Scholars debate when the postmodern era actually began. Some feel it began in the 1960s; others claim it started with the introduction of the computer and the internet. Another group of scholars heralds the beginning of the postmodern age with questioning of scientific method as the best approach for discoveries to answer the questions surrounding humanity, the environment, and health-related issues (Watson, 1999). Wilson (1998) introduced the term consilience to describe the unity of knowledge. Consilience represents the point where scientific, artistic, ethical, spiritual, social, environmental, and personal knowledge intersect. Some research has discovered that spirituality plays a key role in health and healing, and qualitative research methods hold the same promise as quantitative research in generating health care knowledge. During the first decade of the 21st century, professional nurses continued to adapt to the changes in practice and the society. Scientific advances increased the complexity and cost of health care.
According to the Centers for Medicare & Medicaid Services (CMS, 2010), health care accounted for 17.6% of the gross domestic product at this time. The population of persons over age 65 years increased 15.1% from 2000 to 2010 (U.S. Census Bureau, 2011). The CMS estimates that close to 80% of health care resources are used by the persons over age 65 years. Efforts to contain health care costs resulted in further reduction in inpatient stays, leading to the transfer of health care services from acute care to either the home or rehabilitation setting. The gap between the rich and the poor continues to widen, resulting in an increase in governmental funding for health care services. Sources of health care insurance include employers, private purchase, or the government. Nearly 50 million Americans have joined the ranks of the uninsured and 39 million persons participate in Medicaid programs (Holahan & Chen, 2011). By virtue of education and practice, nurses are the best-equipped health care team members to assume the gatekeeper and advocacy roles required of case managers. Nurse practitioners have demonstrated the ability to deliver high-quality health care economically without compromising care quality. Hospitals currently employ 62.2% of working RNs; many other RNs work in extended-care facilities, homes, clinics, and community health settings (U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, 2010).