Meta-Paradigms in Nightingale’s Nursing Philosophy

The core concepts of metaparadigms of nursing are the person (patient), health, nursing, and environment (Zerwekh & Zerwekh Garneau, 2014). There are various nursing theories and philosophies, but the four metaparadigms are present in each of them. Every theorist outlines particular concepts and propositions in his/her own way. However, any nursing model incorporates the four major metaparadigms.

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In Nightingale’s environmental theory, the concept of person is defined as the “recipient of nursing care” (Zerwekh & Zerwekh Garneau, 2014, p. 51). Nightingale considered the person “the center of the model” and suggested an integrated approach to the person as someone combining “psychological, intellectual, and spiritual components” (Masters, 2017, p. 163). Virginia Henderson also views the person as the receiver of nursing care but extends the definition of the person by sociological and biological features (Zerwekh & Zerwekh Garneau, 2014). Jean Watson’s theory defines the person as a “unity of mind – body – spirit/nature” (as cited in Zerwekh & Zerwekh Garneau, 2014, p. 54). Patricia Benner views the concept of person as an “embodies person” who is “self-interpreting” (as cited in Zerwekh & Zerwekh Garneau, 2014, p. 57). According to Benner, every person obtains a definite mission during his/her life and not at birth. Martha Rogers understands the person as an “energy field” (as cited in Zerwekh & Zerwekh Garneau, 2014, p. 58).

The concept of health is understood in Nightingale’s theory as being well and employing all means of attaining wellness (Zerwekh & Zerwekh Garneau, 2014). Henderson’s theory puts emphasis on the patient’s capability of operating autonomously and being self-reliant (Zerwekh & Zerwekh Garneau, 2014). Watson regards health as “harmony, wholeness, and comfort” (Zerwekh & Zerwekh Garneau, 2014, p. 54). Watson assigns a crucial role to the nurse in achieving this comfort and harmony. According to the theorist, nurses need to involve the patients in a teaching-learning process at the end of which the patients should realize how to attain the best health outcomes. Benner also views health as wholeness (Zerwekh & Zerwekh Garneau, 2014). Rogers considers the concept of health as inseparable from illness in a “continuum” (Zerwekh & Zerwekh Garneau, 2014, p. 58).

The concept of nursing, according to Nightingale, presupposes the adaptation of the environment with the aim of carrying out the health laws (Zerwekh & Zerwekh Garneau, 2014). Henderson understands nursing as the process of helping a person (either ill or healthy) to execute their activities and promoting self-sufficiency. Henderson suggests fourteen core components of nursing care, among which she includes the need for normal breathing, regular sleep patterns, appropriate clothes and other features. Also, Henderson emphasizes the importance of nursing care in sustaining the people’s beliefs and supporting their emotional needs (Zerwekh & Zerwekh Garneau, 2014). Watson entitles nursing with the responsibility of providing care to the patients and helping them achieve their health goals by being creative, sincere, and supportive (Zerwekh & Zerwekh Garneau, 2014). According to Benner, nursing combines the knowledge of both health and illness with the aim of providing caring support to the patients (Zerwekh & Zerwekh Garneau, 2014). Rogers puts emphasis on the synergy between person and environment which would make it possible to enhance these two concepts (Zerwekh & Zerwekh Garneau, 2014).

The fourth concept of nursing metaparadigm is that of the environment in which the person lives and receives nursing care. Nightingale differentiates between internal and external environments. To the internal environment, she relates such factors as medications and food consumed. The external features include such elements as ventilation and temperature in the hospital settings (Zerwekh & Zerwekh Garneau, 2014). Henderson’s understanding of the environment is expanded by the inclusion of the environmental risks and the community’s influence on patients and their families (Zerwekh & Zerwekh Garneau, 2014). Watson views the environment as the “healing space” and “vibrational field” in which the nurse not only is a part of the settings but also embodies the environment (Zerwekh & Zerwekh Garneau, 2014, p. 54). According to Benner, the environment bears a social character and meaning (Zerwekh & Zerwekh Garneau, 2014). Rogers considers the environment an “irreducible, pandimensional, and negentropic” field of energy (as cited in Zerwekh & Zerwekh Garneau, 2014, p. 58). This field, according to the theorist, exists in integration with the universe.

In my nursing practice, I endeavor to employ all four concepts of the nursing metaparadigm. I consider the person as the most important concept of the practice and the one needing my support and care. I understand the concept of nursing as my responsibility to enhance the patients’ adaptation to the treatment and help them recover as soon as possible. The concept of environment is implemented in my practice via creating the most appropriate conditions for my patients and integrating the external and internal settings to create the most beneficial atmosphere. What concerns the concept of health, I employ it as a means of providing the patients with independence and helping them to return to their normal lifestyle after the treatment.

The Two Practice-Specific Concepts

The concepts I consider important for my nursing practice are the components of the Human Caring Theory of Jean Watson and the Systems Model of Betty Neuman. Watson focuses her approach to nursing on caring and empathy (Jesse & Alligood, 2014; Sitzman & Watson, 2014). Thus, the author entitles nurses with the function of understanding the patients’ problems and discerning the physiological issues from the psychological ones. Watson is convinced that the nurse should concentrate on the integrity of the healing process rather than on the disease itself (Sitzman & Watson, 2014). Watson’s main idea is that the nurse’s ability to sympathize with the patients and desire to help them is as crucial as supplying the hospital with the most necessary technical equipment. The author defines ten Caritas processes for the nurses to follow. These Caritas incorporate such requirements to the nurses as practicing sympathy and kindness, encouraging trust, organizing patient education, respecting people’s dignity, and arranging a healing environment (Sitzman & Watson, 2014). I find the concepts delineated in Watson’s theory rather important for my practice. I always try to provide the best care and empathy to my patients so that they could feel less stressed and discouraged by their health condition. I completely agree that caring attitude is a crucial component of the healing process.

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The second group of practice-specific concepts which I consider essential is described in Betty Neuman’s System’s Model. The major concepts of Neuman’s model are the human being, the environment, open system, flexibility, lines of defense and resistance, and prevention (Gonzalo, 2011; “Betty Neuman’s systems model,” 2012). Neuman considers intervention the best preventative method. She distinguishes three kinds of prevention: primary, secondary, and tertiary (“Betty Neuman’s systems model,” 2012). At the first prevention stage, the nurse helps the person to fight the stressors effectively. At the second phase, the patient is taught to confront the stressors and eliminate them. Tertiary prevention is aimed at providing support to the person by encouraging him/her to be energetic and focus on positive things (“Betty Neuman’s systems model,” 2012). Neuman pays special attention to the environment and divides in into internal, external, and created. The latter is established unconsciously and represents the integrity of the system (“Betty Neuman’s systems model,” 2012). According to Neuman, nursing occupies a crucial role in the healthcare system as it promotes people’s wellbeing, helps to stabilize their condition, and decreases the impact of stressors on the patients (“Betty Neuman’s systems model,” 2012). I align with Neuman’s concepts as I find them significant for any nursing practitioner who strives to do his/her job at the highest level.

The List of Propositions Connecting the Concepts

  1. Both concepts consider the nurses able to manage the environment in which their patients find themselves.
  2. The person is regarded as owning a number of integrated features enabling him/her to combine philosophical, spiritual, and developmental features.
  3. Watson’s and Neuman’s nursing health models emphasize the role of external stress determinants in restricting the healing process. Both authors believe that the nurse is capable of helping the patients to overcome these adverse circumstances.
  4. In both concepts, health is equated with the absence of disease.
  5. The two theories have a similar understanding of nursing: it is considered a process of integrated care aimed at providing the best health outcomes, averting the disease, and caring about the patients.
  6. Both concepts are not complicated and can easily be applied in nursing practice.


Betty Neuman’s systems model. (2012). Web.

Gonzalo, A. (2011). Betty Newman: The Newman systems model. Web.

Jesse, E., & Alligood, M, R. (2014). Jean Watson: Watson’s philosophy and theory of transpersonal caring. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed.) (pp. 79-97). St. Louis, MO: Elsevier

Masters, K. (2017). Role development in professional nursing practice (4th ed.). Burlington, MA: Jones and Bartlett Learning.

Sitzman, K., & Watson, J. (2014). Caring science, mindful practice: Implementing Watson’s human caring theory. New York, NY: Springer Publishing Company.

Zerwekh, J., & Zerwekh Garneau, A. (2014). Nursing today: Transition and trends (7th ed.). St. Louis, MO: Elsevier Saunders.

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