In the world of nursing, it is commonplace to hear the question, “Why did you chose nursing?”. For many, there is a short and informal answer that intends to emulate the belief systems, values, and personal experiences of that individual’s life that has led them to the career of nursing. Yet, regardless of the answer to this question, the back story of how they got to that answer is complex and becomes more complex as one becomes more advanced through the median of time, and further bolstered through theoretical frameworks.
As such, I have contemplated the complexities of the profession and have put my own spin on why I have become a nurse. Concept such as caring, compassion, justice, and beneficence resonate strongly in the root of this definition, and from there knowledge acquisition and theoretical understanding have evolved the definition since my career commenced. The purpose of this paper is to more closely examine the intricacies of why I became a nurse while identifying my own definitions of the four components of the metaparadigms of nursing and how they align with my own beliefs and values.
Before I delve into my definition of nursing, I must first define the concepts that affect nursing. These concepts or phenomena are outlined through the work of Jacqueline Fawcett through the metaparadigms. Although discussed by many theorists, Fawcett clearly defines the components as person, health, environment, and nursing. Person is simply described as individuals that are affected by nursing care. Health is the definitions that are set by participants in healthcare and guide the care that is given to achieve such definition. Environment is the surroundings in the internal thought process that affects all aspects of healthcare. And lastly, nursing is the essence is the profession itself (Metaparadigm concepts in nursing, 2015). These are important because each of these must be considered as one constructs their definition of the profession.
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The first aspect of Fawcett’s metaparadigm is the person. As healthcare workers, the acts that we perform affect patient, families, and the community at large. As the first component of the paradigm, this is also the first and foremost reason I became a nurse. This is so because I wanted to help and therefore care for people. In reflection of this concept, Kuiper discusses a patient-centered method in attempt to “navigate complex patient needs” (2015). Her ideas reveal that the interventions that we perform should have the patient at the forefront (Kuiper, 2015). Furthermore, we are seeing the person in its most vulnerable form, so it is important to reflect on how a nurse should interact with the person.
Values such as those set forth by the golden rule in ethics were ones that were implanted into my value system age a young age can help to provide a foundation for that affects these individuals. The golden rule according to Gensler states “do unto others as you would have them do unto you” (2013). I practiced this concept in early life by treating others in a way that I would want to be treated by being kind, showing concern for others, being fair, and helping others when I could. Therefore, it was important for me to choose a career that allowed me to practice these concepts that could provide a meaningful impact on people. This is seen in nursing through caring, compassion, justice, beneficence and many other concepts that are meant to provide the best care possible to patient, families, and the community.
The next of the concepts discussed by Fawcett is health. Aligning with Fawcett, other theorist also given their input on the definition of health. Watson defined health as ‘“unity and harmony within the mind body, and soul” with the degree of congruence between self as perceived and the self as experienced”’ (Alligood, 2018, p. 71). This simply means that everyone regulates their own definition of health, as it relates to physical, mental, and emotional states. It also poses that individuals will perceive a decline or rise in health from their perceived baseline (Alligood, 2018, p. 71).
Due to varying definitions of health, it is crucial that health promotion be implemented such as flu shots and proper hand washing techniques to benefit individuals and the community as a holistic being. These health promotions and my own perception of a health baseline helped create a simplistic definition of health at a young age. Yet, it was not until pursuing my nursing degree that I learned the scientific definitions that describe a healthy individual. After knowing what a healthy individual presented as, I slowly but surely was able to identify traits that made people unhealthy through assessment.
Then as I entered the critical care setting, I saw the vast differences between high acuity patients in the intensive care unit from normal individuals out on the street. It was with this realization in the clinical setting that I was able to differentiate levels of health that differentiate where individuals belong in the hospital, and who is suitable for discharge as they return to the universal baseline.
Yet another piece of the metaparadigms is the environment. Although regularly scene as the world around us Levine theorized that there was much more to the environment. She proposed that “individuals actively participate in his environment” (Alligood, 2018, p.171). This first means that the environment that surrounds us is not just a setting but, and fluid being that individuals must interact with daily. With this acknowledgement and the realization that the patients we care for and the definition of health are fluid, a constant of sorts is needed to balance the fragile ecosystem of healthcare. This normally takes the form of hospitals and clinics. By having a constant, you lessen one of the confounding factors that plagues healthcare, or at least a part of it.
This is in due building standards that remove a patient’s exposure to the elements, available care through a variety of different providers, and hopefully a cleanly environment in which patients have a positive setting to heal. The hospital setting is the first type of environment that I consider in healthcare because I have been to doctors’ offices throughout my life and have seen loved ones become sick and be admitted into the hospital. The direct link between the provision of healthcare and the physical setting of a hospital as an environment of healing was further reinforced as I entered the hospital in my clinical rotation. Yet, in this regard it the hospital environment simply provided a backdrop through which healthcare took place.
Nightingale on the other hand was well known for her work in altering this fluid environment. Through direct observation she was able to see that the environment directly affected people’s health and that by improving the environment she could improve the patient’s health. Aspects such as location, climate, water quality, sewerage removal, building materials, ventilation, and more were observed as components of the external environment that could negatively impact health (Zborowsky, 2014). Now that I am in an active role as a bedside nurse, I can now assess the environment of my patients and be able to alter it in a way that reduces risks such as infection and falls. As such an enormous concept, Florence observed the environment even as a child when she accompanied her mother in providing care to poor families in the community abroad.
By seeing the unfavorable conditions, it allowed her to realize that her definition of environment differed from those less fortunate and therefore set forth to better the environment of the community (Alligood, 2018, p. 55). I too was able to live this realization through a nursing driven mission trip to Nicaragua during my undergraduate as we cared for people in the barrios. Not only was I able to see the poor hospital conditions, but I was also able to work in one of the clinics. This provided an appreciation for the standards that we take for granted in healthcare. This trip also afforded me the opportunity to be assigned to a family, where I was able to assess the family members as patients, but also their dwellings and barrio that surrounded them. We were able to provide cooking supplies, building materials, and water to provide basic needs and fans and bedding to enhance comfort to improve the quality of life for these individuals.
Levine did not stop her definition with the external environment though. She posed that “adaptations represent the accommodation that is possible between the internal and external environment” (Alligood, 2018, p.171). This means that the environment is issues occurring inside the patient and how the patient views the environment can affect their care. The complex nature of the human psyche. The patient is the head of the healthcare team so mental issues should be addressed. Also, the physiological and pathophysiological variations within the individual receiving healthcare. As these internal environmental components are exposed to external environmental components such as perception, conceptual frameworks, and operations that make up their environment, they adapt and become the holistic environment as perceived by the individual (Alligood, 2018, p.171).
As a proof of concept, nurses are also subject to this adaptation between internal and external stimuli. But, due to the responsibilities set forth by the profession, alterations on the nurse’s environment can affect patient care. Copanitsanou et al. used their systematic review on the effects of the work environment, being the hospital in this case, and how it affects nurses and patient outcomes. The summative outcomes were basically that if the nurse had a positive work place environment (external environment) to care for the patients that patient outcomes will be better.
On top of this, if a nurse experienced burn out through fallouts in the structure of the external or mental internal environments, that both patient satisfaction and patient outcomes will be negatively affected in correlation (2017). This facet of the metaparadigm is fascinating because of how closely the environments that are perceived by all individuals in healthcare can change and how they all link in a way that affects each other and more importantly affects the patient’s outcomes.
The last component of the nursing metaparadigm is nursing. Although each facet of the metaparadigm act individually in the healthcare setting, nursing practice is what ties them all together. And it is because of this that the definition of nursing is ever changing as it pertains to the descriptions of the responsibilities of the nursing profession. Even as I pass my second full year of bedside care I have experienced first hand the change of nursing. When looking historically Nightingale believed that all women would perform nursing care in some manner as they would be placed in charge of someone at some point. And in her lifetime, she was able to affect change through the form of empiric or evidence-based practice that lead to the formal training of nurses (Alligood, 2018, p. 54).
We know through modern times that this is not limited to women, but it provided a good foundation for what nursing would become. It was with the advent of Nightingale that nursing began the transformation from a trade to a profession. And with the help of other nursing theorist and activist the profession continues to grow and prosper as an art and a science simultaneously. The science aspects are outlined in formal training and evidence-based practice. The schooling helps to form a solid academic base in which to build on with clinical experience.
This is an aspect is always in motion for me. I loved science in grade school and as I learned about the human body, disease processes, nursing assessment skills, it fascinated me. In my current role I have many opportunities for learning and even went ahead and took my Critical Care Registered Nurse (CCRN) exam to test and validate my knowledge acquisition. Even returning to school has proven to reinforce my love for academia. I also use decision-making processes daily in my career. The form of decision-making in nursing is extremely scientific due to best practices set forth by current research and the American Nurses Association Standards of Practice. Lucille Ferrara used her journal article to discuss this decision-making process stems from current research, previous clinical experience, and instinct as it pertains to forming evidence-based practice. It would be great to be able to make all decisions on proven facts but then the knowledge-base of the profession would be stagnant.
As new clinical scenarios present themselves they can be acted upon to best care for the patient and then those clinical decisions can be evaluated, research, modified, and then be made into standard practice later. This is the essence of the scientific process that continues to morph the profession (Ferrara, 2010). Yet, empiric evidence cannot stand alone. A quality nurse cannot tackle the other phenomena of the metaparadigm with evidence-based practice alone. It takes the art of the profession to be a well-rounded nurse. My favorite definition of nursing comes the theory set forth by Watson. She said that nursing consisted of “knowledge, thought, values, philosophy, commitment, and action, with some degree of passion” (Alligood, 2018, p. 71).
I enjoy this definition because it is everything I wanted in a career and the essence of why I became a nurse. I wanted to gain knowledge through a step-wise approach. I wanted to put thought in my work while resonating with values that I’ve cherish since a young age. I wanted to be able to act on my thought process while using the philosophies that were set forth by nurses before me. And since my initial decision to become a nurse I have had a commitment both on and off the floor to advance myself in the profession with a passion that I had not expected to perceive when I first began. Derek Sellman used this virtue-based care to discuss that there are character traits that make a good nurse. He discusses in depth that nursing can be described as a caring profession. As such justice, courage, honesty, trustworthiness and open-mindedness are underpinnings to what constitutes a good nurse (Sellman, 2011). Combine these virtues with evidence-based practice and that is what I define as the golden standard of what nursing should be.
As I have discussed the nursing metaparadigms of person, health, environment, and nursing, I have attempted to define the reasons why I have become a nurse, my own perspective on the metaparadigm, and how they have affected not only my career choice but how they have affected the growth of my career. It was In Bender’s article that it was proposed that the nursing metaparadigms need to be re-conceptualized due in part to their narrow definition and the dynamic nature of each aspect of the four metaparadigms as they fluidly interact with each other (Bender, 2018).
I have disproved this hypothesis by synthesizing the theoretical concepts of multiple theorist to prove a universality of these concept even though I agree after the research that the metaparadigm needs to be viewed as a dynamic being rather than four isolated components. In summation of my perception of the four metaparadigms I view person as the individuals that are affected by healthcare weather they are patients, families or the entire community that we as nurses care for. Health in my eyes is the definition that each individual constructs to exemplify what they believe is the baseline to their physical and psychosocial being and as one strays from baseline they perceive changes in health.
Environment is the intertwined perception of the external realm that surrounds us as well as the internal components that make us individuals. And nursing is the combination of virtues and evidence-based practices to care for people to improve their health and the environment. I became a nurse to use virtues passed on from my youth, to expand my knowledge and love for academia, and most importantly to provide unparalleled care for to improve the health of the community and individuals that I care for. The next step now is to expand this definition to resonate with why I want to become a nurse practitioner, but I believe I am on the right track.
References
- Alligood, M. R. (2018). Nursing theorists and their work. St. Louis, MO: Elsevier.
- Bender, M. (2018). Re‐conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), 1. https://doi.org/10.1111/nin.12243
- Copanitsanou, P., Fotos, N., & Brokalaki, H. (2017). Effects of work environment on patient and nurse outcomes. British Journal of Nursing, 26(3), 172–176. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=c8h&AN=121207206&site=eds-live&authtype=sso&custid=s8475574
- Ferrara, Lucille R, EdD, MBA,R.N., F.N.P.-B.C. (2010). Integrating evidence-based practice with educational theory in clinical practice for nurse practitioners: Bridging the theory practice gap. Research and Theory for Nursing Practice, 24(4), 213-6. Retrieved from https://search-proquest-com.ezproxy.shu.edu/docview/817175447?accountid=13793
- Gensler, H. J. (2013). Ethics and the golden rule. New York : Routledge, 2013. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=cat00991a&AN=sth.ocn827527639&site=eds-live&authtype=sso&custid=s8475574
- Kuiper, R. (2016). Clinical Reasoning and Care Coordination in Advanced Practice Nursing. New York, NY: Springer Publishing Company. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=e600xww&AN=1233928&site=eds-live&authtype=sso&custid=s8475574
- Metaparadigm concepts in nursing. (2015). Salem Press Encyclopedia of Health. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=ers&AN=109057203&site=eds-live&authtype=sso&custid=s8475574
- Sellman, D. (2011). What Makes a Good Nurse : Why the Virtues Are Important for Nurses. London: Jessica Kingsley Publishers. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=nlebk&AN=388042&site=eds-live&authtype=sso&custid=s8475574
- Zborowsky, T. (2014). The Legacy of Florence Nightingale’s Environmental Theory: Nursing Research Focusing on the Impact of Healthcare Environments. Health Environments Research & Design Journal (HERD) (Vendome Group LLC), 7(4), 19–34. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,sso&db=a9h&AN=100517656&site=eds-live&authtype=sso&custid=s8475574
