Introduction

The meta-paradigm is defined as an area of study ¹ and is the ex- tended consensus within a discipline ². The paradigm is a model or pattern that according to its use is accepted by the community when values and beliefs are shared, and when it transforms because it evolves with time ³.

The nursing discipline has asked about the definition of the meta-paradigm that must be accepted. This questioning milestone is Fawcett’s proposal ⁴ which, in 1984, postulated that the nursing meta-paradigm was the most abstract component within the hierarchical structure of knowledge, restricted by philosophical orientations and the discipline’s worldview. Moreover, she established it is composed of four concepts: person, environment, health, and nursing. On the other hand, Newman ¹ stated nursing is the study of care in the human health experience. In the same line, Monti and Tingen ⁵ outlined the dilemma between having or not a theoreti cal unification and highlighted the importance of the multiple paradigms that add to the advancement of nursing science. New conceptualizations appeared in 2008 with Newman ⁶ and Willis ⁷ who added new concepts and analyses to the already existing ones, exhorting the members of the nursing discipline to unite in a shared meaning to provide the practice with coherence.

In 2018, Bender ⁸ presented the re-conceptualization of the nurse’s meta-paradigm, where she defends a meta-paradigm that articulates the nursing ontology. Smith ⁹ analyzed the literature on the nursing discipline perspective, synthesized the topics, and suggested knowledge development areas for the discipline. The four topics she identified are human integrity, health/healing/well-being, the relationship between the human being, the environment and health, and care.

The questioning regarding the nursing paradigm is current. For this reason, Ph.D. students, that is, doing curricular studies, have reflected and generated innovative proposals closer to everyday life, like Tara and Col ¹⁰ and Reed ¹¹. Even disruptive proposals like Johnson and Carrington’s ¹² have gained momentum because they include a technology-specific domain within the meta-paradigm for advancing to the same pace as novel discoveries.

In fact, in 2023, Fawcett ¹³, after almost 40 years of presenting her initial proposal, questions the need for a meta-paradigm and what its content should be, subscribing to Chinn’s ¹⁴ proposal, that establishes the decolonization of the nursing knowledge and proposes to involve people from different cultures, residents of non-Eurocentric counties, to contribute with their perspectives about the need and the content of the nursing meta-paradigm.

Even though this debate continues and evolves, we are in a transitioning scenario, where a closer approach to the citizen’s everyday life in nursing is required, for which new proposals are being positioned within the academic community that have been more successful in solving the problems nursing is facing. In this article, I expect to broaden the debate by asking what the need for a meta-paradigm’s use is according to the current challenges from two perspectives: The nursing professional and the nursing discipline.

What Does the Nurse Accomplish Using the Meta-Paradigm?

Different definitions and perspectives have been presented about the meta-paradigm, but beyond its conceptualization what is important is the smart implementation by the nurse and its application in everyday life. Here are some examples:

Think like a nurse: From their first training years, the student must learn to develop a broad perspective of the discipline, they must reflect on how the nurse thinks, which elements conform to its struc ture, and of course, what the technical abilities of the instrumental work are. In that way, they evaluate and appreciate the activities performed within a broad world of knowledge. To accomplish this, the teachers have the challenge of educating students with quality, to guarantee they understand the discipline and all the richness they gain from the role they must develop. The meta-paradigm provides general field parameters and offers the scientist (and clinicians) a vast orientation from which to work ¹⁵.

Educate nurses in nursing: There is an urgent need to develop study programs, bachelor’s degrees, master’s, and doctorates, that pro- vide a nursing discipline and knowledge-focused education, includ- ing theory-guided practice and nursing theory-guided research. Nursing has its own science, and that combination must be the basis for the knowledge to educate future generations.

Autonomy: The meta-paradigm allows the nursing professional to master an area of knowledge, support their actions with evidence, and make independent decisions during their practice. The nursing meta-paradigm provides a road map that substantiates and gives sense to diverse nursing practice and research ⁸.

The above is evidenced at the Nursing and Rehabilitation Faculty of Universidad de La Sabana, which, through its undergraduate and graduate degrees, has developed a real and everyday perspective of the discipline with the use and application of nursing theories to teaching, practice, and research. This perspective was implemented via two aspects: First, the development of theoretical thinking that allows the graduate to use and apply the epistemological resources daily with an analysis of the principal nursing concepts and, second, the proposal of solutions to the practice’s challenges and leading projects and processes for innovative management to promote the betterment of the patients and their families’ health situations.

Identity: Having a clear profile allows those who enter the discipline to identify their role, reinforce their identity, and focus on their performance to fulfill their mission.

Interdisciplinary work: Understanding what nursing is and recognizing its knowledge frontiers allows the nurse to interact with freedom and security because they comprehend the difference between what to do and how far to go in the field of global health; a determinant ability to accomplish health goals.

What Does Nursing Accomplish?

Better defining the fundamental concepts: It is important to name the phenomena nursing faces daily to achieve a better appropriation of the discipline’s language. Understanding, describing, measuring, and evaluating what is observed and done daily allows knowing the nursing impact to better address the area of study.

Unite the practice and the evidence: Nursing performance is based on the best available evidence, which ensures people with different health conditions are treated according to best practices. The theory gives structure to the nursing job and each action.

Guiding the research process: According to Kuhn ³, the meta-paradigm shapes how scientists investigate. The ontological and epistemological assumptions of a paradigm direct its methodol- ogies. Nursing has a scope, and it must guide its actions to propose stronger theoretical knowledge. There is a risk that in the absence of a paradigm, all issues seem equally relevant and, therefore, there is no clear research path.

Improving the health conditions of people and communities: Impact populations with concrete actions, that is, understand the phenomena, explain them, identify the causal relationships, establish how they are modified, and prescribe the changes for wellbeing. In that way, the consensus within the discipline can impact the field of study.

The nurses’ mission focuses on an articulated job that reduces the gap between theory and practice. This draws more awareness to the job through tangible results that attempt to structure the discipline’s knowledge. Results include research that permeates the nursing practice and curriculum, an autonomous practice that experiments, debates, expands the theory and creates new research perspectives, and leadership that contributes to improving people and their families’ health conditions through high-impact global actions. Dreaming big does not contradict the nursing vision.

Conclusions

It is important to understand unity strengthens the transition from the abstract to the concrete, makes the use of the meta-paradigm more relevant and prioritizes professional commitment over the different concepts, laws, theories, and views as stated by Kuhn ³. Working on disagreements and building on differences enables nurses to make practical use of the meta-paradigm as a roadmap for nursing.

The ongoing leadership of nurses has developed research, practice, policies, and education. Finding more consistent and specific concepts that allow nurses to have a frame of reference is necessary to position work and improve practice with evidence, guide research processes, and strengthen the health conditions of individuals and communities.

Where else can nursing have the flexibility to perform various functions while having the satisfaction of working directly to improve people’s quality of life and receive a reward for this? The use of the meta-paradigm advances with the flexibility and security of building on the difference.