Evolution of Medical Surgical nursing

Introduction of Medical Surgical nursing evolution and trends of medical and surgical nursing – In ancient times, when medical lore was associated with good or evil spirits, the sick were usually cared for in temples and houses of worship. These women had no real training by today’s standards, but experience taught them valuable skills, especially in the use of herbs and drugs, and some gained fame as the physicians of their era.

• In the 17th cent., St. Vincent de Paul began to encourage women to undertake some form of training for their work, but there was no real hospital training school for nurses until one was established in Kaiserwerth, Germany, in 1846.
• There, Florence Nightingale received the training that later enabled her to establish, at St. Thomas’s Hospital in London, the first school designed primarily to train nurses rather than to provide nursing service for the hospital
• In the United States, nursing modernized rapidly during the late 19th and early 20th centuries. The number of hospitals nationwide grew from only 149 in 1873 to 4,400 in 1910. With this growth, new positions for nurses developed, and nursing gained respectable social status.
• Nursing subsequently became one of the most important professions open to women until the social changes brought by the revival of the feminist movement that began in the 1960s.
• During the late nineteenth and early twentieth centuries in the United States, adult patients in many of the larger hospitals were typically assigned to separate medical, surgical, and obstetrical wards.
• Nursing education in hospital training schools reflected these divisions to prepare nurses for work on these units
• Early National League of Nursing Education (NLNE) curriculum guides treated medical nursing, surgical nursing, and disease prevention (incorporating personal hygiene and public sanitation) as separate topics.
• By the 1930s, however, advocates recommended that medical and surgical nursing be taught in a single, interdisciplinary course, because the division of the two was considered an artificial distinction. Surgical nursing came to be seen as the care of medical patients who were being treated surgically.
• The NLNE’s 1937 guide called for a “Combined Course” of medical and surgical nursing
• Students were expected to learn not only the theory and treatment of abnormal physiological conditions, but also to provide total care of the patient by understanding the role of health promotion and the psychological, social, and physical aspects that affected a patient’s health.
• 1960s, nursing schools emphasized the interdisciplinary study and practice of medical and surgical nursing.
• 1960s and 1970s, standards were developed for many nursing specialties, including medical-surgical nursing.
• Standards, Medical-Surgical Nursing Practice, written by a committee of the Division on Medical-Surgical Nursing of the American Nurses’ Association (ANA), was published in 1974. It focused on the collection of data, development of nursing diagnoses and goals for nursing, and development, implementation, and evaluation of plans of care.
• A Statement on the Scope of Medical-Surgical Nursing Practice followed in 1980.
• In 1991, the Academy of Medical-Surgical Nurses (AMSN) was formed to provide an independent specialty professional organization for medical-surgical and adult health nurses.
• In 1996, the AMSN published its own Scope and Standards of Medical-Surgical Nursing Practice
• The second edition appeared in 2000 [15]. Both the ANA and AMSN documents stated that while only clinical nurse specialists were expected to participate in research, all medical-surgical nurses must incorporate research findings in their practice.

Evolution of Medical Surgical nursing – Trends in Medical Surgical nursing

Recent trends have affected medical-surgical nurses, including:

• The increasing use of nursing case management
• The expansion of advanced practice nursing
• Total quality improvement
• Development of clinical pathways
• Changes in the professional practice model
• Health care reform
• The trend toward increased acuity of patients, begun in the 1980s, has become a fact of life.

Evolution of Medical Surgical nursing – Influences on future nursing practice

• Expanding knowledge & technology
• Healthy people initiatives
• Evidence based practice
• Standardized nursing terminologies
• Health care informatics
• Nursing informatics

Registered Nurse Licensure

• Critical care nurse
• Emergency nurse
• Flight nurse
• Dialysis nurse
• Addiction nurse
• Ambulatory care nurse
• Perianathesia nurse
• Cardiac/vascular Nurse
• First assistant nurse
• Holistic nurse
• Home health nurse
• School nurse

Masters/higher degree in nursing Nurse practitioner

• Acute care NP
• Adult care NP
• Family NP
• Gerontological NP
• Palliative Care NP
• Pediatric NP

Clinical specialist                

• Adult psychiatric & mental
• Community health nursing
• Medical surgical nursing  
• Palliative nursing   
• Pediatric nursing

Others

• Advanced nursing health nursing administration
• Advanced oncology clinical specialist
• Clinical nurse leader

Evolution of Medical Surgical nursing -Social Trends Influencing the Development of Nursing

Ancient Civilizations

• Care of sick was related to physical maintenance & comfort
  • first by family members, relatives , servants or prisoners
  • eventually by religious orders or humanitarian societies
• Mental Health
  • Linda Richards and Dorthea Dix worked to improve the care of the mentally ill v Modern Civilization
  • focus in on technology 

Religious Tradition-Catholic/Protestant

Courage

• care of sick in battlefields, military/naval hospitals and prisons
• care of sick and dying during epidemics like cholera, typhus, smallpox

Women’s Movement

Nursing has been a premiere political force for women’s rights .Nurse’s organized the first major professional organization for women . Edited & published the first professional magazine by a woman, Sarah Josepha Hale.

Margaret Sanger was a public health nurse in New York

• opened the first birth control clinic in U.S. because of large number of unwanted pregnancies.

Lavina Dock was a writer & political activist

• early feminist devoted to women’s suffrage
• participated in protest & demonstrations until passage of the 19th Amendment in 1920, women right to vote.

Wars

Nightingale in the Crimean War . mortality rate dropped from 60% to 2% as a result of the environmental changes she implemented

Clara Barton organized nurses to provide care in the American civil War and established the American Red Cross that serves in war and peace time. American Red Cross was responsible for recruiting women for the Army Nurse Corp during WW I .Their motto was , American Nurses for American Men

Educational Factors

1893 Dock with Isabel Hampton Robb and Mary Nutting founded the American Society of Superintendents of Training Schools for Nurses of the U.S. and Canada. this organization was very politically active & became The National League For Nursing which promotes quality nursing education to this day.

Political Factors

• Nightingale was a political influencerfirst nurse to exert political pressure on government .influential in reforming hospitals & implementing public health policies in Britain
• Clara Barton persuaded Congress in 1882 to ratify the Treaty of Geneva so the Red Cross could perform in peace time impacted on national & international policies
• Lillian Wald’s political pressure lead to the creation of the U.S. Children’s Bureau established by congress in 1912 to oversee child labor laws
• Nursing represents 67% of healthcare providers in the U.S. few nurses are in positions where they can influence health care policy making

Evolution of Medical Surgical nursing-Social Trends Influencing the Development of Nursing

• Groups of practitioners who band together to perform social or political functions b’coz they could not do alone
• Define & regulate the profession
• Development of a knowledge base for practice
• Research
• Transmit norms, values, knowledge, and skills
• Communicate/advocate contributions of the profession
• Address members social & general welfare needs