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Nursing Changes: Focus Shifts to Caring for the Whole Patient


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By E’Louise Ondash, RN, contributor

It's said that nothing is constant except change, and that is definitely true when it comes to the profession of nursing. Science, medicine and how we deliver health care is changing every day, causing a number of nursing changes.

“Traditionally nurses weren’t trained in how to change quickly,” said Paula Roe, BSN, MBA/HCM, FACHE, a senior consultant at Simpler Consulting. “But today, nurses must be adaptive and quick responders.“

As an example, Roe, a 30-year veteran of bedside nursing and nurse leadership roles, said she remembers the early 1980s when there was a move toward highly specialized nursing care. She was critical care nurse and was trained to focus on an acute event rather than thinking about managing the patient throughout the life span.

The emphasis today is different; caring for the whole patient is now the name of the game.

“Today, we are moving away from focusing on episodic events in the inpatient environment, and are now having to look at the whole patient,” she explained. “At every checkpoint, we have to make sure they are receiving everything they need. We have to see if they have a gap in their wellness needs.”

In the past, acute care nurses never gave thought to an adult patient’s vaccination needs, because this was considered the realm and responsibility of the outpatient nurse. Now, however, nurses at every stage must be accountable for preventable aspects of patients’ care--both mental and physical.

That means that hospital nurses in various units may be called upon to check on whether adult patients have had all the appropriate vaccinations, tests and follow-up care.

This practice of caring for the whole patient means nurses must not only understand the physical needs of those in their care, but the psychosocial needs, as well.

An article in the June/July issue of AARP The Magazine profiled several families to illustrate how the definition of the family in this country has changed in recent decades. It pointed out that today’s family units include blended families, interracial families, single parents, parents raising adult children with disabilities, families with adoptees, gay and transgender couples, multigenerational households, older people sharing living arrangements and immigrant families.

Only 20 percent of children today are growing up in families that consist of two married parents with traditional roles, according to the AARP authors, and although the divorce rate has gone down within generations X and Y, the rate of divorce among baby boomers has increased 50 percent in the last 20 years.

These changing families have led to a need for nursing changes, as well.

Nurses must be aware that our perceptions of the “average family” may be out of date, and never assume anything about patients’ social situations. Understanding these new family units is important when it’s time to plot long-term care health plans, especially for the chronically ill, because the plans always involve families--whatever the structure.

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