NUR 3033

1. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 22
Future Issues in Nursing Theory

2. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in the Health Care System
• In the last two decades, there have been major shifts in
demographic patterns in the United States along with
significant changes in the health care delivery system.
• Implementation of the Affordable Care Act (ACA) has
contributed to the emphasis on health care financing,
community-based care, health promotion, and access to
care.
• Restructuring of health care services and growth in
integrated health care systems are anticipated.

3. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future of Nursing—Health Care
Challenges (IOM, 2011)
• Some challenges identified by the IOM
– Chronic conditions (e.g., diabetes, HTN, CVD)
– Aging population
– Diverse population
– Health disparities
– Limited English proficiency

4. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false:
One of the major challenges for the future health care
system address by the Institute of Medicine is health
disparities.

5. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Rationale: Many of the pending concerns and challenges for
the health care system involve the changing
demographics of the United States including growing
populations of minorities, many of which have poorer
health status.

6. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future of Nursing—Health Care Challenges
(IOM, 2011)—(cont.)
• Future health system
– Primary care and prevention are central drivers.
– Interprofessional collaboration and coordination are
the norm.
– Payment for services rewards value rather than
volume.
– Quality care is affordable for individuals and society.

7. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implications for Nurses
• Nurses must work to ensure access to care.
• Nurses must promote high-quality outcomes.
• Competencies include:
– Critical thinking and clinical judgment skills
– Ability to work in a variety of health care settings
– Effective organizational and teamwork skills
– Understanding of EBP
– Recognition of the influence of culture on health
– Commitment to personal accountability and
professional development

8. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in Nursing Science
• Nursing scholars believe nursing should emphasize the
benefits if inquiry per se rather than debating
methodology.
• Nursing science should eliminate obstacles to nursing
research and promote acceptance of multiple methods of
inquiry.
• Combining or triangulating research methods can
maximize the strengths and minimize weaknesses of
each method.
• Nursing should focus on use of research findings—
translation—into practice.

9. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in Nursing Theory
• Nurses should be exposed to relevant theories from a
wide range of fields including natural sciences, social
sciences, biologic sciences, and organizational and
management concepts.
• There is an emphasis on conducting research that will
produce knowledge to support practice.
• There has been a shift to application of “evidence” from
all health sciences (translational research).
• Middle range and situation-specific theories will grow in
importance.

10. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in Nursing Practice
• Increasingly, nurses are finding employment in non-acute
care settings.
• Nursing interventions will focus more on comprehensive
assessment and care planning, case management, health
promotion, and disease prevention.
• Nurses—particularly APNs—need to be prepared to
function in a community-based health care system.
• Related nursing models, theories, and concepts need to
be developed, studied, and refined.

11. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in Nursing Research
• Changes in health care delivery, health care financing,
and populations demography will affect nursing research.
• Technology, staffing patterns, quality, and scientific areas
such as genetics will need to be emphasized.
• Continued development of concepts and theories such as
transitions, quality of life, motivation, health promotion,
symptom management, palliative care, caregiver
support, vulnerability, and self-determination.
• Use of techniques such as meta-analysis and
triangulation to synthesize findings will be important.

12. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues in Nursing Leadership and
Management
• Growing attention will be on cost of health care,
challenges of managed care, health policy and regulation,
interdisciplinary education, nursing shortage, and
workforce development.
• Case management opportunities will lead to greater
levels of collaborative practice.
• Management of complex clients, particularly within the
implementation of the ACA, will be stressed.
• Competencies needed by managers include leadership
skills, financial/budgeting knowledge, communication
skills, understanding of technology, human resource skills
and team building.

13. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false:
One of the significant issues facing nursing in the future is
the need to consider the costs of health care and health
care delivery.

14. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Rationale: As demographics of the United States change,
with the population aging and greater percentages of
people from disadvantaged groups, health care costs will
rise. All health care providers (and consumers) will be
required to pay more attention to costs of health care
delivery than in the last few decades.

15. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues and Nursing Education
• Nursing education must focus on development and
promotion of critical thinking skills.
• Learning experiences must produce graduates with
competences needed for future practice.
• Content areas that need to be enhanced include
diversity, informatics, and EBP.
• Teaching strategies include greater emphasis on use of
distance learning, Internet course simulations, case
studies, active learning strategies, concept mapping,
computer-assisted instruction, and virtual reality
simulations.

16. Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Future Issues and Nursing Education
• Move to competency-based curricula and knowledge
management to promote interprofessional education
• Nursing education programs should stress essential
concepts, theories, and models rather than traditional
specialties.
• Models should incorporate high-tech care, EBP, and
patient safety.
• Curricula should be outcome driven.
• Students should be actively involved in learning.