The wordplastic is derived from the Greek word "plastikos," meaning to mold or give form. The first recorded description of actual reconstructive plastic surgery may be traced back to ancient India, where flaps and grafts were documented to treat terrible facial mutilations such as nose amputations. The nose, a symbol of dignity and respect in many cultures throughout time, is a recurring subject in the documented evolution of plastic and reconstructive surgery. Although there is documentation that addresses the surgical treatment of facial trauma dated somewhere around 3000 BC, it was hundreds of years before the true birth of reconstructive surgery (Ciaschini & Bernard, 2001; American Society of Plastic Surgeons [ASPS], 2004).
Out of necessity, advances in plastic surgery were forced by the horrendous injuries of war. It was the "War to End All Wars," World War I, that "catapulted plastic surgery into a new and higher realm" (ASPS, 2004). Physicians had never been faced with the treatment of such extensive head and facial injuries. Along with the daunting task of restoring function, physicians began to address the appearance of the face and returning the wounded soldiers' appearance to as near as possible what it had been before they were injured (Ciaschini & Bernard, 2001; ASPS, 2004).
From there, plastic surgery evolved to include reconstruction of all parts of the body. Surgical techniques for congenital defects and those maimed by injury or surgical disease intervention were developed and refined. Breast reconstruction developed from insertion of an implant to expansion, and then to flap reconstruction, yielding the most natural result.
Plastic surgery encompasses not only reconstructive procedures of the entire body but also cosmetic ones. Although reconstructive procedures still are being developed and refined, skin care and obliteration of all signs of aging are in the forefront of plastic surgery practice. Aesthetic procedures have taken over in the public eye as the most recognized area of practice in plastic surgery. We must realize this change and be prepared to deliver equally superior care and empathy to our cosmetic-oriented patients.
With each development and change in the specialty of plastic surgery, there have been changes in plastic surgical nursing. In 1975, the American Society of Plastic Surgical Nurses (ASPSN) was incorporated as a nonprofit organization. A dedicated group of nurses saw the need for universal care of the plastic and reconstructive surgical patient and committed themselves to enhancing their education, enabling them to deliver the highest quality of care to that patient (ASPSN, 2004).
In 1988, the first edition of the Core Curriculum for Plastic and Reconstructive Surgical Nursing was published (Goodman, 1988), and on its heels the Plastic Surgical Nursing Certification Board was formed and the first certification examination was administered in 1989. We established our own Research Committee in 1995 to assist ASPSN nurses with research funds and priorities unique to plastic surgical nursing. The year 1996 brought the revision of our Core Curriculum, and in 1998 we established our Web site, http://www.aspsn.org. We continue to grow and cultivate our relationships with our related organizations, the ASPS and the American Society of Aesthetic Plastic Surgeons (ASAPS). The year 2004 marked our inaugural "Aesthetic" conference, held in conjunction with the ASAPS annual scientific meeting. This year also marks our 30th annual conference, "Pearls of Wisdom," held each fall in tandem with the ASPS. Yes, we have seen innumerable developments and changes in our specialty.
Our role descriptions are unlimited, because we deliver superior bedside nursing care, office nursing with patient education responsibilities, and serve scrub, first assistant, and circulating roles in the operating room. We also act as architectural consultants, makers of policy, independent practitioners, and leaders in industry. Not only do we help design all those surgical facilities popping up everywhere, but we manage them, prepare them for accreditation, and mop their floors. We work in industry, developing new products to improve the care offered to our patients, and then we sell those products with the true knowledge of how they benefit our patients.
Educating patients about the technical aspects of their procedure is important, but ensuring that patients have realistic expectations for surgical outcome is essential. This task is accomplished much differently with our reconstructive patients, because they are "correcting" a real or perceived deformity. Aesthetic patients also should recognize that cosmetic procedures are indeed "surgery" and carry with them the possibility for complication.
Emphasis has been placed on patient satisfaction. Achieving this satisfaction is accomplished by patient education, superior care throughout the surgical procedure, and of course, a little "TLC." All of these accomplishments are related directly to nursing care. Take time to educate yourself on the innovative advances in plastic and reconstructive surgery, and this knowledge will enable you to deliver the highest quality of care.
Our role as plastic surgical nurses has been "molded or formed" for the past 30 years. Whether it is a change in surgical procedure, policy, or patient care, enjoy the challenge and embrace change as it occurs.
Barbara Weber, RN, CPSN
President
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