Simulating care: technology-mediated learning in twenty-first century nursing education

PROBLEM. The increased reliance on simulation classrooms has proven successful in learning skills. Questions persist concerning the ability of technology‐driven robotic devices to form and cultivate caring behaviors, or sufficiently develop interactive nurse–client communication necessary in the context of nursing. METHODS. This article examines the disconnects created by use of simulation technology in nursing education, raising the question: “Can learning of caring‐as‐being, be facilitated in simulation classrooms?” FINDINGS. We propose that unless time is spent with human beings in the earliest stages of nursing education, transpersonal caring relationships do not have space to develop. Learning, crafting, and maturation of caring behaviors threatens to become a serendipitous event or is no longer perceived as an essential characteristic of nursing. CONCLUSIONS. Technology does not negate caring–the isolation it fosters makes transpersonal caring all the more important. We are called to create a new paradigm for nursing education that merges Nightingale's vision with technology's promise.     

Reducing health disparities in the twenty-first century: opportunities for nursing research

This article highlights selected components of the National Institute of Nursing Research's (NINR) Strategic Plan on Reducing Health Disparities. Building on its long history of supporting research devoted to improving minority health, NINR has expanded its opportunities and efforts related to health disparities and enhancing the research career development of minority investigators. Given the increased emphasis on reducing and, ultimately, eliminating health disparities, nurse researchers are encouraged to explore the various opportunities provided by NINR when addressing health inequalities.     

Antepartum care in the twenty-first century

Major factors impacting on antepartum care in the twenty-first century were reviewed in this article, including the impact of managed care and collaborative health care teams, the malpractice crisis, antepartum visits and the quality of care, increased use of the Internet and computer technology, the increasing age of childbearing, advances in genetic and prenatal diagnosis, the importance of evidence-based medicine, the goals of Healthy People 2010 [11], the Safe Mother Initiative, and the use of complementary and alternative medicine. Recommendations for antepartum care in the twenty-first century include; the formation of integrated collaborative health care teams to deal with the effects of managed care; development of a more sensitive health care system to assist all parties involved with medical malpractice; increased expertise in the use of the Internet and computer technology; acknowledging and preparing for the increased population of older gravidas; becoming aware of advances in genetic and prenatal diagnosis; increasing the ability to critically evaluate research and incorporate well-founded study findings into clinical practice; incorporating the goals of Healthy People 2010 [11] when providing care to antepartum patients; contributing resources and manpower to the Safe Mother Initiative to decrease maternal mortality in developing countries; becoming knowledgeable, obtaining adequate training, and utilizing or performing evidence-based studies to validate the use of complementary and alternative medicine in antepartum practice; and finally to find a balance between the factors impacting on prenatal care and the ability to continue to provide safe, high-quality, continuous, sensitive, and humane antepartum care.     

Intrapartum care in the twenty-first century

Women will continue seeking obstetrical care from nurses, midwives, and physicians throughout the twenty-first century. In many areas of the country, they will be able to find a midwife who will assist them in having a very personal birth experience. The ACNM remains committed to producing more midwives. More midwives may mean that practitioners educated in normal pregnancy will attend the vast majority of normal births, freeing physician colleagues to best use their skills and expertise in caring for women with medical and obstetrical problems. As most midwives are likely to continue working in hospital settings, those settings will continue to change, offering women more of the comforts and amenities of home. Home birth and water birth may continue to be available with midwives in attendance, though the forces of economics and insurers may restrict the availability of these options for women. Women desiring care in a birth center may find it difficult to locate one within a reasonable distance. The in-hospital "birthing suite", with a midwife in attendance, will be the most likely setting for the vast majority of midwifery attended births. A collection of more evidence through research will stir debate amongst health care providers. Increased access to that information will bring consumers into the debate as well. In the twenty-first century, information will be a very powerful force of change in obstetrical health care. In recent years, legal liability and economics have strongly influenced obstetrical practice. Though this may continue to be true, the impact of more evidence on which to base practice, and the new access that women have to that information, will undoubtedly affect the way care is delivered. A central slogan of the ACNM is "Listen to Women". That will happen more than ever in the twenty-first century. There will be more midwives, more evidence to support midwifery care, and more women learning that birth can and should be a personal, healthy, and empowering experience. These women will seek midwives who practice wisely, blending science with art and intuition. They will learn that the childbirth wisdom that has been passed down through the ages, from woman to midwife to healer to nurse and to midwife, again, delivers the birth experience back to the mother and the healthy baby to the world [3,7].     

Integrating psychiatric nursing into a baccalaureate nursing curriculum

Integrated nursing curricula are believed to carry the risk of diluting psychiatric nursing content and limiting nursing students' opportunities to gain skills in providing care for patients with psychiatric disorders, especially patients with severe mental illnesses. Also, there is fear that integrating psychiatric nursing into more broad nursing content will reduce students' interest in graduate psychiatric nursing study and thus endanger the specialty of psychiatric nursing. This report of a restructured baccalaureate nursing program that adopted the premise of holism—mental and physical health as united—presents a different view. Psychiatric nursing content was incorporated into classroom instruction over four semesters and, with the nursing theory of modeling and role-modeling as a guide, clinical experiences were planned for all students in primary, rehabilitative, or acute care settings. Psychiatric nursing did not disappear, as had been feared. It emerged less stigmatized, more accepted by the nonpsychiatric faculty, and enthusiastically received by the students. (J Am Psychiatr Nurses Assoc [2002]. 8, 152-8.)     

Frontiers of nursing in the twenty-first century: development of models and theories on the concept of nursing*

Theories and models on the concept of nursing are reviewed briefly and their contribution then assessed in terms of their potential to advance the scientific basis of nursing practice. The constructs are acknowledged to have moved the focus of nursing from disease to patient need and provided different ways of looking at the nurse's contribution. Yet, despite this advance, the constructs have not been put to the rigours of scientific testing and so remain at the level of speculation. Therefore, towards the developments for the twenty-first century it is proposed that these ideas should be put to the test to establish their relevance in the real world of nursing care. This requires: a framework from which the nature, extent and purpose of care can be specified; independent criteria which can be used to judge effectiveness of care; knowledge as it relates to the different and varied core concepts underlying the practice of nursing; and a working definition of need. In addition, the extent of care for the community needs to be made explicit through research. Together, this represents a challenge to develop theories which are logically related to single core concepts which themselves represent specific areas of actual nursing practice.     

Disease prevention and wellness in the twenty-first century

Primary care physicians should continue their efforts in disease prevention and also should expand their scope of service to support patients' interests in wellness and health optimization. Taking on this role will require additional time and continuing education, but by knowledgeably helping patients to maximize their health, physicians will provide a needed service, contribute to the health of their patients, and reap the rewards of a stronger doctor-patient bond.     

Hemophilia: treatment options in the twenty-first century

Summary.  In the last three decades, hemophilia has moved from the status of a neglected and often fatal hereditary disorder to that of a fully defined group of molecular-pathological entities for which safe and effective treatment is available. Hemophilia is likely to be the first widespread severe genetic condition to be cured by gene therapy in the third millennium. In the socio-economic arena it remains a challenge to humanity to know that four-fifths of the world's hemophiliacs still receive no treatment at all. Production of factor (F) VIII and IX in the milk of transgenic farmyard animals could provide a source of less expensive replacement therapy for developing countries. Affordable gene transfer will be the ultimate solution for hemophilia in the third world as in the first. Thus it may be confidently predicted that the early new millennium will see an end to this ancient scourge.     

展望21世纪的药物治疗

１引言 ２０世纪的治疗药物获得了令人瞩目的发展,特效药的发现,药物作用的细胞和分子机制的阐明,对药物药效学和药动学规律的了解,发现新药和评价药物的毒性方法等方面,远远超过２０世纪以前人类所有发现的总和。当今现代医学使用的药物,８０％以上的种类是在２０世纪发现的。即使有确切疗效的传统药,也多经过现代医学的加工以新的面孔出现。 ２０世纪以前的威胁人类健康的重大传染病,如天花、结核、霍乱和鼠疫,随着疫苗和抗生素的发现而得到了有效的控制。人类的寿命从而得到了明显的延长。细究其原因,是因为依托了现代的自然科…     

Preparation for the twenty-first century: the educational challenge

In this Presidential Address, I have presented 11 goals for our education programs that are essential to preparation for the twenty-first century. I strongly value the profession of physical therapy and the services we provide to this society. Most of all, I value our education programs and our academicians, without whose efforts none of us would be gathered here today. Early in this Address, I indicated my belief that our education programs have an awesome influence on this profession. But the goals proposed for the twenty-first century pose a challenge to all physical therapists. I make this challenge to academicians, clinical practitioners, educational institutions, and the APTA at all levels. It is imperative that we all join together to identify ways to support, strengthen, and improve our modes of professional education for the twenty-first century. We must do so in pursuit of the educational excellence that has been our consistent endeavor and hallmark for more than 68 years.