Unit-I Nursing History

Objective
At the end of the students will be able to:
• Discuss the nursing practices in ancient civilization
• Understand different historical eras of Nursing
• Analyze the periodic evolution of nursing.
• Familiarize the students with impact of historical events
on nursing.
• Present social factor that have influenced the
development of nursing.
 Introduction

• Nursing is one of the youngest profession but one of the oldest

arts. It evolved from the familial roles of nurturing and care
taking.
• Care for the sick is not new it happened throughout recorded
history.
• The general goals of nursing have remained same over the
centuries, but two factors deeply influenced the practice of
nursing.
 Advances in science
 Changing of society’s needs
 Who is the Nurse?

• The term “Nurse” derived from Latin Nutricia, it means “a

person who nourishes”.

• The Nurse is a person who has completed a program of basic

generalized nursing education and authorized by appropriate
regulatory authority to practice nursing
Prehistoric (Ancient) Nursing History

According to the late 19th century literature

• Human learned caring and variety of therapies from
observing animals.
Bringing the foods for injured and helpless companion.
Therapies such as licking wounds a form of an antiseptic
dressing.
Applying pressure to control bleeding (from apes)
• Different techniques used by early healers such as
Pummeling (a form of massage)
Administering Herbs
Exposing persons to smoke.
Applying roots balms to the skin.
Twisting the body into various positions.
(Nutting and Dock,
1935a)
 Ancient Cont …..
• Ancient Hindus linked hygiene to health (Charaka-Samhita)
• Nursing was viewed as a blessed service
• The Indian record describe the four qualification for a nurse
 Knowledge of a drug preparation
 Cleverness
 Devotion to patient and
 Purity of body and mind
• Early nursing intervention included nutritional therapy,
adequate ventilation, clean environment and musical therapy.
(Nutting and Dock )
 Ancient Cont …..

• Ancient Egypt were Healthiest & most advanced, 3000 BC oldest

written record about medicine and nursing.

• Priestesses whose duties included the care of the sick in temples.

• System of community planning (hygiene, sanitation).

• Hippocrates in the 5th century known as “Father of Medicine”

Developed terms prognosis, diagnosis, cure
(Nutting and Dock )
 Ancient Cont …..

• Roman reserved the best medical and nursing care for

the soldier who were cared by women and old men of
good character.
• These women possessed great knowledge and skills of
treating wounded soldiers, delivering infants and caring
for livestock.
• The hallmark of ancient nursing was caring more than
curing
(Nutting and
Dock )
Early Christian Era
• Caring for the sick and poor became a moral obligation

• Women began nursing as an expression of Christianity

• Most of the nursing duties were performed by men.

• These women workers in church who were concerned with

nursing were Deaconesses and widows.

• In second century, Roman matrons organized and delivered

care to persons in need at their homes.
Apprentice Period
 Apprentice Period (6th to 18th century)
• On-the-job training period
• Learning stopped due to the wars.
• Focus was on care and comfort (basic of nursing).
• Nursing care was controlled by the Catholic Church
• Monasteries became the place for education of medicine and
nursing.
• Nursing done by dedicated women (Nuns) and nursing
brothers (Monks).
 Cont ……
• Hospitals developed on the battlefields during war
• In 11th century, two hospitals were built in England. One for
men and women and one for lepers.

• Nursing became acceptable for women

• In 14th century , nursing experienced decline when funds

designated for the care of the sick were diverted to war.

• As a result person caring for the ill experienced low moral.

 (1500-1860) “Rebirth”
• In 1562 white uniform were proposed for nurses in American
hospitals.
• Interest increased in science and discovery
• Work on medicine increased
• Hospital opened in main cities
• Nursing were the works of the least desirable people
(criminals, slaves)
• Nurses were uneducated, harsh, overworked
 Cont ….

• At the end of 18th century scientific based nursing manuals

began to appear.

• The nursing society of Philadelphia was founded in 1836 and

primarily provided home maternity services.

• In 1850 the society opened a home and school in which

systematic instruction was given on cooking and obstetrics.

Educative Period
 Florence Nightingale era from 1850 to 1917

• Nursing emerged as profession in late 19th century.

• Credit is given to Florence Nightingale

• Educative period began in June 15, 1860 when Florence

Nightingale School of Nursing opened at St. Thomas
Hospital in London England.

• Where 1st program for formal education of Nurses started.

 Cont …..

• Nursing became acceptable, women volunteered to be nurses

• The concept of public health nursing emerged in 1900

• Civil War increased the importance of nursing care

• Houses became wards to care injured during civil war

• Clara Barton established hospitals for both sides and for all
colors of people; later founded the American Red Cross
 Cont …..
Florence Nightingale
• Mother of Modern Nursing
• Lady with the Lamp
• Born on May 12, 1820 in Florence, Italy
• Changed the profile of Nursing
• She trained from deaconesses school of nursing at Kaiserswerth,
Germany for 3 months.
• She reduced the casualties of war by 42%-2% at Scutri Turky.
• By 1887, Nightingale had her nurses working in six countries
and U.S.
• She died on 13 Aug 1910
The concept of Nightingale about Nursing School

• Nursing schools should be separate entities, not connected with

physicians or hospitals.
• The content of nursing education must be defined by nurses.
• Have decent living quarters for students and pay Nurse
instructors
• Correlate theories to practice
• Support Nursing research and promote continuing education
for nurses
 Early 20th century to Post world War-II Era
(1917-1960)
• The hospital and medical reform resulted dramatic changes,
physician demanded educated nurses for patient care.
• 1912 most of the American states established guideline for
professional registration.
• The world war 1917 and influenza epidemic in 1918-1919
increases the need of graduated nurses.
• Media portrayed nurses as attractive women who sacrificed
personal desire for their profession.
 Cont ….

• After world wars graduate nurses become accepted member of

hospital staff.

• Workplace reform 8 hours a day and 40 hours work per week

 Mughal Period
• Nursing and medicine are closely linked together.
• Nursing is regarded as science of care
• And medicine were regarded as science of cure.
• As the science of cure medicine is concerned with the
treatment and diagnosis of illnesses. And as a science of
care Nursing is concerned with the care of people who
are ill.
• Maham a great lady served as a Nurse of King Akbar in
Mughal Empire
Contemporary Period
 Modern Era Post World War II (1960-1999)
• Toward the mid 20th century, a shift in priority from the health
of community to the health of individual occurred.
• And toward the end of 20th century another shift toward care of
patient in the community occurred.
• Advances in medical system increased the need of highly
educated, clinically competent nurses for patient care.
• The 1960s was a decade of growth and changes.
• Nursing is offered in College and Universities
• Primary Health Care – Nurses involvement in CHN
• In 1980s nursing became more specialized and autonomous.
• Development of the expanded role of Nurses
Post modern Era (2000 and beyond)

• Holistic approach become standard practice

• Extended role (nurse practitioner, nurse researcher)

• Education in specialized practice field.

• Developed professional organization in all over the world.

Nursing & Islam
 History of Nursing in Islam
• The first known Muslim nurse and the founder
of the nursing profession in the Arabic and
Islamic history was Rufaida Al Asalmiya.
• Rufaida was a daughter of Saad Al-Aslamy,
who was a leading healer in Al-Medina
(Yethreb).
• Rufaida assisted him and during this time she
developed her nursing skills. As a person,
Rufaida was very patient, kind, devoted and
committed.
• Rufaida and a group of Muslim women assisted
in the holy wars by providing first aid, drinking
water, protecting the wounded and dying
soldiers from the desert wind and heat, in
addition to providing emotional support. With
the advice of Prophet Mohammed, Peace Be
Upon Him (PBUH), Rufaida erected a tent
beside the mosque of Prophet Mohamed,
PBUH, in order to continue providing Nursing
care in peaceful times, to train women as
nurses, deliver health education and social
support in the community.
• Rufaida learned and developed her nursing
skills from her father. She nursed both male
and female patients.
• Furthermore other Muslim women practiced
Nursing during the time of Prophet
Mohammed, PBUH. Some authors argued that
Kuaibah Bint Saad Al-Aslamiya was the first
known Muslim Nurse. She carried and took
care of wounded Muslim soldiers
during battles and also took care of patients
during peaceful times.
• Nasibah Bint Kaab joined the Muslim armies
and also provided care to the wounded
soldiers.
 Nursing definition by WHO
• Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings. It includes the promotion of
health, the prevention of illness, and the care
of ill, disabled and dying people.
 Nursing definition by ICN
• Nursing encompasses autonomous and
collaborative care of individuals of all ages,
families, groups and communities, sick or well
and in all settings. Nursing includes the
promotion of health, prevention of illness, and
the care of ill, disabled and dying people.
Advocacy, promotion of a safe environment,
research, participation in shaping health
policy and in patient and health systems
management, and education are also key
nursing roles. (ICN, 2002)
 Definition of a Nurse BY ICN
• The nurse is a person who has completed a
program of basic, generalized nursing
education and is authorized by the
appropriate regulatory authority to practice
nursing in his/her country.
 Nursing definition by ANA
• Nursing is the protection, promotion, and
optimization of health and abilities,
prevention of illness and injury, facilitation of
healing, alleviation of suffering through the
diagnosis and treatment of human response,
and advocacy in the care of individuals,
families, groups, communities, and
populations.
History of Nursing Education overview
Diploma Education

• Florence Nightingale established the first diploma program at

St. Thomas hospital in 1860.
• In 1872 diploma program were established in USA based on
apprenticeship model (recommended by AMA)
• From 1872 until the mid 1960 the hospital program was the
predominant type of nursing.
• By the 1960 the majority of diploma program were associated
with colleges or universities for the purpose to receive non
nursing credit
• In 1958 there were 944 program which decreased to 86 in 2000.
Degree Program

• The first baccalaureate nursing program established at the

university of Minnesota in 1909 through the efforts of Dr.
Richard Olding Beard.
• The baccalaureate program were gradually increased, in 1983
there were 420 program, and by 2000 there were 695 programs.
• The master education in nursing program began in 1950,
by1990 there were 231 nursing master program in the USA.
• Nontraditional Graduate programs leading to RN Licensure
were simultaneously started in USA.
Doctoral Program
• Doctor of Philosophy (PhD)
• Doctor of Education (EdD)
• Doctor of Nursing Science (DNS, DNSc)
• Doctor of Nursing Practice (DNP)
International Nursing Programs

• LPN or LVN Education Degree

• LPN-to-Associate's Nursing Education Program
• Associate of Science in Nursing Program
• LPN-to-BSN Education Program
• Bachelor of Science in Nursing (BSN) Program
• RN-to-BSN Education Degree Program
• Accelerated Degree BSN Program
 Cont ……
• Master of Science in Nursing (MSN) Degree Program
• RN-to-MSN Degree Program
• Direct Entry MSN Degree Program
• Post-Master's Certificate Nursing Education Programs
• Doctorate Nursing Education Programs
• MSN/PhD Dual Nursing Education Degree
• Accelerated BSN to PhD Nursing Education Degree
• Joint Degree Programs
Nursing in Pakistan a Historical Perspective
Overview
• Before the partition the European and Anglo-Indian ladies
were privileged to be taken for training of nursing.
• There were resistance for native women to entered nursing.
• The first Indian nurse admitted for training in 1934, at Mayo
Hospital Lahore after 50 years starting of nursing training at
British India.
• These prejudiced policies cause the shortage of trained Muslim
nurses after independence in Pakistan.
 Nursing in Pakistan Recently after Independence

• The Govt restarted nursing training in those school where it

was being conducted before the partition.
 Lady Reading Hospital Peshawar (for male & female)
 Civil Hospital Karachi
 Mayo Hospital Lahore.
• Lady Reading Hospital Peshawar and Mayo Hospital were
affiliated with Punjab Nursing Council and Midwife board.
• Civil Hospital Karachi offered general nursing from 1935 to
1939 with affiliation to the Bombay nurses registration council.
• Civil hospital affiliated with Sindh registration council after
Sindh nurses registration Act in 1939.
 Cont ……
• On preliminary basis a temporary cadre of lady assistant was
created.
• Middle passed girls were taken into the Atchison Hospital
Lahore for a two weeks practical course.
• In 1948 the first school of nursing in Pakistan was established
at Sir Ganga Ram Hospital Lahore.
• Mrs Mumtaz Painda Khan was the First Nursing superintendent
of this hospital.
• Mrs G.M. Darrah was the first tutor sister of the hospital.
• The second school of nursing in Pakistan established in Jinnah
Hospital Karachi in 1948.
 Cont …..
• In early 50s “central preliminary training school” established at
Lahore.
• Three months nursing education were given in basic sciences
and nursing procedures.
• This scheme was dropped when student nurses complained of
adjustment problems.
• Subsequently hospital started their own preliminary training
schools.
• The system of training of nurses varied from province to
province.
• The legislation of Pakistan nursing council Act, 1952 brought
uniformity.
The Emergence of PNC, Act 1952
• According to the PNC Act, 1952 the period of training was 03
years for becoming a nurse.
• One year training in Midwifery was optional.
• The following subjects were taught by specialist.
• Anatomy, physiology, Medicine, Surgery, Obstetrics, Hygiene.
• Two exams were conducted during the span of three year
study.
• The exams were conducted by the west and east Pakistan
nursing councils.
• Minimum criteria for admission was Anglo vernacular middle.
• Two grades nurses were prepared, A and B.
 Cont…….
• In 1952, the first batch of seven girls completed their three year
general nursing program from school of nursing Ganga Ram
Hospital.
• During the decade of 1950s the following hospitals established
their nursing school.
 The liaquat Medical College Hospital Hyderabad.
 The Bahawal Victoria Hospital Bahalpur.
 The Nishtar Hospital Multan
 Lahore General Hospital started its nursing classes in 1960
 Sandeman civil hospital quetta started general nursing program in
1961.
• Lady Reading Hospital Peshawar resumed its training in 1960,
where the training classes were discontinued in 1954.
The Emergence of PNC Act 1973

• The new PNC act 1973 envisaged a three year program of

basic training in general nursing.
• After completing three year training female required to be
trained in midwifery for one year.
• Males need to take training in urology for six month.
• The curriculum revised.
• Medical and surgical and pediatric nursing skills were added.
• Provincial nursing council were dissolved.
• Provincial nurses examination boards were established.
• Responsibility of PNC and examination boards identified.
Development of Post Basic Education

• There were four colleges which provided post basic nursing

education
 Jinnah Post Graduate college of Nursing (1956)
 College of Nursing PIMS Islamabad (1985)
 Lahore College of Nursing (1987)
 Post Graduate College of Nursing Peshawar (1988)
• The above colleges offered post basic specialization in different
specialized area and diploma in teaching and ward
administration
Graduate and Post Graduate Programs
• In 1991 University Grants commission recommended to
introduce the BSc degree in nursing.
• University of Peshawar has been awarding BSc degree to
diploma holder who qualify three additional papers.
• AKU started Post RN BSc nursing first time in the country in
1988 and Generic BSc Nursing in 1997.
• University based nursing education in public sector started in
2003.
• Jamshoro college of nursing first started post RN BSc Nursing
in public sector.
• AKU Started MSc Nursing first time in the country in 2001.
• JPMC college of nursing first started MSc Nursing in public
sector.
 National Nursing Educational Programs
• Nursing Assistant certificate course
• LPN
• Diploma in general nursing
• Post basic diplomas (Specialty based)
• Post RN BSc Nursing
• Generic BSc Nursing
• Fast track BSc Nursing
• MSc Nursing
• Transitional MSc Nursing
• Accelerated MSc Nursing
Nursing Leaders of the 19th Century
Mary Seacole (1805-1861)
• Born in Kingston Jamaica
• Not formally trained, she learned nursing skill from her mother.
• She worked during cholera and yellow fever epidemic in Cuba.
• Some time she discriminated because of her race and ethnicity
• She developed hospital and respite home for wounded fatigued
soldier in Balaclava Crimea without receiving any recognition
or rank from British army.
• She known as mother Seacole at battle field.
• Her plight was publicized by newspaper.
• She was recognized in England and Jamaica for her work in the
Crimea.
Clara Barton (1812-1912)
• Born in Massachusetts
• Was a new England school teacher, despite not having formal
training as a nurse.
• She volunteered as a nurse in American civil war.
• She established American Red Cross.

Lillian Wald (1867-1940)

• Born to a middle class Jewish family at Rochester New York.
• Famous for initiating visiting nurse services in New York.
 Mary Adelaide Nutting (1858-1948)

• Born in Canada.
• Well known as an advocate of higher education for nurses.
• A member of first graduating class of nurses at Johns Hopkins
University in 1891.
• She expanded the program for nurses at Johns Hopkins hospital
from two to three years, allowing for greater time in classroom.
• She established higher education program for nurses at
Columbia university, New York in1919.
• She was the first women to hold professorship at Columbia
university.
• She was instrumental in the development and creation of the
American Journal of Nursing
Nursing Leaders of the 20th Century
Margaret Sanger (1878-1966)

• She worked as a nurse with poor women in New York.

• She observe the impact of unplanned and unwelcome
pregnancies among women.
• In 1916 she opened a family planning and birth control clinic
in New York city.
• Her clinic was raided by police, she served 30 days in prison.
• In 1930 she successfully re-opened the family planning clinic.
Virginia Henderson (1897-1996)

• She attended the army school of nursing Washington, DC, and

graduated in 1921.
• She did her master in nursing education from teacher college
Columbia University.
• In 1955 with Bertha Harmer she coauthored Textbook of the
Principles and the Practice of Nursing a fundamental textbook
• she identify a new direction for health care provider is to help
people become independent as possible.
• She described the nurses role as threefold
 Substitutive (doing for the person)
 Supplementary (helping the person)
 Complementary (working to help the patient)
Mildred Montag (1908-2004)
• She graduated in 1930 as a history major from university of
Minnesota.
• She decided to become a nurse and graduated in 1933 as a BS
nursing degree from university of Minnesota.
• She attended Columbia university and teacher college New York,
majoring in nursing education, and graduated in 1938 with MA
degree in nursing education.
• Montag remained director Adelphi college school of nursing from
1943 to 1948.
• In 1950 Montag graduated with a doctorate from teacher college in
New York
• She proposed two year program to prepare technical nurses in her
doctoral dissertation.
• She was the author of many publication, and received many award
related to the development of ADN program.
Hildegard E. Peplau (1909-1999)

• Born in Pennsylvania
• Known for her great work in psychiatric nursing.
• She emphasized the nurse patient relationship as the foundation
of nursing practice.
• She develop interpersonal model, emphasizing the need for
partnership between nurse and patient.
• In 1947 she received a degree in psychiatric nursing.
• She did Ph.D in education with the emphasis of curriculum
development from Columbia University New York in 1953.
M Elizabeth Carnegie (1916-2008)
• She was a nurse historian and the author of several publication
including The Path We Tread: Blacks in Nursing Worldwide.
• Her work to advance and promote minority and black nurses.
• She discriminated on the basis of color when she apply in navy
during world war I and II.
• She was employed by the American journal of nursing from
1953 to her retirement 1978.
• She initiated nursing program in Hampton University Virginia.
• Worked as a president, American academy of nursing and was
the dean, school of nursing at Florida A&M University.
• She has been a famous visiting professor at many universities.
• She received countless awards and honorary degrees from
universities throughout the country.
 References
• Lucy. J, Leddy. K, Conceptual Bases of professional
Nursing, 5th edition Lippincott Williams &Wilkins.
• Klainberb. M, The Impact of Nursing on the Evolution of
Health Care, An Historical Overview of Nursing, Jones
and Bartlett.