1. OVERALL CHARACTERISTICS
1. Some trends are subtle and slow to emerge; others are obvious and quickly emerge.
2. Trends may conflict; some will prevail, others get modified by social forces.
2. GENERAL TRENDS
1. Broadened focus of care—from care of ill to care of sick and healthy, from care of individual to care of family. Focus on prevention of illness, promotion of optimum level of health, holism.
2. Increasing scientific base—in biological-socialphysical sciences, not mere reliance on intuition, experience, and observation.
3. Increasingly complex technical skills and use of technologically advanced equipment, such as monitors and computers.
4. Increased independence in use of judgment, such as teaching nutrition in pregnancy and providing primary prenatal care.
5. New roles, such as nurse clinician, require advanced skills in a particular area of practice. Examples: psychiatric nurse consults with staff about problems; primary care nurse takes medical histories and does physical assessment; one nurse coordinates 24-hour care during hospital stay; independent nurse practitioner has her or his own office in community where clients come for care; case management.
6. Community nursing services rather than hospitalbased; needs of the healthy are served as well as those of the ill.
7. Development of nursing standards to reflect specific nursing functions and activities.
1. Ensure safe standard of care to clients and families.
2. Provide criteria to measure excellence and effectiveness of care.
3. TRENDS IN CARE OF CHILDBEARING FAMILY
1. Consumerism:
1. Consumer push for humanization and individualization of health care during the childbearing cycle to reflect client's role in decision making, preferences, and cultural diversity.
2. Emphasis on family-centered care (including father, siblings, grandparents).
3. Increase in options available for conduct of birth experience and setting for birth: birthing homes, alternative birth center (ABC) in hospitals; birthing chairs; side-lying position for birth; family-centered cesarean birth; healthcare provider (MD, RN, lay midwife); length of postpartum stay.
4. Increased consumer awareness of legal issues, client's rights.
5. Major nursing role: client advocate.
2. Social trends:
1. Alternative lifestyles of families—single parenthood, communal living, surrogate motherhood, marriages without children.
2. Earlier sexual experimentation—availability of assistance to emancipated minors.
3. Increase in number of older (>38 years) primiparas.
4. Legalization of abortion; availability to emancipated minors.
5. Smaller families.
6. Rising divorce rates.
3. Technologies:
1. Development of genetic and bioengineering techniques.
2. Development of prenatal diagnostic techniques, with options for management of each pregnancy.
3. In vitro fertilization and embryo transplantation.
4. TRENDS IN COMMUNITY MENTAL HEALTH (1960s–1990s)
1. Shift from institutional to community-based care.
2. Preventive services.
3. Consumer participation in planning and delivery of services.
4. Original 12 essential services (1975) reduced to 5 (indicated by asterisk [*]) (1981).
1. *24-hour inpatient care.
2. *Ambulatory care.
3. *Partial hospitalization (day or night).
4. Emergency care.
5. *Consultation and education.
6. Follow-up care.
7. Transitional services.
8. Services for children and adolescents.
9. Services for elderly.
10. *Screening services (courts).
11. Alcohol abuse services.
12. Drug abuse services.
5. Protecting human rights of persons in need of mental health care.
6. Developing an advocacy program for those who are chronically mentally ill.
7. Improving delivery of services to underserved and high-risk populations (e.g., minorities).
5. ANA STANDARDS OF CLINICAL NURSING PRACTICE*
1. Use of nursing process: assessment, nursing diagnosis, planning, implementation, evaluation, outcome identification.
2. Performance appraisal review.
3. Continuing education.
4. Collegiality; peer review.
5. Ethics.
6. Interdisciplinary collaboration.
7. Research.
8. Resource utilization—utilization of community health systems.
6. FOUR LEVELS OF NURSING PRACTICE
1. Promotion of health to increase level of wellness. Example: provide dietary information to reduce risks of coronary artery diseases.
2. Prevention of illness or injury. Example: immunizations.
3. Restoration of health. Example: teach how to change dressing, care for wound.
4. Consolation of dying—assist person to attain peaceful death.
7. FOUR COMPONENTS OF NURSING CARE
1. Nursing care activities—assist with basic needs, give medications and treatments; observe response and adaptation to illness and treatments; teach self-care; guide rehabilitation activities for daily living.
2. Case management—a process that includes coordination of total client care—all health team members should work together toward common goals.
3. Continuity of care—process of ensuring that ongoing physical, medical, and emotional health-care needs are assessed, planned for, and coordinated with all providers, for desired outcomes, without interruption of service when the location of care is transferred.
4. Evaluation of care—flexibility and responsiveness to changing needs: clients' reactions and perceptions of their needs.
8. THREE MAIN NURSING ROLES in relation to care of clients and their families (emphasis of each role varies with the situation, with adaptation of skills and modes of care as necessary)
1. Therapeutic role(instrumental). Function: work toward "cure" in acute setting.
2. Caring role(expressive). Function: provide support through human relations, show concern, demonstrate acceptance of differences.
3. Socializing role. Function: offer distractions and respite from focus on illness.

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* Adapted from the complete description in American Nurses Association: 2004 Nursing: Scope and Standards of Practice. Washington, DC, American Nurses Association, 2004. Reprinted with permission. (Rationale and assessment factors for the Standards of Clinical Nursing Practice are available from the American Nurses Association.)