evolution

1. 1. In Ancient times, when medical lore was associated with good or evil
spirits, the sick were usually cared for in temples and houses of
worships.
2. These women had no real training by today’s standards, but experience
taught them valuable skills, especially in the use of herbs and drugs,
and some gained fame as physicians of their era
Evolution Medical Surgical Nursing

2.  In the 17th Century, St Vincent de Paul began to encourage women to
undertake some form of training for their work, but there was no real
hospital training school for nurses until one was established in
Kaiserwerth, Germany, in 1846.
 There, Florence Nightingale received the training that later enabled her
to establish, at St. Thomas’s Hospital in London, the first school designed
primarily to train nurses rather than to provide nursing services to
hospital.
Similar schools were established in 1873in New York city, New Haven
(Conn.), and Boston

3.  Nursing subsequently became one of the most important
professions open to women until the social changes brought by the
revival of the feminist movement that began in the 1960s.
 During the late nineteenth and early twentieth centuries in United
States, adult patients in many of the larger hospitals were
typically assigned to separate medical, surgical, and obstetrical
wards.
 Nursing education in hospital training schools reflected these
divisions to prepare nurses for work on these units.

4. Early National League of Nursing Education (NLNE) curriculum guides treated
medical nursing, surgical nursing, and disease prevention (incorporating
personal hygiene and public sanitation) as separate topics.
By the 1930s, however, advocated recommended that medical and surgical
nursing be taught in a single, interdisciplinary course, because the division of
the two was considered an artificial distinction. Surgical nursing came to be
seen as the care of medical patients who were being treated surgically.
The NLNE’s 1937 guide called for a “combined course” of medical and nursing.

5. Students were expected to learn not only the theory and
treatment of abnormal physiological conditions, but also to
provide total care of the patient by understanding the role of
health promotion and the physiological, social, and physical
aspects that affected our patient’s health. While the
integration of this approach into nursing school curriculum.
1960s, nursing schools emphasized the interdisciplinary study
and practice of medical and surgical nursing.
1960s and 1970s, standards were developed for many nursing
specialties, including medical-surgical nursing.

6.  Standards medical surgical nursing practice, written
by a committee of the division on medical- surgical
nursing of the American Nurses’ Association (ANA),
was published in 1974. It focused on the collection of
data, development of nursing diagnosis and goals for
nursing, and development, implementation, and
evaluation of plans of care.
 A statement on the scope of medical-surgical nursing
practice followed in 1980.

7.  In 1991, the Academy of Medical-Surgical Nurses (AMSN) was
formed to provide an independent specialty professional
organization for medical-surgical and adult health nurses.
 In 1996, the AMSN published its own scope and standards of
medical-surgical nursing practice,
 The second edition appeared in 2000 [15]. Both the ANA and
AMSN documents stated that while only clinical nurse
specialists were expected to participate in research, all
medical-surgical nurses must incorporate research findings in
their practice.

8. Trends in medical-surgical nursing
 Recent trends affecting nursing as a whole have also affected medical
surgical nurses, including
• the increasing use of nursing care management,
• expansion of advanced practice nursing,
• total quality improvement,
• development of clinical pathways,
• changes in the professional practice model to include greater numbers of
nonprofessional staff, healthcare reform,
• and the rise of managed care.
• the trend towards increased acuity of patients begun in the 1980s, has become a fact of
life.

9. Influences on future nursing practice
1.Expanding knowledge & technology
2.Healthy people initiatives
3.Evidence based practice
4.Standardized nursing terminologies
5.Health care informatics
nursing informatics

10. Nursing specialty
Registered Nurse Licensure
 Addiction Nurse
 Ambulatory care nurse
 Paranesthesia nurse
 Cardiac/vascular Nurse
 Critical care nurse
 Emergency nurse
 Flight nurse
 Dialysis nurse
Bachelor’s degree in Nursing
 First assistant nurse
 Holistic nurse
 Home health nurse
 Nursing administration
 School nurse

11. Masters/higher degree in nursing
1. Nurse practitioner
 Acute care NP, adult care NP, Family NP, gerontological NP, Palliative Care NP,
Pediatric NP.
2. Clinical specialist
 Adult psychiatric & mental health nursing, community health nursing, medical
surgical nursing. palliative and pediatric nursing
3. Others
 advanced nursing administration
 advanced oncology clinical specialist
 clinical nurse leader

12. History of nursing
 Societal Trends influencing the Development of
Nursing
 Social Trends
 Ancient civilizations
• Care of sick was related to physical maintenance & comfort
• First by family members, relatives, servants or prisoner.
• Eventually by religious orders or humanitarian societies.
 Mental Health
Linda Richards and Dorthea Dix worked to improve the care of the
mentally ill.
 Modern Civilization
Focus in on technology

13. Societal trends influencing the development of
nursing
Religious tradition- Catholic/Protestant
Courage
Care of sick in battlefields, military/naval hospitals and prisons.
Care of sick and dying during epidemics
Cholera, typhus, smallpox
Sacrifice
Creativity
Founding of Alcohol Anonymous & AI – Anon
Compassion

14. Societal trends influencing the development of
nursing
Women’s movement
 Nursing has been a premiere political force for women’s
rights.
 Nurses organized the first major professional organization
for women edited & published the first professional magazine
by a female

15. Marth Danger was a public health nurse in New York
 Open the first birth control clinic in U.S. because of large number of
unwanted pregnancies in the working poor
Lavina Dock was a writer & political activist
 Early feminist devoted to women’s suffrage
 Participated in protest & demonstration until passage of the 19th amendment in
1920
 Cultural factors
 First major professional group to integrate black & white members

16. Wars
 Nightingale in the Crimean war
Mortality rate dropped from 60% to 2% as a result of the
environmental changes she implemented
 Clara Barton organized nurses to provide care in the American civil war
and established the American Red Cross that serves in the war and peace
time.
 American Red Cross was responsible for recruiting women for the army
nursing corp during WWI
 Their motto was, American Nurses for American Men

17.  Economic factors
 Insurance
Fee for service
Managed care
Cost of health care rising faster than inflation
 Educational factors
 1893 Dock was Isabel Hampton Robb and Mary Nutting founded the
American Society of Superintendents of Training Schools for Nurses of
the U.S. and Canada.
This organization was very politically active & became the
NLN which promotes quality education nursing to this day.

18.  Political Factors
Nightingale was political
First nurse to exert political pressure on Government
Influential in reforming hospitals & implementing public
health policies in Britain.
 Clara Barton persuaded Congress in 1882 to
ratify the Treaty of Geneva so the Red Cross
could perform in peace time
Impact on national and international policies

19.  Lillian wald’s political pressure lead to the
creation of the U.S. Children’s Bureau.
Established by congress in 1912 to oversee child labour
laws
Nursing represents 67% of the healthcare providers
in the U.S.
few nurses are in position where they can influence
health care policy making

20.  1990- Nurses became involved in politics at the
local, state & national level.
- Eddie Bernice Johnson into US House of Representative from
Texas
- Ada sue Hinshaw directed the NIH center for Nursing Research.
- Nurses in all practice areas are affected by public policy on a
daily basis
Nursing agenda for Health Care reform
- developed in 1991
- nurses can use this agenda to unite and become a political
force in health care delivery

21.  Group of practitioners who band together to perform
social or political functions they could not do alone
Define and regulate the profession
Development of a knowledge base for practice
Research
Transmit norms, values, knowledge, and skills
Communicate/ advocate contributions of the profession
Address members social & general welfare needs

22. INTERNATIONAL CLASSIFICATION OF
DISEASES

23. International statistical classification of diseases
• International statistical classification of diseases and related health problems
in short “ICD” is the international standard diagnostic tool for epidemiology,
health management and clinical purposes.
• ICD is designed as health care classification system which provides the
diagnostic codes for classifying diseases including classification of wide
variety of signs, symptoms, abnormal findings, complaints, social
circumstances and external cause of injury or disease.

24. Historical synopsis
• In 1860, Florence nightingale →made first model of systemic collection of
hospital data.
• In 1893, French physician, Jacques Bertillon→
• introduced Bertillon classification of cause of death
• In 1898, American public health association→ recommended revision of ICD
system every 10 years.
• The revision followed minor changes until 6th version of ICD→ morbidity and
mortality condition and section on mental disorders
• WHO →responsibility for preparing and publishing the ICD revisions every 10
years.

25. • The ICD -10 was formed in 1893, as the Bertillon classification of
international list of causes of death.
• The work on ICD -10 started in 1983 → approved in 1990 at 43rd world health
assembly (WHA)

26. FLORENCE NIGHTINGALE
The lady with the lamp

27. JACQUES BERTILLON (1858 -
1914 )

30. CAUSE OF DEATH
• THE CAUSES OF DEATH to be entered on the medical certificate are all those
diseases, morbid conditions or injuries which are either resulted or contributed
to death and circumstances of accident or violence , which produced any such
injuries.
UNDERLYING CAUSE OF DEATH
a) Diseases or injury which initiated the sequence of events leading directly to
death
b) The circumstances of the accident or violence which produced the fatal
injury.

32. Later more scientific approach was adopted in classifying diseases. According
to certain characteristics of diseases or injuries, such as
1. The part of the body affected
2. The etiological agent
3. The kind of morbid change produced by the disease or injury .
4. The kind of disturbance of function produced by disease or injury.

33. Classification (ICD-10)

34. The ICD -10 is arranged in 21 major chapters
1. Certain Infectious and parasiticdiseases.[A00- B99]
2. Neoplasms [C00-D48]
3. Diseases of the blood and blood forming organs and certain disorders involving
the immune mechanism[D50 – D89]
4. Endocrine nutritional and metabolic diseases [E00-E90]
5. Mental and behavioral disorders [F00-F99]
6. Disorders of the nervous system [G00-G99]
7. Diseases of eye and adnexa [H00-H99]

35. 8. Diseases of the ear and mastoid process [H60-H95]
9. Diseases of circulatory system [I00-I99]
10. Diseases of respiratory system [J00-J99]
11. Diseases of digestive system [K00-K99]
12. Diseases of the skin and subcutaneous tissue [L00- L99]
13. Diseases the musculoskeletal system and connective tissue[M00-M99]
14. Diseases of genitourinary system [N00-N99]
15. Pregnancy , childbirth and puerperium [O00-O99]

36. 16.Certain conditions originating in perinatal period [P00- P96]
17.Congenital malformations, deformations and chromosomal
abnormalities [Q 00- Q99]
18.Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere
classified [R00-R99]
19.Injury, poisoning and certain other consequences of external causes [S00-T98]
20. External causes of morbidity and mortality [V01-Y98]
21.Factors influencing health status and contact with health services . [Z00-
Z99].

37. THE CODING SYSTEM
• The first character of the ICD -10 code is a letter and each letter is associated
with a particular chapter except for letter D, which is used in chapter 2 and
chapter 3, and letter H which is used in chapter 7 and chapter 8.
• Chapter 1, 2, 19, 20 use more than one letter in the first position of their
codes
• Each chapter contains sufficient 3 character categories to cover its contents
• Most of the 3 character categories are subdivided by means of a 4th numeric
character after a decimal point, allowing up to 10 subcategories

38. Example :-
 Chapter 21–factors influencing health status and contact with health
services [Z00 - Z99]
 _Z 22 –carriers of infectious diseases
• Z22.0 –carrier of thyroid
• Z22.1 –carrier of intestinal infectious diseases
• Z22.2 –carrier of diphtheria
• Z22.3 –carrier of specific bacterial diseases
• Z22.4 –carrier of infections with predominantly sexual mode of transmission
• Z22.5 –carrier of viral hepatitis
• Z22.6 –carrier of human T- lymphotropic virus type -1(HTLV-1) infection
• Z22.8 –carrier of other infectious diseases
• Z22.9 –carrier of infectious disease, unspecified .

39.  Z 72- Problems related to life style
 Z 72.0 – tobacco use
 Z 72.1 – alcohol use
 Z 72.2 – drug use
 Z 72.3 – lack of physical exercise Z 72.4 – Inappropriate
 Z 72.5 –high risk sexual behavior
 Z 72.6 –gambling and betting
 Z 72.8 –other problems related to life style
 Z 72.9 –problem related to life style, unspecified

40. EXAMPLE :-Chapter 21–factors influencing health status and
contact with health services [Z00- Z 99]
 Z 22 –carriers of infectious diseases
 Z22.0 –carrier of thyroid
 Z22.1 –carrier of intestinal infectious
 diseases
 Z22.2 –carrier of diphtheria
Z 72- Problems related to life style
Z 72.0 – tobacco use
Z 72.1 – alcohol use
Z 72.2 – drug use
Z 72.3 – lack of physical exercise
Z22.3 –carrier of specific bacterial diseases Z 72.4 Inappropriate
Z22.4 –carrier of infections with
sexual mode of transmission
Z22.5 –carrier of viral hepatitis
Z22.6 –carrier of human T- lymphotropic
virus type -1 infection
Z22.8 –carrier of other infectious diseases
Z22.9 –carrier of infectious disease,
Z 72.5 –high risk sexual behavior
Z 72.6 –gambling and betting
Z 72.8 –other problems related to lifestyle
Z 72.9 –problem related to life style,
unspecified

41. Z 22.3-carriers of specified bacterial diseases
• Z 22.31 : carrier of bacterial diseases due to meningococci
• Z 22.32 : carrier of bacterial diseases due to staphalococci
• Z 22.33 : carrier of bacterial diseases due to streptococci
• Z 22.34 : carrier of bacterial other specified bacterial diseases

42. ICD - 10
The latest version of ICD -10 which came into force in January 1st 1993,
revised in 2003.
 The main innovations of ICD 10th Revisions are :
1. Relevant information for ambulatory and managed care encounter
2. Expanded injury codes
3. New combination codes for diagnosis / symptoms to reduce the number of
codes needed to describe a problem fully .

43. 4. Classification refined to increased data granularity
5. Replacing numerical system of coding frame with alphanumerical coding
frame.
6. Of 26 available letters 25 have been used , except the letter “U” being left
vacant .

44. Classification (ICD-11)
• The world health organization is currently revising the ICD towards ICD-11.
• The development is taking place on an internet based workspace called " icat "
platform ,
• The draft of the ICD -11 system → submitted to WHO’s world health
assembly (WHA)→ by 2017 and a final version → in 2018.

45. CHAPTERS IN ICD-11
1. Certain infectious or parasitic diseases (1A00- 1H0Z)
 This chapter includes certain conditions caused by pathogenic organisms or
microorganisms, such as bacteria, viruses, parasites or fungi.
2. Neoplasms (2A00-2F9Z)
 An abnormal or uncontrolled cellular proliferation which is not coordinated with an
organism's requirements for normal tissue growth, replacement or repair.
3. Diseases of the blood or blood-forming organs(3A00-3C0Z)
 This chapter includes diseases of the blood as well as diseases of blood forming organs.
4. Diseases of the immune system (4A00- 4B4Z)
5. Endocrine, nutritional or metabolic diseases( 4A00-5D46)
 This chapter includes endocrine diseases, nutritional diseases as well as metabolic
diseases.

46. Classification (ICD-11)
6.Mental, behavioural or neurodevelopmental disorders (6A00-6E8Z)
 Mental, behavioural and neurodevelopmental disorders are syndromes
characterised by clinically significant disturbance in an individual's cognition,
emotional regulation, or behaviour that reflects a dysfunction in the psychological,
biological, or developmental processes that underlie mental and behavioural
functioning. These disturbances are usually associated with distress or impairment
in personal, family, social, educational, occupational, or other important areas of
functioning.
7.Sleep-wake disorders(7A00-7B2Z)
 Sleep-wake disorders are characterised by difficulty initiating or maintaining sleep
(insomnia disorders), excessive sleepiness (hypersomnolence disorders), respiratory
disturbance during sleep (sleep-related breathing disorders), disorders of the sleep-
wake schedule (circadian rhythm sleep-wake disorders), abnormal movements
during sleep (sleep-related movement disorders), or problematic behavioural or
physiological events that occur while falling asleep, during sleep, or upon arousal
from sleep (parasomnia disorders).

47. Classification (ICD-11)
8.Diseases of the nervous system8A00-8E7Z)
 This is a group of conditions characterised as being in or associated with
the nervous system.
9.Diseases of the visual system (9A00-9E1Z)
 This refers to any diseases of the visual system, which includes the eyes and
adnexa, the visual pathways and brain areas, which initiate and control visual
perception and visually guided behaviour.
10.Diseases of the ear or mastoid process (AA00-AC0Z)
 This chapter contains diseases of the ear and diseases of the mastoid process.

48. Classification (ICD-11)
11. Diseases of the circulatory system (BA00-BE2Z)
 This refers to diseases of the organ system that passes nutrients (such as amino acids,
electrolytes and lymph), gases, hormones, blood cells, etc. to and from cells in the body to
help fight diseases, stabilize body temperature and pH, and to maintain homeostasis.
12. Diseases of the respiratory system (CA00-CB7Z)
13. Diseases of the digestive system ( DA00-DE2Z)
14. Diseases of the skin (EA00-EM0Z)
 Diseases of the skin incorporate conditions affecting the epidermis, its appendages (hair,
hair follicle, sebaceous glands, apocrine sweat gland apparatus, eccrine sweat gland
apparatus and nails) and associated mucous membranes (conjunctival, oral and genital), the
dermis, the cutaneous vasculature and the subcutaneous tissue (subcutis).

49. Classification (ICD-11)
15. Diseases of the musculoskeletal system or connective tissue (FA00-FC0Z)
 This chapter contains diseases of musculoskeletal system and diseases of connective
tissue.
16. Diseases of the genitourinary systemGA00-GC8Z)
 Any disease characterised by pathological changes to the genitourinary system.
17. Conditions related to sexual health ( HA00-HA8Z)
18. Pregnancy, childbirth or the puerperium ( JA00-JB6Z)
 A group of conditions characterised as occurring during the period of time from
conception to delivery (pregnancy), during labour and delivery (childbirth) or during the
approximately six weeks after delivery during which the uterus returns to the original size
(puerperium).

50. Classification (ICD-11)
19.Certain conditions originating in the perinatal period (KA00-KD5Z)
 This chapter includes conditions that have their origin in the perinatal
period even though death or morbidity occurs later.
20.Developmental anomalies (LA00-LD9Z)
 This chapter includes conditions caused by failure of a particular body site
or body system to develop correctly during the antenatal period.

51. Classification (ICD-11)
21. Symptoms, signs or clinical findings, not elsewhere classified (MA00-
MH2Y)
 Clinical findings include those found using physical, laboratory and imaging
techniques. Diseases can manifest in many ways and in different body systems.
Such specific
 manifestations may be a reason for treatment or encounter, with or without
identifying
 or addressing the underlying condition.
 Categories in this chapter include the less well-defined conditions and
symptoms that, without the necessary study of the case to establish a final
diagnosis, could be designated 'not otherwise specified', 'unknown aetiology'
or 'transient'.

52. Classification (ICD-11)
22. Injury, poisoning or certain other consequences of external causes (NA00-
NF2Z)
 In the ICD, injury means physical or physiological bodily harm resulting
from interaction of the body with energy (mechanical, thermal, electrical,
chemical or radiant, or due to extreme pressure) in an amount, or at a rate of
transfer, that exceeds physical or physiological tolerance. Injury can also
result from lack of vital elements, such as oxygen. Poisoning by and toxic
effects of substances are included, as is damage of or due to implanted devices.
Maltreatment syndromes are included even if physical or physiological bodily
harm has not been reported. Otherwise, psychological effects are not included
(e.g. injured feelings).

53. Classification (ICD-11)
23. External causes of morbidity or mortality (PA00-PL2Z)
 The WHO definition of an ‘injury’ is: ‘Injuries are caused by acute exposure
to physical agents such as mechanical energy, heat, electricity, chemicals, and
ionizing radiation interacting with the body in amounts or at rates that exceed
the threshold of human tolerance. In some cases, (for example, drowning and
frostbite), injuries result from the sudden lack of essential agents such as
oxygen or heat’. Injuries may be categorized in a number of ways. However,
for most analytical purposes and for identifying intervention opportunities, it
is especially useful to categorize injuries according to whether or not they were
deliberately inflicted and by whom.

54. Classification (ICD-11)
24. Factors influencing health status or contact with health services (QA00-QF4Z)
 Categories in this chapter are provided for occasions when circumstances other
than a disease, injury or external cause classifiable elsewhere are recorded as
"diagnoses" or "problems". This can arise in two main ways:
1. When a person who may or may not be sick encounters the health services for
some specific purpose, such as to receive limited care or service for a current
condition, to donate an organ or tissue, to receive prophylactic vaccination or to
discuss a problem which is in itself not a disease or injury.
2. When some circumstance or problem is present which influences the person's
health status but is not in itself a current illness or injury. Such circumstance or
problem may be elicited during population surveys, when the person may or may
not be currently sick, or be recorded as additional information to be borne in
mind when the person is receiving care for some illness or injury.

55. Classification (ICD-11)
25. Codes for special purposes (RA00-RA26)
• International provisional assignment of new diseases of uncertain aetiology
and emergency use
• National provisional assignment of new diseases of uncertain aetiology
26. Supplementary Chapter Traditional Medicine Conditions( SA00-SJ3Z)
27. Supplementary section for functioning assessment (VA00-VC50)
 The section allows for creating functioning profiles and overall functioning scores
of individuals, which are suitable to describe and quantify the level of functioning
associated with a health conditions. To guide functioning assessment, the section
includes two ICF-based instruments developed by WHO: the WHO Disability
Assessment Schedule (WHODAS 2.0 36-item version), and the Model Disability
Survey (MDS).
28. Extension Codes (XA0060-XY9U)

56. THANKS