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Presented by Lt Col Geetha R I Year MSc Trainee Officer

The only thing that is constant is change - Lord krishna

This is a time of confusion within health care systems all around the world. New diseases such as AIDS, Cancer and the threat of bio-terrorism have entered our lives. New technologies and treatments occur rapidly, but are often expensive. Patients are moved out of hospital rapidly, and those that remain are more acutely ill than they have been in the past.

Those discharged patients often need more assistance at home and in the community than in previous years, and those services can also be expensive. Nurses are a vital part of the health care system, but nursing shortages have appeared in many areas. The nursing profession needs to begin to recognize new trends and patterns in the coming years.

Nursings future challenges

Societal challenges Societal influences are expected to have major impact on the future of the nursing profession Demographic challenges Environmental challenges Lifestyle challenges Cost control challenges Regulation challenges

Demographic challenges

Rising number of elderly The world future society predicts that by the end of 21st century, the average life span will approach 100 years(Hendrick,1995) Many elderly people are healthy, but the likelihood of illness become greater as people age. By the age of 90, one out of two people will develop Alzheimers disease(Herbert et al, 1995) Ethical issues such as euthanasia and assisted suicide will become increasingly important as technology enables patients to sustain life far beyond the point of useful, meaningful existence.

Continuing poverty The gap between haves and have-nots is ever widening, creating discontent and disillusionment. When basic needs for food, clothing and shelter are unmet or uncertain, health care becomes a luxury. Childrens immunization , prenatal care for pregnant women, nutritional meals are neglected. Poor people tend to put off seeking care until illness is advanced and thus harder to treat. Preventable conditions are not preventable because of lack of education, lack of sanitation, crowded living conditions, improper shelter, homelessness, and a host of other factors.

Increasing cultural diversity Cultural diversity refers to the array of people from different racial, ethnic, religious, social and geographic backgrounds who make up a particular entity. Some countries are homogenous in culture and some are heterogeneous cultural mix. Each group has its own nutritional practices, health beliefs, folk remedies and conventional wisdom about health and sickness. Nurses need to take these beliefs in to consideration when planning and implementing nursing care for individuals of diverse cultural background. Culturally sensitive care will be most important in the future than ever before.

Continuing urbanization People moving from rural, farming areas to cities, has increased since the time of the industrial revolution. Cities with large population of poor people create major social problems such as homelessness, drugs, gangs, single parent households, mental illness, violence and crime. Despite programs designed to deal effectively with social problems, they continue to grow. Nurses of the future will be increasingly confronted with health problems created by these social phenomena.

Environmental challenges
Every newspaper, news magazine, the television news program brings disturbing reports of the deterioration of our environment. There is gradual decline in the quality of the worlds air, water, plant and animal life. Acute and chronic respiratory diseases, allergic reactions and cancer of all types are increasing. Overpopulation contributes to the deterioration of the worlds environment. The related problems of environmental deterioration and overpopulation are health care issues that future nurses will undoubtedly have to face, and there are no easy answers.

Lifestyle challenges
Obesity is known to predispose people to a number of illness. Tobacco use and smoking are another lifestyle issue- which leads to lung cancer, emphysema, chronic lung disease, oral cancer. Lack of exercise and stress are another lifestyle issue. AIDS and drug abuse are spreading like an epidemic, nurses of the future will be called to provide intensive nursing care to these patients. Nurses will be involved in the development of sound public policies concerning these issues. Nurses will play an increasingly important role in educating people about wellness and self care in the years ahead.

At federal, state, and local levels government spent more money than was generated through taxes, and the pressure for health care for the elderly and the poor created a significant part of those budgetary problems. In many states, Medicaid is the largest and fastest growing state expense. One cost effective method of providing basic health care to children is through school nurses. Nurses has expanded roles in prevention and community based nursing which will reduce hospital admission and cost of hospital based treatment will reduce

Cost-control challenges

Regulation challenges
Nursing through its professional associations, will continue to be a powerful player in the health care politics. Nurses will form coalitions with consumer groups to influence consumer friendly legislation at state and national levels. Nurses will become increasingly active in developing health policies that improve access, quality and value in the delivery of health services.

Challenges in nursing practice

Nurses in the next decade will face an ever widening array of practice opportunities in hospital and community based health care settings, each of which will bring its own set of challenges.

Challenges in nursing practice

Challenges in cost containment Challenges of autonomy & accountability Challenges of technology Challenges of practice in expanded settings Challenges of differentiated practice

Nursing Practice
The Practice in a cost containment environment (cost-effective and high quality care). The mission of health care is being redefined. Environment for bed side care are changing. Care is shifting from hospital based to community based care. Hospital nursing will continue to become more selective and specialized. Collaborative, interdisciplinary practice models will come into vogue in all setting. Communication, computers and information networks will erase boundaries created by distance and inaccessibility to physical facilities.

Greater emphasis will be placed on the ethical component of care.

As the profession of nursing matures, more nurses will recognize the value of bachelors degree for beginning professional practice and masters degree for advanced practice. More nurses will pursue doctoral degrees to prepare for leadership roles in research and theory development. In response, college of nursing will expand flexible educational programs to improve access.

Challenges in nursing education

Challenges in nursing education

Challenges in outcome- based education Challenges in diversity Challenges of technology & the knowledge explosion Challenges of collaboration Challenges in health care and educational reforms Challenges in nursing research

Nursing Education
Major curriculum changes for graduate nursing education will be necessary. Educational pathway for advance practice nurses in clinical practice will become more distinct. Distance education will assist nurses in lifelong learning.

Research priority will be outcome measurement studies that demonstrate cost effective care. Emphasis will be on collaborative, multidisciplinary and multicenter research studies. Development of stronger Evidence base through rigorous methods and multiple, confirmatory strategies.

Nursing Research

Flow of resources
Where is the money going and where is it likely to go? Money flowing into health care in the community will be a driving force for changes in the area, but a blocked flow will be a straining force to preventive health care services. Nursing input and political power can impact that flow to provide effective health care program and services.

Supply of man power and competition

Manpower shortages or surpluses in health care professions impact the utilization of nurses and advanced practice nurses. Who are our competitors for delivery of services and resources? This is a particularly important area in times of nursing shortage to be sure that less qualified health care workers are not used to substitute for the sake of expenditure and reduced costs. How can we develop competitive and marketing strategies? How can we form coalitions to reduce competition? Collaborative rather than competitive strategies can strengthen quality of care by better utilizing the expertise of each participant.

Are the jobs keeping up with the expectations of nurses and with advanced practice nursing? How are supports worker jobs defined? How do professional standards interact with reality? How many people are required to do the job? Can one person realistically do the job? How can job satisfaction be increased in this era of high stress in the workplace?

Role delineation & role confusion

Public opinion
Nurses need to be aware of the public perception of their role. Development of coalitions and supporters within communities and media can be a driving force for advanced nursing practice. Consumer or professional opposition can provide barriers to practice, and be a restraining force.

We are a global economy and health care services face similar problems Internationally. We can learn and benefit from contacts in other countries, and we can offer our services when appropriate to improve overall healthcare in both developing and industrial countries. Global terrorism needs to be addressed, and nurses need to be well prepared to deal with the aftermath and to document its effects on those we care for. Nurse educators need to incorporate disaster training and stress counseling into the curriculum and to provide workshops in this area for nurses already in practice

Global trends

Nursing practice and theory

Nursing research and theory development need to be supported and findings disseminated to continue to build our nursing science and incorporate the results into practice. We need to increase our core of nurses who have met high academic standards for carrying out research and provide resources for their activities. Nursing research and theory also have the potential to contribute to the body of knowledge of other disciplines in the same way that we have borrowed from other theorists to use in our practice. The role of advanced practice nursing has been growing and has demonstrated effectiveness in the health care system. These nurses are now able to provide medical expertise in diagnosing and treating specific conditions, but are not mini-doctors. The medical portion of their practice is only one tool within their whole tool box of nursing competencies for use in providing holistic nursing care and health education.

Leadership within the profession

Leadership within the profession also influences the trends in nursing. Nursing is moving towards professionalism due to the untiring efforts of nurses who have been dedicated to achieve the aim.

Working conditions
Working conditions for nurses are also changing. There is a gradual change towards shorter and more convenient hours of duty, better accommodations and higher salaries

Patients Bill of Rights

After the development of the Patients Bill of Rights, the nurses are also accountable for patients care and have legal responsibilities for the patient.

Predictions are that in 10 or 20 years, it will look nothing like it does today. With new technologies and drugs, changes in insurance and healthcare policies, and the shortage in nurses, the profession will have to reinvest itself. Many nursing functions will be automated. For example, documentation and updating patient records, smart beds to monitor vital signs, bar codes, and automatic medicine carts could reduce the time and errors in dispensing medications, and voice-activated technology would eliminate the need to constantly write things down. Other nursing task such as serving meals will be taken over by aides. This would give nurses more time to provide a human touch to their patients. As a result of nursing shortages, healthcare facilities will be forced to use their nurses judiciously. Nurses will spend more time at the bedside as educators and care coordinators to refocus on the patient. With the lengths of patient stays shortening, nurses will have to make the best use of a shrinking amount of time and hospital stays. Nurses will also spend more time in administration and supervision positions. They will need to know how to access knowledge and transfer it to the patient and their loved ones.

Future of nursing career

Nurses future challenge

The change in health care delivery systems has also afforded nurses a wider range of functionality. Although independence have been cultivated through expanded roles. Trends towards downsizing and the current nursing shortage have increased the use of nonlicensed personnel in many healthcare arenas. This will continue to force the nursing profession to identify, clarify, and communicate its scope of practice.

Advances in Technology
The explosive growth of technology will continue to have an impact on healthcare delivery. The growth of this technology will change the way nurses function, and lead to the development of new nursing roles. Electronic medical records are expected to replace conventional modes of documentation. The promotion of advanced directives, organ donation, and comfort measures for the terminally ill will lead to elevation in hospice care providers. Care modalities which include pain management, spirituality assessment and bereavement counseling will be incorporated into health care organizations and nursing education curriculums. Nursing research will greatly contribute in developing and implementing these therapy options.

Nursing's dissatisfaction with the workplace environment is another issue that must be faced when considering the profession's future. This dissatisfaction was multifaceted and included issues such as workplace violence, inability to attend continuing education programs due to heavy workloads, exhaustion, and inability to provide safe patient care. Mee and Robinson (2003) state that "nurses need work environments with strong professional practice models that value their work and recognize their impact on patient outcomes.

Work Environments

Factors contributing to globalization include advances in information technology and communications, international travel and commerce, the growth of multinational corporations. Future nurses will face the challenge of maintaining holistic approach to client care in an environment of growing specialization. Focus on health promotion, maintenance, and revitalization will continue to grow.


One of the strongest and most far-reaching current trends in health care is the application of evidence - based practice through the development of research and information technology/informatics. This trend is visible across all sectors of nursing, including practice, education, research, and administration. The rationale behind this trend is to improve client care by selecting best practice options grounded in viable research, and to expand the theoretical foundations of all health professions. The ultimate goal is to shift health care decisions, choices, and actions to a higher, more scientific, research and theoretically-based level.

The advent of Evidence based practice

This approach to knowledge development, and decision-making within practice is not a new one. The seeds of evidence-based practice were first sown in Newtonian times and further developed through the rise of positivism and scientism. Early statisticians in turn developed an informatics model consisting of three essential parts arranged hierarchically, with data at the bottom, an intermediary layer of information, and topped by a knowledge layer (Georgiou, 2002, p. 128).

Maintaining the organizational machine

Since practicing nurses have little time to actually engage in the process of applying research, statistics, and other data to their practice, the EBP movement is often put into motion under the command of nurse leaders (Nurse Informatics) The current trends in health care motivate nursing leaders and hospital administration to align strategic objectives with technological adoption with the end goal of remaining financially competitive (Mazzella Ebstein, 2004).

Shifting the system

For EBP to realistically manifest in nursing practice, a major shift in health care organization and focus must occur. Practicing nurses often lack the knowledge and skill to access the literature and other digital research findings to apply these to practice. As aforementioned, time, rituals and routine expectations are other factors that prevent the proper engagement necessary to genuinely apply EBP to routine nursing care.

The nursing profession needs to begin to recognize new trends and patterns in21st century that are emerging in health care.

Clearly, nursing's future does indeed include manifold opportunities and challenges. The profession must not be complacent but it must become proactive in shaping its future, otherwise someone else will do it for us. We can say that The time is short, resources are scarce, and issues are critical". Nursing must act now in an unified voice with a resolved spirit to determine its own destiny.

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