Historical Perspective of Nursing in the Operating Room Anne Marie Herlehy, RN, MS, CNOR AORN, Board of Directors Objectives for this presentation • Review historical accounts • Define practice • Discuss ways practice has been promoted • Current mission and vision of AORN • Strategies/initiatives for promoting profession • No commercial support “You’ve come a long way baby…” The Perioperative Registered Nurse must have an understanding and appreciation of the history of surgery and the development of Operating Room Nursing. It is the foundation on which current practice is built upon, and the guide by which future practice will be defined. • 7000~6500 BC – Middle Eastern evidence of teeth drilling – People believed disease was caused by evil spirits and could only be cured by appeasing the gods through ritual and sacrifice – In France, 120 prehistoric skulls with trepanation holes (burr holes) were discovered • 3300 BC – In ancient India, the Hindus removed tumors and infected tonsils, credited with developing plastic surgery techniques in response to the common practice of removing a person’s nose or ears • 2650 BC – Egyptian carvings describe surgical circumcision, surgically removed bladder stones, treated bone fractures and performed amputations First Surgical Renaissance: 800 BC – 1500 AD • 800 BC: Nursing first mentioned in India • Treatment a mixture of religious, astrologic, scientific elements • Wine used as anesthetic, cautery with hot irons. • Surgeon =“Cheir”(hand) “ergon”(work) • Surgery deemed manual work…not dignified, barbaric. Hippocrates published descriptions of various surgical procedures, providing directions for the proper placement of a surgeon’s hands. • 390 AD: Nursing- a divine calling. Care provided by deaconesses, virgins, widows. • 625~690 AD Procedures such as the tracheotomy (described in detail by Paul of Aegina) remain relevant today • Surgery by bath keepers, hangmen, and quacks with therapies including bleeding, cupping, leaching • Bloodletting, contributed to the demise of many patients over the course of many centuries Middle Ages • Few advantages were made in surgical practice • Surgeries were left to traveling barbers who cut hair, removed tumors, pulled teeth, stitched wounds and performed bloodletting • Red- and white-striped barber poles were inspired by this practice, symbolizing the colors of blood and bandages, respectively • Introduced the hospital, a refuge for elderly, disabled, and homeless • 1300’s: Hospitals transformed from charity houses to medical facilities. Second Surgical Renaissance:1500-1842 AD • Rebirth of surgery/medical education at universities. • Nursing under secular orders, seen as a domestic service, not a profession. NOT for reputable women!! • 1600-1700’s: Crusades saw nuns providing care to wounded/sick • 1612 1st American hospital (80 beds), all male nurses. • 1628 William Harvey (English physician) proved that the heart, not the liver, propelled blood around the body in a continuous circulation • 1633 Order of Sisters of Charity (1st nursing order) • 1700 traveling French practitioner Frère Jacques de Beaulieu, creator of lithotomy procedure for stones • 1714 Gabriel Fahrenheit developed the thermometer • 1731 Blockley Hospital in Philadelphia • 1751 Pennsylvania Hospital • 1771 New York Hospital • 1774 Bellevue Hospital in New York • 1774 Electric shock used to restart the heart of a 3 year old girl who fell out of a window • Continental Congress established Army hospitals and nurse/patient ratios • 1776 Hospitals improved / hygiene emphasized • 1775-1800 American Revolutionary War – Nurses were camp followers, no training, described as illiterate, heavy-handed, alcoholic, lacking moral standards, unfeeling. • 1798 Dr. Valentine Seaman organized the first school for nurses at the New York Hospital • 1809 - Mother Seaton founded St. Joseph’s Sisterhood • 1821 Massachusetts General Hospital • 1836 – Reverend Theodor & Friederike Fliedner established a 3 year nursing course in Germany • 1839 - Nurses’ Society established in Philadelphia • 1840, British physician Dr. John Snow pioneered the effective and practical use of anesthetic chemicals (i.e., ether, chloroform) • Hospitals were dirty, overcrowded, with high infection rates, and considered “houses of death” • Usually not a separate operating room theater, but procedure performed in the patients room or on a counter in the hospital pharmacy Third Surgical Renaissance: 1843 to present day • 1843 - Sisters of Mercy founded • Localism: treating localized areas • 1846 Use of alcohol/opium replaced by ether and cocaine locals (1881) • 1847 Ignaz Semmelweis (Hungarian physician) emphasized hand washing with chlorine rinse • 1859 Drs. Elizabeth & Emily Blackwell founded Nurses Training School in NJ. • 1860 Florence Nightingale opened her school of nursing in London – “surgery removes the bullet out of the limb, which is an obstruction to cure, but nature heals the wound, and what nursing has to do is put the patient in the best condition for nature to act upon him”. 1861-1865 American Civil War • 1861 Dorthea Dix, Supt. of Army Nurse Corps, Clara Barton, took supplies/aid stations to the front lines • 1862 Germ discovery by Louis Pasteur • 1865 Joseph Lister-use of antiseptic (carbolic acid) applied to wounds/hands. • 1873 less than 200 hospitals in the United States, of which a third was for the mentally ill • 1873 Nurses brought into the surgical theater • 1874 “notes of surgical nursing” with techniques for preparation by Dr. C.H. Barnes • 1877 Basic sciences advanced • 1878 First “listerian” surgical procedure performed in the US at Harper Hospital in Detroit • 1880 Mayo Clinic opened by surgeons with good reputations, outcomes (Drs.Wm./Chas Mayo) • 1880’s 1st electrocautery, arterial clamps, cystoscopes • Caps/gowns worn…..no masks/gloves until 1890 • 1880’s: 3 Nursing Schools established on the Nightingale's system • Physicians objected to women being educated, feared “THEY WON’T DO AS THEY’RE TOLD!! • 1882 Gustav Neuber of Germany introduced the Operating Room – Surgery not performed in same room as where sterilized goods were stored – Use separate rooms for clean and dirty procedures – Marble terrazzo and slanted floors, round corners – Unnecessary furniture was excluded – Patient segregated on wards and dressed in surgical gowns, pre operatively – Patients washed with soap and water, shaved, and draped with a rubber drape – Tables were heated and operating room doors were closed – Surgeons wore water proof aprons, performed a hand scrub outside and inside the operating room suite, as well as walking through an antiseptic mist – Operating rooms were heated, humidified, and had air circulation renewal every 30 minutes • 1884 Dr. Halsted came to Bellevue Hospital • 1885 introduction of steam sterilization • 1889 Caroline Hampton wore gloves and was one of the first operating room head nurses • 1889-Johns Hopkins Hospital: set precedent for nursing in the OR – An OR nurse should have…”a level head and keen eyes, ever watchful for all that may be required, a mind not easily irritated or confused, combined with a facility for keeping out of the way and still being of the greatest help….thoroughness, speed, and gentleness especially fit the surgical nurse.” (Asepsis for the Nurse) Late 1800’s • Post war, general hospitals in were charity, providing free medical care for those without suitable alternatives • 1893 use of formaldehyde for preservation over alcohol, dry sterile field was necessary • 1893 Isabel Robb (Cook County Hospital) – “To ensure thoroughness, one nurse should be given responsibility of the operating room” (Nursing: It’s Principles and Practices in the Hospital and Home) • 1893 World’s Columbian Expedition in Chicago showed the latest hospital technology, autoclaves, rubber gloves, and immaculate operating rooms • 1898 gloves were worn The Early Times • Emphasis was on the technical aspect of nursing rather than patient assessment and safety • Although technology was rudimentary, there remains the basic steps – “The duties of an operating-room nurse, especially if they include the care of the sterilizing room, are very numerous. They require a knowledge of the principles of asepsis, careful attention to details, and much forethought in the preparation of supplies.” The Duties of an Operating-Room Nurse, Martha Luce, Boston 1900-1939 • 1901 specialty of operating room was established in “duties of the operating room nurse” published in the 6th issue of the American Journal of Nursing • 1902: 1st OR Nursing Text-A Nurse’s Guide for the Operating Room (Dr. N. Senn) • 1903: Formal OR experience required for RN licensure • 1905: OR Nursing Interventions listed prevention of infection, promotion of comfort, physical safety, patient monitoring, resuscitation, and psychological support • 1908 Droplet infection made masks mandatory • 1910, pus in a wound was interpreted as a break in aseptic technique. • Mid 1880-1915, operating room team became fully garbed World War I (1917-1918) • As late as 1920, techniques on how to convert ordinary residence into surgical setting was popular • 1920 the phrase registered nurse and abbreviation RN was used nationwide • 1900-1940 evolution of surgery with creating the greatest single demand for expansions of hospitals • 1930 operating room personnel organized for a meeting • 1939 first 3 day institute OR Nursing in the 1940’s and later • Gloves were washed/dried/tested for holes, powdered and re-sterilized • Sutures were prepared/sterilized • Instruments were