This document provides an overview of medical and surgical nursing through history. It defines medicine and surgery, and notes Hippocrates and Joseph Lister as the fathers of medicine and surgery, respectively. It then discusses the evolution of medical and surgical nursing through history from ancient times to modern trends. Key points covered include ancient medical techniques like bloodletting and trepanation; traditional healing practices in early civilizations like Ayurveda, Chinese medicine, and Egyptian medicine; the development of nursing; and modern trends in medical surgical nursing like increased technology use, evidence-based practice, and culturally competent care.

1. UNIT – 1:
INTRODUCTION
( 6 hrs : Theory & 4 hrs: SL)

2. DEFINITION
“The unique function of the nurse is to assist the individual, sick or well, in
performance of those activities contributing to health or its recovery (or to
peaceful death) that he would perform unaided if he had the necessary
strength, will or knowledge and to do this in such a way as to help him
gain independence as rapidly as possible.” : Virginia Henderson.

4. MEDICINE V/S SURGERY
Medicine: it is a branch of science which deals the treatment of disease by drugs,
diet, exercise and other non surgical means. Medical nursing involves the nursing
care of adult patients who are treated and cared medically or pharmacologically.
Surgery: it is a branch of science which deals with disease which requires
operation with the help of instruments and medical treatment. Surgical care given
to patients by nurse is called surgical nursing. The surgical nurses care the
patients before, during and after the surgical intervention for the treatment of the
disease.
Father of medicine: Hippocrates
Father of surgery : Joseph Lister

5. Evolution and trends of Medical
and Surgical nursing.

6. Through the ages, people have wondered why some individuals become sick
while others remain healthy. When the population of early civilization had little
knowledge of disease process, magic and superstition were the mainstays in
treating illness.
As medical knowledge increased, treatment became more science based.

7. Life among primitive people
Pre-historic people led a nomadic roaming from place to place. They used
stones as weapons and used to make fire .They were nature worshipers.
Their belief is known as animism and the period is as stone age.
Primitive people believed that sickness comes due to the following
reasons :
❖ Anger of offended Gods, Devils or Evil spirit,
❖ Supernatural powers of the human enemy
❖ Displeasure of the dead
❖ Due to their own sin

8. Treatment
The treatment was done by Shaman, medicine man or witch –doctor or priest physician.
The practice was not to give rest and quietness to the sick person .Instead, to encourage the evil
spirit to depart from the person’s body by using certain another tricks and methods used on the
sick person .
For Example:
Startling the evil spirit with frightening mask and deafening noises.
Jolting the person by shaking ,biting , pinching and kicking .
Using noxious odors
Giving purgatives and emetics
Putting them in hot and cold water
Pacifying the evil spirit by sacrifice .
Encouraging the evil spirit to come out , using mantras.
Using certain herbal medicines , eg: Bark of tree for rheumatism
Making a hole in the skull with stone if above methods failed
Healing depends on the faith of the person

10. Ancient medicine
techniques:
Bloodletting: For thousands of years, medical practitioners clung to the belief that sickness
was merely the result of a little “bad blood.”
Influential physicians like Hippocrates and Galen maintained that the human body was filled
with four basic substances, or “humors”—yellow bile, black bile, phlegm and blood—and these
needed to be kept in balance to maintain proper health.
With this in mind, patients with a fever or other ailment were often diagnosed with an
overabundance of blood. To restore bodily harmony, their doctor would simply cut open a vein and
drain some of their vital fluids into a receptacle. In some cases, leeches were even used to suck
the blood directly from the skin.

11. While it could easily result in accidental death from blood loss,
phlebotomy endured as a common medical practice well into the
19th century. Medieval doctors prescribed blood draining as a
treatment for everything from a sore throat to the plague, and some
barbers listed it as a service along with haircuts and shaves.
The practice finally fell out of vogue after new research
showed that it might be doing more harm than good, but leeching
and controlled bloodletting are still used today as treatments for
certain rare illnesses.

12. Trepanation
Humanity’s oldest form of surgery is also one of its most gruesome. As
far back as 7,000 years ago, civilizations around the world engaged in
trepanation—the practice of bore holes in the skull as a means of curing
illnesses. Researchers can only speculate on how or why this grisly form of
brain surgery first developed. A common theory holds that it may have been
some form of tribal ritual or even a method for releasing evil spirits believed
to possess the sick and mentally ill. Still others argue that it was a more
conventional surgery used to treat epilepsy, headaches, abscesses and
blood clots. Trepanned skulls found in Peru hint that it was also a common
emergency treatment for cleaning out bone fragments left behind by skull
fractures, and evidence shows that many of the patients survived the surgery.

13. Mercury
Mercury is notorious for its toxic properties, but it was once used as a
common elixir and topical medicine. The ancient Persians and Greeks considered it a
useful ointment, and second-century Chinese alchemists prized liquid mercury, or
“quicksilver,” and red mercury sulfide for their supposed ability to increase lifespan and
vitality. Some healers even promised that by consuming noxious brews containing
poisonous mercury, sulfur and arsenic, their patients would gain eternal life and the ability
to walk on water. One of the most famous casualties of this diet was the Chinese Emperor
Qin Shi Huang, who supposedly died after ingesting mercury pills designed to make him
immortal.
From the Renaissance until the early 20th century, Mercury was also
used as a popular medicine for sexually transmitted diseases like syphilis. While some
accounts claimed the heavy metal treatment was successful in fighting off the infection,
patients often died from liver and kidney damage caused by mercury poisoning

14. Animal Dung Ointments : Lizard blood, dead mice, mud and moldy bread were all used
as topical ointments and dressings. While these remedies may have occasionally led to
tetanus and other infections, they probably weren’t entirely ineffective—research shows
the microflora found in some types of animal dung contain antibiotic substances.
Corpus medicine: Once upon a time, your local physician may have prescribed an elixir
containing human flesh, blood or bone. So-called “corpse medicine” was a disturbingly
common practice for hundreds of years for persistent headaches, muscle cramps or
stomach ulcers. The Romans believed that the blood of fallen gladiators could cure
epilepsy, and 12th century apothecaries were known for keeping a stock of “mummy
powder”—a macabre extract made from ground up mummies looted from Egypt. . In
some cases, the sickly would even attend executions in the hope of getting a cheap cup
of the freshly killed person’s blood.

15. Wandering Womb : Ancient Greek doctors believed that a woman’s womb was a
separate creature with a mind of its own. According to the writings of Plato and
Hippocrates, when a woman was celibate for an extended time, her uterus was
described as a “living animal” eager to bear children ;could dislodge and glide freely
about her body causing suffocation, seizures and hysteria.
This curious diagnosis endured in some form into the time of the Romans and
Byzantines even after doctors had learned that the womb was held in place by ligaments.
To prevent their wombs from going on walkabout, ancient women were counseled to marry
young and bear as many children as possible.
For a womb that had already broken free, doctors prescribed therapeutic baths,
infusions and physical massages to try to force it back in position. They might even
“fumigate” the patient’s head with sulfur and pitch while simultaneously rubbing pleasant-
smelling lotions between her thighs ;the logic being that the womb would flee from the bad
smells and move back into its rightful place.

16. Treatments in early
civilization
Asian countries like India, China and Greeks believed that an imbalance
in the body fluid causes illness.
❖ Indian system
❖ Chinese system of medicine
❖ Egyptian system
❖ Greek medicine

18. Came into existence in about 900 BC.
The word Ayurveda means Ayur means life and veda meaning science.
(science of life)
The ayurveda is said to be an upaveda (part)of Atharva veda.

19. The universe is composed of five basic elements or pancha bhutas.
The fundamental harmony therefore exist between the universe and the
individual.
The human body is in a state of continuous flux or dynamic equilibrium.
The pancha bhutas are represented in the body as the doshas, dhatus,
malas.

21. These 3 should be in perfect equilibrium for the body to remain healthy.
Any imbalance among these constituents results in ill health and disease.

22. SIDDHA
Siddha is a Tamil word derived from “siddhi” : attaining perfection in life.
It is exclusively linked with tamil culture.
Siddha science considers nature and man as essentially one.
Man is said to be the microcosm and the universe is the macrocosm
because what exists in the universe exist in man.

23. Imbalance in panchabhutas causes diseases.

25. UNANI

32. HOMEOPATHY

33. Law of similarities: substance that cause
similar symptoms in healthy person as the
patient can cure the disease.

34. CHINESE SYSTEM OF MEDICINE

35. Traditional Chinese Medicine (TCM) refers to a range of practices that, while
based on their traditional counterparts, are far more modernized and Westernized
that they were in their inception more than two thousand years ago. The modern
practices include herbology, acupuncture, acupressure, mind-body therapy,
dietary therapy, cupping, and massage
China has one of the world’s oldest medical systems. Acupuncture and
Chinese herbal remedies date back at least 2,200 years, although the earliest
known written record of Chinese medicine is from the 3rd century BC. In essence,
traditional Chinese healers seek to restore a dynamic balance between two
complementary forces, yin (passive) and yang (active), which pervade the human
body as they do the universe as a whole. According to TCM, a person is healthy
when harmony exists between these two forces; illness, on the other hand, results
from a breakdown in the equilibrium of yin and yang.

36. Egyptian Medicine

40. NURSING
History of nursing begins with the history of humankind, ancient east and western
cultures and religion. There is hardly any available literature on the ancient history
of nursing and caring sick in primitive times. However, through myths, songs and
archeologists, it has been found that the primitive man had the skill of massaging,
fermentation, bone setting, amputation, hot and cold bath, heat to control
hemorrhages. Temples and houses of worship were to take care of sick people.
Under the ayuervedic system of medicine. There was a mention of ‘upacharika’
means nurse in a book written by sushruta on surgery and years later charaka on
internal medicine describing qualities of upacharika.
In siddha system of medicine, the nurse used to attend the patient with cool
headed pleasant, does not speak ill of anybody, is reliable and attentive enough
fulfil the requirements of the sick and follows the instructions of the doctor.

42. During the king Ashoka period (264 BC), there were a large number of hospitals
for sick persons. Upto world war II period, nursing development in India took place
in three dimensions : civilian nursing, missionary nursing and military nursing.
Civilian nursing in India dates back in 1664 with the upcoming of Government
General Hospital in Madras.
The dawn of modern nursing dates from late 1700s through 1853.
recommendations made by Florence Nightingale led to the beginning of
organized nursing in India, which was the starting point for medical surgical
nursing and preventive care.

49. Nursing developed as a profession with focus on hospital nursing services from
historical period to the pre-independence period.
After independence there has been substantial development in all field nursing
and medical surgical nursing is considered as the foundation of nursing. Many
diploma and certificate courses started. The nursing curriculum included medical
surgical nursing as one component in diploma and degree program that continued
till today.
After 2006 onwards the concept of subspeciality in nursing was introduced in
master’s and post basic diploma program started om cardiothoracic nursing,
critical care nursing, neuroscience, oncology, orthopedic, rehabilitation , disaster
nursing, nurse practitioner.

50. TRENDS IN MEDICAL SURGICAL
NURSING
The entire field of health care is changing day by
day.
These changes occurs at rapid rate. The focus of
MSN is not limited to a disease or a body system but
focus on holistic in nature.
Trend: A general direction in which a situation is
changing or developing.

51. Such changes in professional practices require constant
updating in knowledge, attitudes and skills.
Trends in nursing largely depend upon the changing health
needs of the people, changing health delivery system and
scientific and technical advancement.

52. 1. Quantification of nursing costs.
❖ Quantification of nursing contribution to patient care can be used
to determine the cost of providing care to specific patients.
❖ Quantifying nursing time requires the identification of the level of
nursing care necessary for each patient.
❖ The patient care plan is an integral part of the justification of
nursing care costs.

53. 2. Reduced length of stay
The provision of personalized care must be planned and
provided with continuity as the quality of care time decreases.
Many patients who leave the hospital earlier are still need of
health care.
Aggressive discharge planning must begin on admission.
An effective coordinated plan of care can help ensure
continuity of care.

54. 3. Increase reliance on high
technology.
The evolving technological advances in nursing are the wave of the future
in healthcare. Emerging new technologies in apps and software
development are becoming increasingly popular as more hospitals and
facilities integrate them into their health system.
4. Innovation in planning care through
computerization.
Nurses believe that their better time can be spend at the bedside giving
patient care rather than filling out paperwork. Studies shows that institutions
using computers reports increases number of plan of care being generated.

55. 5. Unification of practice and
education.
The unification model directs nursing education, research, and practice.
Unification is not only a philosophical approach but also an organizational
structure that operationalizes the interdependence among education,
research and practice.
6. Telenursing
Telenursing or telehealth nursing uses technologies to provide nursing
services through computers and mobile devices. It allows patients to connect
with their nurses through mobiles devices, computers etc.

56. 7. Robotic nursing
Robots are used in nursing for monitoring patients via video, helps in
positioning, feeding, shifting etc.
In Japan, a robot has been developed as an assistant to lift up and
move patients from beds to wheelchairs and reduce debilitating lifting
injuries. In Belgium another robot developed as an automated Triage
Nurse, capable of taking a patient's vitals, updating medical records and
medical history. In Duke University ,a robot is designed to take vital
signs for patients with infectious diseases

57. 8. Community based nursing
The health care delivery concept is now changing from hospital centered
to community based nursing.

58. 9. Advanced Practice Nursing
Nurses provide patient centered care under different designations such as
nurse practitioner, registered nurse, nurse educator, clinical nurse in charge.
10. Patient centered care
It means treating a patient with dignity, respect and involving them in
all decisions about their health. Nurse provides care to patient
considering their beliefs, concerns and include them directly in
decision making. This approach provides patient satisfaction.

59. 11. Comprehensive Nursing Care
It describes a competent level of nursing care provided to patient
following steps of nursing process. Here, the medical surgical nurse
provides quality care considering individual as whole including health
care, psychological support, socioeconomic support and maintaining
dignity of individual.
12. Holistic Approach
It incorporates the various dimensions to whole well being, including
a person’s context and individual expression preferences and beliefs.

60. 13. Clinical pathways and care
mapping
They serve as a tool for tracking a patient’s progress toward achieving
positive outcomes within specified time frames.
Clinical pathways have been developed for high risk patients (those who
receive chemotherapy) and for patients with certain common health
problems (DM).

62. Care mapping, clinical guidelines and algorithms are other evidence
based practice tools that are used for interdisciplinary care planning. They
are used in acute situations to determine a particular treatment based on
patient information or response.
Through clinical pathways and care mapping, patients and the care they
receive are continually assessed from pre-admission to discharge.

64. 14. Quality care and evidence
based practice.
Utilizing the EBP, approach to nursing practice helps us provide the highest
quality and most cost-efficient patient care possible.
Evidence based practice includes the use of outcome assessment and
standardized care plans such as clinical pathways and care mapping.
Incorporating research findings in to practice.

65. 15. Changing patterns of disease
With time many diseases are eradicated and many become more prevalent.
There are few diseases such as HIV which cannot be cured. An increasing
number of infectious agents are becoming resistant to antibiotic therapy .
Therefore, conditions that were once easily treated have become complex and
more life-threatening than ever before.
16. Culturally competent care
As cultural composition of the population changes, it becomes increasingly
important to consider cultural aspects in the delivery of health care. Patients
from diverse sociocultural groups have different health care beliefs and
values and these factors significantly affect the way an individual responds to
health care problems. Therefore nurse care should be culturally competent.

66. ▪ Mobile nursing service
▪ Military nursing
▪ Occupational health nursing
▪ Trends in the nursing profession have always been closely related to
those in the medical profession. Growing specialization in medical field is
resulting in a trend towards increased specialization in nursing. The
development of new diagnostic procedure and equipments make
specialization even more necessary.