greater competencies in community assessment and in teaching clinical skills to family members.

Encouraging Interdisciplinary Collaboration

With the blurring of disciplinary lines, the education and practice of health care professionals must become more interdisciplinary. This will necessitate the development of new models of collaboration that are not rigidly hierarchical, but that provide for differentiated practice by education, experience, and demonstrated competence (Fagin, 1992; Pike et al., 1993). Studies of such collaboration have demonstrated improvements in care (Knaus et al., 1986; Garcia et al., 1993). Perhaps no phrase is more bandied about, despite any agreement about its meaning, than "interdisciplinary collaboration." Indeed, some physicians think it refers to cooperation across medical specialties (e.g., pediatricians and psychiatrists working respectfully together) rather than to practice involving different kinds of providers working collegially together (e.g., a mental health strategy involving psychiatrists, psychologists, psychiatric nurses, and psychiatric social workers).

Supporting Informatics and Health Systems Delivery Research

Computers and telecommunications are likely to become more important in the education and practice of RNs as nurses organize patients into electronic self-help groups and customize health promotion (Rheingold, 1993). Technology will be increasingly regarded as an aid to clinical decision making, particularly in ensuring that guidelines and standards are implemented appropriately (Donaldson and Sox, 1992). Electronic links offer the promise of consultation across vast distances, easy access to the latest information, and the possibility of lifelong learning opportunities across state lines. For this promise to be realized, informatics must be mainstreamed into the curriculum.

Nurses must become adept at evaluation research and develop the corresponding technologic and data management skills to achieve that objective (Fagin and Jacobsen, 1985). The large data bases that will be developed to monitor quality and cost effectiveness must include variables of concern to nursing, and nurses must be prepared to make use of these data sets in shaping their practice and policies (NLN, 1993). There is no obvious home for such research, however, since the Agency for Health Care Policy Research is biased toward medical outcomes and work force issues and NINR is geared toward clinical interventions and biomedical research rather than health systems delivery research. Efficacy (what works under relatively ideal conditions) and effectiveness (what works under ordinary conditions) must be monitored not only in terms of patient outcomes, but in terms of what happens to vulnerable populations as a group. There is an important role for the nurse researcher to play in clinical and community

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement