Medical-surgical nursing
Medical-surgical nursing is a specialized branch of nursing focused on the care of patients with medical and surgical conditions affecting one or more organ systems. It encompasses the treatment of diverse health issues, including both diseases that require medical intervention and surgical procedures for trauma or ailments. This field emerged from the historical separation of medical and surgical nursing into a unified discipline in the 1930s, emphasizing holistic care that considers the physiological, psychological, and sociocultural dimensions of patient health. Medical-surgical nurses play a multifaceted role, serving as caregivers, educators, coordinators, and advocates for patients across various healthcare settings, such as hospitals, clinics, and long-term care facilities.
These nurses utilize their clinical skills to assess patient conditions, formulate care plans, and collaborate with a multidisciplinary team to ensure comprehensive treatment. The role also involves teaching patients and their families self-care practices to prevent complications and promote recovery. Education pathways for entering this field vary, with many practitioners requiring certifications and advanced degrees for specialized practice. Medical-surgical nursing is vital in the healthcare system, with a significant number of registered nurses in the U.S. working in this specialty, reflecting the increasing complexity and demand for integrated patient care.
Subject Terms
Medical-surgical nursing
Medical-surgical nursing is a speciality within the nursing practice that deals with the care of individuals having medical and/or surgical conditions affecting single- or multiple-organ systems. Medical patients require a range of treatments to treat diseases, while surgical patients require operative procedures to treat ailments and/or trauma. A single patient may be diagnosed with a medical condition, a surgical condition, or a combination of the two. Medical nursing and surgical nursing were functions that were originally performed separately by specialized nurses in different wards. However, over time, medical and surgical nursing evolved into a single discipline. The care provided by medical-surgical nurses is holistic in nature and is geared toward promoting health, preventing disease, and maintaining health. The emphasis is on delivering comprehensive, overall care, instead of focusing on a specific medical issue.
Medical-surgical nursing, as with the entire nursing profession, has been affected by trends such as greater incorporation of technology, increasing complexity of patient care, development of clinical pathways, regulatory changes, advances in nursing and science research, increasing use of nursing-case management, and changes in the professional practices model.
Brief History
From the late nineteenth to the early twentieth century, patients in many of the major hospitals in the United States were separated into medical, surgical, and obstetrical wards. Nursing education involved separate training for work in each of these sectors. Nursing curriculum guides viewed surgical nursing, medical nursing, and disease prevention as separate topics. However, in the 1930s, medical and surgical training were combined into a single discipline. Nursing students were subsequently required to learn how to provide total care for patients that incorporated knowledge of physiological conditions as well as an understanding of psychological, social, and physical aspects affecting the health of the patient. The integration of total care into nursing courses was gradual, but by 1960 the study and practice of medical and surgical nursing as a single discipline had taken a firm hold. The 1960s and 1970s saw the creation of standards for numerous nursing specialities. The American Nurses’ Association (ANA) committee of the Division on Medical-Surgical Nursing published Standards, Medical-Surgical Nursing Practice in 1974. It dealt with data collection, diagnoses, goals for nursing as well as the development, implementation, and evaluation of care plans. In 1980, the committee published A Statement on the Scope of Medical-Surgical Nursing Practice. In 1991, the independent Academy of Medical-Surgical Nurses (AMSN) was formed, and it published its own Scope and Standards of Medical-Surgical Nursing Practice, extending the work of similar ANA documents. Further editions have been published periodically since then, with the fifth edition released in 2012.
Overview
Medical-surgical nursing is the nursing speciality that is concerned with the diagnosis and treatment of individual patients or groups with existing or potential health problems. It is aimed at promoting, restoring, or maintaining good health. Medical-surgical nursing is geared toward delivering holistic patient care that considers the physiological, psychological, and sociocultural well-being of the individual. A medical-surgical nurse is required to have the particular knowledge and clinical skills necessary to manage health issues affecting patients, their significant others, and the community. Medical-surgical nurses work in an assortment of settings, including care facilities, home care agencies, ambulatory care clinics, outpatient services, residential facilities, homes, schools, private companies, and many others. Medical-surgical nurses perform a variety of roles, including caregiver, case manager, care coordinator, client educator, counselor, client advocate, administrator, care coordinator, consultant, staff educator, and expert witness. Relevant assessment data is used by the medical-surgical nurse to formulate diagnoses. The nurse then collaborates and consults with the client to identify expected outcomes and interventions to accomplish those outcomes. The interventions are then applied and the patient’s responses are evaluated. The medical-surgical nurses must provide care to the patient without judgment or discrimination, and should be sensitive to the gender, age, culture, and lifestyle choices of the patient.
An important part of medical-surgical nursing care is teaching patients and families how to care for themselves or significant others in order to prevent complications, restore health, and prevent further illness. This teaching includes things such as how to take prescribed medications, treating and changing wound dressings, self-care activities, lifestyle changes, and reinforcement of physician or nurse advice. Nurses also teach basic hygiene and nutrition in the framework of health promotion.
Medical-surgical nurses collaborate with other members of the health team such as physicians, registered nurses, physical therapists, respiratory therapists, dietitians, and pharmacy personnel to give the patient an integrated and comprehensive care plan. This collaboration involves the exchange of knowledge, sharing responsibility for problem solving, and making patient care decisions. Nurses are often responsible for coordinating care among team members and initiating appropriate referrals. Case management is an essential component of the collaborative process and involves assessing, planning, facilitating, and advocating for health services to meet the needs of the patient.
Education and Employment Opportunities
Individuals going into medical-surgical nursing come from diverse educational backgrounds. Some enter the profession following an undergraduate or graduate degree. A surgical-medical certification must be completed and maintained to demonstrate proficiency. A master’s degree or doctorate is usually required for advanced medical-surgical practice. An individual in this position must also possess an aptitude for managing, directing, and influencing the care of clients. Elements of this role include clinical practice, research, education, leadership, and consultation and requires interdisciplinary collaboration.
As of 2018, the AMSN estimated that about 650,000 of the approximately 3.1 million registered nurses working in the United States are medical-surgical nurses. Employment opportunities for medical-surgical nurses exist within the hospital setting in outpatient surgery, intermediate care, intravenous therapy team, and emergency department. Aside from hospitals, other sites of employment include long-term care facilities (nursing homes), hospice care, adult group homes, assisted living facilities, ambulatory clinics, medical offices, military service, and dialysis centers. The majority of nurses are employed in nursing homes or long-term care units and often perform an expanded supervisory role in this setting.
Bibliography
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Ignatavicius, Donna D., et al. Clinical Nursing Judgment Study Guide for Medical-Surgical Nursing: Patient-Centered Collaborative Care. 8th ed., Elsevier, 2016.
LeMone, Priscilla, et al. Medical-Surgical Nursing: Clinical Reasoningin Patient Care. 6th ed., Pearson, 2016.
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Masters, Kathleen. Role Development in Professional Nursing Practice. 4th ed., Jones, 2017.
Taylor, Mary K. "Mapping the Literature of Medical-Surgical Nursing." Journal of the Medical Library Association, vol. 94, no. 2, 2006, E65–E73.
Timby, Barbara Kuhn, and Nancy E. Smith. Introductory Medical-Surgical Nursing. 11th ed., Wolters, 2014.
"What Is Medical-Surgical Nursing?" Academy of Medical-Surgical Nurses, 2018, www.amsn.org/practice-resources/what-medical-surgical-nursing. Accessed 23 Feb. 2018.
Williams, Linda S., and Paula D. Hopper. Understanding Medical Surgical Nursing. 5th ed., Davis, 2015.