Chapter 01

Chapter 1
The Evolution of
Professional Nursing
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 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
Prehistoric Period
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 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, and sexual relations, and a
pharmacopeia 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
Early Civilization

 Palestine
• Developed the Mosaic code, one of the first organized
methods of disease control and prevention
 Nursing
• Little information available
• Hebrew priests took on the role of health inspectors
Early Civilization (cont’d)

 Greece
 Health beliefs
• Believed that the gods and goddesses of Greek mythology
controlled health and illness
• Temples built to honor Aesclepius, the god of medicine, were
designated to care for the sick
 Medical science
• Aesclepius carried a staff intertwined with serpents, representing
wisdom and immortality; staff was the model for medical caduceus
• Hippocrates is 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

 India
• Vedas (2000-1200 BC), sacred Hindu books, were the source of
information about health practices
 Vedas emphasized hygiene and prevention of sickness
 Medical science
• Developed procedures to perform major and minor surgical
operations
• Importance of prenatal care was understood
 Nursing
• Hindu physicians performed major and minor surgeries,
including limb amputations, cesarean deliveries, and suturing
wounds
• In rare instances women were allowed to work outside the home
• Public hospitals were staffed by male nurses

 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, including acupuncture, hydrotherapy,
massage, and exercise, to promote health and harmony

 Rome
 Adapted health and medical practices from the
countries conquered and the physicians enslaved
(27 BC-476 AD)
 Established the first military hospital in Europe in
Rome
 Both male and female attendants cared for the sick
• Military nursing orders were developed exclusively by men
 Practiced advanced hygiene and sanitation

 Women used herbs and new methods of healing
 Women cared for the sick in their homes
 Men used purging, leeching, and mercury
 Physicians spent more time translating medical essays
than providing medical care
 The Roman Catholic Church became a central figure in
health care
 Wives of emperors and other women became nurses
 Most changes in health care were based on charity and
the sanctity of human life
 The cross used during this period became a badge and
forerunner for the design of nursing pins
Middle Ages

1. Nursing care during the era of the Civil War was:
A. Plagued by communicable diseases made worse
by unsanitary conditions
B. Conducted under septic conditions previously
recognized as important by Nightingale
C. Provided by trained nurses from many ethnic
backgrounds from both the North and South
D. Provided by male nurses because females were
forbidden to care for male soldiers

 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
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
The Renaissance and the
Reformation Period (cont’d)

 Mexico
 First colonists in Mexico were members of Catholic
religious orders
 Hospital of the Immaculate Conception—first
hospital in North America; built in 1524 in Mexico
City; first medical school; built at the University of
Mexico
 Individuals with infectious disease were isolated in
almshouses or “pesthouses”
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
The Colonial American Period
(cont’d)

 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
King’s College Hospital in London
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 physicians at first
refused her assistance
 Eventually, the physicians, 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 nursing
care
Florence Nightingale (cont’d)

 Major accomplishments
 Founder of professional nursing
 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 physician’s orders, and a system to maintain
patient records
 Kept careful statistics—documented a decrease in the death rate
of soldiers from 42% to 2% as a result of health care reforms
that emphasized sanitary conditions
Florence Nightingale (cont’d)
17Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 Jamaican nurse who played a major role in the
Crimean War
 Was denied the opportunity to join Nightingale’s
nursing brigade because she was black
 Opened a lodging house with her own money to care
for sick and wounded soldiers
 Contributed to control of the cholera epidemic through
extensive knowledge in tropical medicine
 Honored by the Jamaican government and the
British Commonwealth with a medal for saving
the lives of countless sick and wounded soldiers
Mary Seacole

 The Civil War period
 The Civil War or the War Between the States(1861-1865)
 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—500,000
surgical cases; 2000 nurses served in the war
 181 African American nurses, both men and women,
served from 1863 to 1864. Caucasian nurses made $12.00
per month; African American nurses made $10.00
 Epidemics plagued the country: syphilis, gonorrhea,
malaria, smallpox, and typhoid
Nursing in the United States

2. The cross often portrayed on nursing pins today
was derived from the cross:
A. Worn by Florence Nightingale
B. That identified monks and knights as Christian
warriors
C. That untrained nurses carried in the Middle Ages
when assisting with birthing and to bless the birth
of male infants
D. Carried by Aesclepius, believed to be the god of
medicine in ancient Greece

 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, although 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
(cont’d)

 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
 1890s—Establishment of African American hospitals and
nursing schools gained momentum
• In 1896 John D. Rockefeller established the first school of
nursing for African American women at the Atlanta Baptist
Seminary, now known as Spelman College
(cont’d)
22Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

 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 were improved to include a more
comprehensive course of study
• Because of segregation and discrimination, African
Americans had to establish their own health care institutions
(cont’d)

 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
(cont’d)

 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
(cont’d)

 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 and rural communities
• Mary Breckinridge 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
(cont’d)

 Legislation
• Sheppard-Towner Act—first legislation to assist special
populations and provide public health nurses with resources
to promote the health and well-being of women, infants, and
children
 The Great Depression (1930-1940)
 Social issues
• American economy was disintegrated with more than 6
million people unemployed
• Nurses also were forced to join the ranks of the unemployed
(cont’d)

 Legislation
• “New Deal” enacted to rescue the country and provide 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
(cont’d)

• Main purposes of the Social Security Act
 National old-age 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 to strengthen public health services
 A federal-state unemployment system
(cont’d)

 World War II
 Legislation
• Programs enacted to expand nursing education and increase
the number of nurses in all military branches
• Nursing became an essential part of the military advance
• Nurses recognized as an integral part of the military and
attained officer rank
(cont’d)

 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 to continue employment outside the
home
• Demonstrated value to the armed services during the Korean
War
• Emerged as a true profession with minimum national
standards for nursing education established
(cont’d)

• 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 American Nurses Association because of segregation
laws; all barriers were dropped in the early 1960s
(cont’d)

 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
(cont’d)

 Influenced by the women’s 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
 Male nurses began to increase in numbers
 American Nurses Association elects the first ANA President –
Barbara Nichols (served two terms)
(cont’d)

 Types of patients needing health care changed
• Increasing numbers of homeless and indigent
• Emergence of acquired immunodeficiency syndrome (AIDS)
 Spiraling health care costs became an issue
• Diagnosis-related group (DRG) system for reimbursement was
instituted
• Hospitals were forced to enhance efficiencies and reduce patients’
length of stay
• Case management emerged as a new area of nursing specialization
• Outpatient and ambulatory services grew
• Enrollment in managed care plans and health maintenance
organizations grew
• Advanced nurse practitioners increased in popularity
(cont’d)

• 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
(cont’d)

 1988 Institute of Medicine (IOM) landmark study: The
Future of Public Health
• Dismal picture of Public Health
 Late 1980s, enrollment in nursing programs
decreased
• Increase in complexity of health care and changes in nursing
roles
(cont’d)

 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
(cont’d)

 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
(cont’d)

 Nursing in the 21st century
 Challenges facing professional nurses
• Changing duties and responsibilities
• Severe nursing shortage
• Patient safety, accountability, and quality of care
 Core competencies required by professional nurses
• Critical thinking
• Communication
• Interprofessional collaboration
• Assessment
• Leadership
• Technical Skills
(cont’d)

 Knowledge required by professional nurses
• Health promotion/disease prevention
• Information technology
• Health systems
• Public policy
 Consumer issues in health care
• Access
• Quality
• Cost
• Accountability
(cont’d)

 Changes in society
• Aging population
• Intercultural population
• Generational differences in an aging workforce
• High acuity and short staffing
• Consumer health value
• Need for a well-trained work force
• Average age of full time faculty 54 years of age
• Nurse Reinvestment Act signed into bill August 2002 to
provide funds for nursing education, recruitment, and
retention
• 2.9 million nurses make up the largest health care profession
(cont’d)

 2010 – Affordable Care Act (ACA)
• Provide insurance to over 32 million previously uninsured Americans
 Robert Wood Johnson Foundation (RWJF) and IOM – Future of
Nursing
• Nurses should practice to full extent of training
• Nurses should achieve higher levels of education
• Nurses should be full partners with physicians and other health care
professionals to re-design health care in the U.S.
• Improve health care workforce data collection to better assess and
project workforce requirements
 Opportunities for professional nurses
• Opportunities to increase knowledge
• Evidence-based practice
• United efforts to shape health care; influence policy
• United efforts to address the nursing shortage
(cont’d)

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Chapter 01

Editor's Notes