be external to the individual, (2) environmental conditions, which are the set of environmental factors and elements that exist at a given time, and (3) the developmental environment. The nurse, as a provider of care, creates a developmental environment which, for the individual receiving care, promotes personal development in relation to becoming able to meet present or future demands for action. The developmental environment, thus, consists of environmental conditions that motivate the person being helped to establish appropriate goals and adjust behavior to achieve results specified by the goals. It is the total environment, not any single part of it, that makes it developmental.
Health is defined in the metaparadigm as a state of the person that is characterized by soundness or wholeness of developed human structures and bodily and mental functioning (Fawcett, 1989, p. 218). A person's sense of well-being is differentiated from health, in that well-being is a perceptual state, as contrasted to health, which is a physical state. Health is also differentiated from disease or illness, which are involved in the determination of the state of health, and which may occur when care is not maintained. Health is viewed as a continuum from excellent to poor and disease as a separate dichotomy of presence or absence.
Nursing in the context of the metaparadigm is the identification of an individual's need for care action, together with provision and management of such care on a continuous basis in order to sustain life and health, recover from disease or injury, and cope with their effects (Fawcett, 1989, p. 220). Where the physician is concerned with a patient's life processes that have been interrupted by illness, the nurse is concerned with a patient's continuing therapeutic care. Nursing is required when the person is unable to engage in self-care. The ability of the nurse to provide patient care is referred to as nursing agen...