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HISTORY OF NURSING

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ADVANCED NURSING PRACTICE
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CHRISTIAN COLLEGE OF NURSING, NEYYOOR

SEMINAR ON History of development of nursing professionGUIDED BY: Mrs. A. Femila Darling Reader Community Health Nursing Christian College of Nursing Neyyoor PRESENTED BY: J. AsirDhayani M.sc Nursing1stYear Medical Surgical Nursing Christian College of Nursing Neyyoor

PRESENTED ON 17-12--20121

HISTORY OF NURSINGINTRODUCTIONYESTERDAY IS HISTORY OF TODAYTODAY IS HISTORY OF TOMORROW

Connecting the past with the present allows us to catch a glimpse of the future. History can be defined as a study of events from the past leading up to the present time. However the study of history focuses on not just the chronology of events, but also the impact and influence, those events continued to have throughout time. Over the passage of time, events unfold and trends emerge. The historical trends in turn influence or shape the destiny of n individual or group. The development and evolution of the nursing profession is intricately connected to historical influences throughout the ages beginning in antiquity. The study of the history of nursing helps us to better understand the societal forces and issues that continue to confront the profession. Understanding the history of nursing also nurses gain an appreciation of the role the profession has played in the health care system. The historical background of the nursing enables to understand the different stages of development of the profession from the old times until the present time.

TERMINOLOGY*1. Intuition - Immediate cognition without the use of conscious rational processes. 2. Apprentice the system by which person learning who is instructed by a master for a set time under set conditions. 3. Contemporary from the same time period, coexistent in time (modern). 4. Trephining the surgical procedure in which a hole drilled in the shell and a circular piece of bone removed. 5. Renaissance the period of this revival; the transition from medieval to modern times.

*History of Nursing. www.visa pre attorney terminology2

CONTENT DEFINITION 1)History1. History is the study of the human past as it is described in the written documents left by human beings. Krist Hirst

2. A continuous systematic narrative of past events as relating to a particular people, country, period, person etc. usually written as a chronological account. - Dictionary reference.com 3. Usually chronological records of events as of the life or development of a people or institution, often including an explanation of or community on those events. -wwwthefreedictionary.com

2) Nursing1. 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 (or to peaceful death) that he would perform unaided 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. -Henderson, 1966 2. Nursing is the use of clinical judgment in the provision of care to enable people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death. -www ren.org.uk

THEMES COMMON TO NURSING PROFESSION.1. Nursing is caring.3

2. 3. 4. 5. 6. 7.

Nursing is art. Nursing is science. Nursing is client centered nursing. Nursing is adaptive. Nursing is concerned with health promotion, health maintenance and restoration. Nursing is a helping profession.

3) Profession1) Profession is defined as occupation that required extensive education or a calling that required special knowledge, skill and preparation. -Web 2 aabu.edu.jo 2) A disciplined group of individuals who adhere to high ethical standards and uphold themselves to and are accepted by the public as possessing. Special knowledge and skill in a widely recognized, organized body of learning derived from education and training at a high level and who are prepared to exercise this knowledge and these skills in the interest of others. -Dr.Johnsouthwick Austrian. 3) Occupation, practice or vocation requiring mastery of a complex set of knowledge and skills through formal education and/or practical experience. Every organized profession (accounting, law, medicine) is governed by its respective profession. -www.bussiness. dictionary.com

GOALS OF NURSING1. Maintenance of health. 2. Promotion of wellness/health. 3. Restoration of health. 4. Prevention of illness. 5. Facilitate coping. 6. Care of the dying.

PURPOSE OF NURSING.4

1. 2. 3. 4. 5. 6.

To promote and maintain health. To care for people, when their health is compromised. To assist recovery. To facilitate independence. To meet needs. To improve / maintain well-being / quality of life.

PERIODS OF NURSINGThe four great periods of nursing are 1. Intuitive nursing prehistoric time Christian era (early) 2. Apprentice nursing 11 thcentuary to 1836. 3. Educated nursing 1860 -1945. 4. Contemporary nursing began at the end of world war 2 (1945)to present

1.ANCIENT PERIOD-PERIOD OF INTUITION.Intuitive nursing was practiced since prehistoric times among primitive tribes and lasted through the early Christian era nursing was untaught and instinctive. It was performed out of wish of to help others. Ancient people led a nomadic life creaming from place to place. They used stone as weapons and used to make fire. They were nature worshippers. Their belief is known as animism and the period as Stone Age.

BELIEFS OF PRIMITIVE PEOPLE.The prehistoric man believed the illness was caused by the 1. Invasion of the victims body of evil spirit, devils, offended god. 2. Supernatural powers of the human enemy. 3. Displeasure of the death. 4. Own sin. 5. Sorcery-A sorcerer had the ability to use magical ritual formulas to compel the supernatural forces to produce injury, diseases or even death in another person. 6. Magic-they believed in two types of magic; white magic to attract good or helpful spirit. Black magic to destroy evil spirit or bring harm to ones enemies.5

7. Invasion of a disease object-illness was believed to be induced by the entrance into the body of some small object and medicine man sucks it out with his mouth and spit it. 8. Loss of the soul-the soul could entice to leave the body by an evil spirit or a sorcerer. During its wanderings an in injury could prevent its return. A soul catching ceremony was required for its return. It was believed that soul leaves the body 1. 2. 3. 4. During the period of dreaming. Submission resulted in the attitude of what cannot be cured must be endured. Sacrifice involved animal and human. Supplication was expressed through prayer.

PRACTICE OF PRIMITIVE PEOPLE1. The treatment was done by Shaman, medicine man or witch doctor or priest physician. 2. The practice was not to give rest and quietness to the sick person. Instead to encourage the evil spirit to depart from the persons body by using certain other tricks and methods on the sick person. 3. Startling the evil spirit with a frightening mask and deafening noises. 4. Jolting the person by shaking, biting, punching and kicking. 5. Using noxious odors. 6. Giving purgatives and emetics. 7. Plunging them in hot and cold water. 8. Pacifying the evil spirit by sacrifice. 9. Encouraging the evil spirit to come out using chants and mantras. 10. Used certain herbal medicines [Eg.bark of tree for rheumatism] 11. Trephining the skull with stone if the above methods failed. 12. More than all of this, healing depends on the faith of the person.

PREVENTIVE MEASURES1. Using amulets to protect the wearer from evil influence. 2. Talismans were object supposed to bring good luck.

SOURCE OF INFORMATION1. Relics of stone implement. 2. Cave markings.6

3. Skeleton and also from sacred books and other sources.

INITIAL IMAGE OF THE NURSEEarly Nurses Ancient people had family set up. The men were hunters and hard workers. The women were to stay at home and looked after the children. When anybody gets sick, the women were to take care of them as men had no time. Thus they were the early nurses.SERVICES OF EARLY NURSES

1. They extended their services to the neighbors. 2. Nursing started as an intuitive response to the desire to keep people healthy to create a healthful environment, and to provide comfort, care and assurance to the sick. 3. They used problem solving skills as well as intuition in assessment of human needs. 4. They developed a body of knowledge and utilized intellectual, interpersonal and psychomotor skills in meeting human needs. 5. They carried out a sound practical essential that epitomized caring for, caring with, and carrying about a person as well as curing him. 6. They were capable,concerned,compassionate persons whose practice encompassed a wellness in addition to an illness component. 7. They shared their knowledge and skills beyond family and neighborhood bounds by teaching individuals, families, communities and their own successors. 8. They enjoyed freedom of action to be creative and innovative by discovering new knowledge and enriching the scope of nursing practice. 9. They were a composite of nurse,dietician,pharmacist,physiotherapist and social workers. They possessed a role and function separate and distinct from those of medical practitioners.

SKILLS OF PRIMITIVE MAN1. 2. 3. 4. 5. 6. 7. Massage Fomentation Bone setting Amputations Hot and cold baths Abdominal sections Heat to control hemorrhage.

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CONTRIBUTONS OF ANCIENT CIVILIZATIONS TO MEDICINE AND NURSINGCivilization is the emphasis upon mans cultural development. 1. BABYLON [IRAQ 4000 TO 3000 BC] Babylonian empire was founded by KingHammurabi. The people thought disuses were the result of sin. The priests made their diagnosis and prognosis by observing various objects such as the 1. 2. 3. 4. 5. 6. 7. Behavior of animals Flow of water in rivers Shape of oil on water surfaces Irregularity of an animal liver Smoke from a burning fire Personal dreams Difficulty in delivery was considered to be the result of wrong doing.

Code of Hammurabi1. Provided laws that covered every facet of Babylonian life including medical practice. The medical regulations 2. Established fees 3. Discouraged experimentation 4. Recommended specific doctors for each disease gave each patient the right to choose between the use of charms, medications or surgical procedure to cure his disease. 5. Punishment for doctor was severe if patient died (e.g.) the doctors hands were cut off.

Achievements1. Laws to regulate the physician conduct. 2. The Babylonian society was Quasifeudal a) Upper stratum-made of wealthy land owners, merchants and priests. b) Middle class-consist of less wealthy, merchants artisans and priests. c) Lower class-slaves 3. Treatment methods include incantations and by the application of certain herbs.

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4. The religion of worship of Bel later called Marduk,who was identified with the planet Jupiter. 5. The animal scapegoat was sacrificed.Human beings were also sacrificed quite often. 6. From hepatoscopy,the Babylonians learned the structure of the liver and gall bladder and their clay models is excellent anatomical specimen. 7. A Sort of team approach was used to treat the sick person. The physician directed the treatment, the nurse carried out the care, the pharmacist prepared the medicine and the spiritual care was also given along with this. 2. EGYPT

Medical RecordsThe oldest medical records have date back to 1600 BC.The records are written on Papyrus paper and have been preserved in Egypts hot sands. Oneof the best known of these was brought in 1874 A.D by Dr.Ebers of Germany.So it is known as Ebers papyrus.

TreatmentPriest Physician Imhotep means He who cometh in peace was linked by all and was elevated to the rank of God because of his pleasing and kind personality. Temples were built in his name and sick people were brought to these temples for healing.

PyramidThe Egyptians developed the art of embalming or mummifying the body after death carefully to preserve the body in the pyramids, so that the wandering soul could come back at any time. The pyramids were the tombs of the pharaohs. The great pyramid is the largest built by King Khufu nearly 500 feet, height covers an area of 13 acres, 1, 00,000 men worked for 20 years.

Practices1. The Egyptians practiced hygiene, separate areas of the Nile River used for drinking hygiene and sanitation. They also practiced cleanliness in dress and habit and practiced circumcision. 2. They also recognized the importance of an adequate system of drainage, water supply and inspection of slaughter houses.

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3. In Egypt they had medical laws as fixed codes. The law stated what the doctor could do and could not do. If the doctor follow the recognized laws from the sacred books and are yet unable the sick person, he was guiltless. But if he does anything contrary to the written law, he was to get death penalty. 4. Hired nurses assisted in childbirth in ancient Egypt. Reference to nurses in Moses 5th book is a midwife and wet nurse. 5. The Egyptian pharmacopeia included innumerable drugs. They could prepare some drugs for eye conditions and surgery. 6. The healing treatment included prayers and sacrifices. The actual care of the patients, such as dressing wounds was done by helpers.

Achievement1. In 5000 BC, they invented the axe which was used for cultivation and to make houses. 2. In 4000 BC, they produced a calendar of 12 months with 30 days-5 days to celebrate the birth of God. 3. In 3000 BC, they started to put ideas in writing. Developed the ability to make clinical observations and left a record of 250 recognized diseases. 4. They built pyramids to keep the dead bodies of kings and the members of the royal family. 5. Made great progress in the field of hygiene and sanitation. 3. PALESTINE (ISRAEL) 1.The Hebrews book of Genesis emphasized the teachings of Judaism regarding hospitality to the stranger and acts of charity. The writings of Hebrews in the Old Testament speak about laws and principles of sanitation in accordance with modern bacteriology. They mention about the implementation of laws (health rules) like a.Controlling the spread of communicabledisease (segregation of sick e.g. leprosy) b.Cleanliness c.Purification of man (bathing) and his food d. Selection of food (Leviticus 11th chapter) e.Preparation of food f.Disinfection andmidwifery (hygiene for women after childbirth) 2. The ritual of circumcision of the male child on the 8thday (Leviticus 13,14th chapter) 3. Disposal of excreta by burial with enough sand.

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4. Moses is recognized as the Father of Sanitation .He wrote the five books of the Old Testament. 5.On mount Sinai, God gave to Moses the Ten commandments and the Israelites were promised by God when they left Egypt that if they would obey his commandments, he would protect them from disease. I will put none of these diseases upon thee which I have brought upon the Egyptians for I am the Lord that health (Exodus chapter 15v 26Bible) 6. The high priest Aaron was established as the physician of people.

NURSING1..Regarding Nursing, Ancient Hebrew nurses had a high position and participated carefully in planned programmers of visiting the sick at the homes and caring for them. They brought physical and spiritual care for the sick and the family members with family centered approach. 2. In response to the Mosai Health code, the Hebrew nurses were active in promoting and maintaining physical, mental and community health and they continued their service in health maintenance and health education. The importance and independence have been recorded in the Old Testament by the story of a nurse. Midwifewho refused to participate in infanticide when the king Pharaoh ordered to kill the male children of the Hebrews. 4. CHINA 1. In China, long before Christian era, medicine and surgery was honored.The Chinese were well advanced in Medicine and surgery. Before 2000 BC,the doctors used systematic method of diagnosis. 2. Gave the world the knowledge of material medical (pharmacology) method of treating wounds, infection and afflictions. 3. Emperor ShenNung said to be the father of Chinese medicine and the inventor of acupuncture technique. 4. Their slogan was Look,Listen,Ask and Feel. They had good description of the internal organs and circulation and gave stress on behavior of the pulse. 5. Dissection was permitted. 6. They prepared several medicines from vegetables and animals and practiced vaccination as early as 1000 BC. 7. They had physiotherapy, treatment with massage and exercises using heat,light,water and electricity. 8. They were aware of syphilis and Gonorrhea which are sexually transmitted disease. 9. They could treat anemia with the inclusion of Liver in their diet and thyroid with iodine, leprosy with neem oil. 10. In 1 AD they had healing halls next to the temple where the sick prayed for healing. 11. Acupuncture was done as analgesia and was a specialty for them while the other countries did not have.11

12. Opium and its derivatives were also used to relieve pain. 13. Tea drinking was encouraged as a precaution against intestinal infections. 14. Much importance was given to cleanliness and hygiene. 15. Confucius was their religious leader who defined the position of women inferior to men and they could not do anything in public but only to marry, produce children and take care of the house. 16. They also had superstition about certain illness which was caused by the evil spirit and for which bloodletting was done. 17. Medical progress was affected by the belief of the people that the disease was due to the evil spirit and whoever touches the person, the evil spirit will get into their body. So nursing was impossible in this country. 18. No mention of nursing in Chinese writing so it is assumed that care of the sick will fall to the female members of the household. 5. GREECE The Greeks were the true founders of true medical science. In Greece the Medicine was considered as the divine origin. They considered 1. Apollo (the sun of God)-God of health and medicine. 2. ASKLEPIOS (Son of Apollo also known as blameless physician)-God of healing (great healer). 3. Artemis (Apollos sister)-acquitted with medical lore and assisted his instructions. 4. Epigone(wife of Asclepius)-soothing one 5. Six daughters a.Hygeia-Goddess of health b.Panacea-Restorer of health c.Eagle-Light of the sun d.Meditrana-Preserver of health (supposed to be the ancient forerunner of public health nurse) e.Iaso-personified the recovery from illness. 6. One son-assisted him with surgery 7. Another son-assisted him with internal medicine The whole family of Asclepius has significance for the medical and nursing arts.

Symbol of CaduceusIt is the insignia of the medical profession. The staff is entwined with the serpents of wisdom which is still used by practitioners of healing arts is known as Caduceus. Staff represent walk by12

foot if necessary even to the remote areas. Two wings resemble speed at work which a medical person should possess. Serpents-The emblem of wisdom andjuvenescence (becoming young again and immortality. As the serpents cast out their outer covering i.e. the skin, medicalpersonnel should cast out their old ideas and should be up-to-date with the modern treatment according to the changes happening from time to time. Many temple hospitals were built in the memory of God Asklepios.Priest physician was in charge of the temple. The patient on entering the hospital prays to the God Asclepius.Then the patient will go to sleep and in his dream the God Asclepius himself would reveal the drugs to be given.

The famous health resort in Greece was Epidaurus which is few miles from Athens. Templebuildings were made of marble.There were hospital ward and corridors,baths, gymnasia,libraries, hotels, stadium with a capacity of 12,000 spectators. There was a theatre in which 16,000 people could be accommodated.There were rooms for visitors and attendants, houses for priestsand physicians. Patients were accommodated in open portico, one side for females and the other for men. About 500 patients could be kept at a time. In Epidaurus, in the temple of Asclepius sick people gathered and priest physicians received interpreted treatment prescribed by Asclepius.

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Until the time of Hippocrates there was no physical examination of any kind. Patients were bathed and clothed with clean white garments and were put into neat beds. After the evening worship they went to sleep. The priest physician made rounds when all was quiet and talked to patients who were drowsy or sleepy with sedation. They used 1. 2. 3. 4. 5. 6. Massage Inunction Catharsis(purgation) Bloodletting with diet regulation Allowed non-poisonous snakes to lick the wounds as a cleansing treatment. Prohibited dissection, so the advancement of medical work suffered.

Greek civilization has to improve at the same time slavery and poverty was also increased. 7. The intellectual and artistic prestige of Athens gave inspiration to the Greek people. Socrates was a great philosopher. He and his discipline Plato contributed their philosophical ideas for the people and the Government. Aristotle, the discipline of Plato desired to acquire the knowledge and the meaning of life, did dissection on animals. Hippocrates the father of medicine (or) the father of modern medicine (or) the father of scientific medicine was born on Island of Cosin in 460 BC (member of Asclepiad and a son of priest physician. Hippocrates discovered that the diseases are due to disordered function of the body and that the evil spirits were not the causes of diseases. He insisted that magic and philosophical theories had no place in medicine. It was based on the ideas of ethical conduct and practice. Hippocrates stressed on the benefits of fresh air, cleanliness and good diet for health. His methods of treatment were based on the principles 1. Observe all the symptoms 2. Study the patient 3. Evaluate honestly 4. Assist nature His idea is expressed in Hippocratic Oath which is used even today in medical colleges. It forms the base of the Nightingales pledge. Hippocrates medical achievements can be grouped in the four areas 1. Rejection of all beliefs in the supernatural origin of diseases. 2. Development of thorough physical assessment and recordings. 3. Establishment of the highest ethical standards in medicine. 4. Author of medical books.14

But nursing was the task of untrained slave.

6. ROME 1. Acquired their knowledge of medicine from the Greeks. 2. Emperor Vespasian opened schools to teach medicine. 3. Developed military medicine to provide first aid, field ambulance service and hospitals for wounded soldiers. 4. Translated Greek medical terminologies into Latin terms which have been used in medicine. 5. The valetudinarians were buildings in which the soldiers and slaves were treated and cared for in order to increase man power. 6. The Romans are the best known for advances in public health. 7. Had paved roads and bridges. 8. Drinking water by aqueduct. 9. Drainage and sewage system, 10. Public baths. 11. Public dispensary. 12. Malaria was the dreaded disease which was prevalent in Rome. 13. With the advent of Christianity, deacons and deaconates performed the duties of the nurses. a) Phoebe-was the first deaconates and visiting nurse. b) Marcella-was considered the first educator. She taught the care of the sick to the followers. c) Paula-one of the most learned women in this period. She built shelters for Pilgrims and hospital for the sick. d) Fabiola-gave up her early pleasures and lavished her immense wealth on the poor and the sick. Through her efforts the first general hospital was built in Rome. e) Pavbolani-provided an opportunity for the male nurses in the early church period. They took care of the sick and buried the death. 14. Romans were idol worshippers and later period they worshipped their emperors also. 15. Finally when Nero became the emperor, the Christians refused to worship him and many Christians were prosecuted. 16. The Romans were great warriors and thereby Greek scholars were made as slaves and make them as teachers. 17. Greek physicians of the Hippocratic schools, who were also slaves introduced their ideas on the practice of medicine. Moreover they were reluctant to accept advice and direction from the Greek physician because the Romans feared that they might poison them in the name of medicine. 18. Upper class Romans took up medical education in Alexandria.15

19. Dissection was permitted.Galena Greek physician (anatomist) who lived in Rome about 100 BC (1st century) performed numerous experiments in animals to learn about anatomy and disease. His knowledge of anatomy and medicine became the foundation of modern medicine in the 19thcentuary. 20. Roman soldiers got special care. Women of Rome had certain amount of freedom. These women were happy to their sons to war. Old women and men of good character did nursing and male and female slaves did nursing. 21. TheFirst organized visiting of the sick began with the establishment of the order of Deaconeness.They endeavored to practice the corporal works of mercy. a) Feed the hungry. b) Give water to thirsty. c) Clothed the naked. d) Visit the imprisoned. e) Shelter the homeless. f) Care the sick. g) Bury the dead. 7. INDIA The earliest records of Indian medicine are found in the Sacred book Vedas.Apart from Rig Veda,Yajurveda,Sam Aveda and Atharvaveda,supplementalVedaAyurveda was developed;AyurlifeVeda-knowledge by which knowledge can be prolonged or understood. Ayurveda-the science of life which was given by Brahmas which has eight parts such as medicine,surgery,childrens diseases,stress,hygiene and prevention of illness.Atreya was the first great physician and teacher of Ayurveda.He lived about 800 BC. During 700-600 BC.Charaka and Sushruta started practice of medicine and surgery. SushrutaSamhita is written by the great surgeon Sushruta(father of surgery in India) who says about many surgical operations including 1. 2. 3. 4. 5. 6. 7. .Plastic surgery Cataract Amputations 121 surgical instruments Advocated dissection Antiseptic surgery Anesthesia

Antidotes for poisons and vaccination were practiced. The great physician Charaka has written the Charakasamhita in which he explains details of the manner in which drugs should be prepared or compounded for administration.Charaka published16

an encyclopedia in medicine and helped to establish the practice of medicine on a high ethical basis. In the writings of Charaka and Sushruta an estimate was given for the desirable qualification of physicians,nurses,drugs and patient and they were considered s four feet of Padas of the medicine. 1. Physician-thorough mastery of the scriptures, large experience, cleverness and purity (of body and mind) are the qualities of the physician. 2. Nurse-The knowledge of the manner in which drugs should be prepared for administration,cleverness,devotedness to the patient,waited upon and purity (both mind and body) are the qualities of the attending nurse. 3. Drugs-Abundance of virtue,adaptability to the disease under treatment, the capacity of being used in diverse ways and deterioration and attributes of drugs. 4. Patient-memory,obedience todirection, fearlessness, andcommunicativeness is the qualities of the patient. 700-600 BC- Thiruvalluvar in his song speaks highly of medicine. He describes medical care as consisting of patients, doctors and nurses. King Ashoka(226-250 BC) adopted Buddhism made a great stride in the care of the sick both human beings and animals.He brought several changes during his period. Monasteries were built. 1. Houses for travelers were provided. 2. Hospitals for both men and animals were built. 3. He insisted that doctors and nurses were to be trustworthy and skillful. 4. Hygienic practices were enforced. 5. They must wear clean clothes and cut their nails short. 6. Living rooms were kept clean and well ventilated. 7. Operations were preceded by religious ceremony and prayer. 8. Prevention of disease was given first importance. 9. Superstition and magic had been replaced by more up-to-date practices by 1 AD. Medicine still remained in the hands of the priest physician who refused to touch blood or pathological tissue. Dissection was forbidden. In the hospitals,professional musicians and story tellers were also employed to cheer and divert the patients by singing and reciting poetry to them. Indians practiced yoga a method of yoking an individuals soul to the supreme being.

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Bodily purity attained by purgation and bathing followed by concentration to exclude world diversions. The value of certain yoga postures, breathing exercises and breath control are valuable in health practices.

Status of Women in India1. In India, socially the women held a relatively high position in the period proceeding the Vedic period. 2. Monogamy was the general rule even though polygamy was practiced here and there. 3. King.Ashoka showed interest in the education of women and higher caste enjoyed some privileges. 8. CEYLON Ceylon adopted Indias methods. The above factors are also found in sushruta-samhita and charakasamhita. There were hospitals and well prepared physicians and nurses to attend to the sick. Medicine was practiced in humanitarian and reasonably scientific way as in India. 9. PERSIA(IRAN). The Persians had religious law regarding physical health.The Zend-Avesta was their sacred book written by Zoroaster who lived about 600 BC Fire, Earth and Water was considered as sacred elements, and among these, fire was purest. The Persians also believed that the evil spirit was the cause of illness and they had three types of practitioners. They were a. Those who treat with knife and heal were called as surgeons. They were less popular. b. Those who treat with herbs and heal. c. Those who treat with prayer, holy words and heal. They were highly popular. Nothing is mentioned about nursing in this country at this period. 10. AFRICA The nurturing of the nurse included roles as midwife,herbalist,wet nurse andcareer for children and elderly.

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11. ANCIENT AMERICANS In the North and South America, theculture was highly developed before Columbus found that continent and later Spanish established their colonies. There were several groups of people as the Mayas, Incas and Aztecs in America. Mayas practiced human sacrifices to cure illness. At certain sacrificial ceremonies, they removed the hearts of living adults and children. The Incas and Aztecs were the other group and they were skilled engineers and built roads and suspension bridges. They also had superstition and believed that disease is caused by the displeasure of Gods. Diseases were prevalent and treated with 1. Blood letting 2. Cupping or sucking 3. Massaging 4. Sweating 5. Splinting 6. Setting of bones 7. Tooth extraction 8. Amputation 9. Suturing 10. Bandaging and trephining

2.PERIOD OF APPRENTICESHIP NURSING OR CHRISTIAN ERA (1000-1500 AD)Extend from the founding of religious orders in the 6th centuary through the crusade which began in the 11thcentuary to1836.The Deacons school of nursing at Kaiserswerth Germany established by PastorFliedner and his wife. It is the period of on the job training desired of person to be trained. Its most famous student was Florence Nightingale (1820-1910).Nursing was viewed as a very low job in the social hierarchy. Nursing care was performed without any formal education and by people who were directed by more experienced nurses. Religious orders of the Christian church were responsible for the development of this kind of nursing.

a)THE CRUSADESThe crusades were holy wars waged in an attempt to recapture the Holy Land from the Turks who denied Pilgrims permission to visit the Holy Sepulcher.

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b)MILITARY RELIGIOUS ORDERS1. Military religious orders established hospitals that were staffed with men. 2. St. John of Jerusalem (Italian)-devoted to religious life and nursing. 3. Teutonic knights (Germany)-established tent hospitals for the wounded in 1911AD.At this time women order was founded for hospital work. 4. Knights of St. Lazarus (Germany) were founded primarily for the nursing care of Lepers in Jerusalem after Christians had conquered the city.

c)THE ALEXIAN BROTHERSWere members of a monastic order founded in 1348.They established the Alexian Brothers Hospital School of Nursing, thelargest school of nursing under a religious order. It operated exclusively for men in the United States and closed in 1969.

d)SECULAR ORDERSDuring this period, there was also the rise of religious nursing orders for women. Only by entering convent could she follow career obtain aneducation, and perform acts of charity that her faith taught would help her grace in heaven.Queens,Princesses and other ladies of royalty founded many religious orders.

e)MENDICANT ORDERSMendicants were travelling monks. They divided their property among the poor and earned their living by manual labor or begging. Among the mendicants, theDominicans and Franciscans were the prominent orders.

1.St. Dominic (1170-1221)He was from a wealthy Spanish family of Guzman and became the leader of the Dominicans.They travelled far and wide, teaching and preaching Christianity and lived life of Christian principle as an example.

2.St. Francis de sales of Assisi (1186-1226)

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It was the first order. He was the founder of the Franciscans order. He belonged to a middle class family in Italy and once when he was ill he got an inner feeling that he should follow Christianity. Another reason was his charitable nature was not liked by the merchant father. He took up the responsibility of caring for the lepers who were considered to be outcastes. Several people were impressed by his life and followed him. Poverty and humility were emphasized in the Franciscan order.

3.St. Clare (1194-1253)She was from a rich and noble family in Assisi. The life and teaching of St. Francis influenced her and she became a nun and founded the 2nd Franciscan order known as the Poor Clares. The sisters were not expected to beg but supported by the brothers with food and got donations from the community and from the sale of their products.

f)THIRD ORDER(Tertiary Order) Non-ReligiousThis was founded for the lay people of both sexes who wished to continue their ordinary lives in the world; at the same time they were to practice charity and devotion to God in a manner similar to that of religious orders. It composed of members who devoted their time to performance of acts of mercy in their communities, most provided nursing care in homes and hospitals. Several kings and Queens joined in this order. 1. Elizabeth of Hungary (patroness of nurses, daughter of Hungarian king), 2. Catherine of Siena (first lady with a lamp, started service at age 7, referred as little saint and worked as a hospital nurse, prophetess,researcher and a reformer of society and the church), Isabella of France 3. Anne of Bohemia, 4. Brigit of Sweden, 5. Louis of France and 6. Elizabeth of Portugal was members of orders. Such orders still exist in Italy and some other parts of the world.

g)THE BEGUINESIt composed of lay nurses who devoted their lives to the service of suffering humanity. It was founded in 1170 by a PriestLambert Le Begue.They supported them or received help from the societys funds.

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Small cottages built around the church were known as Beguinages.This secular order Beguinagesspread throughout Belgium,France,Germany and Switzerland. They gave aid in time of war and disaster. The main features of this order were 1. They had freedom to leave the order and marry. 2. They could possess property and money. 3. Their work developed according to their own ideas. Some made laces, others taught and many became nuns. 4. They built their own hospitals when need arose. 5. The first beguines were dedicated to St. Christopher the patron saint of travellers which was founded mainly as a home for widows and orphans of crusaders.

h)OTHER1. Oblates-A layperson dedicated to religious life. 2. Benedictines-A monk or nun belonging to the order founded by saint. Benedict. 3. Unruliness-A member of an order of nuns of the Roman Catholic Church th founded in the early 16 centuary and devoted to the education of girls. 4. Nursing order-Camillus de Lellis(16thcentuary) founded a nursing order to provide care for the poor, thesick, the dying and those in prison. 5. In 1633, thesisters of charity were started by Saint Vincent de Paul in France. It was the first of many such orders organized under various Roman Catholic Church auspices and largely devoted to caring for the sick. DARK PERIOD OF NURSING Nursing experienced a dark period from the end of 17thcentuary to the 19thcentuary from the period of reformation until the U.S Civil war.

CAUSES1. Renaissance-the renaissance period characterized by shifts in standards that were evident in literacy and intellectual circles. 2. The religious upheaval led by Martin Luther destroyed the unity of the Christian faith. 3. Disturbed political conditions 4. Reformation Abolition of hospitals 5. Rapid deterioration in the care of the sick. 6. Protestantism wept away everything connected with Roman Catholicism in schools, orphanages and hospitals.22

7. No provisions for the sick. 8. Nursing became the work of the least desirable women. 9. Women who took bribes from patients. 10. Nurses stole the patients food. 11. Used alcohol as a tranquilizer. 12. Nurses worked 7 days a week,slept in cubbyhole near the hospital ward or patient and ate scrapes of food when they could find them. 13. Dead bodies and delirious patients were also kept side by side with the suffering patients. 14. The CounterReformation (catholic revival) the society of Jesuits was founded by Ignatius Loyola-a Spanish nobleman. Religious order reopened and tried to bring back of their traditions.

REFORMS DURING THE DARK PERIODSeveral leaders sought to bring about reforms.

1. St. Vincent de Paul (1576-1660)He was a catholic priest did missionary service among galley slaves.He has founded the order of sister of charity in 1633 with the help of Mile-le-Gras, later known as St. Louse de Marillac.

2. Mille-Le-GrasShe was a widow from the noble family of Paris. She had visited the poor and sick with a group of women volunteers and served them in her home town. SheassistedSt. Vincent de Paul to organize the sisters of charity in 1633.

3. JohnHoward (1727-1789)He was a prison reformer. He spent his imprisonment at France. He experienced the filthy conditions of jails.He found that prisons were dark dungeons without ventilation and lot of vermins.He wrote the report and sent it to the authorities, and got appreciation from the sisters of the charity.

4. Elizabeth Gurney Fry (1780-1845)After 25 years of John. Howards death the next step in the history of the prison reform was taken by the Elizabeth. Shefoundedthe society for visiting nurses with the help of her sister and daughter in 1840.This was first known as the protestant sisters of charity and later as protestant nursing sisters.23

5. AmeliaSieve kingShe was prominent in the womens movement. She has started school for children and for women who want to learn, readandwrite. She organized a home visiting association known as the friends of the poor in Hamburg at Germany; those took care of the cholera patients. She was active in making better housing for low income groups.

6. CharlesDickens (1812-1870)He wrote humorous stories in which he describe end the evils of the day, the poor manners of Betsy Prig, a hospital nurse and SairyGamp a private duty nurse, lack of education and the bad habits of the nurses at that time. These writings helped the public to be aware of the need for reforms.

7. DorotheaLyndaDix (1802-1887)In America she cared for the criminal and mentallyill. She had run a private school in Massachusetts for the children of the well to do and she taught the poor children separately. She presented a course of action in the care of mentally ill. For Example.Instead of restraining them, she allowed them to be free.

8. Mother Mary AikenhandShe established the Irish sister of charity to bring back into nursing, the dedication to the early Christian era.

9. Pastor Theodor Fliedner and Frederika Munster FliednerEstablished the institute for the training of Deaconates at Kaiserwerth,Germany, the first organized school for nurses. Requirements for entering the school were 1. A character reference from a clergy man. 2. A certificate of health from a physician 3. Permission from the nearest relative.

PERIOD OF EDUCATED NURSING (NIGHTINGALES ERA)

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This period began on June 15, 1860 when the Florence Nightingale school of Nursing opened with 15 students at St. Thomas Hospital in London. It was the first secular nursing school in theworld. She was the founder of Modern Nursing. She was also known as the Lady With the Lamp after the habit of making rounds at night to tend injured soldiers. She was born on May 12, 1820 in Florence Italy. Sheraised in England with elder sister Parthenope and received a thorougheducation. She had mastered several ancient and modern languages, well in literature,philosophy,religion,history,political economy,science and higher mathematics (statistician). She came to prominence during the Crimean war (1854) for her pioneering work in nursing. Florence was more interested in politics, and the social condition of the people. She was attracted by the charitable institutions and felt that God had called her to fulfill Mission of Mercy. She met several people who were interested in charitable works 1. Sir. Edwin Chadwick who did sanitary reforms. 2. Elizabeth Fry, the prisoner reformer. At the age of 31 years, she overcame her family resistance to the ambitions. She entered the DeaconatesSchool.She worked as superintendent for Gentlewoman during illness. She advocated for care of those afflicted with the diseases caused by lack of hygienic practices. She disapproved the restrictions on admission of patients and considered the unchristian and incompatible with health care. She changed societys view of nurse. She upgraded the practice of nursing and made nursing an honorable profession for gentlewomen. She led the nurses that took care of the wounded during the Crimean war. She established first nursing philosophy and based on health maintenance and health restoration. She compiled notes of her visits to hospitals and her observations of the sanitary facilities, social problems of the places she visited. She pat her ideas in two published books Notes on Nursing25

and Notes on Hospitals; Notes on Matters affecting the health, efficiency of the British Army. In 800 pages with statistical diagrams. Nursing evolved as an art and science. Formal nursing education and nursing services begun. The Nightingale pledge taken by new nurses was named in her honor and the annual international nurses day is celebrated around the world on her birthday. She was the first practicing nurse epidemiologist and nurse researcher. Florence Nightingale was respected because of her selfless service and honored with various titles as 1. 2. 3. 4. 5. Florence, the first. Empress of scavenger. Queen of Nurses Reverenced mother superior of the British Army Governor of Governess of India

The world is enriched by her wisdom,brilliance and action. On August13, 1910 she died peacefully. The development of nursing during this period was strongly influenced by 1. Trends resulting from wars. 2. An arousal of social consciousness. 3. The emancipation of women. 4. Increased educational opportunities for women Nightingale pledge The Nightingale Pledge was composed by LystraGretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of

26

1893.

It

is

an

adaptation

of

the

Hippocratic

Oath

taken

by

physicians.

A nursing pledge students and graduates moral obligations placed against a school or the whole society, profession, group. Pledges text has been changing; however it has always contained deep humanistic and professional values. Florence Nightingale Pledge was seen as a prototype of a code of ethics. Pledge text saying about fidelity to the Red Cross ideas and professional ethics. During the ceremony the nursing hymn is also sung.

Meaning of Nightingale pledge27

Normative obligation to introducing professional ethics rules in practice. Ethical referring nursing behaviors to the codes rules, consequences in case of insubordination.

Modern nightingale pledge(Lorita Renfro BSN,RN,2012)I pledge myself here, before my God and in the presence of this Assembly, to practice my profession with integrity. I will endeavor to maintain and elevate the standard of nursing, both as a science and as an art. I wholeheartedly recognize the importance of high standards of care and of personal accountability. I devote myself to the healing, protection, and welfare of those committed to my care. I accept a duty to work for the improvement of health in the communities in which I live and work. I will hold in confidence all personal matters committed to my keeping, and will respect the privacy of medical information. I will act with compassion in ethical matters. I will not knowingly administer or consume any harmful substance. I commit to interdisciplinary collaboration and lifelong learning. I fully acknowledge the seriousness of the responsibility that I accept in my calling, and the significance of this pledge that I take today

Nurses Pledge-Trained Nurses Association Of India)I solemnly pledge myself before God and in presence of this assembly to practice my profession with dedication. I will serve mankind with love and compassion, recognizing their dignity and rights irrespective of color, caste, creed, religion and nationality. I will endeavortomaintain uptodate knowledge and skill to uphold standard of nursing care to individual, family and community in all settings and in all aspects of holistic care as a member of the health care team.28

I will hold in confidence personal matters of my clients committed to my care and help them to develop confidence in care rendered by me. I will refrain from any activity that will harm my personal and professional dignity as a Nurse. I will actively support my profession and strive towards its advancement. I will fulfill my responsibilities as a citizen and encourage change towards better health. OTHER IMPORTANT PERSONAGES DURING THIS PERIOD 1. Linda Richards-first graduate nurse in the U.S.graduated on September 1, 1873. 2. Dr.William Halsted- designed the first rubber gloves and Caroline Hampton Robb the first to wear rubber gloves while working as an operating room nurse. 3. Isabel Hampton Robb-the first principal of the John Hopkins Hospitals school of Nursing. 4. Clara Louise Maas-engaged in medical research on yellow fever during the Spanish American War. 5. Edith Cavell-known as Mata Hair, served the wounded soldiers during World War 1 ACHIEVEMENTS 1. Establishment of nursing organizations A) American Nurses Association B) National League for nursing education 2. Development of private duty nursing, settlement house nursing, school nursing, government service of nurses and prenatal and maternal health nursing. 3. Preparation of a standard curriculum based on educational objectives for schools of nursing.

SOCIAL REVOLUTIONS AND THE ADVANCEMENT OF NURSING

1)RenaissanceHumanists emerged and were known to give nursing care.

2)Protestant Reformation.29

Most hospitalclosed. Open hospitals served poor and were staffed by women who were prostitutes and alcoholics.

3)Industrial RevolutionIncreased nurses migrated. Hospital nursing expanded in late 1800s .Lillian Wald and Mary Brewster started community health nursing at the Henry street settlement in 1893.

4)Victorian EraQueen Victoria was a friend of international good will and human betterment. Nurses were predominantly women. Nurses were to be hardworking, submissive and promote harmony. Reform focused on establishing standards for nursing education and practice.

PERIOD OF CONTEMPERARY NURSING*This covers the period after World War 2 to present. Scientific and technological developments as well as social changes marked this period. Nursingraised as a profession. TWENTIETH CENTUARY Nursing evolved toward a scientific research-based defined body of nursing, knowledge and practice. 1. 2. 3. 4. 5. 6. Affiliation of nursing education with universities. Expanded and advanced practice roles. Nursing specializations evolved. Specialty nursing organizations were formed. Establishment of voluntary health agencies like UNICEF(1946)WHO(1948) Peace Corps 1961 were formed to assist in fighting disease by providing health information and improving nutrition, living standards and environmental condition of all people. 7. Progress in transportation; use of ambulances, helicopter etc.

*History of Nursing. www.wikepedia.com.8. Progress in communication telephone, motionpictures, radio and television are used as teaching aids 9. Use of ultrasound in diagnosing and treating diseases. 10. Atomic age-use of radioactive isotopes for medical research.

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11. Early in 1930 an artificial respirator an iron lung machine was invented and used to keep paralyzed (poliomyelitis) patients alive. 12. The discovery of the sulpha drugs as sulphanilamide, sulphapyridine and sulphatiazole reduced the streptococcal and staphylococcal infections. 13. The findings of new drugs as vitamins,penicillin and insulin. 14. Chemotherapy became a vital factor in medical science. 15. Dr.JohnCorrie found out cool air machine to reduce the temperature of the patients room. 16. Refrigeration was another invention of Dr.JohnCorrie for the use of preserving foodstuff. 17. Air mattresses and water mattresses are available in the hospitals. 18. Maternity and mental patients got special attention. 19. Electronic beds are replaced in place of iron beds to enable the lifting of patients earlier. TWENTY FIRST CENTUARY 1. Nurses code of ethics was revised in 2001 to reflect current ethical issues. 2. Use of atomic energy for medical diagnosis and treatment. 3. Utilization of computers for collecting data,teaching,establishing,diagnosis,maintaining inventory,making par rolls,record keeping and billing. 4. Use of sophisticated equipment for diagnosis and therapy. 5. The advent of space medicine also brought about the development of aerospace nursing. 6. Nursing involvement in community health. 7. Health was perceived as a fundamental human right. Laws were legislated to provide such right. 8. Development of expanded role of the nurse; the nurse is constantly assuming responsibilities in patient care which were formerly the sole prerogative of the physician. FACTORS INFLUENCING CONTEMPORARY NURSING PRACTICE

1)ECONOMICSGreater financial support provided through public and private health insurance programs has increased the demand for nursing care. As a result people who could not afford health care in the past are increasingly using such health services as emergency department care, mental health,counseling, and preventive physical examinations.

2)CONSUMER DEMANDSConsumer of nursingservices (the public) has become an increasingly effective force in changing nursing practice. On the whole, people are better educated and have more knowledge about31

health and illness than in the past. Consumers also have become more aware of others needs for care.

3)FAMILY STRUCTURENew family structures are influencing the need for and provision of nursing services. More people are living away from the extended family and the nuclear family. It is also common for young persons to live at a great distance from their own parents. Many of the families live in poverty the children often do not receive preventive immunizations and increased risk for nutritional and other health problems.

4)SCIENCE AND TECHNOLOGYAdvances in scienceand technology affect nursing practice. Nurses must be knowledge about newer drugs, gene therapy, computerizedequipment, monitoring of astronauts and specialist and to adopt health care aids view star an aid for visually impaired, the insulin infusion pump, the voice controlled wheel chair, magnetic resonance imaging, laser therapy.

5)INFORMATION AND TELECOMMUNICATIONSInternet based information is accurate, nurses need to become information brokers so they can help people to access high quality, valid websites, interpret the information and then help clients evaluate the information and determine if it is useful to them. Telehealth uses telecommunication technology to provide long-distance health care. It can include using videoconferencing, computersor telephones.Telenursing occurs when the nurse delivers care through a telecommunication system.

6)LEGISLATIONPatient Self Determination Act (PSDA) requires that every competent adult be informed in writing on admission to a health care institution about his or her rights to accept or refuse medical care and to use advance directives.

7)DEMOGRAPHY32

The population is shifting from rural to urban settings, this shift signals an increased need for nursing related to problems caused by pollution and by the effects on the environment of concentrations of people. Thus, most nursing services are now provided in urban settings.

8)CURRENT NURSING SHORTAGENursing supply is inadequate to meet the demand, especially for specialized nurses (e.g.critical care) and it is anticipated to worsen during the next 20 years. It is recommended to improve the nurses work environment, provide greater flexibility in work hours, and reward experienced nurses who serve as mentors, ensure adequate staffing and increase salaries.

9)COLLECTIVE BARGAININGMore nurses are using collective bargaining to deal with their concerns. Today, some nurses are joining other organizations that represent at the bargaining table. Nurses have gone on strike over economic concerns and over issues about safe care for clients and safety for themselves. NURSING IN INDIA 1. Military Nursing was the earliest type of nursing. 2. St. Stephenss hospital at Delhi was the first one to begin training the Indian girls as nurses in 1867. 3. In 1867, the first school of nursing was started in Government General Hospital, Madras. 4. In March 1888, ten qualified British nurses arrived in India to look after the British army in India. 5. In 1905 during the British rule in India missionary nurses arrived as members of missionary medical association. 6. In 1905 trained nurses association of India (TNAI) was formed. 7. In 1926madras state formed the first registration council-certificates are being registered by the madras nurses and midwives council, which was set up in 1926. 8. The first four year basic bachelor degree program was established in 1946 at the college of nursing in Delhi and Vellore. 9. The Indian nursing council was passed by ordinance on December 31st 1947.The council was constituted in 1949 10. The name of the south India Board was changed to the Board of Nursing Education Nurses League of Christian Medical Association of India South India Branch in 1975.

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NURSING AS A PROFESSION.*Nursing originated from Latin word NUTRIX to nourish. The word NURSE consists of the following noble and profound essence of the profession to begin with N-Nobility U-Understanding R-Responsibility S-Sympathy and Simplicity E-Efficiency and Equality

NursingNursing has been granted great significance for centuries its mission, service, particular tasks in the society. Nursing as a profession begins with establishment of first school for nurses in England, in the 2nd part of 19th century. It is a unique profession regarding intimacy between a nurse and a patient. Nursing is a disciplined involved in the delivery of health care to the society. Nursing is a helping profession. Nursing is service oriented to maintain health and wellbeing of people. Nursing is an art and science.Genevieve and Roy Bixler, a husband and wife team of non-Nurses who were nevertheless advocates and supporters of nursing, first wrote about the status of nursing as a profession in 1945They appraised nursing according to their original seven criteria, noting the progress made in nursing, as a profession.

CONCEPTS OF NURSINGThe nursing profession is built upon four key concepts: 1. Person, 2. Environment, 3. Health 4. Nursing.

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*Alexander. J.G. (2006).Professional Development.www.cure.4kids.org1. PERSON Human beings are considered in terms of their physiological,psychological,social,and spiritual and cultural selves.People are evaluated in terms of their individual place in society as well as their relationships to their family,community and society as a whole. Human beings are viewed in terms of their individual needs and how nursing practice is applied to meet these needs. The purpose of nursing is to identify how a particular individual's needs are either met or not met, to predict future needs and to prioritize those needs in order of importance. 2. ENVIRONMENT. The environment concept of nursing comprises all the internal and external factors that act on human beings and affect their behavior and development.This includes psychological,spiritual,social,physical and cultural forces as well as the environment in which nursing care is provided.eg positive nursing environment demonstrate good health. 3. HEALTH The concept of health refers to an individuals physical,mental and social well-being and at what point they are on the health spectrum,which ranges from good health to poor health or death.Its the responsibility of nursing professionals to identify the patients place on the spectrum and to take steps to help that persons health improve.Health is considered to be affected by genetic factors,environmentalfactors,lifestyle factors and external mechanisms,such as bacteria. 4.NURSING Nursing refers to the process of caring for the health of humanbeings and assisting individuals in meeting their needs while also teaching them the basics of caring for themselves.The responsibilities of the nursing profession are to promote good health,to prevent disease when possible to promote healing in those who are ill and to ease the suffering of dying patients.The concept of nursing extend beyond the health care facility to the community and society as a whole,and views individual health an d the environment s closely related.Nursing is defined as care that is tailored to the needs of individuals and that is provided in n efficient and effective manner

ProfessionProfessions are those occupations possessing a particular combination of characteristics generally considered to be the expertise, autonomy, commitment, and responsibility

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1)Profession is defined as "a vocation requiring advanced training and usually involving mental rather than manual work, as teaching, engineering, especially medicine, law -Webster1989. 2) A profession is an occupation based on specialized intellectual study and training, the purpose of which is to supply skilled services with ethical components and others. 3)A paid occupation especially one that involves prolonged training and a formal qualification. Profession is a calling that requires special knowledge, skill and profession

Difference between profession and occupationSL.NO PROFESSION OCCUPATION

1

College or University

On the job training

2

Prolonged education. Length varies.

Mental creativity. Largely manual work.

3

Needs extensive training and specialized knowledge.

Does not need extensive training.

4

Decisions based on science.

Guided decision making

5

Theoretical constructs Values, beliefs &ethics are integral part of preparation.

theoretical constructs Values, beliefs & ethics are not integral part of preparation

6

Strong commitment

less commitment

7

Autonomous

Supervised

8

Unlikely to change professions36

Often change jobs

9

Individual accountability

Employer is primarily accountable.

Professionl

Nurse

A professional nurse therefore is a person who has completed a basic nursing education program and is licensed in his country to practice professional nursing Professional role is fundamental for nurses, and its essence lies in caring (the most remarkable, referred to public expectations and requirements task). Expectations derive from social values; their observance becomes a criterion of social trust evaluation. Professional prestige, social evaluation, a need for professions existence and development depend not only on education, but also on ethical foundations. Also tradition is of great importance in education and training of nurses.

Criteria of profession.1. To provide a needed service to the society. 2. To advance knowledge in its field. 3. To protect its members and make it possible to practice effectively.

Characteristics of a profession.The occupation to be termed a profession. It should have the following characteristics. 1. It should have a body of organized scientific knowledge and requires its members to attain a pre-set standard before allowing the member to practice. 2. It requires an organized period of extensive study by its members in recognized institutions of higher learning that is not only theoretical in nature but also highly skill based. 3. It must be founded on a scientific basis that is its body of knowledge should be derived from a scientific research. 4. A profession should have a code of conduct to guide its members and the development of the profession. Its members are expected to continue learning throughout their professional life. 5. A profession is primarily concerned with service to humankind. 6. It is dedicated to improvement in the quality of life. Fore a professional person monetary or economic gain is secondary. 7. It has a professional language,, which is known and is used by its members.37

8. Its existence must be deemed necessary and accepted by this community. 9. It should have clear goals aiming at enhancing individual and community development. 10. It has recognition at national and international levels. 11. A profession has to grow and develop in line with the scientific and technological changes in the world. 12. A profession must be self-governing or independent in its functioning. It protects society from unscrupulous people doing professional practice. 13. A basic profession requires an extended education of its members, as well as a basic liberal foundation. 14. A profession has a theoretical body of knowledge leading to defined skills, abilities and norms. 15. A profession provides a specific service. 16. Members of a profession have autonomy in decision making and practice. 17. The profession has a code of ethics for practice

Characteristics of nursing profession*i. Nursing is caring. ii. Nursing involves close personal contact with the recipient of care. iii. Nursing is concerned with services that take humans into account as physiological and sociological organisms. iv. Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status. v. Nursing is committed to involvement in ethical, legal and political issues in the delivery of health care.. vi. Nursing utilizes in its practice a well- defined and well-organized body of specialized knowledge. vii. A profession constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the nurses of the scientific method. viii. A profession entrusts the education of its practitioners to institutions of higher education. ix. A profession applies its body of knowledge in practical services which are vital to human and social welfare x. A profession functions autonomously in the formation of professional policy and control of professional activity thereby. xi. A profession attracts individuals of intellectual and personal qualities who exalt service above personal gain and who recognize their chosen occupation as a life work38

xii. A profession strives to compensate its practitioners by providing freedom of action, opportunity for continuous professional growth and economic security

*Zurker, R. (2012).Is Nursing a Good Career. www.ehow.comQualities of Professional Nurse.Nurses touch people all along the spectrum. Nurses are pretty amazing. The career of nurse offers a sense of personal satisfaction. To succeed in nursing and to gain personal fulfillment, the career needs unique qualities. 1) Personality a) Well combed hair b) Clean face c) Badge d) Washed dress e) Well cut nails f) Clean stockings g)Clean footwear 2) Communication skills Communication skills are a basic foundation for any career. But for nurses, its one of the most important aspects of the job. The nurse has excellent communication skills especially speaking and listening. It helps to understand, advocate for patient and anticipate their needs. 3) Emotional stability. Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. 4) Empathy. Great nurses have empathy for the pain and suffering of patients. They are able to feel compassion and provide comfort but be prepared for the occasional bout of compression fatigue.39

5) Flexibility. Being flexible and rolling with the punches is a staple of any career, but its especially important for nurses. A great nurse is flexible with regards to working hours and responsibilities. Nurses like doctors are often required to work long periods of overtime, late or overnight shifts and weekends. 6) Attention to skills Every step in the medical field is one that can have far- reaching consequences. A great nurse pays excellent attention to detail and is careful not to skip steps or make errors. 7) Interpersonal skills. Nurses are the link between doctors and patients. A great nurse excellent interpersonal skills and works well in a variety of situations with different people. They work well with other nurse, doctors and other members of the staff. 8) Physical endurance. Frequent physical tasks, standing for long periods of time, lifting heavy objects (or people) and performing a number of taxing maneuvers on a daily basis are staples of nursing life.A great nurse maintain her energy throughout the shift staying strong, eating right and having a healthy lifestyle outside of nursing is important too. 9) Problem solving skills. A great nurse can think quickly and address problems or before they arise with sick patients, trauma cases and emergency, nurses always need to be on hand to solve a tricky situation. Whether its handling the family, soothing a patient, dealing with a doctor, or managing the staff having great problem solving skills is a top quality of great nurse. 10) Quick response. Nurses need to be ready to respond quickly to emergencies and situations that arise. Quite often, health care work is simply the response to sudden incidences and nurses must always be prepared for the unexpected staying on their feet, keep their head cool in a crisis, calm attitude are great qualities in a nurse. 11) Respect. Respect goes a long way. Great nurses respect people and rules. They remain impartial at all times and are mindful of confidentiality requirements and different cultures and traditions. Above all, they respect the wishes of the patient him or himself. Great nurses respect the40

hospital staff and each other, understanding that the patient comes first and nurses who respect others are highly respected in return. Great nurses who exhibit all of these qualities each with a smile, who we respect and admire.

ROLES OF THE NURSE.Nurses assume a number of roles when they provide care to clients. Nurses often carry out carry out these roles concurrently not exclusively of one another. For example the nurse may act as a counselor while providing physical care and teaching aspects of that care. The roles required at a specific time depend on the nee needs of the client and aspects of the particular environment. Communication is an important factor in nursing care. The nurse is able to communicate clearly and accurately in order for a clients health care needs to be met.

1)TEACHER.As a teacher, the nurse helps clients learn about their health and the health care procedures they need to preform to restore or maintain their health. The nurse assess the clients clearing needs and readiness to learn sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning.

2)CLIENT ADVOCATE.A client advocate acts to protect the client. In this role the nurse may represent the clients needs and wishes to each other health professionals, such as relaying the clients wishes for information to the physicians. They also assist in exercising their rights and help them speak up for themselves.

3)COUNSELOR.Counseling is the process of helping a client to recognize and hope with stressful psychological or social problems to develop improved interpersonal relationships and to promote.

4)CARE GIVER.The care giver role has traditionally included those activities that assist the client physically and psychologically while preserving the clients dignity. The required nursing actions may involve face care for completely dependent client partial care for the partially dependent client and41

supportive educative care to assist clients in attaining their highest possible level of health and wellness. Caregiving encompasses the physical, psychological, developmental, cultural and spiritual levels. A nurse may provide care directly or delegate it to other caregivers.

5)COMMUNICATOR.Communication is integral to all nursing roles. Nurses communicate with the client, support persons, other health client, support persons, other health professionals and people in the community. In the role of communicator, nurses identify client problems and then communicate these verbally or in writing to other members of the health team.

6)EDUCATOR.Health promotion and disease prevention are a graving concern and focus of the health care delivery system. Educating clients about diseases, prevention, nutrition, and healthy behaviors is essential. Nurses must explain treatments and procedures for which they are responsible, answer any questions clients have and evaluate the program of clients toward health. Education is involved in all nursing activities.

EXPANDED NURSING ROLES.Many additional opportunities for carrier development and advancement are available in nursing. These opportunities some of which require advanced education, lead to new and varied roles and excited challenges.

1)NURSE PRACTITIONERA nurse practitioner has advanced education (at least a masters degree in nursing) and is a graduate of a nurse practitioner program. Nurse practitioners function with more independence and autonomy than other nurses and are highly skilled at doing nursing assessment, performing, physical examinations, counseling, teaching, and treating minor health problems. Nurse practitioners have a specialty such as obstetrics, pediatrics, or family care.

2)CLINICAL NURSE SPECIALIST.42

A clinical nurse specialist has a masters degree in nursing and may have advanced experience and expertise in a specialized area of practice (e.g. Gerontology, pediatrics, critical care, oncology, endocrinology, cardiovascular disease or pulmonary disease. Clinical nurse specialists work in various settings depending on their specialty. Roles of clinical nurse specialists include clinician, educator, manager, consultant and researcher.

3)NURSE MIDWIFE.A nurse midwife is educated in nursing and midwifery. Nurse midwifes provide independent care for women during normal pregnancy, labor and delivery. The practice in conjunction with specific health care agencies from which medical services are available should a client develop complications. Nurse midwives also may perform routine papanicolaou (pap) smears and breast examinations and assist clients with family planning.

4)NURSE ANAESTHETIST.A nurse anesthetic provides general anesthesia for clients undergoing surgery under the supervision of a physician prepared in anesthesiology. Nurse anesthetists are RNS with advanced education in anesthesiology.

5)NURSE RESEARCHERA nurse researcher is responsible for the continued development and refinement of nursing knowledge and practice through the investigation of nursing problems. Nurse researchers have advanced education, usually at the doctoral level. They tend to work in large teaching hospitals. All nurses have a responsibility to be involved in research and to use evidence-based findings to improve nursing care and to practice from a research basis.

6)NURSE ADMINISTRATOR.A nurse administrator manages and controls client care. Nurse administrators are responsible for specific nursing units and serve as liaisons between staff members and directions of nursing. Educational preparation for nurse administrators requires at least a baccalacereate degree in nursing and in some cases, a masters or doctoral degree.

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7)NURSE EDUCATOR.The nurse educator role can be developed in many settings, including schools of nursing and hospital staff development departments. Advanced education in nursing is required, usually a masters degree. Teaching at the baccalaureate, masters or doctorial level in nursing usually requires a doctoral degree. Nurse educators generally have specific clinical specialties and advanced clinical experience. People in this career role must continue to maintain expertise in the practical setting develop expert knowledge of theory, perfect classroom presentation style and have in depth knowledge of curriculum development and higher education.

CRITERIA OF A PROFESSION.Nursing is a noble profession recognized internationally.Nursing is gaining recognition as a profession based on the criteria that a profession must have. 1. Awell-defined body of knowledge. 2. A strong service orientation. 3. Recognized authority by a professional group. 4. A code of ethics: ICN. A professional organization that sets standards: NNC / NAN. 5. Ongoing research. 6. Autonomy. 1)Flexners criteria for defining a profession. In 1915 Dr. Abraham Flexner described criteria of a profession. The criteria include. 1) Professional activity is based on intellectual action along personal responsibility. 2) The practice of a profession is based on knowledge, not routine activities. Professions are based on a specific body of knowledge that can be learned. 3) There is a practical application rather than just theorizing. 4) Professionalwork can be taught through professional education. 5) A profession is organized internally. Professionshave strong internal organization. 6) A profession is motivated by altruism with members working in some sense for the good of society.44

2) William shepherd (1948) criteria of profession 1.scientific principles-A profession must satisfy an indispensible social need and be based upon Well established and socially accepted scientific principles. 2. Demands: A profession must demand adequate pre-professional and cultural training. 3. Demand: A Profession must demand the body of specialized and systematized knowledge. 4. Must give: A Profession must give evidence of needed skills which the public does not possess ie.skills which are partly native and partly acquired. 5.Scientific technique tested experiences. A profession must have developed a scientific technique which is the result of tested experience.

6.Time judgment / duty Performance. A profession must require the exercise of discretion and judgment as to time and manner of performance of duty.This is in contrast to the work which is subject to immediate direction and supervision. 7. Beneficial workProfession must be atype of beneficial work,the result of which is not subject to standardization in term of unit performance or time element. 8.Groupconsciousness: scientific knowledge.Profession must have sufficient self-impelling power to retain its members throughout life.It must not be used to mere stepping stone to other occupations. 9.Sufficient self impelling power. Profession must have sufficient self-impelling power to retain its members throughout life.It must not be used to mere stepping stone to other occupations. 10. Obligation to society: code of ethics.A Profession must recognize its obligations to society by insisting that its members live up to establish code of ethics. 3) Kelly: - 1981 Kelly reiterated and expanded Flexners criteria and listed following characteristics of a profession. 1. The Service provided isvital to humanity and welfare of society.45

2. There is a special body of knowledge which is continually enlarged through research. 3. The service involve intellectual activities,individual responsibility (accountability)is a strong feature. 4. Practitioners are educated in institutions of higher learning. 5. Practitioners are relatively independent and control their own policies and activities (autonomy). 6. Practitioners are motivated by job / service (altruism) and consider their work as an important component of their lives. 7. There is a Code of ethics to guide the decisions and conduct of practitioners. 8. Thereis an organization (association) which encourages and supports high standards or practice.

4) PALVALKOS EIGHT DIMENSIONS OF A PROFESSION. A profession has reliance to social value. When thinking about the characteristic, one has to think about the historical aspect of nursing and its roots in true altruism and providing service to others. Today, registered nurses are concerned with the total patient, focusing on wellness and health promotion as well as the actual disease process. Think about the registered nurse and health promotion and education of the patient, family and community and the impact this has on social values. Elements of self-motivation address the way in which the profession serves the client or family and larger social system. Registered nurses have engaged in political activities in order to reform health care. These actions are a means of translating social valves into action. A profession has a code of ethics. The American nurses association adopted and first published the nursing code of ethics in the 1950s. It has had many revisions reflect the changes in the profession and in society. The code and is the foundation upon which registered nursed provide care, it provides a framework for decision making and basically guides the action of the registered nurse. A professional has a commitment to life-long work. According to Pavalko 1) The professional person looks at the career as more than a job, more than a stepping stone to another area of work.

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2) Member controls their profession. There are numerous controls over the practice of nursing, including but not limited to the 50 nurse practice acts and state boards of nursing. 3) A profession has a theoretical framework on which professional practice is based. Nursing has borrowed much of its information from other sciences and the humanities. There have been many nursing theorists that have contributed to an evolving theory-based nursing science. 4) Members of a profession have a common identity and distinctive subculture. In years past the registered nurse could be distinguished by thenursing cap and the nursing pin. The nursing cap and pin would even reflect the school form which he/she received their basic education. However today the nurse does not wear a cap and frequently not a nursing pin and the name tag is not visible because the nurse does not like the photo identification or the credentials of the registered nurse are not displayed. 5) There is practical application rather than just theorizing. 6) Professional work can be taught through professional education. 7) A profession is organized internally professions have strong internal organization. 8) A profession is motivated by altruism with members working in some sense for the good of society. 5) Bixler and Bixler(1959) Bixler and Bixler criteria of a profession included the following 1. A Profession utilizes in its practice, as well defined and well organized body of knowledge which is on the intellectual level of the higher learning 2. A profession constantly enlarges the body of knowledge it uses and improves its techniques of education and service by the use of scientific method. 3. A profession entrusts the education of its practitioners to institutions of higher education. 4. A profession applies its body of knowledge in practical services which are vital to human and social welfare. 5. Aprofession functions autonomously the formulation of professional policy and in the control of professional activity thereby. 6. A profession attracts individuals of intellectual and personal qualities who exacts service above personal gain and who recognize their chosen occupation as a lifework. 7. A profession strives to compensate its practitioners by providing freedom of action, opportunity for conscious professional growth and economic security.47

IMAGE OF NURSING.HISTORICAL DEVELOPMENT OF NURSINGS IMAGE

Nursing was perceived as womens work a natural extension of all of the altruistic qualities valued in nursing. Women were expected to lovingly devote themselves to the health and well-being of other people The usual image of Florence Nightingale is of a self-sacrificing young woman with no desire or need for money, rest, or recognition. Even today, the image of Florence Nightingale as the lady with the lamp remains perhaps the most popular image of the founder of modern nursing.

LINKAGE BETWEEN MASSMEDIA AND NURSING IMAGE

Extensive researchers on the image of the nursing profession have been done by Kalisch and Kalisch.They identify six periods during which distinct corresponding images of the nursing profession can be seen. PERIOD 1: Angel of Mercy (1854-1919) In the pioneer days of nursing, there were two prominent images of nurses. One image in a novel by Charles Dickens wasSairyGamp, the poorly educated domesticchores. The second prevailing image was Florence Nightingale, theoriginal Angel of Mercy. In the early 1900s nurses were viewed as honorable, moral, spiritual, selfsacrificing and ritualistic. World war 1 media representations continued the Angel Of Mercy image idealizing nurses and making them a totem of exemplary moral purity. During the Angel of Mercy era nurses appeared in a substantial number of a literacy endavers.Nurse heroines were characterized as being involved in a dual search a success and meaning through nursingandhappiness and fulfillment through love and marriage. Films generated from Hollywood emphasized nursing as it was during the war. The war provided an improvement of the professions image in novels. PERIOD2: GIRL FRIDAY (1920-1929) With the passage of the womens suffrage reform in 1919, women entered a new domain of professional endeavors and activities.World war1 and the 1918 influenza epidemic created a vast need for nurses and increased the importance of instructing nurses in the area of home nursing.48

The attitude was conveyed in the enterprises of Hollywood in which nursing was depicted as a conscientious and admirable job choice, but acceptable only until time of marriage.Nursing was simply a means to an end. In novels written after World War 1, nurses diminished in importance. PERIOD 3: Heroine (1930-1945) For the next 15 years, nursing was acknowledged as a worthy and important profession that enabled women to earn an honorable living. Nurses were identified as educated and owning certain abilities. Adjectives such as courageous, chivalrous, fearless, reasonable, clearheaded,humanitarian and magnanimous were used to illustrate and portray nurses. The only feature length films ever produced that focused entirely on the nursing professionseven in number-were released in the 1930s.These films stressed the education and work of professional nurses. Attractive young women were portrayed as putting the demands of their profession before personal ambitions.One of the popular films, nominated for the 1934 Academy Award for best picture, was The White Parade.Loretta Young provided audiences with a realistic portrayal of the challenges and problems encountered in becoming a nurse in a large hospital school. PERIOD 4: MOTHER (1946-1965) After World War 2 major goal for many American women was to stay home and care for children. Nurses during this period were chronicled as maternal,compassionate,unassertive, submissive and domestic. During the 1950s television programs usually portrayed nurses as worthy of respect and appreciated for their skills. They were depicted in roles subordinate to physicians and employed in positions that they would easily surrender for marriage or children. Work as a nurse was often seen as a means to obtain amenities such as a means to obtain amenities such vacations, luxuriesor the home and family. In the figures of Ben Casey and Dr.Kildare 1960s although the nurse was positively portrayed in these films as intelligent,altruistic,perceptive,and energetic,there was a subtle erosion of the nurses image. PERIOD 5: SEX OBJECT(1966-1982) After 1966 the mother image of the nurse, which was popular in the mid 1940s changed to the sex object image.Nurses were increasingly depicted as being sexually promiscuous, selfindulgent, superficial and unreliable.Nurses became sexual mascots for health teams and were seen in x rated movies. Eventually, nurses were portrayed as cold,uncaring, power, hungry, and

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unmotivatedpersons, and the once-honored and virtuous film image of the nurse was a thing of the past. For example, major Margaret hooligan on MASH was technically competent but had little effect on client welfare. As a surgical nurse she was supportive of the surgeons, but they were clearly the heroes. The television show closely associated with scientific endeavors was the portrayal of the nurse in Doctors Private Lives. In her off-duty hours the nurse served as an assistant to a physicianresearcher. The nurse was often chastised,insulted,and sexually manipulated by the physician. Bumper stickers and T-Shirts claiming Nurses Call The Shots and greetingcards that depict nurses who derive pleasure from the discomfort of clients may, on the surface, appearfairly innocent and cute, but they relay a subtle message to those who interpret them in various ways. Shows such as St.Elsewhere, Trapper John,M.D, and daytime dramas depicted nursing in an unfavorable and unprofessional light.

PERIOD 6: CAREERIST (1983-PRESENT) The careerist has become the new image for the mid-1980 and 1990s, portraying nurses As intelligent,logical,progressive, sophisticated, empathetic, andassertive. Men and women in the nursing profession are dedicated to providing the highest standards of health care and the greatest expanse of excellence to the consumer. The enhanced image of nursing in then careerist period is the collaborative practice that has encouraged nurses and physicians to practice in tandem for the quality of care of all, with nurses being recognized as the pivotal provider for entry into the health care system. NURSINGS IMAGE OF ITSELF Individual attitudes,feelings,and perceptions are reflected in ones appearance, behavior,and outcomes of interactions with others, Including clients,peers,and the public.Collectively these individual nurses attitudes, behaviors, and interactions constitute nursings self-image. The image of nursing held by nurses is cited as perhaps the most damaging influence affecting the professions image. Nurse who verbalize comments such as Im only a staff nurse or I was just following the physicians order are not improving the image of nursing. It is the challenge for each nurse to extend the best image possible and offer the utmost by substantiating the value of that service.Tradition is cultural contents passed from generation to generation (customs,

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opinions, beliefs, rituals, norms etc.) accepted by a community (nation) as socially important for its present and future.

NURSING SYMBOLSTransmission of these cultural contents within the community Traditionally, graduation of nurses is celebrated with presenting them professional symbols and signs

1) FLORENCE NIGHTINGALE OLIVE OIL LAMP .The ancient tradition of lighting oil lamps has a special significance, says Ranjeni A Singh.

In Christianity, Judaism and Buddhism, lighting candles and lamps signify the presence of the Divine. In the Quran, there is a chapter devoted to the importance of the inner spiritual light that connects the pious an

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CHRISTIAN COLLEGE OF NURSING, NEYYOOR SEMINAR ON History of development of nursing profession GUIDED BY: PRESENTED BY: Mrs. A. Femila Darling J. AsirDhayani Reader M.sc Nursing1 st Year Community Health Nursing Medical Surgical Nursing 1
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