Title: Nursing in the 21st Century
1Nursing in the 21st Century
2Nursing 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)
3Nursing 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
4Highlights
- 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
5Highlights
- 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.
- 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
6Nursing Professionalism at a Crossroad
- Briefer professional hx than the traditional
professions - Has been and continues to be primarily a womens
occupation
7Problems
- autonomy and independent decision making
- career commitment
- collegial relationships
- professional worth or rewards
8Contemporary 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)
9What 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
10How 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
11What payment should nurses receive for their
services?
- Retrospective reimbursement
- Prospective prepayment
- Managed care managed cost
- Better paying positions requires advanced degrees
12What 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.
13Changing 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
14Traditional 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
15Continued
- 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
16Nursing Options
- Nurse-practitioner
- Clinical Nurse Specialist
- Nurse-midwife
- Nurse anesthetist
- Case manager/clinical manager
17Future 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
18Nursing 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
19Educational 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
20Nursing Education Future Trends
- Changing Student Profile
- Educational Mobility
- Shortage of Qualified Nursing Faculty
- Technology and Education
- Changing Health Care Settings
- The Aging Population
21Research 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
22Manage or Administer Health Care Organizations
- Skills related to management, leadership, and
fiscal responsibilities - BSN provide these courses
23Teach 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
24Entrepreneur
- 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
25New 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
26Computer 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
27Nurse 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
28Sports 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
29Pioneer in Space Health
- Expert care and sensitive communication will be
basic to prolonged confinement - New information weightlessness, sleep,
nutrition, exercise, and mobility, stress,
isolation
30Create Dual Careers
- Artistic or Analytic
- music, art, drama (pediatrics, mental health)
- verbal skills, writers, high tech, people persons
- Law and business
31AIDS
- 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
32Health 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 gt40 million gt 65
33Similarities 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
34RESPONSES 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
35Continued
- Become More Globally Aware
- Increase the Number of Nurses in Health Care
Leadership and Administrative Roles - Achieve Cultural Diversity and Gender Balance in
Nursing
36Globalization
- 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
37Social 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.
38Medicine 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.
39Quality 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
40National 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 lt 3 per year.
41IMAGE 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