Evolution of One Version of Our Disciplinary Metaparadigm

This blog presents the evolution of my version of nursology’s metaparadigm. I present this blog in the context of my admittedly Eurocentric white privilege perspective. Therefore, I very much welcome comments and other blogs that present different perspectives.

Jacqueline Fawcett

What apparently is the origin of the idea of or word for metaparadigm comes from Masterman’s (1970) analysis of the many ways in which Kuhn (1962) referred to paradigms. Masterman (1970) noted that one version of Kuhn’s paradigms could be considered a metaparadigm.

Definition of a Metaparadigm

Following from Masterman’s (1970) discussion, I initially defined the metaparadigm as “a statement or group of statements identifying [a discipline’s] relevant phenomena . . . in a most global manner” (Fawcett, 1984b, p. 84). Later, I expanded the definition of a metaparadigm to be “the global concepts that identify the phenomena of interest to a discipline and global propositions that state the relationships among those phenomena” (Fawcett, 1995, p. 5). Still later, I further expanded the definition to be “the global concepts that identify the phenomena of central interest to a discipline, the global propositions that describe the concepts, and the global propositions that state the relations between the concepts” (Fawcett, 2000, p. 4). Currently, I define the metaparadigm as the global concepts that identify the phenomena of central interest to a discipline, the global non-relational propositions that define and describe the concepts, and the global relational propositions that state the relations between the concepts. This definition refers to the metaparadigm concepts as of central interest, specifies non-relational and relational propositions and adds the word, define, as well as describe, to the non-relational propositions of the metaparadigm. 

Versions of the Metaparadigm of Nursology

Over time, several versions of the metaparadigm of nursology (which is the term I have been using since 2015 as the appropriate label for our discipline (Fawcett et al., 2015)), have appeared in the literature. Some versions are lists of metaparadigm concepts and some are statements of the focus of the discipline (Fawcett, 2019).

My Versions of the Metaparadigm Concepts       

My version of nursology’s metaparadigm followed from Yura and Torres’ (1975) report of the basic concepts they found in an analysis of nursing curricula as man, society, health, and nursing. In a paper I presented at a 1977 National League of Nursing-sponsored conference, I referred to these concepts, which I then labeled essential units, as person, environment, health, and nursing (Fawcett, 1978).

In my 1983 paper, “Hallmarks of Success in Nursing Theory Development,” I explained that “the term, ‘person’ was substituted for ‘man,’ to avoid sexist connotations; and the term ‘environment’ was substituted for ‘society’ to more fully denote the scope of the person’s animate and inanimate surroundings” (Fawcett, 1983, p. 4). Later, I noted that person was substituted for man “to avoid gender-specific language,” and environment was substituted for society “to more fully encompass phenomena of relevance to the person” (Fawcett, 1995, p. 8).

I continued to refer to the central concepts of the discipline as person, environment, health, and nursing (Fawcett, 1984a, 1984b, 1989, 1995, 2000) until 2005, when I changed the term, person, to human beings.

“[I made this change] in response to Leininger’s (2001) argument that the concept of person is not a globally understood term. She stated, ‘From an anthropological and nursing perspective, the use of the term person has serious problems when used transculturally, as many non-Westerns cultures do not focus on or believe in the concept person and, often there is no linguistic term for person in a culture, family and institutions being more prominent”  (Leininger, 2001,  as cited in Fawcett, 2005, p. 6).

Later, I explained that the change from person to human beings was made with the understanding that “in some cultures, the word, person, may be culturally taboo … [and] may lead to cultural clashes, cultural biases, and cultural imposition practices or to serious ethical-moral conflicts” (Leininger, 2006, as cited in Fawcett & DeSanto-Madeya, 2013, p. 6). Continuing, I explained, “[Leininger] endorsed the use of the term, human beings, because this term has a more universal transcultural meaning, carries dignity and respect for people, and is generally more acceptable transculturally” (Leininger, 2006, as cited in Fawcett & DeSanto-Madeya, 2013, p. 6). I added that this change “may address Jacobs’ (2001) charge that [t]he concept of ‘person’ . . . is . . . insufficient to represent all of nursing’s phenomena, thereby indicating a continued need for clarification and validation” (Jacobs, 2001, as cited in Fawcett & DeSanto-Madeya, 2013, p. 6).

In my most recent version of the nursology’s metaparadigm, I have listed the concepts as human beings, global environment, planetary health, and nursologists’ activities (Fawcett, in press). I changed environment to global environment and health to planetary health to acknowledge the contemporary emphasis in all countries and on the health of all human beings of our planet and to encompass the effects of climate change, peace and war, and global interpersonal violence on all human beings’ and the planet’s well-being. These two changes were catalyzed by discussions that lead to a paper for which I was one of several coauthors who represented various expert panels of the American Academy of Nursing (Kuehnert et al, 2022).

 My Versions of the Metaparadigm Propositions

            Although I had added relational propositions to my version of the metaparadigm in my 1983 paper, I did not include non-relational propositions to describe and define the concepts until a year later (Fawcett, 1984a).  

Non-relational propositions. In my 1984a book, I described the four metaparadigm concepts as: “person may be construed to mean the individual, the family, the community, society, or any other entity that is the identified recipient of nursing. Environment may encompass relevant animate and inanimate surroundings. Health may incorporate wellness and illness. And nursing may extend to the totality of activities of members of the discipline” (Fawcett, 1984a, p. 6).

Later, I described the four metaparadigm concepts slightly differently: “Person refers to the recipient of nursing actions, who may be an individual, a family, a community, or a particular group. Environment refers to the recipient’s significant others and surroundings, as well as to the setting in which nursing actions occur. Health refers to the well-being and/or illness state of the recipient. And, nursing refers to the actions taken by nurses on behalf of or in conjunction with the recipient” (Fawcett, 1989, p. 4).

Still later, I included these descriptions of the four metaparadigm concepts: “Person refers to the recipient of nursing, including individuals, families, communities, and other groups. Environment refers to the person’s significant others and physical surroundings, as well as to the setting in which nursing occurs, which ranges from the person’s home to clinical agencies to society as a whole. Health is the person’s state of well-being, which can range from high-level wellness to terminal illness. Nursing refers to the definition of nursing, the actions taken by nurses on behalf of or in conjunction with the person, and the goals or outcomes of nursing actions. Nursing actions typically are viewed as a systematic process of assessment, labeling, planning, intervention, and evaluation” (Fawcett, 1995, p. 7)

Still later, I refined the definitions of the four metaparadigm concepts given here.

  1. The metaparadigm concept person refers to individuals, families, communities, and other groups who are participants in nursing.
  2. The metaparadigm concept environment refers to the person’s significant others and physical surroundings, as well as to the setting in which nursing actions occurs, which ranges from the person’s home to clinical agencies to society as a whole. The metaparadigm concept environment also refers to all the local, regional, national, and worldwide cultural, social, political, and economic conditions that are associated with human beings’ health.
  3. The metaparadigm concept health refers to the person’s state of well-being at the time that nursing occurs, which can range from high-level wellness to terminal illness.
  4. The metaparadigm concept nursing refers to the definition of nursing, the actions taken by nurses on behalf of or in conjunction with the person, and the goals or outcomes of nursing actins. Nursing actions typically are viewed as a systematic process of assessment, labeling, planning, intervention, and evaluation.  
(Fawcett, 2000, p. 5)

In this version of the non-relational propositions, person is regarded as a participant in, rather than a recipient of, nursing. “That change was made to better reflect the contemporary emphasis on the person as an active participant the nursing process, rather than a passive recipient of pronouncements by and ministrations from nurses” (Fawcett, 2000, p. 5). In addition, the definition of environment was expanded “to better reflect the multitude of environmental conditions that are relevant in nursing” (Fawcett, 2000, p. 5).

 The next version of the non-relational propositions incorporates the change of the metaparadigm concept of person to human beings (Fawcett, 2005, pp. 6-7).

  1. The metaparadigm concept of human beings refers to individuals, if individuals are recognized in a culture, as well as to families, communities, and other groups or aggregates who are participants in nursing.
  2. The metaparadigm concept of environment refers to human beings’ significant others and physical surroundings, as well as to the setting in which nursing actions occurs, which ranges from the person’s home to health-care facilities to society as a whole. The metaparadigm concept of environment also refers to all the local, regional, national, and worldwide cultural, social, political, and economic conditions that are associated with the human beings’ health.
  3. The metaparadigm concept of health refers to human processes of living and dying.
  4. The metaparadigm concept of nursing refers to the definition of nursing, the actions taken by nurses on behalf of or in conjunction with human beings, and the goals or outcomes of nursing actins. Nursing actions typically are viewed as a mutual process between the participants in nursing and nurses. The process encompasses activities that are frequently referred to as assessment, labeling, planning, intervention, and evaluation. 
(Fawcett, 2005, p. 6)

            Note that in this version of the non-relational propositions, the definition of health changed from states of wellness and illness to human processes of living and dying. This change was made in response to the point that Fawcett’s “view of health as a ‘state’ that can be characterized on a continuum from ‘high-level wellness to terminal illness’ . . . [implies that] everyone’s health ultimately and unavoidably reaches abysmal levels in the natural dying process” (Cody, 1996, as cited in Fawcett, 2005, p. 7). In addition, the term, clinical agencies, was changed to health-care facilities in the definition of environment. This change was made with the thought that health-care facilities could refer to non-clinical settings in which nursing occurs, such as in a community at large.

The next version of the non-relational propositions (Fawcett & DeSanto-Madeya, 2013) is the same as the 2005 version with the exception of elimination of the word, of, before the label for each metaparadigm concept. For example, “The metaparadigm concept health refers to human processes of living and dying” (Fawcett & DeSanto-Madeya, 2013, p. 6).

            The most recent of my versions of the non-relational propositions for the four metaparadigm concepts are listed here.

  1. Human beings is defined as “human beings of all cultures across the globe (and perhaps in the universe)” (Fawcett, in press).
  2. The global environment is defined as “human beings’ personal environments and the surrounding global environment within the context of climate change, peace and war, and global interpersonal violence” (Fawcett, in press).
  3. Planetary health is defined as “human beings’ and the planet’s continued evolution to wellbecoming” (Fawcett, in press).
  4. Nursologists’ activities is defined as “the definition of [nursology], the actions taken by [nursologists] on behalf of or in conjunction with human beings, and the goals or outcomes of [nursologists’] actions . . . [which] are viewed as a mutual process between the participants in [nursology] and [nursologists]. The process encompasses activities that are frequently referred to as assessment; labeling, or what some [nursologists] refer to as diagnosis; planning; intervention; and evaluation” (Fawcett & DeSanto-Madeya, 2013 as cited in Fawcett, in press)

Relational propositions. In the 1983 paper, I identified the primary relational proposition of our disciplinary metaparadigm as “Nursing [is concerned with] the wholeness or health of humans, recognizing that humans are in continuous interaction with their environments” (Donaldson & Crowley, 1978, as cited in Fawcett, 1983 p. 5). I then added three other relational propositions, which I noted were “major areas of interest to the discipline” (Fawcett, 1983, p. 5). These relational propositions are: 

  1. [T]he principles and laws that govern the life process, well-being, and optimum function of human beings
  2. [T]he patterning of human behavior in interaction with the environment in normal life events and critical life situations
  3. [T]he processes by which positive changes in health status are effected   

(Donaldson and Crowley, 1978, & Gortner, 1980, as cited in Fawcett, 1983, pp. 5-6)

In my 1984b paper and 1989 books, I cited the same three relational propositions as I had in the 1983 paper (Fawcett, 1983, 1984b. 1989). By 1995, I changed the wording of these three relational propositions to include “The discipline of nursing is concerned with …  and changed the word optimum to optimal in the first proposition. This wording continued in my 2000 book.

  1. [T]he discipline of nursing is concerned with principles and laws that govern the life process, well-being, and optimal function of human beings, sick or well.
  2. [T]he discipline of nursing is concerned with patterning of human behavior in interaction with the environment in normal life events and critical life situations.
  3. [T]he discipline of nursing is concerned with the nursing actions or processes by which positive changes in health status are effected.   

(Fawcett, 1995, p. 7; 2000, p. 5)

In 2005 and continuing in 2013, I revised the wording of the three relational propositions to emphasize the focus on human beings rather that the person:

  1. The discipline of nursing is concerned with principles and laws that govern human processes of living and dying.
  2. The discipline of nursing is concerned with the patterning of human health experiences within the context of the environment.
  3. The discipline of nursing is concerned with the nursing actions or processes that are beneficial to human beings.   

(Fawcett, 2005, p. 6; Fawcett & DeSanto-Madeya, 2013, p 6)

Noteworthy is that in my 1984a book, I did not include the three relational propositions listed earlier, although I did include a relational proposition that links the four metaparadigm concepts: “Nursing studies the wholeness or health of humans, recognizing that humans are in continuous interaction with their environments” (Donaldson & Crowley, 1978, as cited in Fawcett, 1984a, p. 6; 1989, p. 6). By the time of publication of my 1995 and 2000 books, the wording of this major relational proposition changed slightly by substituting “is concerned with” for “studies”: “[T]he discipline of nursing is concerned with the wholeness or health of humans, recognizing that humans are in continuous interaction with their environments” (Fawcett, 1995, p. 7; 2000, p. 5). This relational proposition was revised for my 2005 and 2013 books:  “The discipline of nursing is concerned with the human processes of living and dying, recognizing that human beings are in a continuous relationship with their environment” (Fawcett, 2005, p. 6; Fawcett & DeSanto-Madeya, 2013, p. 6)  

The one relational proposition for my most recent version of nursology’s metaparadigm is:Nursologists’ activities are directed toward human beings and planetary health within the context of the global environment” (Fawcett, in press).

I offer these several of my versions of the metaparadigm so that readers of this blog and the in press paper may cite the most recent version rather than the version published in my widely cited 1984b paper. 

References

Donaldson, S. K., & Crowley, D. M. (1978). The discipline of nursing. Nursing Outlook, 26(2),113–120.

Fawcett, J. (1978). The what of theory development. In Theory development: What, why, how? (pp. 17-33). National League for Nursing.

Fawcett, J. (1983). Hallmarks of success in nursing theory development. In P. L. Chinn (Ed.), Advances in nursing theory development (pp. 3-17). Aspen.

Fawcett, J. (1984a). Analysis and evaluation of conceptual models of nursing. F. A. Davis.

Fawcett J. (1984b). The metaparadigm of nursing: Present status and future refinements. Image,16(3), 84–87.

Fawcett, J. (1989). Analysis and evaluation of conceptual models of nursing (2nd ed.). F. A. Davis.

Fawcett, J. (1995). Analysis and evaluation of conceptual models of nursing (3rd ed.). F. A. Davis.

Fawcett, J. (2000). Analysis and evaluation of contemporary nursing knowledge: Nursing conceptual models and theories.  F. A. Davis.

Fawcett, J. (2005). Analysis and evaluation of contemporary nursing knowledge: Nursing conceptual models and theories (2nd ed.).  F. A. Davis.

Fawcett, J. (2019, March 21) Questions and Answers about our Discipline: Name and Metaparadigm. Paper presented at the Nursing Theory: A 50 Year Perspective Past and Future Conference. Sponsored by Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH. nursology.net. https://nursology.net/wp-content/uploads/2019/03/cwru-paper-fawcett-3-28-19.pdf

Fawcett, J. (2022a, June 17). The metaparadigm of nursing: Recent thoughts. Video conference presented for faculty and students at Universidade Federal da Bahia, Brazil.

Fawcett, J., (2022b). Thoughts about the environment. Nursing Science Quarterly, 35(2), 27-269. doi:10.1177/08943184211070578 

Fawcett, J. (in press). Thoughts about the metaparadigm of nursing: Contemporary status and recommendations for evolution. Nursing Science Quarterly.

Fawcett, J., Aronowitz, T., AbuFannouneh, A., Al Usta, M., Fraley, H. E., Howlett, M. S. L., Mtengezo, J. T.,  Muchira, J. M., Nava, A., Thapa, S., & Zhang, Y. (2015). Thoughts about the name of our discipline. Nursing Science Quarterly, 28(4), 330-333. doi: 10.1177/0894318415599224 

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.

Kuehnert, P., Fawcett, J., DePriest, K., Chinn, P., Cousin, L., Ervin, N., Flanagan, J., Fry-Bowers, E., Killion, C., Maliski, S., Maughan, E. D., Meade, C., Murray, T., Schenk, B., & Waite, R. (2022).  Defining the social determinants of health for nursing action to achieve health equity. A consensus paper from the American Academy of Nursing. Nursing Outlook, 70(1), 10-27.  doi:10.1016/j.outlook.2021.08.003.

Kuhn, T. S. (1962). The structure of scientific revolutions. University of Chicago Press.

Masterman, M. (1970). The nature of paradigm. In I. Lakatos & A. Musgrave (Eds.), Criticism and the growth of knowledge (pp. 59-89). Cambridge University Press.

Yura, H., & Torres, G. (1975). Today’s conceptual framework within baccalaureate nursing programs. In Faculty-curriculum development. Part III. Conceptual framework—its meaning and function (pp. 17-25). National League for Nursing.

8 thoughts on “Evolution of One Version of Our Disciplinary Metaparadigm

  1. Thank you for this post. It is the evolution of thoughtful, intentional thinking and revisiting and revising it over time due to new knowledge, changes in societal norms, disciplinary evolution, etc.

  2. What a fantastic review of the evolution of your metaparadigm. This provides important historical context for future scholars, but also serves as an exemplar of the value and importance of ongoing reflection and revision.

    • Thank you so much Jacqui!! In my view, this is a great evolution. I see Planetary Health through the lens of Rogerian Science of Unitary Human Beings (SUHB) and Unitary Caring Science. There are no boundaries. The human being and environment are coextensive fields. Caring and healing for humans and the planet. The health and wellbeing of human beings and the health of the planet are given together. Yes, this is a focus of our discipline at the broadest and most abstract level. THANK YOU!.

  3. Hi Jacqueline
    Thanks so much for this clearly formulated and well explained evolution of nursologie’s meta paradigm including all references.

    While I strongly support the newest changes, I stumble over the change from health – which describes(d) the health of humans as recipients of nursing care. By naming this concept explicitly “planetary health” the health of humans is not included.

    Additionally, stating nursing diagnoses contains much more than “labeling” (=formulating a diagnostic title). Clinical reasoning and critical thinking during the nursing assessment(s) are needed before a nursing diagnosis is stated. Research has shown that documenting the label only is not enough.
    Each nursing diagnosis has a definition (implemented into EHRs database) and standardised, evidence-based defining characteristics and related (etiological) or risk factors. These components define the whole nursing diagnostic concpet, and are to be implemented into Electronic Health Records (EHR) databases.

    Nowadays, nursing diagnoses are taught and applied internationally, and important to document the Advanced Nursing Process in EHRs.

    For this reasons, I suggest to write: labelling/diagnosing – or to delete the term “labelling” altogether. This also would be coherent with ANA’s statement on nursing and on the nursing process.

    Literature:

    Ackley, B. J., Ladwig, G. B., & Flynn Makic, M. B. (2020). Nursing diagnosis handbook: An evidence-based guide to planning care (12 ed.). St. Louis: Mosby/Elsevier.

    Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015a). Expert report on nurses’ responsibility. Bern: Swiss Nursing Science Association (ANS).

    Müller Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015). Rapport d’expertes concernant le domaine de responsabilité des soins infirmiers. Bern: Association Suisse Pour les Sciences Infirmières (AAPSI).

    Müller-Staub, M., Abt, J., Brenner, A., & Hofer, B. (2015b). Expertenbericht zum Verantwortungsbereich der Pflege. Bern: Schweizerischer Verein für Pflegewissenschaft VFP.

    Respectfully
    Maria Müller Staub

  4. Colleagues, Thank each of you for your supportive comments.

    Maria, Thank you for sharing your concerns. Clearly, I have to clarify my definition of planetary health, as I certainly meant to include human beings.
    I have rejected the term, diagnosis, as, according to Myra Levine (Conservation Model), the word means knowledge of disease. Myra referred to the activity as trophicognosis, meaning nursing judgements I used labelling as a more generic term. Some may prefer diagnosis and others may prefer trophicognosis.

    Best regards, Jacqueline Fawcett

  5. Jacqueline, Im thankful for your reply and glad that planetary health will be specified to include human health.
    With respect to “diagnosis” I don’t agree that it solely addresses diseases. Diagnosis stems from the late 17th century: modern Latin, resp. originally from Greek: diagignōskein, and means ‘distinguish, discern’, from dia ‘apart’ + gignōskein ‘recognize, know’.

    Today, even mechanics are diagnosing (distinguishing, recognising, knowing), and car repairs follow after a diagnosis was stated. Several professions state diagnoses to distinguish the concepts of their concern, and in their professional language (so do informaticists). We learnt the diagnosis is the conclusion / summary statement which follows/summarizes the clinical reasoning process (Alfaro, 2010; Gordon, 2015; Lunney, 2009/2010; Müller-Staub, 2006; Müller-Staub & Stuker-Studer, 2006; Müller-Staub, 2008, 2010 + 2012).

    Besides that, health care laws of several countries made it mandatory/obligatory to state and document nursing diagnoses (e.g. Austria, Germany, Swiss education, Spain, Brazil and others).

    It becomes more and more clear to nursing scientists, other health professionals and politicians that nursing needs to be made visible in Electronic Health Reports (EHRs):
    Not only nurses interventions or nursing “tasks” focusing on the medical model – but the full caring assessments and activities (e.g. nursing diagnoses such as anxiety, grieving, powerlessness, stress-overload, hopelessness, family caregiver burden, or spiritual distress.
    And all diagnoses have to be meaningfully linked with their related, evidence-based nursing interventions, which lead to nursing-sensitive patient outcomes.

    How can nursology be made understandable/visilbe if we don’t document the spiritual/emotional aspects of care and caring?

    Even if the link between nursing theories/models and nursing language and the nursing process documentation is still weak, we need to close this gap. Otherwise nursing remains invisible, “the silent discipline” (Germini et al, 2010; Kemmer & Paes da Silva, 2007, Morris et al, 2010).

    Using the full nursing process as described by Standardized Nursing Language (SNL) was strongly supported in a recent conference of the Friends of the National Library of Medicine named “Honoring the Legacy of Virginia Saba”. Almost every presenter stressed that nursing is made visible in the Electronic Health Record by using/documenting the full nursing process, which includes: Nursing assessment, diagnosis, planning (outcomes and interventions), performing, and evaluation. And all nursing process phases are to be stated by using Standardized Nursing Language (SNL). SNLs represent individual patients/humans care needs, and what nurses do to achieve good patient outcomes.
    If we miss this, nursing/nursology will never be made visible and shared electronically in the health care team, with patients/their families, and across health care settings.

    I hope to further help linking these gaps to strengthen nursology and enhance patient outcomes.

    Kind regards
    Maria

    Maria Müller Staub (PhD, EdN, MNS, RN, FNI, FEANS)
    ACENDIO President

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