The Impact of the Theoretical Basis of Nursing on Contemporary Practice - Essay Example

The impact of the theoretical basis of nursing on Contemporary practice Introduction: Scientific and social changes of the 21st century have brought as radical change in the Health care delivery system. Nursing is an important component of the health care delivery system and the role of a nurse in patient welfare has no boundaries for praise. The Nursing profession has evolved through time to establish a firm role in the medical domain based on strong ethical, moral and professional principles. The nursing practice has undergone a positive shift from that of a vocation to a professional status today. That is to say, nursing has a more active role to play in the health care delivery system than the past and nursing as a profession is ‘Accountable’ today. Florence Nightingale was the founder of modern nursing who established the nursing philosophy based on health maintenance and restoration. The civil war (1860-65) enhanced the growth of nursing in United States and the two world wars saw the nobility of the nursing practice. Theoretical Foundations of Nursing Practice A nursing theory is a conceptualization of some aspects of nursing communicated for the purpose of describing, explaining, predicting and or prescribing nursing care. These theories of nursing provide nurses a foundation to view client situations, organize data and analyze or interpret information. There theories of nursing help the nurse understand how the roles and actions of nurses are interrelated. Theories focus more specifically on the events and the phenomena of the discipline and are specific enough to contribute to a sound basis of nursing practice. Development of theory improves nursing science and lots of theories have been laid as foundations of nursing practice. The major theories on nursing can be classified chronologically as follows; 1.Nightingale’s theory( 1860 ): Florence Nightingale’s work ‘Notes on Nursing (1860); What it is and what it is not(1860) is a potential theoretical and conceptual for nursing. In Nightingale’s concept, the environment is the focus of nursing care. Nightingale did not feel nursing as being limited to the administration of medications and treatments but rather as being oriented towards providing fresh air, light, warmth, cleanliness, quiet and adequate nutrition. Through studies, she linked the client’s health status with environmental factors and recommended improved hygiene and sanitary conditions for the patient’s wellbeing. Nightingale’s descriptive theory provides nurses with an approach to perceive nursing with a frame of reference that focuses on environment and the patients. In her letters, she directs the nurse to act on behalf of the patient. According to her, assessment based on observations should not end up in piling up of information or facts but should end up in saving life and increase health and comfort. Her main focus was to facilitate the body’s reparative processes by manipulating client’s environment. 2. Peplau’s Theory(1952): Hildegard Peplau’s theory of nursing focuses on the individual, “the Nurse” and the process of interaction which gives rise to the nurse client relationship. According to Peplau, the client is an individual with a need and nursing is a process of interpersonal therapy. He viewed that the nurse strives to develop a nurse-client relationship in which the nurse serves as a resource person, counselor and surrogate. As the nurse-client relationship develops, the nurse and the client mutually understand the problem and solutions. The client gains from the relationship by utilizing the services to meet his needs and the nurse assists the client in reducing anxiety related to his well being. The unique feature of Peplau’s theory is the description of the collaborative nurse-client relationship which creates a ‘maturing force’ through which interpersonal effectiveness meets the needs of the client. When the client’s needs have been cared for, new needs do emerge and thus the nurse-client interpersonal relationship is characterized by orientation, identification, explanation and resolution. 3.Henderson’s theory (1955): Virginia Henderson defines Nursing as “assisting the individual, sick or well, in the performance of those activities that will contribute to health, recovery or a peaceful death and that the individual would perform unaided if he/she had the necessary strength , will or knowledge. According to him, the process of nursing strives to perform this as soon as possible and the ultimate goal is independence of the client. He classified fourteen basic needs of a whole person which includes physiological, psychological, sociocultural spiritual and developmental aspects. The nurse and client work together to meet the basic needs and attain a client centered goal. 4.Abdellah’s theory(1960): Faye Abdellah developed a theory which emphasizes on delivery of nursing care for the whole person to meet his physical, emotional, intellectual, social and spiritual needs. According to this theory, the nurse requires knowledge and skills in interpersonal relations, psychology, growth and development, communication as well as a thorough basic knowledge of the science of Nursing. He views the nurse as a problem solver and a decision maker formulating an individualized view of the client’s needs, which occurs in the sectors of comfort, hygiene and safety; physiological imbalance; psychological and social factors; and .sociological and community factors. 5. Johnson’s theory (1968): Dorothy Johnson’s theory of nursing elaborates on how the client adapts himself/herself to illness and how an actual or potential stress affects the capacity to adapt. The Theory opines that the goal of nursing is to reduce or remove stress to push the client towards recovery. Johnson defines the nurse’s assessment of the client’s needs in behavior subsystems. According to him, under normal circumstances, the client behaves effectively in the environment . When stress disrupts normal adaptations, the behavior is erratic and less purposeful; the nurse actually identifies this inability for adaptation and provides nursing care to meet the client’s needs. 6.Roger’s theory (1970): Martha Rogers called the individual human being as a Unitary human being. She considered the individual unitary being as an energy field co existing within the Universe. She viewed the individual as a one with continuous interaction with the environment and a united whole entity possessing personal integrity and manifesting characteristics that are more then the sum of the parts. The ‘Unitary Human being’ of Roger is a “four dimensional energy field identified by pattern and manifesting characteristics that are specific to the whole and which cannot be predicted from the knowledge of the parts”. The four dimensions described by Rogers are Energy field Openness, Pattern and organization and Dimensionality. These dimensions are useful in arriving at principles for human development. 7.Orem’s theory (1971): Dorothea Orem defined nursing with emphasis on client’s self-care needs. Self care according to the theory, is a learned, goal-oriented activity directed towards the self in the interest of maintaining life, health, development and well being. The ultimate emphasis of Orem’s theory is on client’s self care. Accordingly, nursing care is needed when the client is unable to fulfill biological, psychological, developmental or social needs and the nurse determines by duty why a client is unable to meet the needs or what must be done to enable the client to meet them. Thus ,Orem defines the goal of nursing as to increase the client’s ability to independently meet their needs i.e., the self care of the client. 8.King’s theory(1971): Imogene King formulated a goal attainment theory which focuses on three dynamic interacting systems namely, personal, interpersonal and social systems. According to this theory, a personal relationship occurs between the client and the nurse, and this nurse-client relationship is the vehicle for the delivery of nursing care, which is defined as a dynamic interpersonal process. This theory emphasizes on the fact that the nurse and the client are affected by each other’s behavior and it is duty of the nurse to maintain this interpersonal process. 9.Neuman’s theory (1972): Betty Neuman defines a total person model for nursing incorporating a wholistic concept and an open-systems approach. Neuman viewed that nursing is concerned with the whole person and the goal of nursing is to assist individuals, families or groups to attain a maximum level of total well being. According to him, the nurse assesses, manages and evaluates client systems focusing on the variables affecting the client’s response to the stress factor. Nursing actions include the primary, secondary and tertiary prevention. The primary prevention focuses on the line of defense by identification of potential risk factors. Secondary prevention aims at strengthening internal defenses establishing treatment plans and priorities. The tertiary prevention stresses on readaptation. The ultimate goal of tertiary prevention is strengthening resistance to stressors by client education and to assist preventing a recurrence of the stress response. 10.Leininger’s theory(1978): Leininger proposed a Cultural Care Diversity and Universality theory in which he states that care is the essence of nursing and the dominant, distinctive and unifying feature of nursing. He viewed that Human Care varies among cultures and the expressions, processes and patterns should be selected by the nurse selects interventions from culture care preservation and maintenance; culture care accommodation, negotiation, or both and culture care restructuring and repatterning. 11 Roy’s theory (1979): Sister Callista Roy’s adaptation theory states that the client is an adaptive system and the goal of nursing is to help the person adapt to changes in physiological needs, self-concept, role function, interdependent relations during health and illness. According to Roy, the need for nursing care arises when the client cannot adapt to external and internal environmental demands. Roy viewed that all individuals should adapt themselves to 1.Meeting basic physiological needs 2.Developing a positive self-concept 3.Performing social roles 4.Achieving a balance between dependence and independence and the nurse determines the demand that cause problems for the client. She also assesses how well the client is adapting and helps him to adapt. 12.Watson’s theory (1979): Jean Watson’s philosophy or theory of transpersonal caring defined the outcome of nursing activity with reference to the humanistic aspects of life. Watson emphasized that the action of nursing is directed at understanding the relationship (interrelationship) between health, illness and human behavior. Watson’s model goes around the caring process, assisting clients in maintaining health or dying peacefully. This process for care requires the nurse to be aware of human behavior and responses to potential illness, needs and limitations. In general, caring refers to all the means the nurse uses to deliver health care to the client. 13.Benner and Wrubel’s theory (1989): The supremacy of care is stressed by the model proposed by Patricia Benner and Judith Wrubel. According to this model, care is central to nursing and caring creates coping the adverse situations of the client. In this theory care is defined as a connection; caring is that persons, events, projects and things matter to people; caring represents involvement. This model sees the personal concern as an inherent feature of nursing practice. Applications of these theories in practice depends on the awareness, understanding and research on their interrelationships. Theories are the fundamental foundations of the nursing practice. Nursing has its own body of knowledge which is theoretical and practical. The theory aspect reflects the basic values, guiding principles, elements and phases of a conception of nursing. Practical aspect of nursing is not organized as that of theory. Practical knowledge depends on nurse’s experience in providing patient care. The relationships of components in a theory serves to understand the concept of nursing. For example, the relationship of components within Orem’s self-care deficit theory has given scope to test new ways for their efficiency to improve patient care. This test approach to theories helps to determine how accurately a theory describes a concept. The theory test approach increases the data of knowledge which can be incorporated into the Nursing Practice. But it is the expert nurse who transports the art and science of nursing into the world of patient care. Thus, theories on nursing provide a know how to improve practice, guide research and nursing curriculum. There theories identify the goals of nursing practice. These theories are a set of concepts definitions and assumptions which have a common goal to describe, predict and prescribe. Nursing theories identify four components namely the person, health, environment and nursing as the major components of the profession. The impact of these theories on Current Nursing Practice Nursing has evolved with time right from the days of Florence Nightingale, the founder of modern nursing who saw the role of nursing as having “change of somebody’s health” based on the knowledge of “how to put the body in such a state to be free of disease or to recover from disease”. She developed the first organized programme for training nurses in London. She also analyzed statistically the conditions like sanitation influencing the disease out breaks like cholera. Her sanitary reforms brought down the mortality rate from 42.7% to 2.2% in 6 months in Barracks Hospital ,Turkey. The civil war in U.S.A and the world wars helped the evolution of nursing role further and Nurses began to take expanded and active practice roles. The early twentieth century saw the affiliation of nursing education with Universities and formation of Nursing organizations. The early twenty first century saw nursing as a profession with population changes, increased life span, new diseases like cancer and life style changes throwing new challenges on the profession. This opened avenues for new approaches to patient care and nursing practice. Thus today Nursing is a profession rather than a vocation. Nursing as a profession accounts for its conscientious, knowledgeable and responsible actions. The profession has extended education avenues, a body of knowledge leading to defined skills, an ability to provide specific service, professional autonomy to make decisions governed by a code of ethics. The theoretical models have served as frameworks for nursing curriculum and practice by increasing the scientific basis of nursing practice. Standards of Professional Performance: The American Nurses Association (ANA) standards of professional performance prescribes a competent level of behavior including quality of care, performance appraisal, education, collegiality, ethics, collaboration, research and resource utilization. Such standards assure the patients, a high quality nursing care. The standards of care are demonstrated by the nursing process of assessment, diagnosis, outcome identification, implementation and evaluation. Such standards of care are important in a society where there is maximum consumer awareness and legal hazards subsequently. Nursing Education: As a profession, nursing has built for its members a high level of academic excellence. There are various routes of education for becoming a professional ‘Registered Nurse’ (RN). In the United States of America, an associate degree or baccalaureate degree programmes enable the graduates to take up the National Council Licensee Examination for Registered Nurses (NCLEX-RN). The associate degree program is a 2 year program usually offered by a junior college or University. The programme emphasizes on the basic sciences of nursing practice. The baccalaureate program goes for 4 years. Masters of Arts in Nursing, Master in Nursing or Master of Science in Nursing are the avenues available in Master’s education. Doctoral programs in nursing (DNSc and PhDs) gives ample scope for research in nursing. Expanding clinical roles, new areas like nursing informatics are some of the reason for the need for doctoral candidates in nursing. Nursing profession is dynamic and ‘Continuing Education’ programs are needed to help nurses to update their skills, knowledge and theory. ‘In-service education programs also provide training and instruction to nurses to improve their competencies and skills. The Ne0 Professional Responsibilities and Roles of a Nurse Nursing profession today demands responsibilities than the past when the principle of a nurse was just to provide care and comfort. Changes in nursing have expanded the roles of a nurse including health promotion and disease prevention with patient’s care as the core element. The growing specialty treatments have a proportional need for a specialty trained nursing professionals. These specialty nursing professionals assist complicated surgeries working in coordination with the specialties Accountability: Accountability means that a nurse is responsible, professionally and legally for the nursing care provided. She is accountable for keeping competent in technical skills. In view of an increased patient awareness, this accountability factor gains great importance. Nursing practice is liable for six kinds of legal authority, viz, ‘The federal or central law’, ’The law of the state’, The international code of physicians’, ‘Institutional rules and regulations’, ‘Standing orders of the chief’ and ‘Precedent court decisions’. There are certain areas in medical practice which have important legal implications called legal hazards. Negligence about these legal hazards can bring about serious legal difficulties. With increased patient awareness of the health care delivery situations, media flare up and public opinions, nursing practice has become more accountable today and there is a radical departure from the traditional practice which draws upon the personal experiences, case studies and research of the physician and not the health care delivery system as a whole entity. Documentation is an important component of the nursing practice today. Documentation includes Advance directives: Advance directives’ are legal documents that specify a patient’s wishes before hospitalization and provide the necessary information for tough decision making situations. Thus, proper documentation of the ‘Advanced directives’ is a key function in medical care of the terminally ill patients and any negligence in this regard leads to litigations. The Advance directive is usually composed of Living will: Living will is a medical directive issued by an individual with sound mind. This documents treatment preferences and provides instructions of care. This is often accompanied by a ‘Proxy directive’. Proxy directive: This is the appointment and authorization of another individual to make medical directives on behalf of the person who created an advanced directive when he/she is no longer able to speak for himself/herself. This is known as Health Care Power of Attorney or ‘Durable Power of Attorney’. A code of practice under the new Mental Capacity Act for doctors and others who deal with people who cannot take decisions for themselves was issued recently in draft for consultation. The draft code applies to England and Wales. It sets out how patient capacity should be evaluated and how these advance directives on treatment will function and how treatment modes should be decided. The act is expected to be in force from 1 April 2007. Thus, failure to adhere to this advance documentation is a serious negligence. Assisted suicide is a criminal offence except in the state of Oregon, U.S.A where there is a statute legalizing physician assisted suicide. Every Health Care delivery center today provides a report to the patient on the details of the diagnosis of the disease with follow up instructions, the Medicine information and the allergy reactions that could follow; dietary restrictions, dos and don’ts, restrictions and exercises prescribed. They take an acknowledgement either from the patient or an authorized person after receiving the report. This documentation serves a key purpose in medical practice (Hackensack University Medical Center, 2006). Failure to provide this document makes the health care system answerable to unnecessary legal questions on what was and why was the treatment; why not a different treatment and a different procedure of treatment etc. Documentation of records of all treatments and medications, as well as a record of a patient’s reactions and behavior should be understood. The health record is the written and legal evidence of treatment. This reflects only facts and not the judgment of the nurse. Careful and accurate documentation is vital for patient welfare and that of the nurse. The use of electronic documentation is becoming increasingly prevalent .Documentation should include, medication administered, treatments done with date & time, factual, objective and complete data, with no blank spaces left in charting, on flow sheets or on check lists, calls made to health care team, client’s response, signature of the nurse in every entry and consent for treatment (Julia ,1998). Before any terminally ill person receives his chemotherapy or an invasive procedure, he or his health attorney should give a well documented informed consent. Informed consent means that tests, treatments and medications have been explained to the person, as well as outcomes, possible complications and alternative procedures. Autonomy: Autonomy is an element of nursing profession today. Autonomy means that a nurse is independent reasonably and self governing in making decisions in practice. There are independent measures a nurse can initiate without medical orders. Advocate: The nurse is a ‘client advocate’. She protects the human and legal rights of the patient under her care, based on his/her cultural and religious affiliations. Care giver: The nurse is a ‘Care Giver’ helping the patient regain health through the process of healing. Healing is not just curing of the illness, but a process that addresses the holistic health care needs of the patient including emotional, spiritual and social well being. Communication: The nurse is the pivot of all communications in the health care delivery system. Communication includes documentary communication for legal safe guards and also communication with patients and their families. The process of communication is vital to give effective care, take decisions, co-ordinate manage patient care, assist in rehabilitation and offer comfort. Educator: A nurse explains to her patients the concepts and facts of health, demonstrates health care and self care activities so that the patient understands the importance of these aspects of health care. She informally reinforces client behavior by simple conversations. She also instructs formally about medications and the action plan for recovery. This is especially true in cases which require insulin injections for diabetes, patients who learn to walk again after a fracture in leg etc. Manager: As a clinical decision maker, a nurse coordinates the activities of other members of the Health Care team like physiotherapists or nutrionists. The nurse takes these decisions alone or in collaboration with the patient or patient family on care aspects, evaluation of care results and the best approach for the desired result. Professional and Career Developments- a product of the evolution of Nursing practice. Changes in health care and practice settings have induced new roles for nurses. Hence there is a need for life long commitment for learning and career enhancement. Thus, a nurse’s career path is expanded and limitless. The new career roles include The Nurse Clinician: Most of the nurses have a goal to provide direct patient care. The nurse providing direct patient care account for the majority of nurses. As health care at home opportunities open up, the opportunities for direct patient care has increased. A clinical nurse provides a climate to promote health care. In a hospital, nurses may choose to practice in a medical surgical setting or concentrate on a more specific area of practice like emergency care. Specialty areas like oncology requires experience as a Medical surgical nurse and training updates. Intensive Care Unit (ICU) nurses require a sound training in advanced cardiac life support system. Advanced Practice Nurses: The Advanced Practice Nurse (APN) is generally the most independent nursing professional. An advanced practice nurse is a Master’s degree candidate in nursing, advanced education in pharmacology and physical assessment with a certification in the specialized area of practice (ANA, 1996). The APN can work in a primary acute or restorative care unit. An APN is a clinician educator, care manager, consultant and researcher in her area of expertise. The term Advanced Practice Nurse also denotes clinical nurse who can be nurse practioners, clinical nurse specialists, certified registered nurse anesthetists and nurse mid wives. Clinical Nurse Specialist: A Clinical nurse specialist (CNS) is a APN with nursing expertise in a specialized area of practice and traditionally in a hospital setting. The CNS can be a specialist in specific diseases like diabetes mellitus, cancer or cardiology, gerontology and other specific fields. Nurse Practioner: The nurse practioner works usually in an out patient, ambulatory or community based setting. They provide care for clients with complex problems, providing a more holistic approach, attending to symptoms of non-pathological conditions. The nurse may work with a specific group of patients or with clients of all ages and health care needs. The nurse practioner categories include adult, family, pediatric, obstetrics, gynecology and geriatric nursing. An adult nurse practioner (ANP) gives primary, ambulatory care to adults with a non emergent acute or chronic illness. They work in unison with primary care physicians. A family nurse practioner (FNP) provides primary ambulatory care for families under a family physician. The FNP manages illness of the family by direct care. A pediatric nurse (PNP) provides health care to infants, neonates and children. PNPs practice in hospitals, ambulatory care, emergency care and physician’s places. A Women’s Health Nurse Practioner (WHNP) provides primary ambulatory care to women seeking gynecological care. An acute care nurse practioner works in coordination with a doctor or house staff physician in an acute care unit. The acute care nurse is a generalist, based in internal medicine focusing on the care of the patient in acute care settings. A Geriatric nurse practioner (GNP) is an ANP with specialization in care of the older adult. GNPs are trained in the needs of old adults with emphasis on care on functional status. Certified Nurse-Midwife: A certified nurse midwife (CNM) is a Registered Nurse (RN) who is well trained in midwifery. The practice of nurse-midwifery involves independent care of women during pregnancy, labor and delivery. It involves (Pap) smears, family planning and treatment of minor vaginal infection. Certified Registered Nurse Anesthetist: A certified registered nurse anesthetist (CRNA) is a registered nurse who has training in anesthesiology. These nurses work under the supervision of an anesthesiologist providing surgical anesthesia under guidance. Nurse Educator: A nurse educator works in the school of nursing, departments of health care agencies and client education departments. Nurse educators should be experts in clinical practice to train students. Usually they have Masters degree in Nursing and additional qualifications including doctoral degrees. Nursing Administrator: A nurse administrator manages care and delivery of specific nursing services within a health care system. The position may be ‘the charge nurse’, the assistant nursing manager at the entry level and may lead to ‘nurse manager’ or ‘house supervisor’ at the middle level. At the upper level assistant or associate director or director of nursing services are the common positions. The nurse administrator requires at least a baccalaureate degree in nursing. Nurse Researcher: The researcher investigates various problems in nursing practice to improve care and define the scope of nursing practice. These nurse researchers work in Hospital, academic settings or community service agencies. Recent trends in nursing practice 1.Collaborative practice: The changing role of nurses as a significant members of the health care team has brought about radical change in Health Care delivery system. The nurse-physician collaborative model is a model which shows a radical shift from the past. In such a model, the health care organizational structure is decentralized and the nurses and physicians function collaborately to make clinical decisions. A joint practice committee, with equal representations functioning at the organizational level to monitor and support those professionals. The clinical records are integrated with joint patient care record views to foster collaboration. 2.Evidence based Practice: Evidence based practice is the conscientious, explicit and judicious use of current best evidence in making decisions about the case of individual patients . The practice of evidence-based medicine is the integration of individual clinical expertise with the best available external clinical evidence from systemic research. Individual clinical expertise is the proficiency and judgment that nurses acquire through clinical experience and practice. External clinical evidence is the relevant patient centered clinical research from the science of medicine. This includes the accuracy and precision of diagnostic tests, prognostic markers, therapeutic, rehabilitative and preventive regimens. External evidence sometimes replaces previously accepted treatments by virtue of accuracy and safety. Evidence based practice takes patient’s perspective also into account. Hence, evidence based practice involves a big process of question building and this process of question building takes into account Clinical findings, Aeotiology, Diagnosis, Prognosis, Therapy and Prevention of diseases. This question building process gives the idea on the most important question, the question which is encountered very often in practice and the question’s relevance very often in practice and the question’s relevance to the patient situation. Evidence based practice is probably best understood as a decision – making framework that facilitates complex decisions across different and sometimes conflicting groups. It involves considering research and other forms of evidence on a routine basis when making health care decisions. Such decisions include choice of treatment, tests or risk management for individual patients, as well as policy decisions for large groups and populations. At a broader level, evidence based practice works by providing a safe framework in which different groups can make tough decisions by safe guarding their concerns by a fair and scientifically sound process. There are essential differences between traditional and evidence based practice. Traditional practice has always drawn upon the personal experience, case studies and research of the physician. In evidence based medical practice, health care decisions are based on a structured organized process to help physicians, nurses and patients alike to choose the best health care options and their consequences. Thus, the basic idea of evidence-based practice is to create a process of life long, self directed, problem based learning for nurses in which caring for their own patients is the prime motive. This caring creates a need for clinically important information about diagnosis, prognosis, therapy and other health care issues. In this process of evidence based practice, the nurses convert this information into answerable questions, tracking down with maximum efficiency, the best evidences which can answer these questions, critically analyze them for clinical applications, apply them, integrate them with their clinical expertise and evaluate their own performance. Of course, the best evidences are based on the conviction that a systematic documenting of a large number of high quality RCTs (Randomized with Concealment, Double blended, complete follow-up, intention to treat analysis) gives the least biased estimate. Thus, this becomes level 1 evidence and recommendations based on level 1 evidence are Grade A. Various terminologies aid evidence based medical practice such as ‘Clinical practice guideline’ which assists the nurse practitioner and patient make decisions about appropriate health care and ‘Randomized controlled clinical trial’ where a group of patients is randomized into an experimental group and a control group. These groups are followed up for the variables and outcomes of interest. Nurses are under increasing pressure to keep up to date and to base their decisions more firmly on evidences as opposed to anecdotal information of the past. Patients are much more informed than they were 10 years ago. No nurse can tell a patient what to do without being questioned. The most important aspect of evidence based practice is that it has provided a fair, scientifically rigorous method for making best-practice decisions. This has ensured professional transparency and accountability. Evidence based practice does have limits. Absence of support structures for sustained evidence, lack of commitment to the process, insufficient evidence for too many problems do pose some challenges. But, evidence based practice provides a nursing practice with a stronger application of the scientific method .This also provides all groups involved in providing health care with a rigorous and acceptable frame work for making complex decisions, at a time when effective decision is badly needed. Future of Nursing Practice Nursing practice trends include a growing variety of employment settings where nurses have a greater autonomy and dignity. Nursing therapies are not only from traditional medicine but also expanding into alternative therapies. Any member of society has been ill, hospitalized or visited an emergency department knows nursing care. The ANA campaign note rightly says “Everybody needs a Nurse”. Works cited Patricia A Potter, Anne Griffin Perry, Fundamentals of Nursing, 6th edition, Mosby 2005 . Read More