Paradigms in Nursing

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The metaparadigm of a discipline identifies common areas of concern. A paradigm is a particular way of viewing the phenomena of concern that have been delineated by the metaparadigm of the discipline. The term paradigm stems from the work of Kuhn (1970), who referred to a paradigm as “worldview” about the phenomena of concern in a discipline. Two individuals with different paradigmatic views can look at precisely the same phenomenon and each will “see” or view the phenomenon differently. For example,
consider the viewpoints of a mother and father who are watching their daughter at T-ball practice. The mother looks at her daughter and “sees” a graceful, yet somewhat shy child who has shown improvement in her ability to make new friends. On the other hand, the father “sees” a strong runner who needs help with batting drills. Each parent is looking at the same phenomenon (their daughter), but each is “seeing” the phenomenon from a completely different perspective. Each parent is operating from a different paradigm. The prevailing paradigm in a discipline represents the dominant viewpoint of particular concepts. This viewpoint is supported by theories and research that for the time being adequately address the concerns of the discipline. By consensus, the community of scholars in a discipline accepts and agrees on a particular viewpoint or worldview. When new theories and research surface that challenge the prevailing paradigm, a new paradigm emerges to compete with the prevailing worldview. The competition between the paradigms results in what Kuhn (1970) refers to as a paradigm revolution. A paradigm revolution is the turmoil and conflict that occur in a discipline when a competing paradigm gains acceptance over the dominant paradigm. If the competing paradigm answers more questions and solves more problems for the discipline than the prevailing paradigm, then a paradigm shift occurs. A paradigm shift refers to the acceptance of the competing paradigm over the prevailing paradigm or a shifting away from one worldview toward another worldview. Again, by consensus the competing paradigm becomes the dominant paradigm and the process begins again (Kuhn, 1970). The notion of paradigm revolution can be likened to the revolution that might occur in a country where the ruling government is overthrown by a competing group who proposed to have more and better solutions to the country’s problems. In this situation, power shifts from one ruling body to another. In another example, a paradigm shift occurred when people began to view the world as round rather than flat. Once it was agreed on by the community of scholars that the world was round (now the prevailing paradigm), all other views about the world also changed. Paradigms can be mutually exclusive.
Members of a discipline cannot subscribe to two competing paradigms at the same time. One cannot believe at the same time that the world is flat and that the world is round. Several nursing scholars have proposed that the discipline of nursing is in the midst of a paradigm revolution. The implication is that there are at least two paradigms in competition with each other. Although the scholarly literature in nursing reflects the views of several authors who present and name different paradigms in nursing, the work of Parse is highlighted here. According to Parse (1987), there are currently two paradigms in nursing: the Totality Paradigm and the Simultaneity Paradigm. Each of these paradigms is composed of various nursing theories that are similar in their worldview of the metaparadigm concepts. However, each theory, which is grouped within a particular paradigm, has different definitions of concepts and propositions that state how these concepts are related.
In the Totality Paradigm, the person, who is a combination of biological, psychological, social, and spiritual features, is in constant interaction with the environment to accomplish goals and maintain balance. “The goals of nursing in the totality paradigm focus on health promotion, care and cure of the sick, and prevention of illness. Those receiving nursing care are persons designated as ill by societal norms”.
Identification with the Totality Paradigm is understandable because it has been and is the prevailing paradigm in nursing. Many of the nursing theories developed to date have a view of the discipline of nursing that fits the Totality Paradigm. In the competing paradigm, the Simultaneity Paradigm, the person–environment interaction is viewed very differently. In the Simultaneity Paradigm, the person is seen as “more than and different from the sum of the parts, changing mutually and simultaneously with the environment . . . as a freely choosing being cocreating health through mutual interchange with the environment”. “The goals of nursing in the simultaneity paradigm focus on the quality of life from the person’s perspective. Designation of illness by societal norms is not a significant factor. The authority and prime decision maker in regard to nursing is the person not the nurse” (Parse, 1987). Clearly, these two paradigms represent very different
viewpoints. Each paradigm has several nursing theories that are congruent with the worldview proposed by that paradigm. Debate, dialogue, discussion, theory development,
and research continue within the discipline of nursing. Some nursing scholars argue about the structural elements of the discipline; some debate the value of competing paradigms; and some present alternative metaparadigm elements. Yet, with all the uncertainty that is created by these questions and alternative ideas, the ongoing dialogue is a healthy sign of the development of the nursing profession.

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