The phenomena of interest are actually what the research is related to; it explains and describes. The phenomena of interest; the person, environment, health, and nursing are central to the nursing science. The meta-paradigm – a framework and act as an encapsulating unit that a more restricted structure develops under it – of nursing consisted of four concepts that are the person, environment, health, and nursing and these all concepts were interrelated. In the meta-paradigm all the concepts have almost equal importance, however, in literature, there is no significant contradiction about the four concepts of meta-paradigm of nursing. In grand theory, it is evident that the author discovered that cultural and care knowledge is lacked and associated them with the missing link to nursing understandings. It is necessary for the nurses to follow many variations in culture and expertise required in the patient care to support compliance, healing, and wellness.
The middle-range theory “Nursing Process theory” used in the study contends that a proper communication system is needed to be developed so that the patient’s essential and immediate needs for help would be fulfilled. Complexity theory used states that complexity system is a collection of individuals who are free to act unpredictably and whose actions are interrelated and interconnected. In the process, one individual’s actions change the context for other individuals (reciprocal impact). Complexity theory is often used interchangeably with other terms. One of the terms mostly known is complex adaptive systems (CAS). Thus, the phenomena of interest are discussed in light of multiple theories and concepts.
Phenomena of interest
The proposed phenomena “phenomena of interest” are actually what the research is related to, explain and describe. The phenomena of interest; the person, environment, health, and nursing are central to the nursing science. In the current study, these phenomena of interest are brought into the consideration. It is argued that in the current era of multimedia technology, one wonders, why some of the essential services are not provided to the extent that they should be. For instance, some of these services are mentioned as immunization of children and adults and the yearly checkup for men and women. Besides, some services related to prenatal and dental care as well as to the childbearing women and adolescents are others services that are not provided 100 percent. Community awareness plays a vital role in preventing healthcare malfunctions (preventive health care). It is particularly crucial for the national administration and the ones responsible for the community healthcare how crucial the community awareness is in preventing malfunctioning of health. It is explained that in a study that included 190 nurses who were caring for different communities namely Asians (Southeast Asians), the blacks and Puerto Ricans, of the community health, showed a different level of confidence scores. The self-efficacy associated with the cultural was noticed to be high when blacks cared, and surprisingly the score was low when they cared for other categories, i.e., Latinos and Asians. The items such as knowledge about the factors of health beliefs and the practices of respect, modesty within individual culture and authority were counted for the low level of scoring. However, the score reached higher when interpreters were used to conveying the correct messages. The problem was lack of confidence resulted from working in a diverse culture while treating patients. These were weaknesses contained in the nursing curriculum which helps nurses to understand and respond different patients of different cultures and groups (Fooladi, 2015).
Most of the times the governments like Iran and other departments implement the preplanned healthcare initiatives to address the issues related to the community preventable health care. However, private sectors in metropolitan cities have assured their existence for offering services mainly cure based on both urban and sub-categories in the urban communities. The farther and rural regions access to multimedia is limited. Therefore, they need to be focused on primary care and preventive health services. Moreover, researchers in British studies established the view that nursing role is essential to the preventive health and they also stated that nurses reduce the risk factors to a large extent, by playing their part, in cardiovascular disease in middle-aged patients. Thus, the theory of Community health respond the concepts of nursing domains to rectify issues related to the environment, resiliency, and community abilities for healthcare in the diverse community. In essence, the nurses get the opportunity to encourage, motivate and most importantly create awareness and lead the public to make it consider health screening habit, yearly check-ups, and immunizations of childhood and adult. Finally, Nurses are playing the crucial role in the successful social healthcare program. They are an integral part of both the private and government funded health plans local and universal and their role in developing the health and wellbeing of a society cannot be denied (Fooladi, 2015).
Fawcett’s Meta-paradigm of Nursing
The meta-paradigm of any discipline as in the paper (Fawcett, 1984) is explained as being a statement or it may be the number of statements that identify phenomena relevant to them. Meta-paradigm only highlights concepts related to the discipline, but it does not link them to the assumptions of different views of the world (MacIntyre & Mcdonald, 2013). However, according to Eckberg and Hill (1979), the meta-paradigm is a framework and act as an encapsulating unit that a more restricted structure develops under it. Fawcett (1984) introduced the meta-paradigm of nursing as result of arguments that scholars jump from one topic to another very soon leaving a topic and area unconcluded. The nursing meta-paradigm that consisted of four concepts which are named to be person, environment, health, and nursing and these four concepts were interrelated. Thus it guides nurses to perform critical thinking, and it contributed to conceptual of the theory. It also guided the nursing process in everyday experiences in clinical settings. It can be, consequently, said that the meta-paradigm is related to the phenomena of interest.
In the meta-paradigm all the concepts have almost equal importance, however, in literature, there is no significant contradiction about the four concepts of meta-paradigm of nursing. Within the context of these four concepts and components of meta-paradigm and their interrelationships theory development has proceeded in nursing. Theoretically one of the parts may emphasize because of the way in which the concepts and their relationships are viewed. Despite these arguments, the role of nursing is somewhat important as it is an essential part of the paradigm as it plays a pivotal role in the paradigm.
The concept of person, as a focal point for the first exploration, needs attention so that other ideas of the meta-paradigm of nursing could be in depth explored. The concept of a person includes individuals, families, groups, and communities that are subject to the nurse care (MacIntyre & McDonald, 2013, p.63). Concerning the diversity of creation, it is evident that none of the individuals is born with same all identical features and behavior. Each person may have unique characteristics, such as different biological, psychological, social, and spiritual base (Thorne, 2010, p.66). For nurses, it is necessary to consider that each will experience different feelings because of these diverse characteristics of their body and behavior.
The second concept of the meta-paradigm of nursing the environment is explained about the other concepts. Its relation to other concepts shows the importance towards the integrity of meta-paradigm. In literature, the theme of “environment” is explained behavioral patterns of the individuals are described and predicted about their surroundings (environment). Moreover, individual behavior is influenced by environmental factors during both periods – wellness and illness. It is essential to study individuals along with the environment but not in isolation. A system and mechanism are known as “regulator” in human prepare every individual to adapt to the specific environment which changes continuously (Roy and Roberts, 1981). The Newman’s theory has explained the impact of environment on the individuals’ health as a combination of all intrinsic and extrinsic forces. The individuals are the powerful beings that continually deals with such interactions of these both forces (internal and external). The model showed that many stressors –the risk factors- work against the defense system of the body. Stressors interact and affect the defense system, and hence the defense system is breached. Consequently, the patient will be exposed to the risk for a variation in health. However, responding to the changes in the environment would develop the immune system and promote and maintain wellness.
The third concept is the health which is the absence of any disease in the body and the health care behavior which is any activity that is undertaken for the health and prevention of diseases by a person. But the term opposite of health is the illness. The illness behavior is explained as any activity undertaken to define the state of health by a person who feels ill. These activities would be aimed to discover suitable remedy (Green & Murphy, 2014).
The fourth concept is the Nursing which is the large umbrella. Nursing is defined in literature by (American Nurses ‘Association, 1980, p. 9) as the diagnosis and treatment of human responses to the problems related to health. Nursing is also an integral a part of the society, and the nursing has been grown from the same society, and still, it is in the phase of evolution. Professionally it is highly valued both within and outside that society as it is highly responsive to the needs of society. Nurses are responsible to society because the societies have given respect and want them to align their professional interests with the interests of society to a large extent. The nursing profession is dynamic but not static, and it responds the changing social needs of the people. Besides, health care is of utmost importance over the world therefor nursing provides a leadership role in leading the general mass and political leaders on many issues. Also, the general public has valued nursing to be the essential and the most-trusted professions. However, in turn, the trust imposes responsibility for nurses to try their best to provide the best health care to the public. This does mean that the nurses should be well-informed (educated), clinically smart and a professionally organized. The nurses would establish a robust and firm code of ethics, standards of care and practice. They are also required to devise educational and practice requirements that help the needs of the day, and policies that govern the profession (Neuman, 1990).
Grand theory discussion
One of the famous grand theory is the “Culture Care and Diversity and Universality theory presented by Leininger (1988)”. In theory the, the author holds that cultural care is regarded to provide to the nurses the comprehensive and most important means for study. It also provides the resources to describe, explain and predict nursing knowledge and connected nursing care activities and practice. The theory is so designed to shape a structure for the culturally compatible nursing care practices. Also, the author explains that if the nurses fully discover care meanings, its patterns, and the processes, they would be able to explain and predict all about the health of the people.
In theory, it is evident that the author discovered that cultural and care knowledge is lacked and associated them with the missing link to nursing understandings. It is necessary for the nurses to understand many variations in culture and knowledge essential to the patient care to support the conditions of wellness, compliance, and healing. These insights started the development of new construct and phenomenon related to nursing care which is called transcultural nursing in theory. Transcultural nursing is a substantive area of study and practice as explained by the author and it is intended to focus on various cultural care values, beliefs, and practices of patients belonging to either the same or different cultures. However, the primary purpose of providing universal nursing and culture-specific care practices is to promote health or well-being.
In the light of the theory, the key concepts discussed are the people belonging to the different culture, nurses and nursing, health and culture (environment). The four concepts of the phenomena of the interest are encircled in the discussion of the theory. The person the one belonging to the different cultures is discussed as having different needs and show different behavior. Likewise, the health conditions are based on the diversity of the patients of different cultures as evident from the subsequent discussion of the theory. The other concept of the phenomena is the nursing that is the pivotal point of the phenomena. In theory the, concept is more emphasized as to understand the behavior of the patients belonging to the different cultures so that the nurses can respond in the correct and precise manner. Last but not the least, the concept of the environment is discussed in theory being transcultural. It is argued that patients with different cultures possess different behaviors. Humans being the universally caring survive in a diversity of cultures and they provide universality of care in a variety of ways. The caring depends on differing cultures, needs, and settings. Thus nursing practices are needed to be designed to respond to the diversity of the behavior.
Middle range theory discussion
In contrast to grand theories, the Middle-range theories are narrower and more concrete. Middle-range theories are consisted of factors (concepts) with limited number and the testable statements which are given at the relatively concrete and specific level. Typically middle-range theories are of three types. Amongst them, descriptive middle-range theories are the basic type theories. The descriptive theory is characterized to describe or classify a particular phenomenon. It may encompass just one concept throughout the discussion.
Some theories are used to discuss the nursing phenomena. But the current study would be discussed in light of the “Nursing Process theory” written by Orlando (1961). According to this theory, a proper communication system is needed to be developed so that the patient’s urgent needs for help would be fulfilled. The patient’s prevailed behavior for help might be different from usual, i.e., it may be a cry for help. But sill the help the patient needs may be different from what it appears to be. In such circumstances, nurses are required to perceive and think about the particular behavior so that they could understand the feeling produced by their thoughts. This would help to explore the meaning associated with the behavior patient, and it would not be possible otherwise. Thus, the process helps nurses evaluate the nature of the patient’s needs and provide the help he or she requires.
It is further explained in that the creation of an effective response would require the nurses to decode the social information. However, the decoding process would be achieved by using a cognitive process that evaluates multiple factors. Apart from this emotional regulation and planned response construction are essential to arrive at an appropriate, achievable and beneficial response (Sheldon, & Ellington, 2008).
In the light of the above grand theory, several aspects of phenomena are clear. The theory can be articulated with the four concepts discussed in above sections. As for as the concept of person is concerned, the theory explains the alternative word of the patient to the person. In theory, three concepts are used one of which is patients behavior. The nurse-patient communication is developed when patients send cue in the form of behavior. In the whole process of communication, the patient behavior is interpreted and responded with a suitable answer. The cognitive ability of the nurses makes it possible to perceive the behavior and interpret it properly.
The second component that has been discussed in theory is nurse an essential concept in the phenomena of interest. The relation, in theory, is mainly based on the interaction between the nurses and patients. The nurse is the behavior responding component (Nurse’s Reaction) in theory. Nurses react in two ways to respond to the patients’ behavior. One is an observable reaction, and the other is a non-observable reaction. The non-observable response is consisted thoughts, perceptions and feelings. But the observable response is the final activity to respond the patients’ behavior. Orlando’s theory suggested that non-observable reaction is the effective an effective practice. Nurses establish a reciprocal relation with patients, and the relation becomes more dynamic and collaborative.
Since the theory is based on the communication and collaboration between the patient and nurse, the process of nursing is developed as a result. Nursing in the POI section has been defined as the diagnosis and treatment of human responses to the problems related to health, and the relation is confirmed in the theory of nursing process.
Keeping the whole discussion in mind, it can be argued that one concept – Environment- of the phenomena of interest is less focused directly on the theory. However, the idea of environment cannot be ignored in the current discussion. Moreover, no theory can be developed without considering the environment. In theory, the environment can be the hospital; it can be the friendly relation between the nurse and patient. In one way or the other, the concept has been discussed. For instance, the communication is developed when patients send cue in the form of behavior, and the behavior pattern is influenced by the environment. Thus the patient behavior is the function of the situation (context) which generates a unique behavior. And in that environment, the nurse responds to the unusual behavior so caused.
The complexity science has gained much popularity in different disciplines. Complexity is the interactions between the different parts of the system. Complexity science is concerned with the wholes not just to the elements. It is because to understand a phenomenon in a more in-depth and qualitative way. Complexity theory is defined as a collection of individuals who are free to act unpredictably and whose actions are interrelated and interconnected. In the process, one individual’s actions change the context for other individuals (reciprocal impact). The complexity system consists of a vast variety of components, and the elements have specialized functions. These components are organized at the level of internal hierarchic. The array of connectors are involved in linking the levels and parts highlighting the high density of interconnections. However, complexity theory is often used interchangeably with other terms. One of the terms most known is complex adaptive systems (CAS) (Notarnicola, Petrucci, De Jesus Barbosa, Giorgi, Stievano, Rocco & Lancia, 2017).
In light of the complexity science and complex adaptive system, it can be argued that nothing is static. The human body is not a machine which is operated sequentially. In the nursing profession, the updated knowledge is very much necessary to comprehend the behavior of the patients. However, the learning of the nurses is an unpredicted process as illustrated by the CAS. The knowledge and the response to the patients are developed as a complex and contingent environment. It contends that most of the time things happen unplanned and the planned ones rarely happen because circumstances change. Thus, it emphasizes the importance of the person, environment, and nursing.
The phenomena of interest are actually what the research is related to, explain and describe. Different but mostly few and specific concepts are used in phenomena of interest. Four of them are the person, health, environment, and nursing; central to the nursing science. The meta-paradigm has shifted the concentration of the scholars towards the left gap in nursing in the four concepts. The meta-paradigm has argued that the general public has valued nursing as a highly trusted profession and in turn, the trust makes nurses responsible for providing the valuable health care. This phenomenon of trust does mean that the nurses should be well-educated, clinically astute and a professionally organized. Several overarching theories are used to encircle the importance of the phenomena of interest. However, the grand theory is used in the study to explain the phenomena. In grand theory, the discovered that cultural and care knowledge is lacked and associated them with the missing link to nursing understandings. The author emphasized that it was necessary for the nurses to follow many variations in culture and expertise required to support wellness, compliance, and healing of the patients.
The middle-range theory “Nursing Process theory” used in the study contends that a proper communication system is needed to be developed so that the patient’s immediate needs for help would be fulfilled. The creation of an effective response would require the nurses to decode the social information. However, the decoding process would be achieved by using a cognitive process. Finally, the complexity theory states that individuals are free to act unpredictably and whose actions are interrelated and interconnected. In the process, one individual’s actions change the context for other individuals (reciprocal impact). In the process, multiple components are involved, and these components are organized at the level of internal hierarchic. Variety of connectors are included to link the levels and elements highlighting the high density of interconnection.
Eckberg, D. L., & Hill Jr, L. (1979). The paradigm concept and sociology: A critical review. American Sociological Review, 925-937.
Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Journal of Nursing Scholarship, 16(3), 84-87.
Fooladi, M. M. (2015). The Role of Nurses in Community Awareness and Preventive Health. International journal of community based nursing and midwifery, 3(4), 328.
Green, E. C., & Murphy, E. (2014). Health belief model. The Wiley Blackwell encyclopedia of health, illness, behavior, and society.
Leininger, M. M. (1988). Leininger’s theory of nursing: Cultural care diversity and universality. Nursing science quarterly, 1(4), 152-160.
Leininger, M. M. (Ed.). (1988). Care: The essence of nursing and health. Wayne State University Press.
McIntyre, M., & McDonald, C. (2013). Contemplating the fit and utility of nursing theory and nursing scholarship informed by the social sciences and humanities. Advances in Nursing Science, 36(1), 10-17.
Newman, M. A. (1990). Newman’s theory of health as praxis. Nursing Science Quarterly, 3(1), 37-41.
Notarnicola, I., Petrucci, C., De Jesus Barbosa, M. R., Giorgi, F., Stievano, A., Rocco, G., & Lancia, L. (2017). Complex adaptive systems and their relevance for nursing: An evolutionary concept analysis. International journal of nursing practice, 23(3).
Orlando I.J. (1972) The Discipline and Teaching of Nursing Process (An Evaluative Study). G. P. Putnam’s Sons, New York.
Orlando, I. (1961). The dynamic nurse-patient relationship. New York: Putnam.
Roy, C., & Roberts, S. L. (1981). Theory construction in nursing: An adaptation model. Englewood Cliffs, New Jersey: Prentice-Hall,
Sheldon, L. K., & Ellington, L. (2008). Application of a model of social information processing to nursing theory: how nurses respond to patients. Journal of advanced nursing, 64(4), 388-398.