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Critical Care Nursing

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Critical Care Nursing DAVIDA MICHAELS Critical Care Nursing Memories of Early ICU’s – 1969 - 1978 Davida Michaels MSN, M.Ed RN 5/14/2019 Memories of my early days working as a staff nurse in two community hospitals and having the opportunity of starting he first ICU in a community hospital. Contents Memories of Critical Care Nursing circa 1969 – 1978. ................................................... 2 Background .................................................................................................................. 2 Early Cardiac Monitoring on a General Medical-Surgical Unit ............................... 3 My First ICU Experience ............................................................................................. 4 Genesee Hospital - ICU ........................................................................................... 5 Continuing Education New Unit and Growth of Critical Care Nursing ...................... 7 Greater Rochester Area Chapter of the American Association of Critical-Care Nurses ...................................................................................................................................... 9 ICU Memories ............................................................................................................... 11 Critical Care Nursing: ................................................................................................ 11 Cardiac and Respiratory Arrests / Codes ............................................................... 11 Respiratory Care 1970 ........................................................................................... 13 Teamwork – A Snow Story........................................................................................ 14 Living in the Intensive Care Unit............................................................................... 15 Toward A New Life ............................................................................................... 16 Memories of Critical Care Nursing circa 1969 – 1978. Writing about the history of critical care nursing and reading “Critical Care Nursing: A History” by Fairman and Lynaugh brought back memories of my experiences working in several intensive care units and having the privilege of being a part of starting the first ICU in a community hospital . My first position as a new graduate of Genesee Hospital School of Nursing in Rochester N.Y. was in their newly opened Intensive Care Unit. Background Strong Memorial Hospital is the Teaching Hospital for University of Rochester’s School of Medicine and Nursing programs. Strong opened the areas first critical care 2 units –CCU (coronary care) and ICU (intensive care units) and formed the nexus for the development of Coronary care and Intensive Care units in local community hospitals. Genesee Hospital, was one of the community hospitals that opened a six bed Coronary Care Unit (CCU) in 1967. The CCU was located at one end of the cardiac floor. As a nursing student in the hospital’s diploma nursing school. I had had a rotation on the cardiac floor during my junior year. We were given a tour of the CCU but not assigned any patients in the unit. When CCU patients condition improved they ‘graduated’ to private or semi-private rooms on the cardiac floor; many of the patients transferred were not stable, plus there were patients admitted to the cardiac floor that had coronary artery disease and advanced heart failure. I witnessed my first emergency while caring for a patient on the cardiac floor. I was assigned care for an elderly woman who was on digoxin. As I was to administer her morning medications I had studied the actions of this medication and was able to answer my instructor’s questions. I recall thinking that her heart rate was very fast and so she surely needed her morning digoxin. I administered the medication, then assisted her to the bathroom as she had diarrhea. The EKG technician arrived just as I had assisted her to back to bed. I had no idea what the EKG ishowed but the technician called for help. Doctors and nurses ran into the room. My instructor ran in and told me to stand quietly and observe. One of the new interns (now called first year residents) came in and attempted to start an intravenous line (IV) he knelt down, worked steadily and I was allowed to help by providing the equipment he required. Finally after all was over and the patient stabilized, started an IV as I recall in her thumb. He also needed much support as did I. We developed a good working relationship as we both gained clinical experience. After the patient had been transferred back to the CCU my instructor told me that the patient had been in ventricular tachycardia – the rapid heart rate and the diarrhea were signs that she had digitalis toxicity. Early Cardiac Monitoring on a General Medical-Surgical Unit The general medical surgical units in Genesee Hospital were designed using a “T” shape with the top of the “T” having a two long .arms of private and semiprivate rooms; the stem of the “T” was a short hall with semi-private rooms. The nurses’ station was in the center where the ‘arms’ and stem of the “T” joined. In response to demands by physicians and surgeons who wanted their patients to receive closer observation and cardiac monitoring; monitors were placed on utility carts and located in the hall outside the patient rooms. As the rooms were semi-private the hall quickly became crowded with utility carts all with blinking lights and alarms.. 3 The nurses’ station was at the end of the hall – there was no central bank of monitors – so when an alarm went off nurses had to investigate the cause of the alarm. Monitors were checked to see if they were working and if the monitor had the capability to generate a short rhythm strip this was checked, the nurse then entered the room to check the patient. If a patient was restless and their monitor went off too frequently, some staff would turn it off - later the term “alarm fatigue” was coined for this problem. Staffing was increased on this unit and, as students, we were welcomed. As you can imagine, this system was not optimal. In my senior year we learned that the hospital was converting the old surgical suite to a 10 bed Intensive Care Unit. Our instructor informed (threatened) us - if our grades in the Senior Medical-Surgical course were not good we would not be allowed to work in ICU after graduation. While there were some who desired a career in Pediatrics or OB/GYN, the thought of working n either CCU or ICU appealed to many of my classmates. I had hoped to work in ICU after graduation and, as I was married with two young children, this shift would allow me to be at home during the day. I requested the 12 midnight to 8 am or ‘deep nights’ shift and was hired .After graduation our little family celebrated mother’s new career and took a short vacation to celebrate. My First ICU Experience As a graduate of the hospital’s nursing program, I did not require an orientation to the hospital; there was 2 week orientation the ICU on the day shift; the focused on ICU policies and procedures. “At Philadelphia's Presbyterian Hospital, physicians Lawrence Meltzer and J. Roderick Kitchell, with RN Rose Pinneo, conducted research that found nurses could successfully take on the new, high-level responsibilities of cardiac monitoring, CPR, and cardiac defibrillation. Their resulting work -- Intensive Coronary Care for Nurses: A Manual – helped thousands of nurses learned to interpret EKGs.” ii According to Pinneoiii: “The cardiac monitoring system in a specially designed facility never replaces the personnel. In fact, the most vital element to the success of a coronary care unit is the staff of physicians and nurses involved in patient care. A new outlook in nursing is experienced when a team approach is evident in which each team member fills his own responsibility and shares problems with the others. When physicians and nurses can work together as a team in identifying and solving problems, the effectiveness of the program is 4 enhanced. As a result, patients ' need s are met and all team members derive satisfaction from their work. Because the nurse member of the team is responsible to continuously assess the Patient’s clinical status and make decisions when warranted, she becomes the key to success of the program. To function in such a responsible capacity, she must be equipped with specialized knowledge in recognizing all arrhythmias and the ability to initiate treatment for those which are life-threatening.” At that time (1969), Rose Pinneo was teaching at the University of Rochester. The head nurse of the ICU, along with shift supervisors from Genesee, were sent to classes at Strong and brought back hand-outs from Pinneo’s book which were used to teach new ICU staff. Genesee Hospital - ICU The new ICU was built using a design similar to an old ward design; patient cubicles were on the along the outside with a central nurses’ station. Private rooms intended for isolation were located in three of the four corners. Supplies were located in the short hall off the fourth corner. While the CCU located at the end of the cardiac floor had windows, the ICU only had windows in the end rooms and these were near the ceiling and very small Thus patients and staff were in isolated in artificial light. Staff could and did, take a break and go outside the unit to check the weather; patients could not. This situation led to what became known as “ICU psychosis”iv. I was very fortunate as the 11 – 7 charge nurse was an experienced
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