Theoretical Foundations

in
Nursing
ST
(1 SEM 2023-24)
DEAN MARIA LUISA T. UAYAN, MSC, DHSC
PROF. JACQUELINE MAE C. GABIANA, MAN, RN.
Learning Outcomes
❖Describe the evolution of nursing
❖Describe the different eras in the development of Nursing
❖Explain the significance of each era in the present day of nursing practice
 Meaning of “Theory” and
Related Concepts
THEORY
Is a set of propositions (statements / opinions),
suppositions (assumptions / hypotheses), or constructs
(ideas), that purport to explain, describe and predict a
reality. It is an abstraction of a reality.
 The Evolution of Nursing
A. Intuitive Period
B. Apprentice Period
C. Educational Period
D. Contemporary Period
 Intuitive Period
(Primitive era – 6th Century)
What is intuition?

Nursing was “untaught” and instinctive. It was

performed of compassion for others, out of the
wish to help others.
Nurse’s role was instinctive and directed toward
comforting, practicing midwifery and being wet
nurse to a child.
 Intuitive Period
▪Nursing was a function that belonged to women.
▪No caregiving training is evident
▪Primitive men believed that illness was caused
by the invasion of the victim’s body of evil spirits.
▪Believed that medicine man was called shaman
or witch doctor having the power to heal using
white magic.
▪Trephining
 Intuitive Period
Early theories

▪Music and singing was often used to chase away

spirits.
▪In some cases, TREPHINING was used.

▪TREPHINING is cutting a hole in the head of the

afflicted to let out the evil spirit.
 Prehistoric Medical Practice
▪Different prehistoric medical practices
▪Use of mercury
▪Blood Letting with the use of leeches Lobotomies
▪Heroin for headaches
▪Electroconvulsive Therapy (ECT)
▪Trephining
▪Cannibalistic Medical Practices
https://www.youtube.com/watch ?v=jOfIdGlyX5c

https://www.youtube.com/watch ?v=Wtx5wQ0pkzI
Prehistoric Medical Practices
• Radium Water
• Ecraseur
• Plombage
• Peg Legs
• Morphine for teething
• Starvation for Aneurysms
• Hydroelectric Baths for Migraines
 Rise of the Early Civilization and
Ancient Cities and their contribution
to Medicine
Mesopotamia
• No distinction between rational science and magic
• Diagnostic Handbook - introduced the methods of
therapy and cause. The text contains a list of medical
symptoms and often detailed empirical observations
along with logical rules used in combining observed
symptoms on the body of a patient with its diagnosis
and prognosis.
 Mesopotamia
•Asipu – Medical Authority/ Exorcist- Healer
• Prophylaxis
•Mental Illness is associated with Deities
 Egypt
• Egyptians are considered
“The Healthiest of all men”
• Public Health System
• Medical information in the Edwin Smith Papyrus
may date to a time as early as 3000 BC. It details
cures ailment and anatomical observation.
 Egypt
• Edwin Smith Papyrus is an ancient textbook on
surgery almost completely devoid of magical
thinking and describes in exquisite detail the
examination, diagnosis, treatment, and prognosis
of numerous ailments.
• The Kahun Gynaecological Papyrus treats
women's complaints, including problems with
conception.
• The earliest known physician is also credited to
ancient Egypt ("Chief of Dentists and Physicians"
for King Djoser in the 27th century BCE)
• Peseshet – Earliest known woman physician.
 India
• The Atharvaveda – Ancient text dealing with
Medicine
• Ayurveda – “Complete knowledge for long life”
Medical system of India with 8 branches of medicine
• Charaka and Sushruta – 2 most famous medical
texbooks that describes physical examinations,
diagnosis, treatment and prognosis and several
surgical procedures.
• Suśrutasamhitā - Describes several surgical
procedures
 China
Huangdi neijing
- The foundational text of Chinese
medicine written 5th century to
3rd century BC- Basis of traditional
Chinese medicines, acupuncture
and moxibustion
 Greece
and
Roman Empire
•Wound treatment
• The Romans attempted to
maintain vigorous health, because
illness was a sign of weakness.
• Care of the ill was left to the
slaves or Greek physicians. Both
groups were looked upon as
inferior by Roman society
 The Apprentice Period
(6th Century- 18th Century)
What is an apprentice?

Period of “on the job” training.

From the founding of the Religious
orders in the 11th century up to 1836
with the establishment of the
Kaiserwerth Institute for training of
Deaconesses.
 The Apprentice
Period
•Nursing performed without
any formal education and by
people who were directed by
more experienced nurses
• Founding of religious order
 The Beginning
of
Religious War
•A religious war or holy war is a war
primarily caused or justified by
differences in religion.
• The Crusades - They were Holy Wars
waged in an attempt to recapture Holy
Land from the Turks who denied
Christ’s pilgrims permission to visit
Holy Sepulcher.
 Military Religious Orders and
their Work
• Knights of St. John of Jerusalem (Italian) - Also known as “Knight
Hospitalers” They founded Hospitals
• Teutonic Knights (German)- Established tent hospitals for the
wounded
• Knights of St. Lazarus- Founded primarily for nursing care of lepers in
Jerusalem
• The Alexian Brothers were members of a monastic order founded
1348. They established the Alexian Brothers Hospital School of Nursing
the largest School of Nursing under religious order. It operated
exclusively for men in United States.
 The Rise of Secular Order
• There was the rise of Religious Nursing Orders
for women. Although Christianity promoted
equality to all men, women were still
concentrated in their roles as wives and
mothers.
•Religious taboos and social restrictions
influenced nursing at the time of the religious
Nursing Orders.
 Secular Orders Founded
during the period of Crusades
• Order of St. Francis of Assisi (1200-
Present)
• The Beguines- composed of lay nurses
who devoted their lives to the service of
suffering humanity
• The Oblates (12th Century)
• Benedictines
• Ursulines
 Important Nursing
Personages
St. Clare - founder of the second
order of St. Francis of Assisi.
St. Elizabeth of Hungary – known as
the “Patroness of Nurses”, she was
the daughter of the Hungarian King.
She lived her life frugally despite her
wealth.
 Important Nursing
Personages
St. Catherine of Siena
– The first lady with the lamp. She
was a hospital nurse, prophetess,
researcher and a reformer of
society and the church.
 The Rise of Protestantism
(1520-1562)
From 1520 onwards, Martin Luther’s ideas and works could be found in
France – they even influenced the court of Francis I. The king’s sister,
Marguerite of Angoulême asked the Bishop of Meaux to reform his diocese
so he asked James Lefèvre d’Etaples to come and join him.
He was the author of a French version of the New Testament which had been
considered heretical by the Sorbonne and was the founder of the Circle of
Reformers in Meaux which had been forbidden by the Church. Luther’s
works were translated into French, mostly printed in Switzerland and passed
from one person to another in secret.
 The Rise of Protestantism (1520-
1562)
The Protestants, who were called ‘Lutherans’
at the time, belonged to the higher, literate
class of society and were condemned as
heretics by the Church. Persecution began in
1521: they had to pay fines, were sent to
prison and even burnt at the stake.
 The Start of dark period of Nursing
The world of nursing, despite wars and plagues made
considerable progress under the influence of Christianity. It
maybe said that nursing owes its foundation to the work of
benevolent men and women, the crusades and the guilds.
But this progress in nursing was brought to a halt by
industrial and political revolution and the Reformation in
the 16th century.
 Dark Period of Nursing 17th to 19th Century
Also known as the period of reformation and American civil war
Hospitals were closed
Nursing was the works of least desirable people
Nurses were uneducated, filthy and overworked
Mass exodus of nurses
The religious upheaval led by Martin Luther destroyed the unity of
the Christian faith.
The wrath of Protestantism swept away from everything connected
with Roman Catholicism in schools, orphanages and hospitals.
Properties of hospitals and schools were confiscated.
Dark Period of Nursing 17th to 19th
Century
Dark Period of Nursing 17th to
19th Century
Theodore Fliedner
– Reconstituted the deaconesses and
later established the school of nursing in
Kaiserwerth, Germany where Florence
Nightingale had her first formal training
for 3 months as a nurse.
 1st Training School of Nursing
United States of America Bellevue
Hospital School of Nursing
- Founded in 1873 in New York. It
was the first school of nursing in the
United States to be founded on the
principles of nursing established by
Florence Nightingale.
 1st Training School of Nursing
Philippines
Iloilo Mission Hospital School of
Nursing
– Established in 1906 it is the
first hospital in the Philippines
which trained Filipino nurse.
Florence Nightingale
 Nightingale Era
• Florence Nightingale
• Born on May 12, 1820
• Born to a wealthy English parents
• Known as “The mother of modern nursing”
“The Lady with the Lamp” and “Professional
Nurse Pioneer
• Most famous for her work during the
Crimean War (1854-1856)
 Nightingale Era
Under Florence’s leadership, the nurses
brought cleanliness, sanitation,
nutritious food and comfort to the
patients.
Nightingale was known for providing
the kind of personal care, like writing
letters home for soldiers, that
comforted them and improved their
psychological health.
 Nightingale Era
Her group of nurses transformed the hospital
into a healthy environment within six months,
and as a result, the death rate of patients fell
from 40 to 2 percent (5). In 1857, Florence
returned home a heroine. It was the soldiers in
Crimea that initially named her the “Lady with
the Lamp” because of the reassuring sight of
her carrying around a lamp to check on the sick
and wounded during the night, and the title
remained with her.
 Nightingale Era
Published in 1859 Notes on Nursing provides
a simple but practical discussion of good
patient care, along with helpful hints.
According to Florence Nightingale, hygiene,
sanitation, fresh air, proper lighting, a good
diet, warmth, quietness and attentiveness
were necessary conditions for hospitals and
were to be ensured by trained nurses.
Environmental Theory and Statistical
 Nightingale Era
Nightingale implemented handwashing
and other hygiene practices in the war
hospital in which she worked.
More soldiers die because from infection
than from bullets she advocated sanitary
living conditions as of great importance.
 Education Period
(18th – 20th Century)
Florence Nightingale was one of the
pioneers in establishing the idea of
nursing schools from her base at St
Thomas' Hospital, London in 1860
when she opened the 'Nightingale
Training School for Nurses’, now part
of King's College London.
 Nightingale School of Nursing
During the war a public subscription fund was set up for Florence
Nightingale to continue her education of nurses in England, and
the Nightingale Training School at St. Thomas’ Hospital opened in
1860.
The education of recruits involved a year of practical instruction in
the wards, supplemented with courses of lecturing, and followed
by two years of work experience in the hospital. After graduation,
many of the students staffed British hospitals, and others spread
the Nightingale education system to other countries.
Concept in the Nightingale system of Education
1. Government funds should be allotted to nursing education • First nurse political activist

2. Training schools of Nursing should be in close affiliation

3. Professional nurses should train nurses

4. Nursing students should be provided with residence near their training hospitals

•Written orders of doctors were insisted

•Nurses should go with doctors during their rounds

Concept in the Nightingale system of Education

5. All nurses must be trained, in a regular civil hospital

6. Training was fundamentally on the apprenticeship model: hands-on, in the wards, under the ward sister

7. Classes, given by medical doctors, augmented training in the wards

8. The “home sister” or “mistress of probationers” organized the training

9. District nurses had to be hospital trained (or they would not see enough serious cases)

10. Midwifery nurses had to be hospital trained

Concept in the Nightingale system of Education
11. Training was required for administrative positions

12. Probationers kept diaries and case notes of their work, examined by the matron and home sister, and often by Nightingale.

13. A major component of training was moral: ethical standards for patient care

14. Technical training had to be updated

15. A Probationers’ Home should be provided, with a private room for each, comfortable (common) living

16. Responsibility for probationers’ health and safety, including rules to prevent septicemia and ongoing monitoring of probationers’
health
Concept in the Nightingale system of Education
17. Certificates and letters of reference had to be dated and were relevant only for
a short time

18. A matron should have a housekeeper under her so that she could concentrate
on the nursing and the nurse training

19. The superintendent herself must have the highest knowledge of nursing, be
herself resident in the hospital, make the training in nursing her first object, and
be herself a trained nurse of the highest order.
 Contemporary Period
(21st Century)

What is contemporary?

How will you describe nurses

and nursing today?
 Nursing after World War I
• World War I - World War I (often abbreviated
as WWI or WW1), also known as the First World
War or the Great War, was a global war
originating in Europe that lasted from 28 July
1914 to 11 November 1918
• Conflict between the great powers of Europe
were divided into two coalitions: the Triple
Entente—consisting of France, Russia and
Britain—and the Triple Alliance of Germany,
Austria-Hungary and Italy
 Nursing after World War I
• The silver lining of the great war
• Volume of patients drastically change the role of
nurses
• The nurses performed triage as patients came in
on ambulance trains, directed corpsmen who had
little medical training, managed entire wards of
patients and performed a variety of procedures,
including irrigating wounds and managing
infection.
• Dependent to Independent nursing practice
 Nursing after World War I
•Good Infection control and wound care even with the absence of
antibiotics and electricity
•American nurses worked on base hospitals, hospital trains,
hospital ships, field hospitals, camp hospitals and even evacuation
hospitals and mobile units.
• Mobilizing women and women empowerment
•Nurses earned the respect of those they served with, and they
were decision-makers. That was very different for them, not just as
nurses but as women.
 Nursing After World War II
•New Opportunities for Women:
Wartime and the American Workforce
•Nurses on the Front Lines
• The Scars of War: PTSD in WWII
Nurses (Post Traumatic Stress
Disorder)
 Rise of the BSN Curriculum
The Degree of Bachelor of Science in
Nursing: 1941 – 1951
A nursing curriculum which was based on
the thesis presented by Julita V. Sotejo,
graduate of the Philippine General Hospital
School of Nursing, tackles on the
development of a nursing education within a
University-based College of Nursing.
 Rise of the BSN Curriculum
•When the Japanese occupied the Philippines in 1942, training and
practice at the hospital schools of nursing in Manila was “violently
disrupted.”
However, U.S. colonial patterns in Philippine nursing education soon
returned after the U.S. reclaimed the country in 1945 and even after
the Philippines gained independence from the U.S. July 4, 1946.
 Rise of the BSN Curriculum
The First Colleges of Nursing in the
Philippines
•University of Santo Tomas-College of
Nursing (1946)- In 1947, the Bureau of
Private Schools permitted UST to grant
the title Graduate Nurse to the 21
students who were of advanced
standing from 1948 up to the present.
 Rise of the BSN Curriculum
Manila Central University-College of
Nursing (1947)
The MCU Hospital first offered
BSN and Doctor of Medicine degrees
in 1947 and served as the clinical
field for practice.
 Rise of the BSN Curriculum
University of the Philippines Manila-
College of Nursing (1948)
The idea of opening the college began in a
conference between Miss Julita Sotejo
and UP President. In April 1948, the
University Council approved the
curriculum, and the Board of Regents
recognized the profession as having an
equal standing as Medicine, Engineering
etc. Miss Julita Sotejo was its first dean.
 Nursing in Today’s Society
•Change is the only constant thing
in the world.
•“Nursing is caring” (Womb to
Tomb)
•“Nursing is an Art”
Nursing is an Art
 Nursing in Today’s Society
• Recipient of Nursing - Patients,
community, family, clients and co-workers
• Scope of Nursing
1. Promoting Health and Wellness
2. Preventing Illness
3. Restoring Health
4. Care for the Dying
 Nursing in Today’s Society
Roles and Functions of the Nurse today
1. Caregiver
2. Communicator
3. Teacher
4. Client Advocate
5. Counselor
6. Change Agent
7. Leader
8. Manager
9. Case Manager
10. Expanded Career Roles
 Expanded Career Roles for Nurses
•Nurse Practitioner
• Clinical Nurse Specialist
•Nurse Anesthetist
•Nurse Midwife
•Nurse Research
•Nurse Administrator
•Nurse Educator
•Nurse Entrepreneur
References:
1. Aligood, M. & Tomey, A. (2018) Nursing Theorists and their
Work, 9th edition, Singapore

2. McEwen, Melanie (2019) Theoretical Basis for Nursing, 5th

Ed. Wolters Kluwer
Thank you!