American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

The Road to Pediatric Surgical

Ellen A. O’Donnell RN, MSN, CPNP-PC APSNA’s 23rd Annual Scientific Conference Phoenix, Arizona May 2014

Disclosures

I have no commercial relations relevant to the topics presented, no conflicts of interest, and do not endorse any particular commercial product .

Accreditation Statement APSNA is an approved provider of continuing nursing education by NAPNAP. The NAPNAP contact hours is accepted by ANCC.

Objectives

1. Describe the history of nursing and how the role has evolved over the years 2. Discuss perspective & offer insight from 2 nursing colleagues each with over 4 decades of pediatric 3. Discuss APSNA’s role in the future of pediatric surgical nursing

1 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

History of Hospitals for Children

By the 1860’s –US special hospitals for children were becoming increasing necessary since many of the newly founded general hospitals refused to admits children Indigent or Abandoned children- some that so happened to be ill 1. sickness represented poverty 2. moral & spiritual guidance, food and clothing- rise above their conditions 3. some hospitalized for months receiving food and fresh air only 4. exposure to the wealthy Trustees 5. parents NOT encouraged to see children

Medical Specialties Forming

• 1864- 1880 medical specialties were forming – was one • 1900 every state defined practice of medicine –specialist began to have appointments at teaching hospitals • Abraham Jacobi - considered the Founder of Modern Pediatrics – Pediatricians should concern themselves with child health and well-being – To become involved in infant feeding, child hygiene and disease prevention – “Americanize immigrants”: look at disease prevention in healthy children and not just specific disease, education of parents on child rearing and social activism for children’s rights

Founding of Pediatric Organizations

• 1880 section of the Diseases of Children in the American Medical Association • 1888 The American Pediatric Society

2 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Surgical History

History can be defined in many ways: “a systemic account of the origin and progress of science…history never looks like history while you are living through it…for 1914 Children’s Hospital pediatric …it is Milk for Children the past that is significant not the present”

N. A. Myers History of pediatric surgery, Pediatr Surg Int (1997) 12:79-80

Germ Theory:1870-1880

• Robert Koch, Louis Pasteur & Joseph Lister • What causes diseases- typhoid, leprosy, malaria, TB, cholera, diphtheria & other conditions were identified • These illnesses were no longer specific to the poor and indigent • Reshaped and medical care

Historical Perspectives in Medicine

• 1846 William Morton 1st to use ether • 1868 Clinical thermometer invented • 1896 Wilhelm Rontgen discovered x-rays • 1928 “Iron Lung” • 1949 1st mechanical ventilator • 1942 Penicillin invented • 1975 CT Scan invented

3 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Forefathers of Pediatric Surgery

• Dr. William Ladd (1880-1969) – treated many children with severe burns – 1927 dedicated to pediatric surgery • Dr. Robert Gross (1905-1988) – Dr. Ladd’s student – 1st divided PDA in a child – Maria Dresser, designated scrub nurse • Dr. Mark Ravitch (1910-1989) – only non-cardiac children’s in the Johns Hopkins Hospital – Head of the Department of Pediatric Surgery University of Chicago; professor of surgery at Johns Hopkins in Baltimore and then University of Pittsburgh – 1949 1st pectus -expert on the correction of chest-wall deformities – “It is a great field! But there may be no future for the specialty.”

Early Pediatric Surgery

• 1941 Abdominal Surgery of Infancy and Children, published by Ladd & Gross • Became the Bible of the budding pediatric surgical specialty • 1966 Surgical Section of the American Academy of Pediatrics: Pediatric Surgery Training Program Committee

4 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Charles Everett Koop (1916-2013)

• American pediatric surgeon • 13th Surgeon General of the United States (1982 to 1989)

First Children’s Hospitals

1855 Children’s Hospital of Philadelphia -CHOP • Tension between child’s social welfare and medical missions became apparent

• Advancement to surgical gloves & sterilization of 1869 Boston Children’s Hospital equipment • made pediatric surgery safer • Hospitals became medically oriented

Childrens Hospitals : Mission

• Noticeable in the community • Pride with social welfare mission • Pediatrics evolve into a specialty of medicine and nursing

J&J Campaign for Nursing’s Future

5 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Boston Children’s Hospital

Then…. Now…

Pediatric Surgical Leaders: Boston Children’s Hospital

Dr. Moses Judah Folkman Father of Angiogenesis Theory Dr. W. Hardy Hendren III Emeritus Chief of Surgery

Dr. Robert C. Shamberger Chief, Department of Surgery

Definitions

• Nursing comes from the Latin word “to nourish” or “to cherish” • Patient comes from the Latin word “to suffer” or “to bear” • Nursing is: – Caring & helping – An art and a science – Client centered – Holistic – Focused on health promotion, maintenance and restoration (excerpt CNA 1987)

6 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Historical Perspectives in Nursing

• Ancient civilizations women were responsible for nurturing, nourishing and providing care to children and ill family members. • By the 16th century, nurses were known as persons who wait upon or tend to the sick. • 17th century male nurses were first documented in practicing primitive nursing • 19th century that the definition of nursing was broadened to include those trained to tend to the sick and carry out duties under the direction of a physician

Founder of Modern Nursing 1859 : "It is the real test of a nurse whether she can nurse a sick infant” 1860 Nightingale Training School for nurses in London to standardize care of patients Nurses worked on the wards usually unsupervised for 12 hours a day 6 days a week – 50 weeks a year!

“Special personality of the nurse needed to care for children” • Improved sanitary conditions and reducing mortality rates during the Crimean War

Nurses Throughout the Years

• 1802-1887 - – “not too young, not too pretty, and of strict moral character” • 1818-1882- Mary Todd Lincoln • 1820-1910-Florence Nightingale – made rounds at night “Lady of the Lamp” – 1862 began training nurses in England – stressed good food, clean air and sanitation • 1821-1912- – Founded the American Red Cross • 1845- 1926 -Mary Eliza Mahoney – first Black Nurse to complete training (1879) – inducted into both the Nursing Hall of Fame and the National Women's Hall of Fame • 1879-1966 - Mary Eliza Mahoney • 1897-1966 Virginia Henderson

7 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Professional Nursing • – 1st graduate of a nurse training school in 1873 – pioneer of nursing education @ Massachusetts General Hospital – Chief Nurse and Director of the MGH Linda Richards Training School for Nurses 1874-1876 • Bess Lank 1904-2001 – 1935-1969 pioneer in “new” specialty: 1st pediatric • Marie Dresser – 1st “scrub” nurse – 35 years Dr. Gross’s scrub nurse

Marie Dresser

Standardization

• Remember medicine 1900 • 1920 standard nursing education, curriculum, registration and licensure

8 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

1923 First Pediatric Nursing Text published

9 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

What is Nursing Today?

Nursing: • protection, promotion & optimization of health and abilities • prevention of illness and injury • alleviation of suffering through the diagnosis and treatment of human response • advocacy in the care of individuals, families, communities, and populations. (ANA)

What is Surgical Nursing?

Surgical nursing specialize in peri-operative care: care provided to surgical patients before, during and after surgery • Pediatric Surgical Nursing is the protection, promotion, and optimization of health and abilities for children of newborn age through young adulthood, before, during, and after surgery or hospitalization, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations.

10 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Goggle Search: “Pediatric Surgical Nursing”

• American Pediatric Surgical Nurses Association www.apsna.org • Nursing Care of the Pediatric Surgical Patient wins an AJN 2013 Book of The Year Award Latest News: 1/15/2014 Member Listserve has moved. • Nursing Care of the Pediatric Surgical Patient www.jblearning.com/catalog/9780763799939 • Nursing Care of the Pediatric Surgical Patient, Third Edition includes information on pre- and post-operative care, minimally invasive surgery, innovative therapies ... • Amazon.com: Nursing Care Of The Pediatric Surgical Patient ... www.amazon.com › … › Education & Reference › Schools & Teaching • By Nancy Tkacz Browne · Hardcover Nursing Care of the Pediatric Surgical Patient and over one million other books are available for Amazon Kindle. Learn more • STAT!Ref - Nursing Care of the Pediatric Surgical Patient online.statref.com/titleinfo/fxid-427.html • This is the first book to address all aspects of pediatric general surgery from a nursing perspective—appropriate for nurses in pediatric surgery departments ... • How to Nurse a Pediatric Surgical Patient | eHow www.ehow.com › Health › & Operations › Surgeries • How to Nurse a Pediatric Surgical Patient. When your child has surgery, he is closely monitored and treated by a highly skilled staff of medical professionals. When ... • Nursing Care of the Pediatric Surgical Patient - Google Books books.google.com › Medical › Nursing › General • The book packages all aspects of the pediatric surgical nurse's job into one comprehensive reference, including pre- and post-operative care, minimally invasive ... • Surgical Care in Pediatrics - Medscape www.medscape.org/viewarticle/575648 • Three sessions presented at the National Association of Pediatric Nurse Practitioners (NAPNAP) conference centered on the special needs of the pediatric surgical patient. • Journal of Pediatric Surgical Nursing - LWW Journals ... journals.lww.com/journalofpediatricsurgicalnursing/pages/default.aspx • Nursing Care of the Pediatric Surgical Patient, Third Edition by Nancy Tkacz Browne, Laura M. Flanigan, Carmel A. McComiskey, and Pam Pieper was awarded second …

Common Pediatric Surgical Conditions

Congenital Anomalies: Acquired conditions: • lymphangioma, EA/ • appendicitis, NEC, TEF, pyloric stenosis, bowel obstructions, intestinal atresia, trauma related meconium plugs, injuries, IBD, short Hirschsprung’s disease, bowel syndrome, anorectal tumors, intestinal and malformations, complex wounds abdominal wall defects, vascular anomalies , chest wall deformities, childhood tumors

American Pediatric Surgical Organizations

• 1970 APSA Founded

• 1991 APSNA Founded

11 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Nursing Care of the Pediatric Surgical Patient

1st Edition (2000): 2nd (2007) & 3rd Edition (2013):

• Barbara V. Wise • Nancy Tkacz Browne • Chris McKenna • Laura M. Flanigan • Gail Garvin • Carmel A. McComiskey • Bethany J. Harmon • Pam Pieper

Interview: Anne Nelson RN

• 1952 graduated Boston Children’s School of Nursing • Roles- private duty, numerous leadership roles within the hospital, served with Project Hope on the ship SS Hope • Preceptor, mentor and friend • Bedside nurse- “real nurse”

BCH 1952 School of Nursing

Insight and Reflections

• Caring most importantly- “hands on” • Mentality change over time • Nursing “as a profession” • Partnering with parents • Mutual respect • Change in physician/surgeon/nurse relationship • Technology good and bad–taking nurses more and more away from the bedside

12 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Interview: Jo Ann Rosen RN

• 1971 graduated • 43 years as an pediatric OR nurse @ BCH • Why she chose OR nursing: “teamwork” • Criteria and requirements need to be an OR nurse • Tools/surgical instruments needed • Changes: 8-12 OR’s now 25 with 2 procedure rooms • Clinical Cases different • Staffing model • Service oriented

Insight and Reflections

• Efficiency/turnover • Computer • Sale representatives in OR • Robotic surgery • Waiting area for families • Parents • Cultures

Future of the OR • Always be a team: surgeon, anesthesia and nursing, OR Tech’s • Technology- good and bad • Efficiency • Good patient care • Patient safety • Working with less- not replacing staff • Equipment cheaper- “lean” • How the future of the OR surgical nurse will be developed

13 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

2014 Perioperative Experience

Supplies….

14 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Equipment Sterilization

Reflections on why we each chose nursing?

Pediatric surgical nursing- what does it mean to me and you?

Numerous roles in pediatric surgical nursing

Pediatric nursing education- variety of paths

Mentoring

Precepting

15 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

The Future of Nursing: Leading Change, Advancing Health • In October 2010, The Institute of Medicine released its report: The Future of Nursing: Leading Change, Advancing Health. The report’s 4 key messages include: 1. Nurses should practice to the full extent of their education, and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other professionals, in redesigning health care in the United States. 4. Effective health care workforce planning and policy making require better data collection and an improved information infrastructure.

Collaboration

• NAPNAP • Nursing Organizations Alliance (NOA) • Institute of Pediatric Nursing (IPN) • Nursing school education

APSNA

Haven’t we come a long way? Imagine what the future will hold? Each one of us has a part in influencing the next generation of nursing.

Thoughts for our future: • What can you do as a member? • What can we do as an organization? • Challenge us and you as a individual

16 American Pediatric Surgical Nurses Association 111 Deer Lake Rd., Suite 100● Deerfield, IL 60015 ● http://www.apsna.org 23rd Annual Scientific Conference | May 26-29, 2014 | Phoenix, AZ

Thank You! • Thank you to all the patients and their families……if they were someone I met once or have known all their lives….it’s a privilege to have cared for them…

References

Boston Children's Hospital Archives, Boston, Massachusetts.

Clatworthy, H. (1999). Ladd’s vision. Journal of Pediatric Surgery, 34(5), Suppl 1, 32-37.

Hendren, WH (1998). Pioneers and modern ideas. Pediatric surgery. Pediatrics, 102, 275-277

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved May 2014 from http://books.nap.edu/openbook.php?record_id=12956&page=R1

Meyers, N.A. (1997) History of pediatric surgery: Editorial comment. Pediatric Surgery International, 12, 79-80.

17