Caring in Crisis: An Oral History of Critical Care Nursing

By Jacqueline Zalumas | Go to book overview
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5. Critical Care Nurses Speak

The purpose of this study has been to acquire and interpret, through the techniques and methods of oral history, interviews with critical care nurses. Nurses as individuals and nursing as a discipline are obscure in written histories. Nursing is often viewed in the shadow of the history of medicine, and even when the story of nursing is told, problems exist in finding appropriate primary source materials. While the details of nursing education and professional organization are well documented, the story of the development of actual clinical practice is almost non-existent. Further, written histories of nursing almost always demonstrate region, class, and sex bias; most written histories represent the activities of middle- and upper-class, northeastern white women. The development, since the 1960s, of clinical specialization has received even less attention by scholars.

The development of critical care nursing is tied to developments in medical specialization after World War II and the increasing use of highly complex technology in the hospital care of patients. The trend to locate very ill and dependent patients with highly skilled nurses began with the recovery room experience in the 1940s and 1950s. Improved techniques in cardiac surgery and developments in equipment for monitoring and manipulating cardiac status at the bedside accelerated this trend. The surgical and medical intensive care units (ICU) appeared in the 1950s and the coronary care units (CCU) in the 1960s. By the late 1960s, ICUs and CCUs were common in American hospitals of all types and sizes. Community hospitals would commonly have a large combined medical-surgical ICU and a separate CCU, while university teaching hospitals might have multiple ICUs representing medical and surgical specialties such as heart surgery, pulmonary, organ transplant, burn care, and the like. Patients in the 1990s might be admitted to an ICU for an acute illness like a heart attack; for short-term management after specialized surgery such as removal of a brain tumor; or for long-term management of complications of either, such as respiratory support on a ventilator after a postoperative stroke or pneumonia.

Political, economic, and social realities have changed the U.S. health care establishment and the populations requiring care. Americans are older


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Caring in Crisis: An Oral History of Critical Care Nursing


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