2 years ago

DNA Reporter - August 2018

  • Text
  • Nursing
  • Delaware
  • Programs
  • Diploma
  • Association
  • Wilmington
  • Steward
  • Profession
  • Healthcare
  • Campbell
  • August

Page 4 •

Page 4 • DNA Reporter August, September, October 2018 Nursing History: Where We Came From William T. Campbell, EdD, RN See Guest Editor for complete bio on page 1 (Excerpted from the Keynote Address at the Delaware Nurses Association’s (DNA) 2011 Spring Conference, April 7, 2011, in Newark, DE on occasion of DNA’s 100th anniversary.) Let’s spend some time reflecting on nursing, our profession, our accomplishments, our concerns, and the many changes. It’s interesting to take time and reminisce some days, when we have time, about what has changed since we graduated from nursing school, and what has not. The changes have a way of sneaking up on us. It’s not just reusable scissors, posey keys, and glass thermometers; it’s the whole profession of nursing that some days seem to have changed and other days to never change. If you graduated in the past 5, maybe 10 years, you probably have no idea what I’m talking about (“posey keys, etc”), but if you graduated 30 or 40 years ago you may remember some of these: white uniform dresses, white hose, white uniform shoes, nursing caps, the capping ceremony, white pocket protectors, Flowmeter labels actually used for timing IV infusion, Clinitabs, or no gloves. The units of measurement have even changed: minims, drachms, grains, and even cc’s have been discarded. What about all those abbreviations: QD, QOD, QID, QAM, QPM, QHS, TID, BID, PC, AC, LOC, or DC. Now the Joint Commission – or was it JCAHO – even the name of the change agent changed – says we can’t use those. How about LOC? - level of consciousness or laxative of choice? Or DC? - discharge the patient or discontinue the med? How confusing. Maybe that’s the reason for the changes. Now it’s the same words and meanings – it’s just spelled out instead of abbreviated. In some cases it’s just a different abbreviation for the same thing – ECG, not EKG, ED, not ER, and before that the “accident room.” Change means progress, but some of the changes predate some of us. Remember (or not) when you literally had to crank the head of the bed up, not just push a button. Remember when you had to repeatedly pump the rubber bulb on the sphygmomanometer to take a BP, not just push yet another button. Before that were changes many of us have never seen except in photos and museums. How about: iron lungs for polio victims, invalid feeders for clear/full liquids, porcelain bedpans, bandage rollers, lint scrapers, chatelaines, thermometers that were in cases pinned to the nurses uniform and used for every patient on the ward, or a glass syringe in a case with two needles that were cleaned between patients and occasionally resharpened. Change is everywhere. In 1911 when DNA was formed it was no different. There had already been many changes in the profession and there would be many more in the next 107 years. What was happening in nursing in America and in nursing in Delaware in 1911? 1911 was a time of change in nursing. The Spanish American war had ended and had created a demand for nurses for the first time since its birth in the last war in the 1860’s. The Army Nurse Corp was organized. The American Red Cross had recently been organized by Congress and Clara Barton as their first president was still alive. Florence Nightingale had just died 4 months previously. State registration and licensure for nurses was being developed. Minimum standards of nursing education were being debated. Higher education in nursing was appearing in a few universities such as Columbia Teachers College. Government social services including nursing and nursing specialties were new and growing concepts. More women were going to school, delaying families, and starting professional careers. It was a time of social change and social unrest. Segregation was strong. Nursing was a profession for white unmarried females. Minorities felt socially and professionally isolated. Males could not attend most nursing schools and had their own schools. Males could not work in hospitals except for the insane asylums. They could not be nurses in the military; that discrimination would continue until well after World War II. Trained and licensed male nurses entering the military had to work as medics or pharmacist mates, not as nurses, until 1954. (See C. Campbell’s article about nurses in WWII in this issue.) African American nurses could not attend the same schools or work in the same hospitals as whites. They could contract for private duty and care for white patients in their homes, but could not eat a meal with the family whose home they were employed in. Males were 6% and African American females composed 4% of all nurses. Both minorities would drop to 2% during the 1950’s and 60’s, but have increased slowly since then. In this time of change and professional progress, Delaware Nurses Association (DNA) was organized on April 18, 1911, but would not join the American Nurses Association (ANA) until 1916. ANA had started in 1896, but was then called Nurses Associated Alumnae of the US and Canada. Canada was dropped in 1901. In 1911 the name changed to ANA but its constituents were still associations, not states. In 1916, its constituents became the states, Delaware joined, and ANA closely aligned itself with the American Journal of Nursing and the National League of Nursing Education. So close in fact that they shared clerical staff. What did nursing in Delaware look like in 1911? Nurses were being trained at hospitals for 3 years, in hospital based schools, owned and operated by the hospital, taught theory content in lecture by the physicians, supervised in clinical on the units by the head nurses and supervisors. It was mostly an apprenticeship, on-the-job training for the student, and free labor for the hospital. A donation of the lecture notes of a nursing student from the 1920’s for the Nursing Departmental Museum at Salisbury University was recently reviewed. The notes for each lecture had the name of the male physician lecturer at the top, the pages of notes were corrected by him, and then initialed by him at the bottom of the last page. Lectures were in anatomy, physiology, bacteriology, chemistry, psychology, and hygiene. At that time there were 74,000 nurses in the U.S. How many nurses were there in Delaware in 1911? The Board of Nursing doesn’t have records to tell us how many, but they do know that in 1911, that year 18 new nurses received their licenses. The Delaware Board of Examiners for Nurses had started in 1909 charged with “regulating the practice of professional nursing in the State of Delaware.” There were no LPN’s, RN’s, or APN’s, just “professional nurses.” There was no exam for licensure, those 18 were granted licensure by “waiver” – “waiver” remains undefined and unrecorded. The licensing exam started the following year in 1912 – 5 days of paper and pencil testing with no computers and no 265 question maximum. It was administered only twice a year! Today there are over 18,000 nurses in Delaware. Where were nurses trained in Delaware? These nurses learned their profession at hospitalbased training schools such as The Delaware Hospital School of Nursing. That school started in 1901 and in 1911 graduated 6 students – the largest class in 11 years! Some years there were only 3-4 students. Delaware Hospital started in 1890, became Delaware Division of the Wilmington Medical Center, then Wilmington Hospital, and still exists today. The Homeopathic Hospital 1888 became Memorial Hospital, then Memorial Division in 1965, and closed in 1985. The Physicians & Surgeons Hospital 1908 became Wilmington General, then General Division in 1965, and also closed in 1985. The latter two merged with the earlier one in 1965 to create Wilmington Medical Center and the two were later replaced by Christiana Hospital, now all are incorporated in Christiana Care. Their respective nurses’ training schools merged in 1965 to create the Nursing School of Wilmington which also closed in 1985. St. Francis Hospital operated a school of nursing based on strong Catholic morals and values. It opened in 1924 in the former Hilles Mansion and saw its first graduating class in 1927. The last class of 21 students graduated in 1976 when the school closed. Delaware State Hospital at Farnhurst opened their nursing school in 1929 with the philosophy of preparing nurses to better care for mentally ill patients. Milford Emergency Hospital (later Milford Memorial Hospital, today Bayhealth Milford Campus) also opened a school of nursing in 1921 to train nurses to deliver nursing care to a southern Delaware patient population. All four would close during the 1970-80’s era when hospitalbased schools of nursing would drastically decline and transition to university- and college-based basic RN programs offering degrees instead of diplomas. Beebe Hospital in Lewes would not be built until 1916 and would open their nursing school also in 1921. It continues to educate nursing students today and is Delaware’s only hospital-based school of nursing. (See N. Hall and K. Pickard‘s article about diploma schools in this issue.) All other hospitals and schools would follow many years later. While the University of Delaware in Newark, Delaware State University and Wesley in Dover, and Goldey-Beacom in Wilmington were open to students in 1911, they did not grant degrees in nursing. Wilmington University would not even be founded until 1968. Where did these nurses work? Most nurses worked in private duty, not in hospitals. Remember the hospitals had free apprentice labor for 3 years; the students would then graduate, only to be replaced by the next cohort of students. There were jobs in hospitals for nurses as supervisors/instructors. Many would take jobs as private duty nurses in homes of wealthy patients. Those patients that could not afford private duty nurses would be patients in the hospitals to be taken care of by the students. Most nurses would work in private duty for a few years, leave to start or raise their families, and then a few would return to the hospitals as those supervisors and head nurses to supervise and educate the students. A few found employment in the TB sanitariums or the visiting nurse agencies. Most would never return, but elected to remain homemakers. What did these nurses do? Nursing skills remain much the same: bathing, assessing, diet, inserting a Foley, giving an enema, injections, medication administration, and documentation, only the instruments and tools have changed. Auscultation was being performed, the monaural stethoscope had been replaced by the binaural stethoscope in the 1880’s; the silver metal catheter (a sound) had been replaced by a flexible latex one (the Foley) and then a silicone one due to latex allergies, and flexible tubing and a bag had replaced the enema syringe. While many of the skills and treatments were similar, one can rest assured that nursing diagnosis did not exist, medical diagnosis was the guiding force, and the physicians’ orders were the plan of care to be followed without question. Critical thinking and evidence based practice were not buzz words yet, but the physicians stated that they wanted educated nurses who could solve problems in their absence. Many medications that we use today were already being used, but not the most important ones, antibiotics. Isolation, prevention, and some vaccines were in use. Smallpox, yellow fever, and malaria were under control, but polio, measles, and influenza were not. With the understanding of germ theory, sterilization and antiseptics in the 1870’s, surgery was now being used and decreasing what were previously 100% fatal conditions, like appendicitis. Some nurses were finding employment as: “instrument passers” and anesthetists in the OR. Nursing had a long way to go, but as a profession it had already come a long way since its birth in the 1870’s. This author, like many nurses, but unlike some contemporary nursing historians and writers, recognize the birth of nursing as 1861-1865, or the American Civil War. If not the birth, then most certainly it was the catalyst that initiated the birth. Florence Nightingale laid the groundwork for nursing in the 1850’s through her nursing in the Crimean War, her research of hygiene and ventilation, and her statistics to prove that hygiene and hospital design did make a statistically significant difference. Her political action made the British government change their policies and drastically decreased the death rate of their soldiers from 40-60% to 2.2%. She then disseminated her findings through her writings, first in England, and then in America in 1860. (See L. Derickson’s article about Florence Nightingale in this issue.) The following year, 1861, exactly 50 years before 1911, the Civil War began and the healthcare demand was overwhelming. Over 200,000 men would die of battle wounds and another 420,000+ would die of diseases. A limited number of surgeons, Hospital Stewards, male detailed nurses, female paid nurses, and female volunteer nurses would attempt to meet the huge demands of sick and wounded soldiers in a time of limited medical knowledge. (See W. Campbell’s article on Hospital Stewards in this issue.) Nursing has come a long way since 1911 and the founding of DNA. It has journeyed an even further distance since Nightingale of the 1850’s, Hospital Stewards of 1861-65, and the opening of nursing schools in the U.S. in 1873, the diploma schools of the late 1800’s and early 1900’s, and the military nurses of WWII (1941-45), but the journey will continue with the progress, the challenges, the triumphs, and the changes. The reader is left with this quote, very much abbreviated from its original 2 pages, “we have followed the development of nursing…to the rather highly organized, widely varied, and expert forms of nursing service represented by the profession of nursing…today. We have noted how other powerful forces and movements…have acted and reacted on the development of nursing, helping direct its course and modify its character. In the face of almost overwhelming difficulties, hampered by every kind of restriction, beset by all the forces of ignorance and superstition, we have seen how untiringly they [nurses] labored, clearing away the obstructions in the path of progress, and building the foundations on which our work of the present day rests.” Modern day, 2018? No, the book: A Short History of Nursing by Dock and Stewart; the publication year: 1920!

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