Rethinking the nursing paradigm: redundancies in the four-part paradigm

Discussion board post for NURS608 Philosophical and Critical Foundations in Nursing, posted on May 22, 2022.

In my nursing undergraduate studies, we conducted a thought exercise where we were required to reflect on our workplaces or clinical experiences and devise a concept map of all the different interactions patients may have during their experience in that particular setting. As I was working as an RPN in the ED at the time, I developed a comprehensive and busy map of the various specialties and healthcare professionals that a patient could interact with during their time in the emergency department, and I presented it to my class. When my presentation was over, my professor kindly asked, "Where does the nurse fit into your model?" It did not occur to me until that moment that I had not included the nurse into my concept map with the patient at its center. I considered the professor's question and realized that, in my understanding of nursing, the nurse and the patient would occupy the same space in my map, with the nurse encompassing the patient, as such (simplified):

In this conceptualization, nursing is the patient's connection to the healthcare system, and to the rest of the disciplinary team. This is why our compassion and professionalism is so important to our responsibility for connecting the patient with the system, providing education and clarity for them, and ensuring that their needs are being addressed and met by their interdisciplinary care team.

Essentially, my view of the nursing paradigm - as some of my colleagues have iterated in this discussion thread, and as the literature consistently returns to - is that the patient is really the core of nursing. Without the patient, whether that is defined as a population, a family, or a single individual, there is no purpose to nursing. What differentiates nursing theories tends to be "the various ways in which they conceptualize the client," and disagreement between them often lies in "diverse claims about the way in which nursing ought to understand the individual" (Thorne, 1998). But are these theories really all that different? It seems there is a collective understanding at this point in our profession that the patient can be an individual or a group (patient) who is affected by their social, political, geographic, economic, and spiritual conditions (environment), whose concept of health is unique and variable depending on mentioned and other circumstances (health), and whose outcomes are affected by the nature of their relationship and interactions with nurses (nursing) (Kim, 2015).

It seems to me that each of the four prongs of the nursing metaparadigm eventually return their focus to the patient, so they are redundant in that sense. Even a recent analysis of caring by Hadadian-Chaghaei (2022) sets out to discuss the concept from the angle of how nurses enact caring, but ultimately returns to the client experience of it, because fundamentally there cannot be caring or nursing without a patient to receive it.

I do not personally feel that I have come to a conclusion in this post, nor in my mind, about my views of the nursing metaparadigm, which is unsurprising given our greatest scholars are still grappling with the question in our profession. But writing this post, and engaging in these readings has made me wonder whether we are simply going in circles with these theories, and whether there is merit to this continued debate when it seems that there is already some degree of common ground and understanding. How relevant is this to nurses practicing in the field, and is there perhaps more benefit to tackling our more immediate issues of the overburdened healthcare system and nursing burnout crisis?

References

Hadadian-Chaghaei, F., Haghani, F., Taleghani, F., Feizi, A., Alimohammadi, N. (2022). Nurses as Gifted Artists in Caring: An Analysis of Nursing Care Concept. Iranian Journal of Nursing and Midwifery Research, 27(2), 125-133.

Kim (2015). The client of nursing (Chapter 2, pp. 21-36)

Thorne, S., Canam, C., Dahinten, S., Hall, W., Henderson, A., Reimer Kirkham, S. (1998 ). Nursing's metaparadigm concepts: Disimpacting the debates. Journal of Advanced Nursing, 27(6), 1257-1268.