FUTURISTIC NURSING

Nursing is a dynamic profession undergoing change every moment “we are in a

new place, we are not on the edge of the old place. We are not pushing the
envelope, we are totally a new envelope. So the rule have changed, ever
fundamental premise old way of thinking is no longer applies.”
- Sister Elizabeth Davis
INTRODUCTION
Many new trends in nursing are likely to develop in the near future. Some
can be predicted with certainty while others may be unexpected. These trends of
the future will result from very rapid changes that takes place in all areas of life.
You will have to make effort to keep informed through all available sources. It is
the only way which will help you to know what is happening at present and what
may come in the near future.
NURSING AGENDA FOR THE FUTURE
 Leadership and planning
 Delivery system and nursing models
 Legislation/ regulation/ policy
 Professional/ nursing culture
 Recruitment and retention
 Economic value
 Work environment
 Public relations/ communications
 Education
 Diversity
ASPECTS OF FUTURE NURSING
 Nursing education
 Nursing service
NURSING EDUCATION
Future directions for nursing education
In 1993, three major organizations issued statements and reports about
nursing education for twenty first century. Their reports addressed the new
directions of nursing education needed to take in the future. Although the three
organizations advocated somewhat different approaches and strategies, several
common themes emerged in their reports included the following 8 points.
1) Schools should recruit diverse students and facilities that reflect the
multicultural nature of society.
2) Curriculum and learning activities should develop student’s critical thinking
skills.
3) Curriculum should emphasize students’ abilities to communicate from
interpersonal families and inter disciplinary colleagues.
4) The number of advanced practice nurses should be increased and curriculum
should emphasize health promotion and health maintenance skills for all
nurses.
5) Emphasis should be placed on community based care increased
accountability state of the art clinical skills and increased information
management skills.
6) Cost effectiveness of care should be focused in nursing curriculum.
7) Faculty should develop programs that facilitate program articulation and
career mobility.
8) Continuing faulty development activities should support excellence in
practice teaching and research.
Another group whose work has significantly affected nursing is that of
the Pew Health Profession Commission. Although issued in the form of reports
rather than a study, the recommendations that have come from the Commission
caused many nursing organizations to take a serious look at themselves and their
activities. The reports of the Commission addressed issues related to nursing
education, to credentialing and to the supply of health care professionals. The
recommendations in the first report regarding nursing education included the
following:
 Recognizing the value of multiple entry points to professional practice.
 Consolidating professional nomenclature so that there is a single title for
each level of nursing preparation and services.
 Determining the practice responsibilities associated with different levels of
nursing education.
 Reducing the size and number of nursing education programs.
 Expanding the number of masters level nurse practitioner programs.
The second report dealt with credentialing issues and recommended
that scopes of practice be eliminated and that unlicensed personnel be employed in
health care. It also addressed the need to ensure competence among today’s
licensed health care practitioners.

NURSING SERVICES
By the year 2020 less than 15 years from now a study from Occupational
Health and Safety Administration predicts that the need for registered nurses in
nursing homes will increase 66% for licensed practical and vocational nurses by
72% and the need for certified nursing assistants will increase by 69%. For nurses
working in home health settings which include managed nursing care home
settings – those numbers are even higher, well above 250% increase at every level
of licensing.

VISIONS FOR THE FUTURE OF NURSING

 Addition of new diseases and threat of bio – terrorism.
 New treatments and technologies.
 Patients are moved out of hospital rapidly, those that remain are more
actually ill.
 Those discharged patients need more assistance at home.
STRATIEGIES

 Explore vital role

- Managerial expertise
- Observable caring behaviours and attitude
- Remind that nurses are vital to health team
 Practice based discipline
- Computers can’t replace educators
- Nursing is build on human relations
 The right attitude and the caring nature
 Commitment to the nursing profession, House oriented, develop passion to
profession
 Formal and Informal education
 Professional development
 Higher studies
 Nursing research
 Policy making and planning
 Separate budget for nursing: Nursing seems blurred unless a big thrust from
right thinking citizens, government and nurses
  Client satisfaction: Client satisfaction highlights nursing care. Nurses are
back bone of the hospital. Inculcate this facts in students.
 Continuing education
 Interdisciplinary approach
 Nursing standards
- Written and evidence based protocols
- Achievable and measurable
- Constantly renewed and modified
 Nursing organisation at national and state level
 Think globally and act locally

NURSING IN 21ST CENTURY

 For the nursing graduate, the future holds numerous social, political and
technological changes.
 During the 21st century, societies will continue to move towards
globalization, with an increased sharing of products, attitudes and financial
investments. The clients may be more likely to combine conventional
therapies with complementary healing techniques, such as homeopathy,
neuropathy, therapeutic touch, reflexology, acupressure, aromatherapy and
nutritional therapy.
 As the nursing profession entered into 21st century it found itself perplexed
with many of the concerns related to the impending nurse shortage. Various
groups became involved in studying work force issues, with a primary
research occurring on the state level, with individual states examining their
current and potential work force and establishing strategic plans to address
the identified issues. An exception to the state studies is the one mentioned
earlier in this chapter that was conducted by the Robert Wood Johnson
Foundation and addressed the nursing shortage.
 Sibbold and other experts on nursing and health care also predict the
following
 Neighborhood will employ nurses who will work in 24 hour nurse
managed clinics.
 Nurse Practitioners will cross medical threshold to provide services
usually provided by physicians.
  Nurse Therapists will provide numerous services to the clients and
their families.
 Hospital stays will be exceedingly short and early discharge will
become more important.
 Nurses will be strong and autonomous practitioners whose practice
and care delivery focuses much more on health than illness.
FUTURE TRENDS IN NURSING:-
Nursing is not a static, unchanging profession but is continuously growing
and changing as society changes, as health care emphasis and methods change, as
lifestyles change and as nurses themselves changes.
The current philosophies and definitions of nursing demonstrates the
holistic trends in nursing- to address the whole person in all dimension in health
and illness, and in interaction with the family and community.
TRENDS IN FUTURISTIC NURSING
 Service (practice) education
 Practice (nursing care) Research Administration
1. Clinical nurse specialist {C.N.S}
2. Nurse practitioner {N.P} academic administration
3. Adult nurse practitioner
4. Family nurse practitioner Master’s education
5. Acute care nurse practitioner
6. Doctoral programs in nursing
7. Geriatric nurse practitioner
8. Bachelor of Science in management/ Pediatric nurse practitioner
health care.
9. Women’s health nurse practitioner Certificate in Forensic Nursing
10. Certificate in legal nurse consulting
Certified nurse midwife (C.N.M.)
Certified registered nurse anesthetist (C.R.N.A.) administration
Other areas for practice in service
1. Mobile nursing / Health care Education
2. Space nursing certified nurse practitioner
3. Licensed practical nurse
4. Arrow nursing
5. Masters of science in nursing/ Masters of health administration

SERVICE {PRACTICE} EDUCATION :-

Innovations in health care, expanding health care systems and practice settings, and
the increasing needs of clients have been a stimulus for new nursing roles are
specific employment positions or paths. Because of increasing educational
opportunities for nurses, the growth of nursing as a profession, and a greater
concern for job enrichment.
 It includes three broader areas:-
o Practice (nursing care)
o Research
o Administration
PRACTICE (NURSING CARE):-
Graduate education prepares nurses for advanced practice in a variety of
specialized roles in primary, secondary and tertiary settings. This covers four
principle types of APN’s.
1) Clinical Nurse Specialist:-
The C.N.S is an Advanced Practice Nurse with nursing expertise in a
specialized area of practice and may work in any practice setting. The C.N.S. may
also assume administrative and management roles. The C.N.S. functions as an
expert clinician, educator, case manager, consultant and researcher to plan and
improve quality of care provided to the client and family.
The C.N.S. should have following eight characteristics:-
• Clinical judgment
• Clinical enquiry
• Facilitator of learning
• Collaboration
• Systems thinking
• Advocacy or moral agency
• Caring practices
• Response to diversity
2) Nurse Practitioner:-
 Nurse Practitioner provides health care to clients usually in an outpatient,
ambulatory care, or community based setting.
 Nurse Practitioner provides care to the clients with complex problems and
provide a more holistic approach, attending to symptoms of non-pathologic
conditions, comfort and comprehensiveness of care.
 Nurse Practitioner have legal authority to implement patient management by
ordering diagnostic tests and treatments and prescribing medications.
a) Adult nurse practitioner (A.N.P.):-
Adult nurse practitioner provides primary, ambulatory care to adults with a
non-emergent acute or chronic illness and in some settings tertiary care. The role
includes case management, consultation, leadership, education and research and
health policy development.
b) Family Nurse Practitioner (F.N.P):-
Family Nurse Practitioner provides primary ambulatory care for families,
usually in collaboration with a family care physician. The F.N.P. meets the
families health care needs, manages some illness by providing direct care, and
guides or counsels the family as needed.
c) Acute Care Nurse Practitioner (A.C.N.P):-
Acute Care Nurse Practitioner is a registered nurse with a graduate degree in
nursing who is prepared for advanced practice using a collaborative model to
provide direct services to adult patients who are acutely or critically ill in a variety
of setting such as hospital or speciality clinic. The A.C.N.P. is a generalist, usually
based in internal medicine, focusing on the care of the hospitalized patient.
d) Geriatric Nurse Practitioner(G.N.P.):-
G.N.P’s are trained in the specialized needs of the ageing adults, with
emphasis on health promotion, health maintenance and functional status. Age of
the client is usually 65 and older.
e) Pediatric Nurse Practitioner(P.N.P.):-
P.N.P. provides specialty care for children from birth to 21 years of age. P.N.P’s
practice in hospital ambulatory care, emergency care and physicians’ offices.
f) Women’s Health Nurse Practitioner (W.H.N.P.):- WHNP provides
ambulatory care to women seeking obstetrical and gynecological health care.

3) Certified Nurse Midwife (C.N.M):-

C.N.M. is a registered nurse who has advanced educational preparation in
midwifery which includes theory and extensive supervised clinical experiences in
prenatal care, management of labor and delivery, postpartum care of the mother
and the infant, family planning, pap smears and treatment for vaginal infections.
C.N.M. practices with a health care agency that provides medical
consultation, collaborative management and referral. C.N.M. practices in all 50
states in the United States, Great Britain, Canada in hospitals and in birthing
centers and in the home, but it has not yet started in India.

4) Certified Registered Nurse Anesthetist (C.R.N.A):-

C.R.N.A. is a registered nurse who has advanced educational preparation,
including classroom and Laboratory instruction and supervised clinical practice in
the delivery of anesthesia to client in a variety of pract ice settings, including
hospitals, ambulatory surgical centers, birthing centers and clinics.
C.R.N.A. takes care of patient’s anesthesia needs before, during and after
surgery.
The role includes:-
• Performing physical assessment
• Participating in pre-operative teaching
• Preparing for anesthetic management
• Maintaining anesthesia intra operatively
• Overseeing recovery from anesthesia
• Following the patient’s post-operative course from recovery room to patient care
unit.
OTHER AREAS FOR PRACTICE IN SERVICE MOBILE NURSING:-
Mobile nursing is a service agency that provides home teaching and care for
patients with varied needs and health problems.

BENEFICIARIES OF MOBILE NURSING:-

 Patients discharged early from hospitals.
 Patients suffering from chronic and acute medical problems.
 Surgical patients.
 Patients requiring I.V. therapy.
 The elderly Respiratory patients.
 The seriously ill. Patients in need of medication management
 Hospice concept
 Ventilator dependent
 Assistance with bathing, dressing, meals, transportation, light housekeeping

SPACE NURSING :-
 Space Nursing Society (SNS)
 Founded in 1991, over 400 members from around the world.
 Space Nursing provides a forum for the discussion and exploration of
issues related to nursing in space and its impact upon the understanding of earth
bound nursing through conference participation.
 Cardiac monitors originated with space program.
 Ultrasound studies assessing bone loss in astronauts abroad the space
station could help nurses better care for patients with osteoporosis.
FUNCTIONS OF SPACE NURSING :-
• Evaluate emergency plans.
• Use of medications in space.
• Telemedicine opportunities.
• Performing surgery in space.
• Developing a condition database to evaluate the risk of certain accidents or
illness during a flight.
FORENSIC NURSING:-
 Specialized training in forensic evidence collection, criminal procedures,
legal testimony expertise.
 Liason between the medical profession and that of the criminal justice
system.
 Came about in 1992 during the first ever national convention of sexual
assault nurses.

ARROW NURSING:-
Services provided by arrow nursing are:-
 Administration and stoppage of blood services.
 Clinical laboratory services.
 Activities services
 Dental services
 House keeping services
 Mental health services
 Nursing services
 Occupational therapy services
 Pharmacy services
 Physical therapy
 Physician services
 Social work services
 Speech/ language pathology services
 Diagnostic X-ray services
DISASTER NURSING
 Readiness and preparedness in responding to immediate community
needs during and after a catastrophic event.
 Medical history and physical assessment, psychosocial assessment and
referral to mental health services.
HOSPICE NURSING
observing, assessing, and recording symptoms for terminally ill patients.
 patient’s social worker, home-care aide and physical, occupational, or
speech therapist.
RESEARCH:-
Research is directed towards building a body of nursing knowledge about
“human responses to actual or potential health problems”.
The vision for nursing in the 21st century is the development of scientific
knowledge base that enables nurses to implement on evidence based practice.
Evidence Based Practice incorporates critical thinking and research
utilization competencies. It stresses the use of research findings, and as
appropriate, quality improvement data and affirmed experiences to support a
specific practice.

AIM OF RESEARCH IN FUTURE:-

 To create a research culture.
 Provide high quality educational programme to prepare a workforce of
nurse scientist.
 Develop a sound research infrastructure.
 Obtain sufficient funding for essential research

EVIDENCE BASED PRACTICE:-

 Goal is to achieve cost-effective, high quality patient care based on
scientific inquiry
 Nurses need to understand research process involved
 Nursing care should not be based on opinions, past practices, but on the
results of scientific research

FUTURE OF NURSING CAREER:

 Many nursing functions will be automated.
 Result of nursing shortages, healthcare facilities will be forced to use
their nurses judiciously.
 Changes in technology will possibly attract more men and minorities into
the profession.
 The number of outpatient care will increase, as will the need for home
health care nurses.
 Community health care.
 focus more on preventing the illnesses rather than treatment.
Client advocate
 Nurse protects the clients human and legal rights
 Providing information to assist in decision making
 Patient Bill of Rights
Comforter Role
 Caring for client as a human being
 Role is traditional to nursing
 Care is directed to whole person, not just a body part
 Demonstration of care and Concern
Rehabilitator Role
Assist client to return to optimal level of functioning
Nurse helps client to adapt physically and emotionally to changes in
lifestyle, body image
Communicator Role
 Role is central to all other roles
 Involves communication with client, family, healthcare team members,
resource people, and the community
Without clear, concise communication it will be difficult to give effective
care
Teacher/Educator Role
Explains concepts and facts about health, demonstrates procedures,
reinforces learning, determines understanding, and evaluates progress of learning
Unplanned or informal education
 Planned or formal education.
TECHNOLOGICAL ADVANCEMENT
Technology has facilitated change and improvements in health care at a
more rapid pace than ever before with each passing year, the pace of that change
and accumulation of knowledge increase exponentially. Computers have helped
tremendously because they have taken away the need for nurses to remember so
much information. Advanced monitoring tools have improved efficiency.
Technology can make it more challenging, to make sure the art of nursing in not
over shadowed by science.
Telemedicine
The concept of telemedicine was introduced more than 30yrs ago through
the use of telephone and slow – scan games.
The term telemedicine in short refers to the utilization of telecommunication
technology for medical diagnosis, treatment and patient care.
Telemedicine is a rapidly developing application of clinical medicine where
medical information is transferred via telephone, the internet or other networks for
the purpose of consulting and sometimes remote medical procedures or
examinations.
Telemedicine enables a physician or specialist at on one site to deliver health
care, diagnose patients, give intraoperative assistance, provide therapy or consult
with another physician or paramedical personnel at a remote site.
Telemedicine system consists of customized medical software integrated
with computer hardware, along with medical diagnostic instruments.
The great impact in telemedicine may be in fulfilling its promise to improve
the quality, increase the efficiency and expand the access of the health care
delivery system to the rural population and developing countries.
Telehealth nursing
Telehealth is defined as “the delivery of health care services and related
health care activities through telecommunication technology”
Nurses have always used telephones to communicate with physicians,
patients and other health care providers. Todays technology have evolved far
beyond the telephone to include computers, interactive audio and video linkages
teleconferencing.
The goals of healthy people 2010 include eliminating health disparities
among population and improving quality of life and life expectancy.
Many health disparities occur because of barriers such as geographic
location.
The use of telehealth expands access to the health care for undeserved
populations and individuals in both urban and rural areas.
It also serves to reduce the sense of professional isolation experienced by
those who work in such areas and may assist in attracting and retaining health care
professionals in remote areas.
Impact of telehealth on patient outcomes:
Telehealth use in home health care opens the door for direct communication
between the patient and the provider by integrating information and technology to
facilitate health care delivery.
Telehealth essentially removes time and distance barriers via videophones,
video camera and sensory monitoring devices.
The telehealth contributes to positive outcomes in terms of self management
and compliance.

ROBORTIC NURSING
Staff shortages and technical
challenges (such as patient lifting and
moving) means there is a present and
growing incentive to design, develop and
implement robotic technology in the delivery of health care. The reliance on
robotic technology in surgical fields has been a reality for decades, but recent
trends and developments indicate that the emergence of technology and even
robotic technology in the delivery of primary healthcare is a growing phenomenon.
Lifting Robot – is intended to assist nurses particularly in the aged care setting to
lift or move patients. The obvious benefit being that there is no need for nurses to
compromise their own back-health in the process of assisting their patients
 The use of a robot, as opposed to a mini-lifting machine is intended to
make the process a bit less intimidating for the patient.
 ‘Stan the Man’ – which is used to train nurses and health professionals.
The robot is designed to respond to various treatments applied by the trainee nurse.

FUTURISTIC CYBER NURSING

When you arrive at work, your ID tag is automatically detected and you are
clocked in as you walk through the door.
 The patient is being monitored by automatic vital signs.
 You do your assessment verbally into your hand held device that converts it
to readable notes on the computers main system.
 At patient’s bed side, you can get chemistry, hematology with a small hand
device that requires no blood drawn. You just place sensor on the patient’s
skin and you have auto results.
 You verbalize your order into the hand held which goes directly to pharmacy
which fills the orders automatically directly to patients room.
 Most diagnosis will have a system for auto care plans upon patient
admission.
 Patients have a bedside computer to access educational tools and progress of
their recovery or stay.
 Nurses getting laptops and using internet to do their jobs. This is the way to
spend more time with the patients and less time for doing paperwork.
CONCLUSION
Future of nursing is of great scope. The nurses can make use of the great
scope for their professional advancement and to safeguard their lives.
BIBLIOGRAPHY
Janis Rider Ellis, “Nursing in today’s world”, 8th Edition, Lippincott
publishers, pg. no. 175
Taylor, “fundamentals of nursing,” 8th Edition, Wolters Kluwer publishers,
Pg. No. 70
Eleanor C. Hein, “ Nursing Issues in the 21st Century,” Lippincott
publishers, pp.no.137
 Shabeer P. Basheer, “ A concise textbook of Advanced nursing practice,”
Emmess publication, PP. 62 to 65