Interdisciplinarity catalyzes sustained development of nursing discipline

Nursing as an independent discipline is faced with tremendous opportunities and challenges in the 21st century—opportunities and challenges brought about by an aging world population, a changing disease spectrum, a global shortage of nurses, an increasingly complex and diverse needs in nursing care, a quantum leap in medical technologies, and an evolving landscape of health policies1,2. In China, in particular, this discipline contends with even higher expectations, as strategies such as Healthy China and New Medical Disciplines have been set forth to improve health policies and provide all-around and full-of-life-cycle health services to all3. In this backdrop, interdisciplinary research and integration have become an inevitable path forward for nursing and a focus of its disciplinary development. The word “interdisciplinary” was first used in public in 1926 by Robert Sessions Woodworth, a psychologist at Columbia University, to refer to practices that went beyond the boundaries of any established discipline to involve at least one other4. Interdisciplinary research is a natural development in the unidisciplianry-multidisciplinary-interdisciplinary trajectory of research paradigms5. An ancient art as it is, nursing is young as a discipline. It is an applied science based on natural and social sciences that studies the theory, know-how, skills, and development pattern of care for the maintenance, promotion, and restoration of human health6. The core of this discipline is practicing the art and science of nursing to improve the health of human beings within their environments7. To this end, its knowledge body encompasses sciences both within and beyond its boundary and has extensive cross-over with disciplines of natural and social sciences. A review of the origin and development of nursing as we know it today may shed light on the profound transformation it has been through in the last 200 years and the catalytic role played by interdisciplinarity in this process. This article, therefore, looks into the 3 periods when interdisciplinary practice and research drove the development of modern nursing. Interdisciplinarity in the birth and early development of modern nursing Florence Nightingale’s scientific approach to nursing was the first leap forward in the field, marking the birth of modern nursing8. This innovative approach was created precisely through interdisciplinary practice. She witnessed, during the Crimean War in the middle of the 19th century, a mortality of up to 42% among British soldiers. By applying statistics to her analysis and using polar-area diagrams, she revealed to members of parliament that most soldiers were dying not because of battle wounds but hygiene-related infections9. Therefore, she gained support from the parliament for taking measures to improve sanitary conditions in the military and brought the death rate down to 2.2%10. It’s worth noting that polar-area diagrams, also known as Nightingale Rose Charts, were created by Nightingale in her report to visualize the situations in Crimea. She is therefore hailed as a pioneer in data visualization and statistical graphics11. Her success during the Crimean War also catalyzed the development of modern nursing education. Through funds raised in her name, Nightingale established the first professional nursing school12. It was through the integration of nursing with statistics that Nightingale substantially improved the outcome of care, proved that nursing was a legitimate profession based on science, raised the professional and social recognition of nurses12, and put nursing education on a modern footing. In a way, it is via interdisciplinary practice that nursing has become a contemporary profession. Interdisciplinarity in creating the theoretical system of nursing and raising it to higher education In the years that followed, interdisciplinary research continued to enrich nursing, making it an independent discipline of higher education with a complete theoretical system. In 1950–1980s, trainings of nurses shifted from diploma programs in hospitals to formal education in colleges and universities, leading to an exponential increase of studies in nursing-specific higher education and theories, where scholars of nursing and educational backgrounds worked to define nursing science and establish nursing as an academic discipline13, an effort driven by the discipline’s interdisciplinary nature. The educational reform in the 1950–1960s lifted the dominance of medical education in the training of nurses. Nursing programs offered by higher education institutions became more liberal and incorporated subjects of physics, biology and social sciences14,15. Meanwhile, the focus of nursing has expanded from “disease” in conventional biomedical model to “holistic person” in biopsychosocial model. Moreover, by crossing over with disciplines in social sciences and humanities, theoretical research of nursing advanced rapidly in creating frameworks, models, and grand theories. Nurses with Ph.D. in education, biomedicine, and behavioral and social sciences13 applied their knowledge and expertise to the nursing practice and put forward 4 categories of nursing theories16, which were centered around (1) nurse-patient relations (such as Theory of Goal Attainment by Imogene King and Theory of Human Caring by Jean Watson), (2) patient needs and issues (such as Environmental Theory by Florence Nightingale and Self-Care Deficit Nursing Theory by Dorothea Orem), (3) systems (such as Roy Adaptation Model by Callista Roy, Systems Model by Betty Neuman and Transcultural Nursing Theory by Madeleine Leininger), and (4) energy fields (such as Science of Unitary Human Beings by Martha Rogers and Theory of Health as Expanding Consciousness by Margaret Newman). These theories combined personal practices in care with philosophy, psychology, physics, sociology and logics, and approached nursing from multiple angles and levels. With these theories, nursing scholars and educationists were finally able to draw the disciplinary boundaries between nursing and other health specialties, making nursing an independent discipline and thus triggering its second leap forward. Interdisciplinarity in solving complex nursing challenges At present, the nursing field is taking a third leap with the help of interdisciplinary forces. In an era of the aging population, changing disease spectrum and evolving life sciences, conventional nursing techniques can hardly meet the increasingly complex needs of care, and a single disciplinary approach wouldn’t make much of a difference. However, technologies of engineering origin (such as artificial intelligence, big data and internet of things) and emerging fields like care robots, precision care and smart care17 may provide new ways to address the undersupply of professional care services, offer personalized health management and create innovative models of care. For instance, the Augmented Reality-based Motor skill Intelligent Tutoring System (ARMs-ITS) developed by Prof. Shaomei SHANG at Peking University can replace humans in providing procedural training, providing a new approach to address the shortage of qualified trainers18. The knowledge graph for the care of older adults with dementia and the algorithm-based recommender system for family caregivers developed by the group led by Prof. Zhiwen WANG, on the other hand, may bring precision and personalization to nursing intervention and health education19. Promising as it is, the combination of nursing and engineering is still in its early days, and nurses and engineers may not always see eye to eye with each other. For example, nurses are more concerned about the “art of caring” and the “practice of health promotion”, while engineers focus more on the “art of design” and the “practice of building”20. As Olga F. Jarrin rightly observed7, “caring is the essence of nursing and the unique and unifying focus of the nursing profession.” How to maintain this essence in their cooperation with engineers and how to give a touch of humanity to technological innovation would remain major issues facing nursing experts. Going forward, nursing—like other disciplines of life sciences—will continue to pursue interdisciplinary development, targeting frontier issues and health needs from its unique strengths while striking a balance between technology and humanity. This interdisciplinary path may be 3-pronged: (1) nursing engineering, nursing informatics and environmental nursing, joining hands with engineering, informatics, architecture, material science and environmental science to spur innovation; (2) nursing economics and nursing humanities, bringing in economics, management, sociology and demography; and (3) integration with basic medical sciences, clinical medicine, public health and pharmacology, to identify underlying mechanism of and creative solution to complex nursing issues, and promote disciplinary development in the long run. Interdisciplinarity is vital for disciplines to attain development and solve problems. The “nursing plus” approach may help to close the gap between disciplinary paradigms, consolidate resources, navigate complex health issues, and improve services. Besides, this approach is also valuable in breaking disciplinary silos, enriching respective disciplines, achieving sustainable development and producing multitalented nursing professionals. The journal of Interdisciplinary Nursing Research will therefore commit itself to profound, complex and systemic issues encountered in nursing research and build itself into a platform of interdisciplinary integration featuring frontier research, new perspectives, extensive scope, and exciting exchange. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report.