RESOLUCION SBS Nº 1535-2007

The profession of nursing recognised early on that when nurses were providing care for certain patients or working in particular environments they were required to develop greater knowledge and skills in order to care for those patients.108 Smoyak discusses how in the early days of nursing the term specialty was only used to identify a particular field of nursing or a disease and she gives as example; tuberculosis hospitals and psychiatric nursing. As time went on the term specialist grew to mean doing something in nursing especially well, a notion that she believes is a far cry from the latter connotation of

104

Trubuhovich and Judson, Intensive Care, p.105. 105

Wellington Hospital Archive, WOW00200, Wellington Hospital Intensive Care Unit Patient Admission Books, 24 August 1964.

106

Trubuhovich and Judson, Intensive Care, p.98. 107

www.pcc.govt.nz

108

expanded knowledge or clinical expertise.109 Peplau believes that specialisation within a profession often evolves from a division of a generic field or some recombination of aspects of different fields that occur along logical lines.110 Footner argues that it could be said that all qualified nurses working in a particular setting for any given period of time become specialists. Further to this she says that a nurse can only be deemed a specialist once they have successfully completed advanced studies and have had some degree of prolonged working in their chosen specialist field of nursing.111

Peplau considers that several trends tend to lead toward specialisation in nursing. Firstly, any significant increase in knowledge about phenomena of interest to a particular field results in specialty of those practitioners. Secondly, new knowledge in applied science inevitably leads to new technology which in turn calls for more complex technological skills and intellectual capabilities amongst practitioners working in that field. Lastly, when the attention or needs of others, such as hospital management, focuses on areas which have previously received scant attention, new areas of specialisation tend to be formed. These new fields usually have an initial shortage of personnel who have both the required knowledge and interest to develop the field further without the interest of others.112 Smoyak credits Peplau as hastening the move toward clinical specialisation by her identification in 1965 of eight possible categories for nursing specialisation. Within each of these eight categories were subcategories as shown in Table 1.113 Smoyak succinctly sums up the idea of specialisation as a combination of the inevitable result of new knowledge within a field of medicine or nursing and a result of demands from the public for new services.114

109

S.A. Smoyak., „Specialization in nursing: From then to now‟, Nursing Outlook, 24, 11 (1976), p.676. 110

H. Peplau, „Specialization in professional nursing‟, Clinical Nurse Specialist, 17, 1 (2003), p.3. 111

Footner, „Nursing specialism‟, p.219. 112

Peplau, „Specialization in professional nursing‟, p.3. 113

Smoyak, „Specialization in nursing‟, p.678. 114

Table 1. Peplau’s Eight Categories of Nursing Specialisation115

Organs and body systems

 Renal, cardiac, metabolic nursing Age of the client

 Premature, infant, adolescent, geriatric nursing Degree of illness

 Intensive care, intermediate, self-care, long-term nursing Length of illness

 Short or long-term nursing Field of knowledge

 Nuclear, interpersonal, electronic, space nursing Subrole

 The mother surrogate nurse, expert technical nurse, health teacher, nurse counsellor

Professional Goal

 Preventative, curative, rehabilitative nursing Clinical service

 Medical-surgical, psychiatric, maternal-child nursing

Intensive care nursing began to evolve as a specialty with the advent of ICUs internationally. Although there is no one defining moment that represents the beginning of intensive care nursing, the nursing literature credits the phenomenon of “private duty nursing” for sick hospital patients and the start of “respiratory wards” set up during the poliomyelitis epidemics as the starting points.116117

115

As discussed in Smoyak, „Specialization in nursing‟, p.678. 116

Private duty nursing was a widespread practice within hospitals prior to the development of ICUs. It refers to nurses who were employed either by patients or their families to care for individual patients on a one-on-one basis. This was not a practice in New Zealand hospitals.

117

Fairman and Lynaugh credit the origins of intensive care as evolving from an increasing demand for nurses and physicians services, together with hazardous care conditions and a continuously rising demand for more hospital care. It was as a result of these factors that nurses and physicians turned to the familiar, traditional system of intense observation and triage of the most seriously ill. These two very old ideas were combined and refined to form a new idea of intensive care.118 Hence the evolution of intensive care nursing as a specialty stemmed from the need to provide safe and effective care to those patients described by Fairman and Lynaugh as the “sickest and most helpless,” with hospitals prioritising patient care according to their physiological stability.119

Lynaugh comments that the concept of differentiating intensive care nursing around a human condition, i.e. the concept intensive or critical, as opposed to differentiation around disease or organ systems which is the classic basis for medical specialisation is considered by some to be significant.120 According to Fairman and Lynaugh the main principle of ICUs in regards to delivering effective care to critically ill patients was the continuous presence of the nurse who was constantly on watch:121 “You were sitting right next to the patients… they could hear everything, they felt safe because you were right there. It scared them to death when the nurse left the room.”122 Though the beginnings of intensive care nursing may have been rudimentary, the principal concept proved sound. The parameters for monitoring the patient then were principally the measurement of vital signs, the level of consciousness, intake and output, and weight. In addition to

118

Fairman and Lynaugh, Critical Care, p.12. 119

Fairman and Lynaugh, Critical Care, p.12. 120

J. Lynaugh, „Moments in Nursing History‟, Nursing Research, 39 (1990), p.255. 121

Fairman and Lynaugh, Critical Care, p.15. 122

Fairman and Lynaugh, Critical Care, p.15, citing a quotation from an interview with Shephard and Vaughan, 1989.

this the nurse‟s sense of hearing, sight, touch, smell and sometimes her intuition were all utilised.123

With intensive care nursing beginning to develop as a specialty, consideration was given to the physical and psychological aspects of the role. Several traits were considered essential for the intensive care nurse to possess:

Of paramount importance is the possession of both native intelligence and innate curiosity, enabling continued study and progress in the art and science of medicine, especially in extending diagnostic and therapeutic skills. Since there is little place in an intensive care unit for the nurse who does exactly what is ordered, no more and no less, initiative is a prime qualification. Age as such is probably not an important factor; on the other hand, good health is considered essential, because nowhere else in nursing are tasks more arduous. Other vital factors are the possession of emotional stability and empathy. Ideally the intensive care nurse should be quite stable because the almost continuous care of critically ill patients, many of whom are in a dying state, is bound to take an emotional toll. Empathy as displayed by a reassuring countenance, soft touch, and kind word of explanation to patients can make an immense contribution to these individuals. Certainly people in the critical or dying situation and their families deserve compassion more than in any other situation in the practice of medicine. Nonetheless, compassion and emotions should not be permitted to interfere with good judgement and logic. The nurse who becomes too deeply involved with the patient may be unable to render necessary life-saving service in the moment of crisis. The key to successful operation of the unit, regardless of the quality of the medical staff, is the kind, intelligent, well-informed, and observant nurse. This is true in no other branch of nursing as it is in the intensive care unit.124

123

Fairman and Lynaugh, Critical Care, p.16. 124

Z.L. Burrell, Jr, and L.O. Burrell, Intensive Nursing Care, The C.V. Mosby Company, Saint Louis, 1969, pp.4-5.

This critical care workforce developed for different reasons in various countries, but essentially each focused on the critically ill patients need for close, frequent and prolonged observation.125