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For the rapidly growing older adult population, disaster consequences are frequently life disruptive and even life threatening. By 2050, it is estimated that the global older adult population will reach 22 percent of the total. With declining health, this population poses a particular risk needing to be addressed in emergency preparedness and disaster recovery. The purpose of this article is to describe a Flex-Model (F-M) for the long-term assessment of older adults following a disaster. An F-M is a series of three-dimensional representations of an archetype with flexible components, both linear and parallel, that can be adapted to situations, time, place, and needs. The model incorporates the Life Patterns Model and provides a template that can be adjusted to meet the needs of a local community, healthcare providers, and emergency management officials, regardless of the country or region, during the months after a disaster. The focus is on changes resulting from the disaster including roles, relationships, support systems, use of time, self-esteem, and life structure. Following a baseline assessment, each of these life patterns is assessed through the model with options for interventions over time. A pilot study was conducted in Georgia to gain information that would be helpful in developing a more specific assessment tool following a severe winter storm. While this is a local study, the findings can nevertheless be used to refine and focus the F-M for future implementation. Results indicated that older adults used high-risk heating and lighting sources and many were totally responsible for their own welfare. Findings have implications for emergency preparedness and long-term recovery.

Background and Purpose: To develop, test, and establish the validity and reliability of 4 instruments to evaluate perceptions of paired patients and patient-identified significant others to assess the impact of continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDII) on diabetes management and lifestyle. Methods: Sociotechnical systems theory and the life patterns model framed the study. Four parallel survey instruments (patient CSII and MDII and significant other CSII and MDII) were developed to elicit demographic information and perceptions concerning CSII and MDII. Results: Validity and reliability were established. Conclusions: The instruments developed for this study could be adapted or used as templates in management approach impact studies of other chronic diseases. The study should be replicated with a different geographic sample.Keywords: diabetes management; continuous subcutaneous insulin infusion (CSII); multiple daily insulin injections (MDII); perceptionsDiabetes mellitus (DM) is the seventh leading cause of death and disability in the United States, costing approximately $174 billion annually (Cauchi, Mason, Chung, Thangasamy, 2011; Centers for Disease Control and Prevention, 2011). In 2010, 10.9 million Americans age 65 years and older had either diagnosed or undiagnosed DM, comprising 26.9% of this age group and the highest percentage of any age group (Centers for Disease Control and Prevention, 2011). Diabetes is a growing national health care crisis. Older adults are particularly at risk and developing viable insulin management approaches is paramount.BACKGROUND AND CONCEPTUAL FRAMEWORKManagement of DM is a critical issue in health care systems worldwide. The World Health Organization (WHO, 2011) estimated that 346 million people had DM in 2011 and that 3.4 million people died in 2004 from the consequences of elevated glucose levels. More than 80% of DM-related deaths occur in low- and middle-income countries where deaths from DM are projected to double by 2030 (WHO, 2011).Current management recommendations target levels of blood glucose control in both Type 1 and Type 2 DM that will result in glycosylated hemoglobin (HA1c) levels of 7% (53 mmol/mol) or lower (Golden et al., 2012; Holmann et al., 2009; Koro, Bowlin, Bourgeois, & Fedder, 2004). Two years after initiation of insulin therapy (but not "intensive diabetes management" [IDM]), however, HA1c levels exceed 8% (64 mmol/mol) in more than 60% of patients with Type 2 DM (Koro et al., 2004) and more than a third of IDM patients using multiple daily insulin injections (MDII) fail to achieve the 7% (53 mmol/ mol) goal (Holmann et al., 2009). IDM can nevertheless improve overall health status in DM, prevent or delay complications, and reduce health care costs. IDM using intensive insulin therapy includes either MDII or continuous subcutaneous insulin infusion (CSII). The goals of both techniques are to achieve and maintain near normal blood glucose levels, avoid short-term crises such as hypoglycemia, minimize long-term complications, and improve patient quality of life. In 2012, the Agency for Healthcare Research and Quality's Comparative Effectiveness Review Number 57 reported thatintensive insulin therapy can be individualized to patient preference that will maximize . . . quality of life, as both CSII and MDII have similar effectiveness on glycemic control and severe hypoglycemia, except in adults with Type 1 Diabetes where, however, CSII had a favorable effect on HgbA1c. (Golden et al., 2012, para. 5)IDM is being used successfully in the U.S. and globally. In 2010, Medical Technology Business Europe (2010) valued the global insulin pump market at more than $586 million, projecting a growth rate of 9% into 2016 fueled by DM's increasing prevalence, recognition of nearly 4 million annual diabetes-related deaths, and increasing recognition of the technology's value. Increasing general physician interest in technology, coupled with increasing patient desire to improve DM control and health-related quality of life, is positively impacting CSII use (Renard, 2010). …

Purpose To investigate impacts of multiple daily insulin injections (MDII) and continuous subcutaneous insulin infusion (CSII) on disease management and patient lifestyle by patients and significant others (SOs). Hypotheses Older patients (>50 years) and their SOs will perceive differences in satisfaction between CSII and MDII impact on diabetes management and lifestyle. Methods Patient and paired SO completed parallel instruments framed by sociotechnical systems theory and the life patterns model. Alpha = .901–.940. Results Whites reported greater satisfaction with CSII and non-Whites with MDII. Both reported increased independence. CSII scored significantly higher than MDII. Age did not reduce positive impacts. CSII enhanced independence of SOs but 38.6% of SOs did not know how to suspend CSII for hypoglycemia; 47.3% of patients believed SOs would not know. Conclusions Neither age nor diabetes type contraindicate using CSII in older patients. CSII is perceived more impactful on disease management and lifestyle. Education of SOs needs emphasis.

Moving to a retirement community involves a major life transition that requires adjustment to a new way of life. The purpose of this study was to develop a tool to assess the psychosocial adjustment of residents. Using the Life Patterns Model as a conceptual framework, residents of 3 retirement communities (n = 240 residents) were surveyed. Median ages were ∼84 years, Nearly 85% (202) reported that they feel good about themselves and most (92.5%; n = 221) have things to do that they enjoy. Health status was strongly associated with having nearby relatives (rs = -.232, p > .000, n = 239). A factor analysis supported the use of the conceptual framework. Findings indicate that the tool can used for the designed purpose.

International migration has doubled worldwide since 1970, and nurses are increasingly becoming a part of this trend. In 2008, approximately 5.6% of RN positions were filled by nurses educated in other countries. One of the critical issues is the transition of these immigrated nurses to the U.S. health care system and acculturation in a new society. Continuing education is necessary to promote adjustment and provide for a successful transition while ensuring quality patient care. The life patterns model provides a framework to describe the challenges and potential mediators in the transition process. J Contin Educ Nurs. 2017;48(3):139–144.

Citation: Rosenkoetter, M., (May 31, 2016) "Overview and Summary: Organizational Outcomes for Providers and Patients" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 2, Overview and Summary.DOI: 10.3912/OJIN.Vol21No02ManOSThe Commonwealth Fund (2014) reported that while the United States (US) has the most expensive healthcare system among 11 industrialized countries, it ranked last on "measures of health system quality, efficiency, access to care, equity, and healthy lives" (para.1). While we have a substantial investment in healthcare, there continues to be a deficient in attainable outcomes. The Patient Protection and Affordable Care Act (ACA) (Kaiser Family Foundation, 2013), was signed into law on March 23, 2010 by President Obama as a comprehensive health reform law. It was intended to "expand healthcare coverage, control healthcare costs, and improve healthcare delivery system[s]" (p. 1). Controversy continues regarding whether the outcomes of this law have actually achieved the goals and the original purpose. In this election year, the law has become fodder for considerable debate, with some Republicans pushing for its repeal. The outcome of the Presidential and Congressional elections may well determine the law's future.At the same time, total healthcare costs in the US are expected to be $4.8 trillion in 2021. Healthcare spending was nearly $2.6 trillion in 2010 and half of this was to pay the cost of medical services by hospitals and physicians (Aetna, 2016). Many Americans continue to lack health insurance, experience rising healthcare costs, and have difficulty paying for healthcare needs (Consumer Reports. 2014). With healthcare costs rising, accountability and measuring the actual outcomes of care provided has greater emphasis. The ACA includes a provision to "allow providers organized as accountable care organizations (ACOs) that voluntarily meet quality thresholds to share in the cost savings...[and] ...must agree to be accountable for the overall care of their Medicare beneficiaries." (Kaiser Family Foundation, 2013, section 11). This implies that sufficient data must be compiled to document outcomes.Two other current concerns are the number of preventable adverse events that occur in hospitals and premature deaths associated with preventable harm. James (2013) estimated this number between 210,000 and 400,000 per year, depending on the completeness of medical records and the search technology. Given the ramifications and potential repercussions of these events, it is plausible to assume that some are not reported and hence, accurate outcomes are unknown. Greater involvement in their healthcare decisions by patients and families is indicated, with greater attention to outcomes that they perceive have caused "harm" as well as how nursing care at the individual and team level can impact those outcomes.Over the past decade, technology has increasingly changed both healthcare delivery and outcome measurement. Electronic medical records, medication distribution systems, online patient record systems, and sophisticated diagnostic technology have grown exponentially. Technology has not only facilitated accuracy but many patients now have full access to their healthcare records. Patients themselves are better able to judge the effectiveness of their care and determine which of many alternatives they wish to pursue. It is the responsibility of healthcare providers to make the information available so patients, and their families, can make informed decisions. Concepts such as telehealth and eHealth will continue to grow; with this growth is the concomitant need to measure the effectiveness of these new approaches and protect privacy while providing quality care. Telemedicine can impact cost effectiveness, reach remote patients, monitor patients in home settings, facilitate physician consultations, reduce travel, and provide rural healthcare providers with access to specialty care (American Telemedicine Association, 2015; California Telehealth Resource Center, n. …

University of California, San Francisco, San Francisco, CA, USA Pierce and Associates Nursing Consultants, Knoxville, TN, USA Georgia Health Sciences University, Augusta, GA, USA University of Medicine and Dentistry of New Jersey, Newark, NJ, USA Brigham Young University, Provo, UT, USA California State University, Northridge, CA, USA Vanderbilt University, Nashville, TN, USA University of Toledo, Toledo, OH, USA University of St. Francis, Joliet, IL, USA University of Delaware, Newark, DE, USA

No published studies assess the knowledge of staff nurses regarding intravenous connectors, yet connectors remain a primary cause of infection and mortality. Anonymous survey (N = 100) in acute hospitals revealed 78% of nurses were uninformed about different connector types and their different care and 43% could not name two complications of connectors. No significant relationship was found between education (r = 0.121, p < 0.05) or nursing specialty (r =-0.059, p < 0.05) and identifying types of connectors. Sixty-four per cent were involved in 5—6 hours of intravenous therapy and maintenance per 12-hour shift, hence connector care is significant. Education about connectors has implications for nursing associated with catheter-related bloodstream infections, occlusion and thrombosis. The Centers for Disease Control includes catheter-related bloodstream infections as a worldwide priority. This study identified a significant need for further nursing education and research regarding the types, maintenance and care of intravenous connectors.

A technology-driven generation of students expects faculty to use innovative and interactive approaches to teaching. To address this issue, the authors discuss their use of one classroom participation system, the i>Clicker, and student outcomes.

Vascular access devices (VAD) represent high technology and are used frequently in infant, pediatric, adult, and geriatric populations for vascular infusion of chemotherapy, immunotherapy, blood products, biologic response modifiers, nutrition support, analgesics, ionotropics, antibiotics, and other medications, as well as for extraction of pleural fluid from patients with chronic effusions and for treatment with dialysis. Increasingly, these devices are migrating to the home setting as they are used in chronic care and as insurance requirements reduce access to prolonged hospital stays. Surveillance of infections in high risk patients such as those with cancer, cardiac conditions, or post-trauma convalescence is essential to avoid adverse events and to offer early treatment. VAD site and blood stream infections are common VAD complications, occurring in up to 50% of home care patients, usually during days 4–25 after hospital discharge. Our literature search for reports of remote home monitoring for support of VAD patients and their caregivers found none. The use of videoconferencing technology to assess VAD sites in the post-discharge environment would significantly enhance patient safety, facilitate continuity of care, and meet the Communicable Disease Center's stated need for the development of surveillance systems to monitor infections in home care settings. Low-cost Internet- or telephone-based videoconferencing technology that could be deployed easily and used during risk periods would be highly beneficial to patients and increase the cost-effective use of homecare nursing personnel. We report criteria-based protocols for remote assessment of VAD status, for monitoring VAD care procedures employed in the home, and for conducting VAD-care teaching of patients and their caregivers. In addition, we report an initial evaluation of the ability to assess VAD status using low-end videoconferencing technologies.

Medication errors occur frequently in hospital settings, creating harmful consequences for patients and families, as well as tremendous financial losses. “Smart pump” technology is one means by which these errors can be reduced. The study reported here is a part of a three phase study and focused on the perceptions of nurses (n=512) in a tertiary care hospital regarding the impact of the implementation of “smart pump” technology and its impact on nursing care provided, medication errors, and job satisfaction. Sociotechnical System Theory and the Life Patterns Model were used to frame the study. The Infusion System Perception Scale was used to assess demographic information, and perceptions of nurses on a 30-item five-point Likert scale. Results indicate that nurses perceived the “pump” increased safe medication administration, did not decrease the perception of the punitive nature of reporting medication errors and did not increase the nurse's workload, but did make routines easier. The “pump” was perceived to increase self-confidence but had no effect on use of the pharmacy staff. Findings suggest that the “pump” could be implemented in a variety of settings, regardless of the age, gender, and educational background of the nurses. The “pump” offers an effective approach to the reduction of intravenous medication errors.

This article describes an exploratory study designed to compare the characteristics, evacuation beliefs, risk factors, and health problems of older adults living in two Georgia counties and three North Carolina counties regarding willingness to evacuate in the event of a natural disaster. More than 75% of men and women in this study listened to news about Hurricane Katrina, yet one third of the men said that they may or would not evacuate. In this study, being influenced by the outcomes of Hurricane Katrina and belief in following the advice of county officials were the only two statistically significant predictors of evacuation tendency.

The American Academy of Nursing's (AAN) Expert Panel on Global Health's white paper examines critical issues in the international nursing arena, including the global shortage of nurses, legal and ethical issues in recruiting international students for nursing positions in developed countries, the nurse faculty shortage, faculty and student exchanges, effects of the U.S. Citizenship and Immigration Services law, and laws governing nursing practice within the public domain. Realistic models directed toward viable solutions to these issues are critically needed. It offers 13 recommendations to address issues from a global perspective, including hosting a conference on global nursing, health research, and faculty exchanges; annual meetings; and an international conference of world nurse leaders, the AAN, and Global Panel representatives to discuss this white paper and plan follow-up actions. The final white paper was approved by the AAN in 2005 and is published here to stimulate discussion regarding current and future initiatives.

Objectives: To investigate the evacuation needs and beliefs of older adults in 2 counties in Georgia; to identify health risk factors; and to provide public health and emergency management officials with planning information. Design: A descriptive survey using The Older Adult Disaster Evacuation Assessment. Sample: 139 lower socioeconomic participants at congregate meal sites. Results: Hurricane Katrina significantly influenced decisions to evacuate in disasters. Over 70% said they would definitely evacuate in the future and nearly 16% would probably evacuate, yet over 13% reported "maybe" or "no." Multiple logistic regressions suggest that those who do not trust their TV and county officials' information would have only 1/4 the odds of definitely evacuating. Those who say they would not follow their county officials' advice have only 1/3 the odds of definitely evacuating. Primary health problems were decreased mobility (40.1%), hypertension (70.5%), and arthritis (53.2%). Forty-six percent would need transportation; approximately 40% lived alone; and about 40% had fair or poor health. Conclusions: Trust and belief in county officials and the media were the best predictors of willingness to evacuate. Participants in this study would need assistance with transportation, preparation, and support for serious health problems in order to evacuate. Further study is needed with a larger, more representative sample. Language: en

For the rapidly growing older adult population, disaster consequences are frequently life disruptive and even life threatening. By 2050, it is estimated that the global older adult population will reach 22 percent of the total. With declining health, this population poses a particular risk needing to be addressed in emergency preparedness and disaster recovery. The purpose of this article is to describe a Flex-Model (F-M) for the long-term assessment of older adults following a disaster. An F-M is a series of three-dimensional representations of an archetype with flexible components, both linear and parallel, that can be adapted to situations, time, place, and needs. The model incorporates the Life Patterns Model and provides a template that can be adjusted to meet the needs of a local community, healthcare providers, and emergency management officials, regardless of the country or region, during the months after a disaster. The focus is on changes resulting from the disaster including roles, relationships, support systems, use of time, self-esteem, and life structure. Following a baseline assessment, each of these life patterns is assessed through the model with options for interventions over time. A pilot study was conducted in Georgia to gain information that would be helpful in developing a more specific assessment tool following a severe winter storm. While this is a local study, the findings can nevertheless be used to refine and focus the F-M for future implementation. Results indicated that older adults used high-risk heating and lighting sources and many were totally responsible for their own welfare. Findings have implications for emergency preparedness and long-term recovery.

The purpose of this project was to implement and evaluate the Video Analysis Tool (VAT) system, a tool for capturing and analyzing video evidence of students' clinical performance. Through the VAT system, nursing student dyads from 4 universities used a video camera, a computer, and a tripod in the residences of older adults to record interactions and psychosocial assessments of older adult clients. Using their recordings to compare their clinical activities with predefined clinical objectives derived from gerontological nursing standards, they made video clips of their assessments to demonstrate the required outcomes. Use of the VAT system received positive evaluations from students, faculty, and residents in multiple clinical sites. The process has significant implications for assessing clients and health care providers in their interactions in a variety of settings, including on home visits. It has additional applications for documenting performance measures of nurses and team members as they provide client care.

This was a descriptive study to examine the relationship between retirement planning, use of time, and the psychosocial adjustment to retirement. A 72-item questionnaire was mailed to all retirees (N = 1565) from an international company residing in seven southeastern states with a response of 764 (48.82%). Significant differences were found when comparing what retirees indicated they had done to prepare for retirement, and what they believed after retirement was important for people to do to prepare. Following retirement greater emphasis was placed not only on financial factors, but also on psychosocial adjustment and use of time. Findings suggest that retirement as a psychosocial transition needs to be an integral component of nursing assessments and interventions for retirees and their families.

Retirement is a significant transition in life that creates major changes, especially regarding how a person uses available time. The purpose of this study was to examine the perceptions of all retirees (N = 1,565) from an international company living in seven southeastern states regarding changes in 12 use of time activities following retirement and the implications of those changes for preretirement planning and postretirement interventions. Findings indicate that among a primarily healthy sample, there were significant changes in 10 of the 12 activities. There was an increase in sedentary activities, no change in physical exercise or social activities, and a minimal difference across gender. Type of preretirement position held, however, was a factor. This suggests the need for early planning and programs on use of time activities and management designed to meet individualized needs in preparation for retirement and during postretirement adjustment.

This study was designed to: (a) identify the perceptions of retirees about changes in their life patterns during retirement; (b) investigate the kinds of adjustment problems occurring in retirement as a basis for developing prevention oriented pre-retirement programs; and (c) identify extant factors which could demonstrate underlying themes relating to retirement adjustment. A 72-item, multiple response questionnaire was used to gather demographic data, information on use of time, pre-retirement planning, health problems, changing life patterns, and adjustment to retirement. It is the latter which is reported in these findings. The population included 1565 retirees from a designated company living in the south-eastern United States of America, with a response of 764 subjects (48.82%). Findings suggest the respondents were generally healthy and well adjusted; however, numerous adjustment problem areas were identified within the six life patterns. Additional factor analysis (principal components) demonstrated four factors of particular importance: satisfaction with retirement, retirement concerns, spousal relationships, and pre-retirement preparation outcomes.

N urses from the United States are increasingly being asked to assist their colleagues in other countries with the multifaceted tasks of curriculum development, strategic planning, health care interventions, and the often complicated processes of acquiring funds from local and international "agencies." This is clearly an exciting opportunity but requires considerably more talent and foresight than simply visiting another country and giving advice. The role of today's nurse consultant involves sharing information, exchanging ideas, learning from the host country, and being creative, innovative, and flexible in a complex, changing global environment.

Nurse educators have the responsibility of assisting students and their colleagues with understanding and practicing ethical conduct. There is an inherent responsibility to keep codes current and relevant for existing nursing practice. The code presented here is a revision of the Code of ethics for nurse educators originally published in 1983 and includes changes that are intended to provide for that relevancy.

To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction.Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety.Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%.Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices.It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology.Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses.

As university faculty, Certified Registered Nurse Anesthetists (CRNAs) are expected to meet the same obligations as other members of the academy. The purposes of this investigation were to describe the educational preparation and role expectations of nurse anesthesia faculty. Following institutional human assurance committee approval, an investigator-developed questionnaire was mailed to the directors of 85 nurse anesthesia programs recognized by the Council on Accreditation of Nurse Anesthesia Educational Programs. Responses were analyzed using descriptive statistics. Of the full-time faculty, 25% held doctoral degrees. CRNAs participated in all 3 traditional faculty roles of teaching, research, and service. Program administration and classroom teaching accounted for 66% of program directors' time. Assistant directors allocated 75% of their time to classroom teaching, clinical teaching, and program administration. Among all program faculty, limited time was reserved for research and scholarly activities. Increasing the percentage of doctorally prepared faculty and the amount of time allocated to research and scholarship are essential for full integration of nurse anesthetists into the university and to continue the development of nurse anesthesia's specialty knowledge.

The Nurse Scholars Program was developed for two reasons: to attract highly qualified students to nursing, and to increase the retention of graduates as they enter employment in local agencies following graduation. Scholars receive dollar 10,000 for each of their junior and senior years and are asked to work for 1 year at the agency for each dollar 10,000 received. Additional monies are set aside to assist graduate and doctoral students through stipends. Scholars are paired with Mentors, nurses selected for their expertise and experience and brought into the "family" of the hospital through special events. Mentors are included in educational activities and related programs. To date, dollar 840,000 has been committed to the program, and data regarding the success of the program are continually being assessed.

Brutus made no judgments. He gave only care and devotion. As a visiting "therapist," the Doberman Pinscher brought joy and activity to nursing homes.

We measured the pokeweed mitogen (PWM)-induced secretion of IgG by the unfractionated mononuclear cells (MNC) of young adult donors, and correlated the results with the functional activity of cell suspensions enriched for T helper (T4+) and T suppressor/cytotoxic (T8+) cells. The distribution of IgG levels secreted by MNC differs from a Gaussian curve, implying that the group is composed of distinct heterogeneous populations. When donors were compared who were judged to be very low responders or very high responders on the basis of IgG secretion levels by MNC (less than 700 ng/ml or greater than 2500 ng/ml), no differences were found in the capacity of T4+-enriched cells to support PWM-driven IgG secretion by a common B cell pool. In contrast, the addition of 0.2 X 10(5) T8+ cells from these low responders to PWM-stimulated cultures of 0.5 X 10(5) T4+ cells plus 0.5 X 10(5) B cells resulted in significantly less IgG secretion (389 +/- 121 ng/ml) than did the addition of the same number of T8+ cells from the high responders (2241 +/- 548 ng/ml, p less than 0.01). Normalized percent suppression by T8+ cells was higher in low responders than in high responders (77.0 +/- 9.9% vs 33.0 +/- 8.5%, p less than 0.01). Both high and low responders markedly suppressed IgG secretion when 0.5 X 10(5) T8+ cells were added. No correlation was found either between proportion of T3+, T8+, T4+, or M1+ cells within the MNC population and levels of IgG secretion by MNC or between T8+ numbers and levels of suppression induced by a constant number of T8+-enriched cells. Our data indicate that differences in the functional activity of T8+ cells, rather than quantitative differences, account for the wide range of PWM-induced IgG secretion by MNC.

In the dictionary "retire" is defined with such words as seclusion, retreat, and isolation. Help your older clients avoid isolation by planning for meaningful activities designed to promote feelings of self-worth. Help them answer the question "Where do I go now?"

Increased technology and scientific knowledge have had significant influence on surgical care during the past decade; however, the effects will be even more profound in the 20 to 30 years to come. Although concrete, futuristic developments in this area are speculative at best, one can perhaps foresee the utilization of currently developing concepts and

In the last few decades, the complexities of living have multiplied geometrically and so have the ethical dilemmas that confront us all. Understandably, then, there has been a burgeoning interest in ethics and moral philosophy. In nursing, there has been a parallel increase of attention directed toward ethical issues in nursing practice and toward the teaching of ethics in nursing programs. As Davis and Aroskar state, “The nurse is concerned with values, choices, and priorities related to the ‘good’ of the individual, the profession, and society “[8, p 19]. It seems consistent then that the scope of this concern must be broad enough to include nursing education. However, little appears in the literature relating to an ethical base for this area of endeavor.