Guided by

Mrs. A.Femila Darling

Reader in Community Health Nursing
Presented by
J.Asir Dhayani
M.sc nursing 1st year
PERIODS OF NURSING
1.INTUITIVE NURSING
 INTUITIVE NURSING
ANCIENT PERIOD-PERIOD OF INTUITION
Extends from prehistoric time to early Christian
era.
1.Ancient people led a nomadic life.
2.Used stone as weapons and to make fire.
3.Natural worshippers and their belief is known
as animism and the period as stone age.
4.Nursing was untaught and instinctive. It was
performed out of wish to help others
1. BELIEFS OF ANCIENT PEOPLE
Illness was caused due to
a) supernatural power of human enemy.
b)DISPLEASURE OF DEATH.
C)OWN SIN.
d)SORCERY.
e) MAGIC
white magic to attract good spirit.
black magic to destroy evil spirit.
f) INVASION OF A DISEASE OBJECT.
g) BODILY INVASION OF SPIRIT
h) Loss of soul
BELIEF OF SOUL LEAVES THE BODY
a) Dreams.

BELIEF SOUL LEAVES THE BODY

b)submission
c)sacrifice
d)supplication
Practice of primitive people
a)Treatment by shaman or medicine man or
priest physician
b)Using certain tricks and methods on sick
person
c)startling the evilspirit with frightening mask
d)startling the evil spirit with deafening noises
and tricks on sick person
e)Jolting the person by shaking, biting, pinching
and kicking.
f)using noxious odours
g)giving purgatives and emetics
h)plunging them in hot and cold water
i)pacifying the evil spirit by sacrifice
j)encouraging the evil spirit to come out using
chants and mantras
k)using certain herbal medicines. Eg.: bark of
tree for rheumatism
l)trephining
m)faith of the person
Preventive measures
A)amulets
B)talismuns
Source of information
A)stone implements
B)cave markings
C)skeleton
D)sacred books
IMAGE OF NURSING IN ANCIENT PERRIOD
1.Women are early nurses.
2.Nursing started as intuitive response.
 3.Use problem solving skills
• For example
Physicians of the day believed that illnesses were caused
by an imbalance in the levels of four substances, called
humors, inside the body.

blood, from the heart, was warm and wet; phlegm,

from the brain, was cold and wet; yellow bile, from
the liver, was warm and dry; and black bile, from the
spleen and bowel, cold and dry. The ancient Greek
term for black bile is melaina chole. An excessive
influx of it into the brain caused melancholia, which
Hippocrates defined simply as “fear and dejection
that is prolonged.”
4.Utilize intellectual, interpersonal, and
psychomotor skills.
5.Practical
6.Capable, concerned, compassionate persons
7.Teach the knowledge and skills to individual,
family, communities, own successors
8.Discover new knowledge through freedom of
action.
9.They were composite of nurse, dietician,
pharmacist, physiotherapist, social worker.
SKILLS OF PRIMITIVE PEOPLE
a)massage
B)fomentation
C)bone setting
D)amputations
E)hot and cold baths
F)abdominal sections
G)heat to control hemorrhage
 CONTRIBUTIONS OF
ANCIENT CIVILIZATION
TO MEDICINE AND
NURSING
1)BABYLON(IRAQ4000-3000 BC)
Civilization is the emphasis upon man’s cultural
development. Babylon empire was founded by
king. Hammurabi.
1.Believed diseases were the result of sin.

• 1.
Priest made diagnosis and prognosis by
1.Observing the behavior of animals
2.flowing of water in rivers
3.shape of oil on water surfaces.
4.irregularity of an animal liver.
5.smoke from a burning fire.
6. personal dreams.
7.Difficulty in delivery as a result of
wrong
• Code of Hammurabi-provided laws that covered
every facet of Babylonian life including medical
practice.
.
1.The medical regulations
established fees.
.
2. discouraged experimentation
3..recommended specific doctors for each
disease.
4.gave each patient the right to choose between
the use of charms, medications or surgical
procedure to cure disease
 ACHIEVEMENTS
1.Law to regulate the physician conduct.
2.The Babylonian society was quasifeudal
• upper class- wealthy land owners, merchants
and priests.
• middle class-less wealthy merchants, artisans
and priests.
• Lower class-slaves.
3.treatment methods include incantations and
by the application of herbs.
4.The religion of worship of Bel,later called
Marduk,who was identified with the planet
Jupiter.
5.The ancient people of Mesopotamia (the
name of the general geographical area) built
enormous brick or stone temples
called ziggurats.
6.The animal scapegoat was
sacrificed.Humanbeings were also sacrificed
quite often.
7.From hepatoscopy,the Babylonians learned the
structure of the Liver and gallbladder and their clay
model are excellent anatomical specimen.
8.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
1.Oldest medical record date back to 1600 BC,
written on papyrus paper and have been
preserved in Egypt’s hot sands. One of the best
known is brought in 1874 AD byDr.Ebers of
Germany. So it is known as Eber’s Papyrus.
2.One outstanding priest physician Imhotep
means He who cometh in peace and was liked
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.
3.The 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 at any time.
4.The pyramids were the tombs of the Pharaohs.
The great ‘Pyramid's the largest built by King.
Khufu nearly 500 ft., height covers an area of 13
acres 1,00,000 men worked for 20 years.
.
5.The Egyptians practiced hygiene, separate
areas of the Nile River used for drinking hygiene
and sanitation
6.They also practiced cleanliness in dress and
habit and practiced circumcision.
7.They also recognized the importance of an
adequate system of drainage, water supply and
inspection of slaughter houses.
8.In Egypt they had medical laws as fixed laws. 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 to
heal the sick person, he was guiltless. But if he does contrary to
the written law, he was to get death penalty.
9.Hired nurses assisted in childbirth in ancient
Egypt reference to nurses in Moses 5th book is a
midwife and wet nurse.
10.The Egyptian pharmacopeia included
innumerable drugs. They could prepare some
drugs for eye conditions and surgery.
11.The healing treatment included prayers and
sacrifices.
12.The actual care of the patients, such as
dressing wounds was done by helpers.
ACHIEVEMENT
1.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. Egyptians added five days to the
Babylonian 360-day calendar. The ancient
Egyptian civil calendar had three season: 1)
Akhet (Flooding); 2) Peret (Growing or Sowing);
and 3) Shemu (Harvest). Each season had four
months with 30 days. The additional five days
were tacked onto the end of Harvest and set
aside for feasting during the annual flooding of
the Nile.
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)
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
1.Purification of man(bathing)and his food
2.Selection of food(Leviticus 11th chapter)
3.Preparation of food
4.Disinfection and midwifery(hygiene for women
after childbirth)
5.Controlling the spread of communicable
disease(segregation of sick e.g. leprosy)
6.Cleanliness
a.The ritual of circumcision of the male child on the
8th day(Leviticus 13,14th chapter)
disposal of excreta by burial with enough sand.
b.Moses is recognized as the ‘’FATHER OF
SANITATION”. He wrote the five books of the old
testament.
c.On mount Sinai, God gave to Moses the’ Ten
commandment’s’ 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 Ch. 15v 26Bible)
d.The high priest Aaron was established as the
physician of people.
e.Regarding Nursing, Ancient Hebrew nurses had a
high position and participated carefully in planned
programs 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.
f. 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 Midwife who
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 Shen Nung 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 an analgesia and
was a specialty for them while the other
countries did not have.
12.Opium and its derivatives were also used to
relieve pain.
13.Tea drinking was encouraged as an precaution
against intestinal infections.
14.Much importance was given to cleanliness and
hygiene.
15.Confucicus was their religious leader who
defined the position of women s 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
blood letting was done.
17.Medical progress was affected by the belief
of the people that the disease was due to the
evil spirit and who ever touches the person, the
evil spirit will get into their body. So nursing was
impossible in this country.

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.Appollo(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(Appollo’s sister)-acquinted with
medical lore and assisted his instructions.
4.Epigone(wife of Asklepios)-soothing one
5.Six daughters
Hygeia-Goddess of health
 Penacea-Restorer of health
Aegle-Light of the sun
Meditrana-Preserver of health(supposed to be the
ancient forerunner of public health nurse)
Iaso-personified the recovery from illness.
6.One son-assisted him with surgery
7.Another son-assisted him with internal medicine

8.The whole family of Asclepius has significance for the

medical and nursing arts.
SYMBOL OF CADUCEUS
• It 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 by foot if necessary
even to the remote areas. Two wings resembles speed
at work which a medical person should possess.
• Serpents-The emblem of wisdom and
juvenescence(becoming young again and immortality.
As the serpents cast out their outer covering i.e. the
skin, medical personnel 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.
1.The famous health resort in Greece was Epidaurus
which is few miles from Athens. Temple buildings
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
accomodated.There was rooms for visitors and
attendants, houses for priests an d 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 Epideurus,in the temple of
Asclepius sick people gathered and priest
physicians received interpreted treatment
prescribed by Asclepius
2. 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
a.Massage
b.Inunction
c.Catharsis(purgation)
d.Blood letting with diet regulation
e.Allowed non-poisonous snakes to lick the wounds as a
cleansing treatment.
f.Prohibited dissection, so the advancement of medical
work suffered.
3.Greek civilization has To improved at the same
time slavery and poverty were also increased.
4.The intellectual and artistic prestige of Athens
gave inspiration to the Greek people .
5.Socrates was a great philosopher . He and his
discipline Plato contributed their philosophical
ideas for the people and the Government.
6.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.

7. 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
8.His methods of treatment were based on the
principles
a. Observe all the symptoms
b. study the patient
c.evaluate honestly
d.assist nature
His idea is expressed in Hippocratic oath which is
used even today in medical colleges. It forms the
base of the Nightingale’s pledge.
 • 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
Askiepiade and a son of priest
physician.
9. Hippocrates discovered that the diseases are due to disordered
function of the body and that the evilspirits 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
9.Hippocrates medical achievements can be grouped in
the four areas
a.Rejection of all beliefs in the supernatural origin of
diseases.
b.Development of thorough physical assessment and
recordings.
c.Establishment of the highest ethical standards in
medicine.
d.Author of medical books.
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 has 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 Rome
a.Had paved roads and bridges.
b.drinking water by aqueduct.
c.drainage and sewage system,
d.public baths.
e.public dispensary.
malaria was the dreaded disease which was
prevalent in Rome.
with the advent of Christianity, deacons and
deaconates performed the duties of the nurses.
a.Phoebe-was the first deaconeness 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.
9.Romans were idol worshippers and later period they
worshipped their emperors also. Finally when Nero became
the emperor, the Christians refused to worship him and many
Christians were prosecuted.
10. The Romans were great warriors and thereby Greek
scholars were made as slaves and make them as teachers.
11.Greek physicians of the Hippocratic schools, who were also
slaves introduced their ides 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
12Upper class Romans took up medical education in
Alexandria.
13. 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
19th century.
14. 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.
15.The first 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
1.The earliest records of Indian medicine are found in the
Sacred book Vedas.Apart from Rig veda,Yajur veda,Sama
veda and Atharva veda,supplemental veda Ayur-veda was
developed;Ayur-life veda-knowledge by which knowledge
can be prolonged or understood.
2. Ayurveda-the science of life which was
given by Brahma which has eight parts such as
medicine,surgery,children’s diseases,stress,hygiene and
prevention of illness.Atreya was the first great physician
and teacher of Ayurveda. He lived about 800 BC.
3.During 700-600 BC. Charaka and Sushruta started
practice of medicine and surgery.
4.Sushruta Samhita is written by the great surgeon
Sushruta(father of surgery in India) who says about
many surgical operations including
a.Plastic surgery
b.Cataract
c.Amputations
d.121 surgical instruments
e.Advocated dissection
f.Antiseptic surgery
g.Anesthesia
5. Antidotes for poisons and vaccination were
practiced.
6.The great physician Charaka has written the
Charaka samhita in which he explains details of the
manner in which drugs should be prepared or
compounded for administration. Charaka published
an encyclopedia in medicine and helped to
establish the practice of medicine on a high ethical
basis.
7.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 undeterioration and attributes of drugs.
4.Patient - memory, obedience direction, fearlessness,
communicativeness are the qualities of the patient.
8.700-600 BC- Thiruvalluvar in his song speaks
highly of medicine.He describes medical care as
consisting of patients,doctors and nurses.
9.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
10..Monasteries were built.
11.Houses for travelers were provided.
12.Hospitals for both men and animals were built
13. He insisted that doctors and nurses were to be
trustworthy and skillful.
14. Hygienic practices were enforced.
15.They must wear clean clothes and cut their nails short.
16.Living rooms were kept clean and well ventilated.
17. Operations were preceded by religious ceremony and
prayer.
18. Prevention of disease was given first importance.
19. Superstition and magic had been replaced by more up-
to-date practices by 1 AD.
20. Medicine still remained in the hands of the priest
physician who refused to touch blood or pathological tissue.
21. Dissection was forbidden.
22.In the hospitals, professional musicians and
story tellers were also employed to cheer and divert
the patients by singing and reciting poetry to them.
23.Indians practiced yoga a method of yoking an
individual’s soul to the supreme –being.
24.Bodily purity attained by purgation and bathing
followed by concentration to exclude world
diversions.
25.The value of certain yoga postures, breathing
exercises and breath control are valuable in health
practices.
STATUS OF WOMEN IN INDIA
1.In India, socially the women held a relatively
high position in the period preceding 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
1. Ceylon adopted India's methods. The above
factors are alsop found in sushruta-samhita and
charaka samhita.
2.There were hospitals and well prepared
physicians and nurses to attend to the sick.
3.Medicine was practiced in humanitarian and
reasonably scientific way as in India.
9.PERSIA(IRAN)
1. 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.
2. The Persians also believed that the evil spirit was the
cause of illness and they had three types of practitioners.
They were
3. Those who treat with knife and heal, were called as
surgeons. They were less popular.
4.Those who treat with herbs and heal.
5.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 and career
for children and elderly.
 11.ANCIENT AMERICANS
In the North and South America, the culture 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.
1. Diseases were prevalent and treated with
Blood letting
2.Cupping or sucking
3.Massaging
4.Sweating
5.Splinting
6.Setting of bones
7.Tooth extraction
8.Amputation
9.Suturing
1o.Bandaging and trephining
 PERIOD OF APPRENTICESHIP
NURSING(1000-1500AD)OR CHRISTIAN
ERA
1. Extend from the founding of religious orders
in the 6th centuary through the crusade which
began in the 11th century to1836.The Deacons
school of nursing at Kaiserswerth Germany
established by Pastor Fliedner 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.
2. 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
1.CRUSADES
The 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.
MILITARY RELIGIOUS ORDERS
1.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)was founded
primarily for the nursing care of Lepers in
Jerusalem after Christians had conquered the
city.
THE ALEXIAN BROTHERS
 Were members of a monastic order founded in
1348.They established the Alexian Brothers
Hospital School of Nursing, the largest school of
nursing under a religious order. It operated
exclusively for men in the United States and
closed in 1969.
SECULAR ORDERS
 During this period, there were also the rise of
religious nursing orders for women. Only by
entering convent could she follow career
obtain education, 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.
MENDICANT ORDERS
Mendicants were travelling monks. They
divided their property among the poor and
earned their living by manual labor or begging.
Among the mendicants, the Dominicans' 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)
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 Clare's’. 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.
THIRD ORDER(Tertiary Order)Non Religious
This 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. Elizabeth of
Hungary(patroness of nurses, daughter of
Hungarian king
4.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, Anne of Bohemi,
Briget of Sweden, Louis of France and Elizabeth
of Portugal were members of orders. Such
orders still exist in Italy and some other parts of
the world.
5.THE BEGUINES
It composed of lay nurses who devoted
their lives to the service of suffering humanity. It
was founded in 1170 by a Priest Lambert Le
Begue. They supported themselves or received
help from the society's funds.
Small cottages built around the church
were known as Beguinages. This secular order
Beguines spread 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 beguinage was dedicated to St.
Christopher the patron saint of travellers which was
founded mainly as a home for widow’s and orphans
of crusaders.
OTHER
1.Oblates-A layperson dedicated to religious life.
2.Benedictines-A monk or nun belonging to the order
founded by saint. Benedict.
3.Ursulines-A member of an order of nuns of the Roman
Catholic Church founded in the early 16th century
and devoted to the education of girls.
4.Nursing order-Camillus de Lellis (16th century) founded
a nursing order to provide care for the poor, the sick, the
dying and those in prison.
5.In 1633,the sisters of charity was 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 17th centuary to the 19th
centuary from the period of reformation until the U.S Civil war.
CAUSES
1.Renaissance-the renaissance period characterized by shifts in standards that
were evident in literacy and intellectual circles.
2.The religious upheaval led by Martin Lurther destroyed the unity of the
Christian faith.
3.Disturbed political conditions
4.ReformationAbolition 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.
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 patient’s food.
11.Used alcohol as a tranquilizer.
12.Nurses worked 7 days a week, sleep-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 counter Reformation(catholic revival)the
society of Jesuits was founded by Ignatius
Loyala-a Spanish nobleman. Religious order
reopened and tried to bring back of their
traditions.
REFORMS DURING THE DARK PERIOD
Several 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-Gras
She 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. She assisted St.Vincent de Paul
to organize the sister’s of charity in 1633.
3.John Howard(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
vermin. He wrote the report and sent it to the authorities ,and
got appreciation from the sister’s of the charity.
4.Elizabeth Gurney FRY (1780-1845)
After 25 years of John.Howard’s death the next
step in the history of the prison reform was taken by
the Elizabeth. She founded the 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.
5.Amelia Sieveking
She was prominent in the women’s movement.
She has started school for children and for women who
want to learn, read and write. 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.Charles Dickens(1812-1870)
He wrote humorous stories in which he
described the evils of the day, the poor manners of
Betsy Prig, a hospital nurse and Sairy Gamp 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.Dorothea Lynde Dix(1802-1887)
In America she cared for the criminal and
mentally ill. 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 Eg. Instead of restraining them, she
allowed them to be free.
8.Mother Mary Aikenhand
She 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
Fliedner
Established the institute for the training of
Deaconeness at Kaiserwerth, Germany, the first
organized school for nurses. Requirements for
entering the school were
A character reference from a clergy man.
A certificate of health from a physician
Permission from the nearest relative.
• 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 mentally ill.
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 Aikenhand

She 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
Fliedner
Established the institute for the training of Deaconates at
Kaiserwerth, Germany, the first organized school for
nurses. Requirements for entering the school were
A character reference from a clergy man.
A certificate of health from a physician
Permission from the nearest relative.
PERIOD OF EDUCATED NURSING
(NIGHTINGALE’S ERA)
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 the world.
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. She
raised in England with elder sister Parthenope and
received a thorough education. 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 fulfilla’ ’Mission of Mercy’’.
• She met several people who were interested in charitable
works
• Sir.Edwin Chadwick who did sanitary reforms.
• 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
society’s 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 Nursing 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
nurse’s 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. Florence, the first
2.Empress of scavenger
3. Queen of Nurses
4.Reverenced mother superior of the
British Army
5.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
Trends resulting from wars.
An arousal of social consciousness.
The emancipation of women.
Increased educational opportunities for women
ACHIEVEMENTS
1.Establishment of nursing organizations
2.American Nurses Association
3.National League for nursing education
4.Development of private duty nursing,
settlement house nursing, school nursing,
government service of nurses and prenatal and
maternal health nursing.
5.Preparation of a standard curriculum based on
educational objectives for schools of nursing.
UNIVERSAL SYMBOL OF NURSING

White heart
The white heart was officially launched as a universal
symbol for nursing in 1999, on the occasion of the
100th anniversary of the International Council of
Nurses. The symbol is meant to characterize the caring,
knowledge and humanity that infuse the work and
spirit of nursing. The white heart is also a unifying
symbol for nurses globally.
White was selected because it brings together all
colours, demonstrating nursing's acceptance of all
people. White also has a world-wide association with
nursing, caring, hygiene and comfort. The heart shape
communicates humanity and the central place that
nursing has in quality health care.
Nightingale pledge

The Nightingale Pledge was composed by

Lystra Gretter, an instructor of nursing at the
old Harper Hospital in Detroit, Michigan, and
was first used by its graduating class in 1893.
It is an adaptation of the Hippocratic Oath
taken by physicians.
 A nursing pledge Student’s and graduate’s
moral obligations placed against a school or the
whole society, profession, group. Pledge’s text
has been changing, however it has always
contained deep humanistic and professional
values.
Commonly known is the Florence
Nightingale Pledge formulated in 1893 and for
many years seen as a prototype of a code of
ethics. During the ceremony the nursing hymn
is also sung.
• Modern nightingale pledge
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.
SOCIAL REVOLUTIONS AND THE
ADVANCEMENT OF NURSING
1)Renaissance
Humanists emerged and were known to give
nursing care.
.
2)Protestant Reformation.
Most hospital closed. Open hospitals served
poor and were staffed by women who were
prostitutes and alcoholics
• The closing of monasteries during the
Reformation by Luther and his views about
the place of a woman caused many hospitals
to shut to the sick and poor and further
disrupted nursing care and quality. As women
tended to hold the positions of nursing how
women were treated and viewed strongly
affected how nursing was viewed.
During the 16th century Reformation and Catholic
Counter-Reformation
Religious orders were suppressed causing
hospitals to become places of horror and a period
of stagnation in nursing and health care followed.
Because monasteries and hospitals were shut to the
poor the sick were no longer separated from the
healthy such that disease and epidemics spread.
3)Industrial Revolution
Increased nurses migrated. Hospital nursing
expanded in late 1800’s .Lillian Wald and Mary
Brewster started community health nursing at the
Henry street settlement in 1893.
4)Victorian Era
Queen 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.
TWENTIETH CENTUARY
1.Nursing evolved toward a scientific research-
based defined body of nursing, knowledge and
practice.
.
2.Affiliation of nursing education with
universities
3.Expanded and advanced practice roles.
4.Nursing specializations evolved.
5.Specialty nursing organizations were formed.
Red cross(1866,switzerland)
American nurses association (1896)
Trained nurses association of
India(1905,Lucknow)
Young womens christian
association(1892,Brooklyn,Newyork)
6.Establishment of voluntary health agencies like
UNICEF(1946)WHO(1948)
7.Progress in communication telephone, motion
pictures, radio and television are used as
teaching aids
8.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.
9.Progress in transportation; useof ambulances,
helicopter etc.
10.Use of ultrasound in diagnosing and treating
diseases.
11.Atomic age-use of radioactive isotopes for
medical research.
12.Early in 1930 an artificial respirator an iron
lung machine was invented and used to keep
paralyzed (poliomyelitis) patients alive.
13.The discovery of the sulpha drugs as
sulphanilamide, sulphapyridine and
sulphatiazole reduced the streptococcal and
staphylococcal infections.
14.The findings of new drugs as
vitamins, penicillin and insulin.
15.Chemotherapy became a vital factor in
medical science.
16.Dr.JohnCorrie found out cool air machine to
reduce the temperature of the patient’s room
17.Refrigeration was another invention of for
the use of preserving foodstuff.
18.Air mattresses and water mattresses are
available in the hospitals.
19.Maternity and psychiatric patients got special
attention.
20.Electronic beds are replaced in place of iron
beds to enable the lifting of patients earlier.
TWENTY FIRST CENTUARY
1.Nurse’s 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 bar 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
of the physician.
 FACTORS INFLUENCING
CONTEMPORARY NURSING
1.PRACTICE ECONOMICS
Greater 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 DEMANDS
Consumer of nursing services (the public) has
become an increasingly effective force in
changing nursing practice. On the whole,
people are better educated and have more
knowledge about health and illness than in
the past. Consumers also have become more
aware of other’s needs for care.
3.FAMILY STRUCTURE
New family structures are influencing the need
for and provision of nursing services.
 Nuclear family.
 Young persons live at a great distance from
their parents.
 Families in poverty the children often do not
receive preventive immunizations and increased
risk for nutritional and other health problems.
4.SCIENCE AND TECHNOLOGY
Advances in science and technology affect
nursing practice. Nurses must be knowledge
about
• newer drugs,
• gene therapy,
• computerized equipment,
• 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 TELECOMMUNICATIONS
 Internet 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,
 computers,
 telephones.
Telenursing occurs when the nurse delivers
care through a telecommunication system.
6.LEGISLATION
Patient 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.DEMOGRAPHY
 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 SHORTAGE
Nursing supply is inadequate to meet the
demand, especially for specialized nurses (eg.
critical care) and it is anticipated to worsen
during the next 20 years. It is recommended to
improve the nurse’s work environment, provide
greater flexibility in work hours, and reward
experienced nurses who serve as mentors,
ensure adequate staffing and increase salaries.
9.COLLECTIVE BARGAINING
More 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
NURSING IN INDIA
1.Military Nursing was the earliest type of nursing.
• 1
2.St. Stephens’s 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.

• 4
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 1926 madras 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.