The Historical Development of Intensive Care Nursing at Vancouver General Hospital, 1960-1985 by Deborah Hamilton Bachelor of Applied Arts in Nursing, Ryerson University, 1989 Master of Theological Studies, Vancouver School of Theology, 2002 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in The Faculty of Graduate Studies THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2010 © Deborah Hamilton, 2010 Abstract This thesis describes the historical development of intensive care nursing in the adult medical and surgical intensive care unit (ICU) at Vancouver General Hospital (VGH) from 1960 until 1985. The ICU was established to group a new, emerging cohort of critically ill patients in one centralized place the hospital. Doctors referred critically ill patients to the ICU, believing the patient would benefit from the continuous nursing care of a bedside nurse in the ICU. The concepts of place and space, specialty nursing education, professionalism, gender, and the expansion of new medical technologies used in critical care, form the central categories for analysis. I examine the broader social, cultural, economic influences, and the hospital context that shaped critical care nursing in Western Canada in the 1960s, using one hospital as a case study. An analysis of the transformation from one-to-one nursing of the most critically ill patients on the general nursing wards, to specialized critical care nursing in the ICU, significantly contributes to the history of nursing. As nurses developed new critical care nursing expertise, their work relationships with other nurses and health professionals changed. As their expertise deepened, nurses integrated new technologies that were introduced into the ICU into their practice. Nurses created critical care nursing theory in a grassroots process using their experiences in critical care, as the foundation. They also formalized this knowledge into a critical care nursing program. This process was not without its tensions, as nursing education was also beginning to make the transition from hospital-based to degree based education. It was a question of where and how the education of critical care nursing would fit in. Oral history accounts from former and practicing nurses and physicians involved in the establishment of the ICU at VGH form the primary source material, augmented by archival hospital and government records, and photographs. The individual experiences of bedside nurses provide a unique lens to understand the evolution of critical care nursing knowledge and practice at VGH in the broader context of critical care nursing history. ii Table of Contents Abstract .......................................................................................................................................... ii Table of Contents ......................................................................................................................... iii List of Figures .............................................................................................................................. vii List of Abbreviations ................................................................................................................. viii Acknowledgements ...................................................................................................................... ix Dedication ...................................................................................................................................... x Chapter 1-Introduction ................................................................................................................ 1 Scope of Research ....................................................................................................................................1 Significance of Historical Research on Intensive Care Nursing, to Nursing History, and to Current Practice .... 3 Research Questions .................................................................................................................................5 Social Factors ...........................................................................................................................................6 Framework ..............................................................................................................................................7 Social Historical Framework ............................................................................................................................... 7 Gendering of Hospital Work ................................................................................................................................ 7 Technology-in-Practice Framework..................................................................................................................... 9 Place and Space.................................................................................................................................................. 10 Background Literature Review ...........................................................................................................10 Methodology ..........................................................................................................................................17 Primary Sources ................................................................................................................................................. 17 Oral History Approach ....................................................................................................................................... 18 Participant Biographies in Chronological Order According to Graduation Date ..........................22 iii Chapter 2-The Intensive Care Unit at Vancouver General Hospital: The Meaning of Place and Space ..................................................................................................................................... 27 Introduction ...........................................................................................................................................27 Theoretical Perspectives in Medical Geography ................................................................................27 Focus of The Chapter............................................................................................................................30 Historical Background ..........................................................................................................................31 VGH: Medical Politics of a New ICU ..................................................................................................33 Planning the Intensive Care Unit .........................................................................................................37 Management of Patient Care in the ICU: Teamwork ......................................................................................... 38 Working Relationship between Nurses and Doctors: New Professional Boundaries ........................................ 40 The Physical Layout of the VGH ICU, 1967 .......................................................................................44 Nurses Impressions of the Place and Space ....................................................................................................... 47 Drawbacks With The Space ............................................................................................................................... 48 Advantages of the Space .................................................................................................................................... 50 The Significance of the new ICU Space: Expansion of Nursing Knowledge and Practice .............51 Job Satisfaction .....................................................................................................................................52 Increased Status Among Nurses ..........................................................................................................53 The ICU Patient Population .................................................................................................................54 Nursing Environment and Routines Conforming to Limited Space ................................................58 The Second ICU: “Back of Emerg:” 1983 ..........................................................................................61 Physical Layout of the Second ICU ....................................................................................................63 Nurses Impressions ............................................................................................................................................ 63 New Places, New Spaces: New Developments in Nursing Education, Allied Health Professionals .................................................................................................................................................................66 Advantages to the New ICU Space .................................................................................................................... 68 iv The Third ICU: Laurel Pavilion, 1985 ................................................................................................71 Physical Layout .....................................................................................................................................71 Nurses Impressions ...........................................................................................................................................