My interest in nursing peaked at an early age when I attended Clara Barton High School for health professions in Brooklyn NY and graduated in 1991. I first worked as a nurse's aide and home health aide for about two years and found this position to be quite rewarding. I subsequently moved to North Carolina where I took the CNA course in 1995 and began working as a CNA at various nursing homes and hospitals in the regional area. My experience as a CNA certainly helped me in my journey and provided the foundation for the later developments in my career.
Later I moved to Las Vegas in 1997 where I got married in 1998. After forming this union I went back to school for my BSN in 2002 while working as a CNA. I finished my BSN from Nevada State College in 2006 and I worked in Med Surgical Settings in a Rehab Hospital and also at a Large Hospital for a couple of years to gain some experience. Following that experience, I decided to go back to school for my MSN, which I completed in 2010 at Walden University. I am currently employed full time as a staff nurse at the local VA Hospital in Las Vegas and part time at the Clark County Detention Center in booking as a Charge Nurse.
The metaparadigm is the most broad and comprehensive level of the world view or ideology that distinguishes a discipline. At this level most of the thought is abstract and not targeted at any specific objective. At this level, nurse can paint what they do and what they do not do with broad strokes. The four primary metapardigms include the concepts of patient, nurse, health, and environment. However, there have been attempts to expand on these ideals by including such concepts as social justice. It is argued that Social justice should be the central conceptual philosophy for urban community and public health nursing practice (Schin, Benkert, Bell, Walker, & Danford, 2006).
Figure 1 - Levels of Nursing Inquiry
In the development of these models, it was believed that model builders were not "inventing" nursing but developing devices to explain the complexities that are inherent in the discipline and Fawcett's (1984) articulation of four metaparadigm concepts (person, health, environment and nursing) served as an the organizing framework around which this conceptual model developed (Thorne, et al., 1988). However, these concepts remain rather abstract and there is significant debate about what constitutes health and quality of life.
The human being is so complex that it is entirely impossible to summarize this existence within on particular model. The idea of health can include mental health and a more holistic notion of health than simply focusing on symptoms. For example, if an individual breaks a leg then this is obviously an event that would decrease their quality of life and should be treated. However, at the same time there are opportunities to further improve the health of the patient that go far beyond the treatment of the leg and the person. However, the notions of "health" at this level can become abstract and subjective. For example, even though a nurse might understand how to improve the quality of life for a patient, at some level the decision making about one's personal health resides at the level of the individual.
The Roy Adaptation Model (RAM) for Nursing originated in the brain of Sister Callista Roy shortly after she entered the master's program in pediatric nursing at the University of California in Los Angeles (UCLA) in the nineteen sixties (Nursing Theory, 2011). The Adaptive Model is developed on the foundation that includes four primary components which are the person, health, environment, and nursing (Andrews & Roy, 1991). The model is primarily based on a holistic approach that considers a bio psychosocial approach to the role of nursing and promoting a patients physical and mental health.
Roy utilized a multi-disciplinary approach which borrowed heavily from other fields to combine fragments of knowledge and adapt these concepts for use in describing circumstances of people in both times of health as well as illness (Nursing Theory, 2011). In essence, the patient is forced into a continual process of adaptation due to an ever changing environment and dealing with the physical aspects of the patient's health or illness is merely one aspect of this holistic approach to caring for the patient. Roy developed a six-step nursing checklist which includes items such as assessment of behavior, assessment of stimuli, nursing diagnosis, goal setting, intervention and evaluation (Farlex, 2011).
List of Propositions
1. Health can be subjective but worth striving for nonetheless
2. The quality of life and personal choices can be at odds in some cases.
3. A nurse's level of intervention can be considered on many different levels.
4. Mental health can be as valuable, if not more so, than physical health
5. Preventive care represents a more complex and holistic model that optimizes health and the quality of care.
1. How do I define and employ the four basic metaparadigms of nursing theory in my professional practice?
The metaparadigms can be included in my professional practice as a list of priorities. Obviously, meeting the basic health care needs of the patient set the foundation for the practice. However, there are increasingly opportunities to identify more comprehensive needs that could be responsible for some of the symptoms that a patient has. These might include lifestyle choices.
2. What are the major concepts I employ that are unique to my professional practice?
In my practice, I try to tailor the approach that is used for the patient with their individual needs and expectations. For example, someone who is seeking treatment for a cold might not want a comprehensive health assessment. However, while treating the cold, it also represents a good opportunity to provide some information about the next steps that the individual can take to help foster their health and their quality of life.
3. What philosophies and theories from the literature of nursing and other disciplines/domains are consistent with these concepts?
I really enjoyed learning about the RAM model and I believe it is consistent with the way I try to operate my practice. Each individual and each situation is unique even though the symptoms are generally treatable in a similar manner. However, the progress on improving one's health can take very different courses and must be developed with the assistance of the patient. Thus this represents a dynamic process in which the nurse plays a supportive role in one's quality of life and health achievements.
4. How are the concepts of transcultural nursing, the health promotion model, skill acquisition, role theory, and change theory specifically integrated into my philosophy and practice?
The idea, in my opinion, is to put the patient first. If you do this, then many of the philosophical justifications fall into place. For example, if a patient is from a different culture and you wish to fully understand them then you must study their culture which often requires skill acquisition. Furthermore, in order to promote health, this often requires a component of education and change management. I like the Social Cognitive Theory which incorporates learning through observation, personal, and environmental factors proposed by Albert Bandura. There are five areas which connect students to learning which includes: observational learning and modeling, outcome expectations, perceived self-efficacy, goal setting, and self-regulation (Denler, Wolters, & Benzon, 2013).
5. What research supports these theories and concepts?
I believe that most of the theories presented can be applied in a consistent manner that depends mostly on the level of care. The highest level of care is that creates a customized plan for improved health and quality of…