Challenges for Nursing in Future Trends and Developments

Abstract

Nurses based on a fundamental moral value which is the interest of the person—therefore, actions and interventions must take into account the needs and interests of the Other. This chapter discusses four challenges, moving from nursing epistemology to research-based practices. It is necessary to emphasize knowledge to establish a robust connection between the nurses’ fields of activity. We also discuss the challenges associated with technology in learning and teaching, in telenursing or clinical nursing. The third choice we made is to enrich the development of emotional skills by sharing components and dimensions. The emotional competence was first studied in a clinical context before being extrapolated to teaching and management. To be more precise, emotional competence belongs to the subject himself as the first resource. In the fourth challenge, the environment and the world are seen from a broader perspective. We question whether improving literacy is relevant to empowering people and citizens to promote and fight for safe care and a sustainable and peaceful environment in the context of “One Health” and “One Ethics.” These four trends are both challenges and horizons. Furthermore, as we approach any horizon, it gets closer until we reach a new starting point.

Life is divided into three terms

– that which was, which is, and which will be

Let us learn from the past to profit by the present,

and from the present, to live better in the future”.

– William Wordsworth

1. Introduction

Nursing, as a discipline of knowledge and liberal profession, faces, in our century, a set of challenging dimensions, with diverse origins, from the internal issues of the discipline (such as the epistemological approach, the relationship between theories and practices, the specific theoretical development of its own) to broader social issues, the social area, technology, also crossing education, management, and clinical nursing.

Without claiming to address them all, we consider it proper to propose a set of challenges, related and interconnected but also autonomous in themselves and their individual results and representations: (1) Bringing theories and practices closer together using research; (2) Technology-based teaching-learning and teleconsultation; (3) Development of emotional competencies; (4) Salutogenic perspective and environmental commitment.

1.1 Bridging theories and practices through research use

Nursing epistemology has various possibilities of approaching, and for this effect, we are focused on two relevant aspects: how we know and what we do with the produced knowledge (usually named “evidence”).

We could ask anyone: people have no difficulty saying that they know; for example, the street where they live, the other people come across, and the places they pass through and have passed through. However, it seems that we know more than the things we had direct access to because we also think to know from the narratives of Others, from readings, and indirect learning. So, looking to improve the meaning, we can pose an apparently simple question: How do we know what we think we know? As health professionals, how do nurses know what they think they know to deliver care?

It is a kind of trigger question—“when you decide to provide care, how do you know you know?”, invokes strangeness, even perplexity. Trained nurses do not usually interrogate themselves these kinds of questions. You could ask them what they base their decisions on, which would at least be more orthodox. Nevertheless, the central epistemological question is about knowledge, how we know what we think we know, and what is the validity of the knowledge we must care for people. Moreover, we realize it sounds weird.

However, “how do you know that you know?” is only a first question, and it is not despicable that when a nurse provides care, they are expected to know what they are doing, why they are doing it, and what for, as well as to be confident in the act.

Interestingly, it is often the case that nurses in postgraduate education answer this question by first saying something related to outcomes. Furthermore, when we counterargue that we cannot decide on outcomes when planning nursing care for people, they suggest other grounds: like undergraduate training, research, professional experience, the reflection of previous care experiences, imagination, intuition, and heuristic thought. In short, various sources of knowledge in Nursing [1]. Ask yourself: How do I know that I know? How did I know what I think I knew? What do I do with what I [think I] know?

There are more questions right up front: under what conditions do nurses know? How did they obtain the knowledge? How do they know it is reliable or trustworthy? When do they know, justifiably, that they know something? How do they support and justify beliefs? What are the limits of knowledge?

Saying “nursing epistemology” means we are concerned with questions regarding the nature, sources, and validity of knowledge in nursing, the study of the knowledge, and justified beliefs we hold, including questions of knowledge creation and dissemination.

Dreyfus puts it simply—“The radical gap between what is inside the mind and what is outside in the world must be mediated in order for a subject to have knowledge of the world, and epistemology is the study of this mediation” [2]. In the case of nursing, it is about considering the core of the discipline and the modes of operationalization of materialization in professional action.

As Mark Risjord put, “Nursing has two faces. To the public, nurses embody the best of modern health care. Efficient, effective, and caring nurses are at the center of the patient’s experience. The other face is largely invisible to the patient, even though it has been a part of nursing since the time of Florence Nightingale. Nursing requires knowledge” [3].

Nursing education is a trajectory in which a student moves toward the construction of personal knowledge (which, let us face it, in the academic phase, tends to be more standardized than unique). The enrichment of personal knowledge comes from the personal experiences and reflective construction of the person (including knowledge about oneself) and from the study, research, and updating of knowledge. Public knowledge, as Risjord says, concerns the knowledge of a discipline that is available, having the characteristics of systematization and generalization (although these characteristics vary with the maturity of the discipline, the way it integrates new knowledge into a coherent whole and encompasses epistemological issues).

The development of nursing knowledge is oriented toward the enrichment of public knowledge since this is the foundation of the discipline. Through the development of research, nurses have long asserted ownership over the knowledge necessary for their praxis—and at this point, we must define nursing knowledge as the knowledge relevant to nurses, “warranted as useful and significant to nurses and patients in understanding and facilitating human health processes useful and meaningful for understanding and facilitating human responses to developmental and health processes” [4], therefore, related to the understanding, explanation, and prediction of nursing phenomena, in relation to clients and outcomes for practice.

We would agree that nursing knowledge is anchored in a multifaceted base that includes data from science (evidence and research), experience, and personal derivatives of understanding. Moreover, if it is true that scientific knowledge is acquired from research, it is not the only type of evidence that nurses use in practice (instead, in their praxis), as they also use acquired experience and their own personal learning. Therefore, describing nursing knowledge becomes complex because it is embedded in practice and because nursing involves a set of dynamic interactions that make us realize that we know more than we can communicate.

At this point, it makes sense to call Michael Polanyi and his concept of tacit knowledge is that “complete objectivity as usually attributed to the exact sciences is a delusion and is, in fact, a false ideal”¹ [5].

“We must now acknowledge belief once again as the source of all knowledge. Tacit assent and intellectual passions, the sharing of a language and cultural heritage, membership of a like-minded community: such are the impulses that shape our view of the nature of things, on which we rely for our mastery of things. No intelligence, however critical or original, can operate outside such a fiduciary framework” [6].

He then wrote The Tacit Dimension and was one of the first to discuss and develop the concept of tacit knowledge, identifying it as the dominant principle of all knowledge. In Latin origin, tacitus, from silent, expresses an implicit understanding—something that does not need to be said to be recognized. In his words, “I will reconsider human knowledge, beginning with the fact that we can know more than we can say. This fact seems obvious. But it is not easy to say exactly what it means” [7].

For Polanyi, tacit knowledge comprises two distinct dimensions:

1. the technical, including personal skills that are commonly referred to as know-how, relates to a type of knowledge deeply rooted in action and commitment to a specific context—an art or profession, a particular technology or market, or even the activities of a work group or team; and

2. the cognitive includes mental models, emotions, values, and beliefs. These elements—which we may call cognitive structures—are embedded in us in such a way that we take them for granted, defining how we act and behave and constituting the filter through which we perceive reality. Difficult to articulate in words, the cognitive dimension of tacit knowledge shapes how we perceive the world.

Looking at us, in the discipline of Nursing, any experienced nurse can provide examples of tacit knowledge in concrete situations naturally associated with their experience.

Furthermore, we realize that tacit knowledge, which we take for granted and allows us to understand the world and discern meaning in it, can be fully utilized in clinical reasoning for at least two reasons: because it explains that a recommendation of the evidence may not be suitable for that particular person (which articulates knowledge with personalization of care) and because clinical and human experience is essential and cannot be replaced by epidemiological data and scientific literature (and we are evoking the tone of voice, the expression, the words used in the narration of the story, that each person apportions in their health-disease process and the emotions, the values, and beliefs that they also transmit when narrating the story).

Each of us knows, whatever the ways of perceiving and understanding ourselves and the world. On the one hand, knowledge concerns what is expressed, what is brought to a certain level of awareness and can be shared, communicated, and researched [8]; on the other hand, knowledge is considered a central feature of professionalism because professions are based on knowledge and disciplines are an established body of formal knowledge. Therefore, it would be essential to understand how each one develops and uses his/her professional knowledge.

In fact, it is worth calling upon Charles Taylor, who insists that knowledge is primarily the result of embodied existence and experience. The way we find ourselves in the world is cognitively shaped and contained by the fact that we are bodies, which gives us a perceptual orientation to the world from our sense organs.

In the first instance, for example, we can only see things from certain angles, although we can change the angle from which we see something by moving ourselves or the objects. Today, we know in many ways that far transcend our bodily limitations (think of the microscope, the telescope, the CAT scan, or magnetic resonance imaging). However, some are concerned that the more sophisticated forms of knowing, made possible by technologies, are incorporated into, and ultimately dependent upon, our (primitive) ontological ways of knowing.

The world around us appears as a meaningful context in which we act, interact, and pursue our purposes. Knowledge does not mean it is necessarily conscious or articulate; interpretations can be tacit and pre-reflexive. As such, they typically form the backdrop to knowledge, to be accompanied by what we might call post-reflexive knowledge. Interestingly, Charles Taylor considers that “the semantic dimension” is what allows us to express ourselves correctly, so we look for the best way to express ourselves, to say it in the right way, semantically speaking.

As for those questions regarding “How do they know they know?”, “Under what conditions do they know?”, “How did they obtain the knowledge?”, “How do they know it is reliable or trustworthy?”, “What are the limits of the knowledge?”, many answers report experience, talking to colleagues and team members, validation with those they consider experts, research, and “going looking in books” as an option. That, in the first place, has appeared, above all, asking the teams’ experts or clinical leaders.

Furthermore, it is relevant that once the questions have been asked, nurses begin to discuss the issue and question themselves about the knowledge they think they have and how they obtained it. In other words, they should think about nursing epistemology, focusing on issues related to the nature, sources, and validity of nursing knowledge, the study of the knowledge, and justified beliefs we have, including the issues of knowledge creation and dissemination.

There is a commonly used speech about the separation theory-practice or the theory-practice gap, as an expression often associated with the lack of alignment between what is available in public knowledge and what is used in individual practice [3, 9]. Moreover, we need to hold meetings to enhance and strengthen the knowledge developed through the work of researchers and the personal knowledge of nurses.

Let us clarify that the expression “theory-practice gap” has been used in at least two senses:

• In a first, more superficial sense, it is said that existing theories may be considered irrelevant to practice—and, in this sense, the theory-practice gap assumes that there is intellectual knowledge that should inform practices and that this does not happen, that the body of knowledge is not used as it should be—therefore, there is a utilization gap;

• In another sense, many nurses question the direct relevance between theoretical material and care provision, questioning the relevance, importance, or usefulness of existing research and theories—which can be referred to as the relevance gap. This relevance gap is deeper and disturbing because it affects the very foundations of the discipline and becomes an issue of nursing philosophy.

So, we need to stop saying, “there is a gap between theory and practice.”

We must change our language and use other words, such as «we need to bridge between theory and practices, embedded practices with evidence and conceptual knowledge as well as research findings.

Neither practice arises independently of theory, nor does theory dispense with the realization of practice, which is not the same as saying that they must be considered the same or that they are superimposable. If the practice were the criterion of theory, it would become a sham and distort theory; if the theory were only aimed at giving pointers to practice, it would not fail to overestimate the particular, nor would it be able to resist the fascination of the casuistic.

Thus, we end up at a crossroads where the ontology of the person (complex, dynamic, inseparable from their environment, and which cannot be reduced to a health or disease situation), the ontology of nursing (due to the nature of care), and the ethical framework (due to the nature of interpersonal relationships) are interrelated.

Due to the nature of the subject who knows and the people cared for, nursing knowledge goes beyond the territory of scientific and technical knowledge, into ontology and ethics, into helping and caring relationships. However, the nursing process integrates diagnoses, interventions, and outcomes informed by scientific evidence and a wide range of therapeutic modalities. In fact, there is some space and opportunities for nurse scientists to develop.

2. Technology-based teaching-learning and telenursing

WHO defines eHealth as the “cost-effective and secure use of information and communications technologies supporting health and health-related fields, including health-care services, health surveillance, health literature, and health education, knowledge, and research. Clear evidence exists on the growing impact that eHealth has on the delivery of Health care around the world today, and how it is making health systems more efficient and more responsive to people’s needs and expectations” [10].

Before the COVID-19 pandemic, it was assumed that the convergence between technology and health care brings indisputable benefits, namely faster and easier access to care and health information, greater control of the user over his health information as well as in greater efficiency in the provision of care and the development of clinical and scientific research.

“The unprecedented spread of mobile technologies, as well as advancements in their innovative application to address health priorities, has evolved into a new field of eHealth, known as mHealth. According to the International Telecommunication Union, there are now close to 5 billion mobile phone subscriptions in the world, with over 85% of the world’s population now covered by a commercial wireless signal” [11].

We are surrounded by smart technology (and smart means “Self-Monitoring Analysis and Reporting Technology”). The use of information and communication technologies (ICT) in health and health-related fields aims to enhance the quality, efficiency, and effectiveness of health-service management. Referring eHealth technology could be presented as a set of overlapping groups [12], including assistive technologies, safety and social technologies, Health technologies, Self-activation and personal development technologies, Design-for-all and ambient assisted living (AAL) technologies, Gerontechnology, Hospital technology, and EHR systems.

Inevitably, if the social and health reality has changed with the increasing use of technology, education cannot remain indifferent to or on the fringes of these developments.

The pandemic context and our learnings during the lockdown and social isolation show us the multiple uses of technologies to bring people closer and to teach and learn, to provide and to access clinical care or support in crisis (or just because they feel to need).

Also, the delivery of health care and nursing care, especially when distance is a critical factor, becomes easier to connect digitally. Some things we learn during the pandemic, such as the time economy of online meetings, could become part of our day-by-day.

Technology usage in teaching and learning has risen to its peak recently, given the current coronavirus disease 2019 pandemic and its social distancing protocols. Higher education institutions, including nursing education institutions globally, have resorted to online learning to continue teaching and learning amidst the COVID-19 pandemic.

However, we need to distinguish between “emergency remote learning” during the pandemic and distance learning, considering that synchronous digital media functions as face-to-face. Being in a synchronous online class and teaching at a distance is different.

Portable digital assistants and technology usage have become an integral part of contemporary teaching and learning—cloud computing, which includes YouTube, Google Apps, Dropbox, and Twitter, has become the reality of today’s teaching and learning and has noticeably improved higher education, including nursing education [13].

Several studies have highlighted the benefits of technology usage in nursing education associated with its exponential growth; technology use in teaching and learning is flexible, minimizes traveling, and thus is cost-effective [14].

However, a gap in informatics expertise among nursing students, practicing staff, and faculty has been noted globally, which reduces the potential for nurses to utilize technology to enhance patient care and digital health was identified as an area that needs investment. We need to find ways to incorporate digital health into a pedagogic framework grounded in the spiral learning approach [15].

Furthermore, all of us, nursing teachers, are aware of technology usage in clinical settings, which can facilitate work-integrated learning and access to recent studies and guidelines (for example, for allowing access to journals and databases).

Nevertheless, nurse managers and educators feel that technology usage in nursing education is disruptive, mainly when used in clinical settings. However, we need to distinguish it from non-proficiency regarding its use, which could be a huge factor influencing its counterproductivity [16].

With the conscience that, in a very high probability, nursing students have a smartphone in their pockets, and teachers could also think of most clients or patients with smartphones. Some of them will use it to contact their family nurse or the nurse that is a reference for them to manage their individual care plan. So, it will become a challenge to use technology for health and nursing care purposes, reviewing our legal and ethical frameworks to include technology. Because we live through a digital transition, neither nursing education nor practice will remain on the side-line or immune to this considerable transformation.

3. Emotional competencies development

Our first incursions into the area of emotional competence were related to an investigation in which we focused on the nurses’ professional performance and the contexts that are experienced to make it possible to mean the nurses’ emotional competence in palliative care units [17].

Understanding emotions as figures of human behavior is one of the major objectives for those who develop their professional activity with and for people. Emotions constitute a permanent challenge to the human being’s ability to think about himself/herself and his/her relationship with the world. Emotion only increased as a field of research in Nursing after the 90s of the last century.

Nowadays, many authors consider the integration and development of emotions essential in various areas of life, from training contexts to care contexts. Initially, the major focus of Nursing studies was on emotional strategies to enhance the provision of comfort care, patient information, and empowerment, as well as on identifying nurses’ and patients’ emotional experiences, thus leaving room for the nurses’ emotional competence.

Emotions are not rational acts, so they are not (direct) causes of cognition. They generate feelings and rational acts, which are used for learning, that is, they are initiators of the process (of learning). As an organism faces specific challenges and opportunities, emotions immediately respond. The feeling related to them provides this as a mental alert. Feelings amplify the impact of a given situation, enhance learning, and increase the likelihood that similar situations can be anticipated [4]. In this sense, associating the emotional mind with the rational mind guides us toward the emotional matrixes as the rudder of human behavior and professional performance.

Learning and emotional development assume themselves as an important vector in the life of the human being, helping to experience daily life with emphasis on intellectual capacity and the establishment of significant interpersonal relationships.

However, emotions do not depend only on the type of circumstances in which the human being lives but instead on the evaluation of these circumstances involving a substantial modification. They occur when the person perceives very significant changes in the context that he experiences. From this function, it becomes possible to inscribe emotions in the sphere of the regulatory functions of behavior and personal and professional performance.

In this study [17], we identified and further developed a set of skills that allow knowing, regulating, achieving, and managing emotional phenomena to build and maintain interpersonal relationships in an emotional environment, which conceptualize the nurses’ emotional competence. Let us consider the findings of those five dimensions:

1. emotional knowledge, recognized as the ability to know personal and Other’s emotions and what their impact is on the emotion-cognition-behavior triad, identifying the following units of competence associated with it: (1) Identifies and locates personal emotions; (2) Identifies and locates emotions of Others, and (3) Identifies behaviors that generate emotions;

2. emotional regulation, the capacity to regulate emotional expressiveness to generate positive emotions, identifying the following competence units associated with it: (1) Expresses emotions; (2) Regulates manifestation; (3) Manages emotional conflicts, and (4) Self-generates positive emotions;

3. “emotional autonomy” is assumed as the capacity to attain emotional autonomy, to build day-to-day life with positive emotional tones, identifying the following competence units associated with it: (1) Builds positive day-to-day life; (2) Acts with emotional involvement; (3) Faces obstacles; (4) Builds emotional relations, and (5) Reflects in the face of the context;

4. “Social competence” is assumed as the ability to build and maintain interpersonal relationships, accepting individual choices. The description of the emotional dimension allows us to identify the following competence units associated with it: (1) Adopts listening attitudes; (2) Initiates and maintains communication; (3) Accepts choices; (4) Maintains emotional sharing, and (5) Regulates the experience;

5. “Life skills and well-being” is assumed as the capacity to manage personal defense mechanisms, organizing thoughts and attitudes to achieve balance and well-being. The description of the emotional dimension allows identifying the following units of competencies associated with it: (1) Defines Goals; (2) Takes decisions; (3) Identifies needs and resources; and (4) Promotes significant activities.

The emotional phenomena experienced are (important) circumstances that should guide human behavior. Emotional experiences are essential to access the meaning and sense we attribute to experiences. Therefore, the symbiotic relationship between knowledge, reflection, and valuation attributes meaning and power (strength) to the interpersonal relationships built.

The experience of tension and suffering requires nurses to know how to manage the associated emotional states to adapt their behavior and, consequently, the self-control required for the desired emotional regulation given the experience. However, it is essential to recognize the internal resources that allow (and facilitate) emotional regulation, to develop the ability to reflect on the various emotional shades experienced in this context of professional activity and, consequently, achieve emotional (self)regulation under the experience, focusing on generating positive emotions.

A few years later, we wrote a paper “Meaning assigned to Emotional Competence of the Nurse: an empirical study and impact on education” [18]. Emotional education is a permanent educational process, which should start in the family, then go through academic education and, consequently, professional life, which is influenced by the evolution of society (which naturally includes the family, the groups, and the school).

The challenge of emotional education is for the person to feel and recognize that the genesis of emotional development is centered on looking at oneself, assuming the understanding of what happens inside as a major objective. This means that it enhances the encounter with oneself and provides relationships with the surrounding contexts—school, family, and/or professional, and/or professional contexts.

Thus, the search for an integral human being stimulates the discovery of a balance between emotion and reason through emotional education in intrinsic connection with academic education. Therefore, it is considered fundamental to promote the need to explore and enhance the balance between people’s cognitive rationale and emotions (students and/or professionals) in schools, families, and organizations.

By promoting emotional and intellectual growth, emotional education promotes the reflexive control of emotions. Personal competence is not only a competence of the emotions but also a competence of the mind—and emotional competence results from the permanent educational process that provides the knowledge (emotional knowledge) to recognize the importance of moderating negative (unpleasant) emotions and valuing positive (pleasant) emotions without repressing them in any case.

For example, the current reality in undergraduate curricula shows that the syllabus is filled with numerous (all relevant) themes, accompanied by a lack of understanding of the subject “emotional competence”. The same is true for postgraduate study syllabus unless the subject is directly related to it.

Emotions could influence nursing decision-making and action, and nurses’ emotional ability affects every nursing intervention. Also, it might impact the learning quality, ethical decision-making and critical thinking of nursing students, evidence and knowledge use in practice, the quality of patient care, and patient outcomes [19]. Besides palliative care, which we have already focused on, also other clinical contexts, such as in critical situations, are examples of the need to integrate emotional competence into training programs [20]. Some studies evidenced the relevance of emotional competence in the clinical ability in internships [21] as newly graduated nurses [22].

Nurses’ emotional competence skills affect personal satisfaction, autonomy, interpersonal relationship skills, self-control, problem-solving, and positive mental health elements. They found solutions to problems easily by developing positive interpersonal relationships, utilizing effective coping skills, and were less affected by adverse situations. Nurses with emotional competence skills include making conscious decisions and developing and maintaining a care strategy.

Numerous studies stated a significant relationship between emotional competence skills and pro-social behaviors—which means the person acts for the benefit of others and is conducive to social harmonies, such as helping, cooperating, sharing, and comforting. Moreover, this could positively promote the mental health of those who engage in it and those who receive it, as well as the development of human society [23]. Nursing leaders must be emotionally competent in order to encourage and foster innovative behavior among their staff. In order to increase productivity and efficiency, leaders must motivate and inspire their employees [24]. The nurses’ training and emotional education are assumed to optimize the quality of care provided by these professionals, so it is reiterated that the curriculum should focus on a paradigm of emotional education as cross-cutting themes for different areas of knowledge.

Emotional learning supports nurses in making decisions in their life (personal and professional), and the reference to subjective well-being as a positive consequence of emotional development is unanimous. With this purpose, emotional education allows nurses to (reflexively) control their emotions to promote their emotional and intellectual growth, being the matrix for increasing their level of emotional competence. The complexity and demand of care contexts require increasingly differentiated professionals, and the organizational dynamics should enable the growth of the professionals and, consequently, the development of organizational competencies.

4. Salutogenic perspective and environmental commitment

We hesitate in the designation of this challenge. This could be health literacy, which refers, broadly, to the ability of individuals to “gain access to, understand, and use information in ways which promote and maintain good health” [25] for themselves, their families, and their communities. As a result, health literacy is more than a resource for individuals.

Healthy behaviors and information about services and information are more likely to be adopted by people with higher health literacy levels. As a result, health literacy empowers individuals to protect themselves, their families, and their communities.

Improving health literacy in populations enables citizens to take an active role in improving their health, engage in community action for health, and push governments to address health and health equity issues. The Sustainable Development Goals do not include a specific target for health literacy. Efforts to raise health literacy will be critical in realizing the 2030 Agenda fully. In other words, health literacy is a valuable tool that empowers individuals and communities to improve their health status and achieve sustainable development.

Empowering citizens in health literacy is not about diseases and sickness—we need a salutogenic perspective focused on health promotion and prevention.

Literacy, which can be defined as the ability to use the skills taught and learned, is a determinant of individual and collective behaviors and participation in society. When applied to health, literacy enhances the capacity to make the necessary decisions for autonomous health management [26]. Health literacy can also be extended to communities while considering social and cultural contexts. Here, the concept of critical health literacy emerges. This concept considers the overall picture and thus enables people to make decisions about their individual health and the health of their community [27]. Due to the widespread use of technologies, health literacy should also emphasize digital tools as a way to promote health-related decision-making.

Research and evaluation of strategies and characteristics of interventions that use new information technologies to personalize information and promote behavior change are urgently needed. Health promotion, risk reduction, chronic disease control, and improper access to emergency services are all areas where these interventions can make a direct impact [28].

A challenge arises for national health systems—to adopt an approach centered on different contexts (personal and community) of health promotion and surveillance, leveraging technology to facilitate fruitful, effective, and motivational interventions, and providing interactive digital repositories for health promotion and e-consultations, for instance.

The Ottawa Charter for Health Promotion was adopted in 1986 to enable people to improve their health and well-being by creating healthier and more sustainable environments for living, working, studying, and playing. The slogan: “Health for All and All for Health” to achieve this transformative Agenda 2030, all actors need to be engaged in a new global partnership that leaves no one behind.

The environment is a key concept (meta-paradigmatic) in Nursing. The environment is an umbrella concept made up of human, physical, political, economic, cultural, and organizational elements, which condition and influence lifestyles and impact the concept of health.

Nurses focus their intervention on the complex interdependence of person/environment and in delivering safe care.

5. Conclusion

We considered four key challenges;

• Bridging theories and practices using research

The focus and relevance of Nursing epistemology, the construction of personal knowledge in education and experience practices, ending the speech about “gaps” between theory and practices and prefer the idea of bridging between theories and practices mediated by research findings. Due to the nature of the subject who knows and the people cared for, nursing knowledge goes beyond the territory of scientific and technical knowledge, into ontology and ethics, into helping and caring relationships. The nursing process integrates diagnoses, interventions, and outcomes informed by scientific evidence and a wide range of therapeutic modalities. In fact, there is some space and opportunities for nurse scientists to develop.

• Technology-based teaching-learning and teleconsultation

Technology usage in teaching and learning has risen to its peak recently, given the current coronavirus disease 2019 pandemic and its social distancing protocols. Higher education institutions, including nursing education institutions globally, have resorted to online learning to continue teaching and learning. So, it will become a challenge to use technology for health and nursing care purposes, reviewing our legal and ethical frameworks to include technology. Because we live through a digital transition, neither nursing education nor practice will remain on the side-line or immune to this considerable transformation.

• Emotional skills development

Nurses’ emotional competence skills affect personal satisfaction, autonomy, interpersonal relationship skills, self-control, problem-solving, and positive mental health elements. They found solutions to problems easily by developing positive interpersonal relationships, utilizing effective coping skills, and were less affected by adverse situations. Nurses with emotional competence skills include making conscious decisions and developing and maintaining a care strategy.

• Salutogenic perspective and environmental engagement

We need a salutogenic perspective focused on health promotion and prevention. The slogan: “Health for All and All for Health” to achieve this transformative Agenda 2030, all actors need to be engaged in a new global partnership that leaves no one behind. The environment is a key-concept umbrella made up of human, physical, political, economic, cultural, and organizational elements, which condition and influence lifestyles and impact the concept of health. Developing health literacy, particularly concerning the profitability of technology, is one of the most significant challenges facing national health systems today as a way of empowering individuals and communities to improve their health status.

Ethical issues will have to be considered in its implementation and development, as well as the protection and safeguard of human rights.