DOCUMENT RESUME ED 282 494 HE 020 321 TITLE Shifting Patterns of Nursing Practice: Impacton Nursing Education. Papers Presented at the 1986 Annual Meeting of the Southern Councilon Collegiate Education for Nursing (Atlanta, Georgia, October 28-30, 1986). INSTITUTION Southern Council on Collegiate Education for Nursing, Atlanta, GA.; Southern Regional Education Board, Atlanta, Ga. PUB DATE 87 NOTE 89p. AVAILABLE FROMSouthern Council on Collegiate Education for Nursing, 592 Tenth Street, NW, Atlanta, GA 30318-5790 ($6.50). PUB TYPE Collected Works Conference Proceedings (021) Viewpoints (120) EDRS PRICE MF01/PC04 Plus Postage. DESCRIPTORS Associate Degrees; Bachelors Degrees; Change Strategies; *Curriculum Development; Doctoral Programs; Educational Change; *Education Work Relationship; Geriatrics; *Graduate Study; *Health Services; Higher Education; Masters Programs; Medical Services; Nursing; *Nursing Education; OlderAdults; *Undergraduate Study ABSTRACT Changes in the delivery of health care services and their implications for nursing practice and nursing educationare discussed in nine papers from the 1986 annual meeting ofthe Southern Council on Collegiate Education for Nursing. Titles andauthors are as follows: "Changes in Health Care and Challenges for Nursing Education" (Jacquelyn S. Kinder); "Redesigning NursingEducation Curricula to Meet Changing Needs" (Verle Waters); "Redesigning Nursing Education Curricula to Meet Changing Needs: Implicationsfor Doctoral Programs" (Billye J. Brown); "Redesigning Nursing Education Curricula to Meet Changing Needs: Implications for Master'sPrograms" (Joan Farrell); "Redesigning Nursing Education Curriculato Meet Changing Needs: Implications for Bachelor's Programs" (MargaretL. McKevit); "Shifting Patterns of Nursing Practice:Impact on Associate Degree Nursing Education" (Margaret G. Opitz); "Theory-Based Nursing--The Foundation for Practice and Education: ANurse Administrator's View" (Sarah E. Allison); "Alternative Approachesto Care for the Elderly: What Nurses Need to Know" (Miriam K. Moss); and "Unity in Nursing--A Public Imperative" (VirginiaM. Jarratt). (SW) *********************************************************************** * Reproductions supplied by EDRS are the best that 6an be made * * from the original document. * *********************************************************************** U.S. DEPARTMENT OF EDUCATION Office of E tional Research and Improvement "PERMISSION TO REPRODUCE THIS EDUCIONAL RESOURCES INFORMATION MATERIAL HAS BEEN GRANTED BY CENTER (ERIC) is document has bean reproduced es received from the person or organization originating it. 0 Minor changes have been made to improve reproduction quality. Points of view or opinions stated in this docu- ment do not necessarily represent Official TO THE EDUCATIONAL RESOURCES OERI position or policy. INFORMATION CENTER (ERICV Shifting Patterns of Nursing Practice: ImpactonNursing Educafion Papers Presented at the 1986 Annual Meeting of the SOUTHERN COUNCIL ON COLLEGIATE EDUCATION FOR NURSING SOUTHERN COUNCIL ON COLLEGIATE EDUCATION FOR NURSING 592 Tenth Street, N.W. Atlanta, Georgia 30318-5790 1987 $6.50 FOREWORD The annual meeting, October 28-30, 1986,provided a forum for the Southern Council on Collegiate Education for Nursingto discuss changes in the deliveryof health care services and their implicationsfor nursing practice and nursing education.The Council, whose membership includes alllevels of college-based nursing education programs, addressed topicsof mutual concern to all of nursing education--such as the question raised by Verle Waterson a multiform vs a uniform system of nursing education, Sarah E. Allison's pleafor theory-based nursing as the foundation for both practice and education, and MiriamMoss's admonition that, "We do not assign students withouta good basis in pediatrics to an 8-year-old surgical patient. Why do we allow students to take responsibilityfor an 80-year-old surgical patient without such knowledge base in geriatrics?" In response to Verle Waters'paper on overall curricular concerns, speakers addressed specific considerations for associate degree,baccalaureate, master's, and doctoral education programs. Papers presented at the meetingare containee: in this publication. Audrey F. Spector Executive Director TABLE OF CONTENTS Page. FOREWORD iii CHANGES IN HEALTH CARE AND 1 CHALLENGES FOR NURSING EDUCATION Jacquelyn S. Kinder REDESIGNING NURSING EDUCATIONCURRICULA TO MEET CHANGING NEEDS 11 Verle Waters REDESIGNING NURSING EDUCATION CURRICULA TO MEET 23 CHANGING NEEDS: IMPLICATIONS FORDOCTORAL PROGRAMS Billye J. Brown REDESIGNING NURSING EDUCATIONCURRICU.A TO MEET 27 CHANGING NEEDS: IMPLICATIONS FORMASTER'S PROGRAMS Joan Farrell REDESIGNING NURSING EDUCATIONCURRICULA TO MEET 37 CHANGING NEEDS: IMPLICATIONSFOR BACHELOR'S PROGRAMS Margaret L. McKevit SHIFTING PATTERNS OF NURSINGPRACTICE: 43 IMPACT ON ASSOCIATE DEGREENURSING EDUCATION Margaret G. Opitz THEORY-BASED NURSING--THE FOUNDATIONFOR PRACTICE 55 AND EDUCATION: A NURSE ADMINISTRATOR'SVIEW Sarah E. Allison ALTERNATIVE APPROACHES TO CAREFOR THE 69 ELDERLY: WHAT NURSES NEED TO KNOW Miriam K. Moss UNITY IN NURSING--A PUBLIC IMPERATIVE Virginia M. 3arratt 79 CHANGES IN HEALTH CARE AND CHALLENGESFOR NURSING EDUCATION Jacquelyn S. Kinder President National League for Nursing Things have not been "businessas usual" in health care for some time now. The government is still extremely worried about soaring costsi health care; our rate of spending in the health sector isstill much higher than in othersectors of the economy. Although some policymakers claim we haven't accomplishedall that much in the way of controlling health costs throughDiagnostic Related Groupings (DRGs) (people like health economists Eli Ginzbergand Uwe Reinhardt claim that we're just shuffling the deck chairs), thenew DRG system of prospective payment, which ushered in a health care revolution severalyears ago, isstill proceeding at a breakneck speed. The extraordinary changes that have occurredsince the introdLction of DRGs have placed us on the verge of the evolution anddevelopment of a true healthcare marketplace. Wall Street has discovered healthcare and, in this DRG era, thousands of new health care businesses havesprung up on the stock exchange. Indeed the corporatism of healthcare is upon us, for better or worse. Health care decision makers' attention thesedays is focused on product line management, customer relations, and bottom lines.Productivity, profitability, and competition are driving the vectors of change inhealth care.The results are massive restructuring and rampant diversificationinto wellness centers, cardiac rehab ceniers, pizza parlors, hotels and motels,and even parking garages to buttress ailing profit margins in hospitals. There isnot a single hospital chain in the nation that is not involved in a business venture thai iscompletely unrelated to health care.The latest rage in venturesamong several of the for-profit chains is the insurance business.Hospital Corporation of America (HCA), inconjunction with Equitable, Humana, National Medical Enterprisesalllooked tothe insurance business as the great white hope for redeeming operatinglosses as a result of declines in the volume of in-patients. Such innovative revenue-enhancing tactics,say many industry observers, merely forestall the inevitable.Hospital occupancy nas suffereda permanent decline. According to a study conductedby the consulting firm of Arthur Andersen and Company and the American College ofHospital Administrators, hospitalswill continue to get a smaller share ofthe nation's health dollars.1 They'll receive only 38 cents of every dollar spenton medical care in 1985, compared with 42cents in 1982. The Andersen study also foundthat the number of hospitals ownedor run by hospital multisystems or chains has increasedfive percent in the past fiveyears. Today more than 35 percent ofhospitals are part of a health-caresystemnearly 15 percent of those are owned by for-profit chains.By 1995, the Andersen studysaid, most hospitals will be owned, leased,or managed by multihospital systems. Many others have forecast that a handful ofhospital chains in the nation willswallow up other providers, including home healthagencies, and that eventuallya few hospital chains will own and control all the free-standingagencies and independent enter- prises in the nation. I think itis becoming increasingly clear thatthis scenario won'tpan out. Anxious to diversify when their in-patientvolume took a nosedive post-DRGs,the powerful hospital management companiesare the best example of that foiled plan. Humana, for instance, is sufferinga major loss as a result of its foray into the insurance business. HCA, which was not quiteas aggressive, is not sufferingas great a loss but the new venture is not thegreat savior it was expected to be. In addition, as biomedical advancementsincrease, the physical hospital will likely be smaller because patients willbe able to function in their homesas lif e- support and maintenance technologiesare made more easily accessible to the average person.Under these circumstances the hospitalindustry may well shrink dramatically into second place, giving riseto home care as the major type of health care in this country. Home care is currently the most rapidlygrowing component of the health system and it is projected to grow atas rapid a rate in the future. This major trend is a result of thenew prospective payment system and the burst of activity in the homecare and community areas.Naturally,