Trends and issues shaping nursing

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TOC Index 
Nursing
Foundation:
Concepts and
Perspectives (For
Post Basic BSc
Nursing)
SECTION 6
Jogindra Vati
TRENDS AND ISSUES IN
SECTION 1: CONCEPT OF NURSING AND
PROFESSIONAL ORGANIZATIONS NURSING
 1: Development Of Nursing As A Profession:
Its Philosophy And Objectives
 2: Responsibilities And Expanded Role Of A
Nurse
 3: Development Of Nursing Education In India
 4: Professional Organizations And Regulatory
Bodies
 5: Career Planning And Development
• Trends in Nursing Practice and Nursing Education
SECTION 2: CONCEPT OF NURSING PRACTICE • Ethical Issues and Code of Ethics in Nursing 272
• Legal Issue in Nursing Practice
Trends In Nursing Practice

19
 And Nursing Education
Chapter Outline
Competencies
Introduction
Trends in Nursing
Trends in Nursing Services
Emerging Trends in Nursing Service
Trends in Nursing Education
Factors A ecting Trends in Nursing
Issues in Nursing
Issues in Nursing Service
Issues in Nursing Education
Future Issues in Nursing

Future Nursing Practice Issues
Future Issues in Nursing Administration
Future Issues in Nursing Education
Ways to Meet Challenges
Key Points
Chapter End Questions
Suggested Reading
COMPETENCIES
After completion of this chapter, the learner will be able to:
Understand the concept of trends in nursing
https://www.ijccm.org/eReader/chapter/9789351527886/ch19 1/18
TOC Index  Describe trends in nursing

Enumerate various emerging trends in nursing
Discuss major trends in nursing education
Nursing
Foundation: Enlist factors affecting trends in nursing
Concepts and Identify issues in nursing service and education
Perspectives (For
Identify future issues in nursing and ways to meet challenges.
Post Basic BSc
Nursing)
Jogindra Vati
INTRODUCTION
PROFESSIONAL ORGANIZATIONS
Nursing has traditionally been the profession that carries out medical regimes,
provides nursing care and assesses and treats the patients in the context of his
 2: Responsibilities And Expanded Role Of A or her environment. Nursing has a long and rich heritage; nurses with their
Nurse unique, divergent opinions and talents have made many valuable individuals
and collective contributions to the society within the total health care
Bodies
environment. Due to modernization, globalization and liberalization there is a
 5: Career Planning And Development rapid change in general and nursing education from the past.
SECTION 2: CONCEPT OF NURSING PRACTICE
TRENDS IN NURSING
A trend in nursing is a change that is taking place in present days in any eld of
nursing, which affects the profession as a whole. A trend means a change or
movement in a particular direction. It also denotes general directions and
 tendencies especially of events, of opinion or movements in a particular
direction. Trends are akin to the changes that take place and become vogue.
It is the general direction towards which the different nursing events have
moved and are moving as well as the opinions in and around nursing and
tendencies that we nd in and about our profession. It also means a change
currently taking place in any area of nursing and in uencing the profession.
There are many changes that took place in nursing:

TRENDS IN NURSING SERVICES
Trends in nursing services are multidimensional directly or indirectly related to

care, nurses, their roles, nursing education, etc. (Table 19.1).
Nature of care: In the past the focus of nursing care was traditional type of
care, at present, the nursing care is based on evidence; whereas in future the
trend will continue and it would be based on evidence that would be generated
in Indian settings.
Type of nursing care: At present the emphasis is on specialized nursing

care, e.g. caring of patients suffering from cardiovascular, respiratory as
compared to past that was emphasis on general nursing. In future the focus of
nursing care as well the nurses would be trained for super specialty care.
Use of information technology: There is advancement in technology in the

present era which was lacking in the past and due to this, there are many
changes in the curriculum as well in the practice area. The emphasis is given on
hospital information system, computerized record system. 274
Table 19.1 Trends in nursing services: past, present, and future

Trends In Nursing Services
Past Present Future
Type of nursing Military nursing Civilian Govt. Private hospital based

hospital based nursing
nursing
TOC Index 
Nursing agency by western nurses By Indian nurses By Indian nurses
Christian and Anglo irrespective of irrespective of caste, creed
Indian nurses caste, creed and and religion
Nursing
religion
Foundation:
Concepts and Focus on nursing Basic patient care Quality Quality assurance,
Perspectives (For care assurance Standards
Post Basic BSc
Nursing) Nature of care Traditional care Evidence based Research oriented
Jogindra Vati care Evidence based care
Type of nursing General nursing Specialized- Super specialized nursing

PROFESSIONAL ORGANIZATIONS care nursing
Its Philosophy And Objectives Use of Lacking Computerization Advanced
 2: Responsibilities And Expanded Role Of A informational
Nurse
technology
 4: Professional Organizations And Regulatory Marital status of Unmarried nurses Majority of Majority of married nurses
Bodies
nurses married nurses
Uniform attire Western type Indian culture Indian culture
Shift duty Split shift duties Straight shift Straight shift duties
pattern 8 hours duties duties
Assignment of Functional Functional Patients assignment

nurses assignment assignment
 Patients
assignment
Role Basic role Multiple roles Multiple roles
Nurse Dependent role Independent Independent practitioner

practitioner practitioner
Attendance of Lacking Mandatory and Self motivated and

in-service organized organized
education
Awareness Ignorant about their Well aware of Well aware of their rights
among nurses rights their rights Participation in association
Participation in
association
Leadership Autocratic Democratic Participative,

styles transformational
transactional
Turnover Less Increasing Debatable
Nursing Recognized and Recognized Recognized

institutions unrecognized schools/colleges schools/colleges of
schools of nursing of nursing nursing (Diploma nurses)
(certi cate nurses) (Diploma nurses) Degree and postgraduate
Degree and nurses
postgraduate
nurses
No. of Few Mushrooming of Stabilization of

schools/colleges school/colleges schools/colleges of
of nursing of Nursing Nursing
Marital status of nurses: In the past, nurses used to be unmarried, gradually,

majority of nurses are married and in future the same trend will continue.
Uniform attire: Earlier the image of nurses was due to uniform attire that
was of western type and in white shade, now the trend has been changed and
TOC Index  the uniform is adopted that suits to Indian culture and of different shades.
There is no uniform shade throughout India.
Nursing Shift duty pattern: In the past, nurses used to work in split shift duties or 8
Foundation: hours duties; now mostly all the hospitals follow straight shift duty pattern
Concepts and which is convenient for nurses and this trend may continue in near future.
Perspectives (For
Post Basic BSc Assignment of nurses: Due to shortage of nurses in hospitals, the hospital
Nursing) used to follow functional assignment for nurses rather than patient’s
Jogindra Vati assignment. In the present scenario, there is no uniformity as regard to
assignment of nurses, both functional and patient’s assignment methods are
SECTION 1: CONCEPT OF NURSING AND followed; whereas in future, the trend may be for patients’ assignment only for
rendering holistic or individualized patient care.
Role of nurses: In the past role of nurses was limited, now roles of nurses
Nurse are many due to advancement in improvement in education and communication
 3: Development Of Nursing Education In India technology and in future nurses will be engaged in multirole and will be
 4: Professional Organizations And Regulatory specialized in rendering care.
Bodies
 5: Career Planning And Development Nurse practitioners: In past, nurses were having dependent jobs, now trends
to prepare nurses as independent practitioners and this trend will continue in
future also.
275
Attendance of in-service education programme: Earlier, in-service education
was not given so much importance during service tenure of nurses, but now
more of importance for staff development and in-service education is given to
update knowledge and skills of nurses to t into current scenario. In future also
 the same trend may continue.
Awareness among nurses: In the past majority of nurses were not even
aware of their rights, but now nurses are more concern about their rights and
they have their associations and societies to redress their grievances and ght
for their rights and for the profession.
Leadership styles: It was observed that nurse leaders used to follow

autocratic leadership style in the past that has been changed to democratic in
the present situation; and in future it would be democratic as well participatory.
Turnover: The trend of turnover is also changing. In the past, there was not
much turnover in nursing. The evidences show that at present, there is turn over
in nursing and in future it is questionable or debatable.
Nursing institutions: In the beginning, both unrecognized and recognized

institutions were prevailing, but at present it is mandatory to take approval from
nursing councils and university prior starting new courses in nursing and this
trend will continue.
Number of schools and colleges: There were very few schools/colleges of

nursing imparting training programme, but at present there is mushrooming of
schools/colleges of Nursing and in future there will be nursing institution as per
demand.

EMERGING TRENDS IN NURSING SERVICE
Emerging trends that are related to profession, nursing care, theories,

information system, documentation and in-service education programmes. The
need for professional judgment, de ning the concept of care; nursing process,
nursing diagnosis; quality assurance, standards; about nursing audit, how to do,
who is going to do; nursing research, evidence based nursing; concept of
nursing theories; and application of appropriate theoretical models especially in
Indian scenario are the examples of emerging trends in nursing.
TOC Index 
Nursing
Foundation:
Concepts and
Perspectives (For
Post Basic BSc
Nursing)
Jogindra Vati

Figure 19.1: Emerging trend in nursing
Nurse
The concept of multidisciplinary nursing care and primary health care has
been much emphasized in these days. Individualized and specialized nursing
Bodies care; independent areas of practice; electronic networking, teleconferencing,
 5: Career Planning And Development etc. are gaining momentum. Information system, documentation and in service
SECTION 2: CONCEPT OF NURSING PRACTICE education programmes are enhanced (Fig. 19.1).

TRENDS IN NURSING EDUCATION
The trends in nursing education are related to curriculum, teaching-learning

methods, education quality and standardization, educational technology,
 student status, nurse teachers etc that go on changing from time to time and
in uenced by philosophy of nation, education, organization and nursing
profession; globalization advancement in education and technology. Some of
trends in nursing education are discussed below:
Changing focus from cure to care: More emphasis is given to promotive

and preventive aspect hence more manpower is required in preventive and
promotive services. Therefore the nursing curriculum of various courses has
been revised as per the need of national health policy, national education policy.
Change in admission criteria: The minimum quali cation and requirement

including age, experience, etc. for various courses were also changed from the
previous time. The focus is on admission to the nursing courses is through
merit, entrance test.
Improved teaching learning methods: The teaching learning methods both

in the classroom as well in clinical have been replaced from traditional lecture
methods to interactive lecture, social group methods, simulations, programmed
instructions, computer assisted learning, problem based learning, re ective
learning, demonstrations, etc.
Advanced educational technology: Now the education technology

approaches used of both types; hardware approach and software approach as
well system approach to provide scienti c base to nursing education; to make
education more productive, instructions more powerful and useful to make
equal and immediate access to education.
Comprehensive evaluation: Presently the focus of evaluation is continuous

and comprehensive evaluation. Formative and summative evaluation is well
appreciated. Efforts are made to make clinical evaluation more objective by
using Objective structured clinical examination and on various aspects in the
clinical areas.
Emphasis on interpersonal and human relation: The students are taught

with the critical thinking, interpersonal relationship, communication,
understanding self and clients while making correct nursing diagnoses and
making decision for nursing intervention.
TOC Index  Emergence of specialization and research: Due to advancement in medical

and allied professions, specialties and sub-specialties are emerging. The
nursing institutions have already taken lead to prepare specialized nurses to
Nursing render care in super specialty areas. Due to emphasis on evidence based
Foundation: nursing practice, different research methodologies, action research are gaining
Concepts and
importance. Many research projects are being taken up by the nurse faculty
Perspectives (For
through getting funds from different agencies.
Post Basic BSc 276
Nursing) Gaining national importance : The nursing education is having importance
Jogindra Vati
nationally as other educational and professional programmes. Private nursing
institutions are coming up in all the states of India.
Opportunities for higher studies: Comparatively, currently many nursing
Its Philosophy And Objectives both government and approved private nursing institutions are offering nursing
 2: Responsibilities And Expanded Role Of A programmes.
Nurse
 3: Development Of Nursing Education In India Improved student status: In the past, the student were given the student
 4: Professional Organizations And Regulatory status, being working like employed nurses, now they are viewed as student
Bodies
nurses rather nursing students.
Uniform attire: There is change in color, and type of uniform attire of
students in different programmes. There is no uniformity.
Accreditation of nursing institutions: Different from the past the nursing

institutions are regularly accredited by the licensing authority, state nursing
council, university, and state government and follow procedures as per
guidelines to start a programme.

Standardization and quality of education: This is debatable as discussed in
various forums, conferences, that quality of education and standardization of
nursing education need to be improved.

FACTORS AFFECTING TRENDS IN NURSING
Changing health scenario of government : There is constant effort from

government towards health care-healthy people 2020 to improve upon the
health of the people. Efforts are being made to deliver the health care to the
community especially the rural community. Various committees from time to
time had given the recommendations. Various national health programmes
were launched. Some of the communicable diseases were eradicated.
‘Health for All’ development is based on self-determination and self-reliance

of every individual and the community for which the community participation is
necessary. The community is also conscious about their health and their rights.
The main focus is on coordinating the activities of health sector at national,
international and community levels with those other social and economic
sectors including education, agriculture, household, water, housing,
communication, etc. Hence there is call for nursing administrators to prepare
the nurses to work at every level, considering the need of the community at
large. There is a need for manpower, for specialization, incorporating new
courses, revision of nursing curriculum, etc.
Changing demographics: The alarming increase in elderly population will

impact on the health care services and nursing. Increased life span of people
with chronic illnesses will pose further challenges. There is a need increased
nursing manpower with geriatric nursing preparation to deal with them.
Change in health care delivery system: Transition is taking place in health

care system and in the hospitals that affect the role of nurses at top and
supervisory level in hospitals (Box 19.1).
Box 19.1: Transition In Health Care System
TOC Index  Curative Preventive approach
Specialized care Primary health care
Medical diagnosis Patients’ emphasis

Nursing
Foundation: Discipline stovepipes Programme stovepipes
Concepts and Professional identity Team identity
Perspectives (For
Trial and error Evidence based practice
Post Basic BSc
Nursing) Self-regulation Questioning on profession
Jogindra Vati
Focus on quality Focus on costs
Public Private
PROFESSIONAL ORGANIZATIONS High-tech Humanistic: Telecommunication
Competition Cooperation
 2: Responsibilities And Expanded Role Of A Need to supervisey Coaching, mentoring

Nurse
Hierarchies Decentralized approach
Bodies
Impact of globalization : With globalization, there is the narrowing of
distance, the risk of disease transmission has increased and its care has
become imminent, hence there is a need knowledge transfer to deal with these
problems. Nursing education must therefore become more internationally
focused to disseminate information and bene t from this change, hence need
for curriculum revision focused on international health and clinical modalities.
 Advancement in technology: There are different techniques, which are

coming up and are replaced by the old ones in the medical eld as well as in
nursing. Certain methods of treatments, procedures and activities have
completely become obsolete. New technology facilitates diagnosis, decision-
making and research. Although these technologies create constant learning
challenges for all, the ultimate improvements save time and improve quality
care.
In hospital, more documentation will be done directly on a computer, often

at the patient’s bedside. Wireless handheld computers will enable doctors and
nurses to be close at hand, even far away. Personal digital assistants (PDA’s)
and other electronic organizers will help nurses’ access information and
manage time. Computerized records, informally called CPR (computerized
patient records), and CMR (computerized medical records), or OLPR (On-line
patient records) will be common. Nurses are requires being knowledgeable to
manage information and technology. Nurses should be prepared according to
the need of the hour, hence need for curriculum revision; more focus on clinical
modalities, information system, and patient monitoring devices is must for the
safety of patients.
Impact on medical tourism: The concept of medical tourism is coming up.

More and more stakeholders are working on it, if it is so the nursing education
and nursing practice will require focusing on specialization, quality education
and practical oriented.
Advances in medical, paramedical and allied professions: Growing

specialization and super specialization in medical and allied professions have
brought the development of new tests, diagnostic procedures, medicines and 277
machines. There is also focus on quality-oriented services. So the nurses also
need to be trained accordingly to keep pace with the medical and allied
professionals current knowledge in nursing eld has to be improved.
Informatics and efforts to standardize and unify nursing language:

Informatics, the study of how to use computers to capture the data is proved to
be better for clinical and research purposes and it is growing and on demand.
Various programmes are required to take decisions for the nursing care.
TOC Index  Case management, disease management, and telehealth care expansion:
There is a demand to manage the care from a distance, being more people at
home and in remote areas with chronic diseases and complicated treatment
Nursing regimens, through the use of telephones, television monitors, and
Foundation: telecommunication. More nurses will become involved in disease management
Concepts and
and case management that include care delivery models to keep costs down by
Perspectives (For
helping people with chronic illnesses, improve their health status through close
Post Basic BSc
Nursing) monitoring, early intervention, and use of resources.
Jogindra Vati
Diverse responsibilities: Nurses at all the levels in hospitals, homes,
communities are accountable for diagnosis, prevention and management of
PROFESSIONAL ORGANIZATIONS various health problems. Primary health care, patient education, health
 1: Development Of Nursing As A Profession: promotion, rehabilitation, self-care and alternative methods of healing are the
added responsibilities. To carry out such responsibilities, the nurses need to
Nurse
have diverse skills and they need to prepare to gain and enhance their
 3: Development Of Nursing Education In India competencies in the related roles. It also affects nursing education preparation.
Bodies Educated consumers: Education and technology advancement brings about
 5: Career Planning And Development a growing awareness of health needs among people. They are becoming aware
SECTION 2: CONCEPT OF NURSING PRACTICE of their rights, so the nursing needs are to be directed according to their health
needs.
Changing role of women in society: Women are now becoming educated

and active. The status of nurses as women is improving in the society. They are
now independent and they can take independent decisions for themselves and
for their clients.

International in uence: The international organizations and their in uence
encouraged the nurses to participate in international conferences, workshops.
Most of the nurses are sent on deputation for undergoing training programmes
in abroad sponsored by WHO, INC, etc. International Council of nurses
promotes a sharing ideas, whereas WHO, USAID, etc provide assistance for
research, education and publications.

CHANGING FOCUS OF NURSING
Regulatory requirements stress that nurses must prove their values to both
customers and their employers, showing how they impact on patient outcomes.
Changing role: As nurse play a central role in e cient management of

scarce resources, organizational skills-leadership, critical thinking, delegation
and supervision and communication skills-are required for the nurses working
at different levels.
Shared governance: Nurses are required to be included in making decisions

about rules, procedures, and other aspects of care in order to bring results.
Specialization: It is an era of specialization and nurse demand for clinical

nurse experts so nursing educational preparation has to be focus on this
direction.
Nursing shortage threatens patient care: More demand with fewer nurses
threatens patient care. Ways need to nd out to attract and retain nurses.
Nursing education goes online: Various courses of nursing education will

go online in future.
Standards and practice guidelines: This is a high time to have the standards
in nursing and practice models, protocols, guidelines that should aim to reduce
useless or harmful practices.
Evidence-based care: Research and clinical studies are required to have the
evidence that can be analyzed to come to the consensus about what are the
best approaches to speci c conditions from outcome and cost perspectives.
TOC Index  These best approaches often are referred to as benchmarks or best practices.
The nurses need to acquaint with various types of research methodology,
evidence based nursing practice, action research, etc. and thus call for
Nursing appropriate planning nursing education curriculum.
Foundation:
Concepts and New ethical concerns: Now the focus is on End-of-life care, technological
Perspectives (For advancements in the treatment of infertility, genetic testing that challenges the
Post Basic BSc traditional ethical and societal values regarding conception, birth, death, and
Nursing)
dying. Law is now more consumers friendly and nurses need to be educated
Jogindra Vati
regarding ethical and legal issues involved in profession.
SECTION 1: CONCEPT OF NURSING AND Holistic and alternative therapies: There is a great focus on promoting
health and triggering body’s natural healing powers through holistic and
Its Philosophy And Objectives alternative therapies.
Nurse Healthy working environment: New regulation, laws and organizations are
 3: Development Of Nursing Education In India making effort to make the working environment healthy so that nurses can
 4: Professional Organizations And Regulatory work better, stress free.
Bodies

ISSUES IN NURSING
ISSUES IN NURSING SERVICE


ADMINISTRATIVE ISSUES
Insu cient contribution of nurses to health care development due to few

positions for nurses at the state and national levels
Inadequate nursing leadership and strategic management
Inappropriate nurse to population/patient ratio
Inadequate preparedness of nursing workforce
Inadequate recognition of nurse’s status in the health care system
Limited active involvement of professional organizations
Limited role and authority of INC in nursing development due to limited roles
prescribed in the Indian Nursing Council Act, 1947: inconsistency in state
Nursing councils and Indian Nursing Council; insu cient information system
in nursing: shortage of staff at the INC and state nursing councils.
PRACTICE ISSUES
Poor quality of care due to shortage of nursing manpower and others

reasons.
Limited competency of nurses due to too many categories of nurses with 278
overlapping roles; unclear roles and responsibilities of nurses; inadequate
continuing education system; ineffective clinical preparation and supervision
during training and limited utilization of evidence and research; insu cient
clinical nurse specialist and nurse practitioners; inadequate facilities and
opportunities for clinical nurse specialist; and non-creation of posts for
clinical specialist; inadequate standards and guidelines for nursing practice;
ineffective regulation of nursing workforce; inadequate infrastructure; and
inadequate motivation to provide effective care.
Various issues have emerged following studies conducted by nurse

scholars. Study conducted in 1990’s on organization and administration of
nursing services in district hospitals of North India has thrown light on several
issues; Lorensen and Hirch eld (1991) identi ed major problems in a study
TOC Index  conducted in 119 states of different countries including India and Kingma
Mirelle (1993) has emphasized issues in the light of professional and
socioeconomic concern while keeping in mind the quality assurance as an
Nursing ultimate goal (Table 19.2).
Foundation:
Concepts and International Council of nurses in 1993 identi ed major priorities and concerns
Perspectives (For during a survey from its 111 member associations are: Standards of care,
Post Basic BSc nursing leadership, work conditions, nursing legislation, nursing education,
Nursing) nursing research, health policy, nursing practice, nursing management, nursing
Jogindra Vati
costs, recruitment/retention, nursing specialty, professional issues, access to a
university-level education, professional autonomy, concern for nursing care, the
PROFESSIONAL ORGANIZATIONS prescription and raising of nursing standards and quality, need for an auditing
 1: Development Of Nursing As A Profession: system for nursing , and nursing shortage. Major issues are given below:
Nurse
ISSUES IN NURSING EDUCATION
Bodies Uniformity and standardization of nursing education: The nursing manpower
 5: Career Planning And Development available is less as per demand to meet the future health care needs and
SECTION 2: CONCEPT OF NURSING PRACTICE challenges. Numbers of nursing institutions are coming up to prepare the
nurses of different levels. There is a limited involvement of nurses at the policy
level.
Gap between theory and practice: It is observed that there is a gap between
actual lessons taught in the classroom to student and they practice. Thus, they
became theory oriented rather skill oriented.

Change in traditional teaching methods: The lecture methods are being
gradually replaced by newer methods such as problem-based learning,
competency-oriented education, and use of skill laboratories that will improve
teaching learning process, but cannot replace teachers and clinical experiences.
Educational preparation: There is a need to prepare competent students

with adequate knowledge, attitude and skill. The infrastructure, e.g. adequate
library facility, clinical facilities, articles, etc. which is lacking in most of the
nursing institution, if available, not utilized properly.
Lack of competent teachers: Having quali ed and competent nurse

teachers is a major issue at present.
Table 19.2 Identi ed major issues in nursing service

Vati, J. (1990) Lorensen Et Al (1991) Mirelle, K (1993)
Non-availability Lack of nurses Educational standards should focus on

of documents prepared to work in preparing the nurses to function in the
related to policy, nursing work environment. There is a need to
planning and administration bridge the gap between nursing
budget Acute shortage of education and nursing practice
Power vested nurses Continuing education should be need

with the No relationship base trainings
medical between Nursing Need for practice standards
personnel Service and Have su cient number of adequately
Meager Nursing Education trained nursing personnel available and
involvement of Lack of authority in the ability of nursing services to retain
nursing administrative them in active employment
personnel in structure To develop nursing specialties to retain
planning of
Lack of the nurses in the clinical area in the
nursing services
participation by attainment of quality care.
Shortage of nurse Need to introduce an appropriate career
nursing administrations to structure and articulate career paths
manpower assess the
Accountability organizational or Educational and practical experiences

of nursing community needs required for a certain position.
personnel Strange The evaluation promotion criteria
Nursing towards duties relationship Job design and task allocation to de ne
Foundation: other than between nurses the nurses’ scope of activity and roles
Concepts and nursing care and other
Perspectives (For Physical and verbal abuse in the
Post Basic BSc Negative role auxiliaries and also
workplace
Nursing) perception and with physicians
Occupational health and Organisational
Jogindra Vati role demand Lack of teamwork
attitudes
Poor spirit
maintenance of
supply of
Its Philosophy And Objectives equipments and
 2: Responsibilities And Expanded Role Of A drugs
Nurse
 3: Development Of Nursing Education In India Poor
 4: Professional Organizations And Regulatory infrastructure

Bodies
Irregular pattern
of working
Negligible in-
service training
and the
absence of a
good reference
library

Very poor
maintenance of
patient records
Sub-standard
patient care
Poor sanitation
and inadequate
bedlinen
Nursing service
conditions not
in keeping with
the directives of
ILO andINC
Unsatisfactory
pay and no
incentives for
promotion
Lack of crèche,
accommodation
and other basic
facilities
Neglected
Health of
nurses
279
They should have rich experience of clinical with update knowledge of system
and technology used for patient care.
Lack of promotional avenues and team spirit among teachers: In most of

the nursing institutions, the career ladder of nursing faculty is poor and there is
lack of team spirit among them. They have less opportunity to have higher
positions that may create frustrations among them.
Inadequate infrastructure: Inadequate library facilities, transport facilities,

poor nursing lab facilities, inadequate hostel facilities need attention.
Nursing Lack of work culture: There is a need to develop work culture among
Foundation: teachers, students which is lacking.
Concepts and
Quality of nursing education: The quality of nursing education is in jeopardy
Perspectives (For
Post Basic BSc due to an inadequate national nursing educational plan and development and in
Nursing) future it will be judged by the student competencies, i.e. what the student will be
Jogindra Vati able to do after completing the programme and not merely the paper degrees or
certi cates they hold?
FUTURE ISSUES IN NURSING
Nurse
 4: Professional Organizations And Regulatory FUTURE NURSING PRACTICE ISSUES
Bodies
The future nursing practice issues are identi ed as differentiated nursing
practice, competencies, practice models, and a nursing classi cation in order to
keep a pace with international nursing standards (Fig. 19.2).
Figure 19.2: Future nursing practice issues
Differentiated nursing practice: It is de ned as “the practice of structuring

nursing roles on the basis of education, experience, and competence” (Boston,
1990). Efforts to place the right nurse with the right competencies with the right
patient at the right cost become the goal of health care professionals.
De ning and implementing differentiated nursing practice: Differentiated

nursing practice is an important issue in the developing countries that ‘who
should do what, what education should be required for the task, how much prior
experience is required for that particular role/tasks to be carried out etc.
De ning and implementing differentiated nursing practice is a very challenging
task, as there is, shortage of staff and growing demand for accountability.
De ning competencies and models: Competencies refers to what an

individual is capable of performing and including cognitive skills such as
decision-making and interpersonal skills as well as the psychomotor or
technical skills associated with nursing procedures? But what types of
competencies are required for the nursing personnel and what should be the
competency models at different levels is an important issue that needs
exploration? Various experts and commission identi ed different types of
competencies:
The essential characteristics needed by the nurses in the 21st century are
critical thinker, culturally competent, competent provider of health care,
knowledgeable coordinator of community resources, politically aware,
Nursing ethically and legally grounded, effective communicator, role model, and
Foundation: reasonable manger of human, scal and material resources (Halstead, 1996).
Concepts and
Pew Health Professions Commission, 2000, identi es twenty-one
Perspectives (For
Post Basic BSc competencies as critical to practice.
Nursing) Institute of Medicine (2003) identi ed ve core competencies: (i) abilities to
Jogindra Vati deliver patient-center care, )ii) work as a member of an interdisciplinary team,
(iii) engage in evidence-based practice, (iv) apply quality improvement
approaches, and v) use of information technology.
 1: Development Of Nursing As A Profession: Utley-Smith identi ed speci c nursing practice compet-encies that are
related to health promotion, supervision, interpersonal communication,
Nurse
directs care, computer tech-nology, and caseload management (coordination
 3: Development Of Nursing Education In India of client care).
Bodies A ‘nursing practice model’ is de ned as ‘operational model for redesigning
 5: Career Planning And Development nursing practice for the provision of patient care in organizational setting,
SECTION 2: CONCEPT OF NURSING PRACTICE primarily in hospitals and long term facilities (Weisman, 1992). The practice
models should be innovative and focused on differentiated nursing practice.
A nursing nomenclature (classi cation): Naming or describing phenomena

in nursing is known as nursing nomenclature. It is primarily the language of
nursing that addresses nursing diagnosis, nursing interventions, nursing
outcomes and classi cation is the systematic arrangement or a structure
 framework of these phenomena. The most commonly classi cation system
adopted by American Nurses Association is:
North American Nursing Diagnosis Association (NANDA): It contains 71

concepts and 143 items.
Nursing Intervention Classi cation (NIC): It is having 486 interventions

organized into 30 classes and 7 domains
Nursing Outcome Classi cation (NOC): It includes 247 individual level

outcomes, 7 family outcomes and 6 Community Outcomes.
Omaha System: It includes an assessment component- problem

classi cation scheme, Intervention component- Intervention scheme, and an 280
Outcome component- Problem Rating Scale for Outcome.

FUTURE ISSUES IN NURSING ADMINISTRATION
The important issues in nursing administration are related to cost of health care
affecting nursing, challenge of managed care, impact of health care policy and
regulation, nursing shortage, opportunities for lifelong learning, signi cant
advances in nursing science and research.
The issues recognized by Indian Nursing Council are: Renewal of nursing

registration, diploma vs. degree in nursing for registration to practice in nursing,
specialization in clinical areas, nursing care standards, sta ng pattern/nurse
patient ratio, conduct of nursing research, nursing audits, higher education for
senior positions in nursing and independent nurse practitioners.

FUTURE ISSUES IN NURSING EDUCATION
Future issues in nursing education are directed towards a system of education,

students, teachers and infrastructure (Fig. 19.3).
Nursing
Foundation:
Concepts and
Perspectives (For
Post Basic BSc
Nursing)
Jogindra Vati

Nurse
Figure 19.3: Future issues in nursing education
Bodies
Standardization of nursing education: There is an urgent need to have the
uniformity and standardization of nursing education in order to understand the
scope of nursing practice with clearly de ned educational preparation and
licensure. There is also a need to develop a system of ranking of university level
preparation of nurses in terms of competency of the graduates, world-class
research facilities, well stocked library and so on (Samuel, SA, 2012).
Practice oriented education system: The nursing education system should

 be practice oriented. As we know, nursing profession has a social obligation to
the public to meet their general and specialized care needs as well the public
expects that a nurse has the expert knowledge and skills to ensure safe care.
Well planned, mix and match teaching methods: Pedagogies have been
changed and replaced by newer methods such as problem-based learning,
competency-oriented education, and use of skill laboratories will improve
teaching learning process, but cannot replace teachers and clinical experiences.
There is a need to work on a well planned, wise, mix and match methods.
Competent students’ preparation: There is a need to prepare competent

students with adequate knowledge, attitude and skill. The infrastructure, e.g.
adequate library facility, clinical facilities, articles, etc. which is lacking in most
of the nursing institution, if available, not utilized properly.
Preparation of competent teachers: The nurse teachers should have rich

experience of clinical with update knowledge of system and technology used
for patient care. They should be trained with the use of modern education
technology, human relation, communication methods, re ective teaching
learning methods and team building.
Promotional avenues for teachers: There should better career ladder for
nursing faculty with appropriate positions and salary structures.
Adequate infrastructure: There should be proper library facilities, transport

facilities, poor nursing lab facilities, hostel facilities both students and faculty.
Work culture: Emphasis should be made to develop work culture among

teachers, students which is lacking.
Quality of nursing education: For quality nursing education, there is need for
reviewing educational system-imparting knowledge, developing skill and
inculcating a positive attitude to care is must. The selection of students needs
objective criteria and transparency.

WAYS TO MEET CHALLENGES
INC has recommended various solutions to improve overall scenario of nursing

services including practice, administration and education in India:
Strengthen involvement of nurses in health and nursing policy formulation

Nursing
and planning.
Foundation:
Concepts and Empower nursing leaders.
Perspectives (For Develop and implement a quality assurance system for the nursing service.
Post Basic BSc
Nursing) Ensure nursing workforce management as an integral part of human
Jogindra Vati resource planning and health system development.
Enhance nursing autonomy in practice.
Enforce implementation of recommended norms on nurse patient ratio.
 1: Development Of Nursing As A Profession: Produce advanced practice nurses.
Ensure appropriate facilities and adequate equipments and supplies.
Nurse Promote evidence-based practice and nursing research.
Establish a continuing nursing education system.
Bodies Improve pay scales, incentives systems and working conditions.
Ensure quality of nursing education by strengthening nursing programmes,
increasing quali ed nurse educators and allocate appropriate resources to
maximize e ciency and effectiveness.
KEY POINTS
 A trend means a change or movement in a particular direction. A trend in

nursing is a change that is taking place in present days in any eld of nursing, 281
which affects the profession as a whole.
Trends in nursing took place in various areas including nursing care, nurses,
research, administration, use of information technology, nursing education,
infrastructure, etc.
The emerging trends in nursing include professional judgment, de ning the
concept of care; nursing process, nursing diagnosis; quality assurance,
standards; about nursing audit, nursing research, evidence based nursing;
concept of nursing theories; and application of theoretical models and many
more that need attention.
The trends in nursing education are related to curriculum, teaching-learning
methods, education quality and standardization, educational technology,
student status, nurse teachers, etc.
The important in uencing factors for trends to change are technology
advancement, health care delivery system, advancement of nursing, diverse
responsibilities of nurses, educated consumers, shortage of nurses, etc.
Various issues in nursing are identi ed after conducting various studies in
India and abroad, by ICN and also recognized by INC.
The major issues in nursing education are uniformity and standardization of
education, quality nursing education gap between theory and practice,
change in the traditional teaching learning methods, educational preparation,
lack of competent teachers, Inadequate infrastructure, etc.
Future issues in nursing practice would be related to planning and
implementing differentiated practice; de ning competencies; development of
nursing practice models; de ning nursing nomenclature.
Future issues in nursing education would be related to quality nursing
education, practice oriented nursing education, Well planned, mix and match
teaching methods, competent students’ and teachers preparation, etc.
Poor quality of care and poor quality of nursing education are the major
issues at present and INC has recommended various solutions to improve
overall scenario of nursing services in India.
CHAPTER END QUESTIONS
Nursing
Foundation:
Concepts and I. REVIEW QUESTIONS
Perspectives (For
Post Basic BSc De ne trends in nursing and describe trends in nursing service.
Nursing)
Discuss trends in nursing education.
Jogindra Vati
Describe factors affecting trends in nursing.
SECTION 1: CONCEPT OF NURSING AND Enumerate issues in nursing service.
Explain future major issues in nursing education.

Nurse
 3: Development Of Nursing Education In India II. SHORT NOTES
Bodies Emerging trends in nursing.
Enumerate future issues in nursing service.
Issues in nursing education
Ways to meet challenges in nursing.

III. MULTIPLE CHOICE QUESTIONS


Circle the alphabet before the best answer:
1. The general direction and tendencies of movement in a particular direction

is termed as:
(a) Development
(b) Trend
(c) Issue
(d) Challenge
2. The pattern of shift duty of nurses at present followed by the most of

hospitals is:
(a) Straight shift duty

(b) 8 hours shift duty
(c) 12 hours shift duty
(d) Split shift duty
3. The study of how to use computers to capture the data is proved to be

better for clinical and research purposes is:
(a) Case management

(b) Telehealth
(c) Informatics
(d) Computers and technology
4. The differentiated nursing practice is:
(a) The structuring nursing roles on the basis of education, experience, and
competence
(b) Nursing practice using cognitive, interpersonal and technical skills
(c) Redesigning nursing practice for the provision of patient care
(d) Structure framework of nursing diagnosis, nursing interventions,
nursing outcomes

ANSWER KEYS
1. (b)
2. (a)
3. (c)
Nursing
Foundation: 4. (a)
Concepts and
Perspectives (For
Post Basic BSc SUGGESTED READING
Nursing)
Jogindra Vati 1. Anderson, R.D., Sweeney, S.D., and William, A.T.(2000). An Introduction to Management
Science: Quantitative Approach to decision making. New York: South-Western College
SECTION 1: CONCEPT OF NURSING AND Publishing.

2. Bateman, S.T., and Snell, A.S.(1999). Management: Building Competitive Advantage. New York:
Its Philosophy And Objectives Irwin McGraw-Hill.
Nurse 3. Bellock, J.P., and O’Neil, F.H.(2000). Recreating nursing practice for a new century:
 3: Development Of Nursing Education In India recommendations and implications of the Pew Health professions Commissions nal report.
 4: Professional Organizations And Regulatory Nursing and Health Care Perspectives, 21(1),14-21.
Bodies
 5: Career Planning And Development 4. Bose, R. (1994). Nursing administration and services-suggestion for improvement in
SECTION 2: CONCEPT OF NURSING PRACTICE management e ectiveness. The Nursing Journal of India, LXXXV(11), 201-202.
5. Bulechek, G., Butcher, H., Dochterman, J., and Wagner, C. (Eds.). (2013). Nursing interventions
classi cation (NIC) (6th ed.). St. Louis, MO: Elsevier.
Http://Www.Nursing.Uiwa.Edu/Centers/Cncce/
6. Government of India. (1964). Report of Health Survey and Development Committee
Recommendations. New Delhi: Govt. of India.


7. Government of India. (1976, Aug). Critical appraisal of health care delivery system and the
studies there on operational research for improved delivery of health services-report of the
task force. New Delhi; Ministry of health and family welfare.
8. Government of India. (1987). Report of Expert Committee on Health Manpower Planning, 282
Production and Management. New Delhi: Ministry of Health and family Welfare.
9. Halstead, J.A., Rains, J.W., Boland, D.L., and May, F.E.(1996). Reconceptualizing baccalaureate
nursing education: outcomes and competencies for practice in the 21st century. Journal of
Nursing Education, 35(9),413-416.
10. Heller, B.R., Oros, M.T., and Durney-Crowley, J.(2000). The future of nursing education: ten
trends to watch. NLN Journal (Online) Available at:
Http://Www.Nln.Org/Nlnjournal/Infotrends.Htm.
11. Henry, B., Lorensen, M., and Hirsch eld, M.J.(1994). Management and leadership by nurses.
World Health Forum,15(2),153-157. Indian Nursing Council. Indian Nursing Council Act, 1947.
New Delhi. (Amended in 1950 and 1957).
12. ICN. (1994, July-Aug). An analysis of nursing priorities worldwide. Int Nurs Rev, 41(4),115-
117.Http://Www.Ncbi.Nlm.Nih.Gov/Pubmed/7928139
13. Indian Nursing Council. Indian Nursing Council Act, 1947. New Delhi. (Amended in 1950 and
1957). Http://Www.Dauniv.Ac.In/Notices/Indian_Nursing_Council_Act_-_1947.Pdf
14. Indian Nursing Council. (2000). Golden jubilee celebration: nursing in the new millennium. New
Delhi: Daryaganj, Jaina O set Printers.
15. Indian Nursing Council. Regulations, 2001.
16. Joglekar, K.S. (2000). Hospital wards management: professional adjustments and trends in
nursing. Bombay: Vohra Medical Publications.
17. Jolley, M., and Allen, P.(1989). Current issues in nursing. London: Chapman and Hall.
18. Kingma, M. (1993, May-Jun). Professional and socioeconomic issues: separate but
interdependent. Int Nurs Rev, 40(3), 85-88, 94.
Http://Www.Ncbi.Nlm.Nih.Gov/Pubmed/830955
19. Korniewicz, D.M., and Palmer, M.H. (1997, May). The preferable future for nursing. Nursing
Outlook, 45(3),108-113.
20. Lucida, M. (2002). Nursing: practice and public health administration, current concepts and
trends. New Delhi: BI Churchill Livingstone.
21. Manvannan, S. (2000). Transition in Nursing. The Journal of Nepal Council, 9, 201-202.
Nursing
Foundation: 22. McCloskey, J, Bulchek, G (eds.,). Nursing Intervention Classi cation (NIC): Iowa International
Concepts and Project. (3rd ed.) St. LouisMO: Mosby, 2002.
Perspectives (For
23. Mehta, R.S. (2012, Jul 04). Trends and issues in nursing.
Post Basic BSc
Nursing) Http://Www.Slideshare.Net/Rsmehta/12-Trends-And-Issues-In-Nursing?Related=1
Jogindra Vati
24. O’Neale, M., and Kurtz, S.(2001). Certi cation: perspectives on competency assurance.
Seminars in Perioperative Nursing, 10(2),88-92.

PROFESSIONAL ORGANIZATIONS 25. Porter-O’Grady, T. (2001, July). Profound change: 21st century nursing. Nursing
 1: Development Of Nursing As A Profession: Outlook,49(4),182-186.
 2: Responsibilities And Expanded Role Of A 26. Samuel, S.A (2012, Nov). Nursing education: opportunities and challenges, TNAI Bulletin,1(10).
Nurse
Http://Www.Tnaionline.Org/Nov_12/6.Htm
 4: Professional Organizations And Regulatory 27. Scoble, K.B., and Russell, G. (2003, June). Vision 2020, Part 1: pro le of future nurse leader.
Bodies
JONA, 33(6),324-330.
SECTION 2: CONCEPT OF NURSING PRACTICE 28. Vati J. Organization and administration of nursing services in district hospitals of north India.
Unpublished Ph.D. in Nursing Theses, 1992.
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Nursing Education Perspectives, 25(4):166-170.Http://Dx.Doi.Org/10.1043/1536-
5026(2004)0250166:CNBNBG2.0.CO;2
30. Zerwekh, J., and Claborn, J.K.(2002). Role Transitions. In Nursing Today: Transition and Trends
 (4th ed.). Philadelphia: Saunders.

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Trends In Nursing Practice

Emerging Trends in Nursing Service

Trends in Nursing Education

Factors A ecting Trends in Nursing

Issues in Nursing Education

Future Issues in Nursing

Future Issues in Nursing Administration

Future Issues in Nursing Education

Ways to Meet Challenges

Chapter End Questions

After completion of this chapter, the learner will be able to:

Understand the concept of trends in nursing

TOC Index  Describe trends in nursing

TRENDS IN NURSING SERVICES

Trends in nursing services are multidimensional directly or indirectly related to

Type of nursing care: At present the emphasis is on specialized nursing

Use of information technology: There is advancement in technology in the

Table 19.1 Trends in nursing services: past, present, and future

Past Present Future

Type of nursing Military nursing Civilian Govt. Private hospital based

Type of nursing General nursing Specialized- Super specialized nursing

Assignment of Functional Functional Patients assignment

Role Basic role Multiple roles Multiple roles

Nurse Dependent role Independent Independent practitioner

Attendance of Lacking Mandatory and Self motivated and

Leadership Autocratic Democratic Participative,

Turnover Less Increasing Debatable

Nursing Recognized and Recognized Recognized

No. of Few Mushrooming of Stabilization of

Marital status of nurses: In the past, nurses used to be unmarried, gradually,

Leadership styles: It was observed that nurse leaders used to follow

Nursing institutions: In the beginning, both unrecognized and recognized

Number of schools and colleges: There were very few schools/colleges of

EMERGING TRENDS IN NURSING SERVICE

Emerging trends that are related to profession, nursing care, theories,

SECTION 1: CONCEPT OF NURSING AND

TRENDS IN NURSING EDUCATION

The trends in nursing education are related to curriculum, teaching-learning

Changing focus from cure to care: More emphasis is given to promotive

Change in admission criteria: The minimum quali cation and requirement

Improved teaching learning methods: The teaching learning methods both

Advanced educational technology: Now the education technology

Comprehensive evaluation: Presently the focus of evaluation is continuous

Emphasis on interpersonal and human relation: The students are taught

TOC Index  Emergence of specialization and research: Due to advancement in medical

Accreditation of nursing institutions: Different from the past the nursing

FACTORS AFFECTING TRENDS IN NURSING

Changing health scenario of government : There is constant effort from

‘Health for All’ development is based on self-determination and self-reliance

Changing demographics: The alarming increase in elderly population will

Change in health care delivery system: Transition is taking place in health

Box 19.1: Transition In Health Care System

TOC Index  Curative Preventive approach

Specialized care Primary health care

Medical diagnosis Patients’ emphasis

 2: Responsibilities And Expanded Role Of A Need to supervisey Coaching, mentoring

 Advancement in technology: There are different techniques, which are

In hospital, more documentation will be done directly on a computer, often

Impact on medical tourism: The concept of medical tourism is coming up.

Advances in medical, paramedical and allied professions: Growing

Informatics and efforts to standardize and unify nursing language: