Frontiers of nursing in the twenty-first century: development of models and theories on the concept of nursing*

Theories and models on the concept of nursing are reviewed briefly and their contribution then assessed in terms of their potential to advance the scientific basis of nursing practice. The constructs are acknowledged to have moved the focus of nursing from disease to patient need and provided different ways of looking at the nurse's contribution. Yet, despite this advance, the constructs have not been put to the rigours of scientific testing and so remain at the level of speculation. Therefore, towards the developments for the twenty-first century it is proposed that these ideas should be put to the test to establish their relevance in the real world of nursing care. This requires: a framework from which the nature, extent and purpose of care can be specified; independent criteria which can be used to judge effectiveness of care; knowledge as it relates to the different and varied core concepts underlying the practice of nursing; and a working definition of need. In addition, the extent of care for the community needs to be made explicit through research. Together, this represents a challenge to develop theories which are logically related to single core concepts which themselves represent specific areas of actual nursing practice.     

Directions for nursing theory development in the 21st century.

The development of the discipline of nursing has gone through four stages: theorizing, developing a syntax, concept development, and philosophical debate. These stages helped in shaping the characteristics of the discipline as a human science, a practice science, a science with social goals to empower nurses to provide effective and quality care, and one in which gender differences and the need for understanding minorities are areas of primary concern. Further theoretical development in the discipline will be driven by population needs and will be characterized by reaching out to meet the integrative and interdisciplinary nature of these needs. Sources of theories of the future are practice, theory and research. It is anticipated that two models will evolve to guide the development of phenomenon-driven theories in the future and that third generation theorists will utilize these models.     

Mental health nursing in the 21st century

Mental health nursing in the 21st century will expand to include a neuropsychiatric focus that encompasses the science, knowledge, and skills of both neurology and psychiatry. The shift to neuropsychiatric nursing is directed by the explosion of knowledge in the neurobiologic basis of mental illness, tremendous advances in diagnostic technology, and the discovery of new and more effective psychopharmacologic treatments. Neuropsychiatric disorders are common, disabling, costly, and stigmatizing. A neuropsychiatric paradigm allows treatment to reach more people who are affected and is less stigmatizing than a psychosocial view alone. Neuropsychiatric advanced practice nurses will need both primary care and specialty knowledge and skills. The challenge to nursing education is to determine how best to incorporate this knowledge and skills into curricula. Neuropsychiatric research must focus on both biologic and behavioral measures and interventions. The philosophical and ethical challenge to nursing is to integrate biologic and behavioral concepts into the nursing care of mentally ill people while remaining centered in the nursing domain and maintaining our focus on caring and our sensitivity to the human condition.     

Vascular nursing in the 21st century.

J Vasc Nurs 2001;19:38-41     

Critical care nursing in the 21st century

This paper has explored some of the major trends that we can anticipate encountering as we enter the 21st century. Critical care nurses who wish to participate proactively in shaping their professional destiny will listen closely to what futurists have to say about life in the decades ahead. The more we know about what to anticipate, the more informed our decisions will be, and the more likely we will make our desired future a reality.     

Board leadership development: the key to effective nursing leadership in the 21st century

This article discusses the need for board leadership development of nurses. The authors provide an overview of the Sigma Theta Tau International Board Leadership Development program based on the experiences of nine Fellows who completed the program. Elements necessary for a self-developed board leadership development program are presented. Rationale is discussed as to why the Sigma Theta Tau Board Leadership Development program and future similar programs need to include the critical success factors in the development of nurses as board members. The authors discuss the variety of professional and personal benefits of a program of this importance.     

Cultural perspectives on nursing in the 21st century.

By the year 2000, more than one fourth of the US population will consist of individuals from culturally diverse groups. Increasing numbers of international visitors and exchange students will use the US health care delivery system, and US nurses will engage in international interchanges with increasing frequency. To keep pace with these population and health care trends, US nurses will need to base their nursing care on a theoretically sound foundation that draws on knowledge from the physical, natural, and behavioral sciences, as well as on research-based theories from transcultural, cross-cultural, and international nursing. The purposes of this article are to (1) trace past, present, and future population trends among minority groups in the United States; (2) examine the ways in which transcultural nursing has provided a framework for meeting the health care needs of culturally diverse people; (3) identify current issues and trends in transcultural nursing; and (4) suggest ways in which nurses can prepare for the increasing numbers of culturally diverse individuals who are projected to need nursing care in the future.     

Planning nursing education for the 21st century

In looking towards the 21st century, the faculty at the Presbyterian Hospital School of Nursing, along with the Presbyterian Health Services Corporation and Queen's College, adopted a 1-2-1 programme The process of developing a new nursing curriculum is presented as the task force proceeded from the philosophy and goals to conceptual framework and curriculum objectives After discussions with nurse administrators and educators, extensive literature reviews and brainstorming sessions, concepts and subconcepts were chosen to form a philosophy The metaparadigm of nursing and other related concepts were then organized into a conceptual framework Ongoing communication and feedback from the faculty ensured group ownership of all documents The eclectic organizational scheme was a good fit for a large faculty with differing beliefs and values about a nursing curriculum The process of developing a future orientated nursing curriculum has been exciting, challenging and rewarding The faculty is committed to the new philosophy, goals and conceptual framework and believe that the 1–2–1 programme will educate future practitioners who are prepared to meet the challenges and changes in health care for the 21st century     

Development of models and theories on the concept of nursing*

This paper shows how models can be used by practitioners of nursing as a practical tool to analyse their own practice, in particular to assess needs and to plan, implement, and evaluate care. It is argued that the impact of existing work in theory development has been relatively small, at least in the UK, because the theories arc not sufficiently specific to everyday nursing activities and the models are over elaborate and not universally applicable. A simple model of nursing, based on a systems approach is presented and applied to one particular field of nursing practice, i.e. health visiting. The model, which can be used in any field of nursing, stresses the reciprocity of the nurse–patient relationship, and the significance of the environment in determining the concepts of nurse, patient and nursing.     

21st century nursing practice in Ghana: challenges and opportunities

DONKOR N.T. & ANDREWS L.D. (2011) 21st century nursing practice in Ghana: challenges and opportunities. International Nursing Review 58 , 218–224 Aim: This article is intended to stimulate critical thinking and generate fruitful discussion on nursing practice in Ghana as experienced by the authors. Its rationale is to promote exchange of ideas and creative partnerships to ensure that right decisions are made in preparing competent, adaptable and resourceful nurses who can contribute to health for all in the 21st century. The problem: The challenges of nursing education, practice and migration in Ghana seem grim. There is inadequate capacity of training institutions, low staff morale, poor distribution and serious workforce shortages. Methods: Government reports and policy documents on nursing were sourced from official websites and reviewed and discussed in the context of the international scholarly published literature. Opportunities: The authors note that despite the severe crises, a number of opportunities such as improved home‐based training, international nursing education partnerships and welfare and human resource development could foster effective nurse retention and managed migration. Conclusions: To address the issues with nursing health service delivery and nursing shortages in Ghana requires all stakeholders to move beyond the traditional stereotypes and be flexible and forward‐looking. Needed policy options include expansion of local nursing education and training capacity, collaborative training opportunities, improving the welfare and retention rates of current staff and international exchange of nurse resources that is mutually beneficial to both source and sink countries.