Spinoff : What We Do, What We Used to Do

[NursingAgainstdaOdds]

The HIV thread reminded me of a thread I've wanted to start here for a while. (Apologies if it's been done!)

I love to hear accounts from experienced nurses about how nursing practice used to be, or how different practices have evolved. For example, an experienced traveller shared with me recently how patients with feeding tubes used to have what everyone else had - just pureed like crazy. (Interestingly to me, she also informed me that there was no such thing as a tube-fed patient with obligatory diarrhea. She felt this was because the patients got "real" food. I thought that was very thought-provoking.)

So, please share. Nursing history of all kinds really fascinates me. I wouldn't restrict this to practice-based issues, either - nurse/patient, nurse/doctor, nurse/nurse relationships have also evolved in fascinating ways. Let's hear it!

Edited to Add : I'm also interested if anyone has experiences which exemplify where certain procedural changes originated - i.e. our vigilance with IVs.

[TazziRN, RN]

When starting IVs , stuck the IV cath needle in the benchseat of the ambulance or in the cot, or in the gurney at the hospital till could find a needle box. ( Cause they were few and far between) Telling those around you "Watch that needle in the............":nono:

Instead of using a cell phone we used mics tuned to radios on the HEAR 340, you could hear all over the state if you had the right frequency( I know I heard my partner one night while visiting a hosp in IOWA LOL)

Done the needle-in-the-gurney thing many many MANY times! It was the safest place to park a sharp when trying to start an IV, especially on a kid.

When I ran my first MICN call my ex turned his scanner on. I was scared to death and knowing he would be listening in didn't help matters none. The medic on that night took pity on me and called on the land line!

Here's a funny about hearing frequencies over long distances. Just within the last couple of years a call came over our radio, very staticky (not unusual for the region) about a guy who'd fallen from a tower at an oil field and was trying his darnedest to arrest. Coming in code 3. We scrambled. We called for extra help, put the helicopter on notice that we might be flying out a trauma, got the trauma room ready, etc.

Nothing.

Nobody showed up.

I called every dispatcher in the area trying to find out who it was. Nobody knew nuthin'.

We stood down, did some investigating, and turned out it was an ambulance from 2-3 hours' drive away from us, over the mountains!.....and the call had somehow bled through to our radio. We helped them solve a mystery because when they showed up at their ER the crew was getting flak for not having called in!!!

[loaparker]

danissa and ebear- we mix our IVAB ALL the time, plus we get the added bonus of lifting and lowering our the head of our patients beds all day long too-- there is only a handful of electric beds in our hospital.

Absolutely no computer charting, all done by hand.

Good old days alive and well in the outback!

[elizabells, BSN, RN]

In my NICU we still almost never wear gloves, unless a pt is on contact isolation, for the first bath, or there's a known positive maternal HIV status. Most of us don't even wear gloves for IVs/labs. PT/OT and the feeding specialist do wear gloves, but they're going from bed to bed to bed.

That's interesting about the sharps in the gurney thing. My second day as a new grad RN I got a needlestick because someone had defeated the safety on a needle, used it to draw blood, and then stuck it in the isolette mattress and apparently forgot to throw it out. This was on an intralabor transport from a state that doesn't require prenatal HIV testing. Turns out that post-exposure prophylaxis makes you really nauseated. :uhoh21:

[Diary/Dairy, RN]

I have mixed my own phenylephrine gtt this year......something I felt REALLY uncomfortable with - I had 2 people double check my mixing before I went and hung the new bag.....small country hospital without a night shift pharmacy.......

I had no issues BTW with mixing up my own diltiazem gtt, just the phenylephrine made me a bit queasy to think about if it had been wrong!

[NurseNora, BSN, RN]

I remember every woman in labor getting a soap suds enema (4H), a full shave prep, a spinal for delivery and forceps. Pain medication was Demerol 50mg & Largon 20 mg IV q3h. Some of the docs still used Scopolamine gr 1/150 (twilight sleep) with the Demerol and Largon. We used a lot of Narcan. IV's were started with straight needles because we didn't have the caths yet and had to be restarted several times per labor because they blew very easily, what with the sharp point and the patient's movement and all. Only one of the docs I worked with insisted that his patients have the IV started before the spinal was given. We gave Oxytocin straight IV push with the delivery of the head or the anterior shoulder, often mainlining it because there was no IV running at all. There were no fetal monitors; we listened with the fetoscope q15min and usually insisted mom stayed on her back for our convenience.

When we ran Pitocin for induction, we didn't have pumps or IV monitors, we eyeballed it. Started at 5ggt/min and increased 5gtt/min q15min. MgSO4 was often given IM instead of IV: 5cc in each hip mixed with a little Lidocaine because it burned so badly.

To stop preterm labor, we gave IV alcohol. The dose was based on weight, but it worked out to almost 1 L of 10% Alcohol in D5W in the first hour, then about 100cc/hr. They giggled the first 10 min, then started with the "black swirlies" and began to vomit. Then after about 20-25min the passed out and were incontinent of urine until they were taken off the alcohol drip. Boy were they hung over. Some of the docs ordered vodka and OJ for a couple of days after the drip was stopped to wean them off. If we sent someone home in false labor, we'd often advise them to have a couple of stiff drinks when they got home to stop the contractions so they could get some sleep.

I was fortunate to work in a hospital that was doing family centered care even back in the 60's, so I've never had to routinely separate moms and babes. But when mom nursed, she was only allowed to nurse 3 min/side the first time she nursed, 4min/side the second time and so on. Bottle fed infants were often NPO for the first 8 hours. No one was allowed out of bed for the first 8 hours after delivery and if they'd had a spinal, the patient was to be flat for 12 hours. Imagine trying to void for the first time flat in bed, using a bed pan!!!! We did a lot of caths.

We washed our own delivery instruments and didn't wear gloves to do it. I remember one nurse who throughout the fall kept admiring the way her "golden tan" wasn't fading. Then one night we noticed that the whites of her eyes were "golden" as well. She had hepititis.

Thanks for this trip down memory lane.

[CseMgr1, ASN, RN]

Doing all the IV starts, mixing and administering all the IV meds (with the exception of blood products), many moons ago when I was an LPN.

How times have changed.....

[NursingAgainstdaOdds]

Thanks so much for sharing, everyone. This is really interesting.

[OC_An Khe]

Yes using gloves were hard to get used to at first. Still find it easier to find veins without them though.

PM care including back rubs with either oil or powder. Doing all the house keeping chores on the floor and using the unit kitchen to make holiday meals besides tea and toast for the patient.

Of course there are more thimngs we do today that we weren't allowed to do in the past but thats a different thread.

[ebear, BSN, RN]

I have also enjoyed this trip down Memory Lane! I had completely forgotten so much of this stuff! Especially stripping glass IV bottles! hahahaha!!!! ...and sticking sharps into mattresses!!

Do y'all remember when patients were admitted on the day before surgery?

ebear

[rita359]

For those of you who were nurses at a time when gloves weren't required, how was it to make that transition to use gloves? Was the idea to start using gloves reject at first or was it a relief that it was required? Thanks in advance.

It wasn't a transition. As they say "necessity is the mother of invention". HIV was the mother of this invention. It was my first reading about HIV and I began demanding gloves for giving shots and body fluid exposure. Was a matter of protecting myself.

[rita359]

Just my thoughts: 1. metal bedpans and water pitchers. Took water pitchers to dietary qam to put through dishwasher then redistributed. Had hopper room with some device to put bedpans in to sterilize after patients left. 2. Using mylanta or maalox and sugar on bedsores. 3. Orders for IV fluids bid. No sl so twice a day those patients were stuck for another IV site. 3. Medicine cards you checked every shift against the cardex to make sure you had orders for all the meds the patient was on then setting up meds on trays (large enough trays with holes for cups and setting a whole shifts meds up by 8am) 4. Narcotic counts every shift. Remember working an ortho/neuro/ plastic or floor and having scads of narcs that needed to be signed out at the end of a shift. 5. First total hip patients put by one surgeon of circle-electric beds. Could probably go on and on.Regarding Emmanuel and the lady with cervical ca and the way she was treated by her daughter: It sounds so terrible and I'm sure it was but I can remember when there was not a nursing home in our town. The daughter probably had NO choice but to have her mother in her home. Haven't had a patient with that kind of odor for a very long time but remember my first experience with that in a 5 patient ward. It was surely horrible. Was walking through a nursing home the other week to visit my aunt. I was struck by the fact that all those residents in times past would have been cared for at home. Now, for better or worse, we have no hesitancy to warehouse the elderly and sick away from families. Families now do not have to deal with caring for family members or even visit very often and for some residents families do not visit at all. We worry about quality of life and, back to the daughter above, she and her family lived with mother every day with that odor. Putting someone in the hospital was the ONLY way daughter could have a normal holiday unless she could send mother to another relatives which would have been highly unlikely if relatives knew about the odor.

[DusktilDawn]

Regarding Emmanuel's post, I do hope there is a special reservation for the daughter in Hades. It also reminded me of what staff used to do to cover odors, they used coffee grounds and vanilla extract, which is why I cannot stand the smell of vanilla.