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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
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