The Correlation of Nursing Paradigms and Metaparadigms - Essay Example

A Critical Discussion on Nursing Paradigms and the Relativity of them to my Personal Clinical Practice You’re A Critical Discussion on Nursing Paradigms and the Relativity of them on my Personal Clinical Practice Introduction The practice of nursing is a very complex field and for years there have been a number of diverse theories as well as research paradigms to help those in the field correlate their knowledge with compassion and care. Theater nurses are perceived to have an even more direct effect on patients and their outcomes due to the notable role that they play in many life and death situations where surgical intervention becomes a necessity. However, even surgical nurses follow many of these same paradigms and theorizations as ward nurses do as both have to be able to develop a strong interpersonal relationship with the patient and give quality and compassionate care for optimum positivism for the patient in particular. The Correlation of Nursing Paradigms and Metaparadigms on Clinical Practice According to Polit and Hungler (2006) paradigm is a "way of looking at natural phenomena that encompasses a set of philosophical assumptions and that guides ones approach to inquiry" (pg. 183). Nurses naturally use this type of thinking in their practice to assist them in determining what the best care methods are going to be for a patient. Of course this thought moves into the usage of metaparadigms in the field as well, with both interlacing together to form a unified pattern in professional nursing. A Metaparadigm differs from a nursing paradigm as, “it is known as a group of statements identifying a relevant phenomena” (Fawcett 1984, pg. 84). The Metaparadigm model has four known concepts that directly affect the clinical practice of any nurse, regardless of this is in theater or outside on the surgical ward, or even on a basic ward. These four known central concepts that directly affect the discipline of nursing are as follows: Consideration of the patient as a person Environment of the patient before and after admittance Health and wellbeing of the patient before and after admittance The quality of care and compassion of the nurses Carper’s Pattern of Knowing (1995) intertwines with this mental train of thought in nursing because it moves beyond the technical aspects of the field and goes more into personal knowledge and experiences. This is explicably true in the area of understanding the patient’s direct needs and the environment from which they came from before ending up in the medical environment (Sorrell & Sorrell 1995, pg. 2). It is also true that this type of philosophy, while bringing many nursing ideas into a more unified spectrum has also brought in a paramount shift in the profession itself. According to how Sorrell & Sorrell (1995) analyzed this concept in their research, they show how Carper believes that every knowledgeable pattern in nursing must be fully understood so that a perfect type of congruence between all of the theorizations and concepts will develop and not be neglected. This is definitely imperative in nursing because all of the theorizations and research methodologies have a specific role when gaining the ability to care for another human being. Neglecting one concept and focusing on solely one strategy, say possibly an interpersonal model is not going to be as effective as utilizing two or three theories together. It could be said that Carper’s model has helped many nurses in understanding the diverseness of the patient population in Australia itself because years past, and even currently there has been a high debate on the ethical delivery standards of care for those of a different ethnic or cultural background from natural born Australian citizens. It would seem that Carper’s model is not simply focused on any intellectual anomalies in nursing but more on the ethics of care, the personal knowledge of the nurses, the structure of nursing itself, and how the utilization of all theories affect the discipline. Furthermore, although this model has much strength and brings clearer comprehensive patterns for many theorizations it has limitations just as any other nursing paradigm or theory holds. The reason this is stated is because there is not one type of philosophical thought concept that can be totally perfect and that is why it is felt that (as Carper seems to believe) intertwining all of them into the discipline is more imperative to clinical nursing practice. For instance the wellbeing of the patient might follow a holistic theorization while the quality of care and amount of compassion of the nurses would stem from a theory following an interpersonal approach to nursing care. So it can be seen how imperative all nursing theories are to a clinical practice and how much they do affect it as well. In fact it is the nursing paradigms and metaparadigms that actually help develop the nursing theorizations (Christensen 1990, pg. 10). The Australian Nursing Council (ANC 2000) has come to realize the importance of diverse knowledge in professional nursing also and works to try and incorporate many necessary theories into the educational areas of nursing so that the nurses, when graduating will be duly prepared to provide high quality care to all ranges of patients regardless of the background or ethnic identity of any of them. All people deserve the same form of care according to the ANC guidelines (OJIN 2000, pg. 2). To explain further, the ANC defines nursing in the country as, “the diagnosis and treatment of human responses to actual or potential health problems” (OJIN 2000). Diagnosis, according to the nursing process is when the nurses identify the actual problems and find out how to treat them in order to prevent any potential problems, specifically following surgical intervention. If one allows for the Christensen model to be followed then, nursing is establishing limits or boundaries in terms of the person providing care; person with health problems receiving care; the environment in which care is given and an end-state, well-being (Fawcett 1984, pg. 85). It can be clearly stated that within Australia a model such as Christensen’s partnership model has been a necessity for quite some time in order to provide equality and continuous quality care for all people. It identifies the concept for a partnership as the basis for involvement between a nurse and a patient. This concept provides a sound humanistic foundation for nursing practice. From the patient view point, a partnership of equality and respect provides security. From nurses, patients are vulnerable or face situations, which require care from health services. The experience of partnership empowers and enables people when they are patients, and we believe that security proved by the nursing partnership is a basic human right for a patient. For a partnership to exist and work effectively, there must be a willingness from all partners to collaborate as equals, and then to jointly make decisions and endeavour to solve problems (Christensen 1990, pg. 10). Christensen (1990) described partnership is initiated when the patient is admitted to hospital and ceases when they go home. It is a continuous process, which offered ways of looking at what happened when a nurse offered learned expertise to a person who is going through a health related experience. The learned expertise is known as “nursing” (caring). Newman et al (1991, pg. 2) claim that the theoretical aspects of nursing and the various models have definitely affected clinical practice and the discipline of nursing in many pertinent ways, many of them in a positive manner. The Discipline of Nursing and the Theoretics of Knowledge on Clinical Practice The discipline of nursing is considered to be a shared belief and value system among all nurses everywhere around the world. It consists of many different theoretical models and paradigms of research which help facilitate the profession in a way that promotes positive health and well being for all of those in need of medical care, or so the perception is considered to be. A discipline can be implied by one simple statement which brings specificity to a certain field of study, in this case this is professional nursing according to Newman et al (1991, pg. 3). The main focus of the nursing discipline is, “the professions social commitment, nature of its service, and the area of responsibility for the knowledge needed to develop,” to appropriately care for a diverse range of patients in Australia and elsewhere in the world. It has also become clear that sociology is a detrimental aspect in the field of nursing as well. This is due to the fact that there are many sociological factors that become important to the care of the patient whether again recovering on a surgical ward under a theater nurse’s care or on another ward of a medical facility. In this idea, Newman et al (1991, pg. 4) points out that there exists no basic nursing paradigm; as ideas of nursing do differ throughout the world, especially from a sociological standpoint. What one country might view to be expressively important to nursing care another might not hold the same value too. Therefore, although nursing paradigms do hold knowledgeable concepts the relevance of them differs considerable in Australia when compared to the United States and even in some areas of England and other areas of the United Kingdom. However, any aspect of knowledge in nursing that is involved with the care of a patient has an explicable importance to clinical nursing and does affect all nurses. The basic reasoning for this philosophy is due to what has briefly been stated, knowledge development within the field of nursing comes into being through various scientific concepts and as yet there has not been one that has stood alone which has been able to effectively focus on the professional discipline without drawing on other nursing theoretics as well (Newman et al 1991, pg. 4). These thoughts have transformed nursing in a way that has brought in a holistic philosophy and a more thorough humanitarian approach as well as it has become relevant that knowledge is not the only needed aspect but compassion is extremely detrimental. This of course does correlate well with the Christensen (1990) partnership model as well as with an interpersonal approach and even holistic medicine as well. Newman et al (1991, pg. 4) specifically states that clinical nursing and other nursing areas have inevitable become, “something to do with how nurses facilitate the health of human beings.” This draws on personal experience, personal knowledge, and theories of nursing, humanistic thought concepts, holistic health care, and other sociological ideals that are very important to the clinical field of nursing in current times. Furthermore, the epistemology of health care and nursing has become more of an ontological aspect, focusing more on how to directly care for the patient and treating them as part of the treatment regimen rather than just a body lying there in a hospital bed. So obviously, a humanitarian role has taken place through many of these ideas in clinical nursing. As Munhall (1993, pg. 39) quotes from Willis Harman, “Science is not a description of reality, but a metaphorical ordering of experiences…” This clearly shows that the nursing experiences are more fluent in nurses gaining knowledge that correctly correlates with appropriate patient care than any old nursing paradigm could ever offer. This is due to the fact that the field is constantly changing and new ideas are always emerging which all impact upon clinical nursing and various other forms of nursing just as much. As Fawcett (1993) has clearly emphasized by bringing in the paradigm and metaparadigm ideas, nursing knowledge is more than scientific, it draws upon the patients social environment, personal well being, current physical surroundings in the health care facility, and many nursing actions in order to correctly assess, label, plan, intervene, and evaluate the patients condition. Without this form of knowledge and understanding nurses would be lost in their field and not effectively assist the patients that need them when they need medical help the most (Fawcett 1993, pg. 4). So, nursing is the actions or treatment to help the patient promote health not only on part of his body, but nursing is looking at the person holistically. Undoubtedly, clinical nursing has turned towards the idea that the basic form of it is attending to the patients needs and meeting those with high quality compassionate care, without question. Christensen (1990) states that attending takes place during the time of contact between the nurse and patient and also accompanies the patient through hospitalization. Attending is the essence of partnership because it shows that nursing is caring and concern about the change in a patients life. It requires the nurse to view nursing as a collaborative between the nurse and the client. It initiate’s when the patient is admitted to hospital until they go home. It is a continuum process, which offered ways of looking at what happened when a nurse offer learned expertise to a person who is going through a health related experience. Harmer & Henderson (1939) claim that, nursing is today filled with many of the philosophical ideas from Nightingale that was prevalent two decades ago. They state that the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death). Here it is evident how many of these shared belief systems have developed into a form of nursing knowledge that has become very humanitarian and holistic in all aspects of the profession. Christensens partnership model is very similar to this idea as to assist the patient and offer support during this journey of sickness or seeking help with things that they are unable to do for themselves (Harmer & Henderson 1939, pg. 97). This has become the goal of nursing, to use their knowledge to find the most efficient and effective ways of carrying out nursing procedures to help their partner in nursing care as the patient. Moreover, according to attend, being there for the patient and spending time with him in order to understand his or her needs is a crucial factor of caring. Also, ministering, which Christensen (1990) defines as a selective application of nursing knowledge and skills to meet the identified needs of the patient has become paramount in the profession as well. Within that knowledge, nurses have a systematic body of knowledge that underpins practice, which means, they know what to do, how to do it and why they are doing it. For example, an eighteen months old baby was brought from theatre whom he had a Gastrostomy. I took observations on him for half hourly for two hours and hourly after that. Why do I have to do that, because to identify any signs and symptoms of hemorrhage which is potential for shock, it is considered a necessity. That is the basic knowledge that I have taught so far that this baby has a tendency of bleeding. It was very important for me for these observations. According to Christensen (1990), the work of the nurse is dynamic and sensitive as nursing responds to the immediacy of the patients situation in today’s current trends in clinical nursing. During this time the nurse and the patient negotiate their partnership by looking at the work of the nurse and the work of the patient in order to cushion the impact on the patient of the disturbances associated with hospitalization. The following quoted paragraph defines the transformation of nursing with regard to the patients care more fundamentally than any other: Nursing care is a social process which can be used to describe an experience of a significant change in a persons circumstances. It is characterized by giving and receiving of nursing in order for the patient to make an optimal progress for a better health recovery. In reality it may or may not lead to a beneficial passage. But, the work of the nurse begins as soon as the patient is admitted to hospital. It is known as the beginning phase, which is to assist the client to attain the means, opportunities and the ability to act within the present circumstances, though the nurse-client partnership exists for all nursing goals and the expected outcomes may not always turn out as desired (Andrews 1992, pg. 10). Changing Paradigms in Clinical Nursing and the Outcome on Clinical Practice Gradually it is being learned that the paradigms that use to stipulate what measures would be taken for conscientious support and patient care in nursing is definitely transforming due to new holistic approaches and well founded ideas from a humanitarian idea. There is no doubt that this change is real, is definitely accelerating and the new technological fields in nursing within the country of Australia are defining it to be a more thorough and considerate approach to patients needs more so than in any years past (Lea 1994, pg. 308). Australia’s health care has had no choice but to change in order to meet the more diverse needs of its multicultural citizens throughout the country. The reasons for this are many and not wholly focused on ethnicity but also on, “the nursing care environment, increased patient acuity, advanced technology, aging population, decreased resources, and the existing shortage of professional nurses” (Lea 1994, pg. 309). In today’s era Levine (1997) has described nursing as “a human interaction.” It has been defined as such for a number of decades but it is far more intense than it was found to be from the past. Levin (1997) has also described it as being, “a subculture possessing ideas and values which are unique to nurses, even though they mirror the social template which created them.” Ultimately what this means is that nurses are aware of how crucial their role has become to the well-being of the patient and they also realize that in order to build a strong, sound, and positive interpersonal caring relationship they have to focus their abilities on the patients individual needs and work from there, building upon the knowledge that they have already gained through study of theories, nursing paradigms, and personal experiences as well. Nursing has definitely moved from just the paradigms and metaparadigms to more precise and personal ways of “observing, monitoring, analyzing, translating, conceptualizing, synthesizing and decision making processes” in the profession (Kanitsaki 1988, pg. 5). There are three main paradigms that have transformed more so than any other concepts and these are the mechanical paradigm, holistic paradigm, and the ecological paradigm. As has been mentioned the reasons for these transformations are obvious as the human body has come to be viewed as more than a mechanical form that encases a human life, it has definitely become more spiritual in origin which has lead to more of a spiritual identity in the field of nursing that although has existed for decades has become even more profound today. As Taylor (1995) clearly defines, nursing carries a wide berth and it takes a strong level of understanding to realize the importance that one single nurse can pose in the health care of a patient. Taylor (1995) also points out that it is the nursing/patient relationship that develops into a well structure form of knowledge through the various experiences that nurse’s gain. Human interactions are some of the most transforming learning experiences in this field and therefore again, the focus has switched from going by the books and the technical aspects to more up close and personal ways of learning. The pressures and demands of nurses might still be eminent but they have dissipitated considerably now that new ways of gaining knowledge and skill have emerged on a more leisurely type of basis. As Cameron-Traub (1995, pg. 2) does give comprehensive thought to, though nursing is not a leisure activity, the way in which the activities have transformed with regard to caring for patients have indeed developed into an environment where nurses are not as tense and stressed to the point of burn out as they once were which has resulted in far more improved working conditions in clinical nursing. A good example that shows a clear shift in clinical nursing due to the changing ideas and paradigms is Martha Rogers ‘Rogerian Nursing Theory’ (Flege 1996, pg. 5). Rogers has always used a heavy spiritual and humanitarian approach in her ideas about nursing and patient care. This theory really focuses on the reality of nursing and leaves nothing out which benefits nurses immensely in their daily routines. Many other theorists have even stated that the Rogerian theory has helped nurses make many important decisions that have lead to wonderful patient outcomes. There have been times where nurses have been stuck with specific decisions and this theory has guided them out of what many have defined as, “a concrete, static, closed system world” (Flege 1996, pg. 5). The new ideas that have clearly emerged are debated at conferences all over North America in order to bring a fresh and more encouraging way of working in the clinical nursing field which helps both nurses and those needing medical care as well. Conclusion There is little doubt that clinical nursing has undergone significant changes since its early colonial origins over the period of time when caring for the sick was considered to be a task suitable for only maidens, widows, or religious missionaries. Since the early beginning, nursing has progressed gradually through what can be considered a social, educational, technological, political, and professional revolution. Modern nursing represents this progression, and as a result, the role of the clinical nurse has expanded considerably from what was once traditionally the fulfillment of predominantly domestic duties performed at the instruction of doctors. Despite a gradual evolution in their roles and responsibilities, nurses have for many years been publicly identified by traditional roles, dedication, oppression, and harsh working conditions. Distorted images of nurses have also long been portrayed through public imagination and by the media through the reinforcement of unrealistic fantasies and negative stereotypes. It has been shown that not only one such stereotypes is effective in portraying to the public an unreliable image of nurses but they also function to undermine the diverse complexity of the nurse’s role. As the scope of technological advancement and highly specialized and sophisticated health-care increases, it can be said that the demands of the public as the consumers of the health-care render the traditional image of the nurse as not only outdated but also potentially harmful. As contemporary nurses, clinical nurses, and other professional nurses increasingly recognize their unique skills and valuable contribution to healthcare, they will continue to embrace education and professional strategies in order to improve their public image, and to improve the quality of care that they give to their patients. As a result, it can be said that nursing has at last moved from its traditional position of dependence and oppression to one of greater autonomy and respect. It has moved past the technical phases only and transcended into an area where personal experiences help them make responsible and positive decisions in their field. It has become quite obvious through this research that a nurse in any field of nursing is essentially seen as a person responsible for providing care to the sick but as was previously stated, over the years and with new theorizations and research paradigms, this role has changed significantly as more functions and responsibilities have become a part of nursing. Nurses are now required to provide total care and one of the best definitions in this regard was given by Virginia Henderson who said: “I say that the nurse does for others what they would do for themselves if they had the strength, the will, and the knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible.” (Henderson, 1978). Nursing is therefore all about providing "the help a patient requires for his needs to be met" (Orlando, 1961). These needs may include hygiene care, regular blood pressure readings, administration of treatment prescribed by the physician etc. As the responsibilities and functions of a nurse widen in scope, the definition of nursing will keep evolving. For this reason, the Australian Nurses Association keeps changing the way it defines nursing because the definition offered by ANC is considered most authentic. The current definition of nursing given by ANC (2000) says: "Nursing is the diagnosis and treatment of human responses to actual or potential health problems." In all cases and in all eras, nursing has been and will continue to be associated with care, recovery and health promotion. So while the definition changes, one thing is certain, all definitions will be based on the most essential function of a nurse i.e. to provide care in such a manner that it helps the patient make fast recovery. With changes in patient care, functions and responsibilities of a nurse will continue to widen and for this reason, all definitions of nursing must focus on the evolving nature of this profession. Therefore the most profound definition that can be given for clinical nurses and other nurses in the profession comes from personal experience and can be defined much like the International Nursing Association defines it which is, “a dynamic field of practice which is continually evolving to include more sophisticated patient care activities and the functions of the nurse according to this act include “basic health care, that help people cope with difficulties in daily living that are associated with their actual or potential health or illness problems or the treatment thereof, and that require a substantial amount of scientific knowledge or technical skill (Henderson & Nite 1978). Perhaps it can now be said that the traditional public image and the transformations within the field of clinical nursing and others is finally being eroded and slowly replaced with a more realistic and accurate one that truly reflects the unique and valuable work of nurses in every aspect of the profession. Notes 1. Andrews, M. M., “Cultural Perspectives on Nursing in the 21st Century,” Journal of Professional Nursing 8 (1992): 7-15. 2. Cameron-Traub, E., Clinical, Conceptual, and Empirical Aspects of Nursing Practice, in Scholarship in the Discipline of Nursing (1995): 1-20. 3. Christensen, J. The Ethics of Care: Towards Partnership in Nursing (London: Lincoln University Press, 1990): 10. 4. Fawcett, J, “The Metaparadigm of Nursing: Present Status and Future Refinements,” The Journal of Nursing Scholarship 16 (1984): 84-87. 5. Fawcett, J. The Structure of Contemporary Nursing Knowledge (Philadelphia: FA Davis Company, 1993): 1-33. 6. Flege, P., “Changes of Nursing Paradigms: Martha Rogers Theory,” Journal of Advanced Nursing 9 (1996): 5-11. 7. Harmer, Bertha & Henderson, Virginia. The Principles and Practice of Nursing (New York: McMillian Publishing, 1939): 1-1047. 8. Henderson, V. & Nite, G. Principles and Practice of Nursing. (New York: McMillian Publishing, 1978). 9. Kanitsaki, O., “Transcultural Nursing: Challenge to Change,” The Australian Journal of Advanced Nursing 5 (1988): 4-11. 10. Lea, A., “Nursing in Today’s Multicultural Society: A Transcultural Perspective,” Journal of Advanced Nursing 20 (1994): 307-313. 11. Levin, S., “The Relationship between Research and the Nursing Process in Clinical Practice,” Journal of Advanced Nursing 26 (1997): 1045. 12. Munhall, P. L., “Epistemology in Nursing,” Nursing Research: A Qualitative Perspective (1993) PL Munhall & C Oiler Boyd [eds] pp. 39-65 13. Newman, M. A. & Sime, A. M. & Corcorn-Perry, S. A., “The Focus of the Discipline of Nursing,” Advances in Nursing Science 14 (1991): 1-5. 14. OJIN, “Nursing Around the World,” Journal of Issues in Nursing 5 (2000): 2. 15. Orlando, I. J. The Dynamic Nurse-Patient Relationship. (New York: Putnam Press, 1961). 16. Polit, D. F. & Hungler, B. P., “Multiple Paradigms for Nursing: Post Modern Feminisms,” Journal of Research in Nursing 11 (2006): 183. 17. Sorrell, Sliva & Sorrell, C, “From Carper’s Patterns of Knowing to Ways of Being: An Ontological Philosophical Shift in Nursing,” Advances in Nursing Science 18 (1995): 1-13. 18. Taylor, B. J., Understanding the Nature and Effects of Nursing, in Being Human: Ordinariness in Nursing, ( 1995 Churchill, Livingston, Melbourne): 39- 63. Read More