Difference between present practices in history and past practicecs

The Mindset List, created by Beloit College in Wisconsin, helps faculty members prepare for incoming students by ensuring that their cultural references are up-to-date and reflect the worldview of current students. Its originators, Humanities Professor Tom McBride and former Public Affairs Director Ron Nief, have published this clever list since 1998 to help faculty stay in touch with younger generations. The list helps faculty recognize the differences between the truisms of their own formative years and the changes shaping the world of incoming students.

The 75 items on the Mindset List for the Class of 2014 ( www.beloit.edu/mindset) humorously contrast generational differences in the perceptions of trends, celebrities, and politics. They reflect the latest advances in technology, consumer products, economics, sports, and public opinion. Many items on the list will make you laugh; some are reminders of ever-changing sociopolitical norms.

The nursing world, too, has evolved dramatically since the largest cohort of nurses, now ages 50 to 54, entered the workforce in the 1970s. When they graduated from nursing school, news headlines chronicled these events:

• The first Apple® computer is developed.
• The Supreme Court allows removal of life support for Karen Quinlan.
• Elvis Presley dies.
• Congress approves a $1.5 billion bailout for Chrysler.
• The disposable razor is introduced.
• Capital punishment is deemed constitutional.
• Oregon decriminalizes marijuana.
• The Department of Energy is created.

More recently, as nurses entered the workforce during the first decade of the new millennium, we saw headlines like these:

• The Department of Homeland Security is created.
• Medical marijuana is legalized in 14 states and the District of Columbia.
• States place moratoriums on executions, as half the public favors life without parole over the death penalty.
• Congress approves a $25 billion bailout of the auto industry.
• Social networking connects people around the world. (Even Grandma is on Facebook!)

The nurse’s list

In keeping with the spirit of Beloit’s Mindset List, I offer some observations about nursing care from the 1970s to the present.

In the 1970s:

• Nurses lived and died by the Kardex, a folded card-stock roadmap to all things for the patient, completed in pencil and continuously crossed out or erased and updated.
• Universal precautions didn’t exist.
• Electrophysiology studies were done at the bedside to discover and treat arrhythmias.
• GI bleeds were managed by inserting tubes with balloons (attached to football helmets) to tamponade varices.
• Warm-water-heated metal bedpans were used for patient comfort.
• Central venous pressure was measured with water manometers.
• Nurses used the second hand of a wristwatch to calculate I.V. drip rates.
• White oxford lace-up shoes were the norm for nurses.
• Only operating-room (OR) staff and physicians wore scrubs.
• Vital signs recording required a three-colored pen to reflect the three different shifts.
• Nurses mixed antibiotics without pharmacist assistance.
• Nurses became proficient in I.V. sticks by practicing on one another.
• Patients were weighed manually.
• Requisitions were completed on typewriters.
• Public health meant well-baby check-ups at the new mother’s home.
• Grandma died at home.
• Patients heading for the OR had their body hair shaved with hand razors.
• Most surgery patients were admitted to the hospital the night before.
• Nursing caps were still popular.
• The Physician’s Desk Reference and the U.S. Pharmacopeia, chained to the desk, were the common drug references.
• Nurses carried trays with cups of pills and med cards.
• Cancer was a death sentence.
• Staff and patients smoked in the hospital.

Now:

• Nursing care is highly specialized, and hospital patients are grouped geographically in units by disease or body system.
• Computed tomography and magnetic resonance imaging scans are the first order of business before a definitive diagnosis is made.
• The average length of stay in acute-care hospitals is 4 days (down from 11.4 days in 1975).
• Heart revascularization procedures are done on an outpatient basis in the catheterization lab in one day.
• Scopes and lasers are used to treat numerous bleeding conditions.
• I.V. infusions are regulated with sophisticated pumps run by safety software.
• Plastic shoes, clogs, and sneakers are common footwear for nurses.
• Pharmacists and pharmacy technicians prepare, compound, and deliver drugs and infusions following rigorous safety checks, sometimes involving preparation in special hoods.
• Automated beds are used to weigh and reposition patients.
• Ceiling-mounted lifts transport patients from bed to commode.
• Nursing caps occupy space in museums.
• More than two-thirds of patients exceed the 5-year survival rates for most cancers.
• Online references for pharmaceuticals, nursing procedures, and evidence-based practice provide instant information at the point of care.
• Home-care nurses provide acute- and critical-care interventions, and teach family members how to perform these techniques.
• National patient safety goals mandate practices to minimize the risk of errors.
• Multidrug resistant organisms create daily challenges for patients, families, staff, and caregivers.
• Elderly patients undergo invasive procedures at the request of family, even when healthcare professionals know such care is futile.
• Low-birth-weight babies have a survival rate of 90% (up from less than 50% in 1960).
• Nurses provide a growing percentage of primary-care and chronic-care patient management.
• Nurses are leaders in every aspect of healthcare delivery, education, research, and policy formation.

While some people pine for the “good old days,” we need to appreciate the scientific and technological advances that allow nurses to deliver sophisticated care in a contemporary fast-paced environment. At the same time, we must preserve and practice the time-honored skills of listening, therapeutic conversation, and personal touch in caring for patients and families.

Nurses are the ultimate healthcare monitors—vigilant observers and problem solvers, poised to take action whatever the challenge. Our mindset is one of preserving the unique attributes of our roles while embracing the progress that helps us excel.

Pamela F. Cipriano, PhD, RN, FAAN, NEA-BC
Editor-in-chief
American Nurse Today