Neuroscience nursing practice in a new millennium

As the twentieth century closes with the decade of the brain, it is fitting to reflect on the revolutionary changes taking place in the neurosciences and in the management of patients with neurologic health problems. An explosion of basic scientific knowledge in the neurosciences at the molecular and genetic levels, wondrous breakthroughs in medical technology, and incredible advances in computer applications are combining to improve significantly the diagnosis, treatment, and management of neuroscience patients. This revolution in health care has forced a critical reexamination of quality, efficiency, effectiveness, cost, and ethics. Traditions and established patterns of providing care are being challenged. Evidence-based practice and best practice will be what is required in the twenty-first century health care system.(20) Comments such as "we have always done it this way" are no longer acceptable. Therefore, health care providers need new skills and competencies to provide evidence-based practice for the patient populations that they serve. Unfortunately, there are many areas in which the evidence base for practice does not exist. Research will be needed to fill the many voids. The twenty-first century neuroscience nurse must be a partner in delivering continuum-based care, which provides the patient with seamless health care rather than just illness-care. The nurse will no longer be able to focus narrowly on the care offered in the specific setting where he or she practices. For this the nurse needs new competencies and knowledge. In this article we consider neuroscience nursing practice in the twenty-first century from two perspectives: (I) scope of practice and roles within a collaborative interdisciplinary model of care and (2) patient-focused care within the challenging health care system.