Theoretical Paper

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Accordingto the world Health organization, nursing practitioners have enoughevidence to carry out safe and effective practices to address thevarious medical challenges faced by women (WHO, 2015). Altshuler,Gaffield, &amp Kiarie (2015)suggest that selecting the best method of practice requiressufficient prior knowledge of the risks involved, model efficiency,and patient preference. However, most women with comorbidities stilllack sufficient access to pregnancy prevention and birth controlmethods that are safe and efficient. This theoretical paper,therefore, further defines the concept of counseling on birth controland pregnancy prevention in women with comorbidities (POI) within atheoretical and scientific framework.

Phenomenonof Interest: Counseling Women with Comorbidities About Birth Controland Pregnancy Prevention

Thescience of nursing is dynamic, and its development involves years oftheoretical research, practice, and analysis of concepts. Theanalysis of a concept is not the endpoint but the continuation ofknowledge development dependent on critical thinking and common sense(Butts &amp Rich, 2015). Therefore, the continuous development ofnursing concepts like altruism-self-interest is important inaddressing the phenomenon of counseling women with comorbiditiesabout birth control and pregnancy prevention.

Flynnand Black (2013) assert that there is a dearth of information onaltruism and self-interest, counseling and the risk of pregnancy inwomen comorbidities. Thus, individual views remain inaccurate. Assuch, the professional perspective on the POI remains less informedand over generalized. Furthermore, Bousso, Poles, and Cruz(2014) indicate that counseling women with comorbidities on effectivebirth control and pregnancy prevention methods should be investigatedfurther to identify individual attributes. For an effectiveinvestigation on this matter, modern clinical nursing should utilizea more encompassing model to guide theoretical analysis. Fawcettcalls this guiding model as “the metaparadigm of nursing”(Fawcett, 1996).


Tooperationalize a theoretical concept, research must be guided by amore restrictive structure that includes important philosophicalorientations, conceptual models, and theories that guide researchwithin a given discipline. This restrictive structure is what Fawcettcalls a meta-paradigm. A meta-paradigm functions “to summarize theintellectual and social missions of a discipline” and mark theboundaries of a given phenomenon of interest within that discipline(Butt &amp Rich, 2015). As such, a meta-paradigm has fourappropriate requirements (Fawcett, 1996):

First,a meta-paradigm must identifya domain that is distinctive from the domains of other disciplines.That requirement is fulfilled only when the concepts and propositionsrepresent a unique perspective for inquiry and practice. Second, ameta-paradigm must encompassall phenomena of interest to the discipline in a parsimonious manner.That requirement is fulfilled only if the concepts and propositionsare global and if there are no redundancies in concepts orpropositions. Third, a meta-paradigm must be perspectiveneutral. Thatrequirement is fulfilled only if the concepts and propositions do notrepresent a specific perspective, that is, a specific paradigm orconceptual model, or a combination of perspectives. Fourth, ameta-paradigm must beinternational in scope and substance.That requirement, which is a corollary of the third requirement, isfulfilled only if the concepts and propositions do not reflect[particular national, cultural, or ethnic beliefs and values.

Theword “paradigm” is the process of knowledge development within agiven discipline or field of interest. Dr. Jacqueline Fawcettconducted an investigative research in 1984 on the existing nursingtheories and concluded that there are four common concepts toindividual paradigms within each theoretical research, theseare&nbsppatient,environment, health, andnursing.&nbspDr. Fawcett successfully placed the nursing theories within a singlecontext thereby enhancing the potential development of nursingknowledge.&nbsp Fawcett’s work is what is now known as the“Meta-paradigm” of nursing (Smith &amp Liehr, 2014).&nbsp Theknowledge and development of nursing focuses on the “whole” andis usually focused on identifying, defining and understanding theinter-relationships among the four core concepts identified by Dr.Fawcett (Smith &amp Liehr, 2014).

Thefour concepts of the nursing paradigm are “person, environment,health, and nursing” (Fawcett, 1996). The personis the recipient of nursing service and could be an individual,family or community. The environmentis the physical surrounding or setting where nursing is taking placeand could be a health center, patient’s home, among others. Healthis the range of wellness within terminal illness and high-levelwellness. Lastly, nursingis the action taken by a nurse to influence the outcome of the healthof a person within a given environment (Fawcett, 1996).

Theperson in this paper’s POI is the ‘women with comorbidities.`This group of women is highly vulnerable to pregnancy relateddisorders. Furthermore, few, if any, have access to information andcounseling on contraception. The environment is represented by thesetting where counseling is being conducted. This setting is morelikely to be a health center. Health in the phenomenon of interestrefers to pregnancy among the person. Finally, nursing refers to thecounsel being given to women with comorbidities on the safe andefficient methods of birth control and pregnancy prevention.

Thefour concepts are also linked to four propositions: person andhealth, person and environment, health and nursing, and person,environment, and health. The main duty of a nurse is the concern forthe well-being of their patient whether in sickness or wellness. Mostwomen with comorbidities have little or no information concerning thehealth risk involved during pregnancy. Moreover, most of these womendo not believe that safe contraception methods suitable for theirconditions exist. The World Health Organization (WHO) suggests that,due to the sensitivity of the issues of family planning, for propertreatment confidentiality should be guaranteed before counselingcommences (WHO, 2015).

Thesecond proposition links the person to the environment. Nursing isconcerned with the interaction between patient behavior and theenvironment under normal life settings. To do this effectively, anursing counselor must establish a good rapport between them and thepatient (Altshuler, Gaffield, &amp Kiarie, 2015). This ensures thatthe patient relates well with the environment to meet the firstconditions of the first proposition.

Thelink between health and nursing forms the third proposition and ischaracterized by processes and actions that affect positive changesin the health status of the affected. As such, nursing should ensurethat patient’s social, gynecologic, menstrual and obstetricinformation are collected and recorded appropriately. Suchinformation is critical in the identification of suitable methods forthe patient. Furthermore, effective nursing requires that a patient’sintention and reasons on pregnancy be known (Cleland, Conde-Agudelo,Peterson, Ross, &amp Tsui, 2012).

Thelink between the person, environment and health indicates thatnursing concerns itself with the wholeness of the health of itsclients while recognizing the environment as a continuous interactionin the nursing process. Obstetricians should therefore be willing tosacrifice some of their basic rights to counsel women withcomorbidities adequately and more efficiently. Dragoman,Jatlaoui, Nanda, Curtis, &amp Gaffield (2016) assert that altruismis most preferable in encouraging clinical providers to invest in thedelivery of helpful knowledge to women with comorbidities toeffectively fight issues affecting them. Consequently, counselorsshould understand the implications of their engagement with thepatient. Providers are expected to ensure that the environmentfavors the delivery of quality healthcare to the personof interest.

GrandNursing Theory

Nursingas professional practice is believed to have been founded onempirical evidence and should take into consideration the beliefs ofthe patient and their families under the guidance of a disciplinarytheory. The first disciplinary theory is believed to have beendeveloped by Florence Nightingale back in the 19th century in herpublication ‘Notes on Nursing.` Since then, professional clinicianshave developed important theories in nursing to evaluate therelationship between two concepts. In nursing, a conceptual model isusually referred to as a ‘grand nursing theory.` A grand nursingtheory is not specific on guiding nursing actions (Kenney, 2013).

Numerousgrand nursing theories have been developed however, the focus ofthis study is the modeling and role modeling theory developed in 1983by Erickson, Swain, and Tomlin (Petiprin, 2016). The primary conceptwithin the theory is ‘altruism, ’ and it enables nurses to focuson “carefor and nurture each patient with an awareness of and respect for theindividual patient`s uniqueness” (Petiprin,2016).The focus is on the needs of the client and is divided intocommonalities and differences. Some of the important commonalitiesinclude holism, basic needs, cognitive stages, psychosocial stages,attachment and loss, and affiliated individuation. The differencesinclude individual access to safe-care knowledge, resources, andaction.

Undermodelingand role modeling theory, the person is the patient. In this papersinterest, the person is represented by women with comorbidities hoare at the risk of getting pregnant. The environment is theperspective of the patient about the world and their immediatesurrounding based on individual experiences, access to resources,knowledge, among others. The health of the patient is dependent ontheir level of adaption to the various stressors of growth such ascomorbidities. Nursing in the grand theory is represented bymodeling. “Modelingis the process by which the nurse seeks to know and understand thepatient`s personal model of his or her own world, as well as learnsto appreciate its value and significance” (Petiprin,2016).Modeling recognizes the uniqueness of the person and theirenvironment. Nursing utilizes this process to develop andunderstanding and create an image of the patient’s environment fromthe person’s perspective.

Themodelingand role modeling theory is helpful in understanding the phenomenonof interest. The model outlines three key roles for counselors. Thefirst role is facilitation and is used to help women withcomorbidities take the initiative to attain and maintain healththrough the help of a nurse. The counselor provides the necessaryresources and information on birth control and pregnancy preventionin women with comorbidities. The second role if nurturance andensures that nurses give the patient care and comfort. The final roleis unconditional acceptance by nurses which ensures that clinicalservices are given to the patients unconditionally. The counselor isnot allowed to discriminate against any one of the women by theirmerit or demerits (Petiprin, 2016).

MiddleRange Theory

Unlikethe grand nursing theories, middle range theories are more specific,focusing on content and are thus more easily applicable to clinicalpractice. Middle range theories are usually focused on addressing theexperience of a particular patient and their experiences and only oneof the concepts of the metaparadigms of nursing. According to Smith&amp Liehr (2014), middle range theories have often developed fromgrand theories or nursing research. To better define the concept ofcounseling in the POI the study chose to discuss the interpersonaltheory as developed by Hidegard Peplau.

Theinterpersonal theory is defined by four phases involved in anurse-patient relationship. This evolutional phase includesorientation,identification, exploitation and resolution (Petiprin, 2016). According to this theory, nursing care is best realized through“educational, therapeutic, and interpersonal processes” that seekto develop an individual personality (Petiprin, 2016). A personalrelationship is developed between the counselor and an individualwoman with comorbidities to address the risk of pregnancy. Thepopularity of Peplau’s model among clinicians working withpsychologically unwell individuals makes it the more suitable inunderstanding the POI.

Themodelingand role modeling theory places emphasis on nurturing individualawareness based on their uniqueness(Petiprin,2016).To effectively create individual awareness for a particular womanwith comorbidities, a rapport has to be developed between thecounselor and the patient. This ensures that the nursing environmentis friendly enough for the development of an interpersonalrelationship. In order to develop this relationship, Peplau’sevolving phases should be utilized for best results. Counseling is aninterpersonal, clinical action that requires the development of trustto be able to identify, exploit and deliver realtime solutions tocurb the risk of pregnancy in women with comorbidities.


Thescience of complexity is an interdisciplinary paradigm that isincreasingly popular in clinical practice. As the term suggests,multiple fields are involved in complexity science, but the basicassumption is that the whole is more important than the sum of theparts therein. Butt and Rich (2015) assert that complexity sciencehas been applied in healthcare facilities to promote health caredelivery. Using the hospital as the complex adaptive system thissection defines the impact of complexity science on counseling womenwith comorbidities about the risk of pregnancy.

Everycomplex adaptive system is made up of individual units that supportits activities. Within a clinical setup, there are differentdepartments including nursing, among others. Furthermore, within thenursing department, there are simpler units with more specificspecializations and duties. A nursing counselor charged with theresponsibility of advising patients on the best birth control andpregnancy prevention methods should be more knowledgable about theavailable methods and those that are currently under research. Assuch, they should keep abreast with current clinical developments soas to deliver effective medication depending on the uniqueness of agiven case, especially for women with comorbidities. Most patientswith comorbidities are not aware of the risk involved duringpregnancy, and they should, therefore, be engaged in interpersonaldiscussions to establish the best course of action. Theresourcefulness of the nurse involved affects the entire system andmay be felt in other departments involved with the patient (Butts&amp Rich, 2015).As such, counseling women with comorbidities on the risk of pregnancyand the preventive methods involved should be guided by the conceptsand theories discussed in this paper.


Mostwomen with comorbidities still lack sufficient access to pregnancyprevention and birth control methods that are safe and efficient.Selecting the best method of practice requires sufficient priorknowledge of the risks involved, model efficiency, and patientpreference. Therefore, the continuous development of nursing conceptslike altruism-self-interest is important in addressing the phenomenonof counseling women with comorbidities about birth control andpregnancy prevention. However, there is a dearth of information onaltruism and self-interest, counseling and the risk of pregnancy inwomen comorbidities.

Thisstudy finds that the metaparadigm of nursing is important in thedevelopment of philosophical orientations, conceptual models, andtheories that can help in enhancing understanding of the POI. Usingthe four concepts of the nursing paradigm as developed by Fawcett,nurses can easily identify the areas of focus when studying thephenomenon of interest. The link between the person, environment andhealth indicates that nursing is concerned with the wholeness of thehealth of its clients while recognizing the environment as acontinuous interaction in the nursing process. An integration of thenursing metaparadigm concepts (person, health, nursing,andenvironment), the grand theory(modeling and role modeling theorydeveloped in 1983 by Erickson), and the middle range (interpersonaltheory as developed by Hidegard Peplau)can help nurses meet the in ensuringthat the environment favors the delivery of quality health care towomen with comorbidities in an attempt to fill the gap in advancednursing practice indicated in the thesis statement.


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