Characteristics of various Nursing Paradigms and nursing theories within the Totality and Simultaneity Paradigms
Submitted by Ahtisham Younas, BSN, MN (c) (Memorial University of Newfoundland, Canada)
The nursing knowledge includes various philosophical ideas about human universal health process. The nursing researchers and students should be familiar about these ideas because their understanding is important for theory development and knowledge advancement in nursing (DiBartolo, 1998; Northrup et al., 2004). These different nursing philosophical ideas are the origin of various paradigms. A paradigm is defined as a worldview which serves as a philosophical underpinning for explaining any phenomena of interest to a discipline (Parse, 2000). It determines the goals and boundaries of a discipline and organizes its knowledge. Paradigms are abstract ways of articulating knowledge and are discipline specific, philosophical, and changeable (Peterson, 2013; Bahramnezhad, Shiri, Asgari, & Afshar, 2015).
The nursing paradigm represents global ideas about individuals, groups, situations and phenomena of interest to this discipline (Fawcett, 1995). It explains the nature of human beings, their relationship with the environment, and the human-universal-health processes (Fawcett, 1993; Parse, 2000). The nursing philosophers, based on their philosophies, offered various paradigms that contribute to the development of nursing knowledge. Each of these paradigms have their own importance and focuses on different methods of inquiries and practice in the nursing discipline (Parse, 2000; Bahramnezhad et al., 2015). The purpose of this paper is to provide an overview of the characteristics of various paradigms in nursing and exemplify how nursing theories and models fit within a certain nursing paradigmatic classification.
Paradigms in Nursing
Among the nursing philosophers, Parse (1987) classified the two major nursing perspectives as the totality and the simultaneity paradigms. The totality paradigm views the human-universe relationship as cause-effect in nature. However, the simultaneity paradigm is embedded in a view of the human-universe relationship as a mutual process (Parse, 1992). Each of these paradigms has influenced the perspectives of several nursing theorists and there are many theories that fall into these categories. The theories within the totality paradigm consider body, mind, and spirit as separate entities. They emphasize the practice modalities focusing on the physiological, psychological, spiritual, and social well-being of people. The human beings are considered to be in a linear interaction with their environment. On the other hand, the theories within the simultaneity paradigm adheres to descriptions of human beings as whole entities recognized through patterns. The human beings are considered to be in continuous and simultaneous interaction with their environment (Parse, 1992).
Newman (1992) also proposed three prevailing paradigms; the particulate deterministic, the interactive integrative, and the unitary transformative. She clarified that “the first of the paired words describes the view of the entity being studied and the second word describes the notion of how change occurs” (p.10). The particulate deterministic paradigm views nursing phenomena as separable, reducible, and measurable entities. These entities have an ordered connectedness to each other which is linear and casual in nature. The change occurs as a consequence of the antecedent conditions. The identification of these antecedent conditions predict the change in the phenomena of concern. This paradigm mostly focus on the objective nursing phenomena. On the other hand, the interactive integrative paradigm views reality as multifaceted and contextual. It recognizes both objective and subjective nursing phenomena with their reciprocal relationship. Change is assumed to be an effect of multiple antecedent factors and their probabilistic associations. Lastly, the unitary transformative paradigm present reality in a different way than others. It views human beings as uniform beings and evolving as a self-directing field. Their self-directing field is recognized through certain patterns that they develop through interaction with a larger whole. The change is considered random and unidirectional because it moves through “stages of organization and disorganization to more complex organization” (Newman, 1992, p.11)/
Fawcett (1993) analyzed the characteristic worldviews of Reese and Overton (1970), Hall (1981), Newman (1992), and Parse (1987). On the basis of the similarities and differences of these worldviews, Fawcett (1993) generated a set of three paradigms: reaction, reciprocal interaction, and simultaneous action. The reaction worldview combines the features of the totality and the particulate deterministic paradigm. The reciprocal interaction view combines the characters of the totality, simultaneity and interactive integrative worldview. The simultaneous action view comprises features of the simultaneity and the unitary transformative paradigm (Butts, 2011).
This discussion will focus on how grand nursing theories and models fit within Parse’s (1987) paradigm classification. There are many nursing theories that fit into these paradigms. However, this paper will discuss only a few nursing theories and models in this paradigmatic classification for an exemplar. The first section will discuss how Roy’s (1970) adaptation model and Orem’s (1971) self-care theory fits within the totality paradigm. The second section will discuss how Rogers’ (1970) science of unitary human beings and Parse’s (1998) human becoming theory fit within the simultaneity paradigm.
Nursing Theories within the Totality Paradigm
Numerous features of the totality paradigm are apparent in the adaptation model. This model reflects the person as a holistic adaptive system in continuous interaction with both external and internal environment. The goal of nursing is to promote adaptation within four adaptive modes including psychological, self-concept, role function and interdependence (Roy, 1997, 2009). This illustrates that human beings strive towards an optimal level of health through manipulation of their environment. The practice methodology in this model is the six step process similar to the nursing process (Mitchell & Pilkington, 1990). The nurses using this model will assess patient’s condition according to the adaptive modes, categorize the stimuli for those behaviors, develop a nursing diagnose, intervene, and then evaluate patient’s condition. This practice methodology is consistent with Parse’s (2000) statement that nursing process is the distinctive problem solving method within the totality paradigm. All these features of the adaptation model indicates that it fits within the totality paradigm. Similarly, Orem’s theory views human beings as a summative entity that needs to adapt to their environment to meet their goals (Orem, 1997, 2001). Human beings are recognized as active agents capable of taking deliberate actions to maintain self-care (Orem, 2001; Fawcett, 2005). Orem (1997) considered environment as a means to provide basic human needs for survival. These features are consistent with the totality paradigm. Furthermore, Orem stated that nursing is the intervention to meet the required need for self-care and the need for medical care of patients (1997). This is consistent with the goal of nursing in the totality paradigm which focuses on health promotion and prevention of illness (Parse, 1987). Finally, both of these theorists viewed health as the proper functioning of body. Health was considered to be a measurable and observable entity. This clearly indicates that these theories follow the totality paradigm.
Nursing Theories within the Simultaneity Paradigm
The two important nursing theories within the simultaneity paradigms are: Rogers’ (1970) science of unitary human beings and Parse’s (1998) human becoming theory. The science of unitary human beings presents a holistic view of human beings and their environment and conceptualize them as irreducible and indivisible wholes (Rogers, 1970). Human beings and environmental are viewed as energy fields which change continuously. Roger (1970) claimed that the nature of human beings can only be understood through examination of all dimensions rather than their individual dimensions. These features are in line with the features of the simultaneity paradigm. She also stated that her theory is concerned with specific patterns of human and environmental energy fields that may lead to their optimum well-being. According to her, the goal of nursing is not the management of health problems but the progression of change in the direction of wherever human beings think they are going. This indicates that Rogers’s theory clearly fits within the simultaneity paradigm.
Parse’s (1998) human becoming theory is also consistent with the principles of the simultaneity paradigm because she specified that her theory is derived from Roger’s (1970) theory. Parse (1992) stated that "human becoming reflects the unity of the construct man-living-health and in her theory there are no references to particular aspects of humans, such as biological, psychological, or spiritual" (p. 37). She regarded human beings as unitary beings who mutually interact with the rhythmical patterns of their environment. These characteristics directs that this theory fits within the simultaneity paradigm.
In conclusion, nursing is a multi-paradigmatic discipline. The nursing paradigms play an essential role for understanding multifaceted human beings and related nursing phenomena. The conceptual models and theories in nursing represent different paradigms and aspects of nursing. However, the definitive purpose of these paradigms and the models and theories which follow these paradigms is to improve professional nursing practice through knowledge development.
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