HealthFebruary 08, 2017

Our theoretical future: Fifth generation nurse theorists

The following post was written by Dr. Afaf Meleis, author of Theoretical Nursing: Development and Progress, published by Wolters Kluwer.

A leading expert on international health, Afaf I. Meleis, PhD, DrPS(hon), FAAN, has dedicated her career to ensuring vulnerable populations are given a voice, particularly women.

Through her life's work, Dr. Meleis has raised the visibility of the nursing profession, Penn Nursing, and the growing importance of addressing the social inequities facing women and their families around the world.

I recently completed revising the 6th edition of the award winning book Theoretical Nursing: Development and Progress that I first wrote and published in 1985. In revising and updating this (more than) 600 page book, I considered the influence of the 21st century global context, and the many transitions that our discipline has undergone, from its practice beginning, to its current influential scholarly era, to the theoretical progress of the discipline.

In this edition, I celebrate the tremendous progress made in nursing theory and in the well-established theoretical foundations of our discipline, and I provide the rationale to challenge some of the myths and biases which may derail its continuous progress in the future. These myths may influence the nature of education provided to students, which focusses more on practice and research support while minimizing the value and the significance of theory. 

These views may promote atheoretical dialogues, decrease philosophical discourses, ignore the importance of value clarifications and/or the need for questioning assumptions that guide practice. Some of the early silo producing dichotomization of practice, research and theory is still lingering and is not benefitting the 21 stcentury which is focused on collaboration and integration.

In this new edition, I hope readers will sense an urgency in pausing to celebrate our theoretical past and in reclaiming our theoretical future, and in the need to promote discussions, dialogues and debates about what is at stake if we do not groom the next generation of scholars for advancing theory. What is needed is a serious investment in members of future generations who will combine the skills of integrating knowledge and expertise and the ability to articulate findings in coherent theoretical dialogues which provide the language and the voice to influence health care policies for quality care.

In this edition, readers are encouraged to address some threats that may slow down progress and to transform these threats into opportunities for future progress. Among these threats are the potential loss of a nursing identity and nursing voice in the process of becoming more interprofessional. Another threat is in developing theories guided by recent revolutions in the sciences without reflecting the goals and the mission of the discipline of nursing. Another threat is for becoming entrepreneurs by utilizing dynamic and innovative technology, which may lead to reductionist approaches to caring. Finally, the threats of developing theories that do not reflect population diversity and a more global focus to populations may limit the development of culturally appropriate practices and models of care. These threats can only be mitigated by anticipating them, deliberately dialoging about population and environment issues and transforming them into opportunities.

Moving forward, jump restarting theoretical dialogues is a must. It requires an investment by all members of the discipline in fostering and nurturing the development and the sustainability of a disciplinary identity and in providing opportunities to revisit our theoretical heritage. It also requires investing in advancing the development integrated knowledge.

Therefore, the book promotes the reviewing of, and learning from, our history while considering current progress and discoveries, as well as paying particular attention to social and cultural transitions that are occurring globally. It is through all that, that we can envision a future of creativity and innovation to ensure a sustainable healthy future. With the attention the profession of nursing is receiving globally through the many national and international commissions and reports, and the science that nurses developed which provides evidence for practice, the discipline of nursing is poised for a fifth dimension for knowledge development. This fifth dimension addresses and integrates practice, theory, research, education and policies. Through this fifth dimension, members of the profession will be making a major impact on health care by investing in developing and supporting creative fifth generation theorists.  Fifth generation theorists are those who are well groomed and prepared to create population responsive health policies. These are policies to prevent illness, promote wellness, decrease disparities and enhance access to health care through innovative strategies. Fifth generation theorists use the theories to exert their strong voices to affect changes in health care policies that are designed to increase equitable and just access to quality health care.

I am hoping that by reviewing and using this (600 plus page) edition, educators, researchers, students, clinicians and policy makers will be inspired to challenge the myths about the lack of importance of theories in developing research programs, in guiding practice and in empowering nurses” voices. The book also provides an extensive updated list of historical and current theory resources.

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