Critical Care Nursing: A History

Abstract

Reviewed by: Critical Care Nursing: A History Ada Romaine-Davis Julie Fairman and Joan E. Lynaugh. Critical Care Nursing: A History. Studies in Health, Illness, and Caregiving. Philadelphia: University of Pennsylvania Press, 1998. x + 175 pp. Ill. $27.50, £25.00 (paperbound). This outstanding book, takes us on a historical journey through medicine and nursing from the early 1950s through the 1990s—an era in which radical and unprecedented changes occurred in the care of patients (those severely ill, and all others as well) with the development and growth of intensive/critical care units in hospitals. The impetus for initiating these units was multifactorial and complex; the factors included the acute shortage of civilian registered nurses (RNs) during and following World War II, innovative surgical procedures developed in caring for wounded servicemen that later carried over to civilian hospitals, vastly overcrowded hospitals, and the unacceptably high mortality rate among postoperative patients. Nursing care at that time was neither standardized nor organized: it was carried out by licensed RNs and practical nurses (LPNs), and by unlicensed nurse’s aides, each doing what seemed best for the patient at any given time. In 1953, Dr. William McClenahan was the first to recommend and establish, against opposition, a separate unit for critically ill patients. Hospital administrators quickly recognized that these centrally located units were far better models by which to meet the fast-changing needs of these patients. Within less than fifteen years, 90 percent of U.S. hospitals with five hundred or more beds had opened intensive care units (ICUs). A major problem at first was that neither the physicians nor the highly competent nurses hired to work in the new units were familiar with the recently developed cardiac monitors, resuscitation procedures (CPR), and the rapid decision making required in caring for clusters of severely ill patients. In the beginning, therefore, physicians and nurses helped each other to operate the new equipment, to recognize cardiac dysrhythmias on electrocardiographs, and to swiftly and efficiently carry out CPR. The rapidly increasing number of critical-care nurses soon collectively organized a national group, the American Association of Critical-Care Nurses (AACN), which developed standards of care, a core curriculum to educate new nurses entering the field, and a national examination to certify nurses’ knowledge and competency in critical care. These efforts continue to guide the education and clinical competence of intensive-care nurses. At the outset, the traditional relationship [End Page 350] between physicians and nurses was profoundly affected by the degree of collaboration and mutual trust needed to provide quality care in ICUs. Although nurse-anesthetists and nurse-midwives had provided specialty care for several decades, the development of critical-care education programs in schools of nursing across the country opened the doors to the further development of specialty areas of clinical practice for nurses. Clinical nurse specialist master’s programs began in the late 1940s, and the first nurse-practitioner (NP) program opened in 1965 at the University of Colorado, which was quickly followed by the establishment of nurse-practitioner specialty programs in many other schools of nursing around the country. Federal funding of master’s education for nurses boosted the impetus for schools to develop specialty programs in several fields, notably psychiatric/mental health nursing. Fairman and Lynaugh, using archival materials and personal interviews with pioneer nurses in the field of critical-care nursing, have produced a comprehensive, multifaceted book of astounding scope. They trace the development of ICUs, with the attendant problems and solutions, and address continuing complex concerns regarding the care of very ill patients—care that is difficult, often lengthy, often with unexpected consequences, and enormously expensive. However, they state unequivocally that the perseverance of administrators, physicians, and nurses in providing this care “gives testimony to the endurance and power of human ingenuity and caring” (p. 118). This volume is highly recommended for all levels of students, for those interested in medical and nursing history, and for general audiences. Ada Romaine-Davis Johns Hopkins University Copyright © 1999 The Johns Hopkins University Press