Nursing Paradigms: Grand Nursing Theories

Nurses use theory to help guide them in their nursing practice. Paradigms are the way we look at knowledge in a discipline such as nursing (McEwen & Wills, 2014). They take into account different values. Grand nursing theories utilize three paradigms: human needs, interactive and unitary process. These paradigms take into account the nature of human beings and how they do, or do not, interact with their environment and health care providers.
The human needs paradigm evaluates basic human needs and utilizes the scientific method to analyze the nursing practice. The problem is identified and using scientific understanding a treatment is determined and appropriate intervention is provided. This paradigm views humans as the sum of its parts and assumes that change is predictable as humans survive and adapt. Nursing’s role is to identify stressors and provide interventions to treat the patient. For example, the patient admitted to the hospital with congestive heart failure has
fluid overload and needs to be treated with a diuretic. In this paradigm, the nurse treats the client and there is a limited interaction between the client and nurse. It lacks a decision making process on the part of the patient.
Conversely, the interactive paradigm illustrates a relationship between the client and the provider (Tourville & Ingalls, 2003). It assumes that the client has a right to make informed decisions and that the client has the right to accept or reject the plan of care. Additionally, they have a right to the knowledge that will help make an informed decision. They are not merely “being treated” by the provider, but they are part of the decision making process.
Lastly, the unitary process states that the purpose of nurses is to promote health and well-being for all people and that people interact with an ever changing environment (McEwen & Wills, 2014).
The nurse must understand how the environment and person interact in order to provide care for them. One cannot view just the parts of a person and provide interventions to one specific problem. For example, treatment of the patient with congestive heart failure does not consist merely of a diuretic, but one must see how the condition affects the patient’s whole being. We must ask how the patient’s environment may have played a role in the exacerbation of their condition and what change we can provide to the environment to reduce the risk of an exacerbation. The unitary process not only describes how the nurse interacts with the patient, but also has an understanding of how the condition affects the whole person and how the environment plays a role in the condition and the patient’s
recovery.
I find the second part of this question very interesting. Which of these paradigms best fits our personal philosophy of nursing? Each paradigm has validity in its own right. I have a very scientific view of nursing, at the same time I believe that a patient has the right to understand their condition and make choices surrounding their treatment. But one cannot deny that the environment plays a role in how we treat our patients. The unitary process allows for both the human need and interactive paradigms to exist within it. It does not deny the scientific method, but it also doesn’t preclude the patient from having a choice in their treatment. Additionally, it allows for the understanding of how the patient and environment interact and that the nurse has an obligation to understand the interaction in order to provide an appropriate plan of care. For this reason, I would choose the unitary paradigm as the method that supports my personal philosophy of nursing.