"Fear causes many diseases": a review of infection prevention and control measures in pre-Nightingale nursing

Infection prevention and control measures such as hand hygiene and environmental cleaning are used in health care to reduce the risk of transmitting infectious agents. The origin of many of these measures are credited to Florence Nightingale’s accomplishments in reducing the morbidity and mortality rates of British soldiers during the Crimean War and are found in her seminal book, Notes on Nursing: What It Is and What It Is Not (1859). In Notes on Nursing, Nightingale highlighted the inextricable link between health and the sickroom environment and described basic infection prevention and control principles that should be adopted by the caregiver. While Notes on Nursing was never written for vocational nursing, these guiding principles later formed the basis of the Nightingale model for nursing training and are collectively referred to as nursing’s first theory on environmental health. Despite the continual reverence for Nightingale’s contribution to infection prevention and control, little is known about the genesis of her ideas presented in Notes on Nursing nor their influences. This presentation aims to address this gap by exploring the evolution of infection prevention and control measures in pre-Nightingale nursing. Digitised primary sources describing nursing practice between the sixteenth and midnineteenth centuries will be used to investigate the theoretical basis of early modern infection control principles used by nurses. These findings will then be used to critically examine the legitimacy of Nightingale’s unique contribution to the profession

'Three fingers are applied to the artery': pulse assessment in late-eighteenth century Europe

Overview of topic: This study examines the principles of pulse assessment in late eighteenth-century Europe. During this period, pulse assessment became an 'indispensable' nursing skill due to the increasing complexity of medical care and treatments. Physicians such as Joseph-Barthélemy-François Carrère, identified nurses needed education regarding physical assessment skills so that they could appropriately recognize and act on patient deterioration. In order to address this need, Carrère's instructional guide, Manuel pour le Service des Malades (Manual for the Service of the Sick) was released in 1786. The guide proved so popular it was soon translated and adapted to other European countries including Italy, Germany and Spain. Fourteen pages of the guide were dedicated to pulse assessment. The historiographical literature on the topic: While considerable research exists about several groups of pre-professionalized European nurses (e.g., Siobhan Nelson's extensive scholarship on the Daughters of Charity), the clinical practices adopted by such nurses remains underexplored. This study provides unique insights into one aspect of quotidian clinical practice: the evolution of pulse assessment. Methods: Historical methods with a cultural framework are used in this analysis. Primary sources include a digitized copy of Manuel pour le Service des Malades and an English translation of the text. Other primary and secondary sources, including a Spanish adaptation of the text, are used to support and contextualize the interpretation. The key themes are then compared to contemporaneous practice. Summary and implications: Nurses not only learnt the psychomotor aspects of taking a pulse, they were also educated on basic physiology and interpretation. Nurses were expected to perform pulse assessments several times throughout the day in accordance with the treating physician's orders. The nurse could also self-initiate an increased frequency of assessment if they were concerned about the condition of a patient. While palpating the pulse, the nurse was required to observe its rate, rhythm and quality. Their interpretation of these observations took into account the patient's age, gender and activity level, with any deviations from the expected findings being reported to the physician. This study highlights that our predecessors' theory and praxis of pulse assessment are comparable to many aspects of current practice. These findings improve the profession's knowledge about the origins of this fundamental nursing skill. If applicable: Inclusiveness is promoted by offering a non-Anglo-American historical commentary on the development of clinical nursing practice

'Care left undone': not a new phenomenon

Nurses working in contemporary clinical environments are challenged by numerous organisational and external pressures. These pressures include increasing complexities of care, regular staffing deficits, poor skill-mix, and a high patient turnover. Such pressures impact on the nurse's capacity to provide appropriate and timely care resulting in poorer health outcomes for the patient and the risk of burnout for the nurse. These lapses in care are commonly cited as being a 'sign of the times' of contemporary heath care systems and consequently are considered a phenomenon which is unique to today’s nursing practice. However, a seventeenth-century nursing text challenges this assumption. Instruccion de Enfermeros (Instructions for Nurses) was first published in 1617 as an instructional guide for (presumably) novice nurses working at the Madrid General Hospital. This text's content alludes to numerous organisational and external pressures which the nursing profession will recognise as being similar to those faced today. These pressures included: rapid population growth, the consolidation of services, poor public reputation, bed shortages, funding shortfalls, and an advancement in medical knowledge and techniques. Instruccion de Enfermeros' content indicates such pressures impacted on the expectations and role performance of the nurse working in seventeenth-century Spain

Instruccion de Enfermeros (Instructions for Nurses): a precursor to modern nursing?

Purpose of study: This study describes the findings of an analysis undertaken on the first edit ion of Instruccion de Enfermeros (Instructions for Nurses). These findings are used to examine the persistence of practice in clinical nursing. Rationale and significance: Instruccion de Enfermeros is a Spanish nursing treatise that was first published in 1617. This treatise was used as an instructional guide for (presumed) novice and trainee nurses and outlined foundational nursing concepts and care. Significantly, the treatise: included rationales which were (then) scientifically-based; was peer-reviewed; and was endorsed by Spanish royalty. Five editions of the treatise were published over a period of 50 years. The publication of this treatiseintimates that semi-formalized nursing education had commenced in Spain at least two centuries earlier than Nightingale's professio nalization of nursing. Hence, the premise of this treatise challenges the origins of modern nursing. Description of methodology: Traditional historical method is used in the study to critically analyze and interpret the key concepts described in Instruccion de Enfermeros. The key concepts will then be compared to today's foundational care in order to identify areas of persistence in practice. Major primary and secondary sources: The digitized copy of Instruccion de Enfermeros and an English translation of the treatise are used for analysis. Findings and conclusions:The information presented in Instruccion de Enfermeros is similar to the structural organization of today's fundamental nursing texts. Key technical skills such providing comfort, hygienic care, nutritional support, infection control and medication administration are discussed at length in Instruccion de Enfermeros. Further, non-technical skills such as interpersonal skills, scope of practice and resource management are also described in the treatise. The study identified that this document includes multiple exemplars of nursing care that persist today. Consequently, this analysis proposes that contemporary nursing practice remains strongly influenced by past practic

Translating evidence to practice: using the ventrogluteal site for intramuscular medication administration

Student nurses are often 'caught in the theory-practice gap where what they have learnt during their studies does not translate to the realities of working in the clinical environment. This incongruency between theory and practice, places the student in a difficult conundrum where they feel pressured to conform to the existing clinical practice whilst on placement in an attempt to be accepted. However, this willingness to adopt traditional rather than evidence-based practice can arguably be to the detriment of patient care. The ventrogluteal site (VG) for intramuscular medication administration is one example where this discrepancy exists between what is learnt at university and the clinical environment. Typically, Australian nursing students learn about the benefits of using the VG site and the potential complications associated with use of the dorsogluteal (DG) site for intramuscular medication administration during their first year of undergraduate study. Hence, prior to commencing clinical placement, students possess an evidence-based understanding of intramuscular site selection. However, students frequently report that they are discouraged to use the VG site whilst on placement and instead are encouraged to use the DG site. That is, despite the clearly established benefits of using the VG rather than the DG site, this practice has not been readily adopted in the clinical environment. This disconnect between what is best practice and what is reality is a perplexing challenge for students, and if poorly handled, can result in the students' mistrust of either the university or the clinical agency. Nurse academics therefore have an obligation to address such ongoing theory-practice gaps that exist, to not only improve students' learning experiences and developing practice but also to potentially improve patient outcomes. Using this example of intramuscular site selection, an educational strategy that addresses this disconnect between the university and clinical environment will be discussed

Notes on pre-Nightingale nursing: what it was and what it was not

Tanya Langtree studied the evolution of nursing praxis between the sixteenth and mid-nineteenth centuries. Tanya found pre-professionalised nursing practice was scientifically informed and aimed to restore health, promote comfort and prevent complications. These findings disrupt assumptions about early nursing and encourages the profession to reframe its understanding of the past

Professional development of mental health educators through peer learning

Introduction/background: The School of Nursing, Midwifery and Nutrition teach students to use the ventrogluteal (VG) site as the preferred site for intramuscular injections. While on clinical placement, third year nursing students enrolled in a mental health subject identified that clinical preceptors and educators were not familiar with the VG site and felt uncomfortable when supervising students performing this task, and preferred instead for the student to use the dorsogluteal site for intramuscular administration of antipsychotic medications. In response to this identified theory-practice gap a practical educational intervention was developed by staff at James Cook University, in collaboration with mental health educators at the hospital, for hospital clinicians

The clinical simulation conundrum. Does simulation diminish the capacity of the student to foster empathy, sensitivity and the ability 'be with' the person?

With increases in technology, nurses and midwives are required to possess a strong scientific and biomedical focus. Consequently, the emphasis of care has arguably shifted from care-orientated to treatment-orientated practice. This discourse is further compounded by health care systems where a person can be regarded not by the constructs that humanise them but by those constructs which are defined by their diagnosis (Todres et al., 2009). Such models of care often result in the objectification of the individual and their subsequent dehumanisation (Borbasi et al., 2012). Further, a reductionist approach to care is likely. Clinical simulation is gaining popularity as an effective teaching and learning methodology in nursing and midwifery. This methodology permits the replication and amplification of real life events, allowing participants’ opportunity to develop proficiency in action and reasoning within a controlled environment (Gaba 2004). Currently, the evaluation of clinical simulation is primarily focused on technical proficiency and includes aspects such as the development of knowledge acquisition and clinical reasoning (Kable et al., 2013) and the promotion of student confidence (Blum et al., 2010). However, literature is limited regarding whether simulation can replicate the humanistic aspects of care. With increasing pressure to use clinical simulation as a solution to address chronic clinical placement shortfalls and deficiencies, there is a risk that nursing and midwifery educators are perpetuating a reductionist care model which is technology and treatment driven and is devoid of humanism (Hayden et al., 2014). In other words, by using simulation in the absence of an authentic clinical environment, is the student fully able to suspend disbelief and engage in person centred care or are we merely encouraging a student who can espouse the appropriate rhetoric that supports this philosophy? The emerging theory of the mirror neuron and its role in empathy may hold the answer to the question: Does clinical simulation diminish the capacity of the student to foster empathy, sensitivity and the ability 'be with' the person, understanding and connecting with that persons' unique human perspective

Documentation in Nursing and Midwifery: Australian edition

Documenting patient care and records is an important skill for nurses. This book is designed for students in undergraduate nursing programs, and addresses principles of documentation, legislation associated with documentation, methods and systems of documentation, and related documentation matters, in the Australian context

Can simulation be used to develop professional behaviours amongst nursing students?

The development of professional behaviours such as time management amongst nursing students is essential for preparing them for the realities for working in a dynamic, pressured clinical environment whilst on placement. Possessing such skills are thought to establish resilient coping mechanisms of nursing students and thereby lessen the theory-practice gap and reality shock experienced during placement. Traditionally, nursing students learn about professional skills in theory-based subjects. Due to the nature of this delivery, core concepts are often discussed abstractly and consequently many students misjudge the importance of developing and refining these professional behaviours prior to graduating. One way to address this shortfall is arguably via simulation. Simulation is gaining popularity as an effective teaching and learning strategy in nursing education. The literature surrounding the use of simulation currently supports its use for psychomotor skill development and for preparing students for rare or infrequent events. However, little evidence exists for whether simulation can fully capture the complexity of everyday nursing care including the incorporation of professional behaviours. The findings of a study examining first year nursing students' opinions on weekly simulation workshops provide a unique understanding of how students view their development of professional behaviours. This study incorporated an unfolding case study where students were required to work in teams to deliver increasingly complex episodes of care over a period of 10 weeks. In order to fulfil these episodes of care, the students needed to surreptitiously develop professional behaviours such as teamwork, delegation and prioritisation. Whilst the development of these behaviours was not the primary goal of the simulation, the majority of students identified that practising such professional behaviours was the most beneficial aspect of their learning. These findings suggest simulation can be used to foster professional behaviours amongst nursing students in order to produce a graduate that is work-ready