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A new millenium inspires hope that humankind at last will meet one of its major challengesthat of assuring access to affordable health care for every individual. As reforms emerge, nursing's role will be a central one in shaping the policies, structures, and practices to advance access as a national objective. Indeed, nursing's participation in the policy initiatives of the 1990s, grounded on its own national reform agenda, amply demonstrates the profession's commitment to health care as a human right, and calls attention to nursing's readiness to provide cost-effective services to a diverse population seeking health information and choice.
Looking forward, the theme of this textcollaboration for optimal healthis as relevant as when the first edition appeared. The rapid expansion of managed care, to date the major trend in health care reform, makes it so. Managed care, while on the one hand fostering interdisciplinary professional collaboration with its pressures for cost-containment, also brings economic constraints to bear on patient-provider collaboration, often with controversial results. Although the years ahead will determine whether managed care will curtail health care costs over the long term, public concern is now growing over the role of third-party insurers, and how seriously their intervention will erode the foundation on which patient-provider collaboration is based. As the issues in this dilemma are sorted out, consumerism in health care, which manifests the popular demand for choice and participation in decision making, will continue as a powerful movement and an important societal trend.
The collaborative philosophy, which provides a necessary foundation for nursing practice, remains a key feature of our approach and the theme of this edition. Nurses' ability to initiate and influence reforms will to a large extent depend on the strength and quality of their transactions in an increasingly complex and volatile environment. Those transactions will be enhanced by collaboration, which emphasizes the importance of working together with others, using persuasion based on knowledge and reason to attain mutually beneficial, socially important goals.
A philosophy of collaboration is valuable, because it provides an action-oriented framework within which nurses can realize their professional values. Nursing has long recognized that our multicultural society, characterized by population diversity and subgroup value differences, embraces a variety of paradigms on health and illness, paradigms which may have critical implications for care. A philosophy of collaboration is uniquely sensitive to human differences. It assumes that patients will bring their divergent points of view to the encounters they have with health care professionals, which are important points to address in the context of the helping relationship. Indeed, doing so fosters patient dignity and self-determination, hallmarks of caring and central values of the nursing profession.
The environment of health care continues to grow more challenging day by day which means that nursing education will be under constant pressure to align its curricula with the driving forces of change. As a new era opens, the fast-paced scientific advances and ever-changing technology of the 20th Century will persist as important characteristics of the health care environment, as will the provider specialization they promote, delivery system reforms notwithstanding. Although this triad is responsible for much of the service quality improvement of the past, it is also a factor in the spiraling cost increases that make access a problem for so many citizens. Thus, continued pressure for economy is a certainty as the nation's population grows and ages, and its demand for expensive services increases.
In light of that reality, it is important to initiate today's fundamentals students to an economic perspective on practice. This text, along the lines of the first edition, introduces readers to the essentials of health care economics within a collaborative framework that can be applied at the bedside or in the conference room.
Finally, as scarce health care resources are spread ever-more thinly, at least some social turbulence is likely. The changes ahead are certain to bring conflict as competing interests collide. Consequently, the nurses of the future will be called on to engage in political bridge-building, asserting their positions while they negotiate, lobby, and ultimately compromise on policies and plans that acknowledge others' positions yet preserve their own values and ideals. This text introduces students to the art and skills essential to professional collaboration.
Aware of the burdens on today's students, we have revised our text to consolidate its content while still retaining comprehensive discussions of the subjects necessary to prepare students for the challenges ahead. It is important to note that we have not sacrificed essential information, but rather achieved a substantial reduction by paring repetition and merging material related in subject matter. For example, chapters on the nurse and the nursing profession, on family and community nursing, and on health care economics and delivery, have been combined to produce integrated presentations more efficient in their development of material. The content on some concepts (for example, pain and pain management or the self as an aspect of individual personality) has been pulled together to unify the presentation and make content location easier.
A brand new feature of this edition is that our reduced and reorganized content is now divided into three portable volumes which can be used in various ways to support the fundamentals curriculum.
The strong emphasis on nursing diagnosis remains in this edition, however, the management sections of Volume III, where material is again organized around the continuum of care, contain not only fully updated content, but also important new elements:
Other important features include:
Overall, reorganization and content changes make this edition particularly user-friendly. Many first-edition features remain, how ever, to maximize the value of the text as a tool for instruction and learning. Some of them are:
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