Professional Documents
Culture Documents
Ibtihal Haib
Athabasca University
Through the development of theory, philosophy and knowledge, the field of nursing has built
its distinctive discipline. Nurses used to be viewed as direct patient care providers and task
oriented in clinical settings (Graham, 2010). However, nursing scope of practice has expanded
beyond patient care to include research, education, policy making and administrative work.
According to Cody, the expansion of nursing roles can positively influence the development of
nursing practice. The direct involvement of nurses in different roles enables them to be part
of constructing policies and strategies to meet the needs of the discipline (2013, p. 63). In
addition, nursing scholars and theorists have created ontological and philosophical
dimensions that make nursing different from other disciplines such as the ways of knowing
by Carper, 1978. However, the discipline of nursing requires continuous progress by all
different roles to face limitations and barriers that can halt its progress as professional, practice
Historically, nursing was practiced based on the biomedical model that focuses on
disease, diagnosis and treatment where nurses focused on performing set of tasks typically
ordered by doctors. Nursing practice expanded beyond the biomedical model and beyond the
focus on the patient as an object. Nursing become a profession that provides holistic care
including psychological, social, physical and spiritual aspects of the person. Throughout the
years, nurses began to realize that these are essential elements of the individuals that are
also interactive in affecting health and wellness. The field of nursing progressed to
acknowledge and focus on the human experience with regard the physical concerns (Thorne,
Canam, Dahinten, Hall, Henderson & Kirkham,1998). The Authors also explain the
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importance of this evolution where nursing care become more than just treating a disease
Knowledge in Nursing
Nursing practice is based on knowledge, science, critical thinking and problem solving to
promote healing and restoration of physical well being. Zander (2007) identifies two types of
knowledge, tacit and explicit. Tacit is the knowledge gained with experience that can vary
from one person to another which is also dynamic. Werease explicit is the knowledge
learned through writing and reading words, maps and symbols and is more factual
knowledge. In nursing, this type of knowledge is based on practice setting, speciality and
population the nurse works with. Tacit knowledge on the other hand is affected by changes
in health care, social, political and cultural aspects such as cultural diversity. As these
Four ways of knowing were identified by Carper (1978) in the discipline of nursing.
These include, 1) empirics; the science of knowing, 2) esthetics; the art of knowing, 3)
personal knowing and 4) ethics; the moral aspect. The four ways of knowing are
fundamental key concepts for nursing practice. Through these patterns of knowing nursing
epistemology was advanced from a science based, to include moral obligations, caring,
empathy, and nurse-patient relationship. It also assisted nursing to build its autonomous
discipline. According to Hoeck & Delmar (2018) without the transition in nursing research
and theory to a humanistic, caring and nurse-patient relationship, nursing would have
remained a task oriented with the focus on evidence based biomedical knowledge. This
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epistemological shift in nursing has aided in making nursing different from other
disciplines.
Each one of the four patterns of knowing is unique for nursing practice. However,
personal knowing is the pattern that supports patient centred care theories. Through
personal knowing, nurses find what health means and how its defined by the patient
through interactive and therapeutic relationship between the nurse and the patient. Carper
describes this pattern on knowing as therapeutic use of self where the nurse strives to
know the patient as a self and not as an object (1978). Through nurse-patient relationship,
nurses can learn different aspect of the individual's life that can affect their health. This may
include health practices, values, beliefs, access to health care and more. This patient centred
care has driven nursing away from a task oriented profession to a larger body of knowledge
discipline. According to Graham, nursing knowledge is achieved through critical thinking and
problem solving to promote health and well being which requires the use of the four ways of
knowing (2010). The ways of knowing by Carper (1978) was credited by other scholars for
broadening nursing epistemology from a science based to a more complex and diverse field
of nursing. Fawcett describes, that each discipline has a matrix, and the metaparadigms are
the result of nursing disciplinary matrix. In nursing, the matrices defined as conceptual
models which are the result of studying a phenomena such as Orem’s self care model
(Fawcett, 1984). The four metaparadigm include nurse, person, environment and health
became the fundamentals in the field nursing. The metaparadigms of nursing are integrated
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concepts and affect one another. However, scholars have further elaborated on the need to
refine, edit or expand the metaparadigms. Literature has diverse views and definitions of
the metaparadigms.
The first concept, the person; according to Thorne et al., (1998), there are diverse
definitions of the person as a concept, some literature describes the person within the
community and others define the person as the main focus of nursing care. The person was
defined as the patient, who is also the recipient of nursing care. Subsequently the concept was
expanded to include family, caregiver and other individuals considered valuable by the patient.
It describes the person within a society and not as an isolated patient. Schim, Benkert, Bell,
Walker & Danford, 2017 argue that the concept of the person should represents the
diversity of individuals within communities and institutions. This would further expand the
definition of the person to consider cultural, ethnic, and language diversity within nursing
care. This suggestion shows refinement of the concept in order to meet the changes within
societies.
The second concept, nursing; according to Bender & Feldman (2015), nursing and
describes nurse-patient relationship as an integral part of nursing care. Nurses provide care for
patients in a variety of settings including acute care, long term care, community, in patient
homes and others. In all different settings and levels of acuity, the patient is the focus of
nursing care and the goal is to restore health and quality of life or to assist in coping with an
illness. Kim, (2015) describes nursing care as situational and person specific that varies
from patient to patient. Every person is a unique individual that has different experiences,
living conditions, educational, ethnic, and cultural backgrounds. Therefore, nurses need to
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consider all different aspects of the persons within nursing care. Also, caring was described
as the defining term and building block of nursing. Smith, (2007) states, without caring,
nursing does not exist. In contrary, Salem press encyclopedia of health defines nursing care
as guided by professional knowledge, tasks and technical skills (2016). These different
views and definitions show the diversity in nursing literature in defining nursing.
The third concept, the environment; was earlier defined as the the physical
surrounding were nursing care is provided including identified significant others by the patient.
examine the person-environment relationship within the social and political contexts
(1998). On the other hand, the environment from the nurses’ perspective can also be valuable
in influencing the care delivered (Bender & Feldman, 2015). The authors further discuss the
importance of the settings were nursing care is provided that are influenced by workplace
policies, management and other factors which can impact the quality of nursing care.
The fourth concept, health; according to Thorne et al., (1998), health was historically
defined by Nightingale as the physical state of well being and the ability of the person to use
every power he or she has. The authors on the other had argue that health and quality of life are
integrated within social and political contexts. Therefore, nursing should be involved in
addressing factors that can negatively impact the person’s’ quality of life (1998). The social and
political aspects that can affect the human health and quality of life may include social
Roy and Robert describe the individual as an adaptive system that adapts to the
constantly changing environment through coping mechanisms (as cited in Fawcett, 1984). A
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constantly changing environment involves social, political and health care issues which can also
influence the person’s adaptive skills and quality of life. Moreover, Schim, Benkert, Bell,
Walker & Danford found that social justice is a crucial element affecting people’s health
(2017). The authors found limitations in nurses’ knowledge regarding racial and ethnic
backgrounds in the persons of colors those who are foreign or immigrants. Therefore,
(Schim et al., 2017) adopted social justice as the fifth concept of urban health
metaparadigms to address the gap in nursing knowledge and meet the need of minorities
within societies.
In conclusion, nursing has evolved throughout the years to create its own ontological
and philosophical dimensions which elevated the academic quality of the field of nursing.
Nursing was successful in expanding its’ professional role to include research, education,
management and policy making. In addition, patient care roles were advanced and
expanded. Roles such as clinical nurse specialist, nurse practitioner, nurse midwife and
others. However, in order for nursing to continue developing as a theoretical, philosophical and
empirical discipline, it requires continuous adaptation to the changes affecting health, quality of
life and nursing. Hoeck & Delmark, (2018) argue that nursing has social and professional
and developed to meet the needs of the society and the changes in knowledge and science.
Idditionally, Hoeck & Winther, (2012) discussed the implications of the societal changes on
the nursing theory (as cited in Hoeck & Delmark, 2018, p.). These changes may require the
Bender, M., & Feldman, M. S. (2015). A Practice Theory Approach to Understanding the
Carper, B. A (1978). Fundamental patterns of knowing in nursing. Jones & Bartlett Learning,
1 (1): 13-24.
5069.1984.tb01393.x
Schim, S., Benkert, R., Bell, S., Walker, D., & Danford, C. (2017). Social justice: added
metaparadigm concept for urban health nursing. Public Health Nursing, 24(1), 73-
80
doi:10.1177/1527154408
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Thorne, S., Canam, C., Dahinten, S., Hall, W., Henderson, A., Reimer Kirkham, S.