Introduction to Medical Introduction to Medical Surgical NursingSurgical Nursing

Evolution and trends of Evolution and trends of medical surgical Nursingmedical surgical Nursing

Evolution Medical Surgical nursingEvolution Medical Surgical nursing

1.1. In ancient times, when medical lore In ancient times, when medical lore was associated with good or evil was associated with good or evil spirits, the sick were usually cared for spirits, the sick were usually cared for in temples and houses of worship. in temples and houses of worship.

2.2. These women had no real training by These women had no real training by today's standards, but experience today's standards, but experience taught them valuable skills, especially taught them valuable skills, especially in the use of herbs and drugs, and in the use of herbs and drugs, and some gained fame as the physicians of some gained fame as the physicians of their eratheir era. .

In the 17th cent., St. Vincent de Paul began to In the 17th cent., St. Vincent de Paul began to encourage women to undertake some form of encourage women to undertake some form of training for their work, but there was no real training for their work, but there was no real hospital training school for nurses until one was hospital training school for nurses until one was established in Kaiserwerth, Germany, in 1846. established in Kaiserwerth, Germany, in 1846. There, Florence There, Florence NightingaleNightingale received the received the training that later enabled her to establish, at training that later enabled her to establish, at St. Thomas's Hospital in London, the first St. Thomas's Hospital in London, the first school designed primarily to train nurses rather school designed primarily to train nurses rather than to provide nursing service for the hospital than to provide nursing service for the hospital Similar schools were established in 1873 in Similar schools were established in 1873 in New York City, New Haven (Conn.), and Boston. New York City, New Haven (Conn.), and Boston.

Nursing subsequently became one of Nursing subsequently became one of the most important professions open the most important professions open to women until the social changes to women until the social changes brought by the revival of the feminist brought by the revival of the feminist movement that began in the 1960s.movement that began in the 1960s.During the late nineteenth and early During the late nineteenth and early twentieth centuries in the United twentieth centuries in the United States, adult patients in many of the States, adult patients in many of the larger hospitals were typically larger hospitals were typically assigned to separate medical, assigned to separate medical, surgical, and obstetrical wardssurgical, and obstetrical wards..Nursing education in hospital training Nursing education in hospital training schools reflected these divisions to schools reflected these divisions to prepare nurses for work on these prepare nurses for work on these unitsunits

Early National League of Nursing Education Early National League of Nursing Education (NLNE) curriculum guides treated medical (NLNE) curriculum guides treated medical nursing, surgical nursing, and disease nursing, surgical nursing, and disease prevention (incorporating personal hygiene and prevention (incorporating personal hygiene and public sanitation) as separate topics.public sanitation) as separate topics.

By the 1930s, however, advocates By the 1930s, however, advocates recommended that medical and surgical recommended that medical and surgical nursing be taught in a single, interdisciplinary nursing be taught in a single, interdisciplinary course, because the division of the two was course, because the division of the two was considered an artificial distinction. Surgical considered an artificial distinction. Surgical nursing came to be seen as the care of medical nursing came to be seen as the care of medical patients who were being treated surgically.patients who were being treated surgically.

The NLNE's 1937 guide called for a “Combined The NLNE's 1937 guide called for a “Combined Course” of medical and surgical nursing Course” of medical and surgical nursing

Students were expected to learn not only Students were expected to learn not only the theory and treatment of abnormal the theory and treatment of abnormal physiological conditions, but also to provide physiological conditions, but also to provide total care of the patient by understanding total care of the patient by understanding the role of health promotion and the the role of health promotion and the psychological, social, and physical aspects psychological, social, and physical aspects that affected a patient's health. While the that affected a patient's health. While the integration of this approach into nursing integration of this approach into nursing school curriculaschool curricula1960s, nursing schools emphasized the 1960s, nursing schools emphasized the interdisciplinary study and practice of interdisciplinary study and practice of medical and surgical nursing.medical and surgical nursing.1960s and 1970s, standards were 1960s and 1970s, standards were developed for many nursing specialties, developed for many nursing specialties, including medical-surgical nursing. including medical-surgical nursing.

Standards, Medical-Surgical Nursing Standards, Medical-Surgical Nursing Practice,Practice, written by a committee of the written by a committee of the Division on Medical-Surgical Nursing of Division on Medical-Surgical Nursing of the American Nurses' Association (ANA), the American Nurses' Association (ANA), was published in 1974. It focused on the was published in 1974. It focused on the collection of data, development of collection of data, development of nursing diagnoses and goals for nursing, nursing diagnoses and goals for nursing, and development, implementation, and and development, implementation, and evaluation of plans of care. evaluation of plans of care.

A Statement on the Scope of A Statement on the Scope of Medical-Surgical Nursing PracticeMedical-Surgical Nursing Practice followed in 1980. followed in 1980.

In 1991, the Academy of Medical-Surgical In 1991, the Academy of Medical-Surgical Nurses (AMSN) was formed to provide an Nurses (AMSN) was formed to provide an independent specialty professional independent specialty professional organization for medical-surgical and adult organization for medical-surgical and adult health nurses. health nurses.

. In 1996, the AMSN published its own . In 1996, the AMSN published its own Scope Scope and Standards of Medical-Surgical Nursing and Standards of Medical-Surgical Nursing Practice,Practice,

The second edition appeared in 2000 [The second edition appeared in 2000 [1515]. ]. Both the ANA and AMSN documents stated Both the ANA and AMSN documents stated that while only clinical nurse specialists were that while only clinical nurse specialists were expected to participate in research, all expected to participate in research, all medical-surgical nurses must incorporate medical-surgical nurses must incorporate research findings in their practice. research findings in their practice.

Trends in medical surgical nursingTrends in medical surgical nursingRecent trends affecting nursing as a whole Recent trends affecting nursing as a whole have also affected medical-surgical nurses, have also affected medical-surgical nurses, includingincluding the increasing use of nursing case management,the increasing use of nursing case management, expansion of advanced practice nursing, expansion of advanced practice nursing, total quality improvement, total quality improvement, development of clinical pathways,development of clinical pathways, changes in the professional practice model changes in the professional practice model

to include greater numbers of nonprofessional to include greater numbers of nonprofessional staff,staff,

health care reform, health care reform, and the rise of managed care. and the rise of managed care. The trend toward increased acuity of patients, The trend toward increased acuity of patients,

begun in the 1980s, has become a fact of life.begun in the 1980s, has become a fact of life.

Influences on future nursing Influences on future nursing practicepractice

1.1. Expanding knowledge & technologyExpanding knowledge & technology

2.2. Healthy people initiativesHealthy people initiatives

3.3. Evidence based practiceEvidence based practice

4.4. Standardized nursing terminologiesStandardized nursing terminologies

5.5. Health care informaticsHealth care informaticsNursing informaticsNursing informatics

Nursing specialtyNursing specialty

Registered Nurse Registered Nurse LicensureLicensure

Addiction nurseAddiction nurse

Ambulatory care nurseAmbulatory care nurse

Perianathesia nursePerianathesia nurse

Cardiac/vascular NurseCardiac/vascular Nurse

Critical care nurseCritical care nurse

Emergency nurseEmergency nurse

Flight nurseFlight nurse

Dialysis nurseDialysis nurse

Bachelor’s degree in Bachelor’s degree in NursingNursing

First assistant nurseFirst assistant nurse

Holistic nurseHolistic nurse

Home health nurseHome health nurse

Home health nurseHome health nurse

Nursing administrationNursing administration

School nurseSchool nurse

Masters/higher degree in nursingMasters/higher degree in nursing1.1. Nurse practioneerNurse practioneer

Acute care NP, adult care NP, Family NP, Acute care NP, adult care NP, Family NP, gerontological NP, Palliative Care NP, gerontological NP, Palliative Care NP, Pediatric NPPediatric NP..

2. 2. Clinical specialistClinical specialistAdult psychiatric & mental health nursing, Adult psychiatric & mental health nursing, community health nursing, medical surgical community health nursing, medical surgical nursing, palliative and pediatric nursingnursing, palliative and pediatric nursing

3. 3. OthersOthersAdvanced nursing administrationAdvanced nursing administration

Advanced oncology clinical specialistAdvanced oncology clinical specialist

Clinical nurse leaderClinical nurse leader

History of nursingHistory of nursingSocietal Trends Influencing the Societal Trends Influencing the Development of NursingDevelopment of NursingSocial Trends Social Trends Ancient Civilizations Ancient Civilizations

Care of sick was related to physical Care of sick was related to physical maintenance & comfort maintenance & comfort

first by family members, relatives , servants or first by family members, relatives , servants or prisoners prisoners

eventually by religious orders or humanitarian eventually by religious orders or humanitarian societies societies

Mental Health Mental Health Linda Richards and Dorthea Dix worked to improve Linda Richards and Dorthea Dix worked to improve

the care of the mentally ill the care of the mentally ill

Modern Civilization Modern Civilization focus in on technologyfocus in on technology

Societal Trends Influencing the Societal Trends Influencing the Development of NursingDevelopment of Nursing

Religious Tradition-Catholic/Protestant Religious Tradition-Catholic/Protestant Courage Courage

care of sick in battlefields, military/naval hospitals and care of sick in battlefields, military/naval hospitals and prisons prisons care of sick and dying during epidemics care of sick and dying during epidemics

cholera, typhus, smallpox cholera, typhus, smallpox

Sacrifice Sacrifice Creativity Creativity

founding of Alcoholic Anonymous & Al-Anon founding of Alcoholic Anonymous & Al-Anon

CompassionCompassion

Societal Trends Influencing the Societal Trends Influencing the Development of NursingDevelopment of Nursing

Women’s Movement Women’s Movement Nursing has been a premiere political Nursing has been a premiere political

force for women’s rights force for women’s rights Nurse’s organized the first major Nurse’s organized the first major

professional organization for women professional organization for women edited & published the first professional edited & published the first professional magazine by a femalemagazine by a female

Martha Danger was a public health Martha Danger was a public health nurse in New York nurse in New York opened the first birth control clinic in U.S. opened the first birth control clinic in U.S.

because of large number of unwanted because of large number of unwanted pregnancies in the working poor pregnancies in the working poor

Lavina Dock was a writer & political Lavina Dock was a writer & political activist activist early feminist devoted to women’s suffrage early feminist devoted to women’s suffrage participated in protest & demonstrations until participated in protest & demonstrations until

passage of the 19th Amendment in 1920 passage of the 19th Amendment in 1920 Cultural Factors Cultural Factors first major professional group to integrate first major professional group to integrate

black & white membersblack & white members

Wars Wars Nightingale in the Crimean War Nightingale in the Crimean War mortality rate dropped from 60% to 2% as a mortality rate dropped from 60% to 2% as a

result of the environmental changes she result of the environmental changes she implemented implemented

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

Economic Factors Economic Factors Insurance Insurance

Fee for service Fee for service Managed care Managed care

Cost of health care rising faster than Cost of health care rising faster than inflationinflation

Educational Factors Educational Factors 1893 Dock with Isabel Hampton Robb and 1893 Dock with Isabel Hampton Robb and Mary Nutting founded the American Society Mary Nutting founded the American Society of Superintendents of Training Schools for of Superintendents of Training Schools for Nurses of the U.S. and Canada Nurses of the U.S. and Canada

this organization was very politically active & this organization was very politically active & became the NLN which promotes quality nursing became the NLN which promotes quality nursing education to this dayeducation to this day

Political Factors Political Factors

Nightingale was political Nightingale was political first nurse to exert political pressure on first nurse to exert political pressure on

government government influential in reforming hospitals & influential in reforming hospitals &

implementing public health policies in Britain implementing public health policies in Britain

Clara Barton persuaded Congress in 1882 Clara Barton persuaded Congress in 1882 to ratify the Treaty of Geneva so the Red to ratify the Treaty of Geneva so the Red Cross could perform in peace time Cross could perform in peace time impacted on national & international pollicies impacted on national & international pollicies

Lillian Wald’s political pressure Lillian Wald’s political pressure lead to the creation of the U.S. lead to the creation of the U.S. Children’s Bureau Children’s Bureau established by congress in 1912 to established by congress in 1912 to

oversee child labor laws oversee child labor laws

Nursing represents 67% of Nursing represents 67% of healthcare providers in the U.S. healthcare providers in the U.S. few nurses are in positions where they few nurses are in positions where they

can influence health care policy makingcan influence health care policy making

1990s - Nurses became involved in 1990s - Nurses became involved in politics at the local, state & politics at the local, state & national level national level

Eddie Bernice Johnson into U.S. House of Representatives from Eddie Bernice Johnson into U.S. House of Representatives from Texas Texas

Ada Sue Hinshaw directed the NIH Center for Nursing ResearchAda Sue Hinshaw directed the NIH Center for Nursing Research

Nurses in all practice areas are affected by public policy Nurses in all practice areas are affected by public policy on a daily basis on a daily basis

this demands that all nurses be proactive in policy this demands that all nurses be proactive in policy developmentdevelopment

Nursing’s Agenda for Health Care ReformNursing’s Agenda for Health Care Reform developed in 1991 developed in 1991 nurses can use this agenda to unite and nurses can use this agenda to unite and

become a political force in health care become a political force in health care deliverydelivery

Groups of practitioners who band Groups of practitioners who band together to perform social or political together to perform social or political functions they could not do alone functions they could not do alone

Define & regulate the profession Define & regulate the profession

Development of a knowledge base for Development of a knowledge base for practice practice Research Research

Transmit norms, values, knowledge, and Transmit norms, values, knowledge, and skills skills

Communicate/advocate contributions of the Communicate/advocate contributions of the profession profession

Address members social & general welfare Address members social & general welfare needs needs

Thank youThank you