L4 - The Evolution of Professional Nursing

The evolution of

Professional Nursing

The evolution of Professional Nursing

Nursing has been integrated into every facet of life.

A legacy of human caring was initiated when, according to the Book of Exodus, two midwives, Shiphrah and Puah, rescued the baby Moses and hid him to save his life.

This legacy of caring has progressed throughout the years, responding to psychologic, social, environmental, and physiologic needs of society.

Nurses of the past and present have struggled for recognition as knowledgeable professionals.

The evolution of this struggle is reflected in political, cultural, environmental, and economic events that have sculptured our nation and world history.

The evolution of Professional Nursing

In the beginning men were recognized as health healers.

The work of Florence Nightingale and Mary Seacole played a major role in bringing about changes in nursing.

Using the concept of role modeling, these women demonstrated the value of their worth through their work in fighting for the cause of health and healing.

The evolution of Professional NursingDuring the twentieth century nurses made tremendous advancements in the areas of education, practice, research, and technology. Nursing as a science progressed through education, clinical practice, development of theory, and rigorous research. Today nurses continue to be challenged to expand their roles and explore new areas of practice and leadership.

PREHISTORIC PERIOD

The practice of nursing in the prehistoric period was strongly guided by health beliefs.

Nursing and medical practice were delineated by beliefs of magic, religion, and superstition.

Individuals who were ill were considered to be cursed by evil spirits and evil gods that entered the human body and caused suffering and death if not cast out.

EARLY CIVILIZATIONEgyptAncient Egyptians are noted for their accomplishments at such an early period. They were the first to use the concept of suture in repairing wounds. They also were the first to be recorded as developing community planning that resulted in a decrease in public health problems.The Egyptians invented the development of the calendar and writing that denoted the initiation of recorded history. The oldest records date back before Christ in sixteenth century BC Egypt, containing natural pharmacologic remedies was written to assist in the care and management of disease (Ellis and Hartley, 2001).

Palestine

From 1400 to 1200 BC the Hebrews migrated from the Arabian Desert and gradually settled in Palestine, where they became an agricultural society. Under the leadership of Moses, the Hebrews developed the Mosaic Code, which represented one of the first organized methods of disease control and prevention. It contained public health laws that did not allow the eating of a slaughtered animal dead longer than 3 days. Individuals who were thought to have communicable diseases were isolated from the public and could return to their families only after the priest had declared them healed (Ellis and Hartley, 2001). Males who were Hebrew priests and selected women, usually widows and maidens who cared for the sick in their homes, delivered health care : bringing both physical and spiritual comfort to those in need (Stanhope and Lancaster, 2000).

Greece From 1500 to 100 BC Greek philosophers sought to understand man and his relationshipwith the gods, nature, and other men. They believed that the gods and goddesses of Greek mythology controlled health and illness. Temples built to honor Asclepius, the god of medicine, were designated to care for the sick. Hippocrates was the first to attribute disease to natural causes rather than supernatural causes and curses of the gods. Hippocrates' teachings also encouraged health care providers to look at not just the part of the patient that was sick, but to include the patient's environment (Kalisch and Kalisch, 1995).In the ancient Greek culture little is documented about nursing. Attendants - "basket healers" assisted the temple priests and physicians and traveled from town to town with physicians to offer their services (Stanhope and Lancaster, 2000).

India

Dating from 2000 to 1200 BC, the earliest cultures of India were Hindu. The sacred books of the Hindu, Vedas, were used to guide health care practices. The Vedas included herbs, spices, displays of magic, and charms. These ingredients were used to rid the body of demons and cure illness. The Indians documented information concerning prenatal care and childhood illnesses.Public hospitals were constructed from 274 to 236 BC and were staffed by male nurses with qualifications and duties similar to those of the twentieth-century practical nurse. The Hindu physicians performed major and minor surgeries, including limb amputations, cesarean deliveries, and wound suturing. Women were primarily responsible for caring for the home and family, and they did not work outside the home. (Ellis and Hartley, 2001; Walton, Barondess, and Locke, 1994).

China

The teachings of Confucius (551-479 BC) had a powerful impact on the customs and practices of the people of ancient China. One tradition that exemplified their belief about health and illness was the yin and yang philosophy. The Chinese believed that an imbalance between these two forces would result in illness, whereas balance between the yin and yang represented good health (Giger and Davidhizar,1999). The ancient Chinese used a variety of treatments believed to promote health and harmony, including acupuncture to affect the balance of yin and yang. Hydrotherapy, massage, and exercise were used as preventive health measures (Giger and Davidhizar, 1999). The Chinese also used drug therapy to manage disease conditions and recorded more than 1000 drugs derived from animals, vegetables, and minerals (Walton, Barondess, and Locke, 1994).

Rome

The Roman Empire (27 BC-476 AD), a military dictatorship, adapted medical practices from the countries they conquered and the physicians they enslaved. The first military hospital in Europe was established in Rome. Both male and female attendants assisted in the care of the sick.Galen was a famous Greek physician who worked in Rome and made important contributions to the practice of medicine by expanding his knowledge in anatomy, physiology, pathology, and medical therapeutics (Walton, Barondess, and Locke, 1994).

THE MIDDLE AGES

The Middles Ages (476 BC-1450 AD) followed the demise of the Roman Empire (Walton, Barondess, and Locke, 1994). Women used herbs and new methods of healing, whereas men continued to use purging, leeching, and mercury. This period also saw the Roman Catholic Church become a central figure in the organization and management of health care.

THE MIDDLE AGES

Most of the changes in health care were based on the Christian concepts of charity and the sanctity of human life. Wives of emperors and other women considered noble became nurses.Nurses also provided some medical care, although in most hospitals and monasteries female nurses who were not midwives were forbidden to witness childbirth, help with gynecologic examinations, or even diaper male infants (Kalish and Kalish, 1986).

THE RENAISSANCE PERIOD

The Renaissance and Reformation periods (1500-1700), also known as the rebirth of Europe, followed the Middle Ages. Major advancements were made in pharmacology, chemistry, and medical knowledge including anatomy, physiology, and surgery.Nursing was no longer the respected profession it had once been. This period was referred to asthe "Dark Ages of Nursing" (Ellis and Hartley, 2001).

THE RENAISSANCE PERIODSeveral nursing groups, such as the Order of the Visitation of St. Mary, St. Vincent de Paul, and the Sisters of Charity, were organized to give time, service, and money to the poor and sick. The Sisters of Charity recruited young women for training in nursing, developed educational programs, and cared for abandoned children.In 1640 St. Vincent de Paul established the Hospital for the Foundling to care for the many orphaned and abandoned children (Ellis and Hartley, 1988).

FLORENCE NIGHTINGALEFlorence Nightingale was born in Florence, Italy on May 12, 1820. Nightingale was a highly intelligent, talented. From an early age she demonstrated a deep concern for the poor and suffering.1845 - she became interested in training as a nurse.

1851 - her parents finally permitted her to pursue nurse's training.Nightingale attended a 3-month nursing training program at the Institution of Deaconesses at Kaiserswerth, Germany. 1854 - she began training nurses at the Harley Street Nursing Home and also served as superintendent of nurses at King's College Hospital in London (Kalisch and Kalisch, 1995).

FLORENCE NIGHTINGALE

1854 Sidney Herbert, British Secretary of War and an old friend of the Nightingale family, wrote to Nightingale begging her to lead a group of nurses to the Crimea to work at one of the military hospitals under government authority and expense (Dolan, 1978).

Nightingale accepted his offer and assembled 38 nurses who were sisters and nuns from different Catholic and Anglican orders (Kelly and Joel, 1996).

FLORENCE NIGHTINGALE

By the end of the Crimean War, Nightingale had trained as many as 125 nurses to care for the wounded and ill soldiers (Dolan, 1978).Nightingale is credited for using public health principles and statistical methods to advocate improved health conditions for British soldiers.Through carefully kept statistics, Nightingale was able to document that the soldiers' death rate decreased from 42% to 2% as a result of health care reforms that emphasized sanitary conditions.

FLORENCE NIGHTINGALEIn 1860 Nightingale established the first nursing school in England. By 1873 graduates of Nightingale's nurse training program in England migrated to the United States, where they became supervisors in the first of the hospital-based (diploma) nursing schools: Massachusetts General Hospital in Boston, Bellevue Hospital in New York, and the New Haven Hospital in Connecticut.

MARY SEACOLEMary Seacole was a Jamaican nurse who learned the art of caring and healing from her mother.

In her native land of Jamaica, British West Indies, she was nicknamed "Doctress" because of her administration of care to the sick in a lodging house in Kingston (Carnegie, 1995).

MARY SEACOLESeacole learned of the Crimean War and wrote to the British government requesting to join Nightingale's group of nurses.

Seacole built and opened a lodging house. On the bottom floor was a restaurant, and on the top floor an area arranged like a hospital to nurse sick soldiers (Carnegie, 1995).

World War II (1940 to 1945)

The United States officially entered World War II (WWII) after the bombing of Pearl Harbor in December 1941. At that time the nursing divisions of all of the military branches had inadequate numbers of nurses. Congress passed legislation to provide needed funds to expand nursing education. A committee of six national nursing organizations, called the National Nursing Council, received one million dollars to accomplish the needed expansion. The U.S. Public Health Service became the administrator of the funds, which further strengthened the tie between the U.S.Public Health Service and nursing (Bullough and Bullough, 1984; Stanhope and Lancaster, 2000).

NURSING IN THE U.S. in 1960sVery important amendment to the Social Security Act was Title XVIII or Medicare, passed in 1965. The Medicare program provides hospital insurance, Part A, and medical insurance, Part B, to all people age 65 and older who are eligible to receive Social Security benefits; people with total, permanent disabilities; and people with end-stage renal disease. As a result of Medicare reimbursement, many hospitals catered to physicians who treated Medicare patients.

NURSING IN THE 1960sAnother outcome of the Medicare legislation was the home health movement.Home health agencies were established and began to employ increasing numbers of nurses. In the mid-1960s; and, as a result of Medicare reimbursement and other influences, including a growing elderly population, advances in medical technology, and public demand for increased access to health care, the home health industry has continued unprecedented growth into the 1990s (Rice, 1996). Home health was one of the first employment settings that provided nurses the opportunity to work weekdaysonly.

Nursing in the 1970sThe women's movement of the 1970s greatly influenced nursing. During this time nurses played a major role in providing health care to communities and were instrumental in developing hospice programs, birthing centers, and day care centers for the elderly (Stanhope and Lancaster, 2000).

Nursing in the 1970sBasic educational programs for nurse practitioners expanded during the 1970s and master's level preparation was developed as the requirement for graduation and practice, certification was also required to practice as a nurse practitioner.Nursing, a young profession, has had such an academy, created by the ANA Board, only since 1973. The American Academy of Nursing is composed of clinicians, educators, administrators, and researchers.

Nursing in the 1980sRunaway health care costs became a national issue in the 1980s. Medicare was still reimbursing for any and all hospital services provided to recipients. From 1966 to 1981 the federal contribution to hospital care rose from 13% to 41% (Karger and Stoesz, 1994). In 1983 in an attempt to restrain hospital costs, Congress passed the diagnosis-related group system for reimbursement, better known as the DRG system.

Case management and critical pathwayswere developed to more efficiently manage patient care, and case management became a newarea of specialization for the professional nurse.Medical care advanced in areassuch as organ transplantation, resuscitation and support of premature infants, and criticalcare techniques.

Nursing in the 1980sThe types of patients needing health care changed in the 1980s. Just as in the 1980s, the cost of health care continued to increase with the technologic advancementsin medical care.Homelessness became a common problem in large cities. Unstable economic developments contributed to an increase in the indigent populations (Karger and Stoesz, 1994).

Nursing in the 1980sAcquired immune deficiency syndrome (AIDS) emerged as a frightening, fatal disease.

Nurses were interested in employment opportunities in outpatient facilities because they afforded a chance to work only during the day with no weekend assignments.

Health education became more important as consumers were encouraged to take responsibility for their own care (Stanhope and Lancaster, 2000).

Nursing in the 1980sToward the end of the 1980s the American Medical Association announced its answer to the nursing shortage. It proposed to establish a 9-month program to prepare Registered Care Technologists. This proposal incensed unified nurses who fought it. As a result, the proposal came to naught (Schorr and Kennedy, 1999).

Nursing in the 1990sThe 1990s began with alarm over the state of the U.S. economy.Nurses selected jobs in which they could work more hours in fewer days for more money, sometimes sacrificing the fringe benefits, which would allow them to work a second job or earn higher pay through shift differential for working evening and night shifts. Creative shifts such as the 10-hour day, 4-day work week or the 12-hour day, 3-day work week became commonplace in health care facilities.

Nursing in the 1990s1990 - more than two million U.S. residents died from diseases such as heart disease, cancer, cerebral vascular disease, accidents, chronic obstructive pulmonary disease, liver cirrhosis, tuberculosis, and human immunodeficiency virus infection.Healthy People 2000: National1991 - was published Health Promotion and Disease Prevention Objectives by the U.S. Department of Health and Human Services as a nationwide effort to help states, cities, and communities identify health promotion and disease prevention strategies to address these health risk problems.

Nursing in the 1990sIn 1990 the increasing costs of Medicaid and Medicare triggered political action for health care reform. Findings of a federal commission appointed to evaluate the American health care system include (Kalisch and Kalisch, 1995): " Fifteen percent of the gross national product was related to health care expenditures (this amounts to approximately one trillion dollars annually). The United States spent more than twice as much as any industrialized nation for health care services. Americans were living longer, which indicated a growing demand for home health and nursing home care, as well as increased Medicare expenditures.

Nursing in the 1990sThe focus of managed care was on providing more preventive and primary care, using outpatient and home settings when possible, and limiting expensive hospitalizations.The nurse of the 1990s had to be focused on delivering health care services that (1) encompassed health risk assessment based on family and environmental factors, (2) supported health promotion and disease prevention, and (3) advanced counseling and health education (Oermann, 1997).

Nursing in the 1990sIn the 1990s a partnership was forged between mandatory state licensure authorities, which set practice standards at the level of entering associate degree graduates, and national, nongovernmental bodies that certify graduate-prepared specialists.

Nursing in the Twenty-First Century

Professional nurses in the twenty-first century are faced with many challenges within the dynamic state of health care.

Changing duties, responsibilities, and conflicts amidst nursing shortages and public concern over patient safety and quality of care characterize present-day practice.

Nursing in the Twenty-First CenturyThese changes require professional nurses to have core competency in critical thinking, communication, assessment, leadership, and technical skills, as well as knowledge of health promotion/disease prevention, information technology, health systems, and public policy.

In addition to the issues of access, cost, quality, and accountability in health care, nurses today are challenged by an aging population, consumer health values, and an increasingly intercultural society.

Nursing in the Twenty-First CenturyThrough periods of war, socioeconomic change, and health care reform, nurses have played a vital role in initiating change to improve the health care arena. Nurses have provided the integrity to maintain the quality of care in all health care settings. The evolution of the practice from the treatment of disease to health promotion and disease prevention has led the way in determining the type of providers needed to care for patients in the future.

Nursing in the Twenty-First CenturyThis evolution will continue to provide the foundation for the scope of practice, educational curricula, scholarship, and research necessary for nurses to lead and manage the health care environment of the future. Nurses will continue to increase knowledge, manage technology, and maintain ethical standards to provide high quality care to individuals, families, and communities throughout the world.