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The nursing metaparadigm consists of core concepts that form the foundation of nursing practice and theory development. These concepts—person, nursing, environment, and health—are interconnected and guide the creation of effective nursing frameworks (Bender, 2018). The purpose of this paper is to develop a nursing framework by integrating these concepts with program outcomes based on the NLN core competencies in an associate nursing degree program. The four key metaparadigm concepts, which are person, nursing, environment, and health, serve as the framework for understanding the relationships between nursing practice and the environment in which care occurs.
In the nursing metaparadigm, the concept of “person” refers to individuals who receive care. This includes their physical, emotional, and psychological aspects, as well as their spirituality, behavior, and energy (Kalogirou, Olson, & Davidson, 2020). A person is considered an open system with physical, intellectual, sociocultural, spiritual, and psychological dimensions, all of which evolve over time and are influenced by the environment (Bender, 2018). As such, the person is central to the nursing framework, with all other metaparadigm concepts surrounding this individual. These dynamic aspects—along with environmental influences—play a crucial role in determining the person’s well-being and health (Lindahl, 2018).
The environment, as described in nursing, includes both internal and external aspects that affect a person’s experience and development. This includes the surroundings, social interactions, and the broader geographical, cultural, and societal influences a person encounters (Deliktas, Korukcu, Aydin, & Kabukcuoglu, 2019). The environment is considered an energy field that interacts with the person, influencing their care, well-being, and development (Kalogirou, Olson, & Davidson, 2020). Environmental changes, whether external or internal, play a direct role in the person’s health and are intricately connected to nursing care.
Health, within the nursing metaparadigm, is viewed as a dynamic process of well-being that continuously changes due to a combination of physiological, psychological, social, and environmental factors (Thet & Akbar, 2019). The degree of health influences the care needed and reflects the impact of care on the individual. For instance, the human body’s response to external factors such as viruses—like the case of COVID-19—demonstrates how health changes dynamically based on environmental influences. This illustrates the interconnectedness of the concepts of nursing, person, environment, and health (Kalogirou, Olson, & Davidson, 2020).
Nursing is a field that encompasses actions and services aimed at promoting the holistic well-being of individuals. It involves a dynamic process of caring that adapts to the changing needs of a person’s health and environment (Lindahl, 2018). The nursing concept includes ethical practice, professional behavior, and the application of evidence-based care, which are all essential for providing high-quality care (Kalogirou, Olson, & Davidson, 2020). Nursing, as a discipline, integrates knowledge from health, the person, and the environment to improve care and maintain health.
The NLN core competencies for associate degree graduates were used to guide the development of program outcomes for staff development in the nursing department. These competencies, which focus on human flourishing, nursing judgment, professional identity, and spirit of inquiry, shaped the following program outcomes (Fitzgerald, McNelis, & Billings, 2020):
| Program Outcome | NLN Competency |
|---|---|
| Demonstrate an advanced understanding of nursing, humanities, health sciences, and community to improve nursing. | NLN Competency – 1 |
| Promote, improve, and exhibit quality care through advocacy, collaboration, and shared decision-making. | NLN Competency – 1 |
| Implement evidence-based practice and translate research into sustainable practice. | NLN Competency – 3 |
| Understand the nursing concept and demonstrate teaching effectiveness through lifelong learning. | NLN Competency – 4 |
| Empower patients to make decisions through advocacy, communication, and support. | NLN Competency – 1 |
| Demonstrate self-management and self-reflection to maintain competence. | NLN Competency – 1 |
| Resolve education, practice, and nursing problems by incorporating research and knowledge. | NLN Competency – 1, 3 |
| Demonstrate effective inter- and intra-professional collaborative relationships to improve health care. | NLN Competency – 4 |
| Utilize technology to enhance the learning-teaching process and care delivery. | NLN Competency – 2, 4 |
| Promote ethical practices, fulfill responsibilities, and reflect integrity in nursing. | NLN Competency – 1, 3 |
| Demonstrate community-based, patient-centered care to improve quality, safety, and health outcomes. | NLN Competency – 2, 3, 4 |
| Create integrated and lifelong learning experiences through cognitive, psychomotor, and professional development. | NLN Competency – 2 |
| Approach nursing with innovation, critique, and evaluation to drive improvements. | NLN Competency – 4 |
Peer collaboration played a significant role in refining the nursing framework and enhancing the understanding of metaparadigm concepts. It facilitated the recognition of the person as an open system, integrating spiritual and cultural dimensions. Through discussions, it became clear that health and nursing should be considered as central concepts in various contexts, with the person as the core focus. Additionally, peer feedback encouraged the use of only peer-reviewed nursing journals to improve the accuracy and credibility of the work. This collaboration also helped differentiate between the competencies and identify the ones most relevant to the framework.
The collaboration led to several changes in the approach. First, considering the person as an open system highlighted the dynamic internal and external factors influencing health. Second, the focus on using peer-reviewed journals ensured the framework was evidence-based. Lastly, integrating the four NLN core competencies into the program outcomes allowed for the development of measurable, action-oriented outcomes that would guide future nursing practice (Stamps, Cockerell, & Opton, 2020).
The nursing metaparadigm provides a comprehensive structure for developing frameworks in nursing education. The person, environment, health, and nursing concepts are interrelated, with the person being central to the framework. The NLN core competencies were used to develop program outcomes that incorporate human flourishing, nursing judgment, professional identity, and spirit of inquiry. Peer collaboration contributed significantly to refining the framework, ensuring that the program outcomes reflect the essential competencies and skills for nursing graduates. The program outcomes are measurable, action-oriented, and designed to enhance the knowledge and skills of nursing professionals.
Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3), e12243. https://doi.org/10.1111/nin.12243
Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing metaparadigms. Journal Of Nursing Research, 27(5), e45. https://doi.org/10.1097/jnr.0000000000000311
Fitzgerald, A., McNelis, A., & Billings, D. (2020). NLN core competencies for nurse educators. Nursing Education Perspectives, 41(1), 4-9. https://doi.org/10.1097/01.nep.0000000000000530
Kalogirou, M., Olson, J., & Davidson, S. (2020). Nursing’s metaparadigm, climate change and planetary health. Nursing Inquiry, 27(3). https://doi.org/10.1111/nin.12356
Lindahl, B. (2018). On locating the metaparadigm concept environment within caring science. Scandinavian Journal Of Caring Sciences, 32(3), 997-998. https://doi.org/10.1111/scs.12620
NLN. (2020). NLN competencies for graduates of nursing programs. Retrieved September 20, 2020, from http://www.nln.org/professional-development-programs/competencies-for-nursing-education/nln-competencies-for-graduates-of-nursing-programs
Skemp, L., & Wyman, J. (2019). Promoting quality instruction in the care of older adults: Core competencies for gerontological nurse educators. Journal Of Gerontological Nursing, 45(10), 3-5. https://doi.org/10.3928/00989134-20190912-01
Stamps, A., Cockerell, K., & Opton, L. (2020). A modern take on facilitating transition into the academic nurse educator role. Teaching And Learning In Nursing. https://doi.org/10.1016/j.teln.2020.04.002
Thet, E., & Akbar, A. (2019). The philosophies of science in developing nursing science. International Journal Of Nursing And Midwifery Science (IJNMS), 3(1), 43-49.
https://doi.org/10.29082/ijnms/2019/vol3.iss1.212
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