¶ … Practice-Specific Concepts The nursing practice is a profession that is based on conceptual and theoretical models that help in guiding patient safety and quality initiatives. The use of conceptual and theoretical models is an important part in nursing practice that is applied across the various disciplines in this profession. As a clinical nurse specialist, nursing conceptual and theoretical models play a crucial role in achieving the specific goal of identifying, recognizing, treating, and monitoring illnesses or diseases. The process of using nursing conceptual and theoretical models involves developing practice-specific concepts relating to the specific professional practice and creating a personal philosophy and practice guideline. The practice-specific concepts should incorporate the four basic metaparadigms of nursing theory and be supported by research and concepts.

Overview of My Professional Practice and Four Metaparadigms

A clinical nurse specialist is a nurse professional or practitioner who provides a crucial link with regards to detecting, identifying, treating, and monitoring illnesses or diseases. In essence, this professional is an expert in the diagnosis and treatment of diseases in a certain area of expertise. Generally, clinical nurse specialists focus on various specialty areas including patient and their families, administration, and nurse management. Therefore, these professionals play a crucial role in promoting and enhancing the health of people and communities. Notably, together with the other categories of advanced practice nurses, clinical nurse specialists have specialized and extended in different means to achieve various aspects of the health needs of patients and families, groups, and communities (Lyon & Davidson, 2004).

As a clinical nurse specialist, my practice-specific concepts involve defining and incorporating four basic metaparadigms of nursing theory. The first nursing metaparadigm is the person or human beings who are regarded as open energy fields with different experiences in life. In the nursing field, human beings are regarded as valued individuals who need to be treated with dignity, nurtured, and understood. Consequently, humans have the ability to make informed choices or decisions about their health ("Metaparadigm Concepts," n.d.). The second metaparadigm is the environment, which is the landscape and geography of the social experience of humans and the context with which daily life is experienced differently with regards to time, space, and quality. The third nursing concept is health, which is a dynamic process that refers to the synthesis of wellness. The final nursing metaparadigm is nursing practice through which nursing is an educational discipline and practice profession. Nursing practice is the art and science of holistic health care that is governed by the values of human autonomy or liberty, responsibility, and choice.

My Practice-Specific Concepts and Utilization of Four Metaparadigms

One of my practice-specific concepts as a clinical nurse specialist is culturally-informed care for the individual and environment. In this case, the individual or person and the environment are the two metaparadigm concepts of nursing theory employed in the practice-specific concept in this professional practice. As a clinical nurse specialist and part of the various categories of advanced practice nurses, the provision of culturally-informed care for the individual and environment is very important. The significance of culturally-informed care is attributed to the fact that multicultural care is crucial to my daily professional practice given that care focuses on a particular patient population. While my professional practice entails specializing in various kinds of diseases like diabetes, culturally appropriate care an important consideration because the nursing practice involves working in varying clinical environments.

Culturally-informed care for the person and environment is crucial for a clinical nurse specialist since patients are increasingly conscious of social implications in health care practices. Actually, unlike other specialties in the nursing profession and practice, a clinical nurse specialist needs to be increasingly conscious of the social implications of nursing care since daily practices are seemingly dominated by a specific social segment and is characterized by a predominant ethnic group. Therefore, the individual and environment are two nursing metaparadigm concepts that are relevant to a clinical nursing specialist. The clinical nurse specialist must have the ability to provide culturally appropriate advice to the patient in consideration of the patient and his/her environment.

The second practice-specific concept as a clinical nurse specialist is patient safety and quality initiatives throughout health care activities. This practice-specific concept involves the use of three metaparadigm concepts of nursing theory ie. person, health, and nursing practice. With regards to the person and health, patient safety and quality initiatives across health care activities are geared towards ensuring improved outcomes of patient conditions through the use of suitable health practices and/or activities. Generally, health care must be safe, which implies that the clinical nurse specialist must be more careful. When designing...

This implies consideration of various factors related to the patient include social context, culture, and specific health care needs (Roussel & Swansburg, 2009, p.20).
The significance of nursing practice to this practice-specific concept is linked to the fact that my professional practice incorporates the translation of clinical practice into nursing care. The translation is in turn based on evidence-based nursing care standards and programs of care, which acts as the basis for nursing practice. The use of evidence-based standards and programs of care influences nursing practice by influencing the design of nursing interventions. Patient safety and quality initiatives influences my daily professional practices because clinical nurse specialist practice is constantly focused on achieving quality and cost-effective patient-centered outcomes.

Philosophies and Theories from Nursing Literature that Support the Concepts

One of the philosophies for literature of nursing that support or is consistent with these two practice-specific concepts in my professional practice is Florence Nightingale's description of the nature of nursing. According to her observations and data analysis, illness and disease are two uniquely different phenomena since disease is caused by many factors whereas illness can include disease-related etiologies. The description of the nature of nursing is consistent with these concepts since it is foundation with which clinical nursing specialist practice is grounded.

Secondly, these concepts are consistent with the philosophy that culture is one of the organizing concepts through which nursing profession and practice is defined and based. Based on this philosophy, nurses need to understand how cultural groups define health and illness, life processes, maintain wellness, and impact of cultural background on care delivery ("Cultural Diversity in Nursing Practice," n.d.). Notably, cultural diversity in nursing practice obtains its conceptual base and foundation from the nursing profession as well as other cross-cultural health domains and disciplines and social sciences like sociology, anthropology, and psychology.

Third, the concepts are consistent with Watson's theory, Martha Rogers's Science of Unitary Human Beings, and King's Theory of Goal Attainment. The consistency of the concepts with Watson's theory is based on the fact that they focus on carative factors and clinical caritas processes. This theory focuses on the nursing practice aspects incorporated in the concepts with regards to creating a suitable environment and use of appropriate health practices. Martha Rogers's Science of Unitary Human Beings postulates that nursing is a learned profession as a science and an art (Masters, 2014, p.55). The link between this theory and the two concepts is that human beings are vibrant energy fields that are incorporated with environmental energy fields to create a single unit from combination of the person and his/her environment. The consistency of the two concepts with King's Theory of Goal Attainment is related to the focus on achieving improved patient outcomes through the use of patient safety and quality initiatives.

Propositions or Assumptions

The two practice-specific concepts in my professional practice are connected through various propositions or assumptions including

1. It is the clinical nurse specialist's responsibility to ensure suitable nursing practices and administrative functions are established to promote patient safety and improved outcomes.

2. The clinical nurse specialist influences nursing practice through effective nursing administrative practices and diagnosis and treatment processes.

3. Cultural factors and background play a crucial role in determining the effectiveness of health care services and practices.

4. Nursing practices should be focused on enhancing patient's health and wellness by using effective patient safety and quality measures.

5. Effective health care practices depend on interactions between the patient, caregiver, and the environment.

Integrating Role and Change Theory and Other Concepts

The integration of role and change theory as well as transcultural nursing, health promotion model, and skill acquisition into clinical nurse specialist practice is important in order to enhance patient outcomes. Transcultural nursing is integration through understanding the role of cultural factors in health care delivery in light of how cultural background influences patient delivery services and nursing practices adopted by the professional. Health promotion model and skill acquisition are integrated by ensuring nursing practice is based on competence and understanding of the patient's specific health care needs. Moreover, this process involves encouraging patients and communities to assume responsibility for their wellness and health. Actually, clinical nurse specialists integrate role and change theory as well as these other concepts through applying theory in directing and providing patient care (Ryan, 2009, p.161). In the organization in which I practice, these theory and concepts can be integrated through focusing on health behavior…