Literature Review: Meta- paradigms in Nursing
Description of alignment of personal theory with worldview
Analysis of personal utilization of nurses' ways of knowing
Literature Review: Meta-paradigms in nursing
Introduction
This literature review embraces the metaparadigm nursing theoretical perspective and how it relates to ways of knowing in the profession. A critical review aligning personal conceptualizations with a world view interpretation will be explored. Also, an explanation of my personal ideological premise regarding the efficacy of this theoretical perspective to contemporary nursing practice will be analyzed.
The theoretical premise of this literature review hinges on the assumption that meta-paradigm is an inclusive perspective of a profession, a way to describe the theories that concern its practice. As it relates to nursing practice four concepts emerge in accounting for the function of metaparadigm in professional intervention. They are person, health; environment and nursing.
As it relates to health research, which is another branch of nursing intervention informing evidence based practice metaparadigm according to Clarke and Klegg(2000) encompass a “network of coherent ideas” (Clarke & Klegg, 2000), which classify researchers according to the body of knowledge they employ and methods used to inform evidence-based practices.
Similarly, as metaparadigm in nursing practice there are four distinct categories, which are epidemiological, sociological, political-economic and Human rights-based (Clarke & Klegg, 2000). This literature review analysis and synthesis will encourage an eclectic approach towards articulating metaparadigm in both nursing practice and research.
Description of alignment of personal theory with worldview
The fundamental assumptions advanced in the metaparadigm theory of nursing practice pertain towards person, health, environment and nursing. Specifically related to person is the perception that person is a biological entity that has the ability to interact among human elements. As it pertains to nursing meta-paradigm, person is the patient and core element of this discipline.
Environment is conceived as a direct or indirect healing influence mechanism in the nursing process. Health pertains to social, physical, mental well-being and not just the absence of disease (WHO, 2012). Nursing is the science of caring as well as adding to the body of knowledge through scientific research providing evidence based interventions.
In aligning the unitary/transformative paradigms to nursing metaparadigm encircling person, environment, health and nursing process in itself, Newman (2008) posited a classical assumption. This indicated that nursing intervention involves a nurse patient relationship. When this relationship is formed unification occurs, initially. While continuing that process within a nursing care environment the aim is to promote health. Newman (2008) concludes that this interaction is transformative behavior. The patient is transformed and the nurse too (Newman, et.al, 2008).
Unitary/transformative paradigm aligns with the metaparadigm approach to nursing care by linking the patient with a nursing process. The environment could be interpreted as the forces which foster transformation. Precisely, this is the environment and health the focus of all nursing outcomes. Newman (2008) continues to contend that unitary/transformative paradigms ought to be aligned with personal metaparadigms in extending towards a global approach in nursing care intervention (Newman et.al, 2008).
A notable difference between personal metaparadigms and a world view approach of care and intervention is that the personal tends to view the process and profession form a micro level. Thereby specific aspects of a wider caring environment are omitted. These involve how the community responds to caring as against the patient client. The community being a conglomerate of persons. Rather still the community could be interpreted to mean a physical environment away from a hospital nursing home or even the client’s dwellings.
Evidence of critical analysis using literature
Charles Emakpor and Maj–Helen Nyback (2010) applied the notion of caring to the nursing aspect of the metaparadigm to show where caring is science as nursing is a too. They advance that from a world view perspective that love is the unifying force that makes caring within the nursing frame work effective. They contend that without this element no transformative power is available for health to be produced (Emakpor & Nyback, 2010).
In this context the authors have bridged the gap between a personal metaparadigm and the world view concept of caring as nursing.
The writers advocate quoting Steiner (1978) and Erikisson (2001) that love in the world is synonymous to sun light on the earth because it gives beauty, satisfaction and joy to nursing practice. Lack of love they believe impinges on lack of care in the nursing process. Many patients suffer and die, they contend, due to lack of love in caring. Therefore, the nursing concept embodying this metaparadigm embraces subsets such as caring and love (Emakpor & Nyback, 2010).
An assistant professor of clinical nursing, Dr. Terry Jones (2010) conducted studies applying a sociological paradigm in health research model to show where a holistic framework for nursing time is essential at this point in nursing history. This researcher posits ‘that nursing time has relevance for those who produce it those who receive it and those who must pay for it
(Jones, 2010). Further assumptions point towards ‘a holistic approach incorporating the physical, psychological, and sociological aspects and dimensions of nursing’ (Jones, 2010) as being beneficial in executing the nursing metaparadigms embodying person, environment, health and nursing.
The researcher identified time as being crucial to nursing process; patient intervention, health, and patient environment perception, Conclusions derived from this study reveal that by employing many strategies outcomes can be enhanced for the patient. Importantly, the patient experience of nursing time within nursing process articulation is very significant to restoration of health. Major obstacles to adequate time application were cited as competing time structures whereby serious violations of nurse/patient ratios exist to the detriment of patients’ health (Jones, 2010).
Jacqueline Fawcett (2007) attempts an analysis of metaparadigms in nursing to say that confirm that major concepts and themes of the nursing discipline are identified and formalized as nursing's metaparadigm. Persistent applications of these metaparadigms provide direction for formulating new theories to establish evidence based planning and intervention. The researcher recommended combining metaparadigms with paradigms in health research in initiating refinements by designing conceptual models and programs of nursing research. This ultimately adds to the body of nursing knowledge for improvement in execution of nursing process; unifying patient/nurse relationships and transformation of health benefits (Fawcett, 2010).
David Glennister (2012) conducted a literature review investigating systems theoretical approaches to metaparadigm application to nursing practice. He concluded that the potential exists for developing a general systems theory of nursing practice. His premise for this assumption lay in the fact that nursing at the moment does not function by thinking systems even though theoretically it is known. He envisions that this transformation could positively impact nursing administration, healthcare administration, and global healthcare by positioning the profession’s practices in its policy and political environment (Glennister, 2012).
Schim (2007) and his counterparts conducted studies reconstructing the ideology of metaparadigms in nursing to embrace a community health dimension. The researchers argue that while person, environment, health and nursing are the concepts espoused they needed to be adjusted to accommodate the notion of social justice within health care systems existing around the world. They cited countries where health care was available, but not accessible referencing United States of America which has the most health care system in the world (Schim, 2007).
Analysis of personal utilization of nurses' ways of knowing
In establishing applications determining how a nurse functions regarding ways of knowing from emancipatory, empirical, personal, ethical, and aesthetic Michael Ladouceur and
Louela Manankil-Rankin (2009) from MacMaster University School of Nursing offered insights on the subject. They proposed criteria using three levels through which the process is executed.
At the emancipatory level 1 the nurse makes all the decisions pertaining to nursing care. In level 11 there is a joint decision between nurse and patient and at level 111 the patient makes decisions in consultation with the nurse. With empiric first level the nurse applies little or no empirical evidence to the nursing intervention. At the second level anecdotal evidence is applied. In level 111thhe nurse applied evidence based research finding to the nursing process
(Ladouceur & Manankil-Rankin, 2009).
Personal ways of knowing in level 1 implies that the nurse demonstrates limited self-awareness; level 11 a holistic approach is adapted with authenticity; level 111the nurse manifests full awareness for transformation to occur. From an ethical standpoint the nurse makes arbitrary decisions when functioning at the first level. At the second level the nurse refers to rules for taking action and decision making. Thirdly, a matured professional nurse develops a framework of principles to guide decision making (Ladouceur & Manankil-Rankin, 2009).
In demonstrating the highest level thinking capacity the nurse expresses a deep appreciation for meanings of situations and utilized initiative in transforming environmental influences. A second level application reveals that the can has the ability to identify and develop
a creative internal will. At level 1 there is limited understanding of situations and difficulty in making judgments (Ladouceur & Manankil-Rankin, 2009).
When an analysis of these ways of know are applied to the metaparadigm theoretical perspective it is clear that nurse have to always function at the highest level for outcomes to be achieved. The level 1 thinking abilities must be supervised by a senior staff and tasks. Allocations ought to be closely monitored for accuracy of delivery. The person’s environment, health and nursing outcome is compromised when level 1 thinking pervades clinical settings (Ladouceur & Manankil-Rankin, 2009).
Conclusion
Metaparadigm theories of person, environment, health and nursing were explored in this discussion. It is my conceptual framework that since the client/consumer/ person in nursing business government ought to make healthcare easily accessible and just available. Emakpor and Nyback (2010) uncovered the value of love in caring. This confirms numerous studies where especially, the elderly in long term care facilities die due to the lack of touch through a loving embrace (Emakpor & Nyback, 2010).
It is important that application of theories be undertaken and not just written and taught in classroom settings. Usually, the clinical areas are our real textbooks and the patient/person, environment and health determine how effective is nursing care and as well health care system generally in a country.
David Glennister (2012) advocates transforming metaparadigms theories to accommodate more research adaptability. The truth is that more research would not improve healthcare if social justice does not exist within health care administration. The patient/ person access to quality nursing care should not be dictated by the type of health insurance coverage he/she has, but rather from the paradigm of love and social justice. The person pays taxes to the state or country in which he/she resides (Glennister, 2012) (Schim, 2007) (Emakpor & Nyback, 2010).
Emakpor, C., & Nyback, M. (2010). Love, A relevant Concept in Nursing and Caring. Finland.
Nova Publications and Production
Fawcett, J. (2010). The Metaparadigm of Nursing: Present Status and Future Refinements.
Journal of Nursing Scholarship.16 (3), 77–87
Ladouceur, M., & Manankil-Rankin, L. (2009). A comprehensive literature review of how the
ways of knowing have been used elsewhere in classroom settings with postsecondary
students across applied disciplines. McMaster University. School of Nursing
Glennister, D. (2012). Towards a general systems theory of nursing: A Literature Review. Hull,
UK. University of Hull.
Newman MA, Smith MC, Pharris MD., & Jones D (2008). The focus of the discipline revisited.
ANS Adv Nurs Sci, 31(1), E16-27.
Jones, T. (2010). A Holistic Framework for Nursing Time: Implications for Theory, Practice, and
Research. Nurs Forum. 45(3): 185–196.
Schim, M. Benkert, R. Bell, E. Walker, S., & Danford, A. (2007). Social justice: added
metaparadigm concept for urban health nursing. Public Health Nurs. 24(1),73-80.
World Health Organization (2012). Definition of health. Geneva Convention
