The Evolution of Nursing

CHAPTER 1
The Evolution of Nursing
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Mosby items and derived items © 2006, 2003, 1999, 1995, 1991 by Mosby, Inc.
History of Nursing and Nursing Education
• Care of the Sick During Early Civilization

 Illness was considered to be directly related to
disfavor with God.
• Primitive people believed people became sick when an
evil spirit entered the body.
• Good spirit kept disease away.
 Medicine men performed witchcraft to induce bad
spirits to leave the body.
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 Babylonians
• Intellectually, socially, and scientifically well developed
• Lay persons provided medical service, usually men
 Ancient Hebrews
• Attributed their misfortunes and illnesses to God’s
wrath; depended on God to restore health
• Combined health and dietary practices from their
religious beliefs with hygienic practices
• Prevented the spread of communicable disease
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 Ancient Egypt
• Established hospitals
• Physicians were skillful at treating fractures
• Became well acquainted with organs of the body during
embalming
• Developed a number of drugs and procedures such as
surgery
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 Ancient Greece
• Hellenic
 Established temples (hospitals)
o Spas, mineral springs
o Bath gymnasiums
o Treatment and consultation rooms
 Religious influence continued

o Prayer, offerings of thanks, and rituals
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 Ancient Greece (continued)
• Hippocrates
 Brilliant, progressive physician
 “Father of Medicine”
 Rejected the supernatural origin of disease
 Adopted a system of physical assessment, observation,
and record keeping
 Hippocratic Oath (oath taken by physicians)
 Work is basis for the holistic approach to patient care
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 Ancient Greece (continued)
• Promoted public health and safety; emphasis on the
poor, sick, widowed, and children
• Deacons and deaconesses visited the sick in their
homes, prisons, and hospitals
• Phoebe: one of the first “visiting nurses”
• Fabiola: spent her wealth and time nursing the sick and
poor; provided the first free hospital
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• Nursing Education in the 19th Century

 Hospitals
• Overcrowded
• No trained or qualified people
 Women of “proper upbringing” did not work
 Nurses ended up being “inferior” and “undesirable” lower-
class women
• Place to contract disease rather than be cured
 Poor hygienic practices
 Unchecked infection
 Dirty physical conditions
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 Lutheran Order of Deaconesses
• Established the first real school of nursing
• Located in Kaiserwerther, Germany
• Florence Nightingale attended this school.
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 Florence Nightingale
• Changed condition of the hospitals
 Cleaned units, washed clothes regularly, provided
sanitary conditions
 Through her patience, dedication, and empathetic
treatment, made a psychologic change
 “Lady with the lamp”
o Carried a lamp to light her way through the rows of
beds of the injured and sick
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 Nursing from Occupation to Profession
• Florence Nightingale began the reformation of nursing
from occupation to profession by establishing the Saint
Thomas Hospital School of Nursing in London
 1 Year training
 Formal instruction and practical experience
 “Register”
o Beginning of control over nursing graduates and
standard of practice
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 Development of Nursing Education in the U.S.
• During the time that Florence Nightingale was active in
Europe, the same kinds of patient care problems were
occurring in America.
• In 1849, Pastor Theodore Fliedner of Germany traveled
to America with four highly trained nurse-deaconesses.
• Established the first protestant hospital in the U.S.
 Pittsburgh Infirmary in Pittsburgh, Penn.
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• Most early nursing programs were supported by large
hospitals.
 First three schools of nursing in the U.S.
o Bellevue Hospital School of Nursing, New York
o Connecticut Training School, New Haven
o Boston Training School at Massachusetts General
Hospital, Boston
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• American Society of Superintendents of Training
Schools of Nursing
 Established by Isabelle Hampton Robb and Lavinia Dock
 Goal was to set education standards for nurses
 Code of ethics was adopted by the society
o Nightingale Pledge
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• Changes in Nursing During the 20th Century

 Nursing Licensure
• First laws were established in 1903.
• Protect the public
• North Carolina, New Jersey, and New York were first
states
• Isabelle Hampton Robb and Mary Adelaide Nutting
 Developed a program at Columbia University to train and
develop teachers of nursing
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 World War I
• Increased demand for nurses
• Army School of Nursing was established
• Training focused on “service to the patient” rather than
on comprehensive care
• Most nurses returned to previous jobs after the war
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 World War II
• Increased demand for nurses
• Cadet Nurse Corps was established
• Nurses stayed in the military after the war
 Civilian nursing: low pay, long shifts, atrocious conditions
 Military nursing: prestige, good pay, and opportunity for
advancement
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 Contemporary Nursing
• Characteristics of health care changed rapidly as health
care became an industry.
• Growth and diversity became the major emphasis.
• Beginning of contemporary nursing with specialized
nursing care adapted to areas
 Private duty, school nursing, industrial nursing, nurse
anesthesia, and nurse-midwifery
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 Contemporary Nursing
• 1965: American Nurses Association
o Education should take place in institutions of
learning.
o Many hospital-based nursing programs were
disbanded.
o Trend was changed from “training” nurses to
“educating” nurses.
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 Certification
• The nurse is granted recognition for competency in a
specific area of nursing.
• Eligibility
 Current RN license
 Minimum 2 years’ experience in the designated area.
 Currently practicing in the designated area.
• Some areas include gerontologic, medical-surgical,
psychiatric and mental health, and adult nurse
practitioner.
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Development of Practical/Vocational
Nursing in the United States
• Attendant Nurses
 The Ballard School
• First school for training practical nurses
• Started in 1892 in Brooklyn, N.Y.
• 3 Months’ duration
• Trained students to care for the chronically ill, invalids,
children, and the elderly
• Main emphasis was on home care
 Cooking, nutrition, basic science, basic nursing
procedures
• Graduated as attendant nurses
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• Attendant Nurses
 Two other programs patterned after Ballard School
• Thompson Practical Nursing School; Brattleboro,
Vermont; 1907
• Household Nursing Association School of Attendant
Nursing; Boston, Mass.; 1918
 Focus continued to be on home nursing care and light
housekeeping duties
 No hospital experience.
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• Practical Nursing Programs
 Before 1940, practical nursing schools had few
controls, little educational planning, and minimal
supervision.
 Between 1948 and 1954, 260 practical nursing
programs were opened.
 Students in these programs provided nursing service
while they were obtaining their education and training.
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• Organizational Influence
 Association of Practical Nurse Schools
• Founded in 1941
• Dedicated to practical nursing
• Planned the first standard curriculum for practical
nursing
 1942: changed name to the National Association of
Practical Nurse Education (NAPNE)
 1959: changed name to National Association for Practical
Nurse Education and Service (NAPNES)
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• Organizational Influence
 National Federation of Licensed Practical Nurses
(NFLPN)
• Founded by Lillian Kuster in 1949
• Membership is limited to LVNs and LPNs
 National League for Nursing
• 1961; established a Department of Practical Nursing
Programs
• Developed an accreditation service for PN programs;
Council of Practical Nursing Programs
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• Additional Credentialing
 Approved program
• One that meets minimum standards set by the
respective state agency
• Ensures that a given program
 meets the needs of the student
 has adequate course content and qualified faculty
 is of sufficient length
 has adequate facilities
 provides clinical experience
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• Additional Credentialing
 Accreditation
• Program voluntarily seeks a review by a given
organization to determine whether the program meets
the preestablished criteria of that organization.
• Standards are usually far higher than required by the
state.
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• Contemporary Practical/Vocational Nursing
Education
 Nursing programs are offered by various
organizations: high schools,trade or technical schools,
hospitals, junior and community colleges, universities,
private education agencies
 Length of programs: 12 to 18 months
 Skills, theory, and clinical practice
 National Council Licensing Examination for Practical
Nursing (NCLEX-PN)
• Examination for licensure as LPN
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• Contemporary Practical/Vocational Nursing
Education
 Articulation
• Procedure that allows nursing programs to work
together to plan their curricula to decrease duplication
of learning experiences
• LPN/LVN to RN
• RN to BSN
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• Career Advancement
 Career Ladder
• Recognizes the clinical expertise of the nurse and
provides a mechanism for providing the nurse with
financial compensation and opportunities for
advancement
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• Events that Changed Practical/Vocational Nursing
 The need for trained caregivers
 World War I
 The self-taught practical nurse
 The Great Depression
 Duties of licensed practical/vocational nurses
 Position Paper of the American Nurses Association
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• Licensure for Practical/Vocational Nursing
 Licensing Laws
• Protect the public from unqualified persons practicing in
almost any field or profession
 Jurisdictions
• Area such as a state that has the legal power to
regulate nursing licensure and practice
 State board of nursing
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 Laws that Monitor the Licensed Practical/Vocational
Nurse
• Licensing for practical nurses in the U.S. began in 1914
by Mississippi
 By 1955, all states had passed licensing laws
• State Board Test Pool
 NLN Education Committee established a testing
mechanism for all states and administered the exam
several times a year.
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 Laws that Monitor the Licensed Practical/Vocational
Nurse
• National Council Licensing Examination for Practical
Nurses (NLCEX-PN)
 Computerized examination
 Receive score of “passed” or “has not passed”
• Interstate endorsement
 Reciprocity between states
o Licensing in other jurisdictions can be obtained
without repeating the NCLEX-PN
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Health Care Delivery Systems
• Health Care System Defined

 The complete network of agencies, facilities, and all
providers of health care in a specified geographical
area
• Patient, patient’s family, community, current technology,
government agencies, medical professionals, third party
participants
 Goal is to achieve optimal levels of health care.
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 Wellness/Illness Continuum
• The range of a person’s total health; ever changing
• Wellness: A dynamic state of health in which an
individual progresses toward a higher level of
functioning, achieving an optimal balance between
internal and external environment
 Highest level of optimal health
• Illness: A diminished or impaired state of health
 Opposite end of spectrum from wellness
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 Maslow’s Model of Health and Illness
• Developed by Abraham Maslow
 He believed that an individual’s behavior is formed by his
attempts to meet his basic needs.
o Physiological, safety and security, love and
belongingness, esteem, self-actualization

• Hierarchy or pyramid
o Some needs must be meet before advancing to other
needs.
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Figure 1-5
Maslow’s hierarchy of needs.

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 Health Promotion and Illness Prevention
• U.S. Department of Public Health
 Identify what types of diseases are most prevalent, which
age groups are affected by certain illnesses, and which
illnesses are predominant
 Direct efforts toward developing treatment of the illness,
establishing methods to decrease its spread, and
isolating its cause
 Focus has now shifted from curing the problem to
preventing it.
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 Continuity of Care
• Ensuring the continuation of care from one setting to
another
• Understanding what procedures are done, why, and by
whom is a discouraging and often impossible task for
patients already bewildered and frightened by medical
conditions that threaten their well-being.
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• Delivery of Patient Care

 Extremely humanistic activity
• Delivery of services by human beings to human beings
 Treatment of disease and injury
 Prevention of disease
 Restoration of optimal wellness through rehabilitation
 Maintenance of a desirable level of wellness
 Care of the chronically ill
 Provision of assistance to the patient in self-care
 Patient education
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 Participants in the Health Care System
• Professional health care specialists
• Registered nurse
• Licensed practical/licensed nurse
• Additional caregivers
 Social worker, physical therapist, dietitian, respiratory
therapist
• Technologists and medical technicians
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 Economic Factors Affecting Health and Illness
• Rising health care costs
• Aging population
• Advancement of technology
• Health care insurance
• Malpractice insurance
• Miscellaneous factors
 People avoid preventive and routine care and are seen
only in crisis situations.
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 Economic Factors Affecting Health and Illness
• Changes in delivery system
 Case management
 Cross-training
 Additional trends
o Multisystem health care chains
o Health maintenance organizations (HMOs)
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 Environmental Factors Affecting Health and Illness
• Social and physical environmental factors do not
necessarily cause illness, but they do influence the
development or progression of an illness.
• Social: Financial hardship, lifestyle, social pressures,
etc.
• Physical: Stress, conflict, smoking, weight, etc.
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 Expectations of the Patient and Health Care Team
• Health promotion
 Preventive medicine through education
• Patients’ rights
 Patients expect to be treated with dignity and
compassion and have their rights respected.
• Health care providers’ rights
 Expect that patients will actively participate in their care
as much as possible
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 Interdisciplinary Approach to Health Care
• Care plan
 Document that outlines the individual needs of the patient
and the approach of the health care team in meeting
these needs
• Communication
 Good communication is essential for the exchange of
information among the members of the health care team
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Figure 1-6
(From Lindeman, C.A., McAthie, M. [1999]. Fundamentals of contemporary nursing practice.

Philadelphia: Saunders.)
A nurse collaborating with other members of the interdisciplinary

health care team.
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 Interdisciplinary Approach to Health Care
• Documentation
 Any form of documentation is the permanent record of
the patient’s progress and treatment
 It is the formal and legal record of care received by the
patient and the patient’s response to that care
 Provides a progress record of treatment
 Provides a history of events
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Nursing Care Models
• Four Major Concepts

 Nursing
• Encompasses the roles and actions of the nurse
 Patient
• The individual receiving the care
 Health
• The area in which the patient fits on the wellness/illness
continuum
 Environment
• The setting for the nurse-patient interactions
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Contemporary Practical/Vocational
Nursing Care
• Practical/Vocational Nursing Defined
 The activity of providing specific services to patients
under direct supervision of a licensed physician or
dentist and/or RN
 Assist individuals, sick or well, in the performance of
those activities contributing to health, to their
recovery, or to a peaceful death
 Educated to be a responsible member of a health care
team, performing basic therapeutic, rehabilitative, and
preventive care for anyone who needs it
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Nursing Care
• Objectives and Characteristics of
Practical/Vocational Nursing Education
 To acquire the specialized knowledge and skills
needed to meet the health care needs of patients in a
variety of settings
 To be a graduate of a state-approved
practical/vocational nursing program
 To take and pass the NCLEX-PN examination
 To acquire a state license to practice
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Nursing Care
• Roles and Responsibilities of the Licensed
Practical/Vocational Nurse
 Recognizes the LPN/LVN’s role in the health care
delivery system and articulates that role with those of
other health care team members
 Maintains accountability for one’s own nursing
practice within the ethical and legal framework
 Serves as a patient advocate
 Accepts their role in maintaining and developing
standards of practice in providing health care
 Seeks further growth through education opportunities
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The Evolution of Nursing

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The Evolution of Nursing

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CHAPTER 1

The Evolution of Nursing

• Care of the Sick During Early Civilization

• Care of the Sick During Early Civilization

• Care of the Sick During Early Civilization

• Care of the Sick During Early Civilization

o Treatment and consultation rooms

 Religious influence continued

• Care of the Sick During Early Civilization

• Care of the Sick During Early Civilization

• Nursing Education in the 19th Century

• Nursing Education in the 19th Century

• Nursing Education in the 19th Century

beds of the injured and sick

• Nursing Education in the 19th Century

• Nursing Education in the 19th Century

• Nursing Education in the 19th Century

o Connecticut Training School, New Haven

o Boston Training School at Massachusetts General

• Nursing Education in the 19th Century

• Changes in Nursing During the 20th Century

• Changes in Nursing During the 20th Century

• Changes in Nursing During the 20th Century

• Changes in Nursing During the 20th Century

• Changes in Nursing During the 20th Century

• Changes in Nursing During the 20th Century

without repeating the NCLEX-PN

• Health Care System Defined

• Health Care System Defined

• Health Care System Defined

belongingness, esteem, self-actualization

Maslow’s hierarchy of needs.

• Health Care System Defined

• Health Care System Defined

• Delivery of Patient Care

• Delivery of Patient Care

• Delivery of Patient Care

• Delivery of Patient Care

o Health maintenance organizations (HMOs)

• Delivery of Patient Care

• Delivery of Patient Care

• Delivery of Patient Care

(From Lindeman, C.A., McAthie, M. [1999]. Fundamentals of contemporary nursing practice.

A nurse collaborating with other members of the interdisciplinary

• Delivery of Patient Care

• Four Major Concepts

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