The History of Neuroscience Nursing: A Barrow Perspective
Virginia Prendergast, RN, NP-C, CNRN
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
The development of neuroscience nursing at the Barrow Neurological Institute parallels both the development of the institution itself and the specialization of neuroscience nursing. During the past 40 years, Barrow nurses have established themselves as leaders within the institution and within the nursing profession. This article describes the emergence of neuroscience nursing on a national level and specifically chronicles its progress as a nursing specialty at Barrow.
Key Words: history, neuroscience, nursing
Neuroscience nursing was first reported as an observational practice under the tutelage of Sir Victor Horsley, a neurosurgeon at the world's first neurological institute, the National Hospital in Queen's Square, London. In the 1870s, Sir Horsley invited nurses to observe surgery to enable them to better care for the patients postoperatively. During this same period, J.M. Charcot, MD, a neurologist at Salpêtrière in France and a recognized teacher, writer, and mentor, encouraged nurses to learn about the central nervous system.
Although women have always been considered caretakers of the sick and injured, they were rarely trained to provide specialized care. During the Crimean War in the mid1850s, Florence Nightingale established the first standardized training for nurses. Neuroscience nursing began to emerge as a specialty in response to advances in the fields of neurosurgery and neurology as well as in response to the need to care for individuals injured during World Wars I and II and the Korean War.
During the Vietnam War, Margarethe Cammermeyer, RN, served as the head nurse in the neurosurgical unit in the 24th Evacuation Hospital during the Tet Offensive in 1968. Heavy casualties were sustained during this battle, and Cammermeyer was faced with caring for patients with devastating head injuries. Despite limited resources, limited staff, and the overwhelming need to care for an increasing number of critically ill patients, Cammermeyer remained committed to providing care, the human touch, and a sense of compassion to patients. No neurosurgical patient was allowed to be removed from life support unless she was at the bedside so that "no one would die alone" (Cammermeyer M, personal communication, 1995). The simultaneous provision of expert nursing care combined with a sense of compassion began to lay the foundation for neuroscience nursing care as it is known today. This article traces the growth in the profession of neuroscience nursing as it developed at Barrow Neurological Institute and within the greater context of neuroscience nursing.
The 1960s and 1970s
At Barrow, neuroscience nursing officially began on the day that the first units opened in 1962. In the beginning, being a nurse at Barrow translated into being a nurse in one of three newly established units: the operating room (OR), the neurosurgical intensive care unit (NICU), or the general neurosurgical-neurological ward. The combined nursing staff for the three units was 28 nurses.
Dedicated neuroscience units represented a relatively new concept to both St. Joseph's Hospital and the nursing profession at large. While Dr. W. E. Dandy is credited with opening a three-bed specialized care unit for postoperative neurosurgical patients in 1923 at the Johns Hopkins Hospital, the concept of such dedicated units was not widespread, nor did the concept of intensive care units (ICUs) take root for decades. ICUs were just beginning to appear in the late 1960s and early 1970s and typically were designated as postanesthesia care or coronary care units. In the nursing literature, a dedicated neuroscience ICU was first mentioned in 1975. At the time Barrow was founded, there were no dedicated neuroscience units in Arizona.
Consistent with the national trend, the first ICU at St. Joseph's Hospital was the coronary care unit; the second ICU was the NICU. That first NICU housed a total of 6 beds. Four beds were clustered in a general ward setting, and there were two private rooms and one hyperbaric chamber. Despite the neurosurgical title of the NICU, nurses working there treated patients with disease processes other than those with a neurological dysfunction. The NICU included patients undergoing hyperbaric oxygen therapy and renal dialysis, patients requiring support by an iron lung, and burn patients. Ultimately, these services remained a part of the care provided at St. Joseph's Hospital, except for patients with burns. The latter were automatically transferred to Maricopa County Hospital when the burn unit opened there in the 1970s.