nursing in 21st century

8/10/2019 Nursing in 21st Century

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Nursing in the 21st Century

NUR 210


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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)


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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


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Highlights

1950s

Code of Ethics (ANA)

1st CNS programs Nursing Researchfirst

published (1952)

1960s

Post BSN programs

increase Nursing researchers

pioneer clinical

investigations

International NursingIndex categorizes

worldwide nursing

articles


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Highlights

1970s

NP in expanded roles

gain national visibility Nurses Coalition for

Action in Politics

formed

ANA creates AAN tohonor 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 itsmembership

NIH has a National

Center for Nrsg. Res.


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Nursing Professionalism

at a Crossroad Briefer professional hx than the traditional

professions

Has been and continues to be primarily a

womens occupation


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Problems

autonomy and independent decision making

career commitment

collegial relationships

professional worth or rewards


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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)


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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


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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 andresearch


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What payment should nurses

receive for their services? Retrospective reimbursement

Prospective prepayment

Managed care = managed cost

Better paying positions requires advanced

degrees


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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.


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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


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Traditional vs. Nontraditional

Career Options More practice options are possible

Trend toward more advance preparation

External barriers to practice options arepresently decreasing, but have the potential

to go either way


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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


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Nursing Options

Nurse-practitioner

Clinical Nurse Specialist

Nurse-midwife

Nurse anesthetist

Case manager/clinical manager


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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


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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


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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


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Nursing Education: Future

Trends Changing Student Profile

Educational Mobility

Shortage of Qualified Nursing Faculty

Technology and Education

Changing Health Care Settings

The Aging Population


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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


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Manage or Administer Health

Care Organizations Skills related to management, leadership,

and fiscal responsibilities

BSN provide these courses


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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


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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


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Computer Skills

NIC/NOC: computerized interventions and

outcomes

Word processing, file management,accessing information

Data management for staffing and

scheduling, accessing expert practiceconsultants, finding appropriate educational

material for client-patient use


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Nurse Informatics

1994 ANA recognized the field of nursing

informatics (NI)

integrates nursing science, computerscience, and information science in

identifying, collecting, processing, and

managing data and information to supportnursing services

certification available


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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


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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


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Create Dual Careers

Artistic or Analytic

music, art, drama (pediatrics, mental health)

verbal skills, writers, high tech, people persons

Law and business


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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


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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


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Similarities of Care

Misunderstood and ostracized by society

Decreased functional abilities and

increasing dependency on others forassistance

Susceptibility to infection

Nurses can be caregivers, respectors of

personhood, advocates and teachers


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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


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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


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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


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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.


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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.


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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


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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.


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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

nursing in 21st century

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