History of Nursing

1. History of Health Care &
Nursing

2. NURSING: DEFINITIONS
Nursing (as an art)
Is the art of caring sick and well individual. It refers to
the dynamic skills and methods in assisting sick and
well individual in their recovery and in the promotion
and maintenance of health. It involves the creative
application of knowledge in the service of people
Nursing (as a science)
It is the “body of abstract knowledge” arrived through
scientific research and logical analysis.
Is the scientific knowledge and skills in assisting
individual to achieve optimal health.

3. Cont …………
Nursing (as a profession)
Profession- a calling in which its members profess to
have acquired special knowledge by training or
experience, or both so that they may guide, advise or
save others in that special field.
Florence Nightingale
Nursing is the act of utilizing the environment of the
patient to assist him in his recovery.

4. Cont ……….
Virginia Henderson
Nursing is the act of assisting the individual, sick or well,
in the performance of those activities contributing to
health or its recovery (or to a peaceful death) that he
would perform independently if he had the necessary
strength, will, or knowledge, and to do this in such a way
as to help him gain independence as rapidly as possible.

5. Cont ………..
Canadian Nurses Association (CNA)
Nursing is a dynamic, caring, helping relationship in which
the nurse assist the client to achieve and obtain optimal
health. – 1987
Themes that are common to these definition:
• Nursing is caring
• Nursing is an art
• Nursing is a science
• Nursing is client-centered
• Nursing is holistic
•Nursing is concerned with health promotion, health maintenance,
and
health restoration
• Nursing is a helping profession

6. Cont ……..
American Nurses Association (ANA)
1973
Nursing is direct, goal oriented, and adaptable to the needs
of the individual, the family, and community during health
and illness.
1980
Nursing is the diagnosis and treatment of human responses
to actual or potential health problems.

7. Cont ……..
1995
ANA acknowledge four essential features of contemporary
nursing practice:
• Attention to the full range of human experiences and
responses to health and illness.
• Integration of objective data with knowledge gained from
understanding of the client or group’s subjective experience.
• Application of scientific knowledge to the processes of
diagnosis and treatment.
• Provision of caring relationship that facilitates health and
healing.

8. Nurse: Definition
Nurse
• Comes from a Latin word “to nourish” or “to cherish
• One who cares for the sick, the injured, and the physically,
mentally, and emotionally disabled
• One who advise and instruct individuals, families, groups
and communities in the prevention, treatment of illness and
diseases and in the promotion of health.
• An essential member of a health team who cares for
individuals, families and communities in disease and illness
prevention and in the promotion of health.

9. Patient: Definition
Patient
• Comes from a Latin word, “to Suffer” or “to Bear”
• An individual who is in the state of physical, mental, and
emotional imbalance
• An individual who seeks for nursing assistance, medical
assistance, or for surgery due to illness or a disease.
• Is an individual who is waiting or undergoing medical or
surgical care. One who is physically or mentally disabled.

10. History of Health Care and Nursing
in
Ancient civilizations

11. Ancient civilizations
 The first nurse – the first mother
Illness was seen as “magic” “sin” or
“punishment”
 Guidelines of behavior became
rules. rules were to protect people
and guarantee group survival
 Old Testament refers to dietary,
hygiene and health laws for the
Hebrews
 There was no organized nursing
care

12. Evolution of Nursing
 As an instinctive response to the desire to keep healthy,
the sick
 Responsibility – nurturing children, care of the elderly
and the sick
 Education – Through trial & error and information
sharing, intuition
 Religions – accepting the illness but
 Superstition & magic

13. Ancient Societies
 Nomadic
 Solidarity for mutual protection
 Belief in the power of Gods
 Black and white magic
 Ingenious techniques of health practices,
 Med & Surg treatments, Massage, fomentation,
trephining, bone setting, amputation, hot and cold baths.

14. ANCIENT BABYLONIANS
Code Of Hammurabi
1st record on the medical practice
Established the medical fees
Discouraged experimentation
Specific doctor for each disease
Right of patient to choose treatment between the use
of medicine, or surgical procedure
No organized nursing care.

15. ANCIENT EGYPTIANS
 Art Of Embalming
 By river Nile. Healthiest & most advanced
 Priest physicians - Belief in evil spirits
 Imhotep – A surgeon, architect, priest,magician)
 A system of community planning (hygiene, sanitation,
embalming, dentistry)
 Women assisted ‘priest- physician’as priestess/ midwives/
wet-nurses
 Dissection – Prohibited. Hence no further progress
 Documentation about 250 diseases and treatments

16. Medical treatment In ancient Egypt
• Ancient Egypt treatment includes leaves,
grass and the bark of the willow tree contain
salicylic acid used to treat inflammatory
disease, to alleviate birth pains and reduce
fever.
• Egyptian doctors could stitch up wounds,
repair broken bones and amputate infected
limbs. The incision was dressed by mixture of
raw meat, linen, and swabs soaked with
honey. At the beginning of the Late period
and early Ptolemaic period [656 BC–323 BC],
the so-called healing statues were appeared.
• Internal disorders were managed by using
magic and amulets in this case will be wider
beside the invocations to gods who were
considered to be involved in both causing
diseases and cure them.

17. HEBREW
 Motivated servant of God
‘Mosaic code’- Isolation, hygiene, rest & sleep, hrs of
work, disposal of excreta, disinfection, regulations to
check animals before slaughtering/ eating
 Religion ‘Do not eat meat past the 3 rd day’
 King gave health power to ‘priest physician’
 Priest physician – took the role of health inspector
Basic nursing practices were existed.

18. Cont ………
 Purification of man and his food
 The ritual of Circumcision – on the 8th day after birth
 Mosaic Law
 Meant as a survival for health and hygienic reason only
 Use of pharmacologic drugs

19. ANCIENT CHINA
 By the Yellow river
 Confucius – Patriarchal role



Importance to rule of etiquette
Value of family as a unit
Women inferior to men
‘Yang’& ‘Yin’ –Active (male) & passive (female) force
 2000 BC – Dissection done, circulation, pulse, elaborate
materia medica, importance to hygiene

20. Cont……..
 Rule of physical exam – ‘Look, listen, ask and feel’
 Baths to reduce fever
 1000 BC - Sen Lung (Father of medicine), used veg and
animal drugs, vaccination, physiotherapy, treated syphilis
and gonorrhea
 1200 BC - Liver diet for anemia,
 Hence nursing was impossible

21. ANCIENT INDIAN
First civilizations were highly developed
1500 BC Ayurveda
Explains hygiene, disease prevention, major/ minor
surgery, children’s disease, inoculation, materia medica,
disease of CNS & GUS
1400 BC- Sushruta
‘Father of Surgery’ in India. Charaka wrote ‘Internal
medicine’

22. ANCIENT INDIAN
King Ashoka (272 – 236 BC)
Public hospitals with male nurses and some older women,
hospitals for animals. Universities (monasteries) of Taxila
& Nalanda (Bihar)
Nurses should have 3 qualities – high standards, skills and
trustworthiness
1AD
Superstition & magic replaced by more up-to-date practice.
But medicine remained in the hands of priest physician,
who refused to touch blood and pathological tissue

23. ANCIANT INDIAN
1000AD
Brahmin influences gained strength and re-
established itself. Buddhism declined. Brahmins
were priest physicians
Rigid Hindu caste system. No dissection.
Superstition and magic replaced practice of
medicine

24. ANCIENT GREEK
 Apollo (son of God) – God of health
 Asculapus (son of Apollo) – God of healing
 Epigone – (Asculapus’ wife) – Thesoother
 Hygeia – (daughter of Asculapus ) – Goddess of health
 Temples – became social, intellectual and medical centers
 Aristotle – differentiated arteries from vein

25. Greek History
Little is known of Greek medicine before
the appearance of written texts in the fifth
century B.C. Greece as many other
prehistoric countries possessed folk
healers, including priest healers and chief
tribunes employing divination and drugs.
Greek society at large drew heavily upon
sacred healing. In Homer, Apollo appears
as the ‘God of healing’.
Once Asklepius was recognized as the
God of medicine.
During the fourth and the third century the
cult of Asclepius and the practice of
Hippocratic medicine spread, and by 200
B.C. every large town in Greece had an
Asklepieion.

26. Hippocrates in the 5th century
• Known as “Father of Medicine”
 Hippocratic oath is from him
 Said Illness had specific causes: black bile, yellow
bile and red bile
 Developed terms prognosis, diagnosis, cure


Diagnosis—identifying disease scientifically
Prognosis—predicting possible outcome
 Cure— restoration of health
NURSES à function of untrained slaves

27. ANCIENT ROMANS
 Medical advances borrowed from Greece after they
conquered it
 Clung to superstitions
 Had good hygiene and sanitation
 Made drainage systems, drinking water aqueduct,
public baths, hospitals (for soldiers and slaves)
 Men & women of good character did nursing
 Two classes


28. Nursing in Early Christian Era
 Women began nursing as an expression of Christianity
(acts of mercy)
 Women were recognized (first recording in history) as
important members of community
 Phoebe considered the first Deaconess and visiting nurse
 Fabiola started the first public hospital in Rome

29. Early Middle Ages (AD 476-1000)
“Dark Ages”
Learning stopped and Christianity retreated behind the
walls of monasteries due to the wars occurring in the land
(The Roman Empire collapsed)
Focus was on care and comfort (foundation of nursing)
science declined
Nursing care was controlled by the Catholic Church

30. High Middle Ages (1000-1475)
Small states emerged after wars
Catholic Church became dominant
Medicine declined
Monastatic orders began with strict discipline, Obedience
and devotion
Monasteries became the place for education of medicine
and nursing. But Too strict > Diminished interest in work
> decline of monasteries between 9th and 10th century.

31. Cont ……..
 12th – 16th century – Ruled by religious order
 Nursing done by dedicated women, who took vows,
but could not leave or get married.
 Also nursing brothers.
 Age – Between 16 – 24 yrs

32. The Crusades
• Europe rose to reclaim the Holy Land from the Muslims
• Hospitals developed on the battlefields
• Knight Hospitaliers of St. John’s of Jerusalem cared for the
injured
• Knights organized nursing care
• Had a probationary period before you could wear the
“white” robes of knighthood
• Nursing became acceptable for women and encouraged by
Catholic Church

33. The Bubonic Plague (1347-1350)
Ended the middle ages
Was very deadly
Germs carried by rats
Killed ¼ of the entire world population

34. Renaissance (1400-1600) “Rebirth”
Interest increased in science and discovery;
medicine increased
Nursing declined

35. The Reformation
Led by Martin Luther
The birth of protestantism; end of dominance of the
Catholic Church
Women remained subordinate, women did not work
outside the home
 “Wayward” women of low status became “nurses”
instead of going to jail

36. 18th, early 19th centuries
The sick and poor were in great numbers ”change” was
needed, the stage was set for those with “social” vision
19th century
Era of social reform for prisons, public health and care of
the poor
Pastor Theodur Fliedner opened the Kaiserwerth
Deaconess Institute—the first REAL nursing school
Its most famous student:
Florence Nightengale (1820-1910)

38. Florence Nightingale
Mother of Modern Nursing
Went to Kaiserwerth for 3 months
On Oct. 21, 1854, left with 38 women for the Crimean War,
British casualties were high; within 6 months, death rate cut
in half
Made rounds at night with a lamp “Lady of the Lamp”
Opened the Nightingale School of Nursing in 1860 where
she stressed good food, clean air and sanitation
Wrote textbooks on nursing
Wrote famous “Notes on Nursing” Some of her ideas are
still valid today

41. Late 19th Century, 20 Century to NOW
Civil War shaped nursing by dramatizing the need for
nursing care
Clara Barton established hospitals for both sides and for all
colors of people; later founded the American Red Cross
Bellevue Hospital 1873 opened the New YorkTraining
School modeled after Nightingale school
Linda Richards first U.S. Trained nurse, 1873
Mary Mahoney first black nurse trained in 1879

47. 1. Nursing in Pre-historic Times
There are no historical evidence available on ancient
history on nursing care of sick in primitive times
discovered through myths, songs and archeologistTo get
rid of 'evil spirit' unpleasant conditioning like beating,
starving, magic rites, nauseous medicines, loud noises
sudden fright are used methods. Primitive man had the
skill of massaging, fermentation bone setting, amputation,
hot and cold bath, heat to control hemorrhages.
Role of Nurse in Primitive Period
Women were protecting and caring for their children,
aged, sick members of the family. Nursing evolved to
response to the desire to keep healthy as well as provide
comfort to sick.

48. This was reflecting in caring, comforting, nourishing and
cleansing aspect of the patient. These love and hope were
expressed in empirical practice of nursing.
2. Nursing - Vedic Period (3000 B.C - 1400 B.C)
Indian medicines are found in the sacred books of "Vedas". The
'Ayur-veda' is thought to have been given by Brahma. 1400 BC
Sushruta, known as 'Father of Surgery' in India wrote a book on
surgery years later 'Charaka' wrote a book on internal medicine. By
these writings we can learn that those days surgery had advanced to
a high level, also had 4 wings of treatment 'Chatushpada Chikitsa'.
1. Physician - Bhishak
2. Nurse - Upacharika (Attendent - Anuraktha)
3. Therapeutic drugs - Dravya
4. Patient - Adhyaya

49. Characters of Upacharika (Nurse)
Shuchi - Pure or clean in physical appearance and mental
hygiene.
Daksha - Competency
Anuraktha - Willing to care
Buddhiman - Co-ordinator with the patient and doctor /
intelligent.

50. 3. Nursing Post Vedic Period (600 BC - 600 AD)
Medical education introduced in ancient Universities of
'Nalanda' and 'Thakshashila'. King Ashoka (272-236 BC)
constructed hospitals for the people and
animals. Prevention of the disease was given first
importance and hygienic practices were
adopted. Cleanliness of the body was religious duty.
Doctors and midwives were to be trust worthy and
skillful. They should wear clean cloths and cut their nails
short. Lying rooms were kept well ventilated. Religious
ceremonies and prayer precede co-operations.

51. The nurses were usually 'men' or 'old
women'. Women are restricted activities at home
and cared for sick members in the family during 1
AD period superstition and black magic replaced
more in daily practices. Medicines are remained in
the hands of priest - physicians, who refused to
touch the blood and pathological tissues.
Dissection was for bidden. Other religious
restriction and superstitious practices probably
declined the development of nursing.

52. 4. Nursing in Mogul Period (1000 AD)
'Unani' system of medicine developed during the
Arab civilization. It was practiced in Indo-Pakistan
subcontinent. The basic framework are consists of
blood, phlegm, yellow bile and back
bile. Temperament, strengthening of body and
nature are the real physician.
Not believed in eradication of disease greatly
depend on defense mechanism of the body and
self-care and positive health habits. Therefore, it
becomes part of Indian medicine practice.

53. 5. British period (16th Century onwords)
After the Mogul period the nursing in India hindered due
to various reasons like low state of women, system of
"pardha" among Muslims, caste system among Hindus,
illiteracy, poverty, political unrest, language difference and
nursing looked upon as servants work. During the
16th century, nursing development in India taken three
dimensions.
Military Nursing
Civilian Nursing
Missionaries Nursing

54. 1. Military Nursing:
Military nursing born during 1st world war but developed
very slowly. British officers informed need of nurses to
take care British officials and soldiers in India.
On 1888 Feb. 21st - 10 fully qualified certified nurses from
Florence Nightingales, arrived to Bombay to lead nursing
in India. This pave the way to develop one of the best
nursing in the world. 1894 regular system of training for
men for hospital work (orderliness) started. Medical
officers given lecturing to them. Some men were
voluntary did the course and applied for the nursing
certificate.

55. After two months of practical posting to ward, on the
account of supervised sister's report, first time hospital
'orderlines' issued certificate and had official status. This
system laid the possible foundation to existing system of
training and higher education.
1927 - Description of Indian Military Nursing services
formed with 12 matrons, 18 sisters, 25 staff nurses. They
are responsible for supervision, instruction and training of
nursing services for entire Indian hospital corps.

56. 2nd world war expanded nursing services to India and
overseas under the direction of chief principal matron. 3
year training carried out in selected military hospital
preliminary training schools. After completion sent to
military hospital for training. After successful training
certificate issued as "Registered Nurse" and they are
members of Indian Military Nursing Services Auxiliary
Nursing Services
Shortage of trained nurses in India after the 2nd world war,
the Govt., initiated short course of intensive training in
1942 which led to the Auxiliary Nursing Services. Basic
training for 6th month is selected civil hospital after
passing examination at military hospitals in India sent to
overseas to serve in the capacity of 'Assistant Nurses' 3000
women given auxiliary training.

57. 2. Civilian Nursing in India
1664 - East India company built Government General
Hospital at Madras for civilian. 1871 - this hospital
undertook training of nurses. On 1854 midwives training
school granted certificates of 'Diploma in Midwifery' for
passed student and 'sick nursing' for failed students. First
time 6 nurses came out as Diploma in Midwifery Nurses.

58. 3. Missionary Nursing:
Missionary nursing started training for Indian people as
nurses. Various other countries supported. This brought fully
qualified Indian nurses. Those days there were several obstacles for
nursing development.
Girls were not allowed to do work.
Degrading and unworthy attitude of people.
Hindus were hold back due to deep seated caste system.
Muslims held under 'paradha' system.
So Christian girls encouraged and trained first.
Frequent disappointment, degradation difficulties nursing training
came into existence and look its own shape. In the beginning there
is not uniformity in nursing education. There is no particular
standards were given. After the course of lecturing 18 months to
two years, written examination conducted. If failed training
extended to 3 years.

59. From 1888-93 five years various experts like doctors,
surgeons, nursing superintendent, pharmacists - draw up a
curriculum for training. 1907-10 North India united Board
of Examiner formed to maintain nursing administration
and standards. 1928 - Hindi Text book for nurses
developed. 1939 - helped to develop post graduation
school for nurses.

60. Community Health Nursing :
William Rathbone formed Visiting Nurse's Association at
England. She emphasized on charity free care etc. Florence Lees
improved the Visiting Nurses by giving specialized training for their
work. It is influenced in India, because of terrible condition, under
which children were born recognised as cause for high mortality
rate. Because untrained 'Dais' are attending women at the time of
child birth.
Dais were unwilling to trained and patients will to accept the old
customary methods. In 1926 - Midwives Registration Act formed
for the purpose of better training of midwives. Slowly Community
Nursing Training needs felt by the Government. In 1946 -
Community Health Nursing was integrated in Basic Nursing
Programme at Delhi, Vellore and Madras.

61. Trained Nurses Association of Indian (TNAI)
In 1908 - TNAI formed to uphold the dignity and honor of
the nursing profession. Florence Mac Haughton was the
first president of TNAI. In 1910 TNAI published
journals. In 1912 - TNAI affiliated to international
Nursing Council as a 8th Association in the world. In 1917
June 16th under the Registration Act No:XXI of 1860 -
TNAI got registered. In 1922 - SNA formed.