Key Issues in Nursing Theory: Developments, Challenges, and Future Directions

Today, we face a situation some call the "profession at the crossroads." The problem is the development of the profession being threatened by an imbalance among philosophical, conceptual/theoretical, and empirical inquiry.

The aims of this project are to (a) examine the development and contributions of theory, (b) outline the challenges we face in knowledge development, and (c) provide a structure for disciplinary knowledge that provides a unifying focus and renovates theories' place in nursing science that can direct the future of developing knowledge for practice.

A personal narrative along with literature reviews. Narrative strategies included my own publications on theory, some relevant unpublished speeches, memories of meetings checked with concurrent attendees, and similar or dissimilar points of view in nursing theory textbooks.

Contributions of theoretical work in the 20th century included maturing of the discipline, clarifying the theoretical focus of nursing as holistic persons with processes and patterns for environmental integration to attain health, a plurality of grand theories for articulating and testing of theories in practice and research, identification of the mutual impact of theory and education and major conferences, and contributions globally. Twenty-first century developments used all levels of theories particularly for research. Questions are raised about the evaluation of theory. Detours and dead ends for theory development involved metatheory debates and specific events. Challenges identified relate to rapid changes in society, healthcare, and science. A pathway for the future is presented in a figure with its description of the structure of nursing knowledge.

The potential of this structure for developing future theory-based nursing knowledge for practice is envisioned, and strategies for creating this future are suggested.