Concepts Central to the Discipline of Nursing

In order to critically examine the concepts central to the discipline of nursing it is

important to clarify my understanding of what constitutes a discipline. Nursing
literature has led me to understand that a discipline can be, in simple terms,
thought of as a field of study with a unique perspective which gives rise to the
nature and scope of inquiry of that field and therefore leads to a specialized body of
knowledge (Parker, M & Smith, M, 2010). In attempt to cement nursings place in
the professional world and in an effort to distinguish it from other disciplines it
seems imperative that nursing itself agree on the disciplines most significant
concepts. Through early course readings it has become clear that this task is not so
easily achieved. Several nurse scholars have conducted research and devised
seemingly limitless options to choose from. In developing a metaparadigm of
nursing a loose framework is established and agreed upon providing structure in
which more concrete and focused concepts are identified. Through this paper I will
examine and discuss the work of two notable nurse researchers and their
contributions to identifying the central concepts of nursing including the influence of
these concepts on the present state of nursing. In addition, I will address the way
these concepts apply to my nursing practice and identify concepts of personal
importance. Influence of the Central Concepts
Despite the efforts of nurse scholars to clearly define the profession a certain
amount of ambiguity remains and is accompanied by a slight difference in opinion.
Fawcett (1984) identifies four concepts central to the discipline of nursing including
person, environment, health and nursing (p.84). In combination these concepts
create a metaparadigm of nursing, which serves to identify the most salient
phenomena concerning the discipline. The work of Newman, Smith, DexheimerPharris and Jones (2008) elaborates on Fawcetts metaparadigm by identifying
seven, relationship centered, fundamental concepts of nursing. These include
health, consciousness, caring, mutual process, presence, patterning and meaning.
Albeit slightly different in composition and specificity the central concepts identified
by both groups share certain commonalities and both serve to shape the way
nursing is thought about and defined. They lead us asnurses to consider the deeper
meaning behind our actions and guide us in the development of discipline as a
whole. The aforementioned differences notwithstanding, both Fawcett (1984) and
Smith and Parker (2010) acknowledge that there does seem to be a general
consensus among nursing scholars and it these agreed upon concepts that serve to
not only to define the discipline, but to separate nursing from medicine and other
health related studies. As nursing continues to move away from a biomedical model
it is increasingly important to demonstrate the connection between the nursing
metaparadigm and the specialized knowledge that provides nursing with credibility
within the world of academia. In critically examining these concepts nurses are able
to clarify their role in the health-wellness continuum and are better able to
articulate this role to others, including but not limited to, other disciplines, the
public and nurses themselves. Nursing has a unique approach to patient care, which

revolves around key nursing concepts. By staying true to these ideals we will help
preserve our place in the health care. These central concepts remind us that nursing
is greater than the sum of its parts and it is our focus on wholeness and
relationship that helps quantify the uniqueness and defines us a group.
In addition to helping define the discipline the core concepts, as identified by
Fawcett (1984) and Newman, Smith, Dexheimer-Pharris and Jones (2008), have
influenced the focus of nursing and the boundaries of inquiry. Smith and Parker
(2010) illustrate this notion by stating it is only by being thoroughly grounded in
the disciplines concepts, substance and modes of inquiry that the boundaries of the
discipline can be understood (p.6). Nursing as a discipline has set forward an
explicit desire to serve the public and it is the service and commitment to the
individual and overall wellbeing of our society that drives and directs the study and
practice of nurses, educators and nurse scholars (Smith & Parker, 2010).
By outlining the focus and boundaries of the discipline nursing is able to highlight
areas of study that are significant to nursing education and practice, all of which
can be traced back to the fundamental concepts. These central ideas feature as
integral to nursing development and continue to demonstrate their influence by
shaping the way nurses learn and do. Theconcepts of person, health, environment
and nursing are all interrelated, as are the concepts put forward by Newman, Smith,
Dexheimer-Pharris and Jones (2008), and can be identified as prominent in nursing
studies and the development of nursing theories. The nursing theories based on
these fundamental concepts serve as the building blocks for all nursing knowledge
and as Smith and Parker (2010) explain the primary purpose of nursing theories is
to further the development and understanding of nursing practice (p. 8). The
structure of knowledge as described by Smith and Parker provides a clear example
of how nursing metaparadigms have implications for all levels of nursing theory,
education and research from the most abstract or global concepts to the more
concrete ideas related to specific practice areas. Central Concepts in Relation to
Personal Practice
Through the process of reflection I attempted to identify ways in which I was
impacted by the central nursing concepts and ways in which they did or did not
compliment my nursing practice. I would be remiss to claim that one concept or
another does not fit into my personal perception of what is significant to the
discipline as I can see merit and ways in which each has implications for the
development of nursing practice and theory. I do however naturally identify with
certain concepts while feeling somewhat conflicted by others. For example, in
considering the concept of consciousness I found much of it difficult to apply
directly to my nursing practice. Despite my attempt at critical analysis my
understanding of the concept remained abstract and ambiguous. I was left feeling
that if I was having difficulty interpreting the implications of such a notion to the
discipline of nursing then how could I relate its meaning to personal practice and

furthermore how would I share the significance of consciousness with others? The
only way in which I could identify its application to my personal practice was to
view it in terms of consciousness involving all forms of information including
sensation and physiology as well as intellect, emotion and intention (p. E20).
Perhaps as I continue my studies I will gain deeper insight into the relevance of
consciousness in nursing.
Conversely, I readily identified the concept of health to be integral to my nursing
practice. Health is a central concept that is identified by bothFawcett (1984) and
Newman, Smith, Dexheimer-Pharris and Jones (2008). One of the primary goals of
my nursing practice is to facilitate the overall health and well-being of the public. In
some cases that may include recognizing and addressing patterns in an individuals
physical experience of health which may lead to a medical diagnosis and often
includes treatment and hopefully resolution. In other instances it may include
assisting in the exploration of the meaning behind a health related crisis thereby
facilitating a measure of understanding and an improved ability to cope with and
manage the present state of wellness. The thought that pathology remains relevant
to the concept of health without being the singular defining factor (Newman, Smith,
Dexheimer-Pharris & Jones, 2008) resonates deeply with my nursing self. While I feel
that the concept of health and the experience of health are inextricably linked I also
believe that health from a nursing perspective involves a holistic approach and
must take into consideration personal experience and personal meaning thereby
allowing for a feeling of healthiness despite the presence of illness.Conclusion
As I explore and attempt to organize and derive meaning from new terms, theories
and concepts I find that this new exposure results in almost as many questions as
answers. I feel slightly disappointed by the lack of concrete and undisputable
definitions. I can only surmise that it is the stage of development in which nursing
finds itself that leaves me feeling unsure of my new knowledge. Admittedly my
personal definition of nursing has evolved since beginning my baccalaureate degree
and after closely analyzing nursings most central concepts, however, I find it only
mildly reassuring that nurse scholars are similarly having a difficult time in reaching
a consensus that clearly defines the discipline. It believe that it remains important
for nursing to continue to strive for the realization of a global consensus regarding
the constitution of the disciplines central concepts in order to move forward in the
development of the profession and service of others.
References
Fawcett, J. (1984). The metaparadigm of nursing: Present status and future
refinements. Image:
Journal of Nursing Scholarship, 16(3), 84-87.
Newman, M. A., Smith, M. C., Dexheimer-Pharris, M. D., & Jones, D. (2008). The
focus of the discipline revisited. Advances in Nursing Science 31(1), E16-E27. Smith,
M., & Parker, M. E. (2010). Nursing theory and the discipline of nursing. In M. Parker

&
M. Smith (3rd ed.), Nursing theories and practice (pp.3-15). Philadelphia: FA Davis.

As a verb it means training someone to follow a rigorous set of instructions, but also
punishing and enforcing obedience.The medical meaning of discipline is a medical
regimen imposed by a doctor on a patient to the patients benefit. It follows that the
academic discipline can be seen as a form of specific and rigorous scientific training
that will turn out practitioners who have been disciplined by their discipline for their
owngood. In addition, discipline also means policing certain behaviors or ways of
thinking. Individuals who have deviated from their discipline can be brought back in
line or excluded. As a result, there is an important moral dimension to discipline that
defines how people should behave or think. As previously mentioned, the term
academic discipline certainly incorporates many elements of the meaning of
discipline. At the same time, it has also become a technical term for the
organization of learning and the systematic production of new knowledge. Often
disciplines are identified with taught subjects, but clearly not every subject taught
at university can be called a discipline. There is more to disciplines than the fact
that something is a subject taught in an academic setting. In fact, there is a whole
list of criteria and characteristics, which indicate whether a subject is indeed a
distinct discipline. A general list of characteristics would include disciplines have a
particular object of research (e.g. law, society, politics), though the object of
research maybe shared with another discipline, disciplines have a body of
accumulated specialist knowledge referring to their object of research, which is
specific to them and not generally shared with another discipline, disciplines have
theories and concepts that can organizethe accumulated specialist knowledge
effectively, disciplines use specific terminologies or a specific technical language
adjusted to their research object, disciplines have developed specific research
methods according to their specific research requirements and maybe most
crucially, disciplines must have some institutional manifestation in the form of
subjects taught at universities or colleges, respective academic departments and
professional associations connected to it.Only through institutionalization are
disciplines able to reproduce themselves from one generation to the next by means
of specific educational preparation. A new discipline is therefore usually founded by
the way of creating a professional leader devoted to it at an established
university.Some disciplines would be considered to be more useful, more rigorous,
more difficult, or more important than others. Nurses have specialized education
and training validated by professional licensure. Nurses have a code of ethics and
established practice standards, they are bound to adhere to, a violation of which
can result in their license being revoked or sanctioned. They have their own body of
ongoing research that shapes and governs ourpractice. Nurses work autonomously

within their scope of practice. They formulate and carry out their own plan of care
for clients when applicable; they apply judgment, use critical thinking skills, and
make nursing diagnoses. Nurses use their specialized knowledge, experience, and
skill set to initiate live-saving measures, improve and promote the health and wellbeing of the planet, and ease pain, suffering, and loss. They are all united in that
common mission regardless of where they work, their position title, or whether they
are employed, unemployed, or self-employed. Nursing has evolved from being an
occupation to being a profession and an academic discipline.Nursing is variously
described as a profession, a discipline, an occupation. The meanings assigned to
such words and the expectations, demands, and responsibilities that each reveals to
and or exacts from those privileged to call themselves registered nurse provides a
splendid arena for viewing the struggle of nursing as an intellectual endeavor
embedded in its own distinctive knowledge base, experiences, purposes, and
values. Currently, pressure exerted within and without nursing to adopt the selflimiting potential and subordinated position that a professional discipline orientation
and applied degree education talk on nursing is increasing. Nurses roles and
mission, ideals, and ethical and practice standards are one a profession and also the
attributes of an academic discipline. Today nurses are obtaining up to a bachelors
degree at colleges and universities which considered being an academic discipline.
NURSING AS PROFESSION
One way to promote development is to clarify the professional role. The Oxford
English Dictionary defines a profession as a paid occupation, especially one that
involves prolonged training and a formal qualification and in its definition of a
professional; the dictionary uses the words competent, skillful, or assured.
Professional competence and skills are learnt through specialized training,
maintained through continuing professional development and embedded in the
notion of behaving ethically, in the interest of the client or patient, the public or
society. Professions play a role in every part of human society, and we all rely on
professionals at multiple points in our daily lives from dentists to teachers, from
pension managers to careers advisors, from town planners to paramedics. We rely
on professionals to be experts, to know what to do when we need them to, and to
act in our best interests. Back in the nineteenth century, the professions were seen
to be law, religion, and medicine. Nowadays, the number of professions is everincreasing, as occupations become more specialized in nature and more
professionalized in terms of requiring certain standards of initial and ongoing
education so that anything from automotive technicians to web designers can be
defined as professionals. The words occupation and profession are interchangeable.
Profession andoccupation are almost the same, with only minor differences between
them.The difference between occupation and profession can be stated with a simple
example: Designing a building would be called a profession, whereas, constructing a
building is an occupation.A profession needs extensive training and specialized
knowledge. On the other hand, an occupation does not need any extensive training.
A person with an occupation need not have specialized knowledge of his trade. A
profession can be called an occupation when a person is paid for his particular skills,

and his deep knowledge. Doctors, engineers, advocates, journalists, scientists, and
many others, fall under the professional category. On the other hand, persons
engaged in an occupation are not paid for their knowledge, but only for what they
produce. Drivers, clerks and technicians fall under the category of occupation.
Unlike a person engaged in an occupation, a professional has to undergo higher
education. It is noticeable that a profession tends to be autonomous. When
considering responsibilities, a profession demands that the responsibility lies with
the individual. Moreover, only a professional will be able to assess fellow
professionals. In regards to an occupation, no one has autonomous power; he or she
is supervised by another person. Moreover, any person can make assessments, as
this type of work does not require high degrees of knowledge and skill. Well,
professionals enjoy a higher social status than a person engaged in an occupation.
Another difference that can be seen between profession and occupation is that the
former is guided through certain ethical codes, and is regulated by a certain statute.
The term discipline originates from the Latin words discipulus, whichmeans pupil,
and disciplina, which means teaching (noun). Related to it is also the word disciple
as in the disciples of Jesus. A dictionary definition will give a whole range of quite
different meanings of the term from training to submission to an authority to the
control and se lf-control of behavior.