THE DEVELOPMENT OF INTENSIVE CARE NURSING AS A SPECIALTY AT WELLINGTON HOSPITAL INTENSIVE CARE UNIT, WELLINGTON, NEW ZEALAND, 1964 – 1989 by Elinore Harper A thesis submitted to Victoria University of Wellington in fulfilment of the requirements for the degree of Masters of Nursing Victoria University of Wellington 2011 Abstract Intensive care nursing developed as a specialty with the advent of intensive care units (ICUs) following the poliomyelitis outbreaks of the 1950s. In New Zealand (NZ) the first ICU was opened in the early 1960s in Auckland. Many ICUs were quickly established in other NZ hospitals around this time with Wellington Hospitals ICU opening in 1964. This work explores the first 25 years of the development of the Wellington ICU and the specialisation of ICU nursing. Oral history interviews with past and present staff who worked and taught in the ICU during this time and Hospital archives and primary documentation sources provided much of the background information about this development. One find during the cataloguing of materials and administrative records prior to the move to the newly built Wellington Regional Hospital was the patient admission records documenting each year of the unit‟s operation since it opened. The information gathered from these records provided data on patient demographics, giving age, admission diagnosis, discharge destination, mortality information and admission source for each patient admitted. Education of the nurses, many of whom were embracing the knowledge and technology required to look after ICU patients for the first time was paramount to the care of the critically ill patient. With the advent of an ICU six-month nursing course in 1968 many of the educational needs of the nurses were met. Working relationships with the medical staff were very different from those that many nurses had been used to when working in the wards with the Doctor - Nurse relationship becoming less formal and more collaborative. This thesis illustrates the hard work and determination of those early nurses to provide excellent and appropriate care and translate knowledge into practice in order to look after these critically ill patients. Key Words: Nursing, Intensive Care, History, Development, Specialisation ii Acknowledgements This thesis has been an informative and challenging journey. Without the help, support and encouragement of many it would firstly not have begun, but also may never have been finished. Firstly I must extend thanks and gratitude to Dr Pamela Wood whose enthusiasm and passion for historical inquiry inspired me to begin this journey. Her encouragement and support as a supervisor, sounding board and champion mean so much to me; thank you somehow does not seem enough. A special Thanks also to Dr Kathy Nelson who provided thoughts and information on quantitative data gathering and analysis, stepped in as fill in supervisor when Pamela was away and then took on the job of primary supervisor following Pamela‟s departure from the University. It must never be easy to take on a student and shape their ideas and work with so little time left. To those nurses who agreed to be interviewed I am very grateful. I feel privileged to have had you share your stories and memories with me and that you did so so freely with me was a great honour. To those of you who recommended others again thank you. Jan Wigmore, Wellington Hospital‟s Records Management Administrator who discovered the patient admission records and passed them on to me was pivotal in the development of this thesis. Her love of historical documents and willingness to share these with me is appreciated as were her emails informing me of yet another find, aptly referred to by Pamela as “gems”. Also Marion Elliot, ICU secretary, who kindly ordered and returned boxes of records from the Hospital archives whenever I asked, without her help and support the flow of information would have been slow and tedious. Those of my ICU colleagues who have been enthusiastic and supportive upon hearing about this work I hope that you find it informative. Thanks to the ICU consultants and others who fielded my emails and questions and gave suggestions of who and where to go to get information. iii Particular mention must go to my friend and colleague Diane Mackle, who provided valuable insight into the research process, ethics and data gathering and more importantly in the latter half of this journey has shared the highs and lows, been my conscience and provided a valuable sounding board. As a fellow thesis student she understands the journey that this is. I must also thank the Victoria University Graduate School of Nursing, Midwifery and Health for the opportunity to undertake this journey of discovery and learning. To my fellow thesis students the stories you shared during the research schools were inspirational and sent me home with a renewed enthusiasm for my work. It was always a pleasure to hear your presentations and see your work develop; I hope that my journey was equally inspiring to you. Lastly, I must thank my family and Richard for their support and encouragement, and for being so understanding when I was busy and stressed. iv Table of Contents Abstract .........................................................................................................................ii Acknowledgements ...................................................................................................... iii Table of Contents .......................................................................................................... v List of Tables ............................................................................................................... vii List of Figures .............................................................................................................. vii Chapter One – Background .......................................................................................... 1 Context ........................................................................................................................ 1 The Question ............................................................................................................... 3 Scope of the Thesis ...................................................................................................... 3 Historiography............................................................................................................. 5 Structure of the Thesis ................................................................................................. 8 Chapter Two – Methodology and Method ................................................................. 10 Introduction ............................................................................................................... 10 Historical Research .................................................................................................... 10 Why Historical Research? ......................................................................................... 11 Methodology ............................................................................................................. 12 Documentary Primary Sources .................................................................................. 12 Patient Admission Records .................................................................................... 12 Archival Documents .............................................................................................. 14 Other Documents ................................................................................................... 15 Primary sources – Oral History .................................................................................. 15 Rigour and Reliability ............................................................................................... 17 Ethical Considerations ............................................................................................... 19 Method – Oral History ............................................................................................... 19 Oral History Interviewees ...................................................................................... 22 Conclusion ................................................................................................................ 24 Chapter Three – Intensive Care: The Beginning ....................................................... 25 Introduction ............................................................................................................... 25 Precursors to Intensive Care Units ............................................................................. 25 Impetus for ICU Development ................................................................................... 27 The First Intensive Care Units ................................................................................... 28 Development of Intensive Care in New Zealand ........................................................ 31 The Wellington Story ................................................................................................ 34 The Specialisation of Intensive Care Nursing............................................................. 35 Nursing Staff – Why Work in ICU? ........................................................................... 40 Preparation to Work in ICU ....................................................................................... 43 Orientation of Nurses to ICU ....................................................................................