in a wide spectrum philosophical way (p. 43). For a
person to understand philosophies it is required to understand the knowledge
type, metaparadigms.

Metaparadigm

Metaparadigm
is the vast perspective of a discipline and a way to describe a concern
specifically to a profession or department (Alligood, 2014b, p. 42).

Nursing Metaparadigm

In
Table 3-1: A Structure of Nursing Knowledge Types and an Example of each type,
Alligood (2014b) explains metaparadigms in nursing knowledge are human beings,
environment, health, and nursing (p. 42).  These perceptions are exemplified in each
philosophy and conceptual model (Alligood, 2014b, p. 42).

Nursing Philosophy

Therefore,
a philosophy of nursing would be a broad statement that would generate general
ideas about specific values or beliefs. Alligood (2014b) stated, “Philosophies
present the general meaning of nursing and nursing phenomena through reasoning
and logical presentation of ideas” (p. 42). 
For example, Notes on Nursing:
What It Is and What It Is Not, where Nightingale answers the broad, yet
complex, question, “What is nursing?” (Nightingale, 1946).

Metaparadigm

            The
four metaparadigms of nursing include human beings or person, environment or
society, health, and nursing.

Person

Chinn
and Kramer (2015) define the metaparadigm of person aims on the recipient of care
in the aspect of wholeness and the holistic view entirely. This includes a
person’s culture, family, career or socioeconomic status, and even
spirituality. Western cultures consider the whole equal to its sum of the parts
and stress the interrelationships amongst the parts; compared to the Eastern
culture who believes healthcare providers must take into consideration all
aspects of the patient to properly treat them. Western cultures believe in
treating a specific problem, for example a patient presents to the Emergency
room with shortness of breath, cough for a week, fatigue, and pain in her chest
and sides; the physician treats the patient for a sinus infection and
discharges her home without evaluating the whole body. In the Eastern culture,
a physician would evaluate the patient’s entire body, taking into consideration
her history of COPD and current smoking status, including but not limited to
socioeconomic background. The benefits of assessing the whole compared to its
part could be the life-threatening diagnoses of Pulmonary Embolism versus an
uncomplicated sinus infection.  The
Eastern culture philosophies could result in an increase in healthcare costs
for unnecessary lab work, tests, and procedures (Chinn and Kramer, 2015, p.

46-47).

Environment

According
to Chinn and Kramer (2015) the metaparadigm environment or society refers to both dependent and independent factors that
are directly significant to the patient and his or her care (p 47).  For Nightingale environment was essential
while conveying her perception of nursing. She believed all people involved in
the care of a patient should maintain a therapeutic setting to heighten the
comfort and healing (Alligood,
2014a, p. 65). On the other hand, Martha Rogers believes that humans and
the environment are one and their manifestations derive from mutual
developments. She also believes a person is a consolidated whole and cannot be
observed by looking at its parts. Lastly, her philosophies are focused on the environmental
field and human field coinciding (Alligood, 2014a, p.224).  

Health

The
metaparadigm health, as stated by Chinn and Kramer (2015), is distinguished as
the goal of nursing. Health is defined differently among nurse authors varying
from the principle of nursing which is to assist ill patients while attaining
the highest possible quality of health, to health being an influential process
that alters with life circumstances and time. In other words, some authors view
the process of health and environmental circumstances are reciprocals of each
other and others believe the process of health derives from each individual
(Chinn and Kramer, 2015, p. 47).  Several
other nurse authors, including Myra Levine, often avoid the term health or
illness and tend to refer to these terms as conserving wholism. This idea leads
nurses to direct their attention to the entire patient situation and
environment instead of the typical factors referred to by healthcare (Chinn and
Kramer, 2015, p. 48). 

Nursing

Chinn
and Kramer (2015) describe the metaparadigm nursing as the interactions and
helping process between a patient and the nurse (p. 45). In addition, how the
nurse attributes the plan of care and the knowledge he or she presents. From a
medical framework, nursing follows the medical aspect like diagnosis,
assessment, treatment, and medication administration. Contrary, the nursing framework
describes interpersonal interaction as the main component and medical tasks are
supportive. While most nurse authors believe interpersonal interaction as the
center focus of nursing, there are some differences that remain. For example,
the patient that comes in contact with the nurse is the main aspect of
directing what plan of care will be taken and the goals that are achieved. For
others, the nurse’s role in the relationship is predominantly the person
leading the plan of care.  Each patient
and nurse relationship is unique and determined by many factors like time,
culture, experience, psychological development, situation, age, goals, values,
and many others (Chinn and Kramer, 2015, p. 46). Although these relationships
vary, the importance of their similarity is the human interaction for
developing health as a whole. It is fundamental for nurses to incorporate these
four metaparadigms into their nursing practices when caring for patients to
address them as a whole.

Personal
thoughts and beliefs

The
four concepts of the nursing metaparadigm play a major role in the nursing
process and is imperative when caring for patients. William Osler was quoted in
his belief that, “a good physician treats the disease; the great physician
treats the patient who has the disease.” 
This quote illuminates my personal philosophy and the foundation of my
future practice.  Patients are not just a
number or diagnoses; they are each individuals who require and deserve quality
care.  Quality care is compromised of a
comprehensive assessment, which requires evaluating the patient as a
whole.  It is important to not only focus
on the physiological aspects but the psychological and spiritual as well.

Nursing

I
believe the metaparadigm nursing ties all of the concepts together. The nursing
profession is more complex than most people understand. Nurses have the
responsibility of someone’s life in their hands while balancing several tasks,
passing medications, thinking critically about the next step, communicating
with many people involved in each patient’s care, and remaining compassionate
and empathetic. I strongly agree with the idea that every relationship between
each patient and myself is different but the care given remains the same providing
as much dedication and love as if they were my own family members. Some patients
and parents are exceptionally involved in their plan of care, while others are
just in the hospital to be treated and proceed home. The attitude of each
individual strongly determines the plan of care for that particular patient,
which leads into the metaparadigm person.

Person

Each
patient is cared for in the same manner by the healthcare team I work with
daily and everyone is treated based on a holistic standard. I believe each
individual should be assessed, diagnosed, and treated for after reviewing all
aspects of a patient’s life. Many new parents come to the hospital terrified to
ask questions about the actions they are taking at home, but this is the best
time for nurses and medical professional to educate on the benefits and risks
of all healthcare aspects. For example, I have cared for several infants that
are diagnosed with failure to thrive. If I were to just simply come to work,
treat the patient, give medications, and go home then not only would I despise
my profession but also my patient would not benefit from anything I have
provided. It is crucial for the healthcare team and myself to consider all
factors related to this patient. My concerns and questions would vary from how
long has he/she not been taking the bottle, what formula is being fed, how
often and how much is in each bottle, has the formula ever been changed, was
he/she full term or premature, is the baby well-groomed, are the parents
involved in the infant’s care, etc. There are many factors that could be vital
in treating this patient along with labs and procedures needing to be
completed. In this situation a parent may ponder why the healthcare team is
asking all of these questions but the resolution to this failure to thrive
infant could be a simple change in formula with added calories per ounce or a
formula without soy. These questions give the healthcare team a better outlook
on the person, health, and environment.

Environment

Environment
is a vital aspect in the care of individuals. I have no doubt a person’s
surroundings and care that is received can alter their healing process. For
instance, consider how many people go in and out of a patient’s hospital room
within a 24-hour period. If every person knocked loudly, flipped the blinding
light on, were rude and inconsiderate of the sick patient, then left by
shutting the door too hard, the patient would have no rest or calm environment
for his or her body to heal, resulting in a longer visit and
complications.  This is an effortless yet
imperative effort to provide optimal care for a patient. The environment should
be a place where patient feels safe and the healthcare team should promote
comfort, such as opening a window or using aromatherapy. Equally important, a
person’s home environment could alter their overall health as well. People can
perform everyday healthy lifestyle changes to better themselves and others
around them. For example, taking their medications daily, drinking more water,
going for a walk, keeping their house clean of dust, eating more fruits and
vegetables, etc. These are all environmental factors that can drastically
change a person’s health.

Health

The metaparadigm
health in my opinion is focusing on preventing and maintaining excellent health
in the hospital and at home. I believe care focused on preventing disease rather
than treating illnesses, by working, as a team and taking necessary measures to
promote healthy behaviors, would result in patients having better health
outcomes. In addition, early detection is a dynamic aspect of health promotion
that is vital to preventing the chronic disease burden. In the first example
above, the education given to a parent about the change in formula or even a
change in the bottle’s nipple could have prevented this infant with the
diagnoses of failure to thrive and the later complications that could be
associated. In my opinion, nurses need to focus on educating patients and
family members more than simply administering a medication or performing a
procedure. In the second example, education about basic everyday lifestyles
could change someone’s health and prevent them from being hospitalized in the
future. Even providing education about health to family members could go be
beneficial and passed on to several people in the community. 

Concepts Interrelated

            Nursing
actions are based on the interrelationships between these four concepts. A
person can refer to more than just the patient but also the support system and
healthcare team involved in one’s care. An individual’s health will be
influenced by his or her environment and everyday lifestyles. Nurses should
consider a person’s culture, spirituality, beliefs, and wishes, as well as
their home environment and overall health and possible lifestyle changes when
providing nursing care. It does not go without difficulty to define one
metaparadigm without correlating with another. In my practice, I believe each
of these metapardigms is essential in caring for patients. 

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