Nursing practice is defined as an advanced level of clinical nursing that maximizes graduate education and expertise to meet patient needs. Characteristics include autonomous care, leadership, decision-making skills, and influencing health policy. The scope of nursing practice is regulated by each state and varies, but generally involves effective care delivery, research, and standards of practice. Nursing occurs in various settings like hospitals, schools, occupational health, telehealth, space, and more specialized areas like robotics and mobile services. Trends in nursing include total patient care models, evidence-based practice, electronic health records, hospice care, nursing informatics, and standardized terminologies.

1. TRENDS AND SCOPE IN
NURSING PRACTICE
PRESENTED BY:
TAJINDER KAUR
MSC NURSING 1ST YEAR

2. NURSING PRACTICE
DEFINITION: Nursing practice is an umbrella term
describe an advanced level of clinical nursing practice
that maximizes the use of graduate educational
preparation, in depth nursing knowledge and expertise
in meeting the health needs of the individual, family,
group and communities.

3. CHARACTERSTICS OF NURSING PRACTICE
 Provision of effective and efficient care, delivered with a high degree
of autonomy.
 Demonstrate of leadership and initiation of change to improve client,
organization and system outcomes.
 Demonstration of advanced judgment and decision making skills.
 Critical analysis of and influencing on health policy.
 Ability to explain and apply the theoretical, empirical, ethical and
experimental foundation of nursing practice

4. SCOPE IN NURSING PRACTICE
Nursing like other professions, is accountable for ensuring that its
members act in the public interest and provide the unique service that
has been designated to them by society. This process is called
professional regulation.
The profession of nursing regulates itself through defining practice,
establishing an educational system, providing research to further
develop the practice base and developing the standards of practice.
Since each state has legal authority for the regulation of nursing, the
definition and therefore the scope vary from state to state.

5. BACKGROUND:
The scope of practice is defined within a legislative regulatory
framework, and communication to others the roles and the
competences and the professional accountability of the nurse.
Nursing authority comes from evidence-based knowledge related to
its spheres of practice.
However nursing is also allied to other health professions through its
collaborating, referring and coordinating activities and thus has
distinctive as well as shared body of knowledge and practice.

6. BACKGROUND CONTD……
The nursing requires appropriate initial and ongoing
education and training as well as life long learning to
practice competently within their scope of practice.
To enable the profession to provide competent leadership.
The practice and competence of an individual nurse within
the legal scope of practice is influenced by education,
experience and expertise.

7. NURSING PRACTICE IN DIFFERENT SETTING
MOBILE NURSING SERVICES
MILITARY NURSING SERVICES
OCCUPATIONAL HEALTH SERVICES
SCHOOL HEATH SERVICES
THE NURSING ROBOT
SPACE NURSING SOCIETY
TELE-NURSING

8. MOBILE NURSING SERVICES
 In 1984 a need was seen to offer more extensive home health care for
local resistance who preferred to receive needed care n their own
homes.
 This enables many to reduce costs and remain in their homes at least
for a long period of time.
 The organization became known as mobile health care ltd. This was
the area’s first private home health care delivery system.
 It was the first to offer such services at all times of the day and
night.prevuiosly such care was delivered during business hours

9. MOBILE NURSING SERVICES CONT.…..
These services provides home teaching and care for patients with varied needs and
health problems.
- Patients discharged early from the hospital.
- Patient suffering from chronic and acute medical problems
- Surgical patients
- The elderly
- The seriously ill
- Hospice concept
- Ventilator dependent
- Assistance in bathing, dressing, meals, transportation, light and housekeeping.

10. MILITARY NURSING SERVICES
Military nursing has its origin from army nursing services formed in
1881part of royal army. The army nurses served in Flanders, the
Mediterranean, the Balkans, the Middle East and onboard hospital shifts.it
war on 1st Oct. 1926.
Rank structure: various rank in military nursing
o Lieutenant
o Captain
o Major
o Lieutenant colonel
o Colonel
o Brigadier
o Major general
o Commissioned officers

11. TELE- NURSING
DEFINITION: It is use of
telecommunication and
information technology for
providing nursing services in
health care whenever a large
physical distance exist
between patient and nurse
or between any number of
nursing.

12. APPLICATIONS OF TELE-NURSING
INFORMATION EXCHANGE BETWEEN HOSPITALS AND PHYSICIANS.
NETWORKING OF GROUP OF HOSPITALS,RESEARCH EVENTS.
LINKING RURAL HEALTH CLINICS TO CENTRAL HOSPITAL.
VIDEO CONFERENCING BETWEEN PATIENT AND NURSE.
TRAINING OF OTHER HEALTH CARE PROFESSIONALS.
INSTANT ACCESS TO MEDICAL KNOWLEGDE BASE,TECHNICAL PAPERS.
BETTER QUALITY CARE.

13. THE NURSING ROBOT
Development of a nursing robot system includes mobile robot system to help
physically handicapped people.
Completed in 1986 the nursing robot was one of the first fully functioning mobile
robots equipped with a manipulator arm also integrated were seven different sensor
systems.
The system controlled by four networked on board Sinclair spectrum computers and
an off-board IBM PC.
This document describes the features of the mobile nursing robot developed at the
technician.
The nursing robot system comprise of three major components: a self-propelled
vehicle, a robotic arm mounted on it, and a communications post next to the
disabled person’s bed.

14. DEFINITION OF OCCUPATINAL HEALTH
NURSING
According to the Canadian Occupational Health Nurses
Association
"... a registered nurse practicing in the specialty of
Occupational Health & Safety to deliver integrated
occupational health and safety services to individual workers
and worker populations. Occupational Health Nursing
encompasses the promotion, maintenance and restoration of
health, and the prevention of illness and injury."

15. OCCUPATIONAL HEALTH NURSING
Occupational health nurse activities:
Documentation of injury.
Observation and assessment of both the worker and work environment.
Interpretation and evaluation of worker’s medical and occupational history, subjective
complaints and physical examination along with any laboratory values.
Interpretation of medical diagnosis to workers and their employers.
Appraisal of the work environment for potential exposures.
Identification of abnormalities.
Description of workers response.

16. SCHOOL HEATH NURSING
DEFINITION OF SCHOOL HEALTH NURSE:
A school heath nurse is a qualified,
experienced professional and the only trained
nurse working across health and education
boundaries. They also provides link between
school, home and community.

17. ACTIVITIES OF SCHOOL HEALTH NURSING
 Heath assessment for children at entrance to school as required.
 Individual health interviews offered to young people aged 13-14
years.
Immunization programs.
Child protection.
 Heath education
Implementation of other school health services.

18. SPACE NURSING ASSOCIATION
Is an international space advocacy organization devoted to space
nursing and the contribution to space exploration by registered nurses.
 provides a forum for the discussion and exploration of issues related
to nursing in space.
The information being learned in the microgravity environment of
space has tremendous application for bed bound patient on earth.
If one were to consider the issue of confined spaces, closed ecological
systems with little personal space and psychological-social
interactions, there are many earth bound counterparts that could
benefit from what is being learned via space research.

20. TRENDS IN NURSING PRACTICE
Trends of nursing are closely tied to what is
happening to health care in general. Trends are
fascinating phenomena, but they do not exist in
vacuums one trend often spawns another.

21. Total care: It refers to assignments in which a
nurse assumes all the care for small group of
clients. This method focuses more on the client as
whole rather than the collection of nursing tasks
that need to be accomplished. It is often practiced
in the ICU.
Case method: This is the oldest models of nursing
care delivery where one nurse provided all the care
needed by a particular client. Although she would
accompany the client to the hospital if necessary.
She provides care in the home and did many
household duties. As time changed this model
became so very impractical

22. Health care informatics: The current erratic and
inconsistent use of paper records and
computers to document, store and retrieve
patient care information is undergoing a major
upheaval as federal initiatives promote the
development of uniform electronic health record.
An electronic health record is computerized record
of all the health information related to an
individual that can be electronically accessed by
variety of health care providers.

23. Evidence based practice: Nurses are faced with the
challenge of providing safe, effective care. One way to
achieve this goal is to provide evidence based practice.
Evidence based clinical practice is an approach to health in
which the clinician uses current research to help guide
client care decisions. The practice of evidence based care
means integrating individual clinical expertise with best
available from systemic records.
Hospice services: Hospice began in England. Hospice
means shelter for those on a difficult journey. These
services occur in clients home or in special facilities to the
terminally ill.

24. Nursing informatics: It is a nursing
specialty integrating nursing science,
computer science, information science in
identifying, collecting, processing and
managing data and information to support
nursing administration, research and
expansion of knowledge. Nursing
informatics studies the structure, and the
processing of nursing information to arrive at
clinical decision and to build systems to
support.

25. Standardized nursing terminologies: The demand of
current health care systems is challenging the nursing
profession Nursing has moved towards standardizing
nursing terminology. It is used to clearly define and
evaluate nursing care. They can promote continuity of
patient care and provide data can support credibility of
the profession.
ANA recognized nursing terminologies such as:
NANDA Nursing diagnoses definitions and classifications.
Nursing intervention classification (NIC).
Nursing outcomes classification (NOC).
Clinical care classification (CCC).
Systematized nomenclature of medicine clinical
terminology (SNOMED CT).

26. Primary nursing: Here an RN assumes 24
hrs. accountability for the client care and
for the nursing care of assigned client
during his or her shift. The advantage is
that the clients are assured of having a
care given who sees to all of his or
her need and who provides holistic
and comprehensive care.

27. Patient focused care: An updated version of
team nursing and primary care is called
patient focused care where an RN is partnered
with one or more assistive personnel to take
care of a group of clients. The RN may work
with an assistant, respiratory therapist. The
RN may have a role in resources management
and may be held accountable for outcomes of
nursing care such as skin breakdown or early
ambulation.

28. Ambulatory care centers: Some office settings
have broadened to include diagnostic and
treatment facilities such as laboratory,
radiology service, sometimes surgery. They
are often operated by large health care
systems such as corporation who has
hospital and other facilities. This type of
setting is popular because surgeries here
are not burdened with high built in cost
associated with the hospital settings.

29. Functional Nursing: It is a task oriented
model where distinct duties are assigned
to specific personnel for e.g. one takes
all the vital signs and other does all the
dressing and so on. Tasks are divided
and client sees several people during the
shift. Although efficient it fragments
care and is confusing to the client.

30. Team nursing: It emerged to
accommodate the staff with varying
level of education and skill. Here team
is made up of an RN team leader.
Other RN, LP‘s and nursing assistants
who provide care to group of clients.
The leader directs the care provided
by her juniors and works with them in
various capacities.

31. Quantification of nursing care cost: The
professions attention is thus focused on the
cost of providing nursing care to the patient
within the settings of prospective
reimbursement, fewer rupees, limited time
and reduced beds and staff. Quantification
of nursing contribution to patient care can
be used to determine the cost of providing
care to the specific patients. Quantifying
nursing time requires the identification of
the level of nursing care necessary for each
patient.

32. Reduced length of stay: The provision of
personalized can must be planned and
provided with the continuity as the quantity
of care time decreases. Many patients who
leave the hospital earlier are still in need of
health care. Hospitals are responding to this
need by creating transitional care
floors/beds, creating their own health
agencies or hiring hospital based co-
ordination to work with private home health
care agencies.

33. Increasing reliance on high technology: In the
hostile environment of a litigious society, the
practice of defensive medicine has resulted in
increased dependency on sophisticated
diagnostic technology and treatment
interventions. Several year ago high tech
became a trendy phrase, nurses expressed
concern that the patient was in danger of
being lost among tubes, monitors and
machine as complex technology became an
increasingly larger part of health care.

34. Need for collaboration and communication:
Interdepartmental communication and
collaboration may take the form of a
patient care conference. The nurse who
works as a liaison between health care
professionals incorporates information
obtained from these conferences into the
overall plan of care.

35. Innovation in planning care through
computerization: Many nurses believe that their
limited time can be better spent at bedside
giving patient care rather than filling out paper
work. Now a days institutions are using
computers which helps in maintaining digital
recording and reporting of the patient’s
documentation. Computerized system had a
favorable impact on process, as nurse may
quickly enter, display, update, evaluate and
print a plan of care, thus improving the quality
of record keeping.

36. Consumer orientation: The main goal of
nursing care is promotion of health,
prevention of illness, restoration of health
when illness ill occur. During care given to the
client nurse must be oriented to the client,
physical, emotional, spiritual, psychological
nature.
Ethical concern: It is important trend which is
growing among patients and nurses. Ethical
issues sprout when question arises as to who
is right and is right to prevail.

37. RESEARCH ARTICLE:
Advanced practice nurses' scope of practice: a qualitative study of
advanced clinical competencies.
Niemen AL, Mannevaara B, Fagerström L. advanced practice nurses’
scope of practice. The Authors. Scandinavian Journal of Caring
Sciences. 2011. (5-12-2013)
ABSTRACT:
AIM: To describe and explore Advanced Practice Nurses' clinical
competencies and how these are expressed in clinical practice.
BACKGROUND:
Discussion concerning advanced clinical practice has been ongoing
in the USA since the 1960s and in the UK since the late 1980s.
Approximately 24 countries, excluding the USA, have implemented
the role of Advance Practice Nurse (APN). In the Nordic countries,
especially Sweden and Finland, APNs have been introduced in some
organizations but their competency domains have not yet been
clearly defined.

38. METHODS:
Between October 2005 and January 2006, focus group
interviews of Clinical Nurse Specialists who provide
expert functions in pediatric, internal medicine, and
surgical units (n = 26) and APN students (n = 8) were
conducted. The data material was analyzed using
inductive content analysis.
FINDINGS: Grouped into five main themes, the study
results indicate that APNs possess advanced level
clinical competencies in: (A) assessment of patients'
caring needs and nursing care activities, (B) the caring
relationship, (C) multi-professional teamwork, (D)
development of competence and nursing care, and (E)
leadership in a learning and caring culture.

39. CONCLUSION:
Clinical competencies consist of advanced skills, which
typify an expanding role that offers new possibilities for
holistic patient care practice. APNs' scope of practice is
characterized by responsibility and competence in
making autonomous judgments based on expanded
clinical competence. On an advanced level, clinical
competence consists not merely of advanced skills for
assessing and meeting the needs of patients but also
the creation of safe and trustful relationships with
patients and collaboration with colleagues. APNs can
realize advanced skills in their actions through their
manner of knowing, doing, and being.

40. REFERENCE:
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Ansari J. Medical Surgical nursing. 3rd ed. Peeve publishers.
2013. p.1265-68
Ansari J. comprehensive Medical surgical nursing. Vol-1.
Peeve publishers. p. 9-10
 Khan S. Yaseen and Basheer. Shebeer.P. Text book of
Advanced Nursing Practice. 1st Ed. EMMESS medical
publishers. 2012. P.650-58
URL
http://www.medscape.com/viewarticle/466711.Assessed on
6-12-2013 URL http://www.

41. THANK YOU