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Nursing in the 21st Century

NUR 210

Nursing as an ART

Nursingits very essence lies in the


creative imagination, the sensitive spirit,
and the intelligent understanding that
provides the very foundation for effective
nursing care. Donahue(1985)

Nursing as a SCIENCE

Nightingale identified nursing as a scientific


discipline separate from medicine
Educational foundation and basic college
credit in scientific disciplines R/T nursing

Highlights

1950s
Code of Ethics (ANA)
1st CNS programs
Nursing Research first
published (1952)

1960s
Post BSN programs
increase
Nursing researchers
pioneer clinical
investigations
International Nursing
Index categorizes
worldwide nursing
articles

Highlights

1970s
NP in expanded roles
gain national visibility
Nurses Coalition for
Action in Politics
formed
ANA creates AAN to
honor outstanding
nurses
Nurse theorist come
into national spotlight

1980s
MS and Doctorate
programs increase
Prof. Nursing journals
increase
More nurses are
nationally certified
in 17 specialty areas
STTI increases its
membership
NIH has a National
Center for Nrsg. Res.

Nursing Professionalism
at a Crossroad

Briefer professional hx than the traditional


professions

Has been and continues to be primarily a


womens occupation

Problems

autonomy and independent decision making


career commitment
collegial relationships
professional worth or rewards

Contemporary Nursing Issues

CONTROL OF NURSING PRACTICE


extended and expanded role for nurses
Role: a pattern of behavior associated with a
distinctive social position

Extended role: a role lengthened in a unilateral


manner (PA)
Role expansion: multidirectional spreading out (NP)

What services should nurses


provide?

The profession with help from society it


serves should decide what services to offer?

Managed care
Professional competition
Chronic conditions
Aging population

How should nurses be educated?

Half of RNs are ADN


Need for masters prepared nurses as
clinicians, managers, administrators, and
instructors.
Doctoral-prepared are needed as leaders in
all specialty areas, including education and
research

What payment should nurses


receive for their services?

Retrospective reimbursement
Prospective prepayment
Managed care = managed cost
Better paying positions requires advanced
degrees

What will be the influence of


nursing on health care policy?

Viewed as colleagues of other health


professions rather than as extensions

Other professions has issues about unique


services, educational preparation, and
payment of services.

Changing Images

Diversity: most nurses are white and


female, great need for multicultural
diversity, as well as more men
Specialty areas:
Clinical: age groups, illnesses, abilities or
disabilities, and locales
Functional: management/administration,
research, and teaching

Traditional vs. Nontraditional


Career Options

More practice options are possible

Trend toward more advance preparation

External barriers to practice options are


presently decreasing, but have the potential
to go either way

Continued:

More attempts are being made at


collaborative practice

Move toward primary care and community


and home health care

Increasing emphasis on wellness programs


in schools, residential living communities,
and industry

Nursing Options

Nurse-practitioner
Clinical Nurse Specialist
Nurse-midwife
Nurse anesthetist
Case manager/clinical manager

Future of Practice Options

Must take leadership roles

Need to find or generate job opportunities


that allow them to practice as prepared and
grow to their full potential

Nursing Functions

Dependent: performed under delegated


medical supervision or prior routines

Independent/autonomous: initiated as a
result of own knowledge and skills

Interdependent: overlapping functions


shared between nursing and medicine

Educational Requirements

ADN: 2 years (minimal to be RN)


Move to see the BSN as eligibility to
receive professional licensure
Prepare for generalist, entry-level staff
nurse positions
MN, MS, MA
DNS, PhD, DN, JD, EdD, DPH

Nursing Education: Future


Trends

Changing Student Profile


Educational Mobility
Shortage of Qualified Nursing Faculty
Technology and Education
Changing Health Care Settings
The Aging Population

Research and Theory


Development

Clinical trials, intervention research, or


experiments conducted in the real world of
practice
Theory development is needed to guide
research and increase nursings scientific
credibility
New science with much uncharted
territory

Manage or Administer Health


Care Organizations

Skills related to management, leadership,


and fiscal responsibilities

BSN provide these courses

Teach Consumers or
Professionals

Teaching self-care and resolution of


responses to pathology

Opportunities to teach outside the hospital:


shorter stays and increased severity of
illness

Need for nurse educators

Entrepreneur

a contractor and also someone who


undertakes projects requiring
unconventional activity and some risk
20th century: private-duty nurses
screening, counseling, and instruction
before same-day surgery
home health care planning and coordination
alternative birthing arrangements

New Wave of Technology

implants, genetic therapies, imaging devices


medical artificial intelligence such as
computer-assisted surgery, ECG and fetal
monitoring interpretation, clinical dx., and
genetic counseling
telemedicine
devices for home use

Computer Skills

NIC/NOC: computerized interventions and


outcomes
Word processing, file management,
accessing information
Data management for staffing and
scheduling, accessing expert practice
consultants, finding appropriate educational
material for client-patient use

Nurse Informatics

1994 ANA recognized the field of nursing


informatics (NI)
integrates nursing science, computer
science, and information science in
identifying, collecting, processing, and
managing data and information to support
nursing services
certification available

Sports Health and Physical


Fitness

Interest in prevention
Lifetime individual sports offer potential
involvement of an entire society
Physical fitness of children
Fitness facilities in the workplace

Pioneer in Space Health

Expert care and sensitive communication


will be basic to prolonged confinement
New information: weightlessness, sleep,
nutrition, exercise, and mobility, stress,
isolation

Create Dual Careers

Artistic or Analytic
music, art, drama (pediatrics, mental health)
verbal skills, writers, high tech, people persons

Law and business

AIDS

1983: 1st major article about AIDS for


general public was published
FACTS:

difficult disease to catch


CDC Universal Precautions
OSHA is enforcing CDC guidelines
Care required by AIDS clients in not unique

Health Care of the Elderly

Isolated by: early retirement, trend away


from extended families and the trend toward
segregated retirement communities
Most pervasive security need derives from a
common fear of neglect
Changes in Medicare, Medicaid
2010: >40 million > 65

Similarities of Care

Misunderstood and ostracized by society


Decreased functional abilities and
increasing dependency on others for
assistance
Susceptibility to infection
Nurses can be caregivers, respectors of
personhood, advocates and teachers

RESPONSES TO CHALLEGES:

Continue Professionalism of Nursing

Extend Practice through Research

Increase Public Awareness of Nursings


Contribution to Health Care

Increase Nursing Influence on Health Care


Policy and Delivery

Continued:

Become More Globally Aware

Increase the Number of Nurses in Health


Care Leadership and Administrative Roles

Achieve Cultural Diversity and Gender


Balance in Nursing

Globalization

Need to learn about health care beliefs and


practices of other cultures

International nursing forums

Nursing and health care products,


publications and methods and the expanding
nursing knowledge will find new
possibilities in a global economy

Social Change

Three driving forces--aging, technology,


and costs--will reshape health in the future

1.6 million new jobs are projected in the


health care industry from 2000 to 2010. RN
account for more than a third of these jobs.

A shortage of more than 1 million nurses by


the end of this decade.

Medicine and the Public Eye

15,000 Web sites that offer some form of


medical advice

Nurses are a resource for consumers


regarding how to find and evaluate medical
information via the Internet.

Quality of Care

Health care as a purchase


Nurses in a position to offer the best
services for the best prices (role of NP)
Health care will be a focus on the value of
the product
Quality measures will direct our activities at
work and require us to constantly maintain a
level of excellence

National Health Expenditure

1.5 billion in 2000, 2.2 billion in 2005

move from inpatient to ambulatory services

outpatient and home health care costs grow


at 10% per year.

Hospital spending grew at < 3% per year.

IMAGE of Nursing

Directly related to what the profession


offers society and the value placed on that
service.

Nightingales TV program d/c due to


public outcry from nurses

Pearl Harbor, ER, Desert Storm