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Aesthetic Exercise and the metaparadigm of nursing


Case Study, Chapter 2: Overview of Theory in Nursing Aesthetic Exercise
After students have an opportunity to read about and discuss the ways of knowing (pp. 12–13) and nursing’s metaparadigm (p. 41), they will be able to access a different way of knowing (and learning) with this activity. To do so, they will need to create an artistic product to interpret nursing’s metaparadigm.
Please create an artistic expression (the aesthetic aspect of knowing) of one of the following:


Directions: Create something that demonstrates how you interpret or conceptualize nursing’s metaparadigm or domain. Create something demonstrating what you would add to nursing’s metaparadigm.


Please, use your imagination (this is actually difficult for some nursing students who are used to being very concrete). The artistic expression may be a poem, a drawing, a three-dimensional representation (maybe they know how to fold paper!), a song, videos, or even a bit of prose.


Post your artistic expression, and write a one paragraph explanation of the artistic expression


Nursing’s Metaparadigm
The most abstract and general component of the structural hierarchy of nursing knowledge is what Kuhn (1977) called the metaparadigm. A metaparadigm refers “globally to the subject matter of greatest interest to member of a discipline” (Powers & Knapp, 2011, p. 107). The metaparadigm includes major philosophical orientations or worldviews of a discipline, the conceptual models and theories that guide research and other scholarly activities, and the empirical indicators that operationalize theoretical concepts (Fawcett &Malinski, 1996). The purpose or function of the metaparadigm is to summarize the intellectual and social missions of the discipline and place boundaries on the subject matter of that discipline (Kim, 1989). Fawcett and DeSanto-Madeya (2013) identified four requirements for a metaparadigm. These are summarized inBox 2-1.
Box 2-1: Requirements for a Metaparadigm

  • A metaparadigm must identify a domain that is distinctive from the domains of other disciplines … the concepts and propositions represent a unique perspective for inquiry and practice.
  • A metaparadigm must encompass all phenomena of interest to the discipline in a parsimonious manner … the concepts and propositions are global and there are no redundancies.
  • A metaparadigm must be perspective-neutral … the concepts and propositions do not represent a specific perspective (i.e., a specific paradigm or conceptual model or combination of perspectives).
  • A metaparadigm must be global in scope and substance … the concepts and propositions do not reflect particular national, cultural, or ethnic beliefs and values.

Adapted from: Fawcett &DeSanto-Madeya, 2013
According to Fawcett and DeSanto-Madeya (2013), in the 1970s and early 1980s, a number of nursing scholars identified a growing consensus that the dominant phenomena within the science of nursing revolved around the concepts of man (person), health, environment, and nursing. Fawcett first wrote on the central concepts of nursing in 1978 and formalized them as the metaparadigm of nursing in 1984. This articulation of four metaparadigm concepts (person, health, environment, and nursing) served as an organizing framework around which conceptual development proceeded.
Wagner (1986) examined the nursing metaparadigm in depth. Her sample of 160 doctorally prepared chairpersons, deans, or directors of programs for bachelor’s of science in nursing revealed that between 94% and 98% of the respondents agreed that the concepts that comprise the nursing metaparadigm are person, health, nursing, and environment. She concluded that these findings indicated a consensus within the discipline of nursing that these are the dominant phenomena within the science. A summary of definitions for each term is presented here.
Person refers to a being composed of physical, intellectual, biochemical, and psychosocial needs; a human energy field; a holistic being in the world; an open system; an integrated whole; an adaptive system; and a being who is greater than the sum of his or her parts (Wagner, 1986). Nursing theories are often most distinguishable from each other by the various ways in which they conceptualize the person or recipient of nursing care. Most nursing models organize data about the individual person as a focus of the nurse’s attention, although some nursing theorists have expanded to include family or community as the focus (Thorne et al., 1998).
 Health is the ability to function independently; successful adaptation to life’s stressors; achievement of one’s full life potential; and unity of mind, body, and soul (Wagner, 1986). Health has been a phenomenon of central interest to nursing since its inception. Nursing literature indicates great diversity in the explication of health and quality of life (Thorne et al., 1998). Indeed, in a recent work, following a critical appraisal of the works of several nurse-theorists, Plummer and Molzahn (2012) suggested replacing the term “health” with “quality of life.” They posited that quality of life is a more inclusive notion, as health is often understood in terms of physical status. Alternatively, quality of life better encompasses a holistic perspective, involving physical, psychological, and social well-being, as well as the spiritual and environmental aspects of the human experience.

 Enviornment typically refers to the external elements that affect the person; internal and external conditions that influence the organism; significant others with whom the person interacts; and an open system with boundaries that permit the exchange of matter, energy, and information with human beings (Wagner, 1986). Many nursing theories have a narrow conceptualization of the environment as the immediate surroundings or circumstances of the individual. This view limits understanding by making the environment rigid, static, and natural. A multilayered view of the environment encourages understanding of an individual’s perspective and immediate context and incorporates the sociopolitical and economic structures and underlying ideologies that influence reality (Thorne et al., 1998).
Nursing is a science, an art, and a practice discipline and involves caring. Goals of nursing include care of the well, care of the sick, assisting with self-care activities, helping individuals attain their human potential, and discovering and using nature’s laws of health. The purposes of nursing care include placing the client in the best condition for nature to restore health, promoting the adaptation of the individual, facilitating the development of an interaction between the nurse and the client in which jointly set goals are met, and promoting harmony between the individual and the environment (Wagner, 1986). Furthermore, nursing practice facilitates, supports, and assists individuals, families, communities, and societies to enhance, maintain, and recover health and to reduce and ameliorate the effects of illness (Thorne et al., 1998).

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In addition to these definitions, many grand nursing theorists, and virtually all of the theoretical commentators, incorporate these four terms into their conceptual or theoretical frameworks. Table 2-5presents theoretical definitions of the metaparadigm concepts from selected nursing conceptual frameworks and other writings.
Table 2-5: Selected Theoretical Definitions of the Concepts of Nursing’s Metaparadigm

Metaparadigm Concept Author/Source of Definition Definition
Person/human being/client D. Johnson A behavioral system with patterned, repetitive, and purposeful ways of behaving that link person to the environment.
  B. Neuman A dynamic composite of the interrelationships between physiologic, psychological, sociocultural, developmental, spiritual, and basic structure variables. May be an individual, group, community, or social system.
  D. Orem Are distinguished from other living things by their capacity (1) to reflect upon themselves and their environment, (2) to symbolize what they experience, and (3) to use symbolic creations (ideas, words) in thinking, in communicating, and in guiding efforts to do and to make things that are beneficial for themselves or others.
  M. Rogers An irreducible, indivisible, pan-dimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and that cannot be predicted from knowledge of the parts.
Nursing M. Leininger A learned humanistic and scientific profession and discipline that is focused on human care phenomena and activities to assist, support, facilitate, or enable individuals or groups to maintain or regain their well-being (or health) in culturally meaningful and beneficial ways, or to help people face handicaps or death.
  M. Newman Caring in the human health experience.
  D. Orem A specific type of human service required whenever the maintenance of continuous self-care requires the use of special techniques and the application of scientific knowledge in providing care or in designing it.
  J. Watson A human science of persons and human health–illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human care transactions.
Health M. Leininger A state of well-being that is culturally defined, valued, and practiced, and that reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways.
  M. Newman A pattern of evolving, expanding consciousness regardless of the form or direction it takes.
  C. Roy A state and process of being and becoming an integrated and whole person. It is a reflection of adaptation, that is, the interaction of the person and the environment.
  J. Watson Unity and harmony within the mind, body, and soul. Health is also associated with the degree of congruence between the self as perceived and the self as experienced.
Environment M. Leininger The totality of an event, situation, or particular experience that gives meaning to human expressions, interpretations, and social interactions in particular physical, ecologic, sociopolitical, and cultural settings.
  B. Neuman All internal and external factors of influences that surround the client or client system.
  M. Rogers An irreducible, pan-dimensional energy field identified by pattern and integral with the human field.
  C. Roy All conditions, circumstances, and influences that surround and affect the development and behavior of human adaptive systems with particular consideration of person and earth resources.
Sources: Johnson (1980); Leininger (1991); Neuman (1995); Newman (1990); Orem (2001); Rogers (1990); Roy & Andrews (1999); Watson (1985).

(McEwen 41-42)

McEwen, Melanie. Theoretical Basis for Nursing, 4th Edition. Wolters Kluwer Health, 01/2014. VitalBook file.


Relationships Among the Metaparadigm Concepts
The concepts of nursing’s metaparadigm have been linked in four propositions identified in the writings of Donaldson and Crowley (1978) and Gortner (1980). These are as follows:

  • Person and health: Nursing is concerned with the principles and laws that govern human processes of living and dying.
  • Person and environment: Nursing is concerned with the patterning of human health experiences within the context of the environment.
  • Health and nursing: Nursing is concerned with the nursing actions or processes that are beneficial to human beings.
  • Person, environment, and health: Nursing is concerned with the human processes of living and dying, recognizing that human beings are in a continuous relationship with their environments (Fawcett &DeSanto-Madeya, 2013, p. 6).

In addressing how the four concepts meet the requirements for a metaparadigm, Fawcett and DeSanto-Madeya (2013) explain that the first three propositions represent recurrent themes identified in the writings of Nightingale and other nursing scholars. Furthermore, the four concepts and propositions identify the unique focus of the discipline of nursing and encompass all relevant phenomena in a parsimonious manner. Finally, the concepts and propositions are perspective-neutral because they do not reflect a specific paradigm or conceptual model and they do not reflect the beliefs and values of any one country or culture.
Other Viewpoints on Nursing’s Metaparadigm
There is some dissension in the acceptance of person/health/environment/nursing as nursing’s metaparadigm. Kim (1987, 1989, 2010) identified four domains (client, client–nurse, practice, and environment) as an organizing framework or typology of nursing. In this framework, the most significant difference appears to be in placing health issues (i.e., health care experiences and health care environment) within the client domain and differentiating the nursing practice domain from the client–nurse domain. The latter focuses specifically on interactions between the nurse and the client.
Meleis (2012) maintained that nursing encompasses seven central concepts: interaction, nursing client, transitions, nursing process, environment, nursing therapeutics, and health. Addition of the concepts of interaction, transitions, and nursing process denotes the greatest difference between this framework and the more commonly described person/health/environment/nursing framework.  for another thought on expanding the metaparadigm to include social justice.)

Link to Practice 2-1: Should Social Justice Be Part of Nursing’s Metaparadigm?

Schim, Benkert, Bell, Walker, and Danford (2006) proposed that the construct of “ social justice” be added to nursing’s metaparadigm. They argued that social justice is interconnected with the four acknowledged metaparadigm concepts of nursing, person, health, and environment. In their model, social justice actually acts as the central, organizational foundation that links the other four concepts, particularly within the context of public health nursing, and more specifically in urban settings.
Using this macroperspecitve, the goal of nursing is to ensure adequate distribution of resources to benefit those who are marginalized. Suggested strategies to enhance attention to social justice in nursing include shifting to a population health and health promotion/disease prevention perspective; diversifying nursing by recruiting and educating underrepresented minorities into the profession; and engaging in political action at local, state, national and international levels. They concluded that as a caring profession, nursing should expand efforts with a social justice orientation to help ensure equal access to benefits and protections of society for all.

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