Four basic metaparadigm concepts in nursing

Nurse image by Maria Bell from

A metaparadigm is a concept that is extremely general, one that serves to define an entire world of thought. "Meta" means "that which is behind," in Greek, and refers to that which undergirds something else, serving as a conceptual basis.

In her seminal (1984, cited in Slevin) work, "Analysis and Evaluation of Conceptual Models of Nursing," Jacqueline Fawcett developed the basic four metaparadigms of nursing. More recently, these have been revised by Basford and Slevin (2003) and serve to underpin the entire conceptual universe of the nursing profession.


This paradigm refers to the sick individual not as a "patient," but as a "subject," a person in the full sense of the word. This includes families and social groups that have come to define the person as such. This person is unique and autonomous, and should be treated as such. A real person is not a mere object of professional care and surveillance.


Like all meta-concepts, health is immensely general. It does not deal with health in a strictly clinical manner. It concerns nurses as medical professionals (rather than as mere adjuncts to doctors). At the same time, it defines "health" in abstract terms, in that health is "negotiated" and "contextual," in the words of Slevin. Health is not an absolute concept, but exists in the context of the health problems of the individual. A person suffering with cancer considers a good, healthy day as one where they do not die or suffer immensely. But this is no definition of "health" for the perfectly healthy individual. These terms are negotiable given the context of the suffering.


This metaparadigm serves to explain the full context of health care and of nursing specifically. It is little less than the totality of all things that impact on the recovery of the patient. Home life, mental state, addictions, physical pain, chances of relapse, rewarding work and a host of other variables come to define the context of recovery. All of these clearly impact recovery, or even the patient's desire for recovery. This also includes social and cultural dimensions such as religious belief and general attitudes toward death and suffering.


Nursing itself is a meta-theory that seeks to help contextualise nursing. While this might sound strange, Slevin translates "nursing" into "caring." In general, this refers to any "hands-on" medical treatment from nurse to patient. It is the paradigm of compassion, the reason why nurses become nurses: to help and ease suffering. It is an intensely ethical and emotional paradigm that goes to the root of nursing as a profession with its own set of rewards.