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Concepts Central to the Discipline of Nursing In order to critically examine the concepts central to the discipline of nursing it is important to clarify my understanding of what constitutes a discipline. Nursing literature has led me to understand that a discipline can be, in simple terms, thought of as a field of study with a unique perspective which gives rise to the nature and scope of inquiry of that field and therefore leads to a specialized body of knowledge (Parker, M & Smith, M, 2010).
In attempt to cement nursing’s place in the professional world and in an effort to distinguish it from other disciplines it seems imperative that nursing itself agree on the discipline’s most significant concepts. Through early course readings it has become clear that this task is not so easily achieved. Several nurse scholars have conducted research and devised seemingly limitless options to choose from.
In developing a metaparadigm of nursing a loose framework is established and agreed upon providing structure in which more concrete and focused concepts are identified. Through this paper I will examine and discuss the work of two notable nurse researchers and their contributions to identifying the central concepts of nursing including the influence of these concepts on the present state of nursing. In addition, I will address the way these concepts apply to my nursing practice and identify concepts of personal importance.
Influence of the Central Concepts Despite the efforts of nurse scholars to clearly define the profession a certain amount of ambiguity remains and is accompanied by a slight difference in opinion. Fawcett (1984) identifies four concepts central to the discipline of nursing including person, environment, health and nursing (p. 84). In combination these concepts create a metaparadigm of nursing, which serves to identify the most salient phenomena concerning the discipline.
The work of Newman, Smith, Dexheimer-Pharris and Jones (2008) elaborates on Fawcett’s metaparadigm by identifying seven, relationship centered, fundamental concepts of nursing. These include health, consciousness, caring, mutual process, presence, patterning and meaning. Albeit slightly different in composition and specificity the central concepts identified by both groups share certain commonalities and both serve to shape the way nursing is thought about and defined.
They lead us as nurses to consider the deeper meaning behind our actions and guide us in the development of discipline as a whole. The aforementioned differences notwithstanding, both Fawcett (1984) and Smith and Parker (2010) acknowledge that there does seem to be a general consensus among nursing scholars and it these agreed upon concepts that serve to not only to define the discipline, but to separate nursing from medicine and other health related studies.
As nursing continues to move away from a biomedical model it is increasingly important to demonstrate the connection between the nursing metaparadigm and the specialized knowledge that provides nursing with credibility within the world of academia. In critically examining these concepts nurses are able to clarify their role in the health-wellness continuum and are better able to articulate this role to others, including but not limited to, other disciplines, the public and nurses themselves.
Nursing has a unique approach to patient care, which revolves around key nursing concepts. By staying true to these ideals we will help preserve our place in the health care. These central concepts remind us that nursing is greater than the sum of its’ parts and it is our focus on wholeness and relationship that helps quantify the uniqueness and defines us a group. In addition to helping define the discipline the core concepts, as identified by Fawcett (1984) and Newman, Smith, Dexheimer-Pharris and Jones (2008), have influenced the focus of nursing and the boundaries of inquiry.
Smith and Parker (2010) illustrate this notion by stating “it is only by being thoroughly grounded in the discipline’s concepts, substance and modes of inquiry that the boundaries of the discipline can be understood” (p. 6). Nursing as a discipline has set forward an explicit desire to serve the public and it is the service and commitment to the individual and overall wellbeing of our society that drives and directs the study and practice of nurses, educators and nurse scholars (Smith & Parker, 2010).
By outlining the focus and boundaries of the discipline nursing is able to highlight areas of study that are significant to nursing education and practice, all of which can be traced back to the fundamental concepts. These central ideas feature as integral to nursing development and continue to demonstrate their influence by shaping the way nurses learn and do. The concepts of person, health, environment and nursing are all interrelated, as are the concepts put forward by Newman, Smith, Dexheimer-Pharris and Jones (2008), and can be identified as prominent in nursing studies and the development of nursing theories.
The nursing theories based on these fundamental concepts serve as the building blocks for all nursing knowledge and as Smith and Parker (2010) explain “the primary purpose of nursing theories is to further the development and understanding of nursing practice” (p. 8). The structure of knowledge as described by Smith and Parker provides a clear example of how nursing metaparadigms have implications for all levels of nursing theory, education and research from the most abstract or global concepts to the more concrete ideas related to specific practice areas.
Central Concepts in Relation to Personal Practice Through the process of reflection I attempted to identify ways in which I was impacted by the central nursing concepts and ways in which they did or did not compliment my nursing practice. I would be remiss to claim that one concept or another does not fit into my personal perception of what is significant to the discipline as I can see merit and ways in which each has implications for the development of nursing practice and theory. I do however naturally identify with certain concepts while feeling somewhat conflicted by others.
For example, in considering the concept of consciousness I found much of it difficult to apply directly to my nursing practice. Despite my attempt at critical analysis my understanding of the concept remained abstract and ambiguous. I was left feeling that if I was having difficulty interpreting the implications of such a notion to the discipline of nursing then how could I relate its’ meaning to personal practice and furthermore how would I share the significance of consciousness with others?
The only way in which I could identify its’ application to my personal practice was to view it in terms of consciousness involving all forms of information including “sensation and physiology as well as intellect, emotion and intention” (p. E20). Perhaps as I continue my studies I will gain deeper insight into the relevance of consciousness in nursing. Conversely, I readily identified the concept of health to be integral to my nursing practice. Health is a central concept that is identified by both Fawcett (1984) and Newman, Smith, Dexheimer-Pharris and Jones (2008).
One of the primary goals of my nursing practice is to facilitate the overall health and well-being of the public. In some cases that may include recognizing and addressing patterns in an individuals’ physical experience of health which may lead to a medical diagnosis and often includes treatment and hopefully resolution. In other instances it may include assisting in the exploration of the meaning behind a health related crisis thereby facilitating a measure of understanding and an improved ability to cope with and manage the present state of wellness.
The thought that pathology remains relevant to the concept of health without being the singular defining factor (Newman, Smith, Dexheimer-Pharris & Jones, 2008) resonates deeply with my nursing self. While I feel that the concept of health and the experience of health are inextricably linked I also believe that health from a nursing perspective involves a holistic approach and must take into consideration personal experience and personal meaning thereby allowing for a feeling of healthiness despite the presence of illness.
Conclusion As I explore and attempt to organize and derive meaning from new terms, theories and concepts I find that this new exposure results in almost as many questions as answers. I feel slightly disappointed by the lack of concrete and undisputable definitions. I can only surmise that it is the stage of development in which nursing finds itself that leaves me feeling unsure of my new knowledge.
Admittedly my personal definition of nursing has evolved since beginning my baccalaureate degree and after closely analyzing nursing’s most central concepts, however, I find it only mildly reassuring that nurse scholars are similarly having a difficult time in reaching a consensus that clearly defines the discipline. It believe that it remains important for nursing to continue to strive for the realization of a global consensus regarding the constitution of the discipline’s central concepts in order to move forward in the development of the profession and service of others.
References Fawcett, J. (1984). The metaparadigm of nursing: Present status and future refinements. Image: Journal of Nursing Scholarship, 16(3), 84-87. Newman, M. A. , Smith, M. C. , Dexheimer-Pharris, M. D. , & Jones, D. (2008). The focus of the discipline revisited. Advances in Nursing Science 31(1), E16-E27. Smith, M. , & Parker, M. E. (2010). Nursing theory and the discipline of nursing. In M. Parker & M. Smith (3rd ed. ), Nursing theories and practice (pp. 3-15). Philadelphia: FA Davis.