My role in nursing began after graduating from Chamberlain College of Nursing in December of 2013. I was employed as an ICU nurse to care for patients and their families being brought into the hospital. In enhancing my knowledge and skills in this department, I was sent to an extensive classroom and simulation training for 3 months. This is essential since it not only supports the nurses’ competency standards of improving the quality of practice, but also supports one of the metaparadigm of nursing that advocates for professionalism in application of nursing duties (Peterson & Bredow, 2013). This is the first nursing metaparadigm titled ‘nursing’. It advocates for the enhancement of duties and responsibilities of the nurses in a manner that compliments their practice when dealing with patients, their families, and other work colleagues.
Using the change in skills and knowledge that was provided by the hospital was essential in improving my service execution of valuable skills and knowledge to my practice. According to the change theory, one needs to adapt a culture of development of their knowledge and skills and ensure that barriers to change are sorted out before they become an impediment to goals attainment. In this context, the knowledge and skills provided was a form of change from an educated nurse with theoretical knowledge, to a practicing nurse with sufficient knowledge and skills that fall outside the scope of training. It is paramount that nurses to such opportunities consider them as driving forces geared towards development of their nursing practice, rather than boring lectures and seminars meant to torture them. For instance, registered nurses have to engage in knowledge and skill development to become acquainted with the new research data and information on their fields of specialty.
The nurse in the ICU is required to interact with not only the patients, but also their family and friends. According to the nurse competency standards, the nurse is mandated to ensure that they provide education and counseling to patients and their patients on methodologies of dealing with the emotional stress of having their loved ones under close medical care, and without a guarantee of their survival. Accordingly, the nursing metaparadigm dictates that it is the nurse’s duty to carry out this duty to care for these family members. As an ICU nurse, it is paramount that I embody a culture of acceptability and role-playing when dealing with patients and their family members.
This role-playing is applied suing the role model theory that suggests that a nurse should act in a manner that other people can emulate and follow especially the patient and their close family members. In this context, role-playing encompasses the application of several strategies in developing a culture of support emotionally, physically, psychologically, and socially. Role modeling falls outside one’s teachings in school and have to be inherently developed based on one’s character (Institute of Medicine, 2011). The use of interpersonal skills as defined in the goal attainment theory is instrumental in giving the nurse an edge towards presenting an outward appearance and aura of confidence and support for the patient and their family and close friends.
Another nursing metaparadigm is the environment. This defines the kind of surroundings that a patient is exposed to during the recovery period, and outside of the hospital setting. It is the nurses’ duty to ensure that they have a foothold of the activities of patients when exposed to different environments to ensure that their health and welfare is optimal. For instance, as an ICU nurse, I have to ensure that patients within the hospital are provided with all the health care needs, care, equipment, and tools that would serve to improve their health. The ICU environment has to be clean and comfortable as it transitions the patients from this environment to the high dependency unit (HDU), which is the next step towards positive recovery. The diet being provided to these patients is also under scrutiny to ensure that they receive all the necessary nutrients to enhance their energy, immune systems, muscle development and sustenance, and sustained health. All these are provisions of the environment and need to be carefully considered when caring for patients.
Another nursing metaparadigm is health. According to this metaparadigm, the nurse is empowered and mandated to ensure that the health of the patient within and outside the hospital is optimal. This is through the action of such measures as taking patient records, provision of medication, treatment of patients, and diagnosis of diseases, among others. All these are subsets of enhancement of health for patients. In the ICU department, the promotion of the patient’s health encompasses the use of several strategies and systems to enhance and promote the health of the patients. This involves the provision of medication, nutritious foods, clean beddings, and clothes, and maintenance of life supporting systems. All these are paramount for guiding the recovery process for the patients.
Goal attainment theory, a nurse is expected to perform their roles and duties in a manner that ensures that the patient’s health is improved, maintained, and treated. In the ICU unit, this is the vision, mission, and objective of the nurses as they provide quality health care to the patients. The health promotion model also serves to promote a system where the mental, physical, social, and psychological health of the patient is maintained. In this context, the nurse is required to tap into their inherent abilities in the provision of standardized forms of care that would serve to improve the health of the patient.
One of the competency standards that guide nurses during their practice is that they provide health care equitably and without prejudice for all patients regardless of their demographical background (Lee & Fawcett, 2013). This ideology is used under the trans-cultural nursing concept that advocates for equal care of patients of different cultures and employment of systems where culture is not used as an impediment to receiving quality care. One such strategy that I have noted being employed in the hospital is the provision and employment of nurses hailing from different demographical backgrounds such as geographical location, race, ethnicity, gender, disabilities, and economic background. In this context, a multiplicity of cultures is represented within the hospital and hence whenever patients of multiethnic backgrounds arrive at the hospital, a nurse of similar multiethnic background is used to provide quality treatment to the patient since the barrier provided by culture is broken.
The final nursing metaparadigm under consideration is the patient. It defines their psychological, social, personal, and physical attributes as patients and as individuals. The nurse is mandated to understand the person not only based on their health, but also based on their lifestyle choices, trends, environment, physical activity, and work environment (Anderson & Mangino, 2006). This information is not an infringement of the patient’s privacy, but is rather a tool for the nurse to collect useful information regarding the patient’s health and medical condition. For instance, if a patient comes to the hospital with severe respiratory or cardiovascular problems and the nurse deduces that the patient is a frequent visitor to the gym, it is probable for the nurse to deduce that the patient is not suffering from poor nutrition or exercise that are considers as health boosters. Instead, the nurse would focus on underlying exposure to harmful pathogens or irregular application or use of medication.
The collection and understanding of the patient’s lifestyle choices and personal attributes is also paramount when administering the medication and health care that would serve the patient in improving their health (Institute of Medicine, 2011). In a study carried out on hospital readmissions rates of patients suffering from heart failure conditions, it was discovered that the major causality of the readmissions rates increasing is the poor lifestyle choices. According to the study, one of the strategies employed to counter this issue was a requirement that nurses should engage with the patient on an interpersonal level to act as role models where the patients can seek advice of how to maintain their health through healthy living. In this context, it was revealed that this resulted in a reduction of approximately 15% of readmission rates. This means that this strategy was a mesh between role modeling, goal attainment theory, and patient nursing metaparadigm to provide a result that was optimal in enhancing quality health care for the patients.
The promotion of an enabling environment for enhancement of quality health care for all individuals is paramount to ensure that patients receive the necessary tools and systems required to cater to the development of healthy bodies physically, mentally, and psychosocially (Anderson & Mangino, 2006). Meshing this nursing metaparadigm with others such as nursing, patient, and health of the individual was essential in creating a viable strategy for provision of health care. As an ICU nurse, I am mandated to use this nursing metaparadigms to inform my execution of duties and responsibilities assigned to me. Additionally, I am mandated to adhere to a strict code of standard and ethics as outlined in the competency standards that define nursing practice.
It is important that utility and balancing all these parameters be performed in an intricate and useful manner that ensures that the needs of the patients, as well as organizational requirements are sorted. As the ICU nurse, one of the paramount theories that attempt to mesh these nursing metaparadigms is skill acquisition theory (Lee & Fawcett, 2013). According to the theory, it is fair that a nurse endeavors to gain knowledge and skill that seeks to improve on their quality of service delivery and care of their patients. This skill acquisition is achieved through education and training provided by the hospital. Other avenues that these skills can be attained are through interaction with other experienced nurses, performance of research and development of one’s inherent abilities to conform to the nursing practice. Therefore, it can be deduced that nursing practice is a field of practice with a multiplicity of systems, structures, decisions, and strategies that ensure that the patient receive the best optimal care through application various theories, concepts, and nursing metaparadigms.
Anderson, C. & Mangino, R. R. (2006). Nurse shift report: Who says you can’t talk in front of the patient? Nursing Administration Quarterly, 30. (2): 112-122.
Institute of Medicine. (2011). The Future of Nursing: leading change, advancing health. Committee on the Robert Wood Johnson Foundation initiative on the future of nursing, National Academy Press: Washington, D.C.
Lee, R. C. & Fawcett, J. (2013). The influence of the metaparadigm of nursing on professional identity development among RN-BSN students. Nursing Science Quarterly. 26 (1): 96-98.
Peterson, S. J. & Bredow, T. S. (2013). Middle range theories: Application to nursing research (3rd Ed.). Philadelphia, PA: Lippincott Williams & Wilkins.