What is nursing (caring) according to Fawcett (1984)?
Nursing is defined by American Association (1980) as “the diagnosis and treatment of human responses to actual or potential health problems” (cited in Fawcett, 1984, pg. 84). Diagnosis, according to the nursing process is when the nurses identify the actual problems and find out how to treat them in order to prevent any potential problems. According to Walker, 1971) nursing is establishing limits or boundaries in terms of the person providing care; person with health problems receiving care; the environment in which care is given and an end-state, well-being (cited in Fawcett, 1984). This is related to what I mentioned before that the four concepts are interrelated; they cannot work on their own. The connections among the four metaparadigm concepts were clearly identified by Donalson and Cowley (1978) which states that “nursing studies the wholeness or health of humans, recognizing that humans are in continuous interaction with their environments” (cited in Rolfe, 1996, pg.6). This statement may be considered the major proposition of nursing’s metaparadigm.
B: Christensen’s (1990) Partnership Model:
Christensen’s (1990) Partnership Model identify the concept of a partnership as a basis for involvement between a nurse and a patient. This concept provides a sound humanistic foundation for nursing practice. From the patient view point, a partnership of equality and respect provides security. From nurses, patients are vulnerable or faced a situation, which requires care from health services. The experience of partnership empowers and enables people when they are patients, and we believe that security proved by the nursing partnership is a basic human right for a patient. For a partnership to exist and work effectively, there must be a willingness from all partners to collaborate as equals, and then to jointly make decisions and endeavour to solve problems.
Christensen (1990) described partnership is initiated when the patient is admitted to hospital and ceases when they go home. It is a continuous process, which offered ways of looking at what happened when a nurse offered learned expertise to a person who is going through a health related experience. The learned expertise is known as “nursing (caring).
What is nursing (caring) according to Christensen (1990)?
Although many nurses’ scholars described nursing according to their own research, Christensen (1990) defined nursing “when a nurse offered learned expertise to a person who is going through a health related experience” (pg. 47). Also, New Zealand Nurse’s Association (1990) defined nursing is a “specialised expression of caring, concerned primary with enhancing the ability of individuals and groups to achieve their health potential within the realities of their life situations (pg. 7).
So, nursing is the actions or treatment to help the patient promote health not only part of his body, but nursing is looking at the person holistically.
As discuss by Christensen (1990), the major work of nurse-patient partnership is commences at the time of admission to hospital and continues until the patient goes home, as mentioned before. We could see that the work of the nurse is dynamic and sensitive as nursing strategies are selectively used to ease the pathway of each patient through an individual passage. The passage, according to Christensen (1990) is a “social process, which can be used to describe an experience of a significant change in a person’s circumstances” (pg.26). It is characterised by the giving and receiving of nursing in order for the patient to make optimal progress through a health related experience.
So, nursing is attending. According to Christensen (1990) attending takes place during the time of contact between the nurse and patient and also accompanies the patient through hospitalisation. Attending is the essence of partnership because it shows that nursing is caring and concerning about the change in patient’s life. Therefore,
Christensen’s model of nursing partnership involved two or more people in a shared venture. It requires the nurse to view nursing as a collaborative between the nurse and the client. It initiated when the patient is admitted to hospital until they go home. It is a continuum process, which offered ways of looking at what happened when a nurse offered learned expertise to a person who is going through a health related experience.
According to Peplau define nursing is “how to put the constitution in such a state as that it will have no disease”(Cited in Nightingale, 1992, pg. 48), which means what can and should nurses do to promote health, prevent illness and recovery from disease. As I mentioned above in Christensen’s model, nurses work alongside with the patient but using nursing strategies to ease the path of the person by listening to them and taking heed of what they are saying. Moreover, is to comforting them in order to aid recovery from diseases they present.
Harmer & Henderson (1995, cited in Rolfe, 1996) point out that the unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or peaceful death). In Christensen’s partnership model is very similar to this idea as to assist the patient and supporting during this journey of sickness or seeking help with things that they are unable to do for themselves. That is the goal of nursing is to use their knowledge to find the most efficient and effective ways of carrying out nursing procedures to help their partner in nursing care, as the patient. Moreover, according to attend, being their for the patient and spending time with him in order to understand their needs. Also, ministering which Christensen defines as a selective application of nursing knowledge and skills to meet the identified needs of the patient.
Within that knowledge, nurses have a systematic body of knowledge that underpins practice, which means, they know what to do, how to do it and why they are doing it. For example, an eighteen months old baby was brought from theatre whom he had a Gastrostomy. I took observations on him for half hourly for two hours and hourly after that. Why do I have to do that, because to identify any signs and symptoms of haemorrhage which is potential for shock.
That is the basic knowledge that I have taught so far that this baby has a tendency of bleeding. It was very important for me for these observations. According to Christensen (1990) that the work of the nurse is dynamic and sensitive as nursing responds to the immediacy of the patient’s situation. During this time the nurse and the patient negotiate their partnership by looking at the work of the nurse and the work of the patient in order to cushion the impact on the patient of the disturbances associated with hospitalisation.
Moreover, according to Christensen (1990) the passage is “a social process which can be used to describe an experience of a significant change in a person’s circumstances” (p.26). It is characterised by giving and receiving of nursing in order for the patient to make an optimal progress for a better health. In reality it may or may not lead to a beneficial passage. But, the work of the nurse begins as soon as the patient admitted to hospital. It is known as the beginning phase, which is to assist the client to attain the means, opportunities and the ability to act within the present circumstances, though the nurse-client partnership exists for all nursing goals and the expected outcomes may not always turn out as desired.
The beginning is marked by the patient experiencing a health-related problem. The phase begins with awareness that something is wrong which requires an admission to hospital it may be days or weeks or whenever the patient takes responsible for his own self-management. This period precedes entry into the partnership, at the same time the patient prepares for the upcoming experience, whereas the nurse serves to make patient complete, whole being of a person or independent. And I believed this includes identifying the problems of the whole being of the person, that is, culturally, psychosocially and mentally. This relationship includes respect and acceptance of where the person is and the nurse’s openness to another person’s reality. Caring relationships occur with individuals and family and their significant others.
According to Levine (1973) described nursing as “a human interaction. It is a discipline rooted in the organic dependency of the individual human being on his relationships with other human beings” (Cited in Fawcett, 1984, pg 122). She further describe nursing as “a subculture, possessing ideas and values which are unique to nurses, even though they mirror the social template which created them” (ibid, pg, 123). This is true with nursing is caring for another human being which have their own culture, ideas and values which recognise themselves from whom they come from.
When we compare with Christensen’s model (1990), interpreting is the “attempt made by the nurse to attach meaning to the status of the patient and the situation” (pg. 42). Including observing, monitoring, analysing, translating, conceptualising, synthesising and decision-making. When assessing the patient and collecting data, nurses should recognise the social issues and cultural needs of the patient in order to provide treatment that are suitable for them. Moreover, as Christensen stated that the intentional presence of the nurse is essential for coming to know and understand what it means to be human and humans in relationship or partnership. This knowledge provides the basis for the mutual selection of interventions that can promote health and self-determination.
That is the essence of partnership is engaging the person in the process of their journey from the time they face the problem and come in to hospital until they go home. Partnership includes intimacy, trust, and authenticity. Furthermore, commitment, responsibility and accountability, which are the nature of nursing which Christensen identifies. Not only that, caring takes place within the context of a therapeutic relationship and is considered a moral vital of nursing.
According to Henderson’s definition of nursing “I say that the nurse does for others what they would do for themselves if they had the strength, the will and knowledge. But I go on to say that the nurse makes the patient independent of him or her as soon as possible”. “Nurse serves to make patient “complete, whole” or independent” (Cited in USA Nursing Knowledge Consensus Conference, 1998)
Although I found very difficult to understand Fawcett’s description of the metaparadigm but at the end I found this very interesting to know that metaparadigm is like a framework that help me in my practice. Nursing has a unique responsibility to promote, protect and restore the client’s holistic health.
Christensen, J. (1990) The Ethics of Care: Towards Partnership in Nursing,
Lincoln University Press with Daphne Brasell Associates Ltd, London.
Fawcett, J, (1984) The Metaparadigm of Nursing: Present Status and Future Refinements. Images: The journal of Nursing Scholarship, Vol. XVI, No. 3, pg. 84 – 7.
Fawcett, J, (1984) Analysis and evaluation of conceptual models of nursing, F. A Davis Company, Philadelphia.
USA Nursing Knowledge Consensus Conference, 1998, Consensus Statement on Emerging Nursing Knowledge, A value-Based Position Paper Linking Nursing knowledge and Practice Outcomes, Boston, Massachusetts