The Challenge: Be Bold

Being bold implies facing the challenges presented in the current nursing situation. The sanitary crisis produced by the COVID-19 pandemic evidenced the strengths and weaknesses of global public health, as well as the opportunities and threats for our profession ². This and the other crises we are facing demand bold and immediate actions; actions that require nurses to be able to adapt, innovate, and lead the change needed to face the population’s health needs and challenges. We are working on it; our view goes beyond the identification of problems. Besides having a body of knowledge that is better articulated with the practice, we are in a privileged position that not only brings us closer to the people, but it makes us be perceived as the most reliable professionals in the health system. These elements prepare the stage to work toward nursing visibility. Now, more than ever, we need to be bold and contribute our experience and vision to participate in the qualification of education, the promotion of research, the generation of knowledge that guides the practice, and the transformation of the health systems in particular contexts.

Ken Dion, international president of Sigma, encourages nurses to be bold in three critical domains: economics, technology, and preservation. From economics, considered the science of making decisions, time and resources are fundamental, and value and confidence are power elements that nurses must know how to manage to influence in the decision stages. Technology must be our ally to transform the health systems; a leader-nurse can contribute to implementing safer care, based on knowledge integrated and patient-centered knowledge ³. Preservation consists of thinking about planetary health and how we, as leaders, can inspire communities with actions that empower them to prevent the effects environmental changes and emergencies have on health ⁴.

Practice, Research, and Theory: The Triad that Legitimizes, Consolidates, and Nurtures Nursing Knowledge

Nursing is a professional discipline that seeks to answer to the social and practice needs related to the healthcare experiences of human beings ⁵. The practice is the space where nurses become visible; in it, they communicate their knowledge and abilities, recognize the causal factors, and look for solutions to people’s problems. The change of direction and the loss of course in the practice (doing the practice outside of the nursing domain or without theoretical background, subordinate working, distancing from the patients, etc.) distort and turn the practice into a routinary and senseless technique with unfortunate consequences for the people (deficient health results) and for the discipline (frustration and quitting intentions). All of this was evidenced during the pandemic; to counteract it is imperative to guarantee that nurses can have an autonomous practice supported by theory. Coordinated effort and participation in working networks that define common interests and influence political and social decisions are the way to accomplish it.

How Can We Accomplish an Autonomous Practice Supported by the Theory?

According to Durán de Villalobos, it is impossible to think about the practice without knowledge support (theory), and knowledge that has not been supported in the syntactic structure of research cannot be accepted ^6,7.

Nursing theorists affirm that it is necessary to make changes in the training of nurses so that they create knowledge as well as apply it. A strategy for that is to foster the creation, transformation, and application of knowledge derived from the practice. In this way, it is possible to efficiently answer the growing demands to satisfy high-quality attention in changing contexts with limited financial resources ⁸. In this pluralist view, the nursing practice is recognized as a source of knowledge and theory that considers socio-cultural, political, and contextual (health and care) factors such as values, beliefs, diversity, equity, reflection around the nurses a theorist, and the researcher-researched relationship ^8,9.

Practice-based knowledge may be guided by two fundamental elements: knowledge (derived from multiple sources) and the transmission of that knowledge (i.e., using evidence-framed science, thought and criticized within particular contexts as a decision-making tool). Practice-base knowledge reduces the gap between theory and practice because it encourages the nurse to innovate and be open to change using conceptual systems (ideas that influence and are, in turn, influenced by the context) ¹⁰.

How Can Practicing Nurses Develop Theory?

Nursing theory development must not be an exclusive task of specialists and researchers. After all, as Meléis states: “the objective of nursing science is to develop theories to describe, explain, and understand the nature of phenomena, and anticipate the occurrence of events and situations direct or indirectly related to nursing care” ¹¹, that is, with the nursing practice. The expertise gained through practice and postgraduate education prepares nurses to adapt the existing theories and to develop new ones from the meticulous observation of the practice; these theories will be applied, tested, and transformed into self-knowledge through research ¹⁰.

One of the best strategies for a practicing nurse to develop theories is the specific situation theory, a type of theory that reflects on care phenomena from specific populations in particular contexts ¹². To formulate a specific situation theory, nursing perspectives, links between theory, research and practice, and concepts organized in a creative fashion become of greater relevance. The products of these theories include action plans and integrative frameworks or guides for practice and research in nursing care ^13,14.

Discussion

In The Letter for Change¹⁵, the International Nursing Council urges governments, civil society, and health service providers to value, protect, respect, and invest in nurses for the sustainable future of health services. The voices of 28 million nurses worldwide demand the creation and maintenance of safe, affordable, and accessible healthcare systems. The commandment of fundamental political actions is an urgent call to humanity in which raising the voice is an act of courage that claims the fundamental right to health as an investment for the general well-being.

To hold the structure of contemporary nursing knowledge and to avoid its fragmentation, it is essential to reflect on what nursing is, what it can do, and how what nursing is can influence what it does ¹⁶. In other words, we must take a step back and question who we are, where we come from, and where we are going. What shall we do to find our path? (i) Respect and promote the nurses’ performance as health professionals (theorists, scientists, researchers, instructors, and leaders), (ii) invest in accredited high-quality training programs, (iii) empower nurses to work in the practice field, and (iv) actively cooperate in the construction of local and global alliances between different national nursing associations.

There is a discernable emancipatory nursing movement in Latin America. Participation from unions (scientific, professional, managerial, etc.) is more important each time, we finally understood there is strength in numbers. In Colombia, the governing entities in charge of directing, organizing, appointing, and controlling the nursing professional practice formulated for the 2020-2030 decade a national nursing policy that promotes knowledge development by practicing nurses for their practice to be more autonomous ¹⁷. If we want this plan to become a reality, all nurses must participate in it, also contributing to the development of new theoretical knowledge.

Conclusion

Nursing organization and mobilization are a priority we must consider if we want the development and practice of the profession to answer to society’s needs and the universal health access guarantee. To reach this goal, Sigma invites us to be bold in practice, research, and education; it encourages us to be agents of change, develop theories, share knowledge, and cooperate with other professionals. It also inspires us to be leaders, influence public policies, stand up for our rights, and empower our colleagues. The benefit is invaluable—the training of bold leaders, who are creators of professional networks and are at the forefront of nursing knowledge. Being bold is then a quality that must define nursing professionals to achieve excellence.