Virginia Nurses Today - August 2020

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Page 28 | August, September, October 2020 Virginia Nurses Today | www.VirginiaNurses.com Advances in Nursing During World War II Sarah M. Gilbert, PhD, RN, GCNS-BC Samuel D. Lee, BA The World Health Organization designated 2020 as the Year of the Nurse and Midwife as a tribute to the 200th anniversary of Florence Nightingale’s birth. 2020 also marks 75 years since the end of World War II. Military nurses were part of a large medical machine that not only saved lives but also participated in research on new drugs and treatments, which would impact civilian and military care in the future. Specialties were also established or became more valued during the conflict. Specialty Practice Shortages of nurse anesthetists during World War II precipitated a military training program producing at least 2,000 qualified nurse anesthetists (Ray & Desai, 2015). The use of newer anesthetic medications such as ethyl chloride, thiopental sodium, and ethylene in addition to ether and nitrous oxide enabled nurse anesthetists to utilize multiple anesthetics depending on wound type. The use of spinal anesthesia and local nerve blocks also saw increased use by nurse anesthetists after training by anesthesiologists. Additionally, intravenous administration of anesthetic agents became the preferred method of induction. The first cadre of flight nurses experienced a shortened and pointed introduction to flight nursing that included “first aid, medical and surgical care of patients en route by air, loading and unloading patients from the planes, and chemical warfare” (Barger, 2013, p. 42). Subsequent groups of nurses received more detailed education to include “aeromedical nursing, physiology, classification of patients, air evacuation records, operations and logistics, tropical and arctic medicine, tactics of air evacuation, special studies, sanitation, and hygiene” (Barger, 2013, p. 44). In 1943, Elsie Ott successfully completed a six day, multi-stage journey to the U.S. from Pakistan. Ott reported multiple problems, solutions, and successes throughout the trip to her superiors. These concerns were addressed in a letter sent to Air Transport Command officials and subsequently implemented, officially creating flight nurse specialization (Barger, 2013). Psychiatric nursing was in its infancy as a practice specialty in 1940 and nurses were heavily recruited to serve in wards overseas that were overwhelmed NURSES MONTH SPOTLIGHT with “psychiatric casualties” (Silverstein, 2008, p. 721). Nurses in these hospitals assisted with interventional therapies and the aftercare required to assure recovery. Hildegarde Peplau joined the Army Nurse Corps (ANC) after completing extensive education on neuropsychiatry in the U.S. and Great Britain. Her background and education on neuropsychiatry and her belief in psychoanalytic therapy slowly changed the landscape of nursing care and treatment of psychiatric illnesses. She implemented “walking and talking” with the patients singularly or in groups (Silverstein, 2008, p. 726) and subsequently, developed a theoretical framework for psychiatric nursing practice (Smith, 2018). Specialty Units Introduction of field hospitals near the front lines expedited the intensive interventions needed for soldiers’ survival. Due to advanced weaponry, severe thoracic and abdominal injuries were prevalent (Brown, 2015). Volume replacement using whole blood transfusions proved to be the best treatment for shock wounds. In 1943, it was recommended by the Surgical Consultant in the North African Theater of Operation (NATOUSA) that a system to secure and transport whole blood to field hospitals be implemented immediately (Hardaway, 2004). Shock Wards (SW) for intensive treatment of life threatening injuries were created and placed near crucial medical and diagnostic services: operating tent, surgical wards, and x-ray department. The SW was kept warm (80° F), quiet, well ventilated, and smoking was not allowed. Nurses and specially trained enlisted men staffed the eight bed ward, worked 12 hour shifts, and were on call to respond to incoming casualties. One nurse and one enlisted man cared for four critical patients. The ward was prepared by the nurse, who set out equipment and placed hot water bottles in the cots. The enlisted man also had preparation duties and was trained to give injections, take blood pressures and pulses, and recognize changes in the patient’s status. For critically ill patients, vital signs were taken every 15 minutes, morphine was given for pain, and detailed records were completed. The surgeon was notified by the nurse when the patient was stable for surgery (Setzler, 1944, Brown, 2015). Most evacuation hospitals also had an Emergency Admitting Ward (EAW) which was located near the operating tent and x-ray department. Like the SW, casualties arrived by ambulance to the EAW where “each soldier, no matter lightly injured, is assigned to a bed” (Setzler, 1944, p. 937). Each patient’s vital signs were measured and recorded then the patient was examined by a surgeon. The most critically injured were taken to surgery first and then transferred to another hospital ward for recovery. The EAW was staffed by six nurses and six enlisted men, working 12 hour shifts (or more), caring for 25-30 patients. Nurses for these specialty units were trained in the classroom and then precepted by a more experienced nurse (Setzler, 1944, Brown, 2015). The 300th General Hospital was a research site for penicillin testing and administered over five billion units in the first year. This hospital also developed the first ‘recovery room’ after post-surgical wards, who admitted up to 120 patients a day, overwhelmed the nurses, enlisted men and nurse anesthetists, who were transporting patients to and from the wards. This post-operative unit was staffed by one of the surgical nurses and two corpsmen and could accommodate fifteen to twenty patients. There were very few supplies and no vital signs or records were kept (Breakiron, 1995). Conclusion Nurses who volunteered with the armed services were seeking to ‘do their part’ but also to see the world. What they did was elevate nursing to a profession through their courage, bravery, stamina, and ingenuity. They served around the world, laid the foundation for psychiatric nursing, flight nursing, critical care/trauma nursing, and emergency nursing. Certified registered nurse anesthetists advanced their practice through participation in new methods and drugs for induction. Their service showed the value of nursing as an integral part of the armed forces hospital system in times of conflict and crises. Their sacrifices made it possible for nursing to advance as a profession. They were the foundation of modern nursing. References Barger, J. (2013). Beyond the call of duty : Army flight nursing in world war ii. Retrieved from https://ebookcentral.proquest.com ISBN-13: 978-1606351543. Breakiron, M. (1995). A Salute to the Nurses of World War II. AORN Journal, 62(5), 710- 722. doi: 10.1016/s0001-2092(06)63523-0 Brown, W. (2015). Nursing in the 8th evacuation hospital, 1942-1945. U. S. Army Medical Department Journal. https://www.cs.amedd.army.mil/FileDownloadpublic. aspx?docid=6cae702a-664e-4cdb- 9897-516b6dc436bf Hardaway, R. (2004). Wound shock: a history of its study and treatment by military surgeons. Military Medicine. 169. 265-269. Ray, W. T. & Desai, S. P. (2016). The history of the nurse anesthesia profession. Journal of Clinical Anesthesia. 30. 51-58. doi.org/10.1016/j.jclinane.2015.11.005o Setzler, L. (1944). A shock ward in the ETO. American Journal of Nursing. 44(10). 935-937. https://wwwjstor.org/stable/2416769. Silverstein, C. M. (2008). From the front lines to the home front: A history of the development of psychiatric nursing in the U.S. during the World War II era. Issues in Mental Health Nursing, 29(7), 719-737. doi:10.1080/01612840802129087. Smith, K. (2018). Different places, different ideas: Reimagining practice in American psychiatric nursing after World War II. Nursing History Review. 26. 17-47. doi. org/10.1891/1062-8061.26.17.
www.VirginiaNurses.com | Virginia Nurses Today August, September, October 2020 | Page 29 NURSES MONTH SPOTLIGHT NURSES MONTH SPOTLIGHT Here’s What You Missed at VNA’s Spring Conference, Cultivating a Happy Work Environment VNA Commissioner on Nursing Education Catherine Cox, PhD, RN, CEN, CNE, Alumnus CCRN, George Washington University Kudos to VNA for pivoting to a virtual 2020 Spring Conference given Governor Northam’s temporary stay at home order due to novel coronavirus (COVID-19). I believe that those who attended the synchronous Cultivating a Happy Work Environment conference on May 27 were skeptical as to how it would all work out (me included), but soon discovered that it was just as engaging as a face-to-face event. We were able to interact with all of the speakers by asking questions throughout each session as well as answer topical survey questions throughout the day. VNA also hosted a virtual sponsor and exhibit hall, whereby exhibitors and sponsors were able to highlight their products. Additionally, all registered attendees received links to the live webinar in order to view the recording in its entirety - at their own pace and on their own time - through VNA’s CE library, receiving up to six contact hours for participation in the conference after completing the conference evaluation. Julian Lute kicked off the conference with his “Building a Great Workplace with a High-Trust Culture Blueprint” presentation, during which he underscored that people want to trust who they work for, take pride in what they do, and enjoy the people they work with. Also, the best leaders should be trustworthy, transparent, and collaborative whereas employees want to be informed, be free to ask questions, and feel supported. Lastly, employees will go out of their way to get the job done if they look forward to going to work as well as take pride in where they work. Next, Marian Altman talked with us about “Creating and Sustaining a Healthy Work Environment” per the American Association of Critical-Care Nurses (AACN). AACN shared that the healthiest work environments integrate six standards: 1) Skilled Communication, 2) True Collaboration, 3) Effective Decision Making, 4) Appropriate Staffing, 5) Meaningful Recognition, and 6) Authentic Leadership. AACN’s Assessment Tool is free to use and can be accessed via this link: https://www.aacn.org/nursing-excellence/healthywork-environments. Dr. Altman concluded with a five-item “to-do” list: 1) Start with a self-assessment, 2) Try some new techniques (e.g., compliment a coworker every day, never be a silent witness, be a team player, speak your truth, and/or ask someone you do not know to share a meal), 3) Assess the culture on your unit, 4) Create an action plan, and 5) Stay the course. After the lunch break, we got to experience the “Best Practice Short Podium and Idea Pitch Sessions” during which we learned what other healthcare organizations across the commonwealth have implemented within their organizations to create a happy work environment. I was so impressed with the work my peers are doing to make their work environments happy, whether it’s taking time to breathe (stop and pause), increasing resiliency in nurse managers and team members, practicing self-care, and/or saying “thank you” when receiving constructive advice. The day ended with Eileen O’Grady offering “A Master Class on Human Flourishing” where we discovered the science of human flourishing and what we know about cultivating personal well-being. We explored extreme self-care strategies including the difference between self-care and selfishness, how to deal with difficult others, prevent burnout, and build resiliency. Dr. O’Grady is such an inspirational speaker and her strategies were such a great way to end an amazing day. In conclusion, by now our members know that the VNA Fall Conference (September 23-24, 2020) as well as the VNA Legislative Summit (November 10, 2020) will be presented virtually. I hope you plan to join us for both events, knowing that VNA will deliver world-class professional development opportunities at a price-point that works within your budget. To register for VNA’s 2020 Fall Conference, Ending Bullying, Incivility, & Workplace Violence, go to https://virginianurses.com/page/ FallConferenceRegistration. For more information on VNA’s Legislative Summit, visit https:// virginianurses.com/page/LegislativeSummit. The Village at Orchard Ridge is creating an amazing, genuine and caring culture team. join our We CARE team! Now hiring for: RNs - FT 8 hr day shift, FT 12 hr night shift & PRN • LPNs - PRN • CNAs - FT, PT and PRN • CMA (PRN) • MDS/QAPI Manager (FT) Our full time team members enjoy: Generous PTO plan • Medical, Dental, Vision insurance • 403(b) with discretionary employer match Now offering a Sign-On Bonus for all nursing positions!!! If you are interested in applying for a position, go to careers-nationallutheran.icims.com EOE
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Virginia Nurses Today - August 2020

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