Nursing

Is an art and a science bi which people are assisted in learning to care for themselves whenever
possible and cared for by others when are unable to meet their needs
Nursing has evolved from an unstructured method of caring for the ill to a scientific profession.
The result has been movement from the mystical belief of primitive time to a high tech, high touch era.
Nursing combine art and science. Using scientific knowledge in a humane manner, nursing combines
critical thinking skill with caring behavior.
Nursing require a delicate balance of promotion clients independence and dependence. Nursing
focuses not on illness but rather on the clients response to illness.
Nursing promotes health and helps clients move to a higher level of wellness. This aspect of
nursing also includes assisting a client with a terminal illness to maintain comfort and dignity in the final
stage of life.

Historical overview
To understand the present status of nursing, it is necessary to have a base of historical knowledge about
the professor. By studying nursing history the nurse is better able to understand such issues as:
Autonomy unit within the profession, supply and demand, salary, education and current practice.
History is a study of the past that includes events, situation and individual.
Empowerment is a process of enable others to do for themselves. Only when nurse are empowered
are they truly autonomous.

Evolution of nursing
Nursing has evolved with the development of civilization of mankind. Refer to table 1 1 and the
following for a discussion of nursing from early civilizations to the present era of advanced nursing
practice and health care reform.

Early civilizations
Most human group provided care for their sick and wounded. Prehistoric human remains show evidence
of healed major fractures of the legs, arms, and skull, which attest to someone providing care so the
person could heal. The recoded evolution if nursing date back to 4000 bc, to primitive societies in which
mother- nurses worked with priest. In 2000bc. The ise of wet nurses is recorded in babylonia and
Assyria.

Ancient Greece
These temple were more like health spa rather than hospitals in that they were religions
institution governed by priest. Priestesses attended to those housed in the temple. The nursing that was
done by woman was performed in the home.

Roman Empire
Hospitals were first established in the eastern Roman Empire. St. Jerome was responsible,
though one of his disciples, fabiola, for introducing hospital in the west.

Middle Ages
Hospital in large byzantine cities were staffed primarily by paid male assistants and male nurse. During
the medieval era, these hospital were established primarily as almshouses, with care of the sick being
secondary.

Renaissance
During the renaissance (AD 1400 1550), interest in the art and science emerged. This was also the time
of many geographic explorations by europeans. As a result, the world literally expanded.













DATE EVENT
4000bc primitive societies
2000bc Babylonian and Assyria
800-600bc health religions of India
700bc Greece: source of modern medical science
460bc Hippocrates
3bc Ireland: pre-Christian nursing
Ad 390 Fabiola founded first hospital
390-407 early Christianity, deaconesses
711 field hospital with nursing, Spain
1100 ambulatory clinic, Spain (moslems)
1440 first chairs of medicine, oxford and Cambridge
1522 military nursing order
1600-1752 deterioration of hospitals and nursing
1633 founded: daughters of charity
1820 Florence nightingale born
1836 kaiserwerth deaconesses reestablished
1837 first American college for women, Mount Holyoke
1841 founded: nursing sister of the holy cross
1848 womens rights convention, Seneca Falls, new York
1854-1856 Crimean war
1859 nightingales note on nursing published in England
1860 First Nightingale School for Nurse, St. Thomas Hospital, London
1861-1865 Civil War, United State: nursing nuns, untrained nurses provided care
1863 Charter granted to the New England Hospital for Women, Boston
1871 New York State Training School for nurses, Brooklyn Maternity,
Brooklyn, New York
1872 New England Hospital for Women: one year program for nurses
DATE EVENT
1873 Americas first trained nurse, Linda Richards
First three Nightingale school in United State: Bellevue (New York City),
Connecticut, and Massachusetts General
Americas first trained African America nurse, Mary Eliza Mahoney
1881 Founded: America Red Cross
1882 Founded: American Association of University Women
1888 Founded: International Council of Women (ICW)
Founded: National Council of Women (NCW)
1893 First Nurses Settlement House, New York City, founded by Lillian Wald
and Mary Brewers
Founded: first American Nursing Society, American Society of
Superintendents of Training School for Nurse (Superintendents Society)
1896 Founded: National Association of Colored Women
1896-1911 Founded: Nurses Associated Alumnae of the United State and Canada
(Associated Alumnae)
1899 Founded: International Council of Nurse (ICN)
First postgraduate course for nurses at Teachers College, Columbia
University
1900 American Journal of Nursing (IJN)
1901-1912 Founded: American federation of nursing (federation)
Federation joins NCW and ICW
1903 New York: efforts failed to pass a nurse licensing law
North Carolina: passes first state nurse registration law
Founded: Army Nurse Corps
1905 Federation withdraws for, NCW and joins ICN
1908 National Association of Colored Graduate Nurses (NACGN)
Founded: Navy Nurse Corps
1909 Founded: first 3-year diploma school in a university setting at University
of Minnesota
1910 Flexner report
1911 Founded: American Nurses Association (ANA), formerly the Associated
Alumnae
1912 Founded: National Organization of Public Health Nursing (NOPHN)
Founded: National League of Nursing Education (NLN), formerly the
Superintendents Society
ANA represents American nurses at ICN
Nutting Report: Educational Status of Nursing
Developments in preventive medicine
Founded: Town and Country Rural Nursing Service
1913 Founded: National Womens Party
1916 Founded: National Association of Deans of Women
1920 Founded: National League for Women Voters
Congress passes the federal suffrage amendment
1920s Depression: social programs and health insurance
First prepaid medical plan, Pacific Northwest
Founded: Bureaus of Medical Services
Hospitals offered a prepaid plan
Baylor Plan (prototype of Blue Cross)
Goldmark report
1921 Women earn right to vote
Founded: Sigma Theta Tau National Society for Nursing
1922 Studies of institutional nursing
1923 Studies of nursing education
Goldmark report
Founded: Yale University School of Nursing
1926 Burgess report
1929 Stock market crash begins the Great Depression
1933 American Hospital Association endorses Blue Cross
1938 American Hospital Association endorses Blue Shield
Economic Security Program for Nurses
1940 Cost studies of nursing education and service
1943 Founded: Federal Cadet Nurse Corps
1948 Brown report: Future of Nursing
1952 Journal of Nursing Research
1953 U.S. Public Health Studies in Nursing Education
1955 Practical Nursing (Title III) Health Amendment Act
1956 Hughes study: 20,000 Nurses Tell Their Stories
1960s Created: Medicare and Medicaid
1961 Surgeon Generals Consultant Group
1964 Nurse Training Act
1965 ANA position paper on entry into practice
1966 Educational opportunity grants for nurses
1967 First nurse practitioner program, pediatric
1970 Secretarys commission to study extended roles for nurses
1973 Health Maintenance Organization Act
1977 Rural Health Clinic Service Act
National Commission for Manpower Policy Study
1979 U.S. Surgeon General Report Health People
1980 Omnibus Budget Reconciliation Act
1982 Budget cut to Health Maintenance Organization Act
Tax Equity Fiscal Responsibility Act (TEFRA)
1983 Institute of Medicine Committee on Nursing and Nursing Education
study
1987 Secretarys Commission on Nursing
1990s Health care reform
1991 U.S. Department of Health and Human Service Healthy People 2000
1997 Agency for Health Care Policy and Research, now known as the Agency
for Healthcare Research and Quality, established 12 evidence-based
practice centers
2000 U.S Department of Health and Human Services Healthy People 2010
2002 Nursing shortage clearly identified as a crisis for health care delivery
system.





















Enlightenment and industrial revolution
The industrial revolution introduced technology that led to a proliferation of factories. Condition for the
factory workers were deplorable. Long hours, grueling work, and unsafe condition prevailed in the
workplace. The health status of laboratory received little, if any attention.
Religious influences
the strong influence of religions on the development of nursing started in india and flourished in Greece
and Ireland in 3 bc with male nurse priest. In india, only men were consider pure enough to be
nurse.
Florence nightingale
Nightingale forged the future of nursing education as a result of her experiences in training nurse to care
for british soldier. She established the nightingale training school of nursing at st. Thomas Hospital in
London. This was the first school for nurses that provided both theory based knowledge and clinical skill
building. Some of nightingales novel beliefs about nursing education were:
A holistic framework inclusive of illness and health
The need for a theoretical base for nursing practice
A liberal education as a foundation for nursing practice
The importance of creating an environment that promotes healing
The need for a body of nursing knowledge that was distinct from medical knowledge
(nightingale, 1969)

Nursing and the civil war
During the civil war, nursing care was provided by the sister of mercy, daughters of charity,
Dominican sisters, and the Franciscan sisters of the poor. The sisters were influenced by the role
assigned to women during the 19
th
century.
The women movement
By the mid 1900s, more women were being accepted into colleges and universities, even though
only limited numbers of university based nursing program were available
Nursing pioneers and leaders
Note the term trained nurse was used historically as the predecessor of registered nurse.
Information is presented in alphabetic, not chronologic, order.
Mary breackinridge
She created a decentralized system for primary nursing care services in the Kentucky
Appalachian mountains. This system, the frontier nursing service, lowered the childbirth mortality rate
in leslie country, Kentucky, from the highest in the nation to below the national average.
Jane Delano
Delano was opposed to the aide education plan because it violated the education standards
already established by nursing. This position pitted Delano against annie Goodrich and Adelaide nutting.
The Red Cross recognized Delanos leadership abilities and dropped the aide plan.
Lavinia dock
An influential leader in American nursing education was Lavinia Dock, who graduated from
Bellevue Training School for Nurses in 1886. In her early nursing practice, she worked at the Henry
Street Settlement House in New York City providing visiting nursing services to the indigent.
Martha Franklin
Martha Franklin was one of the first people to advocate racial equality in nursing. She was the
only African American graduate of her class at Womens Hospital Training School for Nurses in
Philadelphia. In 1908, Franklin organized the National Association of Colored Graduate Nurses (NACGN),
which advocated that black nurses meet the same standards required of other nurses to prevent a
double standard based on race.
Annie Goodrich
Annie Goodrich was influential in national and international nursing issues. During World War I,
the supply of civilian nurses was greatly depleted because of the Armys need for trained nurses.
Goodrich pushed for the establishment of an Army training school for nurses, which she envisioned as a
model for other schools of nursing.
Amelia Greenwald
Amelia Greenwald was pioneer in public health nursing on the international scene. In 1908, she
entered the Touro Infirmary Training School for Nurses in New Orleans Louisiana. After graduation,
Greenwald studied psychiatric and public health nursing. She served as chief nurse in several field
hospitals during World War I. In 1923, she accepted the challenge of establishing a school of nursing in
Poland.
Mamie Hale
In 1942, Mamie Hale was hired by the Arkansas Health Department to upgrade the educational
programs for midwives. Hale, a graduate of Tuskegee School of Nurse-Midwifery gained the support of
granny midwives, public health nurses, and obstetrician.
Mary Mahoney
Americas first African American professional nurse, Mary Mahoney was a noted nursing leader
who encouraged a respect for cultural diversity. Today, the ANA bestows the Mary Mahoney Award in
recognition of individuals who make significant contributions toward improving relationships among
multicultural groups.

Adelaide Nutting
Adelaide Nutting was a nursing educator, historian, and scholar. She actively campaigned for
nurses being educated in university professorship. In 1910, Nutting was appointed to direct the newly
established department of nursing and health at Teachers College, Columbia University, in New York
City.
Harriet Neuton Phillips
Harriet Neuton Phillips was the first known graduate of the Womens Hospital of Philadelphia. A
6-monthe training course for nurses had been established by Dr. Ann Preston in 1861. Although no
formal diplomas were awarded, the graduate nurses worked in the hospital and did private duty nursing
in homes. Thus, Harriet Phillips can claim the title of the first American nurse to receive a training
certificate.
Linda Richards
In 1873, the first diploma from an American training school for nurses was awarded to Linda
Richards. Richards founded or reorganized 10 hospital-based training schools for nurses. She introduced
the practice of nurses wearing uniforms. As the first Superintendent of Nurses at Massachusetts General
Hospitals, she demonstrated that trained nurses gave better care that those without formal nursing
education.
Isabel Hampton Robb
Isabel Hampton Robb was responsible for founding several nursing organizations, namely the
Superintendents Society in 1893 and the Nurses Associated Alumnae of the United States and Canada
in 1896. She recognized the necessity of nurses participating in professional organization to establish
unity throughout nursing on positions and issues. She was instrumental in establishing both the
American Nurses Association and the National League of Nursing Education.
Margaret Sanger
In 1912 Margaret Sanger, a nursing living in New York City, became concerned with women who had too
many children to support. She coined the phrase birth control and began writing about contraceptive
measures. Sanger fought to revise legislation that prohibited dissemination of information about
contraceptive.
Adah Belle Thoms
Adah Belle Thoms was a crusader for improved relationships among persons of all races. In the
early 1990s, she became acting director of nursing of the Lincoln School for Nurses in New York when
African Americans rarely held high-level positions (Chinn, 1994). Thoms was one of the first to recognize
public health as a field of nursing. She campaigned for equal rights for black nurses in the American Red
Cross and the Army Nurse Corps.


Shirley Titus
Shirley Titus received a diploma from St. Lukes Hospital School of Nursing in San Francisco in
1915. During her career Titus served as dean of the School of Nursing at Vanderbilt University and in
1940 was the executive director of the California State Nurses Association. She advocated improved
economic security for nurses. Some of the many approaches to economic security for which she
campaigned were malpractice insurance coverage, improved salaries and benefits, and collective
bargain.
Lillian Wald
Lillian Wald spent her life providing nursing care to the indigent population. In 1893, as the first
community health nurse, she founded public health nursing with the establishment of the Henry Street
Settlement Service in New York City. Wald was a tireless reformer who:
Improved housing conditions in tenement districts
Supported education for the mentally challenged
Advocated passage of more lenient immigration regulations
Initiated change of child labor laws and founded the Childrens Bureau of the U.S. Department
of Labor
In addition to initiating public health nursing, Wald also established a school of nursing.
Nursing in 20
th
century
The beginning of the 20
th
century brought about change that have influenced
contemporary nursing. Several land mark report about medical and nursing education, as well
as some contemporary reports, are discussed below.
Flexner report
In 1910, supported by a Carnegie grant, Abraham Flexner visiting the 155 medical school
in the united state and Canada. The Flexner report was based on these finding and its goal was
to increase accountability in medical education.
Early insurance plans
At the turn the 20
th
century, there were more than 4,000 hospitals and 1,000 schools of
nursing. During this time, the concepts of third party payments and prepaid health insurance
were insulted
Blue cross and blue shield
The depression provided the main impetus for the growth of insurance plans. In addition, the
American philosophy of health care for all contributed to the growth of insurance plans. In 1920,
American hospital offered a prepaid hospital plans that led to the Baylor plan which
eventually became the prototype of blue cross.

Visiting nurses associations
In 1901, at the suggestion of Lillian wald, the metropolitan life insurance company,
which provided visiting nursing service to its policyholders, entered intro an agreement with the
henry street settlement . wald worked with metropolitan to expand the services of the managed
care began.
Landmark reports in nursing education.
During first half of the 20
th
century, a number of reports were issued concerning nursing
education and practice. Three of them, goldmark, the brown, and the institute of research and
service in nursing education report, are discussed below.
Goldmark report.
In 1918, Adelaide approached the rockefelle foundation for support. Funding was
provided, and, in 1919, the committee for the study of nursing education was established to
investigate the training of public health nurses
Brown report
In 1948 esther Lucille brown a social anthropologist published nursing for the future and
nursing reconsidered: a study for change. Several recommendations were put forth in this study,
including the need for nurses to demonstrate greater professional competence by moving
nursing education from the hospital to the university setting.
Institute of research and service in nursing education report.
During the 1950s, there was a deficit in the supply of nurses as the post world war II
demand for nursing services increased. Some contributing factors to the dearth of the nurses
were the low esteem of nursing as a profession, long hours with a heavy workload, and low
salaries.
Other health care initiative.
In the 1960s,health care service were provided to the elderly and the indigent with the
federal governments inception of medicare and Medicaid.
Selected legislation
The health maintenance organization act of 1973 provided an alternative to the private
health insurance industry. Health maintenance organizations (HMOs) are prepaid health plans
that provide primary health care service for a predetermined fee.
Education and practice: contemporary reports
During the 1980s several important studies were commissioned to examine the areas of
nursing education and practice.

National commission on nursing
The national commission on nursing was created in 1980 by the American hospital
association, the hospital research and education trust, and the American hospital supply
corporation to study nursing education and related issues in the hospital management, nursing
practice, and nursing education. The commissions addressed the need for:
Adequate clinical education for students.
Baccalaureate education and educational mobility
Involvement of nurses in collaborative institutional and clinical decision making
Improved working conditions, specifically, salaries, flexible scheduling, and differential
practice.

Institute of medicine
Concurrent with the national commission on nursing study, another study was initiated by
congress in 1979 and conducted by the institute of medicine. The study, nursing and nursing education:
public policies and private actions, focused on the need for continued federal funding to nursing
education.
Secretarys commission on nursing
As a response to hospitals recruitment and retention challenges, health and human service
secretary otis r. brown, MD, established the secretarys commission on nursing, which made the
fallowing recommendation related to nursing practice:
Nurse compensation
Health care financing
Nurse decision making
Development, use, and maintenance of nursing resources (secretarys commission on nursing,
1988)