Family Health Care Delivery for the 21st Century

Families are where individuals learn lifelong health attitudes and health behaviors. Factors are discussed that will shape the delivery of family health care into the 21 st century. Data on issues and trends from the past decade concerning demographic, economic, epidemiologic, and primary health care generate conclusions about family health care needs. Implications for family health care delivery, health policy, and research are discussed.     

Nursing and Genetics for the 21st Century

This article reviews basic information about the science of genetics and examines the new genetics. It explains the principles of cytogenetics and molecular genetics. Also included is information about genetic abnormalities and the different chromosomal defects that occur. The implications for nursing practice are delineated.     

Perinatal Health Care Policy: How it Will Affect the Family in the 21st Century

Demographic trends, pressures to reduce medical care costs and to improve access, biomedical research, and women's preferences for health care will result in many important changes in perinatal health care during the next 2 decades. These changes have the potential for influencing family structure and functioning. For example, the rates of teen-age pregnancy, unwanted or mistimed pregnancy, and infertility, with all their attendant adverse consequences, might be reduced.     

Back to the Future of Women's Health and Perinatal Nursing in the 21st Century

Trends in women's health and perinatal nursing practice in the 21st century can be projected through looking back at our profession's history. Highlighted in this preview of nursing's future are the societal influences predicted to promote the essence of professional practice, influence our educational processes, and guide our research investigations. Most important among these influences is that of ritual-busting nursing research, which is predicted to elucidate outcomes of practice and provide the groundwork for change. However, research-driven change endorses the shedding of an antiquated maternity nurse image and practice. A call is made for accountability, ethical thinking, and reciprocal nurse trust for professional survival in the future.     

Genetic-Based and Assisted Reproductive Technology of the 21st Century

The scientific advances of human genetics and assisted reproductive technology are redefining the concepts of health and illness by revealing the mysteries of the human genome and the process of conception, implantation, and diagnostic testing of the human embryo. The effect of these discoveries and their clinical applications will move from the tertiary to primary care arena through the ability to readily screen, diagnose, and treat some disorders and offer cure as the end result for others. In addition, the ethical, legal, and social issues, along with the attendant implications for professional practice, will need to be identified. Only a small portion of nurses have had to address the knowledge and practice issues associated with these advances. "Brave new families" are being created. Perinatal nurses must be prepared to meet the emerging needs of these families through the art and science of nursing.     

The Training of the Obstetrician—Gynaecologist for the 21st Century

EDITORIAL COMMENT: It is, perhaps, impertinent to precede an oration with a comment—but we are afraid that some readers may need encouragement to read the views expressed therein—these are opinions held by many but not carried before in the pages of this journal. What is wrong with specialist training?—do our patients' needs drive the engine, or the ambitions of the officers of the Colleges who direct our training programmes? The cost of ever increasing preregistration programmes affects everybody—ultimately the taxpayer, because the State must meet the impressive salaries now paid to consultants-in-training, especially in their senior years; although the inevitable overtime component of remuneration is a major factor, these extra hours worked do not compete with the extra time on duty the registered specialist will experience when he/she begins in full-time private practice. Is there a need for change?—are our plans for subspecialization properly drawn?—this oration directs our attention to many of these problems and suggests some possible solutions.     

The Changing Health Care Needs of Women: Clinical Specialists Take Heed!

The functions of patient education and patient advocacy for the clinical nurse specialist in women's health is discussed. It is noted that the sociocultural situation in which women seek health care has changed dramatically in recent years and that nurses should be able to relate to these changing attitudes.