Dynamic Challenges: The Perioperative Nurse

111. San Diego Union article featuring Della Ruppert
Courtesy of Della Ruppert

This exhibit was developed by Della M. Ruppert, RN, CNOR, former Clinical Director, Perioperative Nursing Division. Mrs. Ruppert retired from the UIHC in 1995 after 44 years of service. During her career she assisted in many types of operations including neurologic and cardiothoracic operations, participated in the first open heart surgery using the new heart-lung machine manufactured in the University's Medical Instruments Lab in the mid-1950s, and assisted in planning and designing operating rooms at the UIHC. She received the Charles B. Moore Operating Room Nurse of the Year award by the Association of Operating Room Nurses in 1967.

112. Letter to Miss Della Timmerman (Ruppert) to confirm employment at the State University of Iowa Courtesy of Della Ruppert

113. Miss Della Timmerman (Ruppert) Courtesy of Della Ruppert

The term "perioperative" refers to the period extending from the time of hospitalization for surgery to the time of discharge.

The 19th and 20th centuries abounded with significant changes for surgery and nurses involved in the care of the surgical patient. Nurses attended the patient in the operating room before the 1890s and later became involved in the preparation for surgery and assisting with instrumentation during surgery. Operating Room Nurses spent a great deal of time in the cleaning, preparation and sterilization of instruments and supplies since there were neither central sterilizing services nor "disposables."

On into the 1950s and 1960s, nurses spent their non-operating time preparing sutures, sponges, dressings, packs, gloves, folding linens, operating steam and dry heat sterilizers and doing a multitude of other tasks. Even in today's modern operating rooms, with substantial assistance from Central Sterilizing and other services, nurses find a great deal of their attention is still needed for preparatory tasks.

114. Cottonoids (Neorsurgery Sponges) Courtesy of Della Ruppert	115. Silver clips Courtesy of Della Ruppert
116. Rubber gloves Courtesy of Della Ruppert	117. Sterilizers Courtesy of Della Ruppert
118. Silk and nylon sutures Courtesy of Della Ruppert	119. Wire suture Courtesy of Della Ruppert
120. Suture (Ethicon) Courtesy of Della Ruppert	121. Needles - reusable Courtesy of Della Ruppert
122. Laparoscopy, May 1968 Demonstration of the first equipment/instruments Sims Prep Room Courtesy of Della Ruppert	123. Counted sponges and laparotomy pads Courtesy of Della Ruppert

Prior to the advent of recovery rooms, patients were taken back to their room or ward by the operating team. Generally one person was assigned to stay with the patient until anesthesia recovery was achieved. Often the assigned person was a nursing student. As the complexity of surgical procedures increased, the need for dedicated post-anesthesia care units and skilled post-anesthesia care nurses became a necessity.

Timeline of events affecting perioperative nursing at UIHC

1800- Many operations were performed in private homes. Wooden furniture, walls, floors and 1900: seating capacity for the medical audience in typical hospital operating rooms were seen as creating unclean conditions.

1845: Introduction of anesthesia

1865: Dr. Joseph Lister introduced antiseptic techniques.
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1873: The Sisters of Mercy opened the first Mercy Hospital in Iowa City as a clinical setting for the State University of Iowa medical students. It was a 20-bed hospital with a 250-seat amphitheater and was located in the abandoned Mechanics Academy building on Linn Street.

1875: The John Dostal Mansion on the corner of Bloomington and Van Buren became the second home of the hospital and was also run by the Sisters of Mercy for the University.

1880s: Introduction of steam sterilization
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1885: Gustav Neuber, German Surgeon, designed and built the world's first antiseptic operating suite in Kiel, Germany.

1895: Neuber's antiseptic ideas were adopted in the United States.

1898: The first University Hospital opened on the East Campus. It was later renamed East Hall and then Seashore Hall. Operating rooms still had observation seats.

1898: University Hospital Training School for Nurses opened.

1904: Surgical gowns were introduced, not to protect patients, but to protect surgeons' clothing. 124. Laundry pickup Patient transport throughout crowded hall on way to the Recovery Room Courtesy of Della Ruppert

1907: At the request of Dr. William Halstead, the Goodrich Rubber Company made rubber gloves for nurse Caroline Hampton who had developed a rash from exposure to bichloride of mercury used for cleaning in the operating room. Like the gowns, use of gloves was not for the protection of the patient.
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1928: The State University of Iowa (SUI) 700-bed General Hospital opened in Iowa City. There were four general O.R.s, identified as Pits 1, 2, 3, and 4, on the sixth floor, and observation rooms on the seventh floor. Later the observation rooms were converted for other services. The eye, ear, nose and throat (Head Specialties) operating rooms were located on the second floor. The Orthopaedic operating rooms were in the Children's Hospital.

125. Surgery Schedule Conference, March 1968 O.R. Nurses attending Courtesy of Della Ruppert

1949: The Training School for Nurses became the University of Iowa College of Nursing and the first Dean was appointed.

1953: Four operating rooms were added to the sixth floor suite.
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1960-1970: Recovery rooms came into being in most hospitals. 126. Recovery (Post Anesthesia Care) Courtesy of Della Ruppert

127. Recovery (Post Anesthesia Care)
Courtesy of Della Ruppert

1970-1990: Disposables of all types became available throughout most U.S. hospitals.

1976: The twelve-room North Tower (Boyd Tower) operating rooms were completed. A new Central Sterilizing Service (CSS) opened on the lower level of the North Tower. The Recovery Room Suite was located at the west end of the original operating rooms.

1978: The original four operating rooms were remodeled and the Head Specialties and Orthopaedic operating rooms were relocated to the 6th level of the General Hospital.

1987: The Ambulatory Surgery Center opened with four operating rooms and eight first stage and eleven second stage recovery beds. (John Colloton Pavilion, 5th level)

1990: A fifth operating room was added to the Ambulatory Surgery Center.
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1993: A state-of-the-art Presurgical Care Unit, Operating Room Suite and Post Anesthesia Care Unit was completed across from the Ambulatory Surgery Center on the 5th floor. The facility opened with 22 O.R.s, 8 presurgical beds, 24 post-anesthesia beds, a pharmacy sub-station, sterile core (staffed by CSS), anesthesia facilities, and a pathology laboratory. Combined with Ambulatory Surgery, this became the Perioperative Care Facilities. The 6th level is devoted to offices for Anesthesia and Nursing, conference rooms, locker rooms, and a dining room. The Day of Surgery Lounge also opened on the 6th level of the John Colloton Pavilion.

1993: A sixth operating room was added to the Ambulatory Surgery Center.
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1995: An anesthesia evaluation facility was added adjacent to the Ambulatory Surgery Center; and the case management approach to patient care was implemented. (see display on adjacent wall)

1996: An additional second stage recovery facility was built to accomodate the increased number of outpatients.

1997: The position of Operating Room Physician Director was established for the perioperative arena

Multidisciplinary Case Management is a group approach to patient care. The patient becomes a member of a team of people including doctors, nurses, pharmacists, and other health care professionals. The goal of the team is to develop the best plan of care for the patient. The method is very precise and involves the use of a CareMapTM which outlines specific guidelines for care and expected outcomes at each stage of illness treatment and recovery. The CareMapTM displayed here is for a patient recovering from a laparoscopic cholecystectomy (removal of the gallbladder). Other CareMapsTM address the problems, goals, and outcomes specific to a particular illness.

128. Utility Room 1. Clinical sink for disposal 2. Plaster trap 3. Glass suction bottles 4. Sink for cleaning bottles and suction tubing 5. Suction tubing on spigots 6. Mops 7. Laundry Courtesy of Della Ruppert

129. Refrigerator 1. Blood in glass bottles/bags 2. Skin 3. Box with auricular well 4. Drawers with drugs and rubber goods Courtesy of Della Ruppert

The Medical Museum is pleased to sponsor this exhibit in recognition of the State of Iowa's Operating Room Nurse Day, established November 14, 1989 by Governor Terry Branstad.

130. State of Iowa Executive Department Proclamation of Operating Room Nurse Day Courtesy of Della Ruppert