A social construction of the development of ICU nursing in Canada, 1960 to 2002.

BACKGROUND: The early 1960s marked the opening of intensive care units (ICUs) in several hospitals across Canada. From the beginning, registered nurses constituted the largest body of health care providers in the ICU environment and they were the central provider of hands-on care to patients and families. From a historical perspective, however, a limited body of knowledge exists specific to the development of ICU nursing in Canada. PURPOSE: In this study we explored the development of ICU nursing in Canada from 1960 to 2002 using a social history approach that emphasized the creation of an historical account from the perspective of the everyday experiences of ICU nurses. METHOD: A social history approach was used. Primary sources included oral history interviews, documents and records, published professional literature between 1960 and 2002, as well as photographs. The study received ethics approval from the research ethics boards at the University of Ottawa (for conducting oral history interviews), as well as Queen's University (for access to archives at the Kingston General Hospital). RESULTS: The findings of this study provide a perspective on how ICU nurses learned and created new knowledge, as well as the establishment of an ICU nursing identity at both the individual and national levels.

"Help Us, Serve England": First World War Military Nursing and National Identities.

Historians generally argue that the First World War was a defining experience from which Canadians emerged with a strong sense of national identity distinct from their British roots. There is little historical research on women's wartime experiences and even less on military nurses. This article explores the working relationships of Nursing Sister Emeline Robinson with British nurses, VAD volunteers, orderlies, and medical officers during her one and a half years with the Queen Alexandra Imperial Military Nursing Service Reserve through her diary, which spans her enlistment, resignation, and re-enlistment with the Canadian Army Medical Corps.

Historical thinking and the shaping of nursing identity.

Nursing history was a core component of nurse training programs as early as 1907, when American Adelaide Nutting published her three-volume history. However, it had all but disappeared by the end of the 20th century, supplanted by other subjects. The University of Ottawa Nursing History Research Unit developed two online nursing history courses, in English and French, respectively, which proved popular and prompted substantial interest in the reintroduction of nursing history to our curriculum. This article presents findings of a study that examined the concept of "historical thinking"-what it is, how it develops, and what it contributes to practice-based professions-based on student postings in these courses. Analysis suggests that primary sources and critical appraisal skills are keys to the formation of historical thinking, and that these courses fostered a strong sense of professional identity among participants who often lamented lack of previous exposure to nursing history. Online nursing history courses can capitalize on e-learning technologies, and fit crowded curricula and student learning styles, while extending the reach of historians beyond traditional university walls.

Evidence to practice: pre-post-implementation study of a patient/provider resource for self-management with heart failure.

Background Evidence-based recommendations for heart failure self-management are contained in quality clinical practice guidelines. To implement these in practice requires additional translation. Partners in Care for Congestive Heart Failure (PCCHF) is a set of resource materials developed to encourage heart failure patients and their families to assume greater responsibility and to participate in daily decision-making related to their illness experience by enhancing their self-assessment and self-management skills. The study objectives were to evaluate its use, acceptability and relevance of this approach by heart failure patients, nurses and policy-makers. Methods A pre-post study was conducted across 10 rural-urban, acute and community care sites within three Canadian provinces and one US state. Patients' health-related quality of life was assessed with Minnesota Living with Heart Failure Questionnaire and Medical Outcomes Short Form before and 6 weeks after using the PCCHF program. Nurses completed a survey and participated in focus groups. Policy-makers were interviewed before and post implementation. Results Baseline and 6-week measures were completed by 239 patients. Health-related quality of life measures revealed statistically significant improvement after 6 weeks. Thirty-three nurses and 19 policy-makers participated in interviews post implementation. Most patients, nurses and policy-makers found the resource acceptable and relevant to support information needs. Conclusion The PCCHF program positively benefited both patients and clinical staff. The evidence-based teaching materials were considered a useful resource for self-management with heart failure. Time constraints and high staff turnover underline the need for resources like PCCHF to assist in patient-oriented heart failure self-management. Copyright for PCCHF has been transferred to the Canadian Heart and Stroke Foundation for widespread dissemination.

"Body work": nurses and the delegation of medical technology at the Ottawa Civic Hospital, 1947-1972.

The absence of ordinary women from histories of science and technology may be partially explained by what has been excluded as science, as well as who have been excluded as women of science. Although the delegation of medical technology to Ontario nurses increased rapidly during the mid-twentieth century, we know very little regarding how these ordinary women engaged in science and medical technology through the everyday practice of "body work." Gender structured the working relationships between predominantly-male physicians and predominantly-female nurses, shaping the process of delegation and generating significant changes in nurses' work as well as who provided bedside care. Trained nurses parlayed these new technological skills to their advantage, enabling the extension of technological care at the bedside and assuring their roles as essential for the functioning of the hospital system.

Emerging scholarship in nursing.

These are dynamic times for nursing history in Canada, as this special issue of the Canadian Bulletin of Medical History demonstrates. Twenty years ago, scholars sought to create one professional identity and one homogenous historical story while current historians of nursing understand that profession to be more diverse and more complex. Emerging scholarship situates itself increasingly within mainstream histories and the subfield of women's history. The articles and book reviews represent a wide range of research interests and approaches, as well as regions outside of Ontario and central Canada. They reveal increasing diversity of primary sources, increasing use of analytical concepts, and fascinating new directions for analyzing practice as authors address questions such as: Who could legitimately claim to be a nurse, what is nursing practice, and what is health care? While these trends are encouraging, significant gaps remain in nursing historiography, and nursing practice continues to be ignored or marginalized with the wider body of health care historiography.

Almonte's great train disaster: Shaping nurses' roles and the civilian use of blood transfusion.

Blood transfusion was initially a small-scale, labour-intensive therapy administered by physicians. Through the first decades of the 20th century, transfusion comprised a "last resort" measure used and tested primarily in the context of war. Media accounts of the Almonte train disaster on the night of 27 December 1942 linked survival to the newly established blood bank located 42 km east in Ottawa, Ontario. This event did not constitute a "first time" occurrence or a "great discovery" in the history of blood. But it did illustrate in a very visible and public manner that blood transfusion technology was now readily available for use in general hospitals and civilian populations. Canada had an infrastructure for the collection, processing, storage, and transportation of blood products, and for the recruitment of blood donors by the mid-1940s. As the need for blood declined toward the end of World War II, transfusion became a technology in need of application. The extension of transfusion to civilian populations, however, would require a ready source of labour-increased numbers of health care workers who were available continuously with the necessary knowledge and skills to assume the responsibility. Nurses were well situated for this technological role by a convergence of scientific, economic, labour, gender, professional, and educational influences that both facilitated and constrained blood transfusion as a nursing competency. This paper examines how the expanded use of one medical technology shaped related roles for nurses. Transfusion ultimately influenced nurses' work and the composition of the workforce as the first medical act "delegated" to nurses in Ontario (1947), setting a precedent for the delegation of further technologies over the next four decades.