What is the Nursing Metaparadigm?

The Four Nursing Metaparadigm Concepts

The Four Nursing Metaparadigm Concepts

Metaparadigms. Theoretical frameworks. Conceptual models. Assumptions. Propositions. Concepts. These are all terms that every nursing student needs to understand and apply for nursing theory class. This post will explain what a metaparadigm is, which phenomena define the four nursing metaparadigms, and provide examples of the metaparadigm concepts from selected nursing theorists. 

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Definition of Metaparadigm

Metaparadigm is defined as:  “a set of concepts and propositions that sets forth the phenomena with which a discipline is concerned. A metaparadigm is the most general statement of a discipline and functions as a framework in which the more restricted structures of conceptual models develop” (Miller-Keane Dictionary, 2003). Another definition is “The concepts that identify the phenomena of central interest to a discipline; the propositions that describe those concepts and their relationships to each other” (Farlex Dictionary, 2009). It’s a global perspective of the discipline. 

The nursing knowledge continuum starts with metaparadigms as the most abstract to practice or situation-specific theory as the most practical and concrete form of nursing knowledge. To remind you of the nursing knowledge continuum, I’ll repost the diagram I designed for the post on theoretical frameworks and conceptual models here. 

The Nursing Knowledge Continuum from Metaparadigm (the most abstract) to Practice Theory (the most concrete)

When we talk about the metaparadigm of nursing, we are talking about the areas that are the most general basis of nursing practice, the elements of nursing.

For a theory to be considered a nursing theory, the four metaparadigm concepts must be addressed. 

The Four Nursing Metaparadigm Concepts

The four phenomena of central interest that define nursing practice (or the key foci of patient care) are identified as nursing, person, health, and environment. These four phenomena or concepts make up the overall metaparadigm of nursing.

Note that the phenomena of Person, Health, and Environment all relate to the recipient(s) of nursing care or nursing actions. The phenomenon of Nursing is only focused on the nurse.

Phenomenon of Nursing: this nursing metaparadigm concept is related to the art and science of nursing; it consists of nursing actions or nursing interventions. Think of this concept as what nurses DO. This concept includes the nurse applying professional knowledge, procedural and technical skills, and indirect and direct (hands-on) patient care.

Phenomenon of Person: nurses provide nursing care to Persons. The Person is the one receiving the nursing care. But importantly, Person is defined according to the recipient of nursing care (the patient or client) and may include the patient’s family and friends and the community. The nurse needs to consider how the patient defines family when planning care. 

Phenomenon of Health: the concept of health is relative to the person and is defined according to the patient’s perspective. What one person considers healthy, may be considered unhealthy to another person. What one person considers an acceptable quality of life, may be considered an unacceptable quality of life to another person. It refers to the patient’s level of wellness (i.e., the health/wellness-illness continuum) in all its many aspects: physical, psychological, mental, intellectual, emotional, and spiritual. The ability to access healthcare and resources to support health and wellness is included. 

Phenomenon of Environment: While we typically think of the environment as something external to us – a setting or place – a person’s environment is also internal. The environment consists of internal, external, and social factors that impact a patient’s health (including genetics, immune function, culture, interpersonal relationships, economics, mental state, geographic location, education level, politics, ecology, social status, job or career level, etc.)

Examples of the Four Metaparadigms According to Nursing Theorists

Each nursing theorist defines the metaparadigm concepts according to their worldview. Because each theorist has a different perception of the role of nursing and the definitions of person, health, and environment, their definitions of the metaparadigm concepts are also different. 

Notice the different language used by these selected nursing theorists to describe the metaparadigm concepts. 

Person metaparadigm concept (definitions from Masters, 2015): 

  • Florence Nightingale: Recipient of nursing care (p. 28).
  • Virginia Henderson: Recipient of nursing care who is composed of biological, psychological, sociological, and spiritual components (p. 37).
  • Jean Watson: A “unity of mind-body-spirit/nature”; embodied spirit (Watson cited in Masters, 2015, p. 53).
  • Dorothy Johnson: A biopsychosocial being who is a behavioral system with seven subsystems of behavior (p. 81).
  • Imogene King: A personal system that interacts with interpersonal and social systems (p. 92).
  • Martha Rogers: An irreducible, irreversible, pandimensional, negentropic energy field identified by pattern; the unitary human being (p. 105).
  • Dorothea Orem: A person under the care of a nurse; a total being with universal, developmental, and health deviation needs, who is capable of self-care (p. 157).
  • Hildegard Peplau: Encompasses the patient (one who has problems for which expert nursing services are needed or sought) and the nurse (a professional with particular expertise) (p. 171).
  • Madeleine Leininger: Human being, family, group, community, or institution (p. 182).
  • Nola Pender: The individual, who is the primary focus of the model (p. 216).
  • Rosemary Parse: An open being, more than and different from the sum of parts, in mutual simultaneous interchange with the environment, who chooses from options and bears responsibility for choices (p. 228).

Health metaparadigm concept (definitions from Masters, 2015): 

  • Florence Nightingale: “Not only to be well, but to be able to use well every power we have to use” (Nightingale cited in Masters, 2015, p. 28).
  • Virginia Henderson: Based on the patient’s ability to function independently (as outlined in 14 components of basic nursing care) (p. 37).
  • Jean Watson: (Healing) Harmony, wholeness, and comfort (p. 53).
  • Dorothy Johnson: Efficient and effective functioning of system; behavioral system balance and stability (p. 81).
  • Imogene King: “Dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living” (King cited in Masters, 2015, p. 92).
  • Martha Rogers: Health and illness are a part of a continuum (p. 105).
  • Dorothea Orem: “A state characterized by soundness or wholeness of developed human structures and of bodily and mental functioning” (Orem cited in Masters, 2015, p. 157).
  • Hildegard Peplau: “Implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living” (Peplau cited in Masters, 2015, p. 171).
  • Madeleine Leininger: A state of well-being that is culturally defined, valued, and practiced (p. 182).
  • Nola Pender: A positive high-level state (p. 216).
  • Rosemary Parse: Continuously changing process of becoming (p. 228).

Environment metaparadigm concept (definitions from Masters, 2015): 

  • Florence Nightingale: External (temperature, bedding, ventilation) and internal (food, water, and medications) (p. 28).
  • Virginia Henderson: External environment (biologic, physical, and behavioral); some discussion of the impact of community on the individual and family (p. 37).
  • Jean Watson: (Healing space and environment) A nonphysical energetic environment; a vibrational field integral with the person where the nurse is not only in the environment but “the nurse IS the environment” (Watson cited in Masters, 2015, p. 53).
  • Dorothy Johnson: Includes both the internal and external environments (p. 81).
  • Imogene King: Can be both external and internal. The external environment is the context “within which human beings grow, develop and perform daily activities”; the internal environment of human beings transforms energy to enable them to adjust to continuous external environmental changes  (King cited in Masters, 2015, p. 92).
  • Martha Rogers: An irreducible, pandimensional, negentropic energy field identified by pattern, manifesting characteristics different from those of the parts, and encompassing all that is other than any given human field (p. 105).
  • Dorothea Orem: Physical, chemical, biologic, and social contexts within which human beings exist. Environmental components include environmental factors, environmental elements, environmental conditions, and the developmental environment (p. 157).
  • Hildegard Peplau: Forces outside the organism within the context of culture (p. 171).
  • Madeleine Leininger: (Environmental context) Totality of an event, situation, or experience that gives meaning to human expressions, interpretations, and social interactions in physical, ecological, sociopolitical, and/or cultural settings (p. 182).
  • Nola Pender: The physical, interpersonal, and economic circumstances in which persons live (p. 216).
  • Rosemary Parse: Coexists in mutual process with the person (p. 228).

Nursing metaparadigm concept (definitions from Masters, 2015): 

  • Florence Nightingale: To alter or manage the environment to implement the natural laws of health (p. 28).
  • Virginia Henderson: Assist the person sick or well, in performance of activities (14 components of basic nursing care) and help the person gain independence as rapidly as possible (p. 37).
  • Jean Watson: Reciprocal transpersonal relationship in caring moments guided by carative factors and caritas processes (p. 53).
  • Dorothy Johnson: An external regulatory force that acts to preserve the organization and integrity of the patient’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found (p. 81).
  • Imogene King: A process of human interaction with the goal of helping patients achieve their goals (p. 92).
  • Martha Rogers: Seeks to promote symphonic interaction between human and environmental fields, to strengthen the integrity of the human field, and to direct and redirect patterning of the human and environmental fields for realization of maximum health potential (p. 105).
  • Dorothea Orem: Therapeutic self-care designed to supplement self-care requisites. Nursing actions fall into one of three categories: wholly compensatory, partly compensatory, or supportive-educative system (p. 157).
  • Hildegard Peplau: The therapeutic, interpersonal process between the nurse and the patient (p. 171).
  • Madeleine Leininger: Activities directed toward assisting, supporting, or enabling with needs in ways that are congruent with the cultural values, beliefs, and lifeways of the recipient of care (p. 182).
  • Nola Pender: The role of the nurse includes raising consciousness related to health-promoting behaviors, promoting self-efficacy, enhancing the benefits of change, contolling the environment to support behavior change, and managing barriers to change (p. 216).
  • Rosemary Parse: A learned discipline; the nurse uses true presence to facilitate the becoming of the participant (p. 228).

You can see from the definitions that all of these nursing theorists have a different picture of the world and central work of nursing. That’s kind of cool, no?

I hope this post has helped you see the metaparadigm concepts more clearly and that you begin to see how the nursing metaparadigm concepts influence nursing practice!

Don’t forget to download this concept guide to help you in your theory classes! Click Here for Your Free Nursing Theory and Philosophy: Terms & Concepts Guide!

How to Cite this Blogpost in APA*: 

Thompson, C. J. (2017, October 3). What is the nursing metaparadigm? [Blogpost]. Retrieved from https://nursingeducationexpert.com/metaparadigm/  

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References

Masters, K. (2015). Nursing theories: A framework for professional practice (2nd ed.). Burlington, MA: Jones & Bartlett Learning. 

Metaparadigm. (2003). Miller-Keane encyclopedia and dictionary of medicine, nursing, and allied health (7th ed.). Retrieved from http://medical-dictionary.thefreedictionary.com/metaparadigm

Metaparadigm. (2009). Medical dictionary. Retrieved from http://medical-dictionary.thefreedictionary.com/metaparadigm