Ever since childhood, my dream was to be a nurse with my main desire being to serve and care for people in need. Now that am already into my dream profession I serve with empathy and compassion which has given me great satisfaction in what I do to an extent that given another opportunity to choose a career, my first priority would still be nursing. I believe that for one to deliver as a nurse patients must be in a position to access quality health care services at the right time, from the right providers and in a way that services given are engineered to meet their individual needs at a particular time. My education has brought change positive change by helping me acquire indispensable values that not only guide my career but my personal life too. The understanding of nursing as a discipline has gone a long way into helping me understand theories that explain the logic behind how the patients I meet behave. I have acquired this knowledge from a variety of sources ranging from books, to lectures as well as interpersonal relationships with both my clients and other health professionals.
As I continue to advance, acquisition of new knowledge with each single day of practice will continue to progress as I meet new patients. If it does not add value to my clinical judgment, I consider the patients affiliations, social status and race of no significant importance for I believe each person has a right to health irrespective of who they are. Each patient deserves my respect and attention that is constant regardless of who they are. It is time that we carried the nursing profession a notch higher where nurses will not serve only for monetary benefits that come along with the profession but will be guided by ethical practices associated with nursing as a vocation. This begins with the creation of enabling environment for patients, which I believe will go a long way in promoting recovery. In my practice I understand that I got to learn from others as well as share knowledge hence I position myself as a valuable member of the healthcare team of whatever workplace I find myself in.I have recognized that it is important to integrate curative and preventive measures in healthcare and for this reason health education is a priority to the patients I meet.
The Four Metaparadigms
Nursing is definitely a professional discipline (Donaldson &Crowley, 1978). As I indicated earlier, patients should be given personalized quality care to meet their individual needs. For me to achieve this as a health professional, I have based my services on the four basic metaparadigms that universally guide the nursing profession. A metaparadigm act as a backbone that can be used as a foundation to the nursing profession from which all nurses can refer to before making clinical judgment (Eckberg & Hill, 1979). The four basic metaparadigms of nursing are person which is the most important of all, the environment, nursing practice and the patients’ health status. Different scholars derived a number of theories on nursing but each of them gives a different perspective of the four metaparadigms in terms of how they affect the patient’s well-being and their medical state at any given time. As a matter of fact the metaparadigm concepts are defined and linked by these theories differently. In this paper, I have discussed these metaparadigms separately while giving a personal input on how best I understand the four components interact and affect the patients’ well-being which has and will always be my agenda.
- Person component
The person component lays emphasis on an individual’s health care need, spiritual needs and most importantly social needs in terms of family ties and other groups of people regarded as important by the individual. How healthy a person is as a result of a complex interaction with both physical and social aspects of life. I agree with Rodgers theory which explains that a unitary human being develops via the three principles of helicy, resonance and integrality (Rodgers 1992). In Watson’s Philosophy and science of caring the person concept is described as an embodied spirit in which there is unity of mind, body and nature (Watson, 1989). On the other hand, Henderson in his philosophy further explains that the person is usually one receiving nursing care and is composed of biological, social physiological and spiritual components (Henderson 1966).
Through practice, I have understood that low self-esteem or stress in most cases hinders recovery. I f my patients are not at ease I take personal initiative to reassure the patient and use holistic approach to health care which in the end helps them to remain calm. By assessing patients’ needs and individual settings, I have been able to respect the uniqueness of each patient and their perspectives in relation to life. An individual gets defined in the course of living and more often than not, through effortless acquisition of knowledge of the self in the universe. There are major aspects of understanding that the person is influenced by their body’s genetic make-up, situation, their personal concerns and temporality (Henderson 1966).
- Environment component
On to the next metaparadigm that is the environment, it focuses on how interactions with the general surrounding affect the health of an individual as a patient. The influences from the environment could either be external or internal. Apart from the physical environment which includes geographical location, the social, cultural, technological and economic aspects of the environment play a crucial role in the wellbeing of a patient.
In Callista Roy’s adaptation model, the environment which includes earth resources that shape behavior can be used to influence health positively through encouraging the patients to cope with the environmental aspects that may not be changeable. The process of coping leads to optimum health and improved quality of life which culminates to death with dignity. In this model there are three adaptation levels which are integrated, compensatory and comprised life processes. The three do not remain constant as change is inevitable from time to time (Roy, 2009). Kings model states that human beings develop in their external environment, while the internal environment is the energy that enables patients to cope with changes in the external environment. This metaparadigm has changed my assessment to one that focuses on both my perspective as well as that of the patient. Through effective communication, I get to understand my patients’ environment and advise them accordingly .In this way our shared goal of the patient’s recovery is achieved.
- Health component
Health is the general wellbeing of an individual. The genetic make-up of a person may predispose the person to particular diseases but what ultimately determines whether the disease occurs or not are the secondary interactions with other factors that may heighten the risk resulting in disease. It is not unusual for patients to have a disease especially during the asymptomatic stage and fail to perceive themselves as ill (Benner, 1999)
All clients have a different inherent approach to stress and coping. I find the understanding of the meaning of health, illness and wellness as of paramount importance to my practice as a nurse since it has helped me understand that at times it’s more appropriate to use placebos to restore the wellness patients who are ill but have no disease. I have also understood that health is not an absolute term but one that is relative e.g. what is healthy in one individual may indicate ill health in another person.
- Nursing component
The nursing component is what involves the delivery of quality health services to the patient for optimal health outcomes. It includes but is not limited to the actions taken from the time of patient’s arrival that include therapeutic nursing interventions as well as the attributes and features of the health worker giving care in terms of their clinical judgment skills. The nurse who is an active participant aims at protecting, promoting and preserving human dignity.
The role of a nurse is to help patients through interpersonal relations and therapeutic management of their environment aimed at promoting health and well-being (Coward, 2010).Nursing is both an academic discipline and practice of profession. It is one guided by the values of human freedom, the choices they make and responsibilities given. As a nurse, critical thinking is an integral part of my career since it has guided me into making the right judgment in providing evidence based care to patients so as to achieve an optimal level of health in the different nursing contexts I find myself in. I as a person am engaged as an active partner in human care activities with people across the life span. Caring is where I source my power from, with which I can act autonomously to empower patients through sharing in their experiences and passing knowledge. I incorporate my decision-making processes, problem solving, communication, interpersonal, intellectual and technical skills n care through collaboration with other health care providers. My core values include commitment, mastery of scope and control over practice to achieve attainable standards of health for my clients.
Two Practice-Specific Concepts
A concept is a complex mental formulation of our perspective in terms of how we view the world .Concepts help us formulate a mental picture about situations. They also act as building blocks for theories (Chinn and Kramer, 1995).
- Health promotion
This involves my experiences of interacting with people suffering from chronic illnesses like diabetes and cancer. Chronic illnesses have in the recent years caused negative impact on the national economy. The direct cost involved in seeking medical care as well as indirect cost e.g. transport and the working hours lost while seeking medical attention are of great significance. Patients with these diseases may not attain recovery but as health professionals, we work to manage cases in a way that prolongs life and slows the rate of disease progression. In the nurse-patient relationship the nurse must work to empower the patient by restoring their will to live and not just give up on life because they suffer from conditions for which they are aware have no cure (Luggen, Travis & Meiner, 1998). I have recognized that health is a matter of social justice and must therefore be incorporated into the societal systems of governance.
I cannot give medication or ask the patients to undergo certain health care procedures without involving them since am aware from experience that unless I include them in my decision-making processes I may not satisfy them that my recommendations will relieve them of their pain and help them recover from illness. This has helped me greatly in achieving compliance of prescribed doses. I therefore feel that hospital processes and procedures must facilitate patient’s empowerment which will improve patient’s satisfaction with the care given. Transformational leadership is important in health promotion since its responsive and not reactive in nature. There is need for senior health professionals to be visionary and work towards influencing the health care team to commit towards achieving set goals.
- Evidence informed practice
I t is defined as the practice that integrates clinical expertise and patient values with the best research evidence available(Sackett et al 2000).I perceive several benefits of using evidence based practice in health care since patients accept recommended care from health workers based on the total trust that they know what’s best for them. One year ago, the mother to a friend of mine went to hospital and was labeled as having breast cancer. The health professional who handled her recommended that she undergo through chemotherapy to control the risk. After consultations with a different health care provider, samples of tissues from the lump were researched on and it was discovered that the lump on her breast was not cancerous. If she would have followed the recommendations of the previous health care provider she would have traumatized as well as her family incurring a lot of financial strain for no reason. Evidence based care supports the decisions made by health care providers in clinical settings as well as in legal issue as need arises.
To the health organizations evidence based practice boosts the image of organizations that embrace it as their approach since they can with ease defend the care delivered to clients as well as justify necessary additional expenditure to clients. To the community, evidence based care reduces strain on resources by minimizing wastage through ineffective or unnecessary interventions.
List of Propositions
A proposition is a structural element of a theory that in itself is a statement that proposes relationship between concepts (Sackett et al., 2000). From the metaparadigms discussed earlier on in this paper, I can derive the following propositions.
- It is possible for each person to manage their own health through positive self-image and behavioral practices that promote good health.
- Modifiable environmental factors can be altered to improve a person’s health and well -being.
- During care physical, emotional, intellectual, spiritual and social well-being must be brought into the picture since they influence the patient’s well- being
- If there is a conflict or misunderstanding between a patient stress and me, stress which may inhibit recovery develops.
- Nursing is not all about care as in the clinical set up but also involves a deeper understanding of all possible factors that influence a patient’s health.