Sketching the Future: Trends Influencing Nursing Informatics

Technologies emerging in the fields of telecommunications, video and digital imaging, and microprocessing are shaping the future of nursing practice. To measure up to the future needs of nursing, nurses of today must have the vision and desire to become computer aware and technologically literate. Hypothetical future situations pose challenges related to current nursing informatics and artificial intelligence issues. Discussion includes technology issues related to the lifetime clinical health record. Areas that the Center for Nursing Research considers priorities for informatics suggest directions for nursing technology efforts. This article calls on all nurses to become active in designing and molding future clinical practice systems.     

Women's health nursing in the context of the National Health Information Infrastructure

Nurses must be prepared to participate in the evolving National Health Information Infrastructure and the changes that will consequently occur in health care practice and documentation. Informatics technologies will be used to develop electronic health records with integrated decision support features that will likely lead to enhanced health care quality and safety. This paper provides a summary of the National Health Information Infrastructure and highlights electronic health records and decision support systems within the context of evidence-based practice. Activities at the Columbia University School of Nursing designed to prepare nurses with the necessary informatics competencies to practice in a National Health Information Infrastructure-enabled health care system are described. Data are presented from electronic (personal digital assistant) encounter logs used in our Women's Health Nurse Practitioner program to support evidence-based advanced practice nursing care. Implications for nursing practice, education, and research in the evolving National Health Information Infrastructure are discussed.     

Using technology to promote perinatal patient safety

Leaders in health care and national health policy recommend information technology information technology as a strategy to promote patient safety. Technology enables error prevention, surveillance, and analysis. Although there is little research about technology and safety in perinatal care, nurses in the specialty can use current evidence about the electronic health record, decision support systems, and medication safety devices to guide practice. This article includes key issues and general recommendations for the use of information technology to promote patient safety, the most common applications relevant to perinatal care, and strategies for perinatal nurses who implement information technology to promote patient safety.     

The 1990s: A Decade for Change in Women's Health Care Policy

As the 1990s usher in the era of reform, nurses and advocates for women's health must work together to elevate and integrate the concept of caring throughout the new health care system. Nurses must develop strategies to empower and educate women and communities to take charge of their health. To accomplish this, nurses must recognize the impact of health care policy on their profession and practice and activate their political power to make needed changes.     

The evolution of advanced practice nursing in the United States: caring for women and newborns

The evolution of advanced practice nurses to care for women and newborns has its roots in public health nursing of the latter decades of the 19th century. As we consider the challenges of practicing as advanced practice nurses in the 21st century, it is instructive to look back on 100 years of creating new programs and systems for delivering care. Such reflection helps us to clear our vision to imagine the future.     

Tensions and Teamwork in Nursing and Midwifery Relationships

Objective: To explore the practice of midwifery within a busy urban tertiary hospital birth setting and to present findings on the relationships between nurses and midwives in providing maternity care.
Design/Method: A focused ethnography on midwifery practice conducted over 2 years (2004-2006) in a teaching hospital serving a primarily Medicaid-eligible population in Northern California. Data were collected through participant observations and in-depth interviews with midwives ( N =11) and nurses ( N =14). Practices and relationships among the midwives and nurses were examined in an ethnographic framework through thematic analysis.
Findings: Two themes described the nature of nursing-midwifery relationships: tension and teamwork. Tension existed in philosophic approaches to care, definitions of safe practice, communication, and respect. Teamwork existed when the midwives and nurses worked in partnership with the woman to develop a plan of care. Changes were brought about to improve the midwife-nurse relationship during the conduct of the study.
Conclusions: Midwives and nurses experienced day-to-day challenges in providing optimal care for childbearing women. The power of effective teamwork was profound, as was the tension when communication broke down. Failure to include nurses resulted in impaired translation of evidence into practice. All stakeholders in birth practices and policy development must be involved in future research in order to develop effective maternity care models.     

Social Justice Considerations for Lesbian and Bisexual Women's Health Care

Lesbian and bisexual women share much with heterosexual women such as the desire to parent and the risk for partner violence. However, these women have unique risks associated with heavy alcohol use, smoking, obesity, and nulliparity. As nurses become increasingly aware of the need for social justice advocacy for marginalized groups, they are in a good position to advocate for lesbian and bisexual women and to bring visibility to their poor treatment in the health care setting.     

Health Care for Women

To provide optimum care to women, nurses need to understand some of the social, historical, and political factors that have influenced women and women's health care. Nurses, as consumers and providers of health care, play a central role in the women's health-care movement by providing education, support, and counseling. Although educational topics are vital, even more important is the way nurses communicate caring, support the woman in decision making, and mobilize available support persons. To provide women's health care, nurses must first do a nursing assessment, which involves gathering physiological, psychosocial, and cognitive data. A sample women's health-care assessment is outlined.     

Human genomics: challenges and opportunities

The pace of knowledge development related to genetics continues to progress exponentially. Knowledge gained through the Human Genome Project will have a profound impact on the practice of nursing, and the widespread integration of genetics into nursing education, clinical practice, and research will be essential. Many nurses continue to view genetic services as relegated to a specialist in a tertiary center and not relevant to their practice. This is certainly about to change. This article reviews the major implications of Human Genome Project for changing the landscape of health care and nursing, discusses several specific examples of genetic testing, and describes strategies under way to help prepare nurses to meet these new demands. Understanding new DNA-based genetic-testing technologies will be important for nurses as these tests become more available and nurses assist clients in the management of their genetic health. Nurses must become active participants in embracing the challenges and opportunities related to this genetic revolution, which over the next 5 to 10 years will reach nurses in every specialty and in every practice setting.     

Understanding Obesity in Women

Obesity is a complex health problem and, because of the incidence of obesity in women, a common concern for providers of women's health care. For many women, obesity becomes an obsession that leads to physiologic, psychologic, and social problems. To address the needs of the obese client better, nurses must acquire a comprehensive, research-based understanding of obesity. To develop a nursing care plan, the nurse must assess the client's diet history, level of motivation to effect a change in life-style, self-image, and self-esteem.     

A Nurse's Guide to Hormone Replacement Therapy

Menopause is a natural event most women experience as they enter their 5th decade. As human life expectancy has lengthened, health issues concerning women in mid-life have become a major focus in holistic, preventive health care, which is heavily influenced by nurses. Controversy continues about the risks and benefits of hormone replacement therapy for women during their years of perimenopause and postmenopause. Evidence is compiling, however, that indicates the benefits of exogenous hormones may outweigh these concerns. As nurses, we must have a current knowledge of hormone replacement therapy to counsel our patients effectively. This article presents information to assist the nurse in meeting this goal.     

浅谈我国社区护理产后访视工作

目的:社区护理为一门结合护理和公共卫生的实践,以促进和维持群体健康的一个专科护理。产后访视是社区护理工作的重要组成部分,其工作特点有连续性、综合性和协调性等。因为这些工作特点来阐述社区护理产后访视工作做到位还需要多方努力。方法:分析我国社区护理产后访视的现状,提出了如何做好社区护理产后访视的对策及建议。结论:通过提高护士的业务素质和职业道德,达到提高产后护理干预的质量。     

The health effects of diethylstilbestrol revisited

Although diethylstilbestrol has not been prescribed commonly for more than 25 years, its effects on the health of exposed persons are still important. In this article, we summarize current information about the major health effects of diethylstilbestrol exposure and delineate implications for nurses. Nurses can help to identify persons at risk from prior diethylstilbestrol exposure, facilitate comprehensive assessments of persons exposed to diethylstilbestrol, and share current information about diethylstilbestrol.     

Women's use of the Internet: what nurses need to know

Women increasingly access the Internet for health information and social support in managing health-related changes. Some women's use of the Internet has empowered them and created changes in nurse-patient relationships. Nurses and patients must have a mutually respectful open dialogue to develop individualized appropriate plans of care, and nurses should recognize that women who do not have Internet access may have different learning needs.     

The Pregnant Smoker: Nursing Implications

Evidence documents that smoking is especially detrimental to the unborn fetus and to the developing child. The reproductive risks associated with smoking are reviewed, and implications for nurses caring for the pregnant smoker are discussed. Strategies to assist patient smoking cessation efforts are outlined. Nurses must consider cigarette smoking in pregnancy to be as serious a risk factor to maternal and infant health as drugs and infectious diseases.     

Cultural Concepts of Women's Health and Health-Promoting Behaviors

Cultural diversity is the reality of the 1990s, and the United States is becoming the most ethnically diverse society in the world. The needs and responses of many different racial and ethnic groups are competing for recognition, and nurses must learn how to meet the health care needs of this multicultural society.
This article explores cultural concepts relating to women's health and health-promoting behaviors in the context of this social change. It explores demographic change, concepts of heritage consistency, traditional health beliefs, and traditional health-promoting behaviors.     

Malpractice and the neonatal intensive-care nurse

Perinatal nursing has become a specialty vulnerable to litigation, due to parents' high expectations of health care providers' ability to monitor for adverse events and intervene appropriately to prevent harm. When a neonate is injured during the perinatal period, a frequent response is to look for someone to blame. Neonatal nursing is considered a specialty area, requiring specialized knowledge and training. By adhering to recognized and accepted internal and external policies, neonatal nurses will uphold the standard of care set for their area of practice and avoid legal liability.     

Narrative Inquiry Into Nursing Care of Pregnant Women and Families in Specialized Fetal Diagnosis and Treatment Settings

ObjectiveTo examine how nurses describe caring for women and families in specialized fetal diagnosis and treatment settings.DesignWe used narrative inquiry.SettingA secure online survey platform.ParticipantsWe recruited 26 nurses from the Fetal Therapy Nurse Network as a subsample from a prior Delphi study on the essential structures, processes, outcomes, and challenges of nursing practice in the emerging field of fetal diagnosis and treatment.MethodsWe used narrative inquiry and Clandinin’s three-dimensional space narrative analysis to interpret the stories provided by participants to illustrate their practice and the relationship between their practice and care quality and health outcomes.ResultsParticipants described three primary types of fetal diagnoses and management scenarios: prenatal intervention (maternal–fetal surgery to treat a fetal anomaly), postnatal intervention (neonatal surgery), and perinatal palliative care (continuation of a pregnancy after a life-limiting fetal diagnosis). We identified three overarching themes related to nursing processes: A Sounding Board: Counseling the Pregnant Woman and Family, A Care Coordinator: Orchestrating a Complex Journey, and A Constant Presence: Being With the Pregnant Woman and Family. We also identified specific outcomes related to nursing care.ConclusionWe used narrative inquiry to expand on prior research and advance the conceptualization of a model of nursing practice in fetal diagnosis and treatment settings. Our results provide a basis to begin to test theories that connect nursing practice to care quality and outcomes in clinical practice settings. To comprehensively evaluate and enhance care as it evolves and expands, the immediate and long-term effects of nursing practice must be identified.     

Healing relationships with nature

Our health is intimately connected to the health of our environment. The contemporary world view which sees a radical distinction between humans as subjects and world as object can obscure our recognition of how much we rely on nature for health and survival. Indigenous traditions and contemporary scholars remind us that we live in a universe in which all things are connected, and in which nature continues to offer its gifts in co-creative partnership for the health and wellbeing of all. Living in awareness of our relationship with nature enables us to open more to the experience of nature's nurturing. Many complementary therapies derive from ancient practices that involve nature in healing partnership. As nurses and midwives we must learn to expand our boundaries to encompass the many ways that nature partners with us for healing.