Nursing Philosophy: Meta-Paradigms, Ethics, and Practice

Introduction

This paper addresses three main areas of discussion related to nursing theory, each compared and contrasted with the author's personal philosophy. The three areas are: the four meta-paradigms of nursing theory, two practice-specific concepts, and a set of five propositions the author offers relative to nursing and personal professional values.

The Four Meta-Paradigms of Nursing

There are four meta-paradigms of nursing theory, each of which merits detailed description and analysis. The first is person. A central point of this meta-paradigm is the preference for the word "subject" rather than "patient" in order to refer to the individual in the fullest and truest sense. The underlying idea is that the person is a fully singular and autonomous being and should be treated as such.

The second meta-paradigm is health. As with many broad topics, health is a wide-ranging subject that can take on many forms and sub-forms. Both clinicians and the subjects themselves may describe health and well-being in very different terms, even when describing the same state of affairs or situation (Basford, 2003).

The third meta-paradigm is environment. The central point here is that a wide range of factors influence how well a patient recovers. Home life, propensity to use drugs or alcohol, overall risk of relapse, and workplace pressures all have a bearing on whether, when, and how well a patient recovers — or even whether the patient wishes to recover at all.

Two Practice-Specific Concepts

The fourth and final meta-paradigm is nursing itself. Slevin suggests that this meta-paradigm might more accurately be called "caring," as that is what is truly occurring. It is a dimension pervaded with ethical and emotional questions (Basford, 2003).

Two practice-specific concepts are particularly important. The first is a strong focus on evidence-based practice. It is essential that nurses, doctors, and other clinicians avoid operating on assumptions or departing from best practices without sound justification. Too often, personal ethics become confused with professional obligations, or care is simply delivered in a careless or haphazard manner. This is not to suggest that clinicians should deploy every available intervention out of fear of failing to solve a patient's problem, fear of litigation, or fear of patient dissatisfaction (Whitlock, Orleans, Pender, & Allan, 2002).

Best practices exist for good reason. The standard course of treatment may not resolve every patient's condition on the first attempt — chest X-rays can yield misleading results, and different illnesses often present with similar symptoms. However, these are clearly outliers. The normal course of treatment should be followed unless there is a clear reason to suspect something else is occurring. For example, cold symptoms paired with a normal pulse are likely unremarkable, but cold symptoms paired with an abnormally low pulse could indicate pneumonia or another serious, potentially life-threatening condition (Whitlock, Orleans, Pender, & Allan, 2002).

Conclusion

The four meta-paradigms and the other subjects discussed in this paper are all worthy of vigorous review and analysis. As the years and decades pass, the medications and practices used to treat disease may change substantially, but the underlying ethics and standards to which nurses and doctors are held should change very little unless there is an overarching reason to do so. Religion and politics are noble pursuits in their own right, but the influence they exert on medical and nursing ethics should be minimal in most clinical contexts (Stone, 2012).