Numerous trends influence all areas of health care, including care by nursing. The rising cost of health care has generated numerous outcomes that have had a broad impact on health care delivery. The potential compensation system for hospital Medicare patients, introduced in 1983, and current managed care competition need cost containment measures and a redefinition of least standards of care for hospitalized patients. The patient care plan should reflect a strategy that best congregates the patient's needs within time limitations and limited resources. The goal of efficiency inflicts shorter hospital stays for patients, reformation of hospitals for economic survival, and efforts to enumerate nursing care costs (Sinclair Vaughn 1988). Patients in hospitals are sicker, are being treated more appropriately, and are being expulsioned before they are completely recovered from their illnesses. Home health care and ambulatory services are growing in retort to the need and the economic inducement ( Freeman et al., 1987, Slemenda Mary Beth, 1983).A subsequent trend in health care relates to the greatly technical hospital environment . Quickly changing technology imposes both knowledge requirements and a rising concern about the impersonality of the critical care environment. Nursing has reacted to these issues by attempts at association and communication in education and perform, innovative attempts at care planning all the way through computerization, organized training and education plans for staff, and new roles and constitutions in nursing practice ( Simpson and Brown, 1985).
Nursing as a discipline is becoming inextricably bounced to technology ( DeVisser, 1981: 127). Specialization in medical practice as the sixties has imposed a national standard of medical and nursing care ( Garlo, 1984). Proceeding to that time, a physician might determine proper care for a heart attack patient. This care might be prejudiced by the region, the personal philosophy of the physician, as well as the resources of the community and hospital. The universal practitioner in a small town might have a diverse standard than would the teaching hospital in a big city. This is less the case now than ever before. National medical board qualifications now determines obstetric or cardiac care in both urban and rural areas, and these standards are upheld officially for physicians, nurses, and hospitals.
Hospitals in small towns might have equipment and offer services once simply seen in a medical center. Regional trauma and neonatal ICU networks exemplify this phenomenon. Third-party payers, including Medicare, inflict a further standard for hospital care. Official approval standards set by the Joint Commission on Accreditation of Healthcare Organizations also encourage similarities somewhat than differences among hospitals. Critical care units have emerged as a general feature of hospitals in the 1990s (Elpern Ellen H., Suzanne B. Yellen, and Laural A. Burton 1998). The consequences of technology for nursing practice comprise demands for education and training, the materialization of specialized clinical roles, artistic and often expensive staffing patterns, salary incentive programs, distresses about abrasion of expert staff, stress and job tension, and the stresses of ethical predicaments arising in critical care settings.
Critical care nursing, at present an anticipated part of hospital care in the 1990s, seems rooted in two discrete features (Campbell Margaret L. and Richard W. Carlson 2002). First, the enormity of patient needs calls for twenty-four-hour nursing surveillance. The temperament of this nurse-patient relationship has social, structural, institutional, and economic roots in the development of nursing in the United States. Private duty nursing and hospital staff nursing both restrain