Sunday, 2 December 2012

WE NURSES


This is the high time for the nursing profession to develop into specialities and super-specialisations. We need more nurses trained specifically to certain area of health care for improving the nursing care provided for the people.  


A BRIEF HISTORY OF NURSING

                                  MEDICINE AND NURSING PRACTISE
                                                                 IN
                                                EARLY CIVILISATION
 
SUMERIAN
Location - West Asia > Mesopotamia Time3300 BCE to 100 CE DirectionVariable
A less common name for Sumer, the region of city-states in ancient Mesopotamia (Iraq). (Sumeria is the normal term for Sumer in Spanish, Portuguese, and other languages of the Iberian peninsula, also in Greek.)
The Sumerians were one of the earliest urban societies to emerge in the world, in Southern Mesopotamia more than 5000 years ago. They developed a writing system whose wedge-shaped strokes would influence the style of scripts in the same geographical area for the next 3000 years. Eventually, all of these diverse writing systems, which encompass both logophonetic, consonantal alphabetic, and syllabic systems, became known as cuneiform.
 There was no empire-wide set of gods; each city-state had its own patrons, temples, and priest-kings. The Sumerians were probably the first to write down their beliefs, which were the inspiration for much of later Mesopotamian mythology, religion, and astrology. (http://en.wikipedia.org/wiki/Main_Page)
Mesopotamian diseases are often blamed on pre-existing spirits: gods, ghosts, etc. However, each spirit was held responsible for only one of what we would call a disease in any one part of the body.
So usually "Hand of God X" of the stomach corresponds to what we call a disease of the stomach.
v WORSHIPED EVIL SPIRITS AS GOD  Presumably specific offerings were made to a particular god or ghost when it was considered to be a causative factor, but these offerings are not indicated in the medical texts, and must have been found in other texts.
v HOT APPLICATION TECHNIQUE WAS FOLLOWED
v A number of diseases simply were identified by names, "bennu" for example. Also, it was recognized that various organs could simply malfunction, causing illness.
v WROTE PEESCRIPTION ON DAY TABLES        
BABYLONIANS(IRAQ) Babylonia was an ancient Semitic nation state and cultural region based in central-southern Mesopotamia (present-day Iraq). It emerged as an independent state in ca. 1894 BC, the city of Babylon being its capital. Babylonia became the major power in the region after Hammurabi (fl. ca. 1792- 1752 BC middle chronology, or ca. 1696 – 1654 BC, short chronology) created an empire out of the territories of the former Akkadian Empire.
v The Babylonians introduced the concepts of diagnosis, prognosis, physical examination, and prescriptions. In addition, the Diagnostic Handbook introduced the methods of therapy and aetiology and the use of empiricism, logic and rationality in diagnosis, prognosis and therapy.
v BELIVED SUN & ANGER OF GOD CAUSED ILLNES
v SICK WERE  BROUGHT TO TEMPLES
v TEAM APPROACH WAS TO TREAT THE SICK The symptoms and diseases of a patient were treated through therapeutic means such as bandages, creams and pills.
PERSIANS(IRIAN)  
v BELONGS TO “ZOARAS TRONUM”RELIGION
v BELIVED IN “EVIL SPIRIT THEORY OF DISEASES”AVESTA
v DEAD BODY WAS KEPT IN “SILENCE TOWER”
The Persian people are part of the Iranian peoples who speak the modern Persian language and closely akin Iranian dialects and languages. The origin of the ethnic Iranian/Persian peoples are traced to the Ancient Iranian peoples, who were part of the ancient Indo-Iranians and themselves part of the greater Indo-European ethnic group. http://en.wikipedia.org/wiki/Main_Page
Pre Islamic period
The Iranian academic centers like Jundishapur University (3rd century AD) were a breeding ground for the union among great scientists from different civilizations.
 Safavid lacquer work illustrating a physician taking the pulse of a patient. From a 17th century copy of Avicenna's Canon of Medicine. Wellcome Library, London.(wikipedia)

Medieval Islamic Period

In the 14th century, the Persian language medical work Tashrih al-badan (Anatomy of the body), by Mansur ibn Ilyas (c. 1390), contained comprehensive diagrams of the body's structural, nervous and circulatory systems.

Cranial surgery and mental health

Evidence of surgery dates to the 3rd century BC, when the first cranial surgery was performed in the Shahr-e-Sukhteh (Burnt City) in south-eastern Iran.
documents give detailed and precise clinical information on the different types of headaches.
Antiepileptic drug therapy plan in Medieval Iranian medicine is individualized, given different single and combined drug-therapy with a dosing schedule for each of those.

Obstetrics and Gynecology

In the 10th century work of Shahnama, Ferdowsi describes a Caesarean section performed on Rudaba, during which a special wine agent was prepared by a Zoroastrian priest and used as an anesthetic to produce unconsciousness for the operation.

ANCIENT EGYPT       
v OLDEST MEDICAL RECORD WAS WRITTEN ON “PAPYRUS PAPER”
v IMHOTEP- ancient Egyptian official. meaning "the one who comes in peace, is with peace, considered as the considered to be the first architect and engineer and physician in early history
v BELIVED LIFE  AFTER DEATH
v PROHIBITED DISECTION OF DEAD BODY
ANCIENT HEBREWS 
v BIBLE (OT)GIVES THE HISTORY OF HEBREWS       
v ISOLATION OF DISEASED PATIENTS
v HIGH PRIEST VISITED HOUSES,HOSPITALS,INNS.,TO CURE SICK
ANCIENT AMERICANS
v MANY CULTURES WERE THERE,MATAS,EUCAS,AZTECS WERE KNOWN
v PRIEST WAS MEDICAL ADVISER & PHARMACIST
v PRACTISED SWEATBAH & HUMAN SACRIFICE TO CURE SICK
INCAS
v TREPHING RING “MAKING A HOLE IN THE SKULL TO CURE DISEASE”
v BELIEVED DISEASE CAUSED DUE TO ANGER OF GOD
v SANDPAINTING ,PRAYERFUL SINGING,SWEET SMELL OF HERBS,EATEN HERBS TO CURE SICK
v HYDAOTHERAPHY(BRINGING DOWN THE TEMPERATURE)
ANCIENT CHINA
v DOCTORS PRACTISED MODERN METHODS
v VACCINE “SEA WEED”_THYPOID,CHAUL MOOGRA OIL TO CURE LEPROSY
v EARLY 13000AD PHYSIOTHERAPY  WAS PRACTISED
v HAD HALLS NEAR TEMPLES FOR SICK,BELIEVED IN EVIL SPIRITS THAT PREVENTED NURSING $ MEDICINE  PROGRESS
ANCIENT JAPAN
v FOLLOWED THE CHINESE SYSTEM OF MEDICINE
v DEVELOPED ACUPUNCTURE ,WHICH IS NOW PRACTISED ALL OVER THE WORLD
ANCIENT GREEK
v BELIEVED MEDICINE ORIGIN WAS REPRESENTED BY GOD
v TEMPLES WERE BUILT FOR WORSHIP$FOR TREATMENT OF SICK
v RESTRICTED UNCLEAN PATIENT FROM TEMPLES
v BUILT HOSPITALS IN 1070AD “EUROPAN HOSPITALS”
HISTORY OF NURSING IN INDIA
ANCIENT INDIA
Ayurveda adopted the physics of the "five elements" (Devanāgarī: [महा] पञ्चभूत); earth (Pṛthvī), water (Jala), fire (Agni), air (Vāyu) and space (Ākāśa) that compose the universe, including the human body.
 Ayurveda describes seven types of tissues of the body, known as the saptadhātu (Devanāgarī: सप्तधातु). They are plasma (rasa dhātu), blood (rakta dhātu), flesh (māṃsa dhātu), adipose (medha dhātu), bone (asthi dhātu), marrow and nervous (majja dhātu), and reproductive (semen or femalE reproductive tissue) (śukra dhātu)
v AYUR-VEDA”GIVES EARLY INDIAN MEDICIAN RECORD
v SUSHURTA & CHARAKA
v KING ASOKA  BUILT MONASTERIES $ HOUSES FOR TRAVELLERS $ HOSPITALS FOR MEN$ANIMALS
v HYGIENIC PRACTISE WAS DEVELOPED
Definition of nursing
VEDIC PERIOD
3000BC-1400BC
1.      Physician - Bhishak
2.     Nurse - Upacharika (Attendent - Anuraktha)
3.     Therapeutic drugs - Dravya
4.     Patient - Adhyaya
Characters of Upacharika (Nurse)
  • Shuchi - Pure or clean in physical appearance and mental hygiene.
  • Daksha - Competency
  • Anuraktha - Willing to care
·         Buddhiman - Co-ordinator with the patient and doctor / intelligent
CHARKA AND VAGBHATA
POST VEDIC PERIOD
600BC – 600 AD
ASOKA -272 – 236 BC
MUGHAL PERIOD – 1000AD
BRITISH PERIOD (16th century onwards) -
1664 – The East India Company started a hospital for soldiers in a house at Fort St.George, Madras. The first sisters were sent from St Thomas' Hospital, London to this military hospital.
1797 -Lying-in-Hospital (maternity) for the poor of Madras was built with the help of subscriptions by Dr. John Underwood.
1854 -The Government sanctioned a training school for midwives in Madras.
1865- Miss Florence Nightingale drew up some detailed "Suggestions on a system of nursing for hospitals in India".
1867-St Stephens Hospital at Delhi was the first one to begin training the Indian girls as nurses
1871- First School of Nursing was started in Government General Hospital, Madras with 6 months Diploma Midwives program with four mid-wife students.
MILITARY NURSING
1888 feb 21st , 10  fully qualified nurses arrived from Florence nightingale school In Bombay
1894 – A regular training system started.
1927 - Description of Indian male Nursing services formed with 12 matrons , 18 sisters , 25 staff nurses .
SECOND WORLD WAR (1939- 1945)
1942 - Auxiliary nursing services
Basic training for 6 month in selected civil hospital after passing examination at military hospitals in India .Auxiliary nurse training given for 3000 women .
CIVILIAN NURSING
1854 – Training school for midwives in madras
Certificates of Diploma in midwifery for passed student .
And
Sick nursing for failed students .
Missionary nursing
Girls were not allowed to work.
Pardha system.
Degrading and unworthy attitude of people.
Hindus were hold back due cast system.
Christian girls encouraged and trained first.
1865 – Miss Florence nightingale drew up some detailed suggestions on a system of nursing .
1871 – First school of nursing at madras GOVT hospital with 6 months midwifery program .

1888-93 five years various experts like doctors, surgeons, nursing superintendent, pharmacists - draw up a curriculum for training. 
1897- Dr. B. C. Roy did great work in raising the standards of nursing and that of male and female nurses.
1890 and 1900-Four lady Superintendents and four trained nurses from England were posted to Madras.
 1905 – Association of nursing superintendents (Lucknow)
1907-10 North India united Board of Examiner formed to maintain nursing administration and standards.
1928 - Hindi Text book for nurses developed. 
1907 -10 – North India united board of examiner .
1908- The trained nurses association of India was formed as it was felt necessary to uphold the dignity and honor of the nursing profession.
.1909 - Inauguration of TNA
1910 – TNA conference at Banaras
                  -election of own members .
1918- Training schools were started for health visitors and dais, at Delhi and Karachi. Two English nurses Miss Griffin and Miss Graham were appointed to give training to and to supervise the nurses.
 1922 – TNA and ANA amalgamated to form TNAI
1925 – Midwives and auxiliary nurses association
1926- Madras State formed the first registration council to provide basic standards in education and training.
1928 – First Hindi text book for nurses published
1929-30 – Student Nurses Association formed .
1931- 39 –With the assistance from the Rockfeller Foundations, seven health centers were set up between in the cities of Delhi, Madras, Bangalore, Lucknow, Trivandrum, Pune and Calcutta.
1946 – Center GOVT granted an approval to the Bhore committee.
Ø Bhore committee suggested establishment of primary health units
Ø The first four year basic Bachelor Degree program were established in college of nursing in Delhi and Vellore.
1947 – India got independence .After the independence, the community development programme and the expansion of hospital service created a large demand for nurses, auxiliary nurse midwives, health visitors, midwives, nursing tutors and nursing administrators.
Community development program and increased demand of nursing professionals.
1947 December 31- The Indian Nursing Council was passed by our ordinance.
1949  -The council was constituted .
1949- university education commission headed by Dr S Radhakrishnan , recommended for raise in the level of nursing education .
1950 – 1970 (period of renaissance )
Considerable steps were taken to reform nursing services .
INC made some important decisions
 There should be only two standards of training .
§         General nursing and midwives
§         A course for auxiliary nurse midwife .
1952 – PHC set up
1954 – Shetty committee
1956-  Miss Adrenwala was appointed as the Nursing Advisor to Government of India.
1959 – A memorandum by TNAI to the health survey and planning committee about situation of nursing in the country .
1960- The first master’s degree course, a two-year postgraduate program was begun  at the RAK College of Nursing, Delhi.
1962 –the national institute of family planning was established
1963- the School of Nursing in Trivandrum, instituted the first two years post certificate Bachelor Degree program.
1967 – A major strike by the nurses in Delhi regarding issues related to safety and security.
1971- The nursing journal of India
1972 – Kartar Singh committee / multipurpose health workers committee .
1973 – Report of kartar singh committee submitted
Recommendations are
ANM                                   female health worker
Other categories               male health worker
Lady health visitor      female health supervisor
1PHC / 5000 population
Each PHC = 16 sub centers
Each sub centers consists of female and male health worker
TNAI developed strike policy
1975 – Shrivastava committee Recommendations on medical education and curriculum.
1977 – rural health scheme
Recommended that the primary health care should be given with in the community.
1983 – medical education review committee/ Mehta committee  dealt with lack of man power in health care field.
1981 – health for all by 2000 – report of working group
1987 – High power committee appointed by ministry of health and family welfare
Recommendations in various aspects of nursing
Ø Nursing education
Ø Working conditions
Ø Establishment of national services
CAREER DEVELOPMENT
INNOVATION IN HEALTH CARE, EXPANDING HEALTH CARE SYSTEM AND PRACTISE SETTING AND INCREASING NEEDS CLIENT HAVE BEEN A STIMULUS FOR NEW NURSING ROLES. BECAUSE OF INCREASING EDUCATIONAL OPPORTUNITIES IT OFFERS EXPANDED ROLES EX. NURSE ADMINISTRATOR, NURSE RESEARCHER, NURSE PRACTITIONER ETC.
NURSES TOMORROW
IN FUTURE, NURSES WOULD BE FACING MORE AND MORE CHALLENGES, AS EVOLUTION IN MEDICAL FIELD WILL DEMAND WIDER NURSING ROLE. VARIOUS DOORS OF HEALTH CARE FIELD WILL BE OPENED FOR THE NURSES TO SHOW THEIR TALENT AND EFFICIENCY, WITH HUMAN BASED APPROACH.
 



 
HISTORICAL DEVELOPMENT, TRENDS AND ISSUES IN THE FIELD OF CARDIOLOGY

Before 1900, very few people died of heart disease. Since then, heart disease has become the number one killer. Change in lifestyle , Diet, Machines, Manual labor was either replaced or assisted by machinery,Automobiles, washing machines, elevators, and vacuum cleaners became commonplace. Modern conveniences made physical activity unnecessary. Rate of heart disease increased so sharply between the 1940 and 1967 that the World Health Organisation called it the world's most serious epidemic.
 The 20th century saw unparalleled increases in life expectancy and a major shift in the causes of illness and death throughout the world. During this transition, cardiovascular disease (CVD) became the most common cause of death worldwide. A century ago, CVD accounted for less than 10 per-cent of all deaths. Today, it accounts for approximately 30 percent of deaths worldwide including nearly 40 percent in high-income countries and about 28 percent in low- and middle-income countries (braunwald).

MILESTONES IN CARDIOLOGY
384 BC – 322 BC- Aristotle – first description of ductus arteriosus
1513 - Leonardo da Vinci drawn detailed anatomy of heart
Early 1800s-  Stethoscopes have undergone dramatic development since Laennec first began using a hollow wooden cylinder in the
19th century:-  flexible, binaural stethoscopes were developed some physicians felt the invention of the stethoscope weakened the physician's own powers of diagnosis the stethoscope offered an immediate diagnosis at a minimal cost and improvements on it continue to be made.
20th century-  Bloodletting
Began by Aelius Galen in to cure people of "diseases from tumors to tonsillitis, caused by an 'imbalance' in the body which could be stabilized by releasing blood."
doctors or laymen typically used a lancet, or an instrument called a lbenswecker
          Blood could be let from any part of the body but most commonly through the veins called "venesection.“
patients sometimes bled to extreme weakness or death
1628  William Harvey, an English Physician, first describes blood circulation.
1706  Raymond de Vieussens, a French anatomy professor, first describes the structure of the heart's chambers and vessels.
1733  Stephen Hales, an English clergyman and scientist, first measures blood pressure
1714-  Stephen Hales opened an artery of a horse, inserted a brass tube, and measured the pressure of the blood.
This was a careful, scientific experiment demonstrating that the heart exerts pressure in order to pump blood however, the result of the experiment was the horse's death.
1801- The first cardiac surgery was performed in Spain by Francisco Romero.

1816 -   Rene T. H. Laennec, a French physician, invents the stethoscope.
1857 - Much safer method for measuring blood pressure was provided by Marey's wrist sphygmograph,
1882 - Dudgeon's wrist sphygmograph was developed
Both were giant steps forward in the search for convenient, simplified measurement of the patients blood pressure.
1901- Willem Einthoven, working in Leiden, the Netherlands, used the string galvanometer to measure electrical activity of heart.
1912 - James B. Herrick, an American physician, first describes heart disease resulting from hardening of the arteries.
1920 - The first EKG machine was a bulky, table-sized apparatus.
development of the electrode.
hands and feet were placed in sodium chloride baths as a means of conduction
1938 -  Robert E. Gross, an American surgeon, performs first heart surgery
1940s- Started using  metal disks with wire leads, were strapped to wrists and ankles, for ECG monitoring.  
1951 -  Charles Hufnagel, an American surgeon, develops a plastic valve to repair an aortic valve.
1952  F. John Lewis, an American surgeon, performs first successful open heart surgery.
1953 -  John H. Gibbon, an American surgeon, first uses a mechanical heart and blood purifier.     
1958 - Pace maker Created by the Colombian engineer Jorge Reynolds,
 The pacemaker began as a large device that the patient had to carry outside of the body.1960s, testing on animals were done
1958. - first pacemaker operation was performed  
Unfortunately the device only functioned for three hours, but the patient survived and underwent several pacemaker operations in the future, living to the age of 86.
Pacemakers have saved many lives and changed the treatment for those with irregular or slow heartbeats
Now, pacemakers weigh less than one ounce and most wearers can live normal lives.
1961 -  J. R. Jude, an American cardiologist, leads a team performing the first external cardiac massage to restart a heart.
1964 - .Angioplasty was initially described by the US interventional radiologist Charles Dotter
1965  - Michael DeBakey and Adrian Kantrowitz, American surgeons, implant mechanical devices to help a diseased heart.
1967  - Christian Barnard, a South African surgeon, performs the first whole heart transplant from one person to another.  The first heart bypass using the patient's very own leg veins occurred,
1982 - Willem DeVries, an American surgeon, implants a permanent artificial heart, designed by Robert Jarvik, an American physician, into a patient.
1994 -The first angioplasty balloon
2001 -Robotics allowed for minimally invasive angioplasty surgeries
2007-  human embryonic stem cells were first used to successfully repair and regrow human heart tissues in the lab.

TRENDS AND ISSUES IN THE FIELD OF CARDIOLOGY
TRENDS
Cardiology is one of the primary focuses of almost every large health care facility in the country
 one of the biggest specialities in the health care industry
so trends in cardiology facility design and operations have big impacts in the practise of medicine
Technological Advances
Improvements in Scanning and Interventional Cardiology:
cardiac cauterisation procedures have decreased the need for open heart surgery.
radiological technologies, such as dual-source CT
MRI imaging
Integrated Digital Technologies:
Electronic Medical Record (EMR) and other digital data storage and transportation systems
doctors and nurses can access patients’ records remotely and immediately, the speed and accuracy of diagnosis and treatment have increased
hospital’s workflow can be improved even more. These time-saving and error-reducing techniques have had and will continue to have powerful and optimistic implications for
    patient care
Consolidation of Systems:
combine multiple pieces of equipment into a single system with a single monitor
 improves the efficiency and safety of procedures
Mobile Scanning:
use of mobile scanning devices to monitor and screen for heart problems without making the patient go to a lab           
 reduces the need for patient transportation
prevents risks that may result in patient transportation
Is also available off- site
Robotic cardiac surgery
minimally invasive surgery
decreases post-operative pain and ensures faster recovery, allowing the patient to quickly return to normal activities.
256-slice multi-detector CT Scan High Speed X-ray Computer
Faster imaging time of just 0.27 seconds per scanning rotation reduces radiation exposure by 30%
Autologous Adult Stem Cell Transplantation for heart Failure Program
Regenerative medicine and cell therapy are emerging clinical disciplines
sources for cell transplantation: human embryonic and adult stem cells
Embryonic stem cells normally exist only in preimplantation embryos (4–8 cell stage to blastocyst) and have the ability to form all
    the cells of the body.
Telecardiology in India
 A country like India , owing to it’s vast geographical spread and the enormous population, requires tremendous resources and well trained medical personnel
The basic requirement for tele-cardiac consultation is for a computer with a web camera, a modem and a standard telephone connection at the remote site with ISDN (Integrated Services Digital Network) or broadband capacity.

Facility Organisation
Changes in layout to solve problems in patient care
For many cardiology patients, mobility is a huge concern
Centralisation: putting all the patients’ and doctors’ needs in one area.
Placing patients’ rooms, cardiac cath labs, operation rooms, rehabilitation facilities, and doctors’ offices all near each other to minimise travel time for patients, doctors, and other staff members
Saves time, both for patients and staff, as well as improve patient care
Adaptability
Renovation can be one of the most expensive and time consuming processes a hospital can go through
so adaptability of space through design can ultimately save a hospital time and money.
Adaptability of rooms also makes space usage more efficient, which can increase hospital revenue each room should be able to support future needs with the necessary infrastructure.
Aesthetics
Pleasing, uncluttered environments make a difference in hospitals, especially when it comes to cardiac care
Aesthetic improvements can play a big part in patient care and produce a better work environment for practitioners.
Eg: natural light, water fall, use curves to improve the experience of the spaces, large, open spaces and warm colours
It provides better patient care and higher revenue
Mobile CCU
provides 24-hour standard and special CCU  ambulance services
Each ambulance is equipped with monitoring devices and resuscitation equipment for immediate medical attention.
The hospital's Mobile CCU is always accompanied by a cardiac medical team, reaching patients quickly and acting immediately, helping to save many lives.
ISSUES IN THE FIELD OF CARDIOLOGY
INCREASING NUMBER OF PEOPLE AFFECTED:
 The magnitude of cardiovascular disease (CVD) and its toll are staggering. According to the WHO estimates, in 2003, 16.7 million people around the globe die of cardiovascular disease each year. This is over 29 percent of all deaths globally. It is the single largest killer. By 2020, CVD will become the leading cause of death.
Presently, 7 crore Indians suffer from heart disease. 50 lakh people die of heart disease in India every year. 28% people who die of heart disease in India are less than 65 years old.
COST OF TREATMENT:
The cost for the treatment of heart disease are relatively high.
The cost of treating an ailing heart has more than doubled in the last three years.
The average claimed amount in circulatory ailments — diseases of the cardiovascular system — has increased by at least Rs2 lakh, from Rs1,53,349 to Rs3,56, 505,according to the Insurance Information Bureau (IIB).
the treatment charges for such diseases have inflated by 132.47% since 2007,
while the overall hospitalisation costs have shot up by 37.15%.
A bypass costs about Rs1.5 and Rs 2 lakhs in case of one block and an angioplasty will cost about Rs1.5-2 lakh
DECREASED ACCESS TO HEALTH CARE FACILITIES
Heart disease is particularly endemic in India, where a genetic trait renders Indians three times more vulnerable than Americans or Europeans.
While the average age for heart attack is 65 in London, it is 45years in India.
On average, there is one doctor for every 2000 people, 70 percent of them are in urban areas.
access to care is determined by the convenience and affordability of travel.
Even when people get to a hospital, 50 percent of people seeking cardiac care at a district hospital would die before they get specialist help
Resuscitation and Life Support
Imagine you’re a doctor operating on a patient whose life you could save.  But if you do, they will spend their entirely life completely immobilised, only able to move their eyes.  Worse, they would be in tremendous pain.
Fully conscious but unable to do anything whatsoever.
All you would have to do to prevent this from happening is slow down a little.  If your operation took 2 hours instead of 1 and a half, the patient would die.  And no one would ever know.

 

 
HISTORY OF CARDIOTHORACIC NURSING
1.     1950s - The first intensive care units (ICU) were developed in response to the need for special areas in hospitals that could provide complex care for critically ill patients, such as polio victims.
2.     1960s-
As a result of the specialised care, patient survival rates improved dramatically, generating a call for additional units capable of caring for seriously ill patients with heart disease.
The first coronary care unit was founded at the Royal Infirmary in Edinburgh, Scotland, by Dr. Desmond G. Julian to attempt to deal with heart attack, sudden cardiac arrest and heart arrhythmia's.
He recommended all staff, including nurses, be trained in cardiopulmonary resuscitation (CPR).
3.     1969-  American Association of Critical-Care Nurses (AACN)(is the world's largest speciality nursing organisation.to help educate nurses working in newly developed intensive care units. )
4.     1978- A survey in the journal Circulation in  indicated coronary care units had reduced mortality from heart attack and sudden cardiac arrest by up to 20 percent in the previous decade. As a result, cardiac care units and departments continued to be added to larger hospitals, driving the need for more trained cardiac nurses skilled in CPR, cardiac monitoring and the administration of cardiac medicines.
5.     1982 The Society for Peripheral Vascular Nursing (SPVN), founded in Boston
6.     1990- renamed the Society for Vascular Nursing (SVN)  
7.      1985- The American Association of Cardiovascular and Pulmonary Rehabilitation was founded with the specific mission of reducing death or disability from cardiovascular and pulmonary disease through education, prevention and treatment, with particular emphasis on rehabilitation and disease management. The association provides education and training for cardiac nurses and other heart care professionals, as well as certification for cardiac rehabilitation facilities.
8.     1985- The American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) is dedicated to our mission of reducing morbidity, mortality and disability from cardiovascular and pulmonary disease through education, prevention, rehabilitation, research and disease management. 
9.     1992-  PCNA was originally founded as the Lipid Nurse Task Force (LNTF) by a small group of California nurses who were concerned about the lack of educational opportunities for nursing professionals specialising in lipid disorders.
10.                         LNTF was established shortly after an initial regional educational conference, and quickly grew beyond its California borders to become an international organisation comprised of nurses and other health care professionals from the U.S. and several other countries.
11.                        2001 MAY - The first Cardiac and Vascular Nurse examinations were administered by the PCNA in conjunction with the ANCC. The PCNA continues to offer the certification exams as well as continuing education courses online and live seminars and training events
12.                        2006 Jan - The British Journal of Cardiac Nursing is a monthly nursing journal which publishes original research and clinical articles relevant to the practise of cardiac nursing. Published by MA Health care Ltd (UK).
13.                        Some famous cardiothoracic Journals

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