Introduction
The nursing profession has evolved through its reliance on sound theoretical perspectives. Fawcett surmised that the nursing metaparadigm comprises four concepts: person, environment, health, and nursing (Fuentes-Ramírez, 2023). In their conception of nursing work, Jackson, Anderson, and Maben (2021) posit that nurses’ prolonged exposure to patients allows for the formation of meaningful therapeutic relationships. These ties provide nurses with in-depth knowledge of their clients, allowing them to advocate for them.
Nurses are best positioned to detect and analyze changes in patients’ situations, efficiently meet their needs, and provide timely care (Jackson, Anderson, and Maben, 2021). All the highlighted elements are critical to providing holistic care in healthcare settings. The nursing metaparadigm, as outlined by Fawcett, and the nature of nursing work, as defined by Jackson, are the constituent elements of a framework that facilitates holistic assessment in healthcare.
Holistic Assessment
Holistic nursing care is a crucial component of nursing practice, as it prioritizes the patient as a whole. Holistic care is defined by the American Nurses Association as the integration of “body, mind, emotion, spirit, sexual, cultural, social, energetic, and environmental” concepts and methods to promote health, enhance well-being, and fulfill human potential (Ambushe et al., 2023, p. 1). The holistic needs assessment (HNA) is an approach that aims to elicit systematic support for all of the patient’s needs(Snowden et al., 2023).
Systematic assessments of the role and function of HNA generally agree that the basic areas comprising holistic needs are physical, practical, emotional, relational, spiritual, and informational (Snowden et al., 2023).HNAs are conducted as part of holistic health care delivery. HNAs take into account the patient’s physical, emotional, spiritual, and financial needs, along with how they respond to illness and how it affects their capacity for self-care (Ambushe et al., 2023). Nurses should practice the aforementioned form of care to achieve specific objectives.
HNAs are guided by holistic nursing care goals such as improving health, alleviating suffering, and preventing sickness. The HNA, commonly used in clinical settings, is the concerns checklist, a list of 48 issues organized into the previously established categories (Snowden et al., 2023). Patients rank their concerns during essential stages of care to facilitate the prioritization of their needs and the provision of the resources necessary to address them (Snowden et al., 2023).
Holistic nurses work to protect, promote, and optimize health and wellness (Ambushe et al.,2023). They also seek to help people achieve calm, comfort, and balance as they experience illness. It is worth noting that there is an ever-increasing global demand for holistic nursing care. The fact that a direct correlation exists between quality of life and holistic care means that any conception of quality of life should be holistic (Ambushe et al., 2023). In essence, different parts of a person’s life will influence others at any one time.
The Nursing Meta-Paradigm
The nursing metaparadigm is a framework that guides nursing practice. It is defined as “an area of study and is the extended consensus within a discipline” (Fuentes-Ramírez, 2023, p. 1). The paradigm is a framework or structure that is accepted by the community, provided its principles and convictions are shared (Fuentes-Ramírez, 2023). Its development and evolution are pegged on changes through time.
The nursing discipline has made exhaustive inquiries regarding the nature and features of an acceptable meta-paradigm. Fawcett’s views, published in 1984, proposed that the nursing metaparadigm was a particularly abstract element within the hierarchical framework of knowledge, constrained by philosophical perspectives and the discipline’s worldview (Fuentes-Ramírez, 2023). The delivery of holistic care is discussed in the backdrop of the metaparadigm.
Fawcett described person, environment, health, and nursing as key elements in the metaparadigm. The person-centered paradigm focuses on the patient receiving care. It often includes an individual’s heritage, religion, relatives, friends, or social class. The internal and external factors that define the individual’s condition constitute the environment meta-paradigm, which includes elements such as interactions with others and immediate surroundings.
The degree of the patient’s wellness is encapsulated in the health meta-paradigm, which also includes their access to essential health services. The nursing component is the fourth meta-paradigm and delineates how practitioners use their knowledge and skills to care for patients. It also describes the nurse delivering the care. The application of the highlighted meta-paradigm is essential to providing holistic care in the nursing process.
Person
The provision of holistic care is essential, given that advancements in the sector promote methodical rather than altruistic approaches. The value of holistic care is best captured by the theory of human caring, as proposed by Jean Watson (Evangelista et al., 2021). The elements proposed in the theory align with Fawcett’s meta-paradigms regarding holistic care and the implementation of HNAs.
A holistic conceptualization of the person meta-paradigm advocates addressing human needs through human care. Every patient has a distinct set of personal and unforeseeable needs, and it is critical to embrace and honor them, irrespective of their preferences, customs, or beliefs. A holistic approach centered on cognitive, physical, and spiritual aspects is required for a person to be fully cured (Evangelista et al., 2021).
According to the theory of human caring, neglecting any of the highlighted elements prevents complete healing (Evangelista et al., 2021). Each patient must be appreciated and understood, with the nurse remaining authentically present at all times. In addition, each patient’s right to have their dignity preserved and safeguarded must be prioritized.
Health
A holistic view of the health meta-paradigm demands much more than just treating a disease. This is because, while curing is necessary, it goes beyond the physiological responses involved in the process. To achieve optimal health, nurse practitioners must adopt a holistic approach that encompasses the patient’s mind, body, and soul. Complete healing requires the precise balance of a person’s bodily, mental, and spiritual selves. Achieving health requires harmonizing all the aforementioned components.
It should be noted that nursing assessment is another crucial aspect of health. To maintain optimal health, it is critical to examine patients holistically, based on their individual needs. Clients in acute care settings, for instance, may require multiple evaluations each day, unlike patients in other areas of nursing who may need less.
The holistic approach emphasizes that just because a person seems to be in good health does not mean that health has been fully realized (Evangelista et al., 2021). It is vital to remember that the holistic approach underscores the importance of disease prevention and overall health. According to the theory of caring, nurses must create care plans that are designed not only to cure present illnesses but also to analyze a patient’s mental condition and background, and to prevent possible ailments.
Nursing
A close assessment of the nursing meta-paradigm demonstrates the need for nurses to cultivate relationships with their patients. It should be stressed that, while science and medicine are essential curative forces, they are not necessarily the most important. Holistic needs assessment is an essential component of the nursing process, as it focuses on the individual as a whole and ensures that practitioners address their clients’ physical, cognitive, and spiritual needs (Snowden et al., 2023).
Nurses can help patients feel safe and comfortable by building genuine relationships. This helps strengthen the bond between the nurse and their clients during care and treatment. Establishing relationships can eventually lead nurses to learn more about patients, thereby promoting greater healing (Evangelista et al., 2021). HNAs should assess avenues where nurses can educate and guide patients to facilitate the complete restoration of health. The nurse ought to be a leader capable of teaching patients how to promote their own healing. Finally, patient examination and evaluation are critical for preventing disease.
Environment
The environment can affect not only patients’ ability to heal but also nurses’ ability to care for them. The theory of human care has the potential to improve relationships between nurses and their clients, as well as nurse practitioners and medical professionals, as they conduct HNAs (Evangelista et al., 2021). HNAs should query patient preferences and prioritize designing spaces that foster an atmosphere that makes patients feel at ease. There should be secure spaces designed to make patients feel safe and comfortable.
Noise levels should be reduced to a minimum to promote serenity. Patients are more likely to feel calm and relaxed in such surroundings, which can help to relieve any further stress and worry. Lighting is also essential, as it can uplift patient spirits, thereby lowering tension and anxiety. Scents and the quantity of space in rooms are essential environmental elements to consider. Although not all of the aforementioned factors will apply to every patient, they are crucial to consider because they can accelerate healing.
The Nature of Nursing Work
Various authorities have debated the nature of nursing work since the profession’s inception. In their quest to contextualize the nature of nursing work in contemporary environments, Jackson, Maben, and Anderson (2022) conducted a study in which nurses defined their duties in terms of broad goals and objectives. The participants seldom described the activities they conducted in terms of the exact nature of their tasks. Instead, they viewed their duties as a fluid framework that enabled customization of work (Jackson, Maben, and Anderson, 2022).
Nurses also stated that they are continually expected to change and that viewing their work as a role enables them to adapt as needed (Jackson, Maben, and Anderson, 2022). Nurses described themselves as being at the center of the patient, their family, and the interdisciplinary team, serving both patients and the healthcare system (Jackson, Maben, and Anderson, 2022). Participants perceived their work as duties to be fulfilled, categorized into clinical, management, and facilitation. It is against this backdrop that the nature of nursing, encompassing physical, cognitive, organizational, and emotional labor, is evaluated in the context of holistic needs assessments.
Physical Labor
In the conceptualization of the nature of nursing work, it is crucial to consider physical labor, which is work done by nurses with their bodies. Touch is an essential component of physical labor and is defined as the amount of physical contact between nurses and patients, such as during cleaning or procedures (Jackson, Anderson, and Maben, 2021). Nursing employment requires a high level of physical interaction, which boosts their ability to influence and meet patient needs. The close contact places nurses in a position to conduct HNAs that effectively address all the requirements of the person metaparadigm, thus enhancing the client’s satisfaction with the services provided in healthcare settings.
Cognitive Labor
Cognitive labor is an essential aspect of nursing’s nature, with a direct impact on the health meta-paradigm and the provision of holistic care. The first element to consider is learning while working, which relates to gaining clinical expertise rather than information gathered through the nursing education process (Jackson, Anderson, and Maben, 2021). Nursing knowledge is described in various models as empirical, aesthetic, personal, and moral.
According to the Novice-to-Expert hypothesis in nursing, nurses build competencies over time through continual learning and experience (Jackson, Anderson, and Maben, 2021). As a result, nursing can be taught in a classroom and learned via practice. Experience-based information facilitates the practical implementation of HNAs that address patients’ emotional, physical, and mental needs.
Thinking is a vital element of nursing work. Jackson, Anderson, and Maben (2021) examine several aspects of cognitive labor, such as critical thinking, clinical reasoning, and clinical decision-making, which form the core of a nurse’s thought process. Although terms such as clinical reasoning, decision-making, judgment, heuristics, problem-solving, and others overlap, there is widespread agreement that thinking, in whatever form it takes, is an essential aspect of nurses’ work (Jackson, Anderson, and Maben, 2021). It is through the aforementioned processes that nurse practitioners can identify specific patient issues during HNAs and propose solutions that holistically address their needs.
Organizational Labor
The concept of organizational labor came into being when it was recognized that the phenomenon is a vital component of the nursing profession. It entails coordinating necessary actions for patients, their families, and the organization to ensure patient flow through the healthcare system (Jackson, Anderson, and Maben, 2021). Nurses primarily undertake organizational labor that is often overlooked, even by nurses themselves.
Organizational labor is viewed as “paperwork” or a bureaucratic exercise that takes nurses away from their “real jobs” (Jackson, Anderson, and Maben, 2021, p.7). However, it is still one of the most crucial jobs in the hospital. Nurses, for example, regulate the flow of information across multiple disciplines and departments, guaranteeing the safe management of patients as they pass through the healthcare system. In this way, organizational labor, an integral aspect of nursing practice, supports the provision of holistic care. This is because even though the nurse may not contact the patient directly, their organizational actions facilitate the seamless transfer of services that ensure all the patient’s healthcare needs are addressed.
Emotional Labor
Jackson’s description of the nature of nursing work involves emotional labor, which significantly impacts the environment in which healthcare services are provided. It is essential to consider the fact that emotional labor has evolved to become a fundamental nursing concept. The sociological conception of emotional labor views it as the commodification of managed emotions (Jackson, Anderson, and Maben, 2021). When staff induce or conceal their feelings to present a desired display, they create a specific feeling in the customer. Nurses often control their emotions as they conduct HNAs to create therapeutic environments for their clients (Jackson, Anderson, and Maben, 2021).
Emotional labor is necessary when nurses seek to project something other than how they feel. A typical example is when nurses maintain a calm demeanor to avoid frightening patients in panic situations. Nurses frequently alter their emotional displays to achieve specific objectives (Jackson, Anderson, and Maben, 2021). The challenge, however, is that nurses are expected to perform emotional labor, yet it is neither taught, supported, nor recognized as work.
Discussion
The provision of holistic care, as in conducting health needs assessments, within the context of the nursing metaparadigm and the nature of nursing, is the basis of contemporary nursing. Policymakers, practitioners, and researchers are increasingly acknowledging the need to move away from the paternalistic, service-centric system in which “physician knows best” in favor of a more collaborative, consultative approach (Wong et al., 2022, p. 1). The novel model ensures that patient views regarding their needs and experiences are highlighted, given that they are users of health services.
The emphasis is now on collaborating with patients and their families to build treatment, information, and care pathways that meet patient requirements. The aforementioned patient-centered care strategy, according to Wong et al. (2022), is associated with greater adherence, improved clinical outcomes, and fewer unnecessary healthcare visits. A holistic needs assessment that effectively addresses physical, emotional, and spiritual needs in the context of the person, environment, nursing, and health meta-paradigms guarantees the delivery of quality services.
The nature of nursing work indicates that, by considering the nursing profession as physical, emotional, cognitive, and organizational labor, the complexity and breadth of the work involved in providing holistic care are contextualized. While the nursing profession is still portrayed as one-dimensional and primarily focused on patient care, research demonstrates that it is complicated and multifaceted (Jackson, Anderson, and Maben, 2021). The recognition of the aforementioned complexity significantly impacts how holistic needs assessments are conducted. For instance, job crafting, a process that allows nurses to develop work strategies that both satisfy organizational goals and reflect personal preferences, is critical to the delivery of holistic care (Jackson, Anderson, and Maben, 2021). Supporting nurses in tailoring their work across different forms of labor may help enhance the extent to which patient needs are addressed.
The nursing metaparadigm has numerous applications in fostering the delivery of holistic services. Nursing students must learn to establish a comprehensive view of the discipline from their initial training years (Fuentes-Ramírez, 2023). Practitioners are expected to reflect on a nurse’s thought process, the elements that conform to its structure, as well as the technical talents involved in the instrumental task (Fuentes-Ramírez, 2023). In this way, nurses develop the capacity to evaluate and value the activities carried out within the vastness of nursing knowledge. The nursing meta-paradigm offers an overview that validates and makes sense of various nursing practice elements and research in holistic care.
Conclusion
Holistic nursing assessment is an essential component of nursing practice, given that it focuses on the overall management of a patient. It is all-encompassing care that takes into account the patient’s physiological, spiritual, psychological, and financial needs, as well as their response to illness and the impact of disease on their capacity to meet self-care needs. The provision of holistic care is inextricably linked to the nursing metaparadigm, which views the profession and its activities through the lens of personal, environmental, health, and nursing components.
Each of the highlighted facets contributes to a patient’s experience in health contexts. It is the basis for conceptualizing the patient’s needs and developing strategies to address them. In the same breath, the conceptualization of nursing as made up of emotional, cognitive, organizational, and physical labor allows for the identification and prioritization of specific elements that constitute the patient experience. As a result, measures that address the patient’s needs holistically can be developed and implemented. Therefore, Fawcett’s nursing metaparadigm and Jackson’s definition of nursing work are essential elements of a framework that promotes holistic care in healthcare.
Reference List
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Snowden, A. et al. (2023) ‘Holistic needs assessment in outpatient cancer care: a randomized controlled trial’, BMJ Open, 13(5), pp. 1–9.