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History of NursingDenise Filiatrault RN, BSN, MNc

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Objectives Describe the evolution of nursing and nursing

education Discuss significant changes in nursing Identify nursing leaders Identify major organizations Identify components of the health care system Define nursing Define roles and responsibilities of the LPN and

RN

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Illness?

Early records Illness = standing with God Medicine man & witchcraft

Evil spirits

Hippocrates (born 460 BC) Rejected ‘supernatural’ Holistic care origins Hippocratic Oath “Do no harm”

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19th Century

Hospitals Overcrowded No training Nurses lower class women Unkempt Poor hygiene practices

Dirty conditions

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In small groups answer…. What standards did Florence Nightingale

contribute to nursing, and how have they affected the standards of the nursing profession today?

What impact did WWI and WWII have on nursing?

Why did professional nursing organizations develop in the twentieth century, and what is their purpose today?

What characteristics define the LPN/LVN role?

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Early Nursing Education Attendant Nurses

The Ballard School First school for training practical nurses Started in 1892 in Brooklyn, NY 3 months’ duration Trained students to care for the chronically ill,

invalids, children, and the elderly Main emphasis was on home care

Cooking, nutrition, basic science, basic nursing procedures Graduated as attendant nurses

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Nursing Education

Lutheran Order of Deaconesses Established the first real school of

nursing Located in Kaiserwerther, Germany Florence Nightingale attended this

school http://www.nytimes.com/learning/gen

eral/onthisday/bday/0512.html

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Nursing Education Florence Nightingale

Changed condition of the hospitals Cleaned units, washed clothes regularly, provided

sanitary conditions Through her patience, dedication, and empathetic

treatment, made a psychological change “Lady with the lamp”

Carried a lamp to light her way through the rows of beds of the injured and sick

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Nursing from Occupation to Profession

Contributions of Florence Nightingale Defined nursing as both an art and a

science Differentiated nursing from medicine Identified personal needs of patient and

role of nurse in meeting them Established standards for hospital

management Established nursing education and

nursing as a respected occupation for women

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Nursing from Occupation to Profession

Contributions of Florence Nightingale Stressed the need for continuing education for

nurses Recognized two components of nursing—health and

illness Recognized nutrition as important to health Instituted occupational and recreational therapy for

sick people Maintained accurate records/beginning of nursing

research

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Nursing Education in the USA Most early nursing programs were

supported by large hospitals. First three schools of nursing in the United

States Bellevue Hospital School of Nursing, New York Connecticut Training School, New Haven Boston Training School at Massachusetts General

Hospital, Boston Goal was to set education standards for nurses Code of ethics was adopted by the society

Nightingale Pledge

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Nursing in the USA

Nursing licensure First laws were established in 1903 Protect the public North Carolina, New Jersey, and New York

were first states Isabelle Hampton Robb and Mary Adelaide

Nutting Developed a program at Columbia University

to train and develop teachers of nursing

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Nursing

World War I Increased demand for nurses Army School of Nursing was

established Training focused on “service to the

patient” rather than on comprehensive care

Most nurses returned to previous jobs after the war

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Nursing World War I and World War II

Increased demand for nurses Army School of Nursing was established Training focused on “service to the patient”

rather than on comprehensive care Nurses stayed in the military after the war

Civilian nursing: low pay, long shifts, atrocious conditions

Military nursing: prestige, good pay, and opportunity for advancement

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Nursing Education

Characteristics of health care changed rapidly as health care became an industry

Growth and diversity became the major emphasis

Beginning of contemporary nursing with specialized nursing care adapted to areas Private duty, school nursing,

industrial nursing, nurse anesthesia, and nurse-midwifery

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Nursing Education Association of Practical Nurse

Schools Founded in 1941 Dedicated to practical nursing Planned the first standard curriculum

for practical nursing 1942: changed name to the National

Association of Practical Nurse Education (NAPNE)

1959: changed name to National Association for Practical Nurse Education and Service (NAPNES)

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Nursing 1961: National League for Nursing

established a Department of Practical Nursing Programs

Developed an accreditation service for PN programs; Council of Practical Nursing Programs

1965: American Nurses Association Education should take place in institutions of learning Many hospital-based nursing programs were

disbanded Trend was changed from “training” nurses to

“educating” nurses

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Contemporary Nursing Education Nursing programs are offered by various

organizations: high schools, trade or technical schools, hospitals, junior and community colleges, universities, private education agencies

Length of programs: 12 to 18 months Skills, theory, and clinical practice National Council Licensing Examination for

Practical Nursing (NCLEX-PN) Examination for licensure as LPN

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Nursing

Licensing laws Protect the public from unqualified

persons practicing in almost any field or profession

Jurisdictions Area such as a state that has the

legal power to regulate nursing licensure and practice State board of nursing

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Nursing as a Profession & Discipline

Practice in a wide variety of settings.

Develop a specific body of knowledge.

Conduct and publish nursing research.

Recognize role in promoting health.

Use nursing knowledge as base for nursing practice.

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Aims of Nursing

To promote health To prevent illness To restore health To facilitate coping with disability

or death

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Additional Roles of the Nurse Caregiver Communicator Teacher/Educator Counselor Leader Researcher Advocate Maybe a cheerleader too?

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Practical Nursing Defined The activity of providing specific services

to patients under direct supervision of a licensed physician or dentist and/or RN

Assist individuals, sick or well, in the performance of those activities contributing to health, to their recovery, or to a peaceful death

Educated to be a responsible member of a health care team, performing basic therapeutic, rehabilitative, and preventive care for anyone who needs it

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Role of the Nurse: 1887 In addition to caring for your 50 patients,

each nurse will follow these regulations:  Daily sweep & mop the floors of your ward, dust the patient's

furniture & windowsills. Maintain an even temperature in your ward by bringing in a scuttle

of coal for the day's business. Each nurse on day duty will report every day at 7 a.m. & leave at 8

p.m. except on the Sabbath on which day you will be off from 12 noon to 2 p.m.

Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church.

The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.

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In a small group: Discuss the Roles

Patient/Client Physician Physician Assistant Residents - Fellows ARNP Registered nurse LPN/LVN Nurses Aid Physical therapists

& Occupational Therapists

Respiratory therapists

Dietician Case Manager Radiology technician Pharmacists Janitor/Housekeeping Phlebotomist Social workers Nurse Managers House supervisors

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In a small group:

Discuss how a multidisciplinary approach to patient care is affected by the influences of other disciplines, economic factors, environmental issues, and expectations of the patient.

How does the nurse fit into this realm?

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In Class Activity Can I have a *not shy*

volunteer?

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Expanded Educational Roles

Clinical nurse specialist (CNS)

Nurse practitioner (DNP, ARNP)

Nurse anesthetist (CRNA)

Nurse–midwife Nurse educator

Nurse administrator

Nurse researcher

Nurse entrepreneur

Nurse Lawyer (RN, JD)

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Educational Preparation

Entry Level

LPN LPN-RN RN RN-BSN BSN

Graduate Level

RN – MN MN PhD now DNP CNS ARNP CRNA

Distribution - Nursing Education

http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurvey2004.pdf

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Advance Practice

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Nursing Research Systematic inquiry to develop knowledge

about issues of importance to the nursing profession Evidence-based practice projects Replications of current reseach Research integration through systematic

review Multisite and interdisciplinary studies Increased focus on health disparities

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Nursing Research Evidence-based practice (EBP)

Basing clinical decisions on best possible evidence—especially high-quality researchLevel of Evidence

Which is stronger?Professional opinion vs. Randomized Control TrialWikipedia vs. Medline

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Goals of Research Improve care of people in clinical setting. Study people and the nursing process.

Education Policy development Ethics Nursing history

Develop greater autonomy and strength as a profession.

Provide evidence-based nursing practice.

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Components of a Research Journal Article

Abstract Introduction Methods Results Discussion References

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Nursing Role in EB ResearchRead widely and criticallyAttend professional conferencesLearn to expect evidence that a

procedure is effectiveBecome involved in a journal clubPursue and participate in EBP

projects

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Nursing Research Related Websites

Organization WebsiteAmerican Nurses Association

www.nursingworld.org

American Nurses Credentialing Center—Magnet Recognition

http://nursecredentialing.org/magnet/

American Nurses Foundation

www.nursingworld.org/anf

Cochrane Collaboration www.cochrane.orgFlorence Nightingale site www.countryjoe.com/nig

htingale/index.htmlJoanna Briggs Institute (Aus)

www.joannabriggs.edu.au

National of Research http://ninr.nih.gov/ninr/Sigma Theta Tau International

www.nursingsociety.org

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Homework for Next Week

Go to one of the above websites and look around.

Post on the discussion board something interesting you found. See next week’s Required

Assignment for details