Response to Fawcett’s Essays About the Metaparadigm and Conceptual Models

To the Editor:

We are writing to comment on Fawcett’s essay “Thoughts about the metaparadigm of nursing: Contemporary status and recommendations for evolution” (2023a) and her essay “More thoughts about health policies: Focus on conceptual models” (2023b).

We appreciate the foundational role of the metaparadigm and conceptual models in guiding nursing research and practice. These frameworks have undoubtedly contributed to our ability to deliver high-quality, patient-centered care and to develop and test evidence-based interventions. Indeed, the concept of a metaparadigm holds immense value for the discipline of nursing, as it forms a foundational framework that guides our understanding of and practice within the discipline.

Fawcett’s (2023a, 2024) version of the metaparadigm of nursing includes five concepts: human beings, the global environment, culture, planetary health, and the activities of nursologists. Focus on planetary health draws attention to an ongoing evolution toward well-being for both humans and the planet itself, recognizing the intricate interactions between human beings’ health and environmental factors such as climate change, ecological degradation, and biodiversity loss. Nurses, as frontline healthcare providers and staunch advocates for patients, play an indispensable role in addressing planetary health issues. This role enables us to pinpoint areas that may benefit from further study. Additionally, the term global environment conveys a comprehensive view of environment, especially when environment tends to be limited to pertaining only to the individual. Nursing conceptual models should address the fundamental ideas and beliefs within the discipline of nursing, which are summarized in the metaparadigm. More specifically, nursing conceptual models should

For example, when the nursing metaparadigm concepts and concepts of a selected nursing conceptual model are applied to mental health or more broadly to behavioral health, a nursing discipline-specific perspective of these health conditions is the result. Mental health is intrinsically linked to physical health, and understanding the complex interplay between the two is vital for comprehensive, high-quality patient care. Integrating a more robust psychological and emotional dimension into these frameworks would better equip nurses to address the holistic well-being of patients.

More specifically, when considering postpartum depression (PPD), the metaparadigm concept of global environment encompasses elements such as the home, family dynamics, community support systems, and healthcare facilities. Nurses must meticulously consider how these environmental factors can either contribute to or mitigate the risk of PPD, recognizing that the environmental context varies across regions and evolves with changing global circumstances.

Ongoing dialogue and collaboration among nursing theorists, practitioners, and researchers will be vital in refining and evolving our conceptual models to be more consistent with all concepts of the nursing metaparadigm. By continually reassessing and improving these nursing conceptual models, we can ensure that nursing practice remains adaptable, patient focused, and responsive to the changing needs of our diverse patient populations and evolving healthcare systems.

We recommend that the social determinants of health and healthcare disparities be given even more prominence within nursing conceptual models. Understanding and addressing the socioeconomic and cultural factors that influence health outcomes are crucial for promoting health equity. Integrating these aspects more explicitly into the metaparadigm and conceptual models would enhance their relevance and effectiveness.