EVOLUTION OF NURSING

JOKINDU RONALD
AskTheNurse
OBJECTIVES
By the end of this session, you should be able to:
 Define Nursing and Nurse

 Goals of Nursing

 Understand Historical Perspectives of Nursing

 Understand Evolution of Nursing as a

Professional Discipline
Definition of nursing
 Nursing is provision of optimal conditions to enhance the person's reparative
processes and prevent the reparative process from being interrupted.

 The practice of nursing is defined as diagnosing and treating human response

to actual or potential health problems through such services as case finding,
health teaching, health counseling; and provision of support to or restoration
of life and well-being and executing medical regimes prescribed by licensed or
otherwise legally authorized physician or dentist.

 Nursing is directed toward meeting both the health and illness need and man
who is viewed holistically as having physical, emotional, psychological
intellectual, social and spiritual.
ICN definition
● Nursing is the autonomous and collaborative care
of individuals of all ages, families, groups and
communities, sick or well and in all settings.

● Nursing includes the promotion of health,

prevention of illness, and the care of ill, disabled
and dying people
Definition of a Nurse- ICN
● The nurse is a person who has completed a program of
basic, generalized nursing education and is authorized by
the regulatory body to practice nursing in his/her country.

● Basic nursing education is a formally recognized

programme of study providing a broad and sound
foundation eg Enrollment training

● Basic nursing education provides foundation for post-

basic education for specialty or advanced nursing practice
ICN Nurse definition continued
The nurse is prepared and authorized to
● Engage in the general scope of nursing practice
○ Promotion of health
○ Prevention of illness and care of physically ill, mentally ill, and
disabled people of all ages and in all health care and other
community settings
● Carry out health care teaching
● Participate fully as a member of the health care team
● Supervise and train nursing and health care auxiliaries
● Be involved in research.
 ICN
● Nursing includes the promotion of health,
prevention of illness, and the care of ill, disabled
and dying people.

● Advocacy, promotion of a safe environment,

research, participation in shaping health policy
and in patient and health systems management,
and education are also key nursing roles. (ICN,
Definition of Nursing- other scholars
 Nursing is a humanistic science dedicated to
compassionate concern with maintaining and
promoting health, preventing illness and caring for and
rehabilitating the sick and disabled.

 Nursing is a deliberate action, a function of the

practical intelligence of nurses and action to bring
about humanely desirable conditions in persons and
their environments.
Nursing goals
Historical context of Nursing
 Nursing is traced to have originated during early
ancient times with rich history.

 This history not only helps us better understand

societal and emerging trends that continue to
confront the profession but also the role the
profession has played in health care system
WHO/ICN factsheet
 The global nursing workforce is 27.9 million, of
which 19.3 million are professional nurses.
 This is an increase of 4.7 million in the total stock
over the period 2013–2018
 59% of the health professions are Nurses.
 The 27.9 million nursing personnel include 19.3
million (69%) professional nurses, 6.0 million
(22%) associate professional nurses and 2.6
million (9%) who are not classified either way.
Historical perspectives of nursing during Ancient period
● Primitive societies practiced nursing unknowingly whereby some
individuals devoted themselves to care for the sick, newborn,
elderly and destitutes
● A person was labelled a caregiver right at birth. Eg among Zuni
tribe , if a baby was born with placenta covering the face, this was
sign of helper (Henlt & Moss, 2007)
● It existed in many societies whereby nursing care role was
assigned to women as they were considered gifted naturally to
care for young ones, elderly and relatives
● There was no formal training, knowledge and skills was transferred from
generation to generation through observation of experienced people
providing care for the sick
Christian revolution
 During early Christian revolution, lay women, nuns and monks in church formed
organized groups in line with Christian faith teaching of charity, service for others
and self-sacrificice
 The role played by the Roman deaconesses gave women meaningful way to
participate in activities of the church
 The deaconesses were matrons and widows appointed by the bishop to pray and
care for bedridden patients at home.
 Through out ancient times, nursing care was provided at home
 Care in the hospital was only reserved for helpless patients with no caretakers.
The beds were aligned around the alter,
 Pioneer hospital set up in France were Covenant hospital and Hotel-Dieu manned
by Augustinian sisters. These hospitals were founded by bishop of Paris in 651AD
 Fabiola set up first church hospital in Rome while Phoebe was the first Visiting
nurse to provide home based care (Nutting and Dock, 1907)
Nursing in early modern Europe
● In England, Protestant reformation caused collapse of care centers and the
land was seized
● Care of the sick fell back on elderly women who had nothing to do. They
provided care to receive community reputation
● Hospital records indicate some nurses could fight, use foul language, petty
theft and extort money from some patients (Parvey, 1953). Is this still
happening?
● Until mid 19th century, British socialist commenced advocating for improved
patient care through formation of women groups to staff hospitals
● In 1840 Elizabeth Fry founded protestant sisters of charity whose members
only received rudimentary training i.e. observing from their preceptors and
then doing under closest observation.
Florence Nightingale-”Lady with Lamp”
● The woman who not only reformed
nursing at that time but also laid strong
foundation for professionalized nursing.
● Daughter and second born of wealthy
British family who toured several European
countries. She was born in Florence –Rome
during tour of Italy on 12th May, 1820. Died
on 13th August 1910 “quietly”
● Mr. Nightingale returned to England and
educated her daughters Naples and
Florence.
● Florence while at school learned multiple
languages ie Greek, Latin, German, French
and Italia. she studied Maths, statistics,
Literature, and natural science (Nutting and
Dock, 1907)
● Given her wealthy family footage, the parents were disgusted by Florence
decision to dedicatedly care for the sick as such work was considered for
women below her class. She declined marital offers even from high class
men.

● She left England for formal basic training, upon completion of the
training, she was appointed superintendent of Upper Harley Street
hospital

● Around 1850s, Russia started war against England, Turkey and France
combined (Crimean war). FN learned that mortality among British army
was 41%. While France had nun nurses caring for their wounded soldiers,
the british had none
Florence Nightingale ….
● Given her political influence, she sought and obtained permission from
government that allowed her and her aides to travel to Crimea to care for
the British soldiers who were actually dying mainly due to sepsis

● She believed that “DIRT” rather than microscopic pathogens were the
cause of disease. She commenced championing sanitary, fresh air and
sunlight exposure practices both in the hospital and barracks. She also
aligned patients in the wards according to severity of their illness
 Florence Nightingale……
 With her knowledge of biostatistics, FN documented all her nursing care and
used it for further interventions.
 Through this credible work, she laid the foundation for evidence based nursing
 Upon her return from Crimea, she received precious award HEROINE
 British people formed a TRUST FUND in appreciation for her dedicated service
 She used the funds to establish Nightingale school of Nursing at St Thomas
hospital in London for education of professional nurses. The student received
theory in class and clinical learning also took place. Curriculum was developed
to guide student learning
 Nursing and midwifery in Uganda
● Nursing and midwifery work started after arrival of Dr. Albert Cook at
Mengo- Uganda in 1897 for missionary work. He came with Miss
Katherine Timpson a trained nurse who later became his wife.
● They found a small dispensary was at Namirembe, run by Ms. Pilgrim
but had no medical training.
● Pilgrim would do what she could with few drugs. Even pregnant
women were cared for in labor by women relatives and friends. herbal
medicine was practiced without preparatory knowledge of dosages,
some witchcraft was also practiced.
Nursing and Midwifery in Uganda continued….
● Later on scientific western Medical work was started by Dr. Cook with very
little equipment, he used scientific methods. He did his first operation in
his own home on a camp bed.
● He built a small hospital with one ward for men and one other for women
and theatre. However, the wards were separated with backcloth curtains.
● To prevent pieces of grass from falling into the operation site, a sheet was
hung above the table.
● Keeping records was started from the first case.
Nursing and Midwifery in Uganda continued….
● In 1902 Mengo hospital got burnt after lightning disaster . All the patients
were rescued, but most valuable equipment were destroyed.
● Dr. Cook built a new hospital with dried bricks, cement floors and iron
roof. However the hospital equipment and building materials had to be
transported from as far as Mombasa by porters on foot.
● The new hospital was opened in 1905, with present day Luke, Catherine
and children’s ward which was a theatre.
● During this time, Dr. and Mrs. Cook had been joined by five more nursing
sisters, and by his brother Dr. Jack Cook and his nephew Dr. Ernest Cook
Early 1900s
● In 1900’s some attempt was made to get the figures for infant and
maternal mortality. The figures revealed infant and maternal mortality
were high.
● This showed that Ugandans were a dying race. But these deaths were
preventable in the midwifery field. Mrs. Cook realized that the only way to
reduce high maternal and infant mortality was having well trained
midwives but she met resistance as parents declined their unmarried
daughters to join midwifery in favor for bride price
Nursing and Midwifery in Uganda continued….
● In 1918 the first pupils began the training in present day Catherine ward
being the labour ward. None of the girls was educated and so had to
consult Mr. A. Binaisa who was a trained teacher to teach them how to
read and write and also learn arithmetic’s.

● When midwives became available, simple and walled buildings were put
up by local chiefs in rural areas and soon the results were seen that the
mortality rate was reduced among people who were delivering from the
maternity centres than those who delivered from outside
Nursing and Midwifery in Uganda continued….
● By 1930 there were 29 maternity centers in the country. However, these
centers have been taken by the government medical service and
midwifery services have been extended. Few of them are still run by
Mengo hospital.
● In 1922 and 1923 a law was set up controlling the practice and discipline
of midwives. This was stated in the midwives hand book as “MIDWIVES &
THE LAW”. The first book whose contents were obstetric emergencies and
midwifery procedures was printed in Luganda in 1926.
● It was noticed that maternal, Perinatal and infant mortality rates were
markedly reduced. The “Uganda Midwives Board” was formed and this
meant that the nurses’ board was separate from the midwives board
Nursing and Midwifery in Uganda continued….
● Gradually midwifery developed significantly with many schools coming up such as Nsambya, Mulago
in 1954, formation of councils such as “THE UGANDA NURSES, MIDWIVES AND MEDICAL ASSISTANT
COUNCIL”. The council was formed by the act of the legislative assembly in 1956 to regulate practice.
● In 1962 the council lengthened the enrolled midwifery course from 2 years to 2 years and 3 months
and at present the course is 2 years and 6 months.
● Between 1960 &1972 government opened up more schools of midwifery at Mbarara, (present day
MUST), Masaka, Jinja and Gulu and missionaries opened more schools too at Kamuli, Kalongo &
Ngora.
● In February 1972 government opened 3 schools of nursing and midwifery at Kabale, Soroti and Arua.
● In 1970 the college for midwifery Tutors was opened at Mulago. More than 20 registered
nurses/midwives enrolled for the course. This college is now affiliated to Makerere University.
Nursing and Midwifery in Uganda continued….
● In 1980’s the people who were allowed to train for the nursing course were supposed to
be having O’ level certificates. It gradually advanced to having A’ level certificates in
1990’s.
● Registered Comprehensive Nursing course started in November 1993.
● In 1993 Bachelor of Nursing Science was introduced at Makerere University.
● In 1999 MUST commenced Bachelor of Nursing Science, which of recent has direct entry
and completion program entry. This was followed by Aga Khan University, KIU in and
UCU in 2001, 2004, and 2006 respectively. many will
● Muni university commenced BSN program in 2016 with ARRH as the clinical teaching
site
● Students should familiarize themselves with universities offering Bachelor of Science
Nursing Program.
Nurses statistics in Uganda-UNMC
● Uganda has 70160 nurses and midwives for a population of
45M

● 2.5 medical staff (physicians, nurses and midwives) per 1,000

people are needed to provide adequate coverage with primary
care interventions (WHO, 2006).
● WHO recommends 1 Nurse: 4 patients
● Graduates (BSN and above) <5%,
● Diploma 20-25%
● Enrolled (certificate) 60-70%.
We’re Nurses “Chosen by God To Love & Serve”