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By changing nothing, we hang on to what we understand, even if it is the bars of our own jail. ( John LeCarre, 1990)
Trends in nursing education and research cannot be isolated from the dynamics of nursing practice. Likewise, nursing trends are responsive to the projected changes in the delivery, organization, and financing of health care. The health care revolution occurring in the United States is spurred by the questionable effectiveness of the current system to provide access to basic health services in an efficient and cost-effective manner. Because of the lack of a unified federal and state health care policy that directs, monitors, and ensures the basic value of health, discussion about appropriate practice roles and an adequate supply of professionals is central in the health care industry. To address these concerns, immediate shifts in traditional activities may offer solutions by developing guidelines for the optimal size of the health care work force, thus providing the nature and structure of care that guarantees access to health care for all U.S. citizens. This chapter discusses the interrelatedness of nursing education, research, and practice. The various educational programs of the United States and Canada are presented in terms of their characteristics and the graduate’s nursing role in health care delivery. Research studies are described within the context of methodology and relationship to practice. This chapter also discusses trends that question nursing’s contribution to health care delivery from an educational or research perspective. Nursing as a scientific discipline and as a profession is an essential component of any delivery system that influences improved health outcomes. According to the American Nurses Association (ANA, 1995a):
Nursing has a single scope of practice that is dynamic and evolves with changes in the phenomenon of concern, knowledge about the effects of various interventions on patient or group outcomes, the political environment, legal conditions and demographic patterns in society. . . . Individual nurses engage in the total scope of nursing practice . . . dependent on their educational preparation, experience, role and the nature of the patient
populations they serve.
To produce beneficial results for the client (individual, family, group, or community), nurses must use scientific methods and other ways of knowing to measure the efficacy of interventions. Theoretical and researchbased understanding of phenomena (observable facts or events that can be perceived through the senses and are susceptible to description and explanation) will influence the quality of clinical decisions made by the nurse. It is within the framework of formal and accountable academic postsecondary education that these cognitive, attitudinal, and psychomotor skills are initially mastered.


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