Historical Perspectives of Nursing and Concepts of Nursing

Objects

【 master 】 Characteristics of nursing profession;

【 comprehend 】 Florence Nightingale’s deeds and her

Contributions to nursing science; Concept and Dimensions of Nursing

【 understand 】 Historical Perspectives of Nursing

Introductions

Nursing began as a desire to keep people healthy and to provide comfort and assurance to the sick.

Although the general goals of nursing have remained relatively the same over the centuries, ever-advancing science and the changing of society’s needs have deeply influenced the practice of nursing.

Stages of Nursing

Nursing from Ancient times to the nineteenth century Early Civilization Christianity Middle Ages Fifteenth to Nineteenth Century

Early Civilization

Egyptian physicians are believed to have specialized in certain diseases (such as internal diseases, fractured bones, and wounds). They also hired women, later known as midwives, to assist with childbirth. These women were the first records nurses.

Early Civilization

Greece

The Greeks believed in Apollo, the Greek god of healing and prayed to him for magic cures for their illness.

400 B.C., the famous Greek physician Hippocrates believed that disease had natural, not magical, causes.

Early Civilization

Roman Empire After 300 B.C., early physicians built on the groundwork of their Egyptian and Greek predecessors. The Romans are best known for advances in the health of the public.

Early Civilization

India

In ancient India, early hospitals were staffed by male nurses who were required to meet four qualifications: knowledge of the manner in which drugs should be prepared for administration, cleverness, devotedness to the patient, and purity of mind and body.

Christianity

With the beginning of Christianity, nursing began to have a formal and more clearly defined role.

Led by the belief that love and caring for others were important, women made the first visits to sick people, male gave nursing care and buried the dead.

Nursing became a respected vocation.

Middle Ages

More hospitals were built.

Nurses delivered custodial care and depended on physicians for direction.

Nurse midwifery, as one of the oldest nursing roles, flourished.

Much nursing care was provided by monks and nuns, which was segregated by sex.

Fifteenth to Nineteenth Century

The extensive population growth in cities, the lack of hygiene and sanitation and the increasing poverty in urban centers resulted in serious health problem.

Society changed from one with a religious orientation to one that emphasized warfare, exploration, and expansion of knowledge.

Fifteenth to Nineteenth Century

Many monasteries and convents closed, leading to a tremendous shortage of people to care for the sick.

Women who had committed crimes were recruited into nursing in lieu of serving sentences.

The only acceptable nursing role was within a religious order where services were provided as part of Christianity charity.

Fifteenth to Nineteenth Century

Period of NightingaleFlorence Nightingale was born in 1820 in a wealthy family;

Period of Nightingaleher education included the mastery of several ancient and modern language, literature, philosophy, history, science, mathematics, religion, art and music;

Fifteenth to Nineteenth CenturyPeriod of Nightingaleshe was determined to become a nurse since she believed she was “called by God to help others and to improve the well-being of mankind”;she visited Kaiserswerth and received nurse’s training at 1850 for three months;

Fifteenth to Nineteenth CenturyPeriod of Nightingalethe outbreak of the Crimean War gave Nightingale an opportunity for achievement;Nightingale and her nurses transformed the military hospitals by setting up diet kitchens, a laundry, recreation centers, and reading rooms, and organizing classes for orderlies;

Fifteenth to Nineteenth CenturyPeriod of Nightingaleafter the war, Nightingale established the Nightingale Training School for Nursed at St. Thomas’ hospital in London; the school served as a model for other training school;as the founder of modern nursing, Florence Nightingale established the first nursing philosophy based on health maintenance and restoration.

Stages of Nursing

Development of modern nursingIn the early twentieth century, a movement toward a scientific, research-based defined body of nursing knowledge and practice was seen;

Stages of Nursing

Development of modern nursingNursing Education:in 1923, the Rockefeller Foundation funded a survey on nursing education, which recommended that nursing schools be independent of hospital and on a college level;in 1924, one of the schools of nursing was set up at Yale University;

Stages of Nursing

Development of modern nursingNursing practice:by 1920’s, nursing specialization was developing;the concept of the clinical nurse specialist arose;from period of Nightingale, the system of nursing management has been improving.

Nursing in China

Ancient nursing practicethe concept of holism; care on the basis of differential diagnosis;

From the middle period of 19th century to the middle of the 20th century

During the latter half the 20th century

Concept of Nursing

3 stages of the concept of nursing:disease centered, patient centered and human health centered

International Council of Nurses, in 1973, nursing is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery , preventing disease or peaceful death.

Concept of Nursing

The American Nurses Association, in 1980, nursing is the diagnosis and treatment of human responses to actual or potential health problems.

Tasks of Nursing

Relieving pains

Maintaining health

Restoring health

Promoting health and wellness

Body of Nursing knowledge

Fundamental knowledge:physical sciencefundamental medical psychological and social scienceKnowledge specific to nursing:clinical nursing: fundamental nursing, specialty nursing, community nursingnursing managementnursing education

Characteristics of a Profession

Has practitioners who are motivated by altruism

Can be taught through a process of professional education.

Is basically intellectual (as opposed to physical).

Improves its techniques by the use of scientific method.

Functions autonomously.

Nursing as a Profession, Kelly,1981

The services provided are vital to humanity and the welfare of society.

There is a special body of knowledge which is continually enlarged through research.

The services involve intellectual activities; individual responsibility (accountability) is a strong feature.

Nursing as a Profession, Kelly,1981

Practitioners are educated in institutions of higher learning.

Practitioners are relatively independent and control their own policies and activities (autonomy).

Practitioners are motivated by service (altruism) and consider their word an important component of their lives.

Nursing as a Profession, Kelly,1981

There is a code of ethics to guide the decisions and conduct of practitioners.

There is an organization (association) which encourages and supports high standards of practice.

Dimensions of Nursing Practice

Clinical Nursing:fundamental nursing, to meet basic needs of clients;specialty nursing, based on nursing science and specialty theories, knowledge and skills;

Community-based health care, directed toward a specific population or group within the community

Dimensions of Nursing Practice

Nursing Education:based on nursing science and education theories;controlled by the state education and health care guide.

Nursing Management:systematic management of factors as nursing professional staff, technologies, equipment, information, financing.

Nursing Research:

Forms of nursing in hospital

Case management ： cared by some fixed nurses

Functional nursing ： centered by orders

Nursing in groups：Primary nursing：Systematic holistic nursing ： philosophy, responsibility, forms

Case management

Functional nursing

Orders,Fundamental

nursing

Shifts of nurses: day/night shift

Nursing in groups

Group A Group B

NURSING HISTORY,

EDUCATION AND

ORGANIZATION

Nursing: An Art…A Science

By using scientific knowledge in a humane way, nursing combines rational, scientific methods with caring behavior.

Nursing focuses not on the illness but the client’s response to illness.

Historical Overview

Nursing is an ancient profession that has evolved alongside human civilization.

Religion heavily influenced this evolution. Many early hospitals were tied to organized religion.

During the industrial revolution, scientific methods became more important.

Florence Nightingale

The founder of modern nursing.

She established the first school for nurses that provided theory-based knowledge and clinical skill-building.Encouraged the belief that there is a body of nursing knowledge distinct from medical knowledge.

Nightingale’s Accomplishments

Demonstrated the value of nursing care in reducing morbidity rates in the Crimean WarEstablished the Nightingale School for Nurses at St. Thomas’ Hospital in LondonAdvocated the principles of cleanliness and nutrition in promoting healthDeveloped public awareness of the need for nurses.

The Civil War & Nursing

America’s tragic conflict underscored the need for nursing.

Clara Barton (1821-1912) volunteered her nursing skills and organized the Red Cross in the United States after the war.

Pioneers of Nursing

Lillian Wald: First community health nurse.

Isabel Hampton Robb: Founded nursing organizations.

Adelaide Nutting: First nurse appointed as university professor.

Lavinia Dock: Author of early textbooks.

Mary Breckenridge: Serviced rural America.

Mamie Hale: Educator of midwives.

Mary Mahoney: America’s first African-American nurse.

Linda Richards: America’s first trained nurse. (Note: The term trained nurse preceded registered nurse).

“Practical” Nursing

Women who cared for others, but who had no formal education, often called themselves “practical nurses.”

Early Practical Nursing Schools

Ballard School. Opened in 1892 in New York City by the YMCA.Thompson Practical Nursing School. Established 1907 in Brattleboro, Vermont. Still operating today.Household Nursing School. Founded in 1918 in Boston.

Nursing Education Changes

The Goldmark Report: Published in 1923, this report concluded that for nursing to be on an equal footing with other disciplines, nursing education should occur in the university setting.

Institute of Research and Sciencein Nursing Education Report: Resulted in the establishment of practical nursing under Title III of the Health Amendment Act of 1955. This led to a growth in practical nursing schools in the U.S.

Nursing Education: LP/VNs

LPNs (Licensed Practical Nurses) and LVNs (Licensed Vocational Nurses) work under the supervision of an RN or other licensed provider such as a physician or dentist.

Education is focused on basic nursing skills and direct client care.

Educated in community colleges, hospitals, vocational programs.

Nursing Education: RNsRNs (Registered Nurses) may operate autonomously and may supervise LP/VNsLVNS.

Education is focused on basic nursing skills and direct client care.

Educated in universities, community colleges, hospitals.

Diploma Programs

Typically 3 years in length and offered by hospitals.Graduates receive diploma rather than a college degree.Program emphasizes basic skills particularly suited for hospital clients.Such programs contribute 6% of nurse graduates.

Associate Degree Programs

2-year program offered through community colleges or as options at four-year universities.Graduate receives Associate Degree in Nursing (ADN).Program stresses basic skill preparation with clinical practice occurring increasingly in community-based institutions (e.g. ambulatory

settings, schools and clinics).Such programs contribute 60% of nurse graduates.

Baccalaureate Degree Programs

Typically 4 years in length, offered through colleges and universities.Graduate receives Bachelor of Science in Nursing (BSN)Emphasizes preparation for practice in nonhospital settings, broader scientific content, and systematic problem-solving tools for autonomous and collaborative practice.Such programs contribute 34% of all nursing graduates.

Nursing Organizations American Nurses Association (ANA)

Purpose: To improve the quality of nursing care.Established 1911.Establishes standards for nursing practice.Establishes a professional code of ethics.Develops educational standardsOversees a credentialing system.Influences legislation affecting health care.

For RNs only.Publications: American Journal of Nursing; American Nurse

Nursing OrganizationsNational Association for Practical Nurse Education and Service, Inc. (NAPNES)

Purpose: To improve the quality, education, and recognition of nursing schools and LP/VNs in the U.S.Established 1941.Provides workshops, seminars, and continuing-education programs.Evaluates and certifies continuing-education programs of others.Provides individual student professional liability insurance program.

Nursing OrganizationsNational Federation of Licensed Practical Nurses, Inc. (NFLPN)

Purpose: Provide leadership for LP/VNs.

Established 1949.

Encourages continuing education.

Establishes principles of ethics.

Represents and speaks for LP/VNs in Congress.

Offers members best type of low-cost insurance.

For LPs/VNs.Publication: AJPN (quarterly newsletter)

Nursing OrganizationsNational League for Nursing (NLN)

Purpose: To identify the nursing needs of society and to foster programs designed to meet these needs.Established 1952.Accredits nursing education programs.Conducts surveys to collect data on education programs.Provides continuing-education programs.

Open to all nurses and non-nurses.Publication: Nursing & Health Care.

Nursing OrganizationsNational Council of State Boards of Nursing, Inc. (NCSBN)

Purpose: Provides an organization through which boards of nursing act together on matters of common interest and concern.

Established 1978.

Develops and administers licensure examinations for RN and LP/VN candidates.

Maintains a national disciplinary data bank.

Serves as the national clearinghouse of information on nursing regulation.

Publications: Issues; NCLEX-RN Program Reports; NCLEX-PN Program Reports.