21st century Nursing

The Scenario

Currently, the work of health industry leaders is the active and committed deconstruction of much of the infrastructure set up in the 20th century for health organizations.

The technology is moving at such a pace that by 2030, much of what was done inside hospital walls will be done in medical offices or clinics. The growing development of technology is mobilizing all healthcare and moving, presumably, to a reality far beyond what is being revealed.

Nursing Practice in this Context

Nursing practice in its current configurations and forms is dying as the demands of the health system are changing the service delivery model. This is the end that most nurses face today in various workplaces. Hospital work is increasingly impossible, as a crazed census of new activities, in unsustainable standards, becomes unmanageable. Nurses take on more of new tasks and activities in a mobile and fast service environment. They do all of this, maintaining their commitment to do everything they have done for patients, from a time when patients stayed around long enough to get it. Nurses run out at an accelerated rate as they become overwhelmed with the workload and continue to claim that there are not enough nurses to do so. On the other hand, the institutions continue to state that they are unable to increase the number of professionals and that there is no funding to sustain this demand.

In the 20th century, a large part of the nursing activity was related to “doing for” others. Most of the care activities were “advanced stage”. At this stage, people were already sick and needed to go through this experience, improve or accommodate their limitations.

Much of the frame of reference and content of education revolved around these changes and the clinical focus was on restoring or “fixing” the problem so that people could return to their lives.

In the 21st century, all the fundamentals of health care are being shaken. Technology is taking services to new heights: less invasive, short-term, with greater impact on duration and quality of life. This implies how the care processes will be treated and the techniques and technologies used to treat people. Now the question is: what will nursing be like in the 21st century?

We are moving towards “primary care services”, which have different bases and constructs for the service. Instead of an event-based, post-fact response, we will be able to anticipate the potential for change and address it while it is still a potential and not a reality. As is already evident, people do not need to stay long periods to receive the kind of care that nurses were so well known for.

In this context, the challenge for the skills of nursing practice is more related to the performance of access, information, guidance, teaching, counseling, technology and linking activities. Mental models and skill sets for this type of practice require a different focus on learning and practice that most nurses currently lack. Across the country, in the various situations in which nurses’ practice, it is customary to hear that nurses no longer have time to meet the growing demands for quality and safety practices. Related issues are written and discussed with great articulation. Less often, you see or read the growing awareness that what we have been able to do may be more and more in its terminal stages. Nurses are now at the beginning of a new paradigm for practice, but many are still unable to stop mourning the loss of what they were, and few are involved in discussions of what they could become.

Current System Configuration and the Primary Care Model
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