Nursing Philosophy and the Development of Conceptual Framework in Nursing Sheila Sheu
The purpose of this paper is to present various definitions of health , person,
environment, and nursing, based on the review of nursing and nursing related
literature. These definitions are examined and synthesized in such a way that to
be consistent with my personal ph ilosophy of nursing. As a result , a research program
are developed. Some research studies and research questions are also discussed .
Definitions of Health, Person, Environment and Nursing
Health:
Health is not only the absence of a disease or infirmity. Health is a state of
complete physical, mental and social weJl-being. (The World Health Organization,
1947 )
He a lth is a state or condition which enables individuals to function adequately .
Oberteuffer ( 1960) defi ned health as the condition of the organism which measures
the degree to which its aggregate powers are able to function. Therefore, health is
positively related to one's ability
to
perform and carry out social roles and tasks.
According to Hadley ( 1947) , health is a state in which the individual is capable
of meeting the minimun physical,physiological and social requirements for appropri­
ate functioning in the sex category and at the given stage of growth and development.
Aubrey ( 1953 ) said that health reflects the coordinated activity of component parts,
each functions within its normal range. The healthy individual should experience
adequate performance of the functions.
Health is the state or condition which enables the individual to adapt adeq uately
to his / her environment. A person's health is judged by his/her ability to react,
accommodate and adjust to the variolls internal and external tensions and strains
that he/ she faces. If the individual is able to adapt, he/she is healthy; if
he / she is unable to adapt, he/s he is diseased (Dubos, 1965 ). Health is a state of
struggle interaction between self and the environment. The goal of the struggle is
homeostatic balance by decreasing the threat of the environment or by raising the
capabilities of the person to defend himself (Beeson, 1967). Health is a purposeful ,
adaptive response. It includes physically, mentally, emotionally, and socially to
internal and external stimuli in order to ma intain stability and comfort (Murray and
.
1 .
Zen tner, 1975) .
He alth is defined by D unn (1 980) as a high level welln ess. He de fin ed that high
level welln ess invo lves th ree com po nents: ( I) pro gres ' in a t'o rward and up ward
di rec t ion to wa rd a higher potenti al of function in g, (2) as open-ended and ever­
ex pan di ng challenge to live at a fuller potential , (3) progressive aggregat io n or
ma turation of the individual at increa. ingly higher levels throughout the life cyc le.
Hoyma n ( 1962) defined healt h as an optimal personal fi tness for a full, fruitful ,
crea tive living. Bauer and Schaller( 1965 ) defined health as the condition of the
hu ma n organ ism tha t pe rmits o ne to li ve happily an d success fully. it helps the perso n
to a ttain the goals and ambi tions in life. T his definti o n stresses the im port ance of
an or ientati on to ward growth, goal directedness,and attainment of goal. Ha nchett
( 1979) imp lied health d is energy, individu a lity, relation shi ps and continuing p rog­
ress towa rd developmental tasks.
Hea lt h also has been defin ed as focusing on both actual ization and stability.
Oe lbau om (1974) identi fi ed 26 functions or behaviors of adults in optimum health .
T he beh aviors are categori zed into two dim ens l,)ns: ac tual i7 ation and stabilization.
He defined healt h is a proce's of growth and devel o pmen t that is futu rist ic in
o rientat io n, while at the same time avoi d ing major d viations in basic human
fu nctio ns or those func tio ns characte risti c o f a given cu lt ure. Pende r ( 198 6) defined
health as the act ual ization of inherent and acquired human potential through
satis fying re latio nships wi th others, go a l directed beha viors and co mpetent personal
ca re,whil e adjust ments are made as needed to mainta in stability and structural
in tcgri ty.
Envi ronment :
T he envi ronment is clas ifi ed as externa l env iro nme nt and in ternal envi ronment.
T he ex terna l env iro nme nt co nsists of ( I) biologic variables, (2) physi cal variables,
(3 ) socia l variables an d (4) c ultural vari abl es . I nte rn al environ ment con sists of ( I)
perso na l cha racteri st ics , (2) physi ca l growt h and devel opmen t,
(3) reg ul a tory
mechanism such as imm une system, neu ro logi cal system (McC lelland, 1985) , (4)
bod y repair mecha nism.s, and ( 5) hu man behaviors (M urray and Ze ntner, t 975 ).
Aa kster (J 974) sai d that social an d cultural env iro nmen ts are more impo rtan t
ro r a perso n's health tha n physical an d bi o lo gical en iro nmenl. Because it will
dete rmine the access of indivi duals to physical resources, and the chance of being
xposed to phys ica l harm . The enviro nment has both res o urces and st ressors. A
person needs the resou rces in the en vironment in o rd er (I) 10 acqu ire essential
materi als for his survival, such as food, air, water, heat etc.; (2) to progress in the
direction or cu lturally legitimated end - states by using socially acceptable and /or
prescribed means; (3) to acqui re identity, usefu l information, social sk ills etc. The
stressor in t he environment is a ny environ men ta l force which leads to disequ il ibrium
• 2 •
upon one or more of the essential variab les in the syst m of a perso n . The stressos can be physical, soci a l, psychological, a n d cultur a l. It also can exi st in either the external or internal environment. Perso n: A person is composed of physical, psychological,social and sp iritu al aspects.
These aspects are interdependent and interrelated. He/she ha s so me si mil a rit ies an d
some differences based on the satis fac ti o n of basic needs, and the cognitive a nd
psychological development which results ina person's unique self ca re knowled ge,
sel f care resources, and adaptation abil ity. Each person has his own model of wo rl d.
In other words, each person differently perceives life, events, peop le, an d sit uat ions.
Each person also communicates, thinks, feels, acts and reacts di fferen t ly (E r ic ks on,
1983) .
A person's behavior is directed to th e attainmenl' of certain go al s (Pender, 1986
Aakster, 1974). These may be identified as love, security, esteem, wisdom, acceptance,
harmony. They may be different for different cultures. (Aakste r, 1974). Pender said
that each person has his unique health behaviors. The interal cogn itive processes
determine what information will be received from the environment and how it will
be interpreted and constructured. A person's health behavi or is dependent on his
perceptions, such as importance of heal th, perceived control, perceived threat,
perceived susceptibility, perceived seriousness, perceived benefits, a nd perceived
value.
Each person has varied degree of adjustive capability. The adjustment can be
internal, migratory, or external adjust me nt (Aakster,1974). According to T aylo r
(1983), a person is adaptive, self-protective, and functional. By searching t he
meaning, gaining sense of mastery and self-enhancing, a person is able to fac e
threatening events. A person has capacity for open exchange of energy w ith ot her
systems within the environment (Hanchett, 1979).
urs mg:
Nursing is an art and the science. N ursing is the proces by w h ich the nurse
seeks to understand his/her client's uniq ue model of the world, and try to hel p a
person with their self-care activities in relation to their health. This is an interactive,
interpersonal process that facilitates, and nurtures a perso n's strengths to enab le
his development, release, channeling and mobilizing of resources for coping wit h
his/her circumstances and environment. The goal is to achieve, maintain o r pro mo te
a state of perceived optimum heal t h and contentmen t (Erickson, 1983) .
Johnson (1980) said that the purpose of nursing is to facilitate a person's effi ci en t
and effective behaviors. These behaviors aim to maintain a person 's eq u ilibrium
and stability, from his point of view,
According to Orem (1980), the goal of nursing is to assist, g u ide. teach. s upp o rt
• 3 •
a person with his self-care. The goal of nursing is to maintain a perso n's ca paci ty
for self-care.
Roy (l976) advocated that the goal of nursing is to facilitate a person' adapta­
tion. Consequences of Roy's adaptation nursing are adapted responses, that is
behaviors that preserve a person 's biopsychosocial integrity.
According to Henderson(1966), the goal of nursing is to maintain or restore
or increase a person's independence in the satisfaction of his fundamental needs
which expresses the biopsychosocial nature of a person. The nursing interventions
focuses on the particular deficit of needs and rei nforce, complete and substitute it.
Nursing helps a person to develo p illusions and nurture those illusions for the
development of cognitive adaptive ability (Taylor, 1983 ). H ow to help a person is
dependent on the attribution of responsibility of a person for a probl e m and for
a solution (Brickman, 1982) .
Nursing functions include the following: (1) establish nurse - c lient relationships.
This relationship is aimed at illness preventions, and health promotion, (2) assess
health, such as health history, physical evaluation , life stress review, life style and
health-habit, health beliefs, (3) clarify values , such as examining value hierarchies,
clarifying personal values, (4 ) educate a person for self- care, such as assessing self
care competence/ knowledge, moti vatio n, sk i II and orientati on; determi n i ng teach i ng
priorities; identifying objectives , facilitating self-learning; using positive reinforce­
ment; identifying barriers to learning; creating an optimum environment fodearning,
and evaluating a person's progress, (5) develop a health protection/promotion plan,
such as identifying self- care strengths. health goals and related areas for improvement
in self-care; identifying effective reinforcement and rewards, determining barriers
to change, (6) take action for prevention and promotion of health, such as mod ifyi ng
a person's life-style, restructuring cognition, operant conditioning, countercon­
ditioning, controlling stimulus review and enhancing social support systems.
(Pender , 1986 )
Synthesis and the De velopm ent of a Mataparadigm in Nursing
A person is a biopsychosocial being. Each component ofa person is interrelated
and interdependent. The internal environment of a person is continuously interacting
with the external environment. In the external environment, there are many biopsy­
chosocial factors which serve as resources or
stressors~
A person may perceive a
stressor as being uncertain, challenging, or threatened. This perception depends on
a person's interpretation. A person has some similarities . He also has some differ­
ences, such as different strength/ weakness. These differences are based on the
inherent characteristics and psychosocial de vel opmental processes. A ll of th ese
contribute to a person's unique cognitive structure. Therefore, each person has
• 4
diflerent self care knowledge, such as perceptions self, values, beli efs , and fee lings.
As a result , each person has different abilities for using self care resources, such
as using both internal and external resources and adapting
to
the continuously
ch a nging external environment. Also, each person has different self care behavi ors,
such as health prevention and health promotion behaviors. Each behavior is aimed
maintaining equilibrium or promoting actualization of a person's physical, psycho­
logical or social functions. In other words , he is continuously trying to maintain
health.
Health is a state of psychosocial equilibrium or actualization . The health status
can be assessed through the normal functions or performances of each aspect of
a person.
Nursing IS a sCience. Through the nurse- client relationship, nurSlllg utilizes
scientific knowledge to evaluate person's health status, assess the contributing factors
or the
deviation of the health, recognize a person's strength and weakness, and
implement appropriate nursing actions. All of these activities aim to maintain or
maximize thes physical / psychological / social functions of a person.
The diagram of the metaparagigm in nursing derived from the previous synthesis
IS
shown in Appendix A .
Resea rch Implication (D ev elopm ent of a Conceptual Fra mework )
A conceptural framework for my research program is derived from the previous
metaparadigm
III
nurSing. The diagram of this conceptual framwork is shown in
Appendix B.
Many research studies can be derived from this conceptual framework. Two
research studies and its corresponding research questions are proposed as follows:
I. The relationsh ips among patients' world, coping patterns, health promotion
behaviors and health status in patients with coronary heart disease(C.H.D.).
a. What is the relation ship between patients' \vorl d and co p ing patterns for
patients with C.H. D.
b. What is the rel ation ship between coping patterns and hea lth promotio n
behaviors for patients with C. H. D . ?
c. What is the relationship between health promotion behaviors and health
status for patients with C. H.D. ?
d. What percentages of variance in health status can be explained by patients'
world, coping patterns, and health promotion beha viors ?
2. The perception of uncertainty, coping patterns and its correlates in patients with
C.H. D .
a. What are sources of uncertatinty for pa tients with C. H.D. ?
b. What is the degree of uncertainty fo r patients with C.H. D. ?
• 5 •
c. What factors contribute to the perception of uncertainty for p at ients with
C.H.D.
?
d. What are coping patterns· in patients with C.H.D. ?
e. Are coping patterns related to the perception of uncertainty?
Many other research studies can be derived from this conceptual framework
for my professional career. However, due to the limitation of time and space, only
my initial ideas are presented in this paper.
Appendix A
Iexternal environment!
e
e x
n t
~ e
1
r
e
self care
x e
t n
perception
of
r
o n
na
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e
v
e i
r r
nO
a n
m
1 e
n
t
n
t
Metapar adigm of Nursing
self care kn ow ledoe
perception o f control
perception of resource
value sys tem
bel ief sys tem
hope
self efficacy
self care resource
ocial support
Internal strength
hea lth behav io r
health preventi o n
behavior
health promotion
behavior
illness behavior
physical status
organic function s
Perce ption of
enviro n me nt
uncertain
threatened
challenging
demogra p h ic status
age
sex
education
personality
environment
resources
stressors
Psyc ho social status
social role, function
anxiety
stress
quality of life
• 6 •
~
7
~
stress
~
7f"
demographic
data
self care
kno wledge
T
l-.:
disease-related
factor
--j
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1
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psychological
development
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perception
of
stress
coping
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style
health
~
H
behavior
health
statue
sel f care
resource
-
-.J
biopsycho­
social status
.stress
belief
perception
clients' world
copIng process
outcome
of
stress
Life S pa n Model of Stress, Cl ients' World, and Coping Proc ess
Appendix B
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Hl
HI
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