Underlying my personal philosophy for the practice of professional nursing is a strong belief that the four metaparadigms of patient, nurse, health and environment describe significantly interconnected phenomena from different perspectives. It is therefore necessary to understand and use all four conceptual bases of patient, nurse, health and environment in order to achieve nursing excellence, and a problem in any one area leads to lesser outcomes in the other areas.

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Orlando’s theory of deliberative nursing identifies the many roles of the nurse from the nurse’s perspective (Fawcett & Desanto-Madeya, 2012). It is important to take such a detailed approach to all four areas of the metaparadigms in nursing, as they are all relevant to one another. One example is the environment and its impact on nursing, as a negative or poorly resourced environment can lead to poor performance and negative health impacts on nurses (Humphries et al., 2014).

This point is particularly important in family practice. The major concepts I employ that are specific to the family practice nurse practitioner (FPNP) are family systems theory and family life cycle theory (Kaakinen et al., 2014). Propositions which adhere to and reinforce these theoretical frameworks include:

1. Interconnection of members of the family in terms of health outcomes;
2. Families change over time;
3. Systems can be broken down into smaller subsystems;
4. The health of a family is more than the health of individual members; and
5. The existence of boundaries between the family and external world (Kaakinen et al., 2014).

Defining and employing the four theoretical metaparadigms of nursing in professional practice requires understanding the framework and perspective of each, and viewing various opportunities, problems and practices through each lens in turn in order to better understand the factors and insights each provides.

Transcultural nursing, the health promotion model, skills acquisition, role theory, and change theory will be specifically integrated into my philosophy and practice using the organizing principle of continuous improvement. Transcultural nursing captures the importance of viewing the health situation and treatment through the patient’s worldview, where health promotion seeks to change the environment to improve health outcomes while skills acquisition, role theory and change theory aid the advanced practice nurse such as the FPNP in achieving nursing excellence while contributing to continuous improvement of the system from all perspectives.

Integrating role and change theory into my professional practice is essential given the nature of the broader objectives of advanced practice nursing, which includes the transformation of the system in order to ensure a better environment and health outcomes for patients to heal and for nurses to do their work, one which is based on evidence gathering and translating research into practice. Per my personal philosophy, this requires engaging each of the four perspectives of the metaparadigms of nursing theory.

  • Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. FA Davis.
  • Humphries, N., Morgan, K., Catherine Conry, M., McGowan, Y., Montgomery, A., & McGee, H. (2014). Quality of care and health professional burnout: narrative literature review. International journal of health care quality assurance, 27(4), 293-307.
  • Kaakinen, J. R., Coehlo, D. P., Steele, R., Tabacco, A., & Hanson, S. M. H. (2014). Family health care nursing: Theory, practice, and research. FA Davis.