ISSUES, CONCERNS AND FUTURE Nursing in the 21st Century

DIRECTIONS OF NURSING
- For nursing graduate, future holds
numerous social, political and
technological changes
Introduction
- During the 21st century, societies will
- Healthcare is changing dramatically continue to move towards
due to advancement of medical globalization with an increased
sciences and technology, the sharing of products, attitudes and
abundance of clinical research and financial investments. The clients
higher demands of consumers may be more likely to combine
- As a key profession of healthcare, conventional therapies with
these changes represent a complimentary healing techniques
significant challenge to nursing such as homeopathy, neuropathy,
profession and nursing education therapeutic touch, reflexology,
acupressure, aromatherapy and
Current trends and Issues in Healthcare
nutritional therapy
- Nursing Shortage
Sibbold and other experts on nursing and
- Patient Satisfaction
health care also predict the following:
- Managed Care
- Transcultural Nursing - Neighborhood will employ nurses
- National Patient Safety Initiatives who will work in 24 hour nurse
- Evidence-based Practice managed clinics
- Legal and Ethical Issues - Nurse Practitioners will cross
- Terrorism/Bioterrorism/Disaster medical threshold to provide
Nursing services usually provided by
- Information Age physicians
- Genetics - Nurse therapists will provide
- Globalization of Health numerous services to the clients and
- Aging Population their families
- Hospital stays will be exceedingly
Vision for future of Nursing
short and early discharge will
- Addition of new diseases and threat become more important
of bioterrorism - Nurses will be strong and
- New treatment and technologies autonomous practitioners whose
- Patients are moved out of the practice and care delivery focuses
hospital rapidly those that remain much more on health than illness
are acutely ill
- Those discharged patients need
more assistance at home
Future trends in Nursing Beneficiaries of Mobile Nursing:
- Nursing is not a static, unchanging - Patients discharged early from
profession but is continuously hospitals
growing and changing as society - Patients suffering from chronic and
changes, as health care emphasis acute medical problems
and methods change, as lifestyles - Surgical Patients
change and as nurses themselves - Patients requiring IV therapy
changes - The elderly respiratory patients
- The current philosophies and - The seriously ill. Patients in need of
definitions of nursing demonstrates medication management
the holistic trends in nursing to - Hospice concept
address the whole person in all - Ventilator dependent
dimension in health and illness, and - Assistance with bathing, dressing,
in interaction with the family and meals, transportation, light
community housekeeping
Future of Nursing Career Forensic Nursing
- Many nursing functions will be - Specialized training in forensic
automated evidence collection, criminal
- Result of nursing shortages, procedures, legal testimony
healthcare facilities will be forced to expertise
use their nurses judiciously - Liaison between the medical
- Changes in technology will possibly profession and that of the criminal
attract more men and minorities justice system
into the profession - Came about in 1992 during the first
- The number of outpatient care will ever national convention of sexual
increase as will the need for home assault nurses
health care nurses
Disaster Nursing
- Community health care
- Focus more on preventing the - Readiness and preparedness in
illnesses rather than treatment responding to immediate
community needs during and after a
catastrophic event
Other Areas for Practice in Service - Medical history and physical
assessment, psychosocial
Mobile Nursing – mobile nursing is a service
assessment and referral to mental
agency that provides home teaching and
health services
care for patients with varied needs and
health problems
Client Advocate Robotic Nursing
- Nurse protects the clients human - Staff shortages and technical
and legal rights challenges (such as patient lifting
- Providing information to assist in and moving) means there is a
decision making present and growing incentive to
- Patient Bill of Rights design, develop and implement
robotic technology in the delivery of
Comforter Role
health care. The reliance on robotic
- Caring for client as a human being technology in surgical fields has
- Role is traditional to nursing been a reality for decades, but
- Care is directed to whole person, recent trends and developments
not just a body part indicate that the emergence of
- Demonstration of care and concern technology and even robotic
technology in the delivery of primary
Rehabilitator Role
healthcare is a growing
- Assist client to return to optimal phenomenon.
level of functioning
Transitions taking place in health care
- Nurse helps client to adapt
physically and emotionally to Curative Preventive Approach
changes in lifestyle, body image Specialized Care Primary health care
Medical Patient Emphasis
Communicator Role Diagnosis
- Role is central to all other roles Professional Team Identity
- Involves communication with client, Identity
family, healthcare team members, Trial and Error Evidence based
resource people and the community practice
Self-Regulation Questioning of
- Without clear, concise
Professions
communication it will be difficult to
Focus on quality Focus on costs
give effective care
Transitions taking place in workplace
Teacher/Educator Role
High-tech Humanistic
- Explains concepts and facts about Competition Cooperation
health, demonstrates procedures, Need to Coaching, Mentoring
reinforces learning, determines supervise
understanding and evaluates
progress of learning Hierarchies Decentralized approach
- Unplanned or informal education
- Planned or formal education
Nursing Shortage National Patient Safety Initiatives
- National problem which is growing - Joint Commission National Patient
- Critical shortage in specialty areas Safety Goals
- Average age of nurse is 45 - Institute for Healthcare
- Resurgence of enticements for Improvement “5 million lives
recruitment campaign”
- The Leapfrog Group
Reasons for Shortage
- Work Environment 1. Joint Commission National Patient
- Recruitment Safety Goals
- Retention - Improve the accuracy of patient
- Aging Workforce identification
- Compensation - Improve the effectiveness of
- Aging Baby Boomers communication among caregivers
- Shortage of Nursing Faculty - Improve the safety of using
medications
Patient Satisfaction
- Reduce the risk of health care-
- Press Ganey Surveys associated infections
- Good Customer Service - Accurately and completely reconcile
- Patient Bill of Rights medications
- Treat patients like family - Reduce the risk of patient harm
- Healthcare is a business from falls
- Encourage patients’ active
Managed Care
involvement in their own care as a
- Goal is to keep length of stay (LOS) patient safety strategy
down - The organization identifies safety
- Capitation risks inherent in its population
- Patients are discharged sooner - Improve recognition and responses
- Patient acuity higher to changes in a patient’s condition
- Health Care Plans 2. The Leapfrog Group
- Case manager work closely with - Reduce preventable medical
physicians and insurance companies mistakes and improve the quality
and affordability of healthcare
Transcultural Nursing
- Encourage health providers to
- Nursing has become a melting pot publicly report their quality
- Nurses are challenged to be more outcomes so consumers can make
culturally aware informed choices
- Cultural sensitivity
 3. IHI “5 Million Lives Campaign” Globalization of Health
- Deploy rapid response teams
- Healthcare has become a global
- Deliver reliable evidenced-based
issue
care for acute MI
- People are mobile, diseases can
- Prevent adverse drug events
travel
- Prevent central line infections
- Nurses need to understand the
- Prevent surgical site infections
issues pertaining to global health
- Prevent ventilator-associated
pneumonia Aging Population
Evidence-Based Practice - Population is aging
- Growing concerns regarding the
- Goal is to achieve cost-effective,
unique needs of the elderly
high quality patient care based on
- Gerontological Nursing
scientific inquiry
- Nurses need to understand research Migration
process involved
Movement of nurses from one country to
- Nursing care should not be based on
another
opinions, past practices but on the
results of scientific research Types:
- Clinical Journals
1. Internal – (rural-urban, public –
- Practice Guidelines
private sector, nursing-non nursing)
- Nursing Research
2. International – from developing
Information Age countries to western countries
- Consumers today are more Reasons of Migration
computer savvy regarding
1. Economics
healthcare
2. Career Advancement
- More info on internet
3. Issues of Safety and Survival
- Consumers could possibly be more
4. Sense of Adventure
informed than health care worker
5. Educational Opportunities
- Joint commission 2014 all medical
6. Intense recruitment of nurses in
records have to be EMR
developing countries
Genetics
Results of Migration
- Many major developments in the
1. Global shortage of nurses
field of genetic research
2. Shortage of nurses in their home
- Stem Cell
countries
- Human Genome Project
3. Negative effect on health care in
- Cloning
home countries
- Legal and Ethical Issues
4. Destabilize nursing education
Challenges of a Migratory Nursing
Workforce
- Regulation and registration
- Cross cultural issues
- Negative effect on healthcare in
developing countries
- Lack of standardization of nursing
registration globally
Challenges of an Aging Nurses Workforce
- Recruitment and replacement
- Retention of older nurses
- Flexible work patterns (sandwich
generation)
- Professional development
- Valuing older nurses
Aging Population/Workforce
US Census Bureau, 2008
- 65 to 85 years – 38.7 million
- 85 years and above – 5.4 million
Projection -2050
- 65 to 85 years – 88 million
- 85 years and above – 19 million

If healthcare needs increase so with the