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Nursing Metaparadigm

      As a new nursing student in the University of New Hampshire’s Direct Entry Masters in Nursing program, the metaparadigm of the school was shared with me in several of the initial classes in the form of the mission statement and school philosophy.  Coming from the corporate world, I have had exposure to mission statements and business philosophies of various companies, all of which had at least some portion that made sense to me.   However, UNH’s metaparadigm really spoke to me on many different levels, which I found both curious and exciting.

      The metaparadigm utilized by UNH is nearly an entire page in length so I will summarize it here.   The foundation of the metaparadigm is to be the center of excellence in education, research and service with the base of evidence-based practice. The mission is to “enhance the health of individuals, families, groups, and communities” (UNH, 2004, p.7).  The Statement of Philosophy goes on to outline the beliefs about person, environment, health and nursing.   They “believe that: 

  • Each person is a self-determining, developing, dynamic human being who has the potential for freedom of creative choice and action… possessing both dignity and intrinsic worth.
  • The environment is the context in which a person exists, including that which is internal to the person and that which is external.
  • The concept of health is relative.
  • Nursing is an art and a science.  It is a professional discipline that has a special value to society.” (UNH, 2004, p. 8 )

      Based on my limited pre-professional experience in the health care environment, I believe the school of nursing’s metaparadigm is well-defined and identified.  It outlines a framework which guides the faculty and the student in order to prepare them to make the greatest impact on not only the field of nursing, but the unique patients they encounter.   It provides structure, yet emphasizes the need to be open to other’s interpretations, cultures, beliefs and views.   In the increasingly diverse health care settings with ever-changing breakthroughs in pharmacology, medical science, alternative therapies, and nutrition the metaparadigm appears to be adaptable enough to be continually applicable.   

      I would not make any changes or alterations to the metaparadigm as I feel removing parts would make the framework too broad to be effective.   Making the metaparadigm more definitive runs the risk of narrowing the metaparadigm, reducing its relevance and agreement about it among faculty.  There is a fine balance that must be struck between the two, and UNH has achieved this. 

      We can explore each of the four major components individually, starting with person.  In the health care environment, person is the patient, client, family or community being served by the health care system or provider. This is an important clarification that a person could be an individual, or a larger group such as a family or even a community.  Holistic nursing requires a wider scope.  As such, the nurse must be aware that every client has unique values and beliefs.   The nurse’s role involves facilitating the client’s health.   Care should be given to assist the client with issues related to participation in their own care, maintenance of dignity and self-worth.   The client-centered model highlights this, as the person is treated holistically, not just the disease and its symptoms. 

      The environment is both internal and external to the client.   The internal environment encompasses all the biological, physiological, spiritual and cultural pieces.   All of these pieces shape the client’s view of the world as well as their decision making process.   The external environment encompasses the client’s physical environment as well as their social, community and cultural environments.  Both internal and external environment considerations are necessary for thorough patient assessment and treatment.   When considering the psychosocial aspects of treatment, the nurse must be cognizant that the environment in which the patient is being treated and the environment in which the nurse is providing treatment.   The environment and perceptions about the environment can alter behavior, patient responses and healing.  

      The concept of health is broad.  The UNH School of Nursing recognizes that the concept is a relative one.   Each nurse and patient may have a different belief of what health is to them, which may provide a framework for their responses.   It is important for the nurse to realize that a patient may not define health based on the absence of disease.   A nurse may treat a patient with diabetes and peripheral artery disease, but that patient may consider themselves to be healthy, while a nurse or other with a more strict view may consider them unhealthy.  With so many cultural variables, religious variables and even alternative treatment modalities, I think this is a very important concept to recognize.   Early recognition will allow the nurse to better understand the patients responses as they relate to their own views, so the nurse can gain the most from the information that is relayed. 

      The UNH School of Nursing recognizes that nursing is both an art and a science.   This is evident in their vision statement regarding excellence in education, research and service based on evidence-based practice.   The focus of evidence-based practice gives a solid foundation to improve outcomes.   There is an art to delivering that care to the patient, as each patient is unique, and treatment and interventions should be patient-centered.   Recognizing nursing as a discipline, yet allowing the freedom to be creative in application of the evidence allows for better overall treatment.   While treatment should not be based on intuition alone, UNH recognizes that the nurse’s ability to use intuition and experience to enhance their understanding and application of the evidence improves both quality of care and patient outcomes. 

         We have explored the metaparadigm outlined by the vision, mission and philosophy of the UNH School of Nursing.   It is both broad and defined.   Having only witnessed treatment from the patient end, the metaparadigm seems appropriate and I would not make any changes.   After all, the metaparadigm is intended to be “a framework for the discipline that sets forth the phenomena of interest and the propositions, principles and methods of the discipline” (Parker, 2006, p.5).  Narrowing such a framework would likely have adverse effects, as well as limit the scope of the school and acceptance among faculty.   However, I realize that my beliefs and opinions may change after I have the opportunity to set foot in one or more clinical rotations, gather practical experience, and continue to learn.  I look forward to the challenges to my beliefs and the metaparadigm as my education and experience evolve. 
 
 

References

Parker, M. E. (2006), Nursing theories & nursing practice (2nd ed.).  Philadelphia, PA:  F.A. Davis Company

University of New Hampshire (UNH), School of Nursing (2004), Graduate Program in Nursing – Direct Entry Master’s in Nursing Handbook (09-10).  Durham, NH:  Department of Nursing

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