a blast from the past: whatever happened to the ‘new nursing’ and ‘nursing beds’?
TRANSCRIPT
International Journal of Nursing Practice
2003;
9
: 67–69
Blackwell Science, LtdOxford, UKIJNInternational Journal of Nursing Practice1322-71142003 Blackwell Publishing Asia Pty Ltd
92April 2003416
EditorialEditorial
10.1046/j.1322-7114.2003.00416.xEditorialBEES SGML
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E D I T O R I A L
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A blast from the past: whatever happened to the ‘new nursing’ and ‘nursing beds’?
While nurses across the world struggle to stay abreast ofthe latest trends in health service delivery designed tocontain costs and improve outcomes, it is often salutary tolook to our past to seek solutions to today’s problems.One such example from the recent past is the develop-ments in nursing ideas in the period 1960–1990.
Until the early 1960s nursing’s major developmentalinterests were directed at the management of the nursingservice and the education of nurses. The establishment ofnursing departments in the universities led to a growinginterest in the practice of nursing. It did not take long forthese new pockets of influence to spawn practical devel-opments in health services.
Nursing was, at that time, seriously attempting to beclearer about the nature of its practice and the contribu-tion it was making as a profession to the health-care sys-tem. A humanistic approach to practice became dominantand the importance of developing relationships—bothbetween nurses and patients, and between nurses and co-health workers—was seen as central to the advancementof a nursing role that would improve patient or clientcare.
The amalgamation of these concepts was said to con-stitute a major reform in nursing
1
and was referred to asthe ‘New Nursing’ by Salvage.
2
The most exiting andinfluential work underpinning these developments wasthat of Lydia Hall and her colleagues at the Loeb Centerfor Nursing and Rehabilitation at the Montefiore Hospitaland Medical Center in the Bronx, New York. Hall arguedthat a need exists in society for the provision of hospitalbeds grouped into units that focus on the delivery of ther-apeutic nursing,
3,4
and her views were supported by anumber of other writers.
5–13
Hall asserted that patients inacute biological crisis require the services of an acute, hightechnology, medically led unit in the initial phases of hos-pitalization only, and that as the crisis is lessened, theintensity of medical and paramedical interventionbecomes lessened also. Both Hall
14
and her coworker
Alfano
7
suggested that as the crisis lessens and the need formedical and paramedical intervention falls, the need forrehabilitative, nurturing nursing rises.
They described how post-crisis patients rapidly replacethe need for medical care with a need for support, nur-turing and teaching once the fear of death and/or pain isresolved, and argued that that these latter needs are legit-imately the concern of nursing. Based on this reasoningLydia Hall established, against a mass of opposition, theLoeb Center for Nursing in 1966. A study of this centre,published in 1975, involved an evaluation of its effects onpatient outcomes through the conduct of a controlledclinical trial.
14
Those admitted to the nursing unit, whencompared to those who pursued a ‘normal’ patient careerin traditional facilities, were: re-admitted less; more inde-pendent; had a higher post-discharge quality of life; andwere more satisfied with their hospitalization experience.
Nursing in the UK embraced these ideas wholeheart-edly in the 1970s and 1980s, largely through the estab-lishment of Nursing Development Units. The term‘Nursing Development Unit’ was first adopted in 1981 bya group of nurses working in a small cottage hospital atBurford in Oxfordshire, UK.
9,15,16
The Burford develop-ments were widely reported on, and written about, inboth the professional literature and the popular press.
9,17–27
Although this work eventually led to an acceptance of theconcept in the UK, it was grounded on the work of LydiaHall and occurred alongside a number of other develop-ments that supported it.
Although relatively small, the initial Burford projectproduced positive results and aroused great interest andsupport throughout the UK and enabled the Burford nurs-ing team to explore possibilities to follow on to a larger,major study. The change process and the development ofpractice within the unit were seen to be successful. Fur-thermore, the results of the pilot study were extremelypositive and suggested that nursing beds could be a usefuland effective addition to acute hospital services. However,
68 Editorial
as the sample size was small and the randomization tech-nique simple, no concrete conclusions could be drawnfrom the pilot evaluation of this first Nursing Develop-ment Unit. It was evident that a larger study needed tobe undertaken to attempt to validate these preliminaryfindings.
The Burford project therefore became the pilot for alarger study. While carrying on in its activities, theBurford team sought funds and support to establish a sec-ond, sister unit within the context of a large, city basedacute hospital in Oxford, UK. The Oxford NursingDevelopment Unit was an experimental unit that wasopened in September 1985, funded by a generous grantfrom one of the Sainsbury Family Trusts, and supportedstrongly by the Oxfordshire Health Authority. The nursingunit was to be the first in the UK to offer the service of‘nursing beds’ within an acute general hospital and thephilosophy of the unit was based on that of Burford Nurs-ing Development Unit and drew on that of the Loeb Cen-tre in New York. The evaluation of this second NursingDevelopment Unit strongly suggested that nursing-ledcare has a positive effect on recovery, quality, satisfactionand mortality, which supported the assumptions of theBurford and Oxford team that nursing in itself is a thera-peutic force.
12
Contemporary health care planners and policy makersexplicitly and consistently urge for higher quality, betteroutcomes and lower costs. This study clearly demon-strated that nursing beds can achieve all three objectives.Such strong results identified the need to maintain theexperimental unit, and to replicate it in other areas of theNational Health Service. The findings of this study clearlydemonstrated the quantitative and qualitative benefits ofproviding therapeutic nursing in a designated nursing unitwhere nursing was the primary therapy, and nurses werethe chief therapists.
However, the Oxford Nursing Development Unit wasclosed down by the Oxfordshire Health Authority in 1989and, despite later assurances that the unit would be revi-talised, it has never reopened. Why this occurred is stillunexplained, though Pembrey and Punton suggest that itmay have been due to a lack of integration of the unit withthe wider hospital.
28
Such an explanation is purely specu-lative and lacks substantiation. The unit itself challengedthe status quo at that time and it most certainly questionedthe legitimacy of existing power structures. The unit wasalso surrounded by much positive publicity and this mayhave led some opponents to it to gather support for its clo-
sure. Both the Loeb Center for Nursing at the MontefioreMedical Centre in New York and the Burford NursingDevelopment Unit were also closed down in the 1990s.
Are we to conclude, then, that the ‘new nursing’ andthe concepts of therapeutic nursing and nursing beds wereimpractical forays into flights of fancy for nursing? Orshould we be examining the rise and fall of these appar-ently useful initiatives to seek answers to the present andfuture problems facing health services by learning from acritical appraisal of the past?
Alan Pearson
Editor-in-Chief
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