Foundation of modern Nursing

By: Ashagre Molla (BSN, MSN)

Learning objectives of the chapter

At the end of this chapter, you are expected to: Discuss the different definitions of nursing by different professionals and organizations. Explain the origin and historical development of nursing profession Discuss the contribution of Florence Nightingale and other nurses for the development of nursing profession Discuss the criteria of profession Discuss the role of nurses

Sub-topics
Definitions of nursing Historical overview of nursing Highlights of the historical evolution of professional nursing History of nursing in Ethiopia Nursing as a profession Roles of nurses

Definition of nursing
Nursing has been defined in many ways by different professionals and organization The act of utilizing the environment of the client to assist him in his recovery Florence Nightingale The diagnosis and treatment of human responses to actual or potential health problems. - ANA

Definition.
"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he/she would perform unaided if he/she had the necessary strength, will or knowledge and to do this in such a way as to help him/her gain independence as rapidly as possible." Virginia Henderson

Definition
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

Definition
The nursing profession exists in response to a need of society and holds ideas related to human health throughout the lifespan. Nurses direct their energies towards the promotion, maintenance and restoration of health; the prevention of illness, the alleviation of suffering and the insurance of a peaceful death when life can no longer be sustained. ..Nursing, a dynamic and supportive profession guided by its code of ethics, is rooted in caring, a concept evident throughout in its four fields of activity: practice, education, administration and research. CNA

Common themes to Nursing

Holism Caring

Teaching Advocacy and supporting Promoting, maintaining, and restoring health

Historical overview of nursing

The study of history of nursing helps us: to better understand the societal forces and issues that continue to confront the profession. to gain an appreciation of the role the profession has played in the health care system

History ..
Nursing is believed to be as old as human kind The word nurse is often related to the Latin nutrix or nutrio which means to nourish. The definition of the term and the practice of nursing has changed greatly over time: wet nurse/dry nurse Very little has been written about nursing as unique function in ancient time.

Nursing in an antiquity
A decision for a care giver was made long before he/she able to make such choice. In many societies the role of giving care was given to female members The earliest nurses learn their art through oral traditions passed from generation to generation. Those who acquired reputation were sought after to provide care for friends and families

Nursing in an antiquity..
Nurses first organized in the early Christian era. Nursing ideals (charity, service to others, and self-sacrifice) were in harmony with early Christian church. Fabiola deaconess credited for the establishment of first Christian hospital in Rome Throughout antiquity the safest nursing care was provided in ones own home. Care in hospitals were for those who have no family /away from families

Period of ..
Early hospitals were found by the members of religious communities nuns and monks who devoted their lives for the care of the sick. Influence of Ancient Egyptians Babylonia Indians The Jews The Greeks

ANCIENT EGYPT 4000 B.C. During this time the priests were the healers. They had some knowledge in the sciences of anatomy and physiology. They could prepare some drugs for eye conditions and surgery. The healing treatment included prayers and sacrifices. The actual care of the patients, such as dressing wounds was done by helpers.

Babylonia
The people thought diseases were the result of sin. The priests made their diagnoses and prognoses by observing the behavior of animals the flowing of water in rivers the shape of oil on water surfaces the irregularity of an animal liver the smoke from a burning fire, and personal dreams When a woman had difficulties in delivery, it was considered to be the result of wrong doing.

Indians
Indians had a highly developed culture and good sanitation system. They had written a number of scientific books, which described different types of diseases. Some of their diagnostic examinations included: Inspection, palpation, auscultation, taking pulse rate, and investigation of urine. Surgery was also highly practiced.

Indians
For suturing intestines, certain types of ants were used to bite the incision line. When their bodies were cut off their mandibles remained attached to the incision as sutures. The people who cared for the sick were well instructed in ethics. They were required to be skilful, dedicated and prudent in both body and mind.

Greeks
Temple hospitals were built The usual methods of deciding treatment praying to god Aesculapius and then the patient sleep in his dreams the god Aesculapius himself would reveal the drugs to be given. The true founder of medical science Hippocrates, the father of modern medicine Discovered diseases are not the result of evil-sprit

The Christian era

The early Christians were inspired by the teachings of Christ. Christ taught people to help one another like brothers and sisters. Service to the sick and the poor was service to God. Bishops formed the religious orders of Deacons and deaconesses. Their duties were to attend to the sick and the poor in their homes. At this time nursing was regarded as a form of religious devotion. Later hospices (houses for the sick and the poor) were built by the monasteries.

Christian era . . .
The monks and nuns cared for the sick, the poor and the aged. Military orders founded hospitals in their kingdom. During 17th century, Augustinian sisters lived religious life and perform nursing care as directed by priests. Later it becomes sisters of charity . Their prime function was to care for the sick. The sisters were instructed to obey the physicians and to serve patients whole-heartedly.

THE DARK PERIOD OF NURSING, (18th Century.)

Despite new discoveries and great scientific progress in medicine, the religious life of the community was shallow. Only a few people were ready to join religious congregations. Those who joined were illiterate, and to make matters worse, Napoleon, the emperor of France closed all the monasteries which catered for the sick and used them for non-religious activities.

THE DARK PERIOD OF NURSING, (18th Century.)

This resulted in crude and unsatisfactory health services. The wards were filthy, bed bugs and lice were abundant.

THE CATHOLIC RELIGIOUS CONGREGATIONS (19th C) Napoleon permitted groups of dedicated females to start religious congregations in order to care for the sick. Theodor Fliedner established a hospital where women of good character were trained as deaconesses. They cared for the sick and young children in both hospitals and homes.

CIVIL ORDERS (THE RED CROSS)

The Red Cross Society was founded in Geneva in 1863 by a Swiss bank manager called Henri Dunant. Its goal has been and still is to train nurses in times of peace in order to be able to care for the wounded in times of war. Many girls were trained and were organized into associations.

Civil Nursing
beginning of 19th century, nursing services started to be delivered by civil nurses - women who did not belong to religious congregations. Florence Nightingale instituted the reforms in the care of the sick, which form the basis for the modern practice.

History of Nursing Ethiopia

In ancient Ethiopia illness was considered to be punishment from sins or magic. Most tribes and people had a medicine man or women called "Hakims" or wegasha" who performed rituals, using various plants and herbs to heal the sick. The religious people were also providing care for the sick or injured in the monks hospital in Debre-libanos.

Nursing in Ethiopia . . .
In late 19th century before nurses training started, foreign nurses were practicing in the health care delivery system of Ethiopia. In 1917 Sister Karin Holmer came as trained nurse to Ethiopia. In 1908, Emperor Menelik II established the 1st Ethiopian Hospital, on the site of the Russian Hospital.

 Governmental public health services, now known as ministry of public health, which is established in 1948. Later on Emperor Hailesilassie established different hospitals in deferent regions including Addis Ababa.

 The first clinic was established at the hot spring at Eilet near Messwa in which sick people used to come for bathing. The Princess Tsehai memorial Hospital was opened in 1951. as a tribute initially from the British people as friendships with Ethiopia - known as Army Hospital.

Training of Medical personnel

Before the Italian occupation with exception of a mission school for midwives in Eritrea, the only training in the public health personnel consisted of auxiliary medical training in several hospitals and missions.

Training . . .
The growth of hospitals made it necessary to start the training of Ethiopians to assist in staffing hospitals and clinics. As a first step training, facilities for medical auxiliary personnel were made available in the Menelik II Hospital.

For some years government and mission hospitals had been engaged in training dressers and other nursing orderlies.

Ethiopian Nurses
Princess Tsehai, the emperor youngest daughter was the first graduated national nurse from Ormand street hospital London. In 1948 the Ethiopian Red cross nursing school established by the Emperor in the private Hospital Bet-Saida which later changed to Haleslassie I Hospital. Then during the Derg regime, this hospital is changed its name to Yekatit 12 hospital, which still exists.

 In 1950, the school of nursing was established at Empress Zewditu memorial hospital for male and female nurses. In March 1953, the first eight nurses from Ethiopian Red Cross of nursing and nine from Empress Zewditu memorial hospital were graduated. In 1951, two school of Nursing was stablished: At the princess Tsehai memorial only for female nurses In Nekemt at the Teferie Mekonnen Hospital

Ethiopian Nurses . . .
In 1959 the post basic training started at princess Tsehai memorial hospital for midwifery nursing and four nurses graduated in 1960. In 1954 the Gonder Health College and training center opened and gave training to community nurses. In 1958 fifteen (15) community nurses graduated from this center.

Today?

Historical evolution of professional nursing

Documentation of the profession is available only for the last 150 years 1 500 G.C. Nursing care primarily involves meeting the hygiene and comfort needs of individuals and families. Christians working in close association with an organized church primarily provide care. Nursing is no longer tied to the church, and nurses are educated in colleges and universities.

1836
Theodor Fliender opens a small hospital and training school in kaiserwort, Germany where Florence Nightingale receives her nursing education.

Hospital based school of nursing continues to exist, but these programmes have been declining in number as the profession moves forward and requires education in academic settings.

1854 1860
This is the period when Florence Nightingale, who named superintendent of nursing, made major contribution to modern nursing, cares for soldiers in the Crimean war. She opened a training school at St. Thomas hospital in London, and publishes Notes on Nursing, What it is, what it is not. Nightingales many contributions to nursing continue to influence the profession. The components of her theory apply even today, and nurses around the world recognize the courage, dedication and work of this early professional leader.

1861- 1865
Dorothea Dix establishes the nurse corps of the UN army. Dix was not a nurse but an advocate for the mentally ill people. Nurses continue to choose careers in the armed services where opportunities for existing and rewarding careers are offered.

1872
American first trained nurse, Linda Richards, graduate from the New England Hospital for women in Boston. Nursing continue to prepare educated, competent individuals to provide nursing care in institutions of higher education.

1974
the first Nightingale model school of nursing in Canada is set up in St. Catherines, Ontario. New Nursing programmes continue to develop.

The profession now offers several routes to a career in nursing including diploma, associate degree, baccalaureate degree, masters and doctoral degree. 1882: Clara Barton organizes the American National Red Cross. The Red Cross continues to exist today, offering care to victims of disasters, maintaining the nations blood supply and educating about HIV/AIDS.

1893
Lillian Wald and Merry Brewster found Henry Street settlement, the first home visiting nurse organization in United States. Visiting nurse associations have grown and become essential health care components in a society. 1897: The American society of superintendents of training schools of the United States and Canada is organized. It is renamed ANA in 1911 and CNA in 1907.

1899
ICN is established which continues to represent and speak to international nursing concerns. 1900: AJN- the first journal of nursing journal to be owned, operated and published by nurses is developed. AJN and The Canadian Nurses continue to be the major references for clinical nursing practice.

1923
Gold-mark report of the Rockefeller Foundation is published, advocating financial support of university-based schools of nursing. Nursing organizations and leaders are working to improve financial assistance to students.

1940
WWII results in another nursing shortage. Esther Lucille Brown completes the Brown report on nursing education, advocating that education for nursing belongs to colleges and universities, not in hospitals. Although hospital based schools of nursing continues to exist they are declining in number, and the students are more frequently choosing college and university educations.

1953
National Student Nurses Association (NSNA) is established which continues to encourage students of nursing to become involved in professional issues. Students are given opportunities to hold leadership positions at state and national levels. The equivalent organization in Canada is known as the Canadian University Nursing Students Association.

1965
ANA issues its first position paper on nursing education calling for all nursing education to take place on institutions of higher education and stipulating Baccalaureate as the minimum preparation for professional nursing and associate degree for technical nursing practice. The entry level debates have not been completely resolved.

1985
National Center for Nursing Research is established at the national institutes of Health in Bethesda, Maryland which upgraded by President Clinton to institute in 1993.

Nursing as a profession
The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at national or state level.

Profession
The aim of the nursing community worldwide is to develop the profession guided by continuing education based on nursing research, and to regulate standards of competency and ethics. There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theory and practice and training in clinical skills.

Contd
Over the past 50 years, nursing has undergone dynamic changes in its scope of practice. Nurses have moved from simply observing and giving prescribed medications to coordinating clinical information for the entire health care team. This coordination allows for the design of the best possible plans of care.

Criteria to be a profession
To provide a needed service To advance its knowledge in its field To protect its members and make it possible to practice effectively Characteristics of a profession: A basic profession requires an extended education of its members. A profession has a theoretical body of knowledge leading to defend skills, abilities and norms. A profession provides specific service. Members of a profession have autonomy in decision making and practice. The profession has a code of ethics for practice.

Role of nurses
Historically, the nurses sole duty was to provide care and comfort to the sick. Advances in technology, knowledge, health promotion, and prevention have expanded the function of todays nurses. Nursing function includes activities that nurses perform independently (example, turning or positioning bed client every 2 hours) or collaboratively (example, prescription of medication by physicians and judgment of nurses for proper administration)

Role
Professional nurses are autonomous and assume the responsibilities of care givers, decision makers, client advocates, managers and coordinators of health care needs, educators, and communicators.