Evolution of Nursing and Health Care At the end of this lecture the student will be able to: 1. Define nursing as an art and a science. 2. Define the history. 3. Identify the importance of nursing history 2. Identify major historical and social events that have shaped current nursing practice. 3. Describe Florence Nightingale’s impact on current nursing practice.

Evolution of Nursing and Health Care 4. Discuss the contributions of early leaders in American nursing. 5. Discuss the impact of selected landmark reports on nursing education and practice. 6. Relate the social forces of nursing’s evolution to the current status of advanced practitioners

History can be defined as: “A study of events from the past leading up to the present time”

Evolution of Nursing and Health Care Definition of Nursing Nursing is an art and a science by which people are assisted in learning to care for themselves whenever possible and cared for by others when they are unable to meet their own needs. - Nursing’s early history was heavily influenced by religious organizations and the need for nurses to care for soldiers during wartime.

THE IMPORTANCE OF STUDYING NURSING HISTORY 1-Helping to understand the societal forces and issues facing the profession. 2-Gaining an appreciation of the role the profession played in the healthcare system. 3-Describing the influence of societal trends on the development of nursing as a profession. 4-Identifying the contributions of selected leaders in the nursing profession.

HISTORICAL OVERVIEW To understand the present status of nursing, it is necessary to have a base of historical knowledge about the profession. By studying nursing history, the nurse is better able to understand such issues as autonomy (being self-directed), unity within the profession, supply and demand, salary, education, and current practice.

HISTORICAL OVERVIEW Through consultation and exchange of information, nurses demonstrate their roles as autonomous professionals.

HISTORICAL OVERVIEW The study of nursing history offers another advantage—learning where the profession has been and its advancements. Empowerment is the process of enabling others to do for themselves. Only when nurses are empowered are they truly autonomous.

HISTORICAL OVERVIEW Graduating Class (1900) of Touro Infirmary Training School for Nurses

HISTORICAL OVERVIEW Empowerment and autonomy go together and are necessary for nursing to bring about positive changes in health care today. Power is not authority— authority is power.

HISTORICAL OVERVIEW Learning from the past is the major reason 1-For studying history. Ignoring nursing’s history can be detrimental to the future of the profession. 2-By applying the lessons gained from a historical review, nurses will indeed be a vital force in the new millennium.

Evolution of Nursing Nursing has evolved with the development of civilization of mankind. The following for a discussion of nursing from early civilizations to the present era of advanced nursing practice and health care reform.

Evolution of Nursing Early Civilizations The evolution of nursing dates back to 4000 BC, to primitive societies in which mother-nurses worked with priests. In 2000 BC, the use of wet nurses is recorded in Babylonia and Assyria.

Evolution of Nursing Ancient Greece The ancient Greeks built temples to honor Hygiea, the goddess of health. These temples were more like health spas rather than hospitals in that they were religious institutions governed by priests. Priestesses (who were not nurses) attended to those housed in the temples. The nursing that was done by women was performed in the home.

Evolution of Nursing Roman Empire Hospitals were first established in the Eastern Roman Empire (Byzantine Empire). St. Jerome was responsible, through one of his disciples, Fabiola, for introducing hospitals in the West.

Evolution of Nursing Western hospitals were primarily religious and charitable institutions housed in monasteries and convents. The caregivers had no formal training in therapeutic modalities and volunteered their time to nurse the sick.

Evolution of Nursing Middle Ages Hospitals in large Byzantine cities were staffed primarily by paid male assistants and male nurses. During the medieval era, these hospitals were established primarily as almshouses, with care of the sick being secondary.

Evolution of Nursing -Medical practices in Western Europe remained basically unchanged until the 11th and 12th centuries, when formal medical education for physicians was required in a university setting. Although there were not enough physicians to care for all the sick, other caregivers were not required to receive any formal training.

Evolution of Nursing The dominant caregivers in the Byzantine setting were men; however, this was not true in the rural parts of the Eastern Roman Empire and in the West. In these societies, nursing was viewed as a natural nurturing job for women.

Evolution of Nursing Renaissance -During the Renaissance (AD 1400–1550), interest in the arts and sciences emerged. This was also the time of many geographic explorations by Europeans. As a result, the world literally expanded.

Evolution of Nursing Renaissance During the Renaissance (AD 1400–1550), interest in the arts and sciences emerged. This was also the time of many geographic explorations by Europeans. As a result, the world literally expanded.

Evolution of Nursing Because of renewed interest in science, universities were established, but no formal nursing schools were founded. Because of social status and customs, women were not encouraged to leave their homes; they continued to fulfill the traditional role of nurturer/caregiver in the home.

Evolution of Nursing Enlightenment and Industrial Revolution The Industrial Revolution introduced technology that led to a proliferation of factories. Conditions for the factory workers were deplorable. Long hours, grueling work, and unsafe conditions prevailed in the workplace. The health status of laborers received little, if any, attention.

Evolution of Nursing Medical schools were founded, including the Royal College of Surgeons in London in 1800. In France, men who were barbers also functioned as surgeons by performing procedures such as leeching, giving enemas, and extracting teeth.

Evolution of Nursing At the end of the 18th century, there were no standards for nurses who worked in hospitals. In the early to mid-1800s, nursing was considered unseemly for women even though some hospitals (almshouses) relied on women to make beds, scrub floors, and bathe the poor. Most nursing care was still performed in the home by female relatives of the ill.

Evolution of Nursing Religious Influences The strong influence of religions on the development of nursing started in India (800–600 BC) and flourished in Greece and Ireland in 3 BC with male nurse-priests.

Religious Influences In 1836, Theodor Fleidner revived the Church Order of Deaconesses to care for those in a hospital he had founded. These deaconesses of Kaiserwerth became famous because they were the only ones formally trained in nursing. Pastor Fleidner had a profound influence on nursing because Florence Nightingale received her nurse’s training at the Kaiserwerth Institute.

Evolution of Nursing Florence Nightingale 1820 Florence Nightingale born. She is considered the founder of modern nursing. She grew up in a wealthy upper-class family in England during the mid-1800s. Unlike other young women of her era.

Evolution of Nursing Florence Nightingale 12 -5- 1820 - 13 -8- 1910.

Evolution of Nursing -Nightingale received a thorough education including Greek, Latin, history, mathematics, and philosophy. She had always been interested in relieving suffering and caring for the sick. -Social mores of the time made it impossible for her to consider caring for others because she was not a member of a religious order. She became a nurse over the objections of society and her family.

Evolution of Nursing Florence Nightingale in the Crimea

Evolution of Nursing -After completing the 3-month course of study at Kaiserwerth Institute, Nightingale became active in reforming health care. The advent of Britain’s war in the Crimea presented the stage for Nightingale to further develop the public’s awareness of the need for educated nurses.

Evolution of Nursing -The implementation of her principles in the areas of nursing practice and environmental modifications resulted in reduced morbidity and mortality rates during the war. -Nightingale forged the future of nursing education as a result of her experiences in training nurses to care for British soldiers.

Evolution of Nursing -She established the Nightingale Training School of Nurses at St. Thomas’ Hospital in London. -----This was the first school for nurses that provided both theory-based knowledge and clinical skill building. She revolutionized not only the public’s perception of nursing but also the method for educating nurses.

Evolution of Nursing Some of Nightingale’s novel beliefs about nursing education were: • A holistic framework inclusive of illness and health • The need for a theoretical basis for nursing practice • A liberal education as a foundation for nursing practice

Evolution of Nursing • The importance of creating an environment that promotes healing • The need for a body of nursing knowledge that was distinct from medical knowledge

Evolution of Nursing Nightingale introduced many other concepts that, though unique in her time, are still used today. She advocated: (2) having a systematic method of assessing clients; (2) individualizing care on the basis of the client’s needs and preferences. (3) maintaining confidentiality.

Evolution of Nursing -Nightingale also recognized the influence of environmental factors on health. She advocated that nurses provide clean surroundings with fresh air and light to improve the quality of care (Nightingale, 1969). Nightingale believed that nurses should be formally educated and should function as client advocates.

Nursing Leaders American nursing’s history is rich with many outstanding leaders. Influential nursing leaders, such as Lillian Wald, Jane Delano, Isabel Hampton Robb, Annie Goodrich, Adelaide Nutting, and Lavinia Dock, were instrumental in the advancement of nursing education and practice.

Landmark Reports in Nursing Education • In 1923, the Goldmark report concluded that, for nursing to be on equal footing with other disciplines, nursing education should occur in the university setting. • The Brown report (1948) addressed the need for nurses to demonstrate greater professional competence by moving nursing education to the university setting.

• Contemporary reports issued by the National Selected Legislation •The Health Maintenance Organization Act of 1973 provided an alternative to the private health insurance industry. Education and Practice: Contemporary Reports • Contemporary reports issued by the National Commission on Nursing, the Institute of Medicine, and the Secretary’s Commission on Nursing focused on the areas of nursing education, practice, and nursing’s role in health care financing policies.

Nurses making a presentation before a state legislature Nurses making a presentation before a state legislature. Considering the issues for which historic nursing leaders worked, what challenges do you think merit your participation in the health care debate?

• Developments such as alternative methods of health care delivery, evidence-based practice, and the efforts devoted to health care reform have led to diversified nursing roles. • As the nursing profession continues to evolve and respond to the challenges within the health care system, nurses will remain responsive to societal needs

A component of the professional role of nurses is the delivery of highly skilled care to clients. In what ways can nurses build on these skills so as to achieve full autonomy and empowerment as members of the health care team?