Historical Development and Current Status of Emergency Nursing in Turkey

Turkish Journal of Trauma & Emergency Surgery Ulus Travma Acil Cerrahi Derg 2009;15(5):413-415 Review Derleme

Historical development and current status of emergency nursing in Turkey

Türkiye’de acil hemşireliğinin tarihsel gelişimi ve mevcut durumu

Deniz ŞELİMEN, Aysel GÜRKAN

As the demand for high quality Accident and Emergency Acil servislerde verilen sağlık hizmetinin ve özellikle de Departments and nursing staff increases throughout Tur- acil bakım hemşireliğinin önemi gün geçtikçe artmakta, bu key, the need for more specialized emergency nurse train- birimlerde hizmet veren hemşirelerin diğer hemşirelerden ing has also increased. Although there have been a number daha farklı özelliklere sahip olmaları ve mutlaka özel eği- of positive developments regarding emergency nursing timden geçmeleri gerekmektedir. Türkiye’deki mevcut du- standards, the general quality of emergency nurse training ruma baktığımız zaman, acil hemşireliği konusunda olumlu needs to be improved and job definitions amended to better gelişmeler bulunmakla birlikte, bu alanda standartların geliş- reflect the specialist duties of emergency nurses. tirilerek görev tanımlarının yapılmasına gereksinim vardır. Key Words: Emergency nursing; historical development. Anahtar Sözcükler: Acil hemşireliği; tarihsel gelişim.

The medical definition of an emergency is ‘ad- formed. In the US, EDNA - the Emergency Depart- ministering healthcare services to a patient immedi- ment Nurses Association - was established by a group ately, for an incident that is related to physical or of nurses to help the medical world recognize their emotional danger’.[1] The Accident and Emergency specialist needs. In 1985, the group changed its name (A&E) service is often the start of a healthcare path- to ENA - Emergency Nurses Association.[4,5] In 1972, way that consists of many other medical services. the English Royal College of Nursing separated acci- The nature of the accident results in healthcare ser- dent nursing and emergency nursing groups. In 1990, vices beginning at the site where the emergency oc- these two separate groups combined under the name curred, and it continues until the patient reaches the “Accident & Emergency Nursing Association”,[5] en- rehabilitation stage.[1,2] abling the group to establish a professional authority Recent History of Emergency Nursing to standardize training opportunities in emergency (International) nursing care. Later, developments within the nursing profession resulted in the roles and responsibilities of Many of the improvements in A&E services were emergency nursing being regarded as a specialized first pioneered in England and Germany. The United branch of nursing, which is based on an extensive and States (US) also started to promote the importance specific set of skills and knowledge.[3,5] of A&E services, especially after the second World War.[2,3] As far back as the 1960s, it was realized that Over the years, when we look at the progression the role of A&E nurses was noticeably different from of this medical area, it becomes clear that the train- that of other nurses. The necessity of providing these ing authorities responsible for the emergency nurses nurses with more specialized training was being real- in the US have officially recognized a higher level ized. As nurse training improved noticeably during of training by awarding graduates with a Master’s the 1970s, the development of branch nursing was degree or a certificate. Certified Emergency Nurs-

Department of Nursing, Marmara University Faculty of Health Sciences, Marmara Üniversitesi, Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Istanbul, Turkey. İstanbul.

Correspondence (İletişim): Aysel Gürkan, M.D. Marmara Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Tıbbiyeler Cad., Haydarpaşa 81326 İstanbul, Turkey. Tel: +90 - 216 - 330 20 70 / 1168 e-mail (e-posta): [email protected]

413 Ulus Travma Acil Cerrahi Derg ing training programs started in the US in the 1980s. disasters and wars, providing first-aid care to the These programs are overseen by CEN - the Certified wounded and to disaster victims.[3,6-8] Emergency Nurse group. These certificates are valid The Ege University School of Nursing was estab- for four years, with a further examination required lished in 1955 as the first degree level nurses training after this period to renew certification.[4,5] In the US, center not only in Turkey, but in all of Europe. The the medical applications of emergency nursing are first Master of Science (Msc) in nursing was started governed by legislation in most states. Addition- at Hacettepe University in 1968, and the first Doctor- ally, the Society of Trauma was established as a sub- ate (PhD) program was started at the same university branch of Emergency Nursing. Trauma core courses in 1972.[7-9] The first academic level training was the were organized in order to maintain international Emergency Nursing Master’s Program, which ran standards for trauma training. The first Internation- from 1996 to 1997 at Marmara University, Nurs- al Emergency Nursing Congress was held in 1985, ing Academy.[2,3,9] In addition to the undergraduate while the first Trauma Core Course was organized in level Emergency Care/First Aid courses being con- England in 1990.[5] ducted at the Nursing Academies in Turkey, obliga- Recent History of Emergency Nursing in Turkey tory Emergency Nursing course modules are now The first known instances of emergency nursing conducted within the subjects of Surgery, Operating in Turkey occurred during the Crimean War (1854- Room, Pediatry and Internal Medicine Nursing as 1856), within the Selimiye Barracks, which were set part of the post-graduate courses.[3] up during the war as a hospital to care for the wound- The effects of the universal changes and deve- ed soldiers. Florence Nightingale worked here du- lopments in emergency nursing were seen in Turkey [3,6,7] ring this time (1820-1910). Turkey witnessed its over this period. Attempts to specialize nurses in the own development of the nursing profession, mainly emergency care arena were underway. An Emer- through the emergency nursing services offered to in- gency Care Nursing Course was set up for the first jured soldiers during the Crimean War. The Turkish time in 1994 by Semahat Arsel Nursing Education army suffered heavy military losses and high numbers and Research Center (SANERC), which is affiliated of wounded soldiers during the war. With the com- with the Vehbi Koc Foundation. The course consists bined effect of the Trablusgarp War (1911) and Balkan of both theoretical and practical training sessions Wars (1912), the necessary care required by so many and runs every year for eight weeks.[3,10] Then, the injured highlighted the importance of and deficiencies [3,7] Emergency Care Nursing Course was held in 2003, in the Turkish emergency nursing services. in collaboration with the Ministry of Health and Uni- During the Washington Congress of the Red versity, in order to develop qualified nurses who are Cross, Dr. Besim Omer Pasha recorded that nursing ready for employment in emergency services. The should be regarded as a profession, and that as such it purpose of this course was to increase the efficiency should be separated into branches. The Turkish Red and reliability of the care provided in these units.[11] Crescent was established and recognized the neces- In December 2005, new medical training guidelines sity for the nursing profession in the country. The were introduced for all registered nurses, healthcare first formal nursing education school in Turkey was assistants and midwives working within the Ministry established in 1911. Turkish women who obtained of Health hospitals. The “Emergency Care Nursing certificates at the end of the six-month course were Training Program” guidelines state nurses must en- given the title of Volunteer Trained Nurse. Nurses roll in a three-week theoretical and two-week practi- who served in the Patient Care Services during the cal training course.[12] Balkan Wars were also awarded this title. These [6,7] The first Trauma and Resuscitation Course (TRC) courses ran until 1914. was organized in 1998 by the Turkish Association of The first implementation and development of the Trauma and Emergency Surgery at the 1st Regional modern nursing profession in Turkey started with the Trauma and Emergency Surgery Congress. Aimed establishment of the Republican government. The at medical doctors, this course still runs in 20 cities first nursing school of the Republican era was the throughout the country.[13] In December 2006, new Kızılay Private Nursing High School. It was opened guidelines, entitled the ‘Ambulances and Emergency in Istanbul in 1925. The graduates of this school Health Vehicles Regulation’, stated “at least one undertook nursing duties during the many national doctor and/or Emergency Medical Technician (EMT-

414 Eylül - September 2009 Historical development and current status of emergency nursing in Turkey

P; paramedic) and healthcare professional must ac- the importance of the emergency health services in company every emergency aid ambulance”. A new Turkey, especially of emergency care nursing, is in- standardized quality of training was required for the creasing accordingly. The medical personnel work- emergency treatment of trauma patients. With the ing in emergency services should have adequate cooperation of the National Trauma and Emergency knowledge, skills and experience in order to attempt Surgery Association and the Ministry of Health, the recovery under often extreme trauma conditions, Trauma and Resuscitation Course for Nurses, Para- which are often life-threatening. In Turkey, there medics and Technicians (TRC-NPT) was established are no existing standards defined by the Ministry of in February 2007. The course is aimed at nurses, Health, higher education institutions or non-govern- paramedics and technicians, and runs in 20 cities mental organizations; however, the studies regarding throughout the country. The TRC-NPT course runs this issue are ongoing. for fours days and consists of theoretical and practi- REFERENCES cal sections. The certificates, which are approved by 1. Adaş G, Sarvan F, Kupelioğlu R, Taviloğlu K. Evaluating the Ministry of Health, are given to those participants the standards of trauma and emergency surgery care in three who are successful in the written, oral and practical hospitals in Istanbul. [Article in Turkish] Ulus Travma Derg examinations held at the end of the course. The TRC- 1997;3:222-7. NPT certificate is valid for five years.[13,14] 2. Kuğuoğlu S. Emergency care. In: Şelimen D, editor. Emer- gency care book. İstanbul: Yüce Pres; 2004. p. 3-18. In order to show the development of an educa- 3. Akyolcu N. 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