Chapter 1 The Evolution of Professional Nursing

 We need to realize and to affirm anew that nursing is one of the most difficult arts. Compassion may provide the motive, but knowledge is our only working power. Perhaps, too, we need to remember that growth in our work must be preceded by ideas, and that any conditions which suppress thought, must retard growth. Surely we will not be satisfied in perpetuating methods and traditions. Surely we shall wish to be more and more occupied with creating them.
M. Adelaide Nutting, 1925

Prehistoric Period
Health beliefs
All natural phenomena, including illnesses, were the work of the gods

Health practices
Engaged in acts intended to deter evil gods and demons

Early Civilization
Egypt
Health beliefs and practices
Valued personal health; preventive measures taken to appease the gods Developed specific laws on cleanliness, food use and preservation, drinking, exercise, sexual relations, and a pharmacopoeia with more than 700 natural remedies

Nursing
Little information available Women were hired by privileged families to care for the sick and to assist with childbirth; Shiphrah and Puah were midwives who saved the baby Moses 4

Early Civilization
Palestine
Health beliefs and practices
Developed the Mosaic Code, one of the first organized methods of disease control and prevention

Nursing
Little information available Nursing and medical care were provided in the home by male Hebrew priests and women (usually widows or maidens) who focused on both physical and spiritual healing and comfort
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Early Civilization
Greece
Health beliefs
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 sick

Medical Science
Asclepius carried a staff intertwined with serpents, representing wisdom and immortality; staff was the model for medical caduceus Hippocrates considered the father of medicine Hippocrates was the first to attribute disease to natural causes rather than supernatural causes and curses of the gods Scientific approach; patient-centered approach
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Early Civilization
India
Health beliefs and practices

Medical science

Vedas (2000-1200 BC), sacred Hindu books, were the source of information about health practices Focused on the use of magic, charms, herbs, and spices to cure disease and remove demons Developed procedures to perform major and minor surgical operations Recorded extensive information about childhood diseases, prenatal care, and conditions of the urinary and nervous systems Hindu physicians performed major and minor surgeries including limb amputations, cesarean deliveries, and suturing wounds Women did not work outside the home
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Nursing

 China

Early Civilization
China
Health beliefs
Teachings of Confucius (531-479 BC) had a powerful impact on health practices Believed in the yin and yang philosophy; an imbalance between the two would result in ill health

Health practices
Used treatments to promote health and harmony including acupuncture, hydrotherapy, massage, and exercise Used drug therapy to manage disease conditions and recorded over 1000 drugs
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Early Civilization
Rome
Adapted health and medical practices from the countries conquered and physicians enslaved (27 BC-476 AD) Established the first military hospital in Europe in Rome

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The Renaissance and the Reformation Period

Major advancements in medicine: pharmacology, chemistry, and medical knowledge Dark ages of nursing
Religious orders became almost extinct as a result of dissension between Roman Catholic Christians and Protestant sects Nursing no longer appealed to women of high social status; hospital care was regulated to common women, prisoners, thieves and drunks Nursing became an undesirable job with poor pay, long hours, and strenuous work that was considered menial

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The Renaissance and the Reformation Period

Social conditions
Famine, plague, filth, and crime ravaged Europe Nursing orders were established out of great concern for social welfare
Sisters of Charity - recruited young women for nurse training, developed educational programs, and cared for abandoned children St. Vincent de Paul - established the Hospital for the Foundling to care for orphaned and abandoned children
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The Colonial American Period

Mexico
First colonists in Mexico were members of Catholic religious orders Hospital of the Immaculate - first hospital in North America, built in 1524 in Mexico City; first medical school built at the University of Mexico

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 Colonial North America

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The Colonial American Period

Colonial America
Health care was sadly deficient; life expectancy was low, plagues such as yellow fever and smallpox were a constant threat Physicians were poorly trained and used crude methods of treatment such as bleeding and purgatives Through the efforts of Benjamin Franklin, Pennsylvania Hospital was the first hospital built in the United States in 1751

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Florence Nightingale
Early nursing career
Family opposed her interest in nursing at first, then she was permitted to pursue nurse training 1851 - Attended a 3-month nurse-training program at the Institute of Deaconesses at Kaiserwerth, Germany 1854 - Began training at the Harley Street Nursing Home; served as the superintendent of nurses at Kings College Hospital in London
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Florence Nightingale
Crimean War
1854 - Accepted an assignment to lead a group of 38 nurses who were sisters and nuns from various Catholic and Anglican orders to the Crimea to work at the Barracks Hospital in Scutari Despite deplorable conditions, the army doctors at first refused her assistance Eventually the doctors, in desperation, called for her help Purchased medical supplies, food, and linen; set up a kitchen; instituted laundry services; initiated social services; spent up to 20 hours each day providing 17

 The Lady With the Lamp

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Florence Nightingale
Major accomplishments
Demonstrated the value of aseptic techniques and infection control procedures Honored for her contributions to nursing research Demonstrated the value of political activism to affect health care reform Established the first nursing school in England Honored as the founder of professional nursing services, initiated social services, spent up to 20 hours each day providing nursing care Introduced principles of asepsis and infection control, a system for transcribing doctors orders, and a system to maintain patient records

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Mary Seacole
Jamaican nurse who played a major role in the Crimean War
Denied the opportunity to join Nightingales nursing brigade because she was black Opened a lodging house with her own money to care for sick and wounded soldiers Contributed to the control of the cholera epidemic with extensive knowledge in tropical medicine

Honored by the Jamaican government and the British Commonwealth with a medal for saving

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 Mary Seacole

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Nursing in the United States

The Civil War Period
The Civil War or the War between the States(18611865) No army nurses and no organized medical corps when the war began Dorothea Dix - Appointed to organize military hospitals, provide trained nurses, and disperse supplies; she received no official status and no salary for this position 6 million people hospitalized during the war - 425,000 for war casualties; vast majority for disease epidemics 181 African-American nurses, both men and women,22

 Nurses Pictured With Civil War Soldiers

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 Field Hospitals with MDs and Nurses

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Nursing in the United States

African-American nurses made important contributions
Harriet Tubman cared for wounded soldiers and conducted an underground railroad to lead slaves to freedom Sojourner Truth, known for her abolitionist efforts as well as her nursing efforts, was an advocate of clean and sanitary conditions so patients could heal Susie King Taylor, though hired in the laundry, worked full-time as a nurse on the battlefront with no pay or pension; not considered an official Union Army nurse

Volunteer nurses who made important contributions

Clara Barton operated a war relief program; credited with founding the American Red Cross Louisa May Alcott authored detailed accounts of the experiences encountered by nurses during the war for a newspaper publication entitled Hospital Sketches 25

Nursing in the United States

Number of nurse training schools increased after the war
Offered little classroom education On-the-job training occurred in the hospital wards Students were used as supplemental hospital staff

1890 - Establishment of African-American hospitals and nursing schools gained momentum

John D. Rockefeller established the first school of nursing for African-American women at the Atlanta Baptist Seminary, now known as Spelman College
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Nursing in the United States

1900 to World War I
Advances in the nursing profession
By 1910 most states passed legislation requiring nurse registration before entering practice Required entry level for nursing students was upgraded to high school graduate Nurse training programs improved to include a more comprehensive course of study

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Nursing in the United States

Lillian Wald developed a viable practice for public health nursing (The Henry Street Settlement) located in the Lower East Side of New York City
Purpose was to provide well-baby care, health education, disease prevention, and treatment of minor illnesses Nursing practice at the Henry Street Settlement formed the basis for public health nursing in the United States

Developed the first nursing service for occupational health (Metropolitan Life Insurance Company)
Prevention of disease in workers to promote productivity Sliding-scale fee

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Lillian Wald

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Nursing in the United States

World War I and the 1920s
Advances in medical care and public health
Improved hospital care and surgical techniques Discoveries in pharmacology - insulin and the precursor to penicillin Environmental conditions improved; serious epidemics of the previous century became nonexistent

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Nursing in the United States

Advances in nursing
Nurses served honorably during WWI Nurse anesthetists made their first appearance as part of front-line surgical teams U.S. Public Health Service sought the assistance of a nurse to establish nursing services at military outposts American Red Cross, founded by Clara Barton in 1882, became more active in urban settings as well as rural communities Mary Breckenridge established the Frontier Nursing Service (FNS) in 1925 in rural Kentucky to assist disadvantaged women and children; documented the impact of nursing services on improving the health of communities; well known for midwifery services

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Nursing in the United States

Legislation
Sheppard-Towner Act - first legislation to assist special populations and provided public health nurses with resources to promote health and well-being of women, infants, and children

The Great Depression (1930-1940)

Social issues
American economy disintegrated with over 6 million people unemployed Nurses also were forced to join the ranks of the unemployed
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Nursing in the United States

Legislation
New Deal enacted to rescue the country and provided for medical care and other services for the large numbers of indigent people Social Security Act of 1935 affected health care and provided avenues for public health nursing

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Nursing in the United States

Main purposes of the Social Security Act
National age-old insurance system Federal grants to states for maternal and child welfare services Vocational rehabilitation services for the handicapped Medical care for crippled children and blind people strengthen public health services A Federal-state unemployment system

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Nursing in the United States

World War II
Legislation
Programs enacted to expand nursing education and increase the number of nurses in all military branches

Advances in nursing
Nursing became an essential part of the military advance Nurses recognized as an integral part of the military and attained officer rank
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Nursing in the United States

Post World War II (1945-1950)
Social issues
Unemployment dropped to all-time lows Women were encouraged to return to childbearing and marriage rather than continue employment outside the home

Advances in nursing
Demonstrated value to the armed services during the Korean War Emerged as a true profession with minimum national standards for nursing education established
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Nursing in the United States

By 1950 all states had adopted the State Board Test Pool Number of nursing baccalaureate programs grew Associate-degree programs developed in community and junior colleges

Legislation

Nurse Training Act of 1943: first instance of federal funding to support nurse training
Hill-Burton Act: provided funding to construct hospitals; created a hospital construction boom that increased the demand for professional nurses African-American nurses were barred from membership in the ANA due to segregation laws; all barriers were dropped in the early 1960s
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Nursing in the United States

Nursing in the 1960s
Legislation had a major and lasting impact on nursing and health care
Community Mental Health Centers Act of 1963 Medicaid, Title XIX of the Social Security Act, 1965 Medicare, Title XVIII of the Social Security Act, 1965

Impact of Medicare reimbursement on nursing

Hospital occupancy increased resulting in an increased need for hospital nurses Nursing embraced the hospital setting as the usual practice site Home health movement was initiated
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Nursing in the United States

Nursing in the 1970s
Influenced by the womens movement, nurses demanded fairer wages and better working conditions Hospitals continued to be the focus of nursing education and practice Nurses were instrumental in developing community programs including hospice programs, birthing centers, and adult day care centers Nurse practitioners began to be recognized as viable, cost-effective providers of comprehensive health services
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Nursing in the United States

Nursing in the 1980s
Types of patients needing health care changed
Increasing numbers of homeless and indigent Emergence of acquired immune deficiency syndrome (AIDS)

Spiraling health care costs became an issue

Diagnosis-related group (DRGs) system for reimbursement was instituted Hospitals were forced to increase efficiencies and reduce patients length of stay Case management emerged as a new area of nursing specialization Outpatient and ambulatory services grew Enrollment in manage care plans and health maintenance organizations grew Advanced nurse practitioners increased in popularity

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Nursing in the United States

Nursing practice began to move from the hospital setting to community settings Disease prevention and health promotion gained importance

Medical care continued to advance

Organ transplantation Resuscitation and support of premature infants Medical specialties flourished Medical technology flourished

Inadequate funding for public health programs became an issue Scholars suggested that nursing research needed to be focused on substantive information to guide practice
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Nursing in the United States

Nursing in the 1990s
Growing concerns about the health of the nation
Healthy People 2000 initiative Increasing focus on health promotion and disease prevention activities

Influence of the AIDS epidemic

New procedures for infection control were required Universal Precautions were mandated

Exposure to hazardous materials

Workplace chemicals and radioactive substances created health risks Employee training was instituted across all industries
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Nursing in the United States

Managed care movement
Focus moved from acute care to prevention and primary care Emphasis on outpatient, ambulatory, and home services Massive downsizing of hospital nursing staff and increase in unlicensed assistive personnel Increasing demand for community health nurses and advanced practice nurses

Changing nursing requirements for the 1990s and beyond

Focus on health risk assessments based on family and environmental issues Focus on health promotion and disease prevention Promote counseling and health education
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Nursing in the United States

Nursing in the 21st century
Challenges facing professional nurses
Changing duties and responsibilities Nursing shortage Public concern over patient safety and quality of care

Core competencies required by professional nurses

Critical thinking Communication Assessment Leadership Technical Skills

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Nursing in the United States

Knowledge required by professional nurses
Health promotion/disease prevention Information technology Health systems Public policy Access Quality Cost Accountability

Consumer issues in health care

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Nursing in the United States

Changes in society
Aging population Intercultural population Consumer health value Need for a well trained work force AACN (2000) reports 7.4% faculty vacancy rate; average full time faculty over 50 years of age; average age of doctorally prepared faculty 55.9 Nurse Reinvestment Act signed into bill August 2002 to provide funds for nursing education, recruitment, and retention

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Nursing in the United States

Opportunities for professional nurses (2.6 million members)
Evidence-based practice United efforts to shape health care United efforts to address the nursing shortage

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