Nursing Metaparadigm

Wit: Susie’s Nursing Metaparadigm One of the pivotal characters in the movie Wit (2001) is that of Susie Monahan. Susie a nurse who has little knowledge of the poetry of John Donne so dear to the protagonist Vivian Bearing. Yet Susie shows expert mastery of the role of a healthcare provider in relation to her patients. Regarding the nursing paradigm of patient, environment, health, and nursing, Susie again and again demonstrates that she regards the patient as central in the ethical responsibilities of the nurse (Nikfarid, et al., 2018).

Other characters, particularly the physicians and researchers handling Vivian’s case, place their own research needs above the needs of the patient. Vivian, although highly educated, admits she knows little of cancer research and does not fully understand she is being used as a test subject for research from which she is unlikely to benefit. For Susie, the patient is always first and foremost the focus of nursing care. Because Vivian is critically ill and has no family members to act as her advocate, Susie takes on that role.

At the beginning of the play, Vivian is encouraged to take part in a grueling chemotherapy regime that—the audience comes to realize before Vivian—is unlikely to help her but may be beneficial to science and to the reputations of the people handling her case. Susie alone strives to act as an advocate for the patient, not for the research interests of the study. She also takes into consideration the patient’s environment, which is a hospital which is extremely focused upon advancing research.

Again, the individual patient’s own interests may be forgotten as a result. With this in mind, using the resources of medical ethics and the legal system, Susie discusses the possibility of a DNR (do not resuscitate) order with Vivian. Susie empowers the patient with knowledge that Vivian can understand, despite Vivian’s weakened state, and allows Vivian to know that despite the external pressures of the environment in which Vivian, Vivian still has autonomy.

The definition of health (or wellness) embraced by Susie is one in which the patient is still capable of enjoying her life and meaningful activities. By the end of the play, Vivian is unable to read, interact with those whom she cares about, or to have much pleasure in her existence. She is in a state of constant pain.

Susie, by offering Vivian the option of signing a DNR order, gives her patient the ability to define health and wellness on her own terms and to opt out of that pain. Health is not simply the absence of illness. “Illness is defined as the lived experience of loss or dysfunction that can be mediated by caring relationships,” which Susie as a nurse offers (“Metaparadigm Concepts,” 2018, par.5).

But the nurse’s mediation also means allowing the patient to still feel empowered and control over her existence, which Vivian briefly loses over the course of the play until Susie enables her to gain it back. Susie’s definition of nursing is therefore critically one of patient empowerment. In all elements of her exercise of the elements of the metaparadigm she is, in many ways, an ideal nurse, one whom I would like to embody in my own practice.

“Nursing is an exercise of both technical knowledge and “concern and empathy, and a commitment to the client’s lived experience of human health and the relationships among wellness, illness, and disease” (“Metaparadigm Concepts,” 2018, par.7). Susie uses her technical knowledge to give physical comfort to Vivian; she uses it to understand what Vivian is enduring and also uses the tool of a DNR order to ensure that Vivian is able to die with dignity and to actualize her personal definition of health.

There is a spiritual dimension to nursing that transcends technical care as noted by theorists such as Jean Watson.