History And Development Of Nursing

Prepared by
Ishfaq Ahmad
 Objectives
• By the end of presentation learners will be able to:
• Summarize the Ancient Cultures in the field of Nursing.
• Describe site of health care in Ancient Cultures.
• Discuss Islam and Nursing.
• Explain Historical perspective and founder of Nursing.
• Discuss mughal period in Nursing. Define nursing by WHO
and different scholars
• Briefly describe types of Nursing educational programs
• History of Nursing Education in Pakistan
 Introduction
• Treating the sick is nothing new.

• People have cared for the sick throughout history,

beginning in ancient times

• Over hundreds of years, nursing has undergone an

evolution, eventually transforming itself into the respected
profession we all know of today.
 Periods Of Nursing
1) Nursing from Earliest times to the nineteenth century.
2) Early Civilization.
3) Christianity.
4) Middle Ages.
5) Fifteenth to Nineteenth Century
 Nursing In Ancient Times
• In some early cultures, the provision of nursing care was
assigned to females, because women provided nurturing to
their infants and it was assumed that they could provide
the same type of care to the sick and injured.
 CONT…
• In other ancient societies, however, men were designated
to care for the sick, because they were considered priests,
spiritual guides or “medicine men.

• The earliest nurses used plants and herbs to heal and

believed that evil spirits and magic could affect one’s
health.

• Illness was often viewed as a sign that something was done

to offend the priests or gods.
 Cont…
• There was no formal education available in primitive
societies, so the earliest nurses learned the tricks of the
trade via oral traditions that were passed down from one
generation to the next.
• They also learned how to nurse patients back to health
through trial and error and by observing others who cared
for the sick.
 Egyptian
• 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.
 Cont…
• The Egyptian healthcare system was the first to maintain
medical records starting at around 3000 B.C.
• Egyptian society was also the first to classify medications
and develop plans to maintain people’s health.
• They were the first to use the concepts of Sutures in
repairing wounds.
• Egyptian physicians are believed to have specialized in
certain diseases (such as internal diseases, fractured
bones, and wounds).
 Greece
• Greece the Greeks believed in Apollo, the Greek god of
healing and prayed to him for magic cures for their illness.

• From1500 B.C. to 100 B.C., Greek philosophers sought to

understand man and his relationship with Gods ,nature
and other men.

• They believed that god and goddesses of Greek mythology,

controlled health and illness.
 Cont…
Temples were built to honor the Asclepius , the god of
medicine, and were designated to care for the sick.

The Greeks believed in Apollo, the Greek god of healing and

prayed to him for magic cures for their illness.
 Cont…
• Hippocrates was the first who attributed disease to natural
cause rather than supernatural causes and curses of gods
and 400 B.C. ,the famous Greek physician Hippocrates
believed that disease had natural, not magical, causes.
 Indian Era
• Dating from 2000 to 1200 B.C., the earliest cultures of India
were Hindu. The sacred books of Hindu, Vedas, were used to
guide healthcare practices.

• The Vedas included herbs, spices, displays of magic, and

charms. The Indian documented information concerning
prenatal care and childhood illness.
 China Era
• The teaching of Confucius (551-479 B.C.) had a powerful
impact on the customs and practices of 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 in illness, where as balance between the
yin and yang represent good health. 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.
 Roman era
•In ancient Rome, during the early Christian era, deaconesses
were selected by the church to provide care for the sick.

•Deaconesses had some education and were selected by the

church’s bishops to visit and care for the sick in their homes.

•The deaconess Phoebe is considered to be the first “visiting

nurse” who provided expert home nursing care.
 Cont…
The Roman Empire (27BC. - 476 A.D.) a military dictatorship,
adopted 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 sick.

Galen was a famous Greek physician who worked in Rome

and made important contribution to the practice of medicine
by expanding his knowledge in anatomy, physiology,
pathology and medical therapeutics.
 Middle Ages
The Middle ages (476BC. To 1450 A.D.) followed the demise
of Roman Empire. Women used herbs and new methods of
healings whereas man continued to use purging and leeching.
This period also saw the Roman Catholic Church become a
central Figure in the organization and management of health
care.
Most of the changes in health care were based on the
Christian concepts of charity and sanctity of human life.
Wives of emperors and other women considered noble were
become nurses.
 Renaissance Period
The Renaissance and Reformation period (1500 to 1700)
also known as the rebirth of Europe, followed the middle ages
period. During the renaissance period, a growing interest in
science and technology led to advances in medicine and
public health.
At the time, the rich paid for their sick to be cared for at
home, while the poor were cared for in hospitals. By the time
many poor people arrived at hospitals, they were already very
ill, so they often died in the hospitals.
Being hospitalized had negative connotations for most
people, as hospitals were considered places where people
went to die. It was also referred as the Dark Ages of Nursing.
 Cont…
• Following the Protestant Reformation, monasteries and
convents were closed, and the lands were seized.
“Common” women who were too old or ill to find other
jobs started caring for the sick.
• Although there were a few hospitals in Protestant Europe,
there were no regular system of nursing. Female
practitioners cared for neighbors and family, but their
work was unpaid and unrecognized.
• In Catholic areas, however, the tradition of nursing nuns
continued uninterrupted.
 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
• Nursing became a respected vocation.
 The Era Of Modern Nursing
• Modern nursing began in the 19th century in Germany and
Britain.
• The practice had spread worldwide by about 1900. British
social reformers advocated for the formation of groups of
religious women to staff existing hospitals in the first half
of the 19th century.
• Two influential women in the field of nursing during this
time period were Elizabeth Fry and Florence
Nightingale.
 19 Century And 20 Century
th th

• In the late 19th century, nursing professionalized rapidly in

the United States.
• Women who had served as nurses during the Civil War
realized the importance of a formal nursing education and
played a crucial role in establishing the first nurse training
schools.
• Hospitals began setting up nursing schools that attracted
women from both working-class and middle-class
backgrounds.
 Cont…
• Development of modern nursing
Nursing 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;
 Cont…
• Development of modern nursing
Nursing 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
 ICN, ANA
• 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.
• The American Nurses Association, in 1980, nursing is
the diagnosis and treatment of human responses to actual
or potential health problems.
 Cont…
• Graduate nursing programs focusing on clinical specialties
laid the basis for the expansion of advanced practice
nursing.
• By the end of the 1960s, there were 1,343 nursing schools
with 1,64,545 nursing students enrolled, according to the
National Student Nurses Association (NSNA)
 Nursing In Islam
• Nursing in Islam is a healthcare services related to caring
patient, individual, family, and community as manifestation
of love for Allah and the Prophet Muhammad(PBUH).
• Nursing as a profession is not new to Islam. In fact, it is
attributive to sympathy and responsibility towards the
concerned in need.
• This undertaking had started during the development of
Islam as a religion, a culture, and civilization.
 Cont…
1. “ heal the breasts of believers ” ‫ص ُدو َر قَ ْو ٍم ُمْؤ ِمنِ َين‬ ُ ‫َويَ ْش ِف‬
Tawba -14
2. “ and a healing for the diseases in your hearts ” ‫َو ِشفَا ٌء‬
ِ ‫لِ َما فِ يا لصُّ ُد‬
‫ور‬ Yonos – 57
3. “ we send down stag by stage in the Qur'an and that
which is a healing and a mercy to those who believe”
Israa – 82 ‫“ َونُنَ ِّز ُل ِم َنا ْلقُرْ َآ ِن َما ُه َو ِش فَا ٌء َو َرحْ َم ٌة لِ ْل ُمْؤ ِمنِ َين‬
4. “and when I am ill, it is He who cures me ” ‫َوِإ َذا َم ِرضْ ُت‬
‫ فَ ه َُو يَ ْشفِ ِين‬Shoaara – 80
 Cont…
• And there are many statements of our prophet.
Muhammad (PBUH) related to this subject example:
– Our God create treatment for every disease some people
know it and some of them don’t.
– Seek for treatment and medical help.
 Cont…
• The first professional nurse in the history of Islam is a
woman named, Rufaidah bento Saad Al Aslamiah, from the
Bani Aslam tribe in Madina Al Monawarah
• She lived at the time of Prophet Muhammad (saw) and was
among the first people in Medina to accept Islam
• Rufaidah received her training and knowledge in medicine
from her father, a physician whom she assisted regularly
 Cont…
•After the Muslim state was established in Medina, she would
treat the ill in her tent set up outside the mosque.

•During times of war, she would lead a group of volunteers to

the battlefield and would treat casualties and injured soldiers.

•Rufaidah is described as a woman possessing the qualities of

an ideal nurse: compassionate, empathetic, good leader and a
great teacher, passing on her clinical knowledge to others she
trained.
 Cont…
Furthermore, Rufaidah’s activities as someone greatly
involved in the community, in helping those at the more
disadvantaged portions of society symbolize the ethos of care
identified above.

Anas ibn Mâ lik said: “Muhammad (PBUH) used to go out to

the battles taking Umm Sulaym and some other women of the
Ansaar with Him; when He fights in the battle, they [i.e. the
women] would give water to the soldiers and treat the
injured.”
 Mughal Period
Maham Anga, a great lady served as a wet Nurse of King
Akbar in Mughal Empire
She nursed during Wars in India and Afghanistan.
Florescence Nightingale
 Cont…
• She was born in 1820 and died in 1910
• Born in Italy to wealthy English parents
• Frustrated by lack of options for women of her social
background
• Challenged parents and society and traveled to Germany
and throughout Europe to train as a nurse
• Her big opportunity came when the Crimean war broke out
in 1854
 Cont…
• 1st Nursing Theorist
• Nursing is separate and distinct from medicine
• All women are natural nurses
• Emphasized importance of environment: fresh air,
cleanliness, nutrition
• Maintained accurate records, 1st Nursing Researcher
 Cont…
• Secretary of War asked her to go take charge of the hospital
at Scutari in Turkey.
• Nightingale showed up with 38 trained nurses and faced a
death rate of 40%
• Nightingale found that conditions in the military hospitals
were terrible. The absence of sewers and laundry facilities,
the lack of supplies, the poor food, and the disorganized
medical services contributed to a death rate of more than
50% among the wounded.
 Cont…
• She established cleanliness and sanitation rules
• Patients received special diets and plenty of food
• Improved water supply
• Patients received proper nursing care
• Nightingale established a reputation which allowed her to
improve nursing standards at home
• Nightingale’s strong statements about the role of nurses
and their need for lifelong education are still quoted widely
today
 Cont…
• Established nursing school at St. Thomas’ Hospital,
London.
• By 1887, had her nurses working in six countries and U.S.
• She was a nurse, philosopher, statistician, historian,
politician and more
• Today she is considered the founder of modern nursing
 Nursing Definitions By Scholars
Nursing definitions by Florence Nightingale
She defined nursing 100 years ago as “ the act of utilizing the
environment of the patient to assist him in his recovery”
(Nightingale 1860)
 Virginia Henderson’s Definition

“The unique function of the nurse is to assist the individual,

sick or well, in the performance of those activities
contributing to health or its recovery( or to peace full death)
that he would perform independently if he had the necessary
strength, will, or knowledge and to do this in such a way as to
help him gain independence as rapidly as possible.”
 ANA’s Definition

• In 1980, the ANA (American Nurses Association)

published this definition of nursing “Nursing is the
diagnosis and treatment of human responses to actual or
potential health problems.”
(ANA, 1980, p. 9)
 Nursing definition WHO

Nursing encompasses autonomous and collaborative care of

individuals of all ages, families, groups and communities, sick
or well and in all settings. It includes the promotion of health,
the prevention of illness, and the care of ill, disabled and
dying people.
 Nursing Education In Pakistan
• Initially, the health-care services in Pakistan were ill-
developed and the rate of employment in health-care jobs in
Pakistan was very low.
• Since 1951 Pakistani governments have concentrated on the
development and improvement of health care services and
one of the major steps is increasing the rate of funding to
PNC Clinics.
• The Nursing council (PNC) has also played a key role to
provide world-class health care and nursing services to the
patients.
• Pakistan had a nurse-to-population ratio of 1:32000 in 1960,
improving to 1:5199 by 1997
 Pre Partition
• Pre- Partition Status of Nursing
• admissions to Nursing were exclusively for Anglo-Indian
and European Girls.
• Both Hindu and Muslims were prevented from enrolling in
Nursing program.
• Mission Hospitals only one to accepts to indian Girls for
training.
 Cont…
• 1887 ten qualified certificated nursing sisters from the
London hire by the British Govt. to lay the foundation of
military Hospital in the country.
• Male attendant.
• 1905 A few Nursing superintendent formed a Nursing
Organization. TNAI
• To work for dignity honour for the profession.
• the first Nursing Journal was publis in 1910.
 Central Nursing Council
• TNAI work hard to developed registration council (CNC)
for the India and Pakistan.
• Uniform standers of training and certificate programs in all
over the country.
• the India Nursing council was passed in 1947 with help of
H. minister of India.
• In same time similar act was passed in Pakistan.(CNCP)
• Constituted in 1949 -1952.- 1973
 Pakistan Nursing Council
The PNC is an autonomous, regulatory body constituted
under the Pakistan Nursing Council Act (1952, 1973) and
empowered to register (license) Nurses, Midwives, Lady
Health Visitors (LHVs) and Nursing Auxiliaries to practice in
Pakistan. PNC was established in 1948.
The PNC has involvement in improving and standardizing
public education and clinical nursing standards. They also
oversee the ethical standards and general welfare of nurses.
 Cont…
Roles/functions of the PNC?
1. PNC sets the curriculum for the education of Nurses,
Midwives, LHVs and Nursing Auxiliaries.
2. PNC inspects educational institutions for approval based
on established standards
3. PNC provides registration (license) to practice.
4. PNC maintains standards of education and practice.
 Cont…
6. PNC works closely with the four provincial Nursing
Examination Boards (NEBs).
7. PNC plays and advisory role for the overall benefit of
Nurses, Midwives, LHVs and Nursing Auxiliaries in the
country.
8. PNC maintains an advisory role for the Federal and
Provincial Government regarding nursing education and
nursing services.
 Cont…
9. PNC communicates policy decisions regarding nursing
education and the welfare of nurses, taken in Council
meetings, to Governments, Nursing Institutions, NEBs and
Armed Forces Nursing Services for implementation.

10. PNC prescribes penalties for fraudulent registration by

intention of removes persons from the Register for
professional misconduct
 Post Partition
• Non Muslim Nursing Migrate to India
• British Nurses left for England.
• Miss Fatima Jinnah and Begum Rana Liaqat Ali Khan to call
hundred of women to left their college and home to go in
Hospital for care wounded patient
 Cont…
• First Nursing School(1948) in Sir Ganga Ram Hospital
Lahore. (Private.) Krachi JPMC & LRH
• First Nusing School in Sir Ganga Ram Hospital. Lahore.
• First Nursing Tutor Mrs. G M Daeeah tile 1961.
• First Nursing Superintendent Of This Hospital .Mrs
Mumtaz Paida Khan Tile 1979
• Every year 1800-2000 Registered Nurses, 1200-1300
Midwives Nurses and 300-400 Lady Health Visitors are
produced in the country
 Cont…
• 1952 The first class of 7 girls Complet of three Years
deploma.( G.N)
• That time th e Partition the Nursing Personal divided in
two Ways:
• Grate: “A”& “B”
• Salary of the staff Nurse was 125/=
• And sister tutorRs.200/=
• Now a day We have lot of opportunity for education
specially in Pakistan and particularly in KPK.
 Future Of Nursing
• International Nurses Day is observed on May 12 across the
globe to acknowledge the role that nurses play in the
healthcare system
• Pakistan is running short of nursing staff and currently
nursing education is in transition period and diploma
education has been replaced by university degree by 2018.
 Cont…
A few universities offer master degree & PhD in nursing
sciences. Recently KMU has started PhD Nursing ( First ever
public sector university of Pakistan).

However, there is a lot to be done more as currently degree

program is lacking quality with exception to some institution,
along with surfacing of some ghost institutions offering
degree to remote students even without attendance, reason
behind is the culture of political nepotism and corruption.