Technology: A metaparadigm concept of nursing

Undoubtedly, technology continues to permeate the world at an unprecedented pace. The discipline of nursing is not alien to this phenomenon as nurses continue to employ various technological objects and applications in clinical practice, education, administration and research. Despite the centrality of technology in nursing, it has not been recognised as a metaparadigm domain of interest in the discipline of nursing. Thus, this paper sought to examine if technology truly reflected a metaparadigm domain using the four requirements posited by Fawcett. Using these requirements, we examined the onto-epistemology of technology in relation to nursing and conclude that technology potentially represents a distinct domain that intersects with nursing (particularly, from the humanities perspective). Also, technology encompasses some phenomena of interest to the discipline of nursing, demonstrates perspective-neutrality, and is international in scope and substance albeit with some nuances which do not fit well with nursing onto-epistemology. Put together, it is highlighted that technology intersects with the existing metaparadigm domains (person, health, environment and nursing) which positions it as a potential phenomenon of interest to the discipline of nursing requiring further work to articulate its position and role.     

Re‐conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice

Jacqueline Fawcett's nursing metaparadigm—the domains of person, health, environment, and nursing—remains popular in nursing curricula, despite having been repeatedly challenged as a logical philosophy of nursing. Fawcett appropriated the word “metaparadigm” (indirectly) from Margaret Masterman and Thomas Kuhn as a devise that allowed her to organize then‐current areas of nursing interest into a philosophical “hierarchy of knowledge,” and thereby claim nursing inquiry and practice as rigorously “scientific.” Scholars have consistently rejected the logic of Fawcett's metaparadigm, but have not yet proposed a substantially agreed‐upon alternative. Through an analysis of articles introducing and critiquing Fawcett's metaparadigm, I argue for a re‐conceptualized metaparadigm that articulates nursing's ontology. What exists for the nursing discipline are not already‐demarcated metaparadigm domains, but rather interdependent, dynamic relations that constitute people, including nurses, in their health/environment circumstance. The nursing discipline aims to skillfully access this dynamic relationality as the basis for action and reflection to produce both positive health trajectories and knowledge that facilitates future action and reflection. Further inquiry into the onto‐epistemology of nursing will produce a more robust understanding of nursing practice, science, and philosophy, and clarify its unique contribution to health and healthcare.     

A personal nursing philosophy in practice

The use of a nursing philosophy as the basis for nursing practice promotes the proper application of nursing knowledge as well as the development of further nursing theory and knowledge. My personal philosophy of nursing seeks to encompass the art of conveying nursing science holistically with compassion and dignity. To illustrate this nursing philosophy, the four nursing metaparadigm concepts are described in relation to nursing as both a science and an art. Nursing science and art are also discussed in relation to nursing as a profession. The concepts of family-centered care and developmental care highlight the practice of nursing as an art. The use of nursing knowledge in practice is discussed through the use of nursing's five ways of knowing, nursing theories, borrowed theories, and nursing's paradigms. The concept of the nurse scholar and the further development of nursing knowledge is identified as a priority. Supportive examples from my nursing experience working in a Neonatal Intensive Care Unit (NICU) are utilized to highlight the importance of nursing knowledge development and the provision of optimal patient care.     

Teaching strategies to incorporate genomics education into academic nursing curricula

The translation of genomic science into health care has expanded our ability to understand the effects of genomics on human health and disease. As genomic advances continue, nurses are expected to have the knowledge and skills to translate genomic information into improved patient care. This integrative review describes strategies used to teach genomics in academic nursing programs and their facilitators and barriers to inclusion in nursing curricula. The Learning Engagement Model and the Diffusion of Innovations Theory guided the interpretation of findings. CINAHL, Medline, and Web of Science were resources for articles published during the past decade that included strategies for teaching genomics in academic nursing programs. Of 135 articles, 13 met criteria for review. Examples of effective genomics teaching strategies included clinical application through case studies, storytelling, online genomics resources, student self-assessment, guest lecturers, and a genetics focus group. Most strategies were not evaluated for effectiveness.     

State of nursing science: on the edge

Nurse scientists have had great and important successes contributing to science and to patient care. To review the state of nursing science is an enormous and complex challenge, and yet the pace of discovery constantly quickens. The purpose of this article, which was read at the 2002 State of the Science Congress, was to use the human response model to describe the domains of nursing science and note exemplary, innovative developments in the context of the model's "person" and "environmental" domains. Advances are noted in genetics, aging, development, and gender studies; also noted is work in infection care, disaster care, and identification of health disparities. Asked to predict the future, we chose instead to describe societal challenges and speculate how nursing leaders can contribute importantly by applying nursing's unique perspective. Benchmarks of our success will include reversal of the nursing shortage, patients living to their highest potential, and penetration of evidence based care into clinical practice and health policy. Furthermore, the media and the public will view nurse scientists as key informants related to clinical care. Nurse scientists will be elected to lead major interdisciplinary organizations, our training programs will prepare new scientists with the knowledge and skills to enter a competitive and ever-evolving field, our schools will have adequate infrastructure to support the advancement using cutting-edge technology, centers of excellence will provide research consultation and collaboration beyond university boundaries, and nurse scientists will assume a more visible role in translational research.     

对社区慢性病患者延续护理服务真实需求的调查

目的：了解社区慢性病患者对三元联动延续护理服务的真实需求。方法自行设计调查表,采用便利抽样法选取5家社区的200例慢性病患者进行调查。结果共发放问卷200份,回收有效问卷178份,有效率为89％。对延续护理服务项目非常了解的慢性病患者仅占21．4％（38/178）;希望出院后继续接受医护照护的慢性病患者占80．9％（144/178）;38．2％（68/178）的慢性病患者“不确定”延续护理服务对疾病疗效的影响;77．5％（138/178）的慢性病患者担心延续护理服务的自费比例问题。社区慢性病患者对延续护理服务的需求包括安全用药知识、血压控制及自我监测、饮食指导、疾病相关知识、血脂及血糖控制与监测、康复锻炼方法等。希望由社区护士提供院外护理服务的慢性病患者仅占8．4％（15/178）。结论社区慢性病患者对延续护理服务内容的需求量比较大,但是尚存在一些瓶颈,因此要充分利用社区护士人力资源,有效开展医院-社区-家庭三元联动延续护理服务。     

Mental health nursing in the 21st century

Mental health nursing in the 21st century will expand to include a neuropsychiatric focus that encompasses the science, knowledge, and skills of both neurology and psychiatry. The shift to neuropsychiatric nursing is directed by the explosion of knowledge in the neurobiologic basis of mental illness, tremendous advances in diagnostic technology, and the discovery of new and more effective psychopharmacologic treatments. Neuropsychiatric disorders are common, disabling, costly, and stigmatizing. A neuropsychiatric paradigm allows treatment to reach more people who are affected and is less stigmatizing than a psychosocial view alone. Neuropsychiatric advanced practice nurses will need both primary care and specialty knowledge and skills. The challenge to nursing education is to determine how best to incorporate this knowledge and skills into curricula. Neuropsychiatric research must focus on both biologic and behavioral measures and interventions. The philosophical and ethical challenge to nursing is to integrate biologic and behavioral concepts into the nursing care of mentally ill people while remaining centered in the nursing domain and maintaining our focus on caring and our sensitivity to the human condition.     

Social justice: added metaparadigm concept for urban health nursing

Historically, the nursing metaparadigm has been used to describe 4 concepts of nursing knowledge (person, environment, health, and nursing) that reflect beliefs held by the profession about nursing's context and content. The authors offer an assessment of the metaparadigm as it applies to community and public health nursing in urban settings and offer an amendment of the metaparadigm to include the central concept of social justice. Each of the metaparadigm concepts and the central concept of social justice is discussed as it applies to a model of urban health nursing teaching, research, and practice.     

The global context of nursing: a human becoming perspective

When one considers global health issues from the natural science worldview, it is with a belief that no one person can have any significant influence, hence, a sense of powerlessness and disconnection. In this column, though, the authors assert that when one's perspective is the human science paradigm, and particularly, the human becoming theory, one person can and does make a difference in global health. The authors discuss the human becoming perspective using the metaparadigm concepts of human, health, and environment, and also, nursing practice guided by the theory. Informed by this perspective, they then explore political implications for global nursing and health.     

Art, science and social science in nursing: occupational origins and disciplinary identity

Art, science and social science in nursing: occupational origins and disciplinary identity
This paper forms part of a wider study examining the history and sociology of nursing education in England between 1860 and 1948. It argues that the question of whether nursing was an art, science and/or social science has been at die 'heart' of a wider debate on die occupational status and disciplinary identity of nursing. The view that nursing was essentially an art and a 'calling', was championed by Florence Nightingale. Ethel Bedford Fenwick and her allies insisted that nursing, like other professions, was a 'scientific' and technical enterprise. Social scientists later came to challenge nursing's claim to professionalism by analysing nursing work first within die context of industrial psychology. But they also advocated a rapprochement between nursing, health services and social science research, a challenge which we are in nursing, still striving to meet This paper argues for a strong coalition of nursing with its former nineteenth century ally, social science, in die continuing struggle for change within nursing and health care policy. Rather than searching for some rarified and purified essence of nursing knowledge, it argues that nurses need to join forces with sociologists and economists in striving to shape die agenda for health services research and provide die evidential basis for health policy transformation more generally.     

The Family as the Unit of Care in Nursing: A Historical Review

Current discussions of nursing theory identify the metaparadigm of nursing as focused upon person, environment, health, and nursing. Literature was reviewed to determine if historical and current sources supported the understanding that the family as recipient of care was a continuing nursing focus. The review supported the contention that the family unit has been an early, continuing, and ever increasing focus of nursing care. Public health nursing was the first clinical area to emphasize service to families, and this continuing emphasis is evident for this practice area. The conclusion is drawn that if the family is now deemphasized as a unit of analysis and care, an historically important focus will be abandoned.     

The nursing metaparadigm concept of human being in Islamic thought

The metaparadigm concept of person as a core emphasis for nursing theorizing has attracted considerable attention in western literature, but has received less attention in the context of eastern philosophical contexts. In this philosophical inquiry, we sought to clarify the concept of what it is to be a human being according to ideas deriving from Islamic tradition, drawing on concept analysis as general approach to advance an understanding of how nursing within an Islamic context might operationalize metaparadigm conceptualization. Specifically, we considered person as human being on the basis of its definition, attributes/characteristics and boundaries to explore the anatomy of the concept in this context. Our analysis revealed that Islamic thought is relevant to two distinct understandings of the holistic concept of human being. Reciprocal interaction worldview organizes the dimensions of being human (cognitive, emotion, social and spiritual) into a whole. Simultaneous action worldview emphasizes that the human is a coherent and unified creature in harmony with the universe. In Islamic thought, these two worldviews are integrated and operate concurrently. Nurse–patient interactions arising from an integrated perspective that aligns both of these worldviews will allow for informed applications of knowledge to practice and enhanced patient care.     

Mandatory continuing education: past, present, and future trends and issues

Mandatory continuing education (CE) for nurses continues to be a viable means by which nurses can remain competent in the face of ever-increasing knowledge and technology in the health care setting. A multiplicity of CE providers, offering a variety of teaching approaches, exists to ensure nurses remain competent and advance in their fields of practice. Presently, more research must be conducted to measure the effectiveness of CE programs on patient care outcomes. Scholarly investigation may assist in justifying mandatory CE for nurses if positive patient care outcomes can be identified. Several states are regulating professional nursing practitioners by requiring CE. Although some states have not endorsed mandatory CE for nurses, it is likely that more state boards of nursing will continue the slow but steady trend of requiring CE for relicensure--especially if research establishes positive patient care outcomes.     

Management of technology and its influence on nursing care

Currently, much nursing care adheres to a specific biomedical paradigm within the positivist framework. However, sometimes nursing care cannot be adapted to numerous human or vital conditions affecting our patients, their families or the environment in which nurses work. An specific example of these nursing interventions are those applied in intensive care units (ICU) where there is a large amount of technology and nursing care is specialized. Several questions that arise are whether the above-mentioned specialization is inherent to nurse care, whether technology management forms part of nursing care, whether this care has a non-nursing origin, and what is the source of nursing knowledge. The present article aims to provide basic knowledge to distinguish the nursing care performed in the ICU within the 2 predominant paradigms in current nursing: the biomedical and the holistic paradigms. The characteristics of nursing care in both paradigms are described and an integrated vision of these 2 paradigms and of nursing care with and without the use of technology is provided.     

Genetic discoveries and nursing implications for complex disease prevention and management.

The purpose of this article is to examine the management of patients with complex diseases, in light of recent genetic discoveries, and to explore how these genetic discoveries will impact nursing practice and nursing research. The nursing science processes discussed are not comprehensive of all nursing practice but, instead, are concentrated in areas where genetics will have the greatest influence. Advances in genetic science will revolutionize our approach to patients and to health care in the prevention, diagnosis, and treatment of disease, raising many issues for nursing research and practice. As the scope of genetics expands to encompass multifactorial disease processes, a continuing reexamination of the knowledge base is required for nursing practice, with incorporation of genetic knowledge into the repertoire of every nurse, and with advanced knowledge for nurses who select specialty roles in the genetics area. This article explores the impact of this revolution on nursing science and practice as well as the opportunities for nursing science and practice to participate fully in this revolution. Because of the high proportion of the population at risk for complex diseases and because nurses are occupied every day in the prevention, assessment, treatment, and therapeutic intervention of patients with such diseases in practice and research, there is great opportunity for nurses to improve health care through the application (nursing practice) and discovery (nursing research) of genetic knowledge.     

Said another way. My definition of nursing

The definition of nursing has evolved since the introduction of the definition by the American Nurses Association in 1980. The society we nurses serve has changed significantly and members of the society demand quality health care and respect for their individual decisions regarding their health care. As a profession, we must keep our fingers on the pulse of society and be ready to respond to the changes of society's needs. Being diligent in defining our position in society is imperative for the preservation of the nursing profession. This paper supports the current definition of the ANA (2003) within the domains of the art, science, and practice of nursing.     

Systems biology for nursing in the era of big data and precision health

Background

The systems biology framework was previously synthesized with the person–environment–health–nursing metaparadigm.

Health-promoting nursing practice: the demise of the nursing process?

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective The nursing process is based in the natural science paradigm and on a biomedical approach to health care In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective Such a shift requires a radical transformation in nursing practice as nurses move away from the'top-down'approach of the nursing process and adopt a'bottom-up'approach to health-promoting nursing practice The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice In particular, a framework for health-promoting nursing practice will be provided     

Describing a model of nursing as a focus for psychiatric nursing care

This thesis would not be complete in it's review of Psychiatric nursing and Psychiatric nurse education, without reference to one of the fundamental changes that is occurring in nursing. One of the major changes that had occurred in recent years has been in the focus of nursing management nurses are placing much more emphasis on nursing diagnosis and nursing theories and are detaching from the more traditional medical model when planning nursing care. This movement towards a greater autonomy in planning their nursing care is assisting nurses in becoming a professional and independent group. Nurses are establishing a body of knowledge and skills which may be called "nursing science". Through the use of nursing models for planning patient and health care, nurses are offering a better service to the individual and the community. These changes in the focus of care commenced in the 1950's within the United States with the introduction of nursing models and theories. The Philosophies and concepts of these theories have outlined various methods and ways that the nurse could better plan and organize their professional work, including patient assessment and care. As early as 1953 the term "nursing diagnosis" was introduced by Fray to describe a step in the organization of a nursing care plan. (1) The various nursing models and theories seemed to have coincided with the movement through the 1950's and 1960's within America towards more generic based integrated curricula.     

Feminism and public health nursing: partners for health

It is a well-known fact that nursing and feminism have enjoyed an uneasy alliance. In recent years, however, nursing has begun to recognize the importance of feminism. Nevertheless, the literature still rarely addresses the relevance of feminism for public health nursing. In this article, I articulate the relevance of feminism for public health nursing knowledge and practice. First, I define and describe feminism and public health nursing and then I discuss the importance of feminism for public health nursing practice. The importance of feminism for the metaparadigm concepts of public health nursing is then reviewed. Finally, I examine several existing challenges relating to feminism and public health nursing research, education, and practice. The thesis of this article is that feminism is vitally important for the development of public health nursing and for public health care.