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My ontological view of nursing is continuously evolving and growing, especially with the spark of new knowledge connected to graduate level education. Being a nurse embodies having a specific skill set, a specialized knowledge base and critical thinking skills while providing individualized client and family centered care in collaboration with an interdisciplinary team. Recognizing clinical trends and knowing what interventions to perform based on assessment results from a client are rooted in the science of nursing. Whereas, that innate capacity to respond to the needs of an individual through therapeutic touch, providing emotional support to a family member that is distraught, draws on compassionate care which falls under the art of nursing.
Kim (2015) states that nursing is patient-specific while action oriented with the intention to help patients live a meaningful and fulfilling life within their health continuum. This is accomplished by viewing each patient as a whole entity; mind, body and spirit. When I introduce myself to my patient as their nurse, history and societal context contribute to the inherent notion that I am there to protect, advocate, guide and care for.
My ontological stance is influenced by Fawcett’s (1984) metaparadigms of nursing in the sense that advocacy, and adaptability are built into my nursing practice.
I believe each patient is a unique and should be appreciated for their individualism. Nurses should consider the patient’s caregiver, family, and community as part of their identity (Adams, 2016). While building a therapeutic nurse-patient relationship, nurses should make the effort to understand the patient in the context of their own life.
Through interpersonal interactions and conversations, patient specific needs, goals and desires can be identified to establish individualized care plans and interventions.
The environment is the most influential factor impacting my ontological stance of nursing. It is crucial for nurses to understand the relationship between environment and overall health. Sometimes while working in a well-funded primary health care facility, access to health care and services can be taken for granted. Nurses should reflect on their implicit biases regarding accessibility to technology, socio-economic status, and basic resources to understand how one’s environment affects their health and well-being (Marmot, 2018). This type of knowledge is difficult to teach in classrooms, and if nurses fail to identify the internal and external factors associated with a patient’s environmental context, this can compromise healthcare delivery to vulnerable populations.
Health as a metaparadigm is vastly subjective. I identify with a holistic view of health which places equal importance on the mental, physical, spiritual, cultural and emotional aspects. Within my own nursing practice, there is an emphasis that health is the absence of illness and tertiary care institutions focus on pharmacological solutions to medical diagnoses. Although I support healthcare treatments using traditional medicine, incorporating holism is vital for disease prevention and population health. Healing and holistic health are life-long processes that introspectively balance the health and illness spheres (Thornton, 2016). My stance on “health’ has a significant impact on my practice as a postpartum nurse in the sense that I chose to incorporate holistic assessments (social determinants of health) and interventions into my care plans. Nurses have the extraordinary capability to advocate for patients to receive an array of services such as spiritual care, physical therapists, social workers and in doing so, they greatly contribute to the overall health of their patients.
From my ontological viewpoint, nursing is the most difficult to conceptualize. On a micro level, nurses conduct assessments derived from scientific knowledge, facilitate recovery from illness, provide emotional support and foster health to prevent recurrence of illnesses. On the contrary, from a macro perspective, nurses drive critical thinking, adapting, collaborating and life-long learning. Advocacy is the fundamental component of moral nursing care practice and the theme of social justice has consistently been a part of the nursing profession since the time of Florence Nightingale (Shetty, 2016). I have experienced the ability to exercise power for the purpose of advocating for opioid-dependent mothers to be included in health programs that exclude based on stigma attached to their health situation. The perception of nursing, requires critical analysis of the status quo, exposing societal issues that form the upstream precursors to urban health disparities (Read et al., 2016). I support the need to incorporate a social justice component to the nursing metaparadigms. This stance is also shared by the Canadian Nursing Association (2017) which states that addressing issues of social justice that are associated with health and well-being is necessary for ethical nursing care.
Over the years, many scholars have contributed theories to define nursing, with the belief that the conceptualization of nursing would enhance nursing education, professional independence, research and autonomy. Nevertheless, due to the complexity of nursing, the metaparadigm concepts have been further polarized (Thorne et al., 1998). These polarized opinions have largely contributed to my nursing perspective. For example, I have a totality paradigm view in health because I consider one’s health as the whole person. In contrast, the simultaneity paradigm views health as a reflection of the whole person’s process (Thorne et al., 1998). Although there are debates amongst scholars between these two theories, instead of determining which theory is right or wrong, scholars should develop a fundamental concept of health that’s includes a neutral perspective, which, in turn establishes a mutual starting point for discussions by both parties (Thorne et al., 1998). There is a great benefit in integrating aspects of multiple theories in conceptualizing the metaparadigms and in supporting solidarity within nursing theory. “Unification within diversity”, will enable nurses to continue to be educated, progressive, and a specialized group of professionals (Thorne et al., 1998).
The metaparadigms of nursing aid in answering the philosophical question “what is nursing?”. Through critical analysis of the metaparadigms of person, environment, health, and nursing, my answer is formulated. As I continue to grow as a nurse, I plan to become more aware of the unique perspectives in nursing and remain open-minded to other views. Furthermore, I will be more conscientious to the changes in society to understand the current health needs.
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