Nursing profession today has the essential elements of accountability and autonomy meaning that a nurse is responsible, professionally and legally for the nursing care provided. Nursing practice is liable for six kinds of legal authority, viz, 'The federal or central law', 'The law of the state', 'The international code of physicians', 'Institutional rules and regulations', 'Standing orders of the chief' and 'Precedent court decisions'( Zwemer,1995). With increased patient awareness of the health care delivery situations, media flare up and public opinions, nursing practice has become more accountable today and there is a radical departure from the traditional practice which draws upon the personal experiences, case studies and research of the physician and not the health care delivery system as a whole entity. Autonomy means that a nurse is independent reasonably and self governing in making decisions in practice. The modern day nurse is a client advocate who protects the human and legal rights of the patient under her care, based on his/her cultural and religious affiliations. The nurse is a 'Care Giver' helping the patients regain health through the process of healing. The nurse is the pivot of all communications in the health care delivery system (Potter, 2005). Thus, an advance practice nurse is motivated to explore research evidence in practice towards establishment of a 1.Evidence based Practice.2.Collaborative Practice.3.Nursing Research and 4.Patient satisfaction by research in the professional life.
Nurse entrepreneurs are nurses who have control over and responsibility for an increased proportion of indirect processes of care in their roles. Nurse entrepreneurs have the capability to plan, organize, finance, operate their own businesses, and they work outside of an organization (Ieong, 2005). An advanced practice nurse entrepreneur is an individual who can identify a patient's need and find a way for nursing to respond to that need in an effective way, formulate and execute a plan to meet that need (Dayhoff et.al, 2003). Nurse entrepreneur has new opportunities in the world of business and need to assemble the resources necessary to successfully exploit that opportunity- money, people and organization (Allen, 2001). A professional nurse entrepreneur thinks globally, makes decisions by consensus, knows the business, thinks big, and conducts business using a business plan (Dayhoff et.al, 2002).Nurse entrepreneurship is one of the ways for nurses to increase their visibility, reclaim their power and direct their creativity and determination (Driscoll,1999). Today, nurse entrepreneurs have established themselves in various care specialties, like acute care, gerontology and home health. (Ieong, 2005). Excellent interpersonal skills, critical thinking skills, collaboration skills, and credibility are essential for a successful nurse entrepreneur. Nurse entrepreneurship is very rewarding with financial stability, freedom, flexibility, status, enhanced patient and professional satisfaction (Roggenkamp et.al, 1998).
The essence of postmodernism theme is that of an epochal shift, discontinuity, or rupture with modernity, bringing new social conditions and sociological principles with it (Baudrillard, 1988). Postmodernism views that the authority and status of the medical professionals does not exist anymore in the area of health care consistent with the postmodern message about the deconstruction of traditional centers of postindustrial authority (Cockerham et.al, 1997). For example, postmodern theorists advocate deinstitutionalization of the mentally ill in the United States (Pescosolido and Rubin 2000). A recent publication on fitness and the postmodern self has described how people can pursue physical fitness to achieve a degree of independence from the medical profession and avert risks to their health with a sense of self (Glassner, 1989). More recent postmodern literature (Varga,2005) analyze the physical body as a sacred object under conditions of hypermodernity and describe the rise of alternative forms of healthcare as a postmodern view of culture (McQuaide,2005). A postmodern literature in nursing elucidates three dialectical layers of a postmodern ethical cornerstone, namely, subjective immersion, objective detachment, and relational narrative. The move from immersion to detachment is a turn from communitarian to rational ethics in nursing practice, replacing traditions with post modern universal principles (Gadow, 1999).v
Problems pertaining to ?End-of ?life? care are on the rise especially when concepts of euthanasia and physician assisted deaths are trying to find legitimate positions in the society. The state of Oregon in U.S.A already has a legal backing and the bill introduced by Lord Joffe in U.K. parliament recently has stirred a chain of debates on the ethical aspects of assisted death of the terminally ill. The concepts of Palliative care and Hospice have primarily evolved only to meet the needs of these terminally ill patients (Potter, 2005). The Palliative care is the comprehensive care for patients, whose disease is not responsive to cure and hence, are terminally ill. Hospice is a coordinated programme of inter disciplinary care provided primarily in the home of the terminally ill patients. In the past two decades there has been a study of enormous magnitude in the care for dying and the studies have identified various aspects underlying the principles of care of the dying. These include, respecting patient?s goals, preferences and choices, attending to the medical, emotional, social and spiritual needs of the dying person, using strengths of interdisciplinary resources, acknowledging and addressing concerns and building mechanisms and systems of support (Potter, 2005). Many terminally ill patients suffer only when they do not receive adequate care for the symptoms accompanying their serious illness. Thus, the care for the dying should not be confined to the physical aliment but also the psychological and spiritual needs.
A woman abuse can be defined as any abuse of power that violates the rights of a woman by a socially unacceptable behavior and has a negative impact on the wellbeing of herself and her community. Psychology points to an evolutionary imbalance of power between men and women resulting in a situation where more than 90% of the victims of this power abuse are women. Women abuse occurs as physical, sexual, emotional, verbal, economic, intellectual and spiritual abuse. Due to the confidential and accessible service offered to the clients abused or battered women who frequently present with injuries both visible and non-visible are treated solely for their injuries and pass through the healthcare system unnoticed (Corbally, 2001). Research studies have explored in depth the role of expert nurses in care for such abused women and have shown that nurses play an important role in the restoration of physical and psychological health of these women.
In This Issue
Agency San Francisco
San Francisco, California
Charles L. Berman
Liz Di Bernardo