Download The Evolution of Professional Nursing

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The evolution of
Professional Nursing
The evolution of Professional Nursing
 Nursing has been integrated into every facet of life.
 A legacy of human caring was initiated when, according to the Book of
Exodus, two midwives, Shiphrah and Puah, rescued the baby Moses
and hid him to save his life.
 This legacy of caring has progressed throughout the years, responding
to psychologic, social, environmental, and physiologic needs of
society.
 Nurses of the past and present have struggled for recognition as
knowledgeable professionals.
 The evolution of this struggle is reflected in political, cultural,
environmental, and economic events that have sculptured our nation
and world history.
The evolution of Professional Nursing
 In the beginning men were recognized as health
healers.
 The work of Florence Nightingale and Mary
Seacole played a major role in bringing about
changes in nursing.
 Using the concept of role modeling, these women
demonstrated the value of their worth through
their work in fighting for the cause of health and
healing.
The evolution of Professional Nursing
 During the twentieth century nurses made
tremendous advancements in the areas of
education, practice, research, and
technology.
 Nursing as a science progressed through
education, clinical practice, development of
theory, and rigorous research.
 Today nurses continue to be challenged to
expand their roles and explore new areas of
practice and leadership.
 PREHISTORIC PERIOD
 The practice of nursing in the prehistoric period
was strongly guided by health beliefs.
 Nursing and medical practice were delineated by
beliefs of magic, religion, and superstition.
 Individuals who were ill were considered to be
cursed by evil spirits and evil gods that entered the
human body and caused suffering and death if not
cast out.
 EARLY CIVILIZATION
 Egypt
 Ancient Egyptians are noted for their
accomplishments at such an early period.
 They were the first to use the concept of suture in
repairing wounds.
 They also were the first to be recorded as
developing community planning that resulted in a
decrease in public health problems.
 The Egyptians invented the development of the
calendar and writing that denoted the initiation of
recorded history.
 The oldest records date back before Christ in
sixteenth century BC Egypt, containing natural
pharmacologic remedies was written to assist in
the care and management of disease (Ellis and
Hartley, 2001).
 Palestine
 From 1400 to 1200 BC the Hebrews migrated from the
Arabian Desert and gradually settled in Palestine, where
they became an agricultural society.
 Under the leadership of Moses, the Hebrews developed
the Mosaic Code, which represented one of the first
organized methods of disease control and prevention. It
contained public health laws that did not allow the eating of
a slaughtered animal dead longer than 3 days.
 Individuals who were thought to have communicable
diseases were isolated from the public and could return to
their families only after the priest had declared them healed
(Ellis and Hartley, 2001).
 Males who were Hebrew priests and selected women,
usually widows and maidens who cared for the sick in their
homes, delivered health care : bringing both physical and
spiritual comfort to those in need (Stanhope and Lancaster,
2000).
Greece
From 1500 to 100 BC Greek philosophers sought to understand man
and his relationship
 with the gods, nature, and other men.
 They believed that the gods and goddesses of Greek mythology
controlled health and illness. Temples built to honor Asclepius, the
god of medicine, were designated to care for the sick.
 Hippocrates was the first to attribute disease to natural causes
rather than supernatural causes and curses of the gods.
Hippocrates' teachings also encouraged health care providers to
look at not just the part of the patient that was sick, but to include
the patient's environment (Kalisch and Kalisch, 1995).
 In the ancient Greek culture little is documented about nursing.
Attendants - "basket healers" assisted the temple priests and
physicians and traveled from town to town with physicians to offer
their services (Stanhope and Lancaster, 2000).
India
 Dating from 2000 to 1200 BC, the earliest cultures of India were
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Hindu. The sacred books of the Hindu, Vedas, were used to guide
health care practices.
The Vedas included herbs, spices, displays of magic, and charms.
These ingredients were used to rid the body of demons and cure
illness.
The Indians documented information concerning prenatal care and
childhood illnesses.
Public hospitals were constructed from 274 to 236 BC and were
staffed by male nurses with qualifications and duties similar to
those of the twentieth-century practical nurse.
The Hindu physicians performed major and minor surgeries,
including limb amputations, cesarean deliveries, and wound
suturing.
Women were primarily responsible for caring for the home and
family, and they did not work outside the home. (Ellis and Hartley,
2001; Walton, Barondess, and Locke, 1994).
China
 The teachings of Confucius (551-479 BC) had a powerful
impact on the customs and practices of the people of ancient
China. One tradition that exemplified their belief about health
and illness was the yin and yang philosophy.
 The Chinese believed that an imbalance between these two
forces would result in illness, whereas balance between the yin
and yang represented good health (Giger and Davidhizar,1999).
 The ancient Chinese used a variety of treatments believed to
promote health and harmony, including acupuncture to affect the
balance of yin and yang. Hydrotherapy, massage, and exercise
were used as preventive health measures (Giger and Davidhizar,
1999).
 The Chinese also used drug therapy to manage disease
conditions and recorded more than 1000 drugs derived from
animals, vegetables, and minerals (Walton, Barondess, and
Rome
 The Roman Empire (27 BC-476 AD), a military
dictatorship, adapted medical practices from the
countries they conquered and the physicians they
enslaved.
 The first military hospital in Europe was established
in Rome. Both male and female attendants
assisted in the care of the sick.
 Galen was a famous Greek physician who worked
in Rome and made important contributions to the
practice of medicine by expanding his knowledge
in anatomy, physiology, pathology, and medical
therapeutics (Walton, Barondess, and Locke,
1994).
THE MIDDLE AGES
 The Middles Ages (476 BC-1450 AD) followed
the demise of the Roman Empire (Walton,
Barondess, and Locke, 1994).
 Women used herbs and new methods of
healing, whereas men continued to use
purging, leeching, and mercury.
 This period also saw the Roman Catholic
Church become a central figure in the
organization and management of health care.
THE MIDDLE AGES
 Most of the changes in health care were based
on the Christian concepts of charity and the
sanctity of human life.
 Wives of emperors and other women considered
noble became nurses.
 Nurses also provided some medical care,
although in most hospitals and monasteries
female nurses who were not midwives were
forbidden to witness childbirth, help with
gynecologic examinations, or even diaper male
infants (Kalish and Kalish, 1986).
THE RENAISSANCE PERIOD
 The Renaissance and Reformation periods (1500-
1700), also known as the rebirth of Europe,
followed the Middle Ages. Major advancements
were made in pharmacology, chemistry, and
medical knowledge including anatomy, physiology,
and surgery.
 Nursing was no longer the respected profession it
had once been. This period was referred to as
 the "Dark Ages of Nursing" (Ellis and Hartley,
2001).
THE RENAISSANCE PERIOD
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Several nursing groups, such as the Order of
the Visitation of St. Mary, St. Vincent de Paul,
and the Sisters of Charity, were organized to
give time, service, and money to the poor and
sick.
The Sisters of Charity recruited young women
for training in nursing, developed educational
programs, and cared for abandoned children.
In 1640 St. Vincent de Paul established the
Hospital for the Foundling to care for the
many orphaned and abandoned children
FLORENCE NIGHTINGALE
 Florence Nightingale was born in Florence, Italy on May 12,
1820. Nightingale was a highly intelligent, talented.
 From an early age she demonstrated a deep concern for
the poor and suffering.
 1845 - she became interested in training as a nurse.
 1851 - her parents finally permitted her to pursue nurse's
training.
 Nightingale attended a 3-month nursing training program at
the Institution of Deaconesses at Kaiserswerth, Germany.
 1854 - she began training nurses at the Harley Street
Nursing Home and also served as superintendent of nurses
at King's College Hospital in London (Kalisch and Kalisch,
1995).
FLORENCE NIGHTINGALE
 1854 Sidney Herbert, British Secretary of War and
an old friend of the Nightingale family, wrote to
Nightingale begging her to lead a group of nurses
to the Crimea to work at one of the military
hospitals under government authority and expense
(Dolan, 1978).
 Nightingale accepted his offer and assembled 38
nurses who were sisters and nuns from different
Catholic and Anglican orders (Kelly and Joel,
1996).
FLORENCE NIGHTINGALE
 By the end of the Crimean War, Nightingale had
trained as many as 125 nurses to care for the
wounded and ill soldiers (Dolan, 1978).
 Nightingale is credited for using public health
principles and statistical methods to advocate
improved health conditions for British soldiers.
 Through carefully kept statistics, Nightingale was
able to document that the soldiers' death rate
decreased from 42% to 2% as a result of health
care reforms that emphasized sanitary conditions.
FLORENCE NIGHTINGALE
 In 1860 Nightingale established the first nursing
school in England. By 1873 graduates of
Nightingale's nurse training program in England
migrated to the United States, where they
became supervisors in the first of the hospital-based
(diploma) nursing schools: Massachusetts
General Hospital in Boston, Bellevue Hospital in
New York, and the New Haven Hospital in
Connecticut.
MARY SEACOLE
 Mary Seacole was a Jamaican nurse who learned
the art of caring and healing from her mother.
 In her native land of Jamaica, British West Indies,
she was nicknamed "Doctress" because of
her administration of care to the sick in a lodging
house in Kingston (Carnegie, 1995).
MARY SEACOLE
 Seacole learned of the Crimean War and wrote to
the British government requesting to join
Nightingale's group of nurses.
 Seacole built and opened a lodging house. On the
bottom floor was a restaurant, and on the top floor
an area arranged like a hospital to nurse sick
soldiers (Carnegie, 1995).
World War II (1940 to 1945)
 The United States officially entered World War II (WWII)
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after the bombing of Pearl Harbor in December 1941.
At that time the nursing divisions of all of the military
branches had inadequate numbers of nurses.
Congress passed legislation to provide needed funds to
expand nursing education.
A committee of six national nursing organizations, called
the National Nursing Council, received one million dollars
to accomplish the needed expansion.
The U.S. Public Health Service became the administrator
of the funds, which further strengthened the tie between the
U.S.Public Health Service and nursing (Bullough and
Bullough, 1984; Stanhope and Lancaster, 2000).
NURSING IN THE U.S. in 1960s
 Very important amendment to the Social Security Act
was Title XVIII or Medicare, passed in 1965.
 The Medicare program provides hospital insurance,
Part A, and medical insurance, Part B, to all people
age 65 and older who are eligible to receive Social
Security benefits; people with total, permanent
disabilities; and people with end-stage renal disease.
 As a result of Medicare reimbursement, many
hospitals catered to physicians who treated Medicare
patients.
NURSING IN THE 1960s
 Another outcome of the Medicare legislation was the home
health movement.
 Home health agencies were established and began to
employ increasing numbers of nurses. In the mid-1960s;
and, as a result of Medicare reimbursement and other
influences, including a growing elderly population, advances
in medical technology, and public demand for increased
access to health care, the home health industry has
continued unprecedented growth into the 1990s (Rice,
1996).
 Home health was one of the first employment settings that
provided nurses the opportunity to work weekdays
 only.
Nursing in the 1970s
 The women's movement of the 1970s greatly
influenced nursing.
 During this time nurses played a major role in
providing health care to communities and were
instrumental in developing hospice programs,
birthing centers, and day care centers for the
elderly (Stanhope and Lancaster, 2000).
Nursing in the 1970s
 Basic educational programs for nurse
practitioners expanded during the 1970s and
master's level preparation was developed as the
requirement for graduation and practice,
certification was also required to practice as a
nurse practitioner.
 Nursing, a young profession, has had such an
academy, created by the ANA Board, only since
1973.
 The American Academy of Nursing is
composed of clinicians, educators, administrators,
and researchers.
Nursing in the 1980s
 Runaway health care costs became a national
issue in the 1980s. Medicare was still reimbursing
for any and all hospital services provided to
recipients.
 From 1966 to 1981 the federal contribution to
hospital care rose from 13% to 41% (Karger and
Stoesz, 1994).
 In 1983 in an attempt to restrain hospital costs,
Congress passed the diagnosis-related group
system for reimbursement, better known as the
DRG system.
 Case management and critical pathways
 were developed to more efficiently manage
patient care, and case management became
a new
 area of specialization for the professional
nurse.
 Medical care advanced in areas
 such as organ transplantation, resuscitation
and support of premature infants, and critical
 care techniques.
Nursing in the 1980s
 The types of patients needing health care
changed in the 1980s.
 Just as in the 1980s, the cost of health care
continued to increase with the technologic
advancements
 in medical care.
 Homelessness became a common problem
in large cities. Unstable economic
developments contributed to an increase in
the indigent populations (Karger and Stoesz,
Nursing in the 1980s
 Acquired immune deficiency syndrome
(AIDS) emerged as a frightening, fatal disease.
 Nurses were interested in employment
opportunities in outpatient facilities because they
afforded a chance to work only during the day with
no weekend assignments.
 Health education became more important as
consumers were encouraged to take responsibility
for their own care (Stanhope and Lancaster, 2000).
Nursing in the 1980s
 Toward the end of the 1980s the American
Medical Association announced its answer to
the nursing shortage. It proposed to establish
a 9-month program to prepare Registered
Care Technologists.
 This proposal incensed unified nurses who
fought it. As a result, the proposal
came to naught (Schorr and Kennedy, 1999).
Nursing in the 1990s
 The 1990s began with alarm over the state of the
U.S. economy.
 Nurses selected jobs in which they could work
more hours in fewer days for more money,
sometimes sacrificing the fringe benefits, which
would allow them to work a second job or earn
higher pay through shift differential for working
evening and night shifts.
 Creative shifts such as the 10-hour day, 4-day
work week or the 12-hour day, 3-day work week
became commonplace in health care facilities.
Nursing in the 1990s
 1990 - more than two million U.S. residents
died from diseases such as heart disease, cancer,
cerebral vascular disease, accidents,
chronic obstructive pulmonary disease, liver cirrhosis,
tuberculosis, and human immunodeficiency virus
infection.
 Healthy People 2000: National
 1991 - was published Health Promotion and Disease
Prevention Objectives by the U.S.
 Department of Health and Human Services as a
nationwide effort to help states, cities, and
communities identify health promotion and disease
prevention strategies to address these health risk
problems.
Nursing in the 1990s
 In 1990 the increasing costs of Medicaid and Medicare
triggered political action for health care reform. Findings of a
federal commission appointed to evaluate the American
health care system include (Kalisch and Kalisch, 1995):
 • " Fifteen percent of the gross national product was related
to health care expenditures
(this amounts to approximately one trillion dollars annually).
 • The United States spent more than twice as much as any
industrialized nation for health care services.
 • Americans were living longer, which indicated a growing
demand for home health and nursing home care, as well as
increased Medicare expenditures.
Nursing in the 1990s
 The focus of managed care was on providing more
preventive and primary care, using outpatient and
home settings when possible, and limiting
expensive hospitalizations.
 The nurse of the 1990s had to be focused on
delivering health care services that
 (1) encompassed health risk assessment based on
family and environmental factors,
 (2) supported health promotion and disease
prevention, and
 (3) advanced counseling and health education
(Oermann, 1997).
Nursing in the 1990s
 In the 1990s a partnership was forged
between mandatory state licensure
authorities, which set practice standards at
the level of entering associate degree
graduates, and national, nongovernmental
bodies that certify graduate-prepared
specialists.
Nursing in the Twenty-First Century
 Professional nurses in the twenty-first century
are faced with many challenges within the
dynamic state of health care.
 Changing duties, responsibilities, and
conflicts amidst nursing shortages and public
concern over patient safety and quality of
care characterize present-day practice.
Nursing in the Twenty-First Century
 These changes require professional nurses to
have core competency in critical thinking,
communication, assessment, leadership, and
technical skills, as well as knowledge of health
promotion/disease prevention, information
technology, health systems, and public policy.
 In addition to the issues of access, cost, quality,
and accountability in health care, nurses today
are challenged by an aging population,
consumer health values, and an increasingly
intercultural society.
Nursing in the Twenty-First Century
 Through periods of war, socioeconomic
change, and health care reform, nurses have
played a vital role in initiating change to improve
the health care arena.
Nurses have provided the integrity to maintain the
quality of care in all health care settings.
The evolution of the practice from the treatment of
disease to health promotion and disease
prevention has led the way in determining the
type of providers needed to care for patients in
the future.
Nursing in the Twenty-First
Century
 This evolution will continue to provide the
foundation for the scope of practice, educational
curricula, scholarship, and research necessary for
nurses to lead and manage the health care
environment of the future.
 Nurses will continue to increase knowledge,
manage technology, and maintain ethical standards
to provide high quality care to individuals, families,
and communities throughout the world.