An Integrative Framework for Conceptualizing Clients: A Proposal for a Nursing Perspective in the New Century

It is exciting to view the year 2000 as the beginning for a new century and a new millennium that can be based on a new resolve and a refreshing insight. In thinking and reflecting about what aspects of nursing and nursing knowledge development that should be the focus for formulating such a new resolve or a refreshing insight, pluralism comes to mind as one of the critical issues that is both important and troublesome. Nursing has pursued multiple paths to develop knowledge with different commitments to philosophies and epistemological orientations during the past three decades. The resulting pluralism is evident not only in philosophical orientations regarding human nature and nursing, but also in theories, scientific explanations, and methods of inquiry adopted in nursing science. During the past three decades we have put a great deal of our scientific effort into developing nursing knowledge in terms of (a) conceptualizing the key and essential phenomena of concern, (b) identifying the nature of nursing problems and different ways of solving such problems, (c) understanding fundamental human processes associated with health and illness through development of multiple theories, (d) identifying the impact of environment on human functioning and health, and (e) advancing technical supports that enhance human health. These efforts have resulted in truly pluralistic knowledge development in nursing in terms of theories, empirical findings, and practical approaches, along with differences in philosophical and value orientations. A rich array of scientific results has provided the foundation to move nursing practice to be grounded in scientific knowledge. On the other hand, multiple theories, conflicting findings, and competing approaches to patient care have created confusion as well as a heightened sense of separation and schism between science and practice in nursing. One of the most critical aspects of such pluralism is in regard to theories and conceptualizations about phenomena in the client domain. Client domain, identified as one of the four domains of nursing’s subject matter (Kim, 1987), refers to the key area of nursing’s concern for knowledge development. There has been a long-standing presumption that through the understanding and explanation about client phenomena, nursing could develop its approaches, that is, therapeutics and strategies of care regarding clients’problems. The conceptual works of early nurse scholars helped to shift nursing’s orientation from medicine and pathologies to human needs. In the ensuing decades, the relevance of these frameworks as a basis for the practice of nursing became apparent, and a series of grand theories concerned with the knowledge domain of the client were proposed and studied. Rogers’s (1970, 1992) science of unitary human beings, Roy’s (Roy & Andrews, 1997) adaptation model, Orem’s (1995) self-care model, Neuman’s (1995) systems model, and Parse’s (1998) theory of human becoming are the major grand frameworks in nursing that try to formulate and explain client domain phenomena from generalized conceptualizations of humanity and health. These and related nursing models can be categorized into six major types according to their views on humanity and health: (a) holistic processes as the modes through which humans coexist within their environment, (b) balance as the essential human characteristic that expresses human condition, (c) configuration of structural and functional aspects as an integrative basis for human functioning, (d) aggregation of parts as revealing states of the human condition, (e) experiencing as the basic form of human existence, and (f) meaning-making as the essential feature of human life. This categorization suggests that in nursing there is diversity in the way clients and client phenomena are conceptualized and that there is no generally endorsed unified perspective regarding humans. It would be quite premature to state that nursing has firmly established specific paradigms or schools of thought based on these differing conceptualizations of humans and grand theories. However, these grand theories persist as the bases for empirical work and research, middle-range theory development, nursing curricula, and Editor’s Note: Send abstracts, outlines, or query letters about ideas for this column to Marilyn M. Rawnsley, RN, DNSc, P.O. Box 2188, Flagler Beach, FL 32136; phone/fax: (904) 439-3406; e-mail: mrawnsley2@aol.com. Persons interested in being critical respondents should forward curriculum vitae and a statement indicating areas of expertise and interest.