ITS ABOUT HOW THIS PROFESSION HAS EVOLVED

1. History of Development of
Nursing Profession
NEHA DAGAR
NURSING TUTOR

2. Introduction
 llness earlier was seen as “magic”, “sin” or “punishment”.
 During 700-600 B.C - Sushruta Samhita was written by the great surgeon Sushruta, who
said "the physician, the patient, the drugs and the nurse are four feet of `Padas' of the
medicine, upon which the cure depends".
 The first nursing school started in India in 250 B.C. during Charaka's time and only men
were considered pure enough to be nurses.

3.  300 AD Entry of women into nursing.
 1633 -Sisters of Charity founded by Louise de Marillac -established the first
educational program to be affiliated with a religious nursing order
 1809 -Mother Elizabeth Seton introduced the Sisters of Charity into America, later
known as the Daughters of Charity.

4. Dark Period of Nursing
 From 17th century -19th century.
 Also called the period of reformation until the American Civil War.
 Hospitals were closed. Nursing were the works of the least desirable people(
criminals, prostitutes, drunkards, slaves, and opportunists). Nurses were
uneducated, filthy, harsh, ill – fed, overworked.
 1854-1856(Crimean war)- on oct.21,1854, Nightingale left with 38 women for
Crimean war- made rounds at night with a lamp “lady of the lamp”. Compiled the
notes on nursing: what it is and what is not, and become the first nurse theorist.

5. History

6. THE CRUSADES (AD 1095-1291)
 Monks often cared for the sick and church was established as military nursing
orders, such as the Knight hospitallers to provide care for the poor, the pilgrims
and the travelers.

7. THE RENAISSANCE (1500-1700AD)
 Growing interest in science and technology led to some advances in medicine and
public health.
 In 1601, the church of England mandated the Elizabethan poor law, which created
overseer for poor, blind, orphans and lame.

8. The 18th century
 Industrial revolution began in the late 18th century in England (1706) and
continued to the early 19th century .
 The use of machinery and the development of factories quickly spread throughout
the world.
 Efforts were made to improve the poor and unsanitary conditions of overcrowding
by providing places for people to take hot baths and sanitarian for the disease.

9. The 19th century
 It was also a time for innovation and reform.
 Dr John Snow intervened and was able to handle a major outbreak of cholera in
London. Snow and his assistants calculated the actual number of deaths from
cholera by going door to door and collecting information.

10. Florence Nightingale (1820-1910)
 Florence nightingale often called as mother of modern nursing and also referred
as the lady with the lamp, helped revolutionize the world of nursing and sets
standard for profession.
 She became involved in the Crimean war (1853-1856) after hearing about the
squalid condition of the soldiers who have been injured.

11. Mary Seacole (1805-1861)
 Mary jane grant seacole was born in Kingston, she learned nursing skills from her
mother , she worked during cholera and yellow fever epidemic.
 After learning about the war in crimea, seacole asked the war office of the British
government to send her to the Crimea as an army nurse.
 She established a hospital and respite home for the wounded and fatigued
soldiers in Balaclava. She worked as a volunteer. she was known as “mother
Seacole” on the battlefield, because she nursed the wounded.

12. Clara Barton(1812-1912)
 Born in Massachusetts, was a New England school teacher. Despite not having
formal training as a Nurse, she volunteered as a Nurse during the American Civil
War.
 She was referred to by the soldiers she cared for as the “Little lone lady in black
silk”
 Exhausted following the war, she went to Europe to recover, there she learned
about the International Red Cross.

13. Mary Mahoney(1845-1926)
 The first African-American registered nurse in the United States, was born in
boston.
 In 1879, Mary Mahoney graduated from the New England Hospital. she was the
first black women to graduate from professional school of nursing.
 As a nurse leader, she recognized the need for nurses to work together to
improve their role in the nursing profession, and she became a member of
American Nurses Association(ANA).
 She was the co-founder of the National Association of Coloured Graduate
Nurses(NACGN)

14. Mary Adelaide Nutting (1858-1948)
 Was well known as an advocate of higher education for nurses, born in Canada,
she was a member of first graduate class of nurses at Johns Hopkins University
in1891 and was to become the school’s second superintendent of nursing.
 She was instrumental in creating changes to improve the education of the nursing
students and was also instrumental in the development and creation of American
Journal of Nursing.

15. Lavinia dock (1858-1956)
 She was a graduate of the Bellevue training school for nurses in 1888.
 She was a nurse leader who helped change and advance the profession of nursing.
she used her nursing skills during the yellow fever epidemic in Florida and
provided care at the Johnstown flood in 1890.
 She worked with the New York Women’s Trade Union League.

16. Lillan wald (1867-1940)
 Wald a nurse and a social worker born to a middle-class Jewish family in New
York.
 She initially worked as a nurse at an orphanage.
 Lillian Wald began to care for sick residents of the lower east side and soon
decided to devote her life to this cause.

17. The 20th and 21st centuries
 Issues related to sanitation in relationship to the health of communities were the
primary concern of health care planners and providers.
 Discovery of new more potent antibiotics and other scientific breakthroughs
changed forever how the healthcare system dealt with infection.
 Mid 20th century, shift in priority from the health of the community to the health
and well being of the individual occurred.
 End of 20th century another shift towards care of patients in the community
occurred. Technology innovation.

18. Nursing leader of the 20th century
Mary Breckinridge(1881-1965)
 In 1925, the frontier nursing service was begun by her.
 The service provided care for the sick poor in rural communities. Nurse travelled
on foot or by horse to reach patients who would otherwise not receive the care of
a healthcare provider.
 During world war 1, while serving as a volunteer nurse in France, Breckinridge met
a British nurse who was also a midwife.

19. Margaret Sanger (1878-1966)
 She worked as nurse with poor women on the lower east side in New York city.
Through this she became aware of the impact of unplanned and unwelcomed
pregnancies upon these women.
 In 1916, Margaret Sanger opened a Family Planning and Birth control clinic in New
York City.
 In 1930, Sanger successfully opened a Family Planning Clinic in Harlem, New York
with support of community. Shortly thereafter, the birth control federation of
America emerged.

20. Virginia Henderson(1897-1996)
 She attended Army school of Nursing in Washington. In 1955, with Bertha Harmer,
Henderson co-authored Textbook of Principles and Practices of Nursing, a
fundamental Textbook.
 She believed that “the unique function of nurse is to assist the individual, sick or
well, in the performance of those activities contributing to health or its recovery
that he would perform unaided if he had the necessary strength, will or knowledge
and do this in such a way as to help him gain independence as rapidly as possible.

21. Mildred Montag(1908-2004)
 She graduated in 1993 with bachelor of science degree in Nursing.
 In January 1943, the school of Nursing at Adelphi College the first programme for
on long Island was established and Dr. Montag was named the Director.

22. Hildegard E Peplau(1909-1999)
 Known for her work and great strides in psychiatric nursing. She helped to create
change in the collective way nurses and patients thought about their roles in the
patient healthcare provider’s relationship.
 Peplau developed an interpersonal model emphasizing the need for theories
which were considered by many to be revolutionary.

23. Ruth Lubic Watson (1931 to present)
 Is a nurse –midwife and in 1993 was the first nurse ever named a Mac Arthur
fellow by the John D. and Catherine T.
 Dr. Watson served as the director of the Maternity Centre Association, which
began in 1917.
 In 1975 she founded the first freestanding birthing centre on the Upper west side
in New York City.
 In 1983, Watson become the president of the National Association of childbearing
centres.

24. M. Elizabeth Carnegie(1916-2008)
 She was a nurse historian and the author of several publications of great
importance to the history of Nursing, including The Path We Trend.
 Dr. Carnegie initiated the nursing programme at Hampton University in Virginia;
was the president of the American Academy of Nursing and was Dean of school of
Nursing at Florida A&M University.

25. Today
 Now in 21st century, there is an emphasis on the health of the individual within the
community.

26. Nursing
 “The unique function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery , that he
would perform unaided if he had the necessary strength, will or knowledge.”
- VIRGINIA HENEDERSON (1966)

27. Profession
 A group must meet the following criteria to be considered a profession (Starr,
1982)
 the knowledge of the group must be based on technical and scientific knowledge.
 the knowledge and competence of members of the group must be evaluated by a
community of peers.
 the group must have a service orientation and a code of ethics.

28. Six Essential Features of Professional Nursing
 1.Provision of a caring relationship that facilitates health and healing.
 2. Attention to the range of human experiences and responses to health and
illness within the physical and social environment.
 3. Integration of objective data with knowledge gained from an appreciation of
patient or group’s subjective experiences.
 4. Application of scientific knowledge to the processes of diagnostic and
treatment through the use of judgment and critical thinking.
 5. Advancement of professional knowledge through scholarly enquiry.
 6. Influence of social and public policy to promote social justice.

29. Professional nurse
 Professional nurse is a graduate of a recognized nursing school who has met the
requirements for a registered nurse in a state in which she is licensed to practice

30. CRITERIA FOR PROFESSION
 1.High intellectual level of functioning
 2.High level of individual responsibility and accountability
 3.Specialized body of knowledge
 4.Evidence based nursing practice
 5.Public services and altruistic activities.
 6.well organized and strong representation.
 7. code of ethics
 8.competencies and professional license.
 9. autonomy and independent practice
 10. Professional Identity And Development

31. High intellectual level of functioning
 Modern nurses use assessment skill and knowledge, have the ability to reason and
make routine judgment depending on patient’s condition. Professional nurses
functions at a high intellectual level. Florence nightingale raised the bar for
education and graduates of her school were considered to be highly educated.

32. High level of individual responsibility and
accountability
 Nurses must be accountable and demonstrate a high level of individual
responsibility for the care and services they provide. The concept of accountability
has legal, ethical and professional implications that include accepting
responsibility for action taken to provide client care as well as accepting
responsibility for the consequences of action that are not performed.

33. Specialized body of knowledge
 Nursing has developed into an identifiable separate discipline, a specialized body
of knowledge called as nursing science.
 It was compiled through the research effort of nurses with advanced educational
degrees. Although this body of specialized knowledge is relatively small, it forms a
theoretical basis for the practice of nursing today.

34. EVIDENCE BASED NURSING PRACTICE
 Evidenced based practice is the practice of nursing in which interventions are
based on data obtained from research that demonstrate that, the findings are
appropriate and successful.
 It involves a systematic process of uncovering, evaluating and using information
from research as the basis for making decisions about providing client care.

35. PUBLIC SERVICES AND ALTRUISTIC
ACTIVITIES.
 Individual is the focal point of all nursing models and nursing practice. Nursing
has been viewed universally as being an altruistic profession composed of
selfless individuals who place the lives and well being of their clients above their
personal safety. Dedicated nurses provide care for victims of deadly diseases
with little regard for their own welfare.

36. WELL ORGANIZED AND STRONG
REPRESENTATION
 Professional organizations represent the members of the profession and control
the quality of professional practice. In India TNAI & SNA are the two
organizations that represent nursing in today’s health care system.
 Many do belong to specialty organizations that represent a specific area of
practice.

37. CODE OF ETHICS
 A code of ethics document may outline the mission and values of the business or
organization, how professionals are supposed to approach problems, the ethical
principles based on the organization's core values and the standards to which the
professional is held. Some of the ethical principles are autonomy, justice, non-
maleficence

38. COMPETENCIES AND PROFESSIONAL
LICENSE.
 Nurses must pass a national licensure examination to demonstrate that they are
qualified to practice nursing. Only after passing the examination the nurses are
allowed to practice. The granting of a nursing license is a legal activity
conducted by the individual state under the regulations contained in the state’s
nursing practice act

39. AUTONOMY AND INDEPENDENCE OF
PRACTICE:
 In reality nursing is both an independent and interdependent discipline. Nurses
in all health care setting must work with physicians, hospital administrators,
pharmacists and other groups in the provision of care. To be considered a true
profession, nursing will need to be recognised by other disciplines as having
practitioners who practice nursing independently.

40. PROFESSIONAL IDENTITY AND
DEVELOPMENT
 Until nurses are fully committed to the profession of nursing, identify with it as a
profession and are dedicated to its future development, nursing will probably
not achieve professional status.

41. CONCEPTS IN NURSING
 The art and science of modern nursing encompasses fundamental nursing
concepts that include health, illness, stress and health promotion. Nurses work
with physicians and other medical staff in a wide variety of medical and
community settings. • They provide preventive, primary, acute and chronic care
for sick and injured patients with health information, restorative care, medication
administration and emergency care. Nursing care focuses on protecting and
promoting physical and mental health for patients and for the community

42. Concepts of Nursing- Health
 Health is the absence of illness, injury and disease. Health as a fundamental
nursing concept involves both mental and physiological well being, and it
changes over a patient's lifetime. Nurses work in health care to promote and
protect health by instructing patients about self-care, and about how lifestyle
and behavior affects their health. They help people to recover from physical and
mental illness, and they tend to sick and injured patients to restore health.

43. Concepts of nursing illness :
 Illness is a fundamental nursing concept that defines a deviation from health
with three stages: the onset of illness, the acceptance of the
 state of illness and the convalescence or recovery stage. A nurse’s role in illness
includes monitoring and interpreting symptoms, administering medication and
self care information, and caring for patients who are incapacitated by illness.

44. Concepts of Nursing Stress:
 Nurses work to make patients more comfortable, and a big part of nursing care
includes reducing patient stress. Nurses explain procedures to patients, listen to
patient concerns and answer questions, protect patients' privacy and ask how
patients are feeling. The goal is to calm them and make them feel more
physically and emotionally comfortable.

45. Concepts of Nursing Health promotion:
 It’s the responsibility of every nurse to promote better health by informing
patients of things such as illness prevention methods, safe health practices and
healthy lifestyle choices. Nurses promote health by discussing weight and
exercise issues, nutrition, the risks of drinking, smoking and drug use, and other
self care that increases their quality and length of life.

46. Objectives of Nursing
 Maintain and promote wellness, prevent illness, care for and rehabilitate the sick
of disabled through the human science of nursing.
 Reduce stress.
 Provide comfort to the client during diseases process.
 Provide service to individual families and societies.
 Work independently with other health workers assisting the client to gain
independence as quickly as possible.
 Develop interaction between nurse and client. Focus on a man a living unity and
man’s qualitative participation with experience.

47. CHARACTERISTICS OF NURSING
 Nursing is caring.
 Nursing involves close personal contact with the recipient of care.
 Nursing is concerned with services that take humans into account as physiological,
psychological, and sociological organisms.
 Nursing is committed to promoting individual, family, community, and national
health goals in its best manner possible.
 Nursing is committed to personalized services for all persons without regard to
color, creed, social or economic status.
 Nursing is committed to involvement in ethical, legal, and political issues in the
delivery of health care

48. Perspective of Nursing Profession Global
and National
 The demand of higher education has increased worldwide and their focus has
been on impressive expansion of education offering both within and across
countries.
 Exported education services are delivered in various ways:
 As student travel abroad to receive their education.
 As education is delivered to them through distance learning.
 As education institutions from one country provide onsite classes in another
country, often through establishing branch campus.

49. Nursing profession at National level
 INC is a statutory body that regulates nursing education in the country through
prescription, inspection, examination, certification and maintaining its stands for a
uniform syllabus at each level of nursing education.
 There are six levels of nursing today, they are:
 ANM or MPHW-F
 Female health supervisors training
 GNM
 B.Sc Nursing
 M.Sc nursing
 M.Phil and Ph.D

50. FUNCTIONS OF A NURSE
1.Caregiver
 The caregiver role has traditionally included those activities that assist the client
physically and psychologically while preserving the client’s dignity. Caregiving
encompasses the physical, psychosocial, developmental, cultural and spiritual
levels.
2.Communicator
 Communication is an integral to all nursing roles. In the role of communicator,
nurses identify client problems and then communicate these verbally or in
writing to other members of the health team. The quality of a nurse’s
communication is an important factor in nursing care.

51. 3. Teacher :
 As a teacher, the nurse helps clients learn about their health and the health care
procedures they need to perform to restore or maintain their health. The nurse
assesses the client’s learning needs and readiness to learn, sets specific learning
goals in conjunction with the client, enacts teaching strategies and measures
learning.
4.Client advocate
 Client advocate acts to protect the client. In this role the nurse may represent the
client’s needs and wishes to other health professionals, such as relaying the
client’s wishes for information to the physician.

52.  They also assist clients in exercising their rights and help them speak up for themselves
5. Counselor
 Counseling is a process of helping a client to recognize and cope with stressful
psychologic or social problems, to developed improved interpersonal relationships,
and to promote personal growth. It involves providing emotional, intellectual, and
psychologic support.
6.Change agent
 •The nurse acts as a change agent when assisting others, that is, clients, to make
modifications in their own behavior. Nurses also often act to make changes in a system
such as clinical care, if it is not helping a client return to health. •Researcher
,rehabilitator,& critical thinker.

53. 7.Leader
A leader influences others to work together to accomplish a specific goal. Effective
leadership is a learned process requiring an understanding of the needs and goals
that motivate people, the knowledge to apply the leadership skills, and the
interpersonal skills to influence others.
8.Manager
The nurse manages the nursing care of individuals, families, and communities. The
nurse-manager also delegates nursing activities to ancillary workers and other nurses,
and supervises and evaluates their performance.

54.  9.Case manager
Nurse case managers work with the multidisciplinary health care team to measure the
effectiveness of the case management plan and to monitor outcomes.