University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2015 "We Were the Eyes and Ears...": Nursing and the Development of Neonatal intensive Care Units in the United States, 1955-1982. Briana Ralston University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the History Commons, and the Nursing Commons Recommended Citation Ralston, Briana, ""We Were the Eyes and Ears...": Nursing and the Development of Neonatal intensive Care Units in the United States, 1955-1982." (2015). Publicly Accessible Penn Dissertations. 1122. https://repository.upenn.edu/edissertations/1122 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/1122 For more information, please contact [email protected]. "We Were the Eyes and Ears...": Nursing and the Development of Neonatal intensive Care Units in the United States, 1955-1982. Abstract ABSTRACT "WE WERE THE EYES AND EARS...": NURSING AND THE DEVELOPMENT OF NEONATAL INTENSIVE CARE UNITS IN THE UNITED STATES, 1955-1982. Briana Ralston, MS, RN Julie Fairman, PhD, RN, FAAN In the 1960s and 1970s, neonatal intensive care units (NICUs) became the standard of care for critically ill newborns in hospitals across the United States. Though work has been done to examine how nurses participated in the development of ICU's for adult populations, scholarship related to the formation of NICUs is sparse. Using historical methodology to examine hospital archival data, oral history interviews, and scholarly literature, this work examines the roles nurses played in the development of NICUs as technological systems between 1955 and 1982 in the United States. By using the lenses of the history of nursing, the history of technology, and the history of children's healthcare, this work contributes to our understanding of the nuanced ways nurses participated in the formation of the NICU - a complex technological system of care - for a vulnerable and medically complicated newborn patient population. The value of newborns as a unique and valued medical population, seen as early the Progressive Era, contributed to the formation of premature infant units and particular nursing care for premature newborns during the first half of the 20th century. This premature infant care in turn influenced the development of later neonatal intensive care units and the ways nurses cared for a broader cadre of sick newborns. Hospitals valued the particular care they gave and made decisions about the dedication of spaces where newborns could be grouped together to receive nursing care. Two case studies of east coast children's hospitals - The Children's Hospital of Philadelphia and Boston Children's Medical Center - shed light on how particular hospitals chose to allocate resources, group patients, and how they made those decisions based on their value of specifically trained nursing staff. The history of NICUs speaks to broader contemporary healthcare themes and issues as we ask questions about who should receive care and precious healthcare resources. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Julie Fairman Keywords intensive care, neonatal, nursing, technological systems Subject Categories History | Nursing This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/1122 “WE WERE THE EYES AND EARS…”: NURSING AND THE DEVELOPMENT OF NEONATAL INTENSIVE CARE UNITS IN THE UNITED STATES, 1955-1982. Briana Ralston, MS, RN A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2015 Supervisor of Dissertation: Graduate group Chairperson: ________________________________ __________________________________ Dr. Julie Fairman, PhD, RN, FAAN Dr. Connie Ulrich, PhD, RN, FAAN Nightingale Professor of Nursing, Chair, Associate Professor of Nursing; and Department of Biobehavioral Health Associate Professor of Bioethics, Sciences and Director of the Barbara Bates Department of Medical Ethics, School of Center for the Study of the History of Medicine Nursing Dissertation Committee: Dr. Cynthia Connolly, PhD, RN, PNP, Dr. Barbra Medoff-Cooper, PhD, RN, FAAN (Committee Member) FAAN (Committee member) Associate Professor of Nursing Ruth M. Colket Professor in Pediatric Nursing “WE WERE THE EYES AND EARS…”: NURSING AND THE DEVELOPMENT OF NEONATAL INTENSIVE CARE UNITS IN THE UNITED STATES, 1955-1982. COPYRIGHT 2015 Briana Leigh Ralston This work is licensed under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 License To view a copy of this license, visit http://creativecommons.org/licenses/by-ny-sa/2.0/ iii Mom told me you came in on your days off when I needed you. Dad told me you made sure to remind them I was a ‘fighter.’ This work is dedicated to you Joan, and the amazing nurses who worked in the NICU at Toronto’s Women’s College Hospital in September 1984. iv ACKNOWLEDGMENTS In the same way, “it takes a village to raise a child,” I can’t begin to thank all those who worked so hard with me on this journey… To the women I worked with at New York Presbyterian hospital – you remembered your stories and shared them with me. Thank you for supporting me as I started my career in NICU nursing. Thank you to the Annie Brogan, archivist at The Philadelphia College of Physicians, Philadelphia, PA, and thank you to Alina Morris at the Boston Children’s Archives, Boston, Massachusetts. You both patiently and tirelessly worked with me. To Cindy, Barb, Pat, and Jean. You read my work, listened to me process, and challenged me. Joan Lynaugh planted seeds in you and you approach your scholarship and your mentorship with a grace and tenacity that pushed me father than I thought I could go. The Bates Center is truly a magnificent place because of you all. To my girls: Katharine Smith, Kathleen Nishida, and Linda Maldonado. You laughed with me on the good days, cried with me when I got frustrated, read countless renditions of my work and gave me feedback. We not only grew as scholars, but you walked with me as I grew through the ups and downs of life. Thank you. Meagan, You. Read. Every. Word. Thank you for being more excited about my work than I was during the homestretch. You are a precious friend! Mom and dad, you told me my own story. Your stories planted seeds that became questions and grew into this work. Thank you for loving me through this wonderfully crazy and magnificent process of life that started in a NICU 3 decades ago. Ben. You always reminded me this too would come to an end and encouraged me every step of the way. You patiently listened to me process ideas and never got annoyed when I talked about my work (again!). You stuck with me. You even asked me to marry you after it was all over! You’re a keeper! I’m very thankful for you. Julie, I joke with you that it all started with a cup of tea. You saw something in me I didn’t see in myself, and you have been amazingly patient as I have grown throughout the process of discovering my capabilities and myself. Thank you for answering my phone calls and always knowing what to say. I can’t tell you how good it feels when Julie Fairman starts to smile and nod at you. You are truly a mentor and I have always been amazed you chose to invest in me. Here’s to many more years of fun, friendship, and good restaurant advice! And to the NICU nurses who have worked tirelessly over the past 60 years to care for the smallest and most vulnerable among us. Thank you. Your stories must be told. This is just the beginning. Psalm 139:13-18 v ABSTRACT “WE WERE THE EYES AND EARS…”: NURSING AND THE DEVELOPMENT OF NEONATAL INTENSIVE CARE UNITS IN THE UNITED STATES, 1955-1982. Briana Ralston, MS, RN Julie Fairman, PhD, RN, FAAN In the 1960s and 1970s, neonatal intensive care units (NICUs) became the standard of care for critically ill newborns in hospitals across the United States. Though work has been done to examine how nurses participated in the development of ICU’s for adult populations, scholarship related to the formation of NICUs is sparse. Using historical methodology to examine hospital archival data, oral history interviews, and scholarly literature, this work examines the roles nurses played in the development of NICUs as technological systems between 1955 and 1982 in the United States. By using the lenses of the history of nursing, the history of technology, and the history of children’s healthcare, this work contributes to our understanding of the nuanced ways nurses participated in the formation of the NICU - a complex technological system of care - for a vulnerable and medically complicated newborn patient population. The value of newborns as a unique and valued medical population, seen as early the Progressive Era, contributed to the formation of premature infant units and particular nursing care for premature newborns during the first half of the 20th century. This premature infant care in turn influenced the development of later neonatal intensive care units and the ways nurses cared for a broader cadre of sick newborns. Hospitals valued the particular care they gave and made decisions about the dedication of spaces where newborns could be grouped together to receive nursing care. Two case studies of east coast children’s hospitals – The Children’s Hospital of Philadelphia and Boston Children’s Medical Center – shed light on how particular hospitals chose to allocate resources, group patients, and how they made those decisions based on their value of specifically trained nursing staff. The history of NICUs speaks to broader contemporary healthcare themes and issues as we ask questions about who should receive care and precious healthcare resources.