INTRODUCTION OF MEDICAL SURGICAL NURSING EVOLUTION AND TRENDS

OF MEDICAL AND SURGICAL NURSING

Evolution of Medical 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. 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

o first by family members, relatives , servants or prisoners
o eventually by religious orders or humanitarian societies
• Mental Health
o Linda Richards and Dorthea Dix worked to improve the care of the mentally ill v
Modern Civilization
o 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 influencer first 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
 INTERNATIONAL CLASSIFICATION OF DISEASES

✓ ICD serves a broad range of uses globally and provides critical knowledge
on the extent, causes and consequences of human disease and death
worldwide via data that is reported and coded with the ICD.
✓ Clinical terms coded with ICD are the main basis for health recording and
statistics on disease in primary, secondary and tertiary care, as well as on
cause of death certificates.
✓ These data and statistics support payment systems, service planning,
administration of quality and safety, and health services research.
✓ Diagnostic guidance linked to categories of ICD also standardizes data
collection and enables large scale research.
✓ For more than a century, the International Classification of Diseases (ICD)
has been the basis for comparable statistics on causes of mortality and
morbidity between places and over time.
✓ Originating in the 19th century, the latest version of the ICD, ICD-11, was
adopted by the 72nd World Health Assembly in 2019 and came into effect on
1st January 2022

ICD PURPOSE AND USES

As a classification and terminology ICD-11:

• Allows the systematic recording, analysis, interpretation and comparison of

mortality and morbidity data collected in different countries or regions and
at different times
• Ensures semantic interoperability and reusability of recorded data for the
different use cases beyond mere health statistics, including decision support,
resource allocation, reimbursement, guidelines and more.

ICD PURPOSE AND USES