Metaparadigm Of Nursing And Watson Essay

Metaparadigm Of Nursing And Watson Essay

Metaparadigm Of Nursing And Watson Essay

Take one component in the Metaparadigm of Nursing (person, health, environment, nursing) and identify the concept or concepts of Watson’s Theory of Caring that support that Watson wrote a theory of nursing.Metaparadigm Of Nursing And Watson Essay


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The purpose of this paper is to present a personal belief about the metaparadigm of nursing and to incorporate it into that of Jean Watson’s Theory of Human Caring.

II. Personal Belief on the Paradigm

Every person’s needs must be recognized, respected, and filled if he or she must attain wholeness. The environment must attuned to that wholeness for healing to occur. Healing must be total or holistic if health must be restored or maintained. And a nurse-patient relationship is the very foundation of nursing (Conway et al 2011; Johnson, 2011). The Theory recognizes a person’s needs above all. It sets up the conducive environment to healing. It addresses and works on the restoration and maintenance of total health rather than only specific parts or aspect of the patient’s body or personality. And these are possible only through a positive healing relationship between the patient and the nurse (Conway et al, Johnson).Metaparadigm Of Nursing And Watson Essay

III. Origin of Watson’s Theory

Watson conceived her Theory of Human Caring while she was teaching at the University of Colorado in 1975 to 1979 (Conway et al, 2011). It evolved from her personal views on nursing and merged with her learning and experience from her doctoral studies in education, clinical and social psychology. With the publication of her first book, Jean Watson developed the initial ideas of her theory and came up with 10 “carative” factors. Her actual theory was published in 1985, after which she further developed the corresponding nursing curriculum. In those years, Watson also extensively traveled in Asia and Australia while practiced. The prevailing influences in the nursing field at the time were those of Carl Rogers, Florence Nightingale and Leininger.Metaparadigm Of Nursing And Watson Essay

Nursing Metaparadigm and Nursing Theory
When planning and providing care for a patient, nurses can benefit from understanding and utilizing various nursing theories. They help us focus care, individualize treatment, identify risk factors, health care needs and educational needs. Nursing theories, such as Betty Neuman’s nursing systems model, can be used within the four concepts of the nursing metaparadigm to address all aspects of care. “In the United States, the nursing metaparadigm has been widely used to describe four spheres of nursing knowledge that reflect beliefs held by the profession about nursing’s context and content” (Myers Schim, Benkert, Bell, Walker, & Danford, 2007, p. 73).
Nursing Metaparadigm
Nursing’s metaparadigm consists of four concepts. These concepts include the person, health, environment and nursing. The concept of person refers to the recipient of care, which may include a person, their family or even the community. Nurses must respect the unique qualities of each patient, family and community and should provide individualized care to meet those needs. Health refers to an individual’s state of health being a balance between their developmental and behavioral wellness to the fullest extent possible. Since health is dynamic and constantly changing one must constantly adapt to change, which may lead to stressors that can have a negative affect on health if not addressed. Environment refers to all the outside conditions that affect the patient within the setting where health care needs occur. These may include health care needs that are being influenced by factors at home, in school or at the workplace. Finally nursing is the diagnosis and treatment of the current or potential health Metaparadigm Of Nursing And Watson Essay

… partners unfaithfulness may lead to trust issues and they may have difficulty establishing intimate relationships in the future. The nurse should include in the individualized treatment plan to encourage the patient to attend group sessions and to seek counseling from a health care professional to help them come to terms with their interpersonal conflict. Educating them on techniques such meditation and self-reflection can help them develop coping skills and reduce stress over their relationship loss.

Throughout the history of nursing, there have been many nursing theorists who have each made significant contributions towards the shaping of nursing knowledge. Each of these theorists have differing perspectives and interpretations of how each domain of the nursing metaparadigm fit into their respective theories. The four domains of the nursing metaparadigm are: person, environment, health and illness, and nursing. The purpose of this reflection is to provide an overview of the domains related to the metaparadigm of nursing as well as to introduce this author’s perspective on their developing personal philosophy of nursing. In this paper, the author will take a closer look at each of these areas, how they are individually defined, and how they each fit into the nursing metaparadigm as a whole. At the conclusion of this overview, readers will be introduced to how these theorists and their perspectives have enabled this author to begin to create their own philosophy of nursing.Metaparadigm Of Nursing And Watson Essay

Watson’s model of caring was developed originally in the 1970’s and amended many
times to the postmodern transpersonal caring-healing paradigm (1999) which is applicable to the
practice of nursing and other disciplines (Fitzpatrick & Whall, 2005) . Watson believes that
many concepts identified by Florence Nightingale and other leaders in nursing are still valid to
modern clinicians and has adopted these traditional concepts into her caring model. Such themes
include, “the view of the human as a valued person in and of him-or herself to be cared for,
respected, nurtured, understood and assisted” as well as, “an emphasis on human-to-human care
transaction between the nurse and person.” Fitzpatrick and Whall also explain that Watson
believes both client and practitioner are to actively participate in healing and caring by,
“experiencing the quantum energy fields conducive to healing from a spiritual, mystical
environment” (2005, p. 297). Many of her concepts have a spiritual element that affects both the
nurse and the client, allowing them to connect deeply and transcend the moment (Fitzpatrick &
Whall, 2005).
Watson’s model can best be described in terms of the nursing metaparadigm. When
describing nursing, Watson proclaims that caring is the “moral ideal” (1988, p.54). She explains
that contact between two human beings can help the ill discover new knowledge that will assist
with recovery and promote harmony. The nurse is involved in a partnership with the patient in
the caring process in which the goal is intersubjectivity. Metaparadigm Of Nursing And Watson Essay Watson explains that because nursing is
a human science, there are important moral, spiritual and metaphysical components and we can
use our spirits to relate to others (Watson, 1988). In describing the person, Watson believes that
the person has three elements within them which are the mind, body and soul, all of which are
influenced by the self. A person is both a physical being and a spiritual being, with an individual
experience and existence. She describes a person as, “the experiencing or perceiving organism.
Nursing Model 3
The person and the self are the same when the person is congruent with the real self. That occurs
when there is harmony in the mind, body and soul of the person” (Watson, 1988, p.55). The
previous sentiment about harmony between all three aspects of person can be used to describe
health. Health also encompasses unity of the self with others and the environment (Fitzpatrick &
Whall, 2005). Health and the client’s perceived sense of health must be in balance as well for
true health to exist (Watson, 1988). Her original definition of health was based on the World
Health Organization’s model which and then transformed into a more unconventional and
spirituality influenced as the model developed (Fitzpatrick & Whall, 2005). Watson discusses
environment in more abstract terms. Environments should be transformative in nature. She
believes that caring and healing must be able take place in an environment that the nurse helps
create. The nurse helps regulate the environment, making sure all factors for healing are present,
such as support, protection and spirituality (Fitzpatrick & Whall, 2005).
Watson describes ten central components called “carative factors” that serve as the basis
of her theory. These carative factors transcend many of the traditional ideas of nursing yet evoke
the dogma of Nightingale (Fitzpatrick & Whall, 2005). Major points of the carative factors
include altruism, love, trust, creativity, teaching, and spirituality (Watson, 1988). The factors
can be used as an entry way into the theory and be built upon to comprehend more philosophical
and complex themes. It is evident that these carative factors influence her beliefs on all aspects
of the nursing metaparadigm.
Watson’s model of caring supports the huge paradigm shift in the field of nursing. The
curriculum revolution, as it has been called, has focused on departing from the conventional
behaviorist and medical model to one rooted in humanistic values with caring as its central focus.
Bevis states, “Nursing has a social mandate toward shaping a healthcare system that is more
Nursing Model 4
efficacious, just, equitable and caring” (1993, p. 56). Many scholars support this shift and
Watson’s model that embodies caring, transpersonal relationships and spirituality fits well within
this newer set of beliefs. Interestingly, caring is far from a new concept. While it may be
traditional it is also unique to the field of nursing, and many educators and experts believe it is an
essential component to the curriculum. Integrating caring into curriculum is especially important
in today’s healthcare environment, where high patient acuity and technological advances threaten
the sacredness of the nurse patient relationship (Watson, 2009). When a college or university
adopts Watson’s theory as a framework, a nursing student obtains an education that has caring
central to all aspects of the curriculum. Therefore, her model and concepts within the model are
used in many nursing curriculums today.
If one is to explore educational philosophies of nursing schools, almost all make some
reference to caring. Not surprisingly, the caring model has been used at the University of
Colorado where Watson serves as professor. The College’s values include the belief that,
“Nursing is a theory-guided, evidence-based practice, focused on holistic, relationship-centered
caring that facilitates health and healing”
( Certain Universities have used Dr. Watson’s caring model as an
influence and formed their own theories based on her core beliefs, such as Watson did with
Rogers. At the Catholic University of America, Dr. Duffy created the Quality Caring Model. It
is described as a, “mid-range theory reflect[ing] nursing’s unique role within a multidisciplinary
health care system and places caring relationships at the center of nurses’ work”Metaparadigm Of Nursing And Watson Essay
( Similar to Watson’s beliefs, this theory places
Nursing Model 5
importance on relationships and the interaction between the patient and nurse where caring can
occur and is paramount.
A multitude of studies have been performed nationally and worldwide focused on the
integration of caring into the nursing curriculum. For example, a study by Sawatzky, et. al.,
aimed to show that a caring model can also be applied to nursing education as well as patient
care. She argues that one’s teaching philosophy should be intertwined with one’s own nursing
philosophy, and caring is at the root of nursing (Sawatzky, et. al, 2009). In Watson’s caring
model, she emphasizes the importance of the nurse – client relationship. She identifies the agent
of change in the healing process as an “intersubjective interdependent process wherein both
persons may transcend self and usual experiences” (Watson, 1988, p.70). Nursing researchers
claim that this personal relationship applied to the client and nurse also applied to student teacher
interactions (Sawatzky, et. al., 2009).The study also suggests that the nurse educator with a
strong caring ethic should serve as a role model for the student. As a result, their beliefs will
pervade all aspects of the curriculum and the student will learn similar values (Sawatzky, et. al.,
2009). Cook and Cullen studied the restructuring of an associate degree nursing program using
Watson’s caring model (2003). The program specificities were adequately described and could
be easily replicated by an institution. This study used the carative factors as an introductory
method to help students begin to understand about caring. Later, students used the factors to
help identify clients’ needs and analyze the incorporation of caring into patient care focusing on
the more complex and abstract definitions of caring (Cook & Cullen, 2003).
According to certain supporters of the caring curriculum shift, behaviorist values stifle
creativity and do not facilitate critical thinking (Bevis, 1993). Using a framework such as
Nursing Model 6
Watson’s to build a curriculum helps interject themes of caring and altruism into content based
courses, which helps reinforce the importance of adoption and implementation of such values in
patient interactions. Adopting a caring model into ones curriculum must have educators whom
also share this philosophy and use caring in their practice. It is postulated that students learn
caring by modeling so it is especially important that faculty members treat students respectfully,
feel good about themselves and confident in their teaching roles (Bauer, 1990). Additionally, in
a clinical setting, students observe caring interactions and learn from experiencing faculty
interactions with patients (Cook & Cullen, 2003).
The humanistic philosophy at its core emphasizes the respect and love for all human
beings (Billings & Halstead, 2009). This concept of altruism is clear throughout Watson’s caring
model. In her caritas processes a, “humanistic-altruistic system of values” is the first concept
listed (Watson, 1988). Watson believes that caring is a moral commitment to humanity that can
spiritually benefit the nurse as well as the welfare of others (Watson, 1988). Both Watson and
Nightingale believe in a “calling” that brings people to the profession of nursing. This sense of
calling is rooted in love and reverence for all human beings (Watson, 1988).Metaparadigm Of Nursing And Watson Essay
Watson was influenced by Carl Rogers, one of the innovators of the humanistic approach
to psychology. Like Rogers, Watson believed that one must have a harmony and balance within
oneself to be capable of knowing and caring for another (Fitzpatrick & Whall, 2005). Much of
her beliefs about the “transpersonal relationship” have been influenced by Rogers as well. The
transpersonal relationship requires both the nurse and client to explore their own beliefs within
themselves in order to maximize their experience as a human being. Watson believes that, “selfknowing is the foundation for loving and accepting the human experience of others” (Fitzpatrick
Nursing Model 7
& Whall, 2005, p.313). In humanism, the ultimate goal is to treat other human beings with
dignity and respect. This goal could be considered equitable to the definition of caring.
One could easily compare the relationship between the student and teacher in the
humanistic educational philosophy with the nurse – client relationship in Watson’s model. When
utilizing a humanistic educational philosophy, the teacher serves at the facilitator of learning,
rather than adopting an authoritarian position (Billings & Halstead, 2009). The relationship
between the teacher and student could be described as a partnership. Learning occurs primarily
within the student and the teacher’s goal is to assist the student on the journey where learning
can occur. The student serves as the agent of change, and the teacher supports the student in
maximizing their potential. The relationship between student and teacher is more egalitarian and
collaborative in nature, compared to traditional paradigms. When describing nurse client
relationships, the nurse similarly is a collaborator in the healing process and helps promote
positive change within the patient (Fitzpatrick & Whall, 2005). The nurse aims to promote
autonomy and freedom of choice in client interactions (Fitzpatrick & Whall, 2005). When a
caring relationship occurs, it allows the client can move towards a more enlightened self
(Watson, 1988). Both the teacher and the nurse’s ultimate goal is the formation of a
collaborative relationship in which change can occur.Metaparadigm Of Nursing And Watson Essay

Paradigm is a vital concept in the philosophy of science that has far-reaching influence on contemporary empirical studies (Fawcett, 2000). Kuhn (2017) defined paradigm to identify study models that shape scientific activities and the progress of scientific knowledge (Smith & Parker, 2015). Kuhn argued that scientific paradigms determine the study questions, interview methodology, data collection methods, and interpretation of study results. Paradigms shape individual behaviors, influences of social phenomena, and attitudes of professional groups. Therefore, paradigms serve as a guide for professional education, philosophy, morals, and ethical principles (Özkan & Akduran, 2014).

Metaparadigms, or dominant paradigms, map out general parameters of a scientific discipline and focus on scientific efforts. Metaparadigms may include several concrete and specific paradigms for researchers (Meleis, 2011). Clarifying metaparadigms and their fundamental thesis statements facilitates a deeper understanding of the attitudes of professionals and provides a better appreciation of the scope of scientific studies (Kim, 2000).Metaparadigm Of Nursing And Watson Essay

Nursing metaparadigms were first classified by Fawcett (1978) into the following categories: person, environment, health, and nursing. The human factor metaparadigm refers to individuals in a definite culture, family, and society. The environment metaparadigm characterizes all regional, national, and global cultural, social, political, and economic conditions related to human health. The health metaparadigm defines processes of life and death. The person metaparadigm describes the nursing profession, nursing practices, and nursing objectives and results (Bahramnezhad, Shiri, Asgari, & Afshar, 2015; Fawcett, 2000). In addition to these four metaparadigms, different versions of the nursing metaparadigm have been offered. For instance, Watson considered nursing care to be the core indicator of nursing practice and suggested nursing care as the fifth metaparadigm (Watson, 2008).Metaparadigm Of Nursing And Watson Essay

In recent years, the conceptual framework of nursing has been used to design nursing curricula. Conceptual frameworks are also regarded as models to construct nursing values and concepts (Alligood, 2014). It is utterly important for the professional development of nursing students that they integrate their clinical experiences into theoretical knowledge. An insight into nursing metaparadigms will certainly enable nursing students to cope with the challenges that face them in developing their professional identity (Lee & Fawcett, 2013).Metaparadigm Of Nursing And Watson Essay

In a recent study, Fawcett (2000) taught “Transition to Professional Nursing” to nursing students and analyzed their feedback with regard to nursing metaparadigms. The participants noted that raising awareness toward nursing paradigms provided a framework for the nursing profession and an intellectual recognition of the fundamentals of nursing while reducing burnout (Fawcett, 2000). A participant further stated that nurses were still a member of a professional group, even when they ignored the significance of nursing paradigms (Lee & Fawcett, 2013). In the same study, another student, on the other hand, admitted that “I have never heard of nursing paradigms before. But now it makes me feel even more dedicated to my professional duties when I think over my nursing philosophy and nursing experiences.”

Nurses’ perceptions of nursing metaparadigms and their awareness of professional concepts will eventually influence their professional development (Fawcett, 2000). Awareness of professional identities and values is established during professional education. Therefore, it is of utmost importance to investigate nursing students’ perceptions of fundamental nursing values and metaparadigms. Accordingly, this study aims to analyze nursing students’ perceptions of the four basic nursing metaparadigms (person, human factor, health/illness, and environment).Metaparadigm Of Nursing And Watson Essay

Research Design
This study was designed as a descriptive, phenomenological study. The main point of phenomenological studies is to unveil participants’ personal experiences and perceptions of concepts (Creswell, 2014). Researchers use descriptive approaches to attempt to describe very carefully the experiences being lived through, and once raw data have been obtained, a thorough phenomenological psychological analysis of the data takes place within the perspective of the phenomenological psychological reduction (Giorgi, 2012). Students are provided with metaphors to signify person and health/illness metaparadigms, which help exemplify the unknown with known examples so that sophisticated ideas may be conveyed and identified more easily, eventually enabling the participants to symbolize their experiences with a single image (Schmitt, 2005).Metaparadigm Of Nursing And Watson Essay

The study sample included fourth-year students at Akdeniz University Nursing Faculty in the 2016–2017 academic year. Purposeful sampling was used to recruit participants. The inclusion criteria of this study were as follows: attending the nursing school as a fourth-year student and being interested in nursing philosophy, being an active member of the Turkish Student Nurses Association, and having completed taking History and Deontology of Nursing and Fundamentals of Nursing courses.

In the Turkish nursing education system, metaparadigms are taught only in History and Deontology of Nursing and Fundamentals of Nursing courses. Thus, students in these courses tend to be more aware of these metaparadigms. Otherwise, eligible students who did not successfully pass these courses were excluded from participation.Metaparadigm Of Nursing And Watson Essay

The sample size in qualitative studies is determined by data saturation, which is marked by repetitive input from newly added participants (Morse, 2015). Data saturation was reached in this study after 13 participants had been interviewed. The participants included only two male students.

Data Collection
The participants were interviewed in the meeting hall of the department using an in-depth interview method, which is the most frequently used data collection tool in phenomenological studies (Creswell, 2014).Metaparadigm Of Nursing And Watson Essay

A personal information form and a semistructured questionnaire, both designed by the researchers, were used in the interviews. The researchers consulted with the experts while designing the semistructured questionnaire. All of the interviews were audio recorded. The interview room was set up for the interviews, and a notice was put at the door. The purpose of the research was explained to the participants by the researchers before their interview session. As suggested by Moustakas (1994), the researchers began the interview with an ice-breaking question like “Would you like to talk about concepts that are significant for nursing practice?” to test their awareness of metaparadigms and to encourage participants’ participation in the interview. Afterward, the interview continued with main items and subitems, if necessary, to help the participants express their perceptions and opinions (Table 1). The interview lasted approximately 35–45 minutes.Metaparadigm Of Nursing And Watson Essay

TABLE 1.: Research Questions
Rigor and Trustworthiness
Lincoln and Guba (1985) proposed that certain criteria, including credibility, transferability, dependability, and confirmability, must be sought in qualitative studies to test reliability and validity. Rigor and trustworthiness were achieved through individual interviews using a semistructured interview form to ensure that the participants were asked a similar range of questions. The researchers, who interviewed the participants and who were not teachers of the participants, were doctoral candidates who held master of science degrees in nursing, had training in qualitative research, and had published more than 10 nursing articles each. Data were coded by two independent researchers (a professor and an assistant professor who were experts in nursing education and qualitative research). For validity, all interview data were transcribed without adding any comments for dependability criterion, and data coding was carried out by two researchers individually. During the coding process, researchers exchanged and discussed their opinions regarding the compliance of codes obtained from data that were repeated. For confirmability (verifiability), a comprehensive interview form and the final version of thematization were evaluated by an expert person.Metaparadigm Of Nursing And Watson Essay

Data Collection
Study data were collected using a 6-item personal information form that gathered information on the descriptive characteristics of the participants and a 15-item semi-structured interview form that gathered information on the participant’s perception of nursing metaparadigms (Table 1). The suitability of the questions in the semi-structured interview form was assessed by a professor and a doctor working in the field of nursing education. Individual, in-depth interviews were conducted with three students to test the validity and reliability of the semi-structured interview form. The researcher rearranged interview questions according to the results of the pilot study. The question “Do you think that your life changed after you encountered nursing paradigms?” was asked to start the interview.Metaparadigm Of Nursing And Watson Essay

Data Analysis
The interviews were recorded on camera and with a voice recorder. The author analysed the data obtained from the study through interview outputs using a written solution and then determined the themes. The study data were analysed in four basic steps, as suggested by Giorgi (2012) for descriptive phenomenological studies. According to this approach a phenomenological attitude, i.e., looking at objects from the perspective of how they are experienced, allows a search for the essence of the phenomenon using free, imaginative variation to reveal why the object makes a specific example of the phenomenon. The procedure consists of the following steps: (a) total impression—from chaos to themes; (b) identifying and sorting meaning units—from themes to codes; (c) condensation—from code to meaning; (d) synthesizing—from condensation to descriptions and concepts (Giorgi 2012; Malterud, 2012).Metaparadigm Of Nursing And Watson Essay

Ethical Considerations
Ethical approval was obtained from the ethical committee of the Akdeniz University Clinical Studies Board of Ethics, confirming that this study follows international standards and the principles adopted in the World Medical Association Declaration of Helsinki (approval No. 15, August, 2017). The Declaration of Helsinki was signed by all researchers. Before commencing the study, the researchers obtained permission from the dean of the Faculty of Nursing. The contact information for the students who met the inclusion criteria was obtained. Oral and written consent was obtained after the students who were targeted for participation were informed about the study. Before each interview session, the participants were informed that interviews would be recorded by camera and voice recorder. Furthermore, they were notified that their voice recordings would not be used for any purpose other than the study. Then, the permission of the participants was obtained. The participants were informed that they were free to leave the room and quit the interview anytime they wished and that their decision to participate or not carried no risk to them.Metaparadigm Of Nursing And Watson Essay

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