Nursing in the 21st Century

1
Nursing in the 21st Century

• NUR 210

2
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)

3
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

4
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

5
Highlights

• 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

6
Nursing Professionalism at a Crossroad

• Briefer professional hx than the traditional
  professions
• Has been and continues to be primarily a womens
  occupation

7
Problems

• autonomy and independent decision making
• career commitment
• collegial relationships
• professional worth or rewards

8
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)

9
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

10
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

11
What payment should nurses receive for their
services?

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

12
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.

13
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

14
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

15
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

16
Nursing Options

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

17
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

18
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

19
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

20
Nursing Education Future Trends

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

21
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

22
Manage or Administer Health Care Organizations

• Skills related to management, leadership, and
  fiscal responsibilities
• BSN provide these courses

23
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

24
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

25
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

26
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

27
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

28
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

29
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

30
Create Dual Careers

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

31
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

32
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 gt40 million gt 65

33
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

34
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

35
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

36
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

37
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.

38
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.

39
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

40
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 lt 3 per year.

41
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