Nursing knowledge development through research: using the Roy adaptation model

Almost half of the ancillary propositions tested in the metaparadigm category were related to the concept of person, and 94% were supported. Theoretically and empirically, there is support for Roy's conceptualization of the person as an adaptive system. Almost 25% of the ancillary propositions tested were related to the concept of health, of which the great majority were supported. Theoretically and empirically, there is support for Roy's conceptualization of health as an outcome of adaptation. Approximately 75% of the ancillary propositions tested were related to the concept of person or health. Of these, only 5 out of 55 ancillary propositions were not supported, or less than 10%. Less than 13% of the ancillary propositions that were tested focused on the metaparadigm concepts of environment or nursing. Of these, 15% were not supported. These findings are not surprising, because conceptual clarity is the foundation of practice theory. The hierarchy of research, according to the classic work by Dickoff and James (1968), progresses from understanding and describing phenomena to situation-producing theory. Nursing models are relatively young. Research is required to validate the concepts within the models. Situation-producing theory, based on the concepts, guides nursing actions and is necessary for a practice discipline to maintain its status as a profession. Based on the findings of the integrative research review, adequate research has provided support for Roy's conceptualization of the metaparadigm concepts of person and health. Future research needs to be directed toward testing propositions derived from the RAM concepts of environment and nursing. Intervention studies need to be designed based on concepts that have been supported. Knowledge development through research and testing of propositions based on the RAM continues to contribute to nursing science. Future directions for RAM research are clear.     

The Metaparadigm of Nursing: Present Status and Future Refinements

The central concepts and themes of the discipline of nursing are identified and formalized as nursing's metaparadigm. Examples illustrate the direction provided by the metaparadigm for theory development. Refinements of the metaparadigm through conceptual models and programs of nursing research are proposed.     

Nursing's metaparadigm concepts: disimpacting the debates

Theoretical advances in nursing have been complicated by polarization and extreme positions regarding nursing's approach to its main metaparadigm concepts: person, health, environment and nursing. In this paper, the authors deconstruct some of the central arguments that are used to further this polarization. Using a critical interpretive approach, they explain some of the logical implications imposed by various extreme positions for the larger project of nursing's health and social mandate, and consider the effects of such polarization. On the basis of an appreciation of the serious difficulties inherent in certain philosophical and theoretical positions currently evident within nursing's literature, the authors argue for a less extreme and more integrated reference point for nursing's theory and practice.     

Nursing Theory and Public Health Science: Is Synthesis Possible?

The American Public Health Association (APHA) and the American Nurses' Association (ANA) have gone on record to define public health nursing as a synthesis of knowledge (APHA) and practice (ANA) from nursing and public health. If this synthesis is to be consistent with nursing, knowledge will have to be congruent with the concepts of nursing's metaparadigm. Disease is not included within the concepts of person, environment, health, and nursing. The focus of the public health tradition is reflected in the concepts of the epidemiologic model (agent, host, environment). Disease and its prevention are the focus of public health science. Reformulation of concepts from public health to be consistent with concepts of person and environment, replacing the concept of illness with that of health, and using methods for study of aggregates are strategies for achieving a synthesis of these two bodies of knowledge.     

Toward Understanding the Self

Others may know "me" but only "I" am the knower of myself. The metaparadigm of nursing includes four concepts: health, environment, nurse, and person. Each concept is complex and can be interpreted in diverse ways. The concept analysis in this article focuses on one aspect of person, specifically "self:" its birth, development, and loss. The author makes suggestions for using the analysis in nursing education, theory development, and clinical practice in caring for and promoting the health of individuals, groups, and families.     

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.     

Structural competency in mental health nursing: Understanding and applying key concepts

Achieving mental health equity requires that nursing address structures that impede the ability of individuals and populations to achieve optimal mental health. Consistent with calls for structural change, this paper intends to promote structural competency in mental health nursing by applying this concept to the field. The first half of the paper discusses structural competency and key concepts vital for its development, namely, structure, social influencers of mental health, equity, structural justice, and historical understanding. In the second half we apply structural competency to mental health nursing at the educational, practice and system levels and conclude with recommendations for change.     

Just-relations and responsibility for planetary health: The global nurse agenda for climate justice

There is an urgent call for nurses to address climate change, especially in advocating for those most under threat to the impacts. Social justice is important to nurses in their relations with individuals and populations, including actions to address climate justice. The purpose of this article is to present a Global Nurse Agenda for Climate Justice to spark dialog, provide direction, and to promote nursing action for just-relations and responsibility for planetary health. Grounding ourselves within the Mi'kmaw concept of Etuaptmumk (two-eyed seeing), we suggest that climate justice is both call and response, moving nurses from silence to Ksaltultinej (love as action). We review the movement for climate justice in nursing, weaving between our own stories, our relations with Mi'kmaw ways of knowing, and the stories of the movement, with considerations for the (w)holistic perspectives foundational to nursing's metaparadigm of person, environment, and health. We provide a background to the work of the Global Nurse Agenda for Climate Justice steering committee including their role at the 26th United Nations Climate Change Conference in Glasgow, 2021, and share our own stories of action to frame this agenda. We accept our Responsibility for the challenges of climate justice with humility and invite others to join us.     

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.     

Social Justice: A Concept Analysis

Social justice is presented frequently as a core or shared value at the very foundation of nursing practice. Despite its acceptance as a core value, its use is varied and there has been inherent difficulty in establishing a definitive explanation for what is meant by social justice. As such, a clearly defined meaning for the concept of social justice does not exist in contemporary nursing literature. Following the method outlined by Walker and Avant, an analysis of the concept of social justice provides clarity to the meaning of social justice as it is used within the nursing profession, in academia, education, and practice.     

The dissection of risk: a conceptual analysis

Recently, patient safety has gained popularity in the nursing literature. While this topic is used extensively and has been analyzed thoroughly, some of the concepts upon which it relies, such as risk, have remained undertheorized. In fact, despite its considerable use, the term 'risk' has been largely assumed to be inherently neutral - meaning that its definition and discovery is seen as objective and impartial, and that risk avoidance is natural and logical. Such an oversight in evaluation requires that the concept of risk be thoroughly analyzed as it relates to nursing practices, particularly in relation to those practices surrounding bio-political nursing care, such as public health, as well as other more trendy nursing topics, such as patient safety. Thus, this paper applies the Evolutionary Model of concept analysis to explore 'risk', and expose it as one mechanism of maintaining prescribed/ proscribed social practices. Thereby, an analysis of risk results in the definitions and roles of the discipline and profession of nursing expanding from solely being dedicated to patient care, to include, in addition, its functions as a governmental body that unwittingly maintains hegemonic infrastructures.     

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.     

Social justice as a framework for professional nursing

A persistent connection exists between health disparity and societal inequality. Since more research is designed to document, rather than alter, those trends, nurses are called on to reinvest in a social justice agenda. An educational focus on social justice is necessary to prepare future nurses to address health concerns related to how societies are structured. This article reports on how social justice was used as a framework to teach concepts related to professional nursing. The course structure is described, a focus on how the course content was taught is outlined, and conclusions are drawn. Linking content on social justice to professional nursing is important because research indicates that, if societal relationships are more equal, population health indicators between diverse groups become more stable nationally and globally.     

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.     

Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge

The nursing metaparadigm, as described by Fawcett in 1984, includes human, health, nursing, and the environment, all of which support theory development by giving direction to our focus as a scientific body. Nursing scientists make their mark in biotechnological applications, mobile health, informatics, and human factors research. We give voice to the patient through design feedback and incorporating technological advancements in our evolving nursing knowledge; however, we have not formally acknowledged technology in our metaparadigm. To continue patient-centered care in this age where machines are enmeshed in daily human life, we propose technology must be a domain of the metaparadigm to continue advancing nursing science and knowledge. In this paper, we propose a separate domain of technology within the metaparadigm to challenge nurses to consider approaches within their research and practice of how technology will impact patient care and their personal development within the profession. A technology-specific domain within the metaparadigm also is a signal to other bodies of science of our willingness and ability to run at pace with novel, exciting new discoveries while adding our perspective. Nurses may become active agents in novel developments rather than passive adopters, continuing our legacy of patient advocacy through new knowledge generation. Emerging and continuing nurse leadership has set the stage for the next era of nurse-led innovation and technology development, which provides an opportunity to embed technology as a core aspect of the nursing metaparadigm.     

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.     

Reinvesting in social justice: a capital idea for public health nursing?

Social justice is a core ethical principle of public health nursing; yet, nurses' work as social activists has largely diminished over the past century. Reengagement in social justice activities is essential to change the current social, economic, and health differentials perpetuated by market justice ideologies. Social capital has emerged in the public health literature as a promising concept for developing community interventions that diminish disparities. Public health nurses, however, must be wary of uncritically adopting social capital as a panacea for inequalities; advocating for interventions seeking to build social capital may be as harmful as the inequalities themselves.     

Critical caring theory and public health nursing advocacy for comprehensive sexual health education

Public health nurses (PHNs) often work with adolescent populations at risk for unplanned pregnancies who do not have access to comprehensive sexual health education (CSHE). Evidence‐based CSHE can have a significant protective effect on adolescent sexual behaviors. This article applies critical caring theory to public health nursing advocacy for CSHE. Critical caring theory defines the social justice work of PHNs as an expression of their caring as nurses. The lack of CSHE in schools for adolescents is a social justice issue, and PHNs can be important advocates. The purpose of this article is to explore how critical caring theory can inform public health nursing practice regarding the importance of CSHE advocacy with the goal of creating equitable access to CSHE for all adolescents.     

Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing

Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis‐oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western‐based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning.