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Chapter 1-History of Nursing

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    Chapter 1The Evolution of

    Professional Nursing

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    We need to realize and to affirm anew that nursingis one of the most difficult arts. Compassion mayprovide the motive, but knowledge is our onlyworking power. Perhaps, too, we need to

    remember that growth in our work must bepreceded by ideas, and that any conditions whichsuppress thought, must retard growth. Surely wewill not be satisfied in perpetuating methods andtraditions. Surely we shall wish to be more and

    more occupied with creating them. M. Adelaide Nutting, 1925

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    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


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    Early Civilization

    Egypt Health beliefs and practices

    Valued personal health; preventive measures takento appease the gods

    Developed specific laws on cleanliness, food useand preservation, drinking, exercise, sexualrelations, 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 andPuah were midwives who saved the baby Moses

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    Early Civilization


    Health beliefs and practices

    Developed the Mosaic Code, one of the firstorganized methods of disease control and prevention


    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 medicalcaduceus

    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

    Vedas (2000-1200 BC), sacred Hindu books, were the source ofinformation about health practices

    Focused on the use of magic, charms, herbs, and spices to curedisease and remove demons

    Medical science Developed procedures to perform major and minor surgical

    operations Recorded extensive information about childhood diseases,

    prenatal care, and conditions of the urinary and nervoussystems

    Nursing 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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    Early Civilization

    China Health beliefs

    Teachings of Confucius (531-479 BC) had a powerfulimpact on health practices

    Believed in the yin and yang philosophy; animbalance between the two would result in ill health

    Health practices Used treatments to promote health and harmony

    including acupuncture, hydrotherapy, massage, andexercise

    Used drug therapy to manage disease conditions andrecorded over 1000 drugs

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    Early Civilization


    Adapted health and medical practices from thecountries conquered and physicians enslaved (27BC-476 AD)

    Established the first military hospital in Europe inRome

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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 andProtestant sects

    Nursing no longer appealed to women of high socialstatus; 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 greatconcern 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


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    The Colonial American Period


    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 andsmallpox were a constant threat

    Physicians were poorly trained and used crude

    methods of treatment such as bleeding and


    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 38nurses who were sisters and nuns from variousCatholic and Anglican orders to the Crimea to workat the Barracks Hospital in Scutari

    Despite deplorable conditions, the army doctors atfirst refused her assistance

    Eventually the doctors, in desperation, called for herhelp

    Purchased medical supplies, food, and linen; set up akitchen; instituted laundry services; initiated social

    services; spent up to 20 hours each day providing

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    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 tomaintain atient records

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    Mary Seacole

    Jamaican nurse who played a major role in the

    Crimean War

    Denied the opportunity to join Nightingales nursingbrigade 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(1861-1865)

    No army nurses and no organized medical corps whenthe war began

    Dorothea Dix - Appointed to organize militaryhospitals, provide trained nurses, and disperse

    supplies; she received no official status and no salaryfor this position

    6 million people hospitalized during the war - 425,000for war casualties; vast majority for disease epidemics

    181 African-American nurses, both men and women,

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    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


    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

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    Nursing in the United States

    Number of nurse training schools increasedafter 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-Americanhospitals and nursing schools gained

    momentum John D. Rockefeller established the first school of

    nursing for African-American women at the AtlantaBaptist 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 nurseregistration before entering practice

    Required entry level for nursing students was

    upgraded to high school graduate

    Nurse training programs improved to include a morecomprehensive course of study

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    Nursing in the United States

    Lillian Wald developed a viable practice for public healthnursing (The Henry Street Settlement) located in the LowerEast 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


    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


    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


    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


    Nurses also were forced to join the ranks of the


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    Nursing in the United States


    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


    Programs enacted to expand nursing education andincrease 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


    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 juniorcolleges


    Nurse Training Act of 1943: first instance of federalfunding to support nurse training Hill-Burton Act: provided funding to construct hospitals; created

    a hospital construction boom that increased the demand forprofessional nurses

    African-American nurses were barred from membership in theANA due to segregation laws; all barriers were dropped in theearly 1960s

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    Nursing in the United States

    Nursing in the 1960s

    Legislation had a major and lasting impact on nursingand 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 needfor hospital nurses

    Nursing embraced the hospital setting as the usual practicesite

    Home health movement was initiated

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    Nursing in the United States

    Nursing in the 1970s

    Influenced by the womens movement, nursesdemanded fairer wages and better working conditions

    Hospitals continued to be the focus of nursingeducation and practice

    Nurses were instrumental in developing communityprograms including hospice programs, birthing

    centers, and adult day care centers Nurse practitioners began to be recognized as viable,

    cost-effective providers of comprehensive healthservices

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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


    Hospitals were forced to increase efficiencies and reduce

    patients length of stay Case management emerged as a new area of nursing


    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


    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 preventionactivities

    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


    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 inunlicensed 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




    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

    Consumer issues in health care


    Quality Cost


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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


    Evidence-based practice

    United efforts to shape health care United efforts to address the nursing shortage