My nursing career began with the broad
scope of practice inherent in serving in a Med-Surg unit at a local hospital.
While nursing in this position, I also floated between floors. This was a night
shift position, and I left in order to take a day shift position at a skilled
nursing and rehab facility as an Assistant Director of Nursing. I also worked
for a short time on an as needed basis in a long term acute care (LTAC)
facility, before moving on to home health, where I worked in the field before
being promoted to a Clinical Supervisor, working directly under the Regional
Director. I was again promoted to the Administrator/Director of Nursing. During
this time, I also worked on an as needed basis for multiple home care agencies.
throughout my clinical experience, I observed and cared for the acute needs of
older adults, and, in particular, the numerous, complex needs of frail, elderly
individuals. Therefore, as a nurse practitioner, my primary focus will be
serving the geriatric population. This target population is increasing rapidly,
as innovative treatments allow patients to live longer with chronic conditions.
However, maintaining quality of life requires quality care and attention from a
primary care provider, and this is my goal.
This metaparadigm focuses on the individual receiving care (Branch, et al.,
2016). Jean Watson’s theoretical interpretation of person emphasizes addressing human needs through care, and stresses
that each individual has unique, unpredictable needs that should be accepted
and honored (Branch, et al., 2016). In nursing theory, human beings are
perceived as open energy fields, with each person possessing unique life
experiences who should be viewed in a holistic manner, as unique, dynamic
individuals (Metaparadigm concepts, 2017). The
geriatric population should be understood within the context of their lives,
which includes their accomplishments, careers, and family relationships.
metaparadigm refers to the setting, which defines the patient’s everyday life
circumstances, and includes social, personal, national and global factors, as
well as values, morals, societal beliefs and customs (Metaparadigm concepts, 2017). Watson emphasized that
caring in a holistic manner promotes the health and well-being (Branch, et al.,
2016). PACE (Program of All-Inclusive Care for the Elderly) has provided
culturally congruent care for senior citizens since 1973. PACE stresses the
importance of environment, as it maintains that it is “‘better for the
well-being of seniors with chronic care needs and their families to be served
in the community whenever possible'” (Gonzalez, 2017, p. 476). Research
indicates that PACE programs are effective in regard to allowing frail elders
to remain safely within their communities (Gonzalez, 2017). The positive effect
of environment on quality of life for older adults demonstrates the importance
of this paradigm.
Health: Watson describes health as a broad term that encompasses much more than simply
curing illness or injury (Branch, et al., 2016). Health is best conceived of as a continuum, with optimum
health defined by the parameters of the individual’s circumstances and
conditions. In other words, wellness constitutes lived experience that is
congruent between what is possible and the realities of one’s life (Metaparadigm concepts, 2017). Illness can be understood as
lived experience that encompasses loss or dysfunction, which is mediated by
caring relationships (Metaparadigm concepts, 2017).
Therapeutic nursing relationships with older individuals achieves this purpose.
Nursing: The art and science of holistic health care is guided
by values, which include human freedom, personal autonomy and responsibility (Metaparadigm concepts, 2017). Holistic nursing means that
health providers consider the entirety of an individual’s needs, taking a
“‘mind-body-spirit-emotional-environment’ approach” to practice (Klebanoff, 2013). The art of nursing practice is actualized
through the provision of therapeutic nursing interventions, which draw
creatively on the knowledge provided by science (Metaparadigm concepts, 2017). Nurses utilize their clinical judgment and
critical thinking skills in the development of evidence-based care for the
individuals, families and communities who constitute the focus of care in order
to the optimal level of wellness in diverse nursing settings and contexts (Metaparadigm concepts, 2017).
C., Deak, H., Hiner, C., & Holzwart, T. (2016). Four nursing metaparadigms.
Indiana University. Retrieved from https://scholarworks.iu.edu/journals/index.php/iusburj/article/viewFile/22199/28143
Gonzalez, L. (2017). A
focus on the Program of All-inclusive Care for the Elderly (PACE). Journal of Aging & Social Policy, 29(5),
A. (2013). Holistic nursing: Focusing on the whole person. American Nurse Today, 8(10). Retrieved from https://www.americannursetoday.com/holistic-nursing-focusing-on-the-whole-person/
concepts. (2017). The College of New
Jersey. Retrieved from https://nursing.tcnj.edu/about/mission-and-philosophy/meta-concepts/