Concepts Central to the Discipline of NursingIn 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 nursing’s place in the professional world and in an effort to distinguish it from other disciplines it seems imperative that nursing itself agree on the discipline’s 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, Dexheimer-Pharris and Jones (2008) elaborates on Fawcett’s 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 discipline’s 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 nursing’s 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 discipline’s central concepts in order to move forward in the development of the profession and service of others.

ReferencesFawcett, 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 patient’s 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 well-being 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 self-limiting 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 bachelor’s degree at colleges and universities which considered being an academic discipline. NURSING AS PROFESSIONOne 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 ever-increasing, 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.