Power point Nurse Theorist Jean watson

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Nursing Science Quarterly 2020, Vol. 33(2) 178 –182 © The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0894318420903495 journals.sagepub.com/home/nsq

Special Feature

Some may question the role of nursing theory and related paradigms in the age of sustainable development. True, what is needed now is action—measurable change with a focus on outcomes showing improved health and wellbeing and a demonstrable commitment to equity, inclusion, universal respect, and environmental thriving. The profession needs leaders to advance nursing’s political voice and harness mutually beneficial, long-term partnerships with stakehold- ers in the economic, financial, agricultural, energy, and busi- ness sectors. One tangible goal, being promoted through campaigns such as Nursing Now (n.d.), is to have a nursing presence at all decision-making tables related to health pol- icy that addresses the myriad determinants of health. With 2020 claimed as the Nurse and the Midwife (World Health Organization [WHO], 2019), we must not only honor our skills to adapt, collaborate, and progress but also celebrate our historical roots that establish nurses as sojourners with society and lightkeepers in a chronically dehumanizing healthcare system.

Why is talk of caring, integrality, and a humanistic nursing lens essential in the context of the 17 United Nations (UN) Sustainable Development Goals (SDGs) (United Nations, 2016) (see Figure)? Theory-guided practice continues to inform discipline-specific care as well as agendas of

advocacy. Nurses across settings and in all nations worldwide play pivotal roles in the global attainment of the SDGs through acts of concerned citizenship and professional lead- ership (Dossey, Rosa, & Beck, 2019; Rosa, 2017a; Rosa, Sullivan-Marx et al., 2019). Theory breathes into the world

903495NSQXXX10.1177/0894318420903495Nursing Science QuarterlyRosa et al. research-article2020

1RWJF Future of Nursing Scholar, University of Pennsylvania School of Nursing, Philadelphia, PA, USA 2Co-Director, International Nurse Coach Association, North Miami, FL, USA 3International Co-Director, Nightingale Initiative for Global Health, Santa Fe, NM, USA 4Anne Furrow Professor and Associate Dean, University of Arizona College of Nursing, Tucson, AZ, USA 5Director, Earl E. Bakken Center for Spirituality & Healing, Professor, School of Nursing, University of Minnesota, Minneapolis, MN, USA 6Director of Nursing, P.D. Hinduja, National Hospital, Mumbai, India 7Dean Emerita and Professor of Nursing and Sociology, University of Pennsylvania School of Nursing, Philadelphia, PA, USA 8Dean, University of Rwanda School of Nursing & Midwifery, Kigali, Rwanda, East Africa 9Colonel (Ret.), Unites States Air Force, Nurse Corps, Partnership Liaison, Caring-Based Academic Partnership in Excellence: Veteran RNs in Primary Care (CAPE-V) Grant, Emeritus Professor, Florida Atlantic University Christine E. Lynn College of Nursing, Boca Raton, FL, USA 10Founder & Director, Watson Caring Science Institute, Boulder, CO, USA

Nursing Theory in the Quest for the Sustainable Development Goals

William E. Rosa, RN; MS; FAAN,1 Barbara M. Dossey, RN; PhD; FAAN,2,3 Mary Koithan, RN; PhD; FAAN,4 Mary Jo Kreitzer, RN; PhD; FAAN,5 Phalakshi Manjrekar, RN; PhD,6 Afaf I. Meleis, RN; PhD; FAAN,7 Donatilla Mukamana, RN; PhD,8 Marilyn A. Ray, RN; PhD; FAAN,9 and Jean Watson, RN; PhD; FAAN10

Abstract The 17 United Nations Sustainable Development Goals (SDG) are intended to promote a safe, healthy, and equitable world by the year 2030. Nurses are at the forefront of realizing the 2030 agenda through concerned citizenship and professional leadership. Nursing theory informs knowledge development and theory-guided practice essential for nurses working in all domains and in all nations. Although all extant nursing theories are relevant, a select few are discussed in detail to make explicit the links between theory and SDG realization. Middle-range theories are also valuable in helping to contextualize nursing practice through the lens of the SDGs. The SDGs address five themes - People, Planet, Peace, Prosperity, and Partnership - and theory remains vital to ensure nurses working in all settings are equipped to meet the needs of humanity and the world, now and in the future.

Keywords global health, SDGs, Sustainable Development Goals, United Nations

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the determination of Florence Nightingale, the grit of Lillian Wald, and the soul of all global nurse leaders who have gone unnamed or uncelebrated. Theory is both a background on which to build and a foreground upon which to envision (Meleis, 2018). You may ask, "Have we not worn out the scholarly dialogue related to theory and theoretical implica- tions of nursing?" And yet theory continues to demonstrate direct links to the world’s current global agendas and the needs of the planet at large.

Never before has a practice rooted in professional heri- tage been so vital. While we must be able to adopt interdisci- plinary solutions to modern-day problems, we must also be able to give language to the unique contributions in ways that honor nursing’s heritage and celebrate our shared humanity with those we serve. In fact, these authors contend that nurs- ing theory is called to evolve and invite the next generation of visionaries to meet the future needs of the global village, ensuring planetary survival and thriving. There are several important points to consider as we strive to keep one foot upon a future of potential SDG attainment and the other firmly balanced on our theoretical-disciplinary foundations. Importantly, all extant nursing theories inform the profes- sion’s role in the global agenda through knowledge develop- ment and the promotion of theory-guided practice. However, only a select few are discussed herein to make explicit the

direct links between nursing science and the SDGs, specifi- cally caring science, transcultural nursing theory, and inte- gral and integrative nursing.

First, caring is a critical way of being, doing, and know- ing in the world while attending to each of the 17 SDGs. The caring sciences inform how we practice and contribute to a global society where every human life matters, guided by an ethic of ‘Belonging’ to universal cosmic love (Watson, 2018). This premise of nursing—the very essence of the profession—strives to protect and engender dignity as a primary tenet at all costs. For 40 years, Watson’s the- ory has reminded nurses worldwide that the power of a caring moment is transpersonal, transcending time, space, and physicality, and that a heart-centered approach to prac- tice is what humanity needs in these times of extreme vul- nerability (Rosa, Horton-Deutsch et al., 2019; Watson, 2012). The SDGs call for a civil society where all lives matter by abolishing the plights of poverty and hunger. Caring gives us a currency of shared humanity with which to empower and nourish not just economic livelihoods but people as human beings who have highly individualized stories and narratives. Caring science offers both an artis- tic texture and scientific premise with which to make new connections between loving-kindness, peace, and social/ moral justice.

Figure. UN Sustainable Development Goals. Reprinted with permission from The United Nations Sustainable Development Goals. https://sustainabledevelopment.un.org/sdgs.

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Second, the many cultures among nations and communi- ties deserve thoughtful attention while striving to achieve the SDGs. Leininger saw a world where culture care was pri- oritized as nurses sought to maintain and improve the health of all people (Leininger, 1970; McFarland & Wehbe-Alamah, 2018). Self-reflection, self-awareness, openness to diversity, and a genuine willingness to see different perspectives are necessary to engage with cultural humility (Foronda, Baptiste, Reinholdt, & Ousman, 2016). Equity does not exist without cultural humility. Ray (2016) has emphasized the need to remember the following when working in transcul- tural nursing arenas: the essence of caring (compassion/love as the guiding force), transcultural caring ethics (a moral car- ing experience promoting ethical engagement), transcultural context (varied personal-communal-societal lived experi- ences), and universal sources (spiritual/religious traditions that inform the transcultural caring relationship). Ray’s (2016) theoretical view provides a cultural roadmap to navi- gate the complexities of realizing the SDGs across countries, religions, norms, and governments with different priorities and laws, and an endless number of subcultures to consider within broader cultural communities possessing distinct val- ues and identities.

Third, the SDGs—quite literally—reflect integral nursing theory and an integrative lens. Dossey (2016) reminded nurses that healing is always at the center of nursing care, even in the absence of cure. We can always promote greater wholeness and soundness in any given setting through our authentic presence, deep listening, holistic skill set, and clear intentionality. This is particularly relevant in resource-poor settings where certain technologies and interventions remain a pipedream. Integral theory (Dossey, 2016) asks nurses to continually view the SDGs, health, and wellbeing through four quadrants of experience: individual interior (psycho- logical/spiritual), individual exterior (physiological/behav- ioral), collective interior (relational/cultural), and collective exterior (structural/social). If the SDGs are to be achieved by 2030, we must take the deep dive into these quadrants of life and living on a consistent basis.

Furthermore, integrative nursing forerunners Kreitzer and Koithan (2019) insist we take a whole-person and whole- system stance, intervening in a manner that respects inherent healing properties and empowering the recipient of care while creating a system that is sustainable and humane (see Table). This is a crucial component of social justice and activism that equips nurses to think broader and substantiate practice grounded in knowledge of dynamic, complex, ever- changing system-level factors. The principles of integrative nursing, consistent and aligned with all of the above nursing theories, provide practical and unambiguous guidance that shapes and directs nursing action toward achievement of the SDGs. Integrative nursing allows us to ride the wave between the needs of the individual and the collective, trusting in the power of nature to restore and enliven.

The theories discussed above—among others—have been employed in practice settings globally. Examples include the conceptual development of caring science literacies and translation to research in South Africa, Peru, Jordan, and Israel (Lee, Palmieri, & Watson, 2017). Leininger’s theory has been used as a premise of nursing care and research for indigenous populations in countries like the United States and Kenya and for immigrants confronting cross-cultural chal- lenges (McFarland & Wehbe-Alamah, 2018). Transcultural caring has been applied to healthcare settings in countries such as Thailand, Norway, Ecuador, China, the Philippines, and Haiti, emphasizing culturally relevant nursing across milieus (Ray, 2016). The theory of integral nursing has been the basis for international health partnerships in India (Dossey, Beck, Oerther, & Manjrekar, 2017) and serves as the ethos of organizations like the Nightingale Initiative for Global Health (2019), which has representation in Uganda as well as consul- tative status at the United Nations. Integrative nursing has been contextualized into educational, practice, and research domains in many nations, including Germany, Turkey, Iceland, and Sweden, challenging the status quo of healthcare by demonstrating whole-person and whole-people care at a systems level (Kreitzer & Koithan, 2019).

Next to consider is that if the SDGs are to be realized, we must honor the importance of middle-range and situation-spe- cific theories for use in dynamic and diverse environments. For instance, Mukamana’s genocide rape trauma management work is based on her grounded theory research and addresses the biopsychosocial needs of Rwandan genocide survivors, supporting the advancement of social services to promote health equity (SDG 3), gender equality (SDG 5), and eco- nomic opportunity for all (SDG 8) within Rwanda (Mukamana, Brysiewicz, Collins, & Rosa, 2018; Mukamana, Collins, & Rosa, 2018). Another example is Meleis’ (2010, 2019) transi- tions theory, which has been applied for a host of populations confronting various chronic illnesses and may prove reliable to help guide nursing service in the face of evolving global transitions, such as the climate crisis (SDG 13) and the

Table. Principles of Integrative Nursing.

1. Human beings are inseparable from their environments. 2. Human beings have the innate capacity for health and

wellbeing. 3. Nature has healing and restorative properties that contribute

to health and wellbeing. 4. Integrative nursing is person-centered and relationship-based. 5. Integrative nursing practice is informed by evidence and uses

the full range of therapeutic modalities to support/augment the healing process, moving from least intensive/invasive to more, depending on need and context.

6. Integrative nursing focuses on the health and wellbeing of caregivers as well as those they serve.

Reprinted with permission. Kreitzer, M. J., & Koithan, M. (2019). Integrative nursing (2nd ed). New York, NY: Oxford University Press.

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multidimensional health influences due to a significant loss of biodiversity (SDGs 14 and 15). In fact, transitions are what the SDGs are all about: accountable and peaceful transnational transitions toward respect, inclusion, thriving, wellbeing, and health in an ever-changing world.

Finally, theory is not static. Theory rises to meet the changing tides of the day. Rosa (2017b) has called for contin- ued theory evolution to inform needs at a planetary level. If nurses are to mitigate the degradation of the biosphere and promote planetary health at institutional, national, and global levels, we must have theories that supply nurses with a struc- ture for disciplinary thinking and service in these domains. We must move toward planetary caring and infuse practice, education, research, and policy with the concept of One Mind-One Health-One Planet (Rosa, 2017c, 2019). The notion of planetary citizenship has been previously discussed (Rosa, 2017c) and carries with it the idea that human health and wellbeing is a farce without planetary interconnected- ness and consciousness linking humanity and human sur- vival to animal species, ecosystems, and all aspects of the environment. Planetary citizenship is built on concepts of caring, integrality and integrative systems thinking, transcul- tural inclusion, and the courage needed to attend to the plan- et’s transitions with disciplinary integrity. We must consider ourselves planetary citizens living in a global world—facili- tators of caring-healing across cultures and contexts tending to people and the environment through integral-integrative models that produce the measures the empiricists demand. Theory must grow as we do at individual and group levels, as both citizens and professionals, today and in the future.

Meleis (2017) wrote that nurses “must systematically and deliberately plan their work, action, practice, and research toward supporting and/or advocating for the SDGs” (p. 526). However, nurses’ contributions to the SDGs will always be lacking if we overlook the role of theory to inform how we think and position ourselves in the world. Theory is lan- guage, expression, power, creativity, resilience, heritage, tra- dition. It is also a key guiding aspect of our professional future. The SDGs rest on five main themes: People, Planet, Peace, Prosperity, and Partnerships. Nursing theory has the potential to get us there—to experience a kinder and health- ier world built on the scholarship and science of those that came before and invite a forum of action for those that are yet to come. Nursing theory is the lineage that connects us across time—now and beyond 2030.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this review.

Funding

The author(s) received no financial support for the authorship and/ or publication of this review.

ORCID iD

William E. Rosa https://orcid.org/0000-0002-0680-8911

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