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COMPC NENTS LEVEL OF ABSTRACTION
11
Conceptual Models,,. n
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D G E is the METAPARADIGM (Figure l-l). A The four requirements, which pertain to the meta-
is tl
a?taparadigm is defined a s paradigm of any discipline, are listed in Table l-l.
me1
he global concepts that identify the phenom- the
enaof central interest to a discipline, the tion
-TABLE 111 Requirements for a Metaparadigm
global propositions that describe the concepts, en0
and the global propositions that state the re- 1. The metaparadigm must idenfify a domain that is dis- tinu
lations between the concepts. tinctive from the domains of other disciplines. That the
requirement is fulfilled only when the concepts and rent
The metaparadigm is the most abstract component
propositions represent a unique perspective for inquiry nurs
f the structural hierarchy of contemporary nurs-
and practice. char
,g knowledge, and acts as “an encapsulating unit,
r f r a m e w o r k , w i t h i n w h i c h t h e m o r e re- 2. The metaparadigm must encompass all phenomena em
tricted structures develop” (Eckberg & Hill, of interest to the discipline in a parsimonious mar,- the I
979, p. 927). The concepts and propositions of a ner. That requirement is fulfilled only if the concepts ent c
letaparadigm are admittedly extremely global and and propositions are global and if there are no redun- nursl
rovide no definitive direction for such activities dancies in concepts or propositions. expa
s research and clinical practice. That is to be ex- 3. The metaparadigm must be perspective-neutra/. That meta
acted because the metaparadigm “is the broadest requirement is fulfilled only if the concepts and propo- was I
Jnsensus within a discipline. It provides the gen- sitions do not represent a specific perspective, that is, a ment
ral parameters of the field and gives scientists a specific paradigm or conceptual model, or a combina- (Kleff
road orientation from which to work” (Hardy, 1978, tion of perspectives. The
. 38). 4. The metaparadigm must be international in scope and four r
Functions of a Metaparadigm substance. That requirement, which is a corollary of l-l. II
The functions of a metaparadigm arc? to summarize the third requirement, is fulfilled only if the concepts perso
me intellectual and social missions of a discipline and propositions do not reflect particular national, cul- regarc
rtd place a boundary on the subject matter of that tural, or ethnic beliefs and values. ing (F
iscipline ( K i m , 1 9 8 9 ) . T h o s e f u n c t i o n s a r e re- Wagn
ectcd in certain Requirements for a Metaparadigm. (From Fawcett, 1992, 1996.) cepts
ing (Flaskerud & Halloran, 1980; Jennings, 1987; wholeness or health of human beings, tecogniri~w that
Wagner, 1986). They are a modification of four con- they are in continuous interaction with their environ-
cppts i n d u c e d f r o m t h e c o n c e p t u a l f r a m e w o r k s ments.
liscipline of nursing more explicit than it is at pres- of knowledge about those phenomena, and what view
knt” (p. 113). Relational proposition 4, according they value with regard to their actions and practices discip
o Donaldson and Crowley (19781, “evolveldl from (Kim, 1989; Salsberry, 1994; Seaver & Cartwright, two d
he practical aim of optimizing of human envi- 1977). In other words, the function of each philoso- ing a9
onments for health” (p. 119). phy is to inform the members of disciplines and essen
the general public about the beliefs and values of a tion, E
:T&en together, the four concepts, the four nonrela- particular discipline. place,
onai propositions, and the four relational propo- ries. F
kions identify the unique focus of the discipline of
Philosophies of Nursing
cancel
ursing and encompass all relevant phenomena in a PHILOSOPHIES OF NURSING encompass ontologi- nursin
Brsimonious manner. Furthermore the concepts cal and epistemic claims about the phenomena of the COI
nd propositions are perspective-neutral because interest to the discipline of nursing and ethical therefc
<ey do not reflect a specific paradigm or conceptual claims about nursing actions, nursing practices, and Con\n
~adel. Moreover, the metaparadigm concepts and the character of individuals who choose to practice concep
Wtjositions do not reflect the beliefs and values nursing (Salsberry, 1994). The ontological claims Consec
f nurses from any one country or culture and, in philosophies of nursing state what is believed metap:
i&forp, are international in scope and substance. about the nature of the person, the environment, interesl
(Text continued on p. 70)
/
Discussion
N~wrnan (1983) proposed that the term client replace the
term petson in the metaparadigm. Kim (1987, 1997) identified four domains of nursing knowl-
edge. The client domain is concerned with the client’s de-
i Critique
velopment, problems, and health care experiences. The
: The term client reflects a particular view of the person and, client-nurse domain focuses on encounters between client
! therefore, is not a perspective-neutral concept. Therefore, and nurse and the interactions between the two in the
the suggested modification does not fulfill the third re- process of providing nursing care. The practice domain
‘; quirement for a metaparadigm (see Table l-l). emphasizes the cognitive, behavioral, and social aspects
of nurses’ professional actions. The environment domain
’ The Conway Proposal
takes in the time, space, and quality variations of the
‘,’ Eliminate the concept nursing from the metaparadigm. client’s environment. Hinshaw (1987) pointed out that
Kim’s work does not include the concept health, and asked,
.i’ it,ter?st to the discipline of nursing. Moreover, Conway lar, Meleis and Trangenstein (1994) maintained that “the
man, health, role, and social systems. metaparadigm concepts as person, environment, health, (P.
and nursing, their proposition does not include environ- Cril
DiSCUSSiO/,
ment. In an attempt to clarify their position, Newman,
Sime, and Corcoran-Perry (1992) later stated, “we view the Par:
King’s (1984) review of the philosophies of a representative
concept of environment as inherent in and inseparable ver:
sample of National League for Nursing accredited nursing
from the integrated focus of caring in the human health ex- stlrr
education programs in the United States revealed nine
perience” (p. vii). Despite that clarification, their proposal OCCI
concepts: man, health, environment, social systems, role,
does not meet the second and third requirements for a nurz
perceptions, interpersonal relations, nursing, and God.
metaparadigm because it is neither sufficiently comprehen- is pf
King found that all nine concepts were not evident in the
sive nor perspective-neutral (see Table l-l). este,
philosophies of all the schools included in the sample. She
the I
recommended that the most frequently cited concepts
The Malloch, Martinez, Nelson, Predeger, Speakman, parti
cror~lti represent the domain of nursing. Those concepts
Steinbinder, and Tracy Proposal is, hr
a,re: man, health, role, and social systems.
unita
Nursing is the study and practice of caring within contexts
Ckitiqoe and t
of the human health experience.
King’s proposal falls short of meeting all requirements for The 1
Discussion
a metaparadigm. First, the inclusion of role and social
Elimil
systems reflects a sociological orientation to nursing. Sec- Malloch, Martinez, Nelson, Predeger, Speakman. Stein-
and s
&d, the elimination of environment and nursing results binder, and Tracy (1992) suggested a revision of the New-
vironr
in a narrow view of the domain. Moreover, the elimination man, Sime, and Corcoran-Perry (1991) statement. Their
Elim
of environment and nursing leaves a list of concepts more focus statement is as follows: “Nursing is the study and
relatic
.‘osely aligned with the discipline of social work (Ben- practice of caring within contexts of the human health ex-
cancel
‘i .n, 1987) than with nursing. Thus, her proposal does not perience” (p. vi). Malloch and her colleagues (1992)
well-b1
i’leet the first, second, and third requirements for a maintained that their statement extends the focus of the
ity of (
~letaparatligrn (see Table l-l). discipline to nursing practice and incorporates the environ-
The core focus of nursing is the human-universe-health nomena of nursing. It appeared to me and other care
scholars that this small elite group were lobbying against
’ process.
the rapidly growing interest in care and transcultural nurs-
; ~Discussion ing” (p. 96). In another publication, Leininger (1990)
Parse (1997) asserted that “the core focus of nursing, the claimed that “human care/caring [is] the central phenome-
metaparadigm, is the human-universe-health process” non and essence of nursing” (p. 19). and Watson (1990)
(p. 74). She went on to explain that the “hyphens between maintained that “human caring needs to be explicitly incor-
the words create a unitary construct incarnating the notion porated into nursing’s metaparadigm” (p. 21). Even more
that the study of nursing is the science of the human- to the point, Leininger (1991a) maintained that: “care is the
universe-health process. Consequently, all nursing knowl- essence of nursing and the central, dominant, and unify-
edge is in some way concerned with this phenomenon” ing focus of nursing” (p. 35). On the basis of that position,
*tological claims in philosophies of nursing also Change occurs only for survival and as a consequence of
!I: ?t one or more broad Categories of Knowledge predictable and controllable antecedent conditions. Change
rrnd in adjunctive disciplines and in nursing. occurs only when the person must modify behaviors to
.+gories of knowledge from adjunctive disciplines survive. Consequently, stability is valued. Threats to stabil-
e developmental, systems, and interaction ity are, however, predictable and controllable if enough is
hnson, 1974; Reilly, 1975; Riehl & Roy, 1980). known about the stimuli that would force a change.
egories of knowledge mentioned in the nursing Only objective phenomena that can be isolated, ob-
ientfocused, person-environment focused, and developed only about objective, quantifiable phenom-
rsing therapeutics focused (Meleis, 1997); energy ena that can be isolated and observed, defined in a con-
Ids (Hickman, 1995; Marriner-Tomey, 1989); and crete manner, and measured by objective instruments.
any given time can only be estimated. mental problems and delineation of intervention strate- For
Realrfy is multidimensional, context-dependent, and rela- gies that foster maximum growth and development of peo-
tive. Both objective and subjective phenomena are stud- ple and their environments. For1
taken into account, the context of the person-environment “that there are noticeable differences between the states of
interaction is considered, and the product of knowledge a system at different times, that the succession of these
development efforts is regarded as relative to historical states implies the system is heading somewhere, and that Peop
time and place. Emphasis always is placed on empirical there are orderly processes that explain how the system may
observations within methodologically controlled situations, gets from its present state to wherever it is going” (Chin, certa
ilange, and unitary-transformative world views. The direction of change is: “(a) some goal or end state ventic
Unitary human beings are identified by pattern. The met- (developed, mature), (b) the process of becoming (develop- tern 0
@OI is the unitary human being, who is regarded as a ing, maturing), or (c) the degree of achievement toward
System
.iolistic, self-organized field. The human being is more than some goal or end state (increased development, increase
snd different from the sum of parts and is recognized in maturity)” (Chin, 1980, p. 31). “A set
.hrocrglr oatterns of behavior. object:
Identifiable State
HU,JJ~?IJ hcings are in mutual rhythmical interchange with 1968, 1
‘heir environments. The person-environment interchange Different states of the person are seen over time. Those
lrltngrc
s a n~titr~al. rhythmical process. states frequently are termed stages, levels, phases, or peri.
Nurr~ar~ heirqs change continuously, unpredictably, ods of development; they may be quantitatively or quali- Ptienor
?nd in the direction of more complex self-organization. tatively differentiated from one another. Shifts in state may interac
Changes in patterns of behavior occur continuously, uni- be either small, nondiscernible steps that eventually are clemen
:lirectinnally, and unpredictably as the human being recognized as change, or sudden, cataclysmic changes
Open a
?vnlves. Although the patterns are sometimes organized (Chin, 1980).
and sometimes disorganized, change ultimately is in the System
Form of Progression
Jirectinn of increasing organization of behavioral patterns. “maintc
The phenomena of interest are personal knowledge and Developmental change is possible through four different building
Tattern recognition. Knowledge develo, ment empha- forms of progression: (I) unidirectional development fl closet
;tzes personal becoming through recognition of patterns. may be postulated, such that “once a stage is worked environ1
The phenomena of interest are, thereforc , the person’s through, the client system shows continued progression continue
ryer experiences, feelings, values, thoughts, and and normally never turns back;” (2) developmental change entropy
,hoices. rnay take the form of a spiral, so that although return to more ciii
a previous problem may occur, the problem is dealt with at Conversl
from Fawcratt, 1993b.) a higher level; (3) development may be seen as “phases move to!
(Continued!
Phenomena are treated “as if there existed organization, Systems are assumed to tend to move toward a balance
interaction, interdependency, and integration of parts and between internal and external forces. “When the balance
elements” (Chin, 1980, p. 24). is thought of as a fixed point or level, it is called ‘equi-
librium.’ ‘Steady state,’ on the other hand, is the term
Lfw7 and Closed Systems
used to describe the balanced relationship of parts that
Systems are viewed as open or closed. An open system is not dependent upon any fixed equilibrium point or
Plalntains itself in a continuous inflow and outflow, a level” (Chin, 1980, p. 25). Steady state, which also is re-
building up and breaking down of components,” [whereas ferred to as a dynamic equilibrium, is characteristic of liv-
4 closed system is] “considered to be isolated from [its] ing open systems and is maintained by a continuous
environment” (van Bertalanffy, 1968, p. 39). Open systems flow of energy within the system and between the system
continuously import energy in a process called negative and its environment (van Bertalanffy, 1968).
entropy or negentropy, so that the system may become
Feedback
More differentiated, more complex, and more ordered.
Conversely, closed systems exhibit entropy, such that they The flow of energy between a system and its environment.
%JVP toward increasing disorder. All living organisms are Systems “are affected by and in turn affect the environ-
(Continued)
Client-Focused Nursil
patien
The person’s perceptions of other people, the environment, Refers to a comprehensive focus on the client as viewed ables I
situations, and events-that is, the awareness and experi- from a nursing perspective (Meleis, 1997). strong
enc‘e of phenomena-depend on meanings attached to enced
Person-Environment Focused
those phenomena. The meanings, or definitions of the situ-
ation, determine how the person behaves in a given situa- Emphasis is placed on the relationship between clients and
tion. People actively set goals on the basis of their per- their environments (Meleis, 1997).
ceptions of the relevant factors in a given situation, which
Nursing Therapeutics
are derived from social interactions with others. (Text CO
Emphasis is placed on what nurses should do and under nursirq
what circumstances they should act (Meleis, 1997). 8 practice
:$ommunication is through language, “a system of signifi- I nursing
Energy Fields
cant symbols” (Heiss, 1981, p. 5). Communication, there- : philosol
fore, involves the transfer of arbitrary meanings of Incorporates the concept of energy (Marriner-Tomey, 19891 i phasize:
.hings from one person to another. People are thought to and focuses on persons as energy fields in constant inter-
actively evaluate communication from others, rather action with their environment or the universe (Hickman,
than passively accept their ideas. 1995).
1 Ihe respf
No/f? intervention
I “simply I
“PrpscripGnns for hehavior which are associated with par- Emphasizes the nurse’s professional actions and decisions/ eration 0
ticrllnr R(:I~I nther c o m b i n a t i o n s t h e w a y s w e t h i n k and regards the patient as an object of nursing rather / practice,
pc<~[~lr, r.! J particular kind ought to act toward various cat- than a participant in nursing. Agency, or action, rests with ! omy, va]l
CONCEPTUAL MODEL
//
/_’
A NOTE ON LANGUAGE “Every science has its own peculiar terms, con- Allynod, I
tianst
cepts and principles which are essential for the de- years
The meaning given to conceptual models in this velopment of its knowledge base. In nursing, as in Al1man. I.,
‘tlaok should not be confused with the meaning of other sciences, an understanding of these is a “tga”
‘jrtibdel found in the philosophy of science literature IEds.),
prerequisite to a critical examination of their contri-
i&d some nursing literature. The latter refers to rep- Barnum. t
bution to the development of knowledge and its ed 1. 1
resentations of testable theories. Rudner (1966), for application to practice” (p. ii). Watson (1997) added, Rarmm1. E
~‘example, defined a model for a middle-range theory “The attention to language is especially critical to ed.1. F
:;& “an alternative interpretation of the same calcu- an evolving discipline, in that during this postmod- Renoliel. J
&s of which the theory itself is an interpretation” ern era, one’s survival depends upon having
OUtlOO
1 structural hierarchy of contempopary nursing knowl- Fawcett, J. (1992). The metaparadigm of nursing: International in scope and
substance. In K. Krause & f? Astedt-Kurki (Eds.). International perspec-
! edge, with emphasis on the distinctions between tives on nursing. A joint effort to explore nursing internationally (Series A
i 3/92. pp. 13-21). Tampere. Finland: Tampere University Department of
i conceptual models and theories. The distinctions be-
Nursing.
; tween conceptual models and theories mandate
Fawcett, J. (1993a). Analysis and evaluation of nursing theories. Philadelphia:
/ separate analysis and evaluation schemata. Chapter F.A. Davis.
i 3 presents a framework expressly designed for the Fewcett. J. (1993b). From a plethora of paradigms to parsimony in world views.
analysis and evaluation of conceptual models of Nursing Science Duarterly, 6. 56-58.
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(3rd ed.). Philadelphia: F.A. Davis.
analysis and evaluation of nursing theories is pre-
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sented in Chapter 11. dialogue. Nursing Science Duarterly. 9. 94-97.
Fawcett. J. (1999). The relationship of theory and research (3rd ed).
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