Nursing metaparadigms which include nursing, health, person, and the environment
Many nursing theorists claim that caring is the one concept that differentiates it from other healthcare professions. Human caring involves the will, demonstration of values, commitment, and knowledge to provide care to the patient when needed. The concept of caring is deeply incorporated in the nursing metaparadigms that provide the structure of how the nursing discipline should function. These concepts that include the person, health, environment, and nursing point to a holistic view of the care that all nurses should provide to patients. While all nurses provide care based on the four concepts, personal philosophy which includes the values, ethics, and beliefs guides individual nursing care delivery to patients. The focus of this discussion is to demonstrate an understanding of the nursing metaparadigm, how my personal philosophies match the caring concept in nursing, and the application of theoretical nursing work in meeting professional standards.
The nursing metaparadigm specifies the boundaries of the nursing discipline that makes it different from other professions such as medicine, sociology, and psychology. Proposed by Fawcett in 1984, the nursing metaparadigm consists of four concepts including the person, environment, health, and nursing (Alligood, 2018a, p. 41). The person components involve the patient and families, caregivers, and communities that combine to provide care to the patient (Bender & Feldman, 2015). The care structure is observed to consider the person’s spiritual and social needs which are a special connection to the individual’s healing. The environmental component is conceptualized as the physical surrounding where healthcare is received as well as the significant others that make care delivery possible. While providing care, the nurse should ensure the patient is in a surrounding that promotes healing. Health is a dynamic process that represents wellness and illness as perceived by the patient. The last component is nursing which includes the reflective, interpersonal, knowledgeable, and relational processes between the patient and the nurse that promote healing.
The person component of the nursing metaparadigm focuses on the receiver of care as well as the families and other groups important to the patient. I believe patients are empowered to manage their well-being by establishing strong relationships with others. Because they depend on others for their health promotion, nurses must involve the patient’s family and significant others in providing care. Human beings are valued persons who require attention, respect, and understanding while providing help and they have the right to make informed choices at their point of need. I have learned that respect and empathy are important during healthcare delivery when focusing on the person paradigm of nursing. My understanding regarding respect has not changed because I have always believed we provide nursing care based on the patient’s wish. The ultimate goal is to provide care that will empower patients to care for themselves. One aspect that I believe has changed during patient care is my respect and involvement of the family in care delivery. I have learned that families are part of the person paradigm and caring for them is equally the same as caring for the patient.
The environment represents the landscape and geography of the human social experience. It goes beyond the physical features like air, water, and land that surround the patient to include aspects of culture, values, beliefs, customs, and expectations. This course has increased my understanding and changed my initial perspectives about the environment paradigm of nursing. Initially, I focused my nursing care delivery on making the patient stay in a comfortable clean, and safe environment with little focus on how culture and beliefs affect the healing process. In my first paper, I described the values of empathy, compassion, and trust to guide my nursing care delivery. I have learned that making the patient comfortable involves more than showing compassion and trust. Respect for the patient’s beliefs, building caring relationships, and assessment of the patient’s expectations can greatly promote healing.
The interaction between the patient and the environment is a crucial aspect that every nurse should work to promote. This course has broadened my mind on how patients interact with the environment especially people and technology. In my first paper, I described good communication and listening to be among the values of my nursing care delivery. On a broader picture, I have realized that good communication and better relationships should be established not only with the nurse but also with the relatives. Social connections are important in promoting healing because upon discharge the patient goes back to live with the family. Above all, trustworthy relationships should exist during care delivery as I described in my first paper. Additionally, the value of honesty makes relationships, even more, stronger during care delivery and positively promotes the sharing of information.
The health component of the four metaparadigms refers to the extent of wellness, illness, and health care access that a patient has. Health represents the ability to function independently and successfully adapting to the stressors of life. I view health as an interaction of the physical body and the inner soul or the mind which dictates the individual’s degree of wellness. Wellness also depends on the care that one receives from the family and others to suit the individual’s expectations and realities. Sometimes the health of individuals can go beyond their control especially when factors such as genetics affect the individual’s well-being. My personal values that are in line with the health paradigm include compassion, honesty, and empathy. I believe my understanding of this course has not changed my values regarding the health of individuals. For instance, the nurse’s role in health promotion is to assist the patient meet their physiological, esteem, safety, and belonging needs with some input on self-actualization.
Illness is a component in the health paradigm that represents loss or dysfunction that requires mediation by caring relationships. I believe honesty is a value that can promote recovery and meeting of the patient’s expectations. I always try to make the patient understand the intensity of their health condition including the expected outcome no matter how hard it is to say. I will then go ahead to help the patient cope with reality by providing nursing care and involving other disciplines to provide emotional and spiritual care. However, I believe I should focus more on helping the patient meet these needs by availing the necessary resources or finding options that the patient can use to meet their demands.
Nursing is an academic discipline and a practice profession that involves the delivery of care through building mutual relationships in a safe care environment. This paradigm defines both the profession and the required skills, knowledge, technology, and collaborations that help achieve better patient outcomes. I believe this component integrates with the other three to produce care that is unique to the profession and the patient. Previously I discussed how trust, honesty, integrity, compassion, empathy, good communication, and respect for the patient guide my nursing practice. After taking this course, I feel my understanding of the above values has even increased because now I fully understand what is required of a nurse. Nurses function autonomously and use their power to empower patients through caring partnerships. I now understand the role of interprofessional collaboration in improving communication and patient care outcomes. I never used to think collaborative practice can add much value to nursing care, but today I can proudly say that the central focus is the patient and nurses ought to do the best to promote better outcomes.
The theoretical work selected for this discussion is Margret Newman’s health as an expanding consciousness theory. This theory was stimulated by concern for those whose health as the absence of disease or disability is not possible (Stec, 2016). Newman’s theory is based on the theory of unitary human beings by Martha Rogers which defines the health of human beings as a unitary phenomenon, an evolving pattern of the human environment. Health is observed as an evolving unitary pattern of the whole including patterns of disease while consciousness represents the informal capacity of the whole which is revealed in the evolving pattern (Alligood, 2018b, p. 77). The theory identifies a pattern that ideally represents the patient, to be evolving as interaction with the environment continues. Sometimes the pattern can be orderly such that the patient copes well even with the presence of disease and on other occasions, the evolving pattern can lead to chaos. These interactions lead to the expansion of consciousness and understanding the pattern becomes essential in disease management. Newman’s theory further expands on the nursing metaparadigms as follows.
The health paradigm is defined differently by Newman as it represents those who believe the disease is part of health. In this theory, health and illness are synthesized as health – the fusion on one state of being (disease) with its opposite (non-disease) (Stec, 2016). Health is a unitary whole that includes both health and disease meaning the focus is put on attaining a higher level of consciousness rather than managing disease. Newman’s theory contradicts the purpose of nursing which is to provide care to the sick and now that sickness is part of health, nurses are observed to have little to contribute to the restoration of balance.
Newman’s health concept emphasizes on attaining a higher level of consciousness during health promotion rather than focusing on managing the disease. Perhaps this concept can only apply to very few individuals who can effectively cope with disease or injury or physical deformities. It slightly differs from my philosophical values of nursing on empathy, integrity, and honesty. The nurse should sympathize with the sick patient and work towards alleviating suffering. I believe focusing on higher-level consciousness cannot alleviate suffering despite the intervention leading to more understanding of self. Secondly, I need to look at the patient and feel I have done my best through nursing care delivery and collaborative approaches to health. Although Newman suggests nurses should help people to use the power within to develop a higher level of consciousness, I believe more values can be incorporated to restore health.
Nursing represents the care provided to individuals when they are at war with the health experiences. Nursing is seen as a partnership between the nurse and client, with both grow in the “sense of higher levels of consciousness” (Stec, 2016). The nurse is responsible for eliciting proper pattern recognition by the patient to boost higher levels of consciousness. The nursing intervention that is dominant in this theory is a caring partnership that enables the creation of a patient-nurse relationship. This relationship is strengthened and used to find meaning in patient experiences.
My current values fit with Newman’s theory on the paradigm of nursing and nursing care delivery. First, my previous paper discussed the importance of good communication and listening to the improvement of better patient outcomes. The theory is observed to support these values by incorporating collaborative care and building strong relationships between nurses and patients. Additionally, the theory aligns with the value of respect for the patient during care delivery which forms the center of building strong relationships.
Newman views the person paradigm as a unitary that cannot be separated into different parts and is inseparable from the larger unitary field. She argues that the individual does not possess consciousness, but rather the person is consciousness and is at the center of that consciousness (Alligood, 2018b, p. 81). While human beings should be treated as a whole, nurses should understand the dynamic processes and patterns that lead to positive health perception.
My current values fit with Newman’s perceptions of the person paradigm of nursing which puts the patient at the center. Demonstration of empathy, trust, integrity, and honesty all aim at improving patient experience and promoting healing. Achieving higher level consciousness as per Newman’s theory means directing all the focus to the patient as depicted in my personal values.
The environment is critical to the provision of nursing care and it represents a universe of open systems that interact with the patient. It contains very abstract open power and energy systems that are manifested through emotions, cognition, and other observable features (Stec, 2016). This theory indicates that the environment plays a critical role in determining physiological aspects like body temperature, diet, blood pressure, and rest. The focus of nursing care is to modify environmental factors to improve the health status of the individual. Newman’s description of the environment fits with my values and beliefs on respect for the patient and good communication approaches to nursing care. Respecting the patient allows for the fulfillment of the emotional and social requirements of the patient. Good communication, on the other hand, ensures optimum care for the patient and timely interventions that promote the health of individuals.
CNO Competencies/ Behavioral Directives
Registered nurses are supposed to coordinate point of healthcare service delivery with the patient, healthcare team, and other sectors to ensure continuity of safe healthcare delivery. CNO competency 5.1 requires the nurse to consults with clients and health care team members to make ongoing adjustments required by changes in the availability of services or client health status (CNO, 2019b, p. 7). This competency is supported by Newman’s theory which requires the nurse to maintain a partnership with the client for the realization of a higher level of consciousness. To achieve this competency, I will work closely with patients and families to make daily plans of care and perform regular evaluations to determine aspects that require improvement (Fujiwara & Endo, 2017).
The second aspect I will work to meet is competency 5.6 on the role of the nurse as a coordinator in which nurses should support clients to navigate health care systems and other service sectors to optimize health and well-being (CNO, 2019b, p. 7). The environment paradigm stresses the importance of meeting the diverse needs of the patient including social connections that are crucial to attaining health. I will meet this competency by helping patients make strong connections with families and allowing the patient families to be part of the team delivering care to the patient.
The environment paradigm in nursing as discussed by Newman involves a universe of open systems that interact to affect the health of individuals. Under the behavioral directives for maintaining commitments to quality practice settings, nurses are supposed to continually evaluate the workplace environment to identify opportunities for improving the quality of care (CNO, 2019g, p. 13). I will work to achieve this standard by performing a regular evaluation of the hospital HCAHPS scores and identifying areas with poor performance. The promotion of the client’s well-being is among the professional standards of nursing practice that ensure the prevention of harm to the patient. While promoting the well-being of patients, nurses are supposed to maintain the therapeutic nurse-client relationship, an aspect that is stressed on the nursing paradigm in Newman’s theory (CNO, 2019g, p. 6). I will demonstrate the maintenance of a therapeutic relationship by practicing empathy, honesty, and integrity. Fujiwara & Endo (2017) also explains that good relationships between the patient and the nurse can be achieved by using effective communication strategies and involving families in patient care.
Nursing metaparadigms which include nursing, health, person, and environment provide structure for how the nursing discipline should function. These paradigms are supported by various nursing theories that further describe how nurses should approach and use each component. One of these theories is Newman’s theory of health as expanding consciousness and caring partnership which directs nursing interventions towards the evolving health of individuals. While practicing safe nursing using theoretical approaches, nurses must demonstrate professionalism by practicing to meet required competencies, standards of practice, and ethical guidelines.
Alligood, M. R. (2018a). Theories and grand theories. In P. Emeritus (EDd 9), Nursing theorists and their work-e-book(pp. 41-). North Carolina: Elsevier Health Sciences. Retrieved from
Alligood, M. R. (2018b). Middle-range theories. In P. Emeritus (EDd 9), Nursing theorists and their work-e-book(pp. 41-). North Carolina: Elsevier Health Sciences. Retrieved from
Bender, M., & Feldman, M. S. (2015). A practice theory approach to understanding the interdependency of nursing practice and the environment. Advances in Nursing Science, 38(2), 96-109. DOI: 10.1097/ANS.0000000000000068
College of Nurses of Ontario. (2019b). Entry-to-practice competencies for registered nurses. Toronto, ON: Author. Retrieved from
College of Nurses of Ontario. (2019g). Practice standard: Ethics. Toronto, ON: Author. Retrieved from
Fujiwara, Y., & Endo, E. (2017). A patient with cancer and her family in caring partnership based on Margaret Newman’s theory of health as expanding consciousness. Asia-Pacific Journal of Oncology Nursing, 4(3), 265. DOI: 10.4103/apjon.apjon_20_17
Stec, M. W. (2016). Health as expanding consciousness: Clinical reasoning in baccalaureate nursing students. Nursing Science Quarterly, 29(1), 54-61. https://doi.org/10.1177/0894318415614901
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