Historical Foundations

and Development of
Nursing Education
__________
Remedios H. Fernando, RN MAN
St. Luke’s College of Nursing
 OBJECTIVES
At the end of the session the students will be able to ;
1. Discuss the evolution of nursing and the different
teaching role of nurses.
2. Recognize the trends/issues affecting the health
care systems and in the practice of nursing.
3. Identify the purposes, goals and benefits of nursing
education.
5.Discuss the barriers and obstacles of teaching
6. Define the different terminologies .
• Can you imagine our life today with out the
health care workers? Especially the nurses ?
• What would think can be the usual scenarios
without them?
• We call them heroes, health heroes,
frontliners, etc!
 #1 Point of Discussion
• Teaching is a vital part of nurses’ role as professional
• Current trends in health care is very important to:
- patients to be prepared and responsible for
taking care of themselves
- nurses working in the different health care
facility, be able to deliver safe and high quality
of patient care.
• The prime goal of modern health care are:
- patients and their relatives have learned
vital KSA for independent care.
-Registered nurses, students nurses should have
acquired the latest trends of KSA
- Updated KSA are rendered competently and
confidently to all clients across all ages in
different health care settings
• Patient education is an issue in nursing
practice and will continue to be a significant
focus in health care environment
(Friberg and Colleague 2012)
• Constant changes are occurring in HCS
• Nurses are increasingly finding themselves in
challenging , constantly changing and highly
complex positions (Gillespie & McFetridge 2006)
• Nursing is an ancient profession that has
evolved along side with human civilization
• Religion heavily influenced this evolution. Many
early hospitals were tied to organized religion
• Stem – religion and military
• In religion nuns/religious figures tend to the sick
• Considered as noble thing to help
• During the industrial revolution scientific
methods became more important
• Gradually the need of experts in the field was
felt, and that is how the focus started shifting
towards nursing.
• Patient education has been a part of health
care since the first healer gave the first patient
advice about treating ailments
 Mid 1800’s
• Mid 1800’s - 20th century
• Formative Pd / First Phase in the development of
organized health care by Dreeben (2010) and
growth of patient education
• Nursing was first acknowledge as a unique discipline
• The responsibility for teaching has been recognized
as an important role of nurses as caregivers .
• Focused not only in caring but also on educating
others for professional practice.
 Mid 1800’s
• James Derhams 1st African American did not
possess a formal degree
• Born into slavery, but training from doctor,
helped him become a freeman
• Lilian Wald – initiated the idea of visiting
nursing when she began teaching a home
nursing class.
- 1st community nurse
 Florence Nightigale (1860)
May 12 1820-Aug 13 1910
• Founder of Modern Nursing
• “the ultimate educator”
• Emerged as resolute advocate of educational
responsibilities of district PHN and authored
Health Teaching in Towns and Villages
(Monterio,1985)
 Florence Nightigale (1860)
May 12 1820-Aug 13 1910

• She developed the first school of nursing, but

also devoted in teaching nurses, physician and
health officials about the importance of
proper conditions in the hospitals and homes
to improve the health of people.
• This school for nurses provided theory-based
knowledge and skill-building.
 Florence Nightigale (1860)
• Encouraged the belief that there is a body of nursing
knowledge distinct from medical knowledge.
• Demonstrated the value of nursing care in reducing
morbidity rates in the Crimean war.
• Established the Nightingale School for Nurses at St.
Thomas Hospital in London
• Developed the Environmental theory
• The need for adequate nutrition, fresh air, exercise and
personal hygiene to improve well being.
• Developed public awareness of the need of nurses.
Picture of Florence Nightigale
 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 US after the war.
• 2nd Phase 20th Century in the development of
organized health care in 1908 which deals
with Child Hygiene, Infants’ Health
 Important events/years
• 1900’s – Public Health Nurses understood the
significance of the role of the nurses as a teacher in
preventing disease and maintaining the health of the
society.
• 1918 – National League of Nurses (NLNE) in the US
observed the importance of Health teaching as
function within the scope of nursing practice.
• PHN were essential to the well being of communities
and the teaching they provided to individuals,
families and groups
• 1923 – Yale University 1st nursing school on the
basis of education rather than the need of the
hospital
• 1937 – NLNE recognized nurses as agents for
the promotion of health and prevention of
illness in all settings in which they practiced.
• 1950 – NLNE identified course content in
nursing school curricula to prepare to assume
the role as teachers of others.
• Third Phase in the development of Health care began
after WW II
• 1940’s to 1950’s described as a time when patient
education continued to occur as part of clinical
encounters
• 1960’s to 1970’s patient education began to be seen
as a specific task
• Mid 1960’s patient was recognized as health care
consumers
• 1970 – patient bill of rights developed and was
adopted by the hospitals
• 1971 – 2 significant events:
- publication from US DOHEW , the Need for
Patient Education
- Pres. Nixon issued a message to Congress to
use the term Health education
• 1976 – JCAHO broadened the scope of patient
education both outpatient and inpatient
services
• 1980 – the role of nurses undergone paradigm shift
(disease oriented approach to prevention oriented)
• 1980’s -1990’s – National Health Education Program
once again became popular as health care trends on
disease prevention and health promotion
• 1993 – JCAHO established nursing standards for patient
education
• 1995 – Pew Health Professions Commission published a
broad set of competencies it believed would mark the
success of the health professions in the 21st century.
• 1998 – PHPC released the fourth report as a follow up
on health professional practice in the new millenium.
New Recommendations specific for nursing profession
have been proposed by the commission.
• 2000 – Patient teaching had been recognized as an
independent function . DOPE – POPE – HOPE. This new
approach has changed the role of nurses from wise
healer to expert advisor/teacher to facilitator of change
• Disease oriented Pt Ed –Prevention Oriented –Health
oriented Pt Ed
• 2001 – JCAHO required accreditation standards have
provided for nursing service managers to put greater
emphasis on unit based clinical staff education.
• 2005- Primary educators of colleagues and other
health care staff personnel increased. The demand for
educators of nursing students is at all time high.
• 2006 – NLN (national league for nursing) developed
the 1st certified nurse educator (CNE) exam, to raise
the visibility and status of the academic educator as
an advanced professional practice discipline.
 Pioneers in Nursing Education
1. Lilian Wald – 1st community nurse
2. Isabel Hampton Robb – Founded nursing organizations.
3. Adelaide Nuttling – first nurse appointed as university
professor.
4. Lavinia Dock – Author of Early Textbooks.
5. Mary Brekenridge –serviced rural America
6. Mamie Hale – educator of midwives
7. Mary Mahoney – America’s first African-American nurse
8. Linda Richards – America’s first trained nurse
 Philippine Nursing Education
• For long time, health care and teaching were
pursued by religious orders.
• Mysticism / supertitions
- early belief of health illness
• Caused of disease – believed to be due to either
another person / enemy / witch / evil spirits
• Evil spirits caused could be driven away by
person’s power to banish demons
• Believe in gods of healing with priest-physician
(word-doctors)
• If they used leaves /roots herbs doctors
(herbolarios)
• Filipino who became sick were usually cared
for by the family members or friends.
 Philippine Nursing Education
• For long time, health care and teaching were
pursued by religious orders.
• Prior to the coming of religious orders,
“arbularyo” or local doctors already tending to
the health needs of the community.
• Relied on indigenous ways and materials in
treating sick.
 Philippine Nursing Education
• Subscribed to superstitious beliefs and practices
to explain the ailments of the sick
(witchcraft/sorcery).
• Religious orders came, the more informed way of
treating the sick had been institutionalized with
the awarding of degrees in nursing and medicine.
• Religious sisters continued to be nurses until they
lay individuals were able to secure nursing
degrees in 1800’s.
 Early Care of the Sick
• Supertitious beliefs/practices in relation to
health and sickness
• Herb man/ herbicheros – one who practice
witchcraft
• Mangkululam/manggaway – person suffering
from disease without any identified cause
believed bewitched
Pamao – difficult childbirth and some diseases
attributed to nunos
• Midwives – assisted in childbirth during labor
• mabuting hilot (good midwife) was called in
• Difficult birth – caused by witches
• Disperse their influence through gunpowder
were exploded from a bamboo cane close to
the head of the sufferer.
Health Care during Spanish Regime
• The context of nursing has manifested through simple
nutrition, wound care and taking care of an ill member
of the family.
• Certain practices when taking care of a sick individuals
entails interventions from babaylan (priest physicians)
or albularyo (herb doctor)
• In 1578 male nurses were acknowledged as Spanish
Friars assistants for caring sick individuals in the
hospital.
• Males nurses called practicante or enfermero
 Earliest Hospital
• Hospital Real De Manila (1577) – it was
established mainly to care for the Spanish
King’s Soldiers, but also admitted Spanish
civilians; founded by Gov. Francisco de Sande
• San Lazaro Hospital (1578) – founded by
Brother Juan Clemente and was administered
for many years by the hospitalliers of San Juan
de Dios, built exclusively for patients with
leprosy
• Hospital de Indios (1586) – established by the
Franciscan order; service was in general
supported by alms and contributions from
charitable persons.
• Hospital de Aguas Santas (1590) – established
in Laguna; near medicinal spring, founded by
Brother J. Bautista of the Franciscan order
• San Juan de Dios Hospital (1596) – founded
the brotherhood of Misericordia and
administered by the Hospitalliers of San Juan
de Dios; support was delivered from alms and
rents ; rendered general health service to the
public
 Nursing During the Philippine Revolution

• In the late 1890’s, the war between the

Philippines and Spain emerges which resulted
to significant amount of casualties.
• Many women assumed the role of nurses in
order to assist the wounded soldiers.
• The emergence of Filipina nurses brought
about the development of Philippine Red
Cross.
• Josephine Bracken – wife of Jose Rizal, installed a
field of hospital in an estate house in Tejeros. She
provided nursing care to the wounded night and day.
• Rosa Sevilla de Alvero – converted their house into
quarters for the Filipino soldiers during the Philippine
–American war that broke out in 1899
• Doῆa Maria Agoncillo de Aguinaldo – second wife of
Emilio Aguinaldo; provided nursing care to Filipino
soldiers during the revolution, President of Filipino
Red Cross branch in Batangas
• Melchora Aquino a.k.a “ Tandang Sora” – nursed the
wounded Filipino soldiers and gave them shelter and
food
• Capitan Salome – a revolutionary leader in Nueva
Ecija; provided nursing care when not in combat
• Aguada Kahabagan – revolutionary leader in Laguna,
also provided nursing services to her troops
• Trinidad Tecson (“ Ina ng Biak na Bato”) – stayed in
the hospital at Biak na Baton to care for wounded
soldiers
 Hospitals and Nursing Schools
• American began training the first Filipino nursing
students in 1907.
• Nursing students in the Philippines studied many f
the same subjects as nursing students in the U.S.
• However it was believed that the curriculum in the
Philippines “was never a mirror-image reproduction
of the American nursing curriculum” and involved
more than a simple transfer of knowledge from
American nurses to Filipino nurses.
• The first Filipino nursing students also studied
subjects that were more relevant to their
patients such as “ the nursing of tropical
diseases” and industrial and living conditions
in the island as described by Lavinia L. Docks
1912 book A History of Nursing; From the
Earliest Times to present Day with Special
Reference to the work of the past Thirty years.
Hospital School of Nursing’s Formal Training
(1901-1911)
• Formal training in hospital school of nursing
transpire. This began when American
missionary doctors and nurses realized that
they manpower is insufficient.
• 1906 Pensionado Act of 1903 (or Act 854) was
mandated allowing the Filipino nursing
students to study in US. Among the first wave
of nurses who went to US
 Philippine History
• In the Philippines the establishment of
Hospitals and School of Nursing Started 1906
• Anastacio Giron - Tupaz
- first Filipino nurse to hold the position of
Chief Nurse and Superintendent
• Cesaria Tan
- first Filipino to receive a masteral degree in
Nursing abroad
• Rosa Militar – pioneer in school health
education
• Sor Ricarda Mendoza – pioneer in nursing
education
• Ms. Rose Nicolet – a graduate of New England
Hospital for Women and Children in Boston
Massachussets was the first superintendent
for nurses
 First Schools of Nursing and Hospital
1. Iloilo Mission Hospital and School of Nursing (1906)
2. St. Paul’s Hospital School of Nursing (Manila, 1907)
3. Philippine General Hosp School of Nursing (1907)
4. St. Luke’s Hosp School of Nursing (QC,1907)
5. Mary Johnston Hosp and School of Nursing (1907)
6. Sallie Long Read Mem Hosp Sch of Nursing (Laoag
1903)
7. Mary Chiles Hospital School of Nursing
(Manila, 1911)
8. Frank Dunn Memorabilia Hospital (Vigan 1912)
9. San Juan de Dios Hospital and School of Nursing
(Manila, 1913)
10. Emmanuel Hospital School of Nursing
(Capiz 1913)
11. Southern Island Hospital School of Nursing
(Cebu, 1918)
 The Start of Nursing Practice (1911-1921)

• Promulgation of Act No. 2493 which amends Medical

Law (Act No. 310) allowing the regulation of nursing
practice transpired during this period.
• 1919 the First True Nursing law was enacted through
Act 2808.
• During this period the Board of Examiners for Nursing
was also created
• The first nursing Board exam was given in 1920
• The first executive officer of the Board of Examiners is a
physician.
 Professional organization (1921-1931)

• Oct 15 Filipino Nurses Association was

established
• Initiated publication of Filipino Nurses Journal
The Degree of Bachelor of Science in Nursing
(1941-1951)
• Nursing curriculum which was based on the
thesis presented by Julita V.Sotejo, a graduate
of PGH School of Nursing, tackles the
development of nursing education within the
University – based College of Nursing
• This dissertation was the beginning of the new
curriculum that made the nursing institution of
the country as a baccalaureate course. During
this period College of Nursing was also created
• 1942 – nursing education was disrupted
• 1945 - returned of Philippine nursing
education and continue then on since
Philippine gained in dependence from US in
July 4, 1946
• Health education has long been considered a
standard care giving role of the nurse.
• Patient teaching is recognized as an
independent nursing function.
• Nursing practice has expanded to include
education in the broad concepts of health and
illness.
 Organizations and Agencies Promulgating
Standards and Mandates
1.NLNE (NLN)
- first observed health teaching as an
important
function within the scope of nursing practice.
- responsible for identifying course content for
curriculum on principles of teaching and
learning
2. ANA
- responsible for establishing standards and
qualifications for practice including patient teaching.
3. ICN
- endorses health education as an essential
component of nursing care delivery
4. State Nurse Practice Acts
- universally includes teaching within the scope of
nursing practice
5. JCAHO
- accreditation mandates require evidence of
patient education to improve outcomes.
6. AHA
- Patient Bill of Rights ensures that clients
receive complete and current information
7. Pew Health Profession Commission
-puts forth a set of health profession
competencies for the 21st century
- over one half of recommendations pertain to
importance of patient and staff education.
 Practical Nursing
• Women who cared for others, but had no formal
education, often called themselves “ practical nurses”.
• Schools of Nursing around the World
• LPN’s / LVN – work under the supervision of an RN
other licensed ; focused on basic nursing skills abd
direct client care
• RN
• Diploma programs – 3 years in length and offered by
hospitals
 Practical Nursing

• Diploma programs – 3 years in length and

offered by hospitals
• Graduate receives diploma rather than college
degree
• Program emphasize basic skills particularly
suited for hospital clients
• Associate Degree – 2 year program
• basic skills more on community
• Baccalaureate Degree Programs – 4 years in
college or universities
• BSN
Thank You!