DQ: Theoretical basis for nursing

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DQ: Theoretical basis for nursing

DQ: Theoretical basis for nursing

There are global areas of knowledge in professional nursing that provide an organizing structure to theory and knowledge development. Nursing is organized by a metaparadigm, which consists of four concepts that define the discipline. The concepts within a metaparadigm help to form a central focus of the nursing discipline. Another way of thinking about this is that a dominant metaparadigm helps form the world view of a discipline (Parker & Smith, 2015). Research, theory, and practice are oriented around this dominant way of thinking about the discipline’s world.

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Reflection

Think about it

Look at the theories in your text, think about the many concepts in those theories, and reflect on the values, beliefs, and principles that were part of your nursing education and are part of your nursing practice. All of these make up the dominant metaparadigm of nursing (Parker & Smith, 2015).

 

Within any profession, there must be a consensus about the concepts of the metaparadigm. For a nursing theory to comprehensively reflect the profession of nursing, each of the key concepts must be addressed, explained, and applied to practice. In doing so, research ideas may be generated, resulting in knowledge development. Once the metaparadigm concepts are agreed upon, theory and knowledge development have organization or a central theme.

Several nursing theorists developed different variations of terms and concepts for the metaparadigm. For professional nursing, consensus in the literature identifies person, environment, health, and nursing as being the concepts within our metaparadigm (Parker & Smith, 2015). This is the most commonly accepted metaparadigm and was initially developed by Fawcett in 1978 and revised in later years. DQ: Theoretical basis for nursing

Metaparadigm Click each term and review the definition

 

Nursing Person Health Environment

 

 

Background

Jaqueline Fawcett, RN, PhD, ScD (hon), FAAN, ANEF was the original theorist who identified the nursing metaparadigm. What follows is an interview with Dr. Fawcett conducted on July 2011 by a professor of nursing as part of a learning activity for an online nursing course.

The Interview

 

Rebecca Lee (RL): Would you please share with the students your own educational pathway to nursing?

Jacqueline Fawcett (JF): I earned a baccalaureate degree in nursing in 1964, a master’s degree in parent-child nursing with a minor in nursing education in 1970, and a PhD in nursing in 1976.

RL: What originally inspired you to develop the metaparadigm concepts?

JF: I was asked to present a paper, “The What of Theory Development,” at a conference sponsored by the National League for Nursing in 1977 (Fawcett, 1978). Viewed through the lens of Kuhn’s (1970) work on the structure of scientific revolutions, Dubin’s (1969) idea of the central concepts of a discipline became nursing’s central concepts, which evolved into the concepts of the metaparadigm of nursing (Fawcett, 2005). DQ: Theoretical basis for nursing

RL: How did these concepts influence the discipline of nursing, both at the time of creation and in the years since?

JF: The metaparadigm concepts, indeed the very idea of a metaparadigm of nursing, influences nurses’ understanding of what nursing is, and especially their understanding that nursing is an intellectual discipline and not only skills used in the care of people who are sick. I believe that a considerable amount of nurse burnout could be reduced if nurses took the time to step back from their concrete clinical practice activities and examine their practice from an abstract theoretical perspective. One theoretical perspective is the concepts of the metaparadigm of nursing. I think that in doing so, nurses will begin to realize that nursing is an intellectual enterprise that encompasses clinical practice activities that are guided by theoretical rationale. Thinking in this way requires nurses to embrace change, which can be scary! But all of us must be willing to take the risks that are inherent in change to grow.

RL: How have your original metaparadigm concepts evolved over the years?

JF: The central concepts I included in my 1978 paper (Fawcett, 1978) were man, society, health, and nursing. Later, I changed man to person in the interests of gender-neutral language, and I changed society to environment in the interests of a broad perspective of the surroundings of nurses and nursing participants. The most recent change, from person to human beings, was in response to the critique that person is not recognized in some cultures. I described these changes in detail in my book, Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (Fawcett, 2005). In that book, I also present other versions of the metaparadigm concepts offered by several nurse scholars There has been some discussion as to whether “nursing” is a tautological concept within the metaparadigm of nursing. However, I have maintained that the inclusion of nursing as a distinct metaparadigm concept is necessary to capture the notion of the definition, goals, and processes of nursing.

RL: Would you please discuss the relevance of the metaparadigm concepts to the profession of nursing in 2011, and beyond?

JF: The concepts of the metaparadigm of nursing, whether my version or another version, are as relevant today as at any other time in nursing’s history, because they are a way to identify what are the boundaries and scope of the knowledge of nursing. Specifically, the metaparadigm concepts identify the global areas of knowledge needed for nursing at the bedside and in administration, education, and research. Individuals who might dismiss the idea of a metaparadigm of nursing as dated should consider their position carefully. For if people do not accept that there is a body of knowledge that constitutes nursing that is distinctive and different from other disciplines, then they do not have the right to say that they are practicing a profession or that they are members of a professional discipline. Instead, they are functioning as trades people.

RL: Could you share with us your own vision for the future of professional nursing?

JF: I regret that I am not optimistic. Too often, we behave as if we are members of a trade rather than of a professional discipline by ignoring the metaparadigm of nursing and by denying the utility of nursing’s discipline-specific knowledge. Instead, we willingly assume tasks and functions given to us by physicians who would rather not bother with certain tasks and functions. See, for example, Sandelowski’s (1999) seminal paper about the history of intravenous nursing.

RL: In closing, do you have any advice for my students as they embark on their educational journey?

JF: Keep going! Don’t be afraid to envision possibilities in your own future. That takes courage! You will no doubt reach a point at which you want more education, so it is best to pursue that education while you are used to being a student. Above all, have the faith of your convictions and don’t be afraid of being alone. DQ: Theoretical basis for nursing

(Lee, & Fawcett, 2013, p. 96-97).

The focus of this week’s content can be summarized by the following question: “Should the nature of nursing knowledge be abstract or concrete?” To answer this question, the following questions need to be considered first:

· How can something abstract be useful at the bedside?

· How can something concrete consider all of the diversity of possible nursing care situations with individuals, families, and communities?

Theory

Consider the following questions: “Should the nature of nursing knowledge be abstract or concrete?”

To answer this question, the following questions need to be considered first:

· How can something abstract be useful in nursing practice?

· How can something concrete consider all of the diversity of possible nursing care situations with individuals, families, and communities?

· How can something concrete consider different roles and practice settings of nurses?

 

Definition of a Theory

A theory is a frame of reference on how individuals view reality. A formal definition notes that theory is a group of interrelated concepts, assumptions, and propositions that explains or guides action. For the nursing profession, a nursing theory provides a view of or a window into the reality of nursing. It guides the thinking about and the doing of nursing. A comprehensive theory includes an explanation of both the noun and verb aspects of the profession, as well as a consideration of the concepts of the nursing metaparadigm: person, health, environment, and nursing (Melnyk & Fineout-Overholt, 2011; McEwen & Wills, 2014). Theories go beyond interventions to consider, in both speculative and practical manners; the focus of the person using the theory; and the desired nursing outcome. Practitioners, researchers, and educators of nursing have a common discussion point of what is and what is not nursing (Parker & Smith, 2015).

Level of Abstraction

Grand Theories

How can something abstract be useful in nursing practice?

Let’s first consider the level of abstraction and how it applies to the scope of a theory. Take a moment a look into the following picture.

https://lms.courselearn.net/lms/CourseExport/files/663217a4-28fb-4ba6-a471-75983f537998/images–W4_Topic1.jpg

Image Description (Links to an external site.)

How many objects do you see?

The first time you read a grand nursing theory with its high level of abstraction, the words may seem fuzzy and unclear. But as you peer into the words more closely, the theory along with its concepts becomes discernible and comprehensible, similar to the picture (Parker & Smith, 2015).

A grand theory uses a high level of abstraction so that its scope or picture of the nursing profession is very broad and generalized. Only by being abstract, ideal, visionary, and even transcendental is a grand nursing theory able to address all of the variables that a professional nurse may encounter while providing care to individuals, families, groups, and communities (Parker & Smith, 2015).

By definition, a grand theory must consider all of the concepts of a profession. Remember, for the profession of nursing, the metaparadigm concepts are person, health, environment, and nursing itself (Parker & Smith, 2015). So the question becomes: How can something abstract be useful in nursing practice? Without careful thought, the initial answer may be: “It can’t be used, because it is abstract.”

Actually, grand nursing theories are too broad to orchestrate direct patient-care activities, but they are useful in nursing practice because more specific theories (i.e., middle-range, practice) can be derived from the grand theories.

Examples of Grand Theories

Previous

Betty Neuman: The Neuman Systems Model

Since the 1960s, Betty Neuman has been recognized as a pioneer in nursing, particularly in the specialty area of mental health. She developed her model while lecturing in community mental health at UCLA. The model uses a systems approach that is focused on human needs and protection against stress. Neuman believed that stress can be modified and remedied through nursing interventions (McEwen & Wills, 2010). She emphasized the need for humans to maintain a dynamic balance that nurses can provide to patients by assisting them to identify problems and agreed-upon mutual goals. The environment component of Neuman’s model is both the internal and external forces surrounding the client and can be influenced or changed at any time. Neuman identified five variables of her theory: physiological, sociocultural, psychological, developmental, and spiritual (McEwen & Wills, 2014). DQ: Theoretical basis for nursing

Virginia Henderson: The Principles and Practice of Nursing

In 1937, Virginia Henderson and other scholars developed a nursing curriculum for the National League of Nursing in which the education was focused on patient-centered care and nursing problems. Thus, her theory was derived from her practice and education. The major assumption of Henderson’s framework is that nurses care for patients until patients can care for themselves. For patients, the desire is to return to a state of wellness and health. The major concepts of the theory relate to the nursing metaparadigm (i.e., patient, nursing, health, and environment). Henderson believes that the unique function of the nurse was to assist the patient during illness and assist in performing those activities that restore the patient to health. She defined the patient as someone who needs nursing care but not limited to illness (McEwen & Wills, 2014).

Faye Abdellah: Patient Centered Approaches to Nursing

Faye Abdellah was one of the first major nursing theorists. Her nursing theory was developed inductively form her practice and considered a human-needs framework. Abdellah and her colleagues developed a list of 21 nursing problems and 10 steps in identifying patient problems. They also identified 10 nursing skills to be used in developing treatment typology. Furthermore, her team distinguished between nursing diagnosis and nursing functions. Diagnoses were a determination of the nature and extent of the patient problems. Other concepts central to her work were: healthcare team, professionalization of nursing, patient, and nursing (McEwen & Wills, 2014).

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