HISTORY &

DEVELOPMENT OF NURSING

By : Ibne Amin
Institute of Nursing Sciences,
Khyber Medical University , Peshawar
 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
• However, considering the long history of nursing, it
was not until fairly recently that nurses received a
formal nursing education.
• Over hundreds of years, nursing has undergone an
evolution, eventually transforming itself into the
respected profession we all know of today.
 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.
 NURSING IN ANCIENT TIMES
In other ancient societies, however, men were
designated to care for the sick, because they
were considered priests, spiritual guides or
“medicine men.”
 NURSING IN ANCIENT TIMES
• 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.
 NURSING IN ANCIENT TIMES
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.
 NURSING IN ANCIENT TIMES
• 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).
 NURSING IN ANCIENT TIMES
Greece
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. 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.
 NURSING IN ANCIENT TIMES
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.
 NURSING IN ANCIENT TIMES
INDIA
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.
 NURSING IN ANCIENT TIMES
CHINA
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.
 NURSING IN ANCIENT TIMES

ROME
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.
 NURSING IN ANCIENT TIMES
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.
 NURSING IN ANCIENT TIMES
The 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.
 NURSING IN ANCIENT TIMES
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.
 NURSING IN ANCIENT TIMES
• 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.
FOUNDATIONS 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.
 THE 19TH AND 20TH CENTURIES
• 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.
 The 19th and 20th Centuries
• The first permanent school of nursing founded
in the United States was the nurse training
school at the Women’s Hospital of
Philadelphia, which was established in 1872.
• During the second half of the 20th century,
the number of graduate programs in nursing
grew rapidly.
 THE 19TH AND 20TH CENTURIES
• 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.
 NURSING IN ISLAM
1.“ heal the breasts of believers ” ‫َو َيْش ِف ُص ُد وَر‬
‫ َقْو ٍم ُم ْؤ ِمِنيَن‬Tawba -14
2. “ and a healing for the diseases in your
hearts ” ‫َو ِش َفاٌء ِلَم ا ِفي الُّص ُد وِر‬ 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 ‫َو ُنَنِّز ُل ِم َن اْلُقْر َآِن َم ا‬
‫“ ُهَو ِش َفاٌء َو َر ْح َم ٌة ِلْلُم ْؤ ِمِنيَن‬
4. “and when I am ill, it is He who cures me ”
‫ َو ِإَذ ا َم ِرْض ُت َفُهَو َيْش ِفيِن‬Shoaara – 80
 NURSING IN ISLAM
• 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.
 THE FIRST MUSLIM NURSE
• 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
 THE FIRST MUSLIM NURSE
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.

.
 THE FIRST MUSLIM NURSE
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 Mâlik 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.”
FLORENCE NIGHTINGALE
 Florence Nightingale
• 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
 FLORENCE NIGHTINGALE
• 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.
 Florence Nightingale
• 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
 FLORENCE NIGHTINGALE
• 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)
 NURSING DEFINITIONS BY SCHOLARS
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.”
 NURSING DEFINITIONS BY SCHOLARS
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 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.
 MUGHAL PERIOD AND NURSING
Maham Anga, a great lady served as a wet Nurse
of King Akbar in Mughal Empire
She nursed during Wars in India and Afghanistan
 TYPES OF NURSING EDUCATION
PROGRAMMES
• NURSING DIPLOMA
• ASSOCIATE OF SCIENCE IN NURSING
• BACHELOR OF SCIENCE IN NURSING (BSN
• RN-TO-BSN (POST RN BSN)
• MASTER OF SCIENCE IN NURSING (MSN)
• DOCTORATE NURSING DEGREE PROGRAMS
• MPH
• MSPH
 HISTORY OF 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
 HISTORY OF NURSING EDUCATION IN
PAKISTAN
• According to figures cited by the Journal of
Pioneering Medical Sciences in 2013, the existing
nurse-patient ratio in Pakistan is approximately 1:50
whereas the ratio prescribed by the Pakistan Nursing
Council (PNC) is 1:10 in general areas and 2:1 in
specialized areas.
• Currently, Pakistan has 162 registered nursing
colleges.
 PAKISTAN NURSING COUNCIL (PNC)
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.
 PAKISTAN NURSING COUNCIL (PNC)
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.
 PAKISTAN NURSING COUNCIL (PNC)
5. PNC works closely with the four provincial Nursing
Examination Boards (NEBs).
6. PNC plays and advisory role for the overall benefit of
Nurses, Midwives, LHVs and Nursing Auxiliaries in the
country.
7. PNC maintains an advisory role for the Federal and
Provincial Government regarding nursing education and
nursing services.
 PAKISTAN NURSING COUNCIL (PNC)
8. 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.

9. PNC prescribes penalties for fraudulent registration by

intention of removes persons from the Register for
professional misconduct.
 HISTORY OF NURSING EDUCATION IN
PAKISTAN
• 1948: First Nursing School was established in Ganga Ram small
private Hospital Lahore.
• In 1952: first group of 07 girls passed the nursing course from
this school.
• In 1948: Second School of Nursing was opened in JPMC
Karachi.
• This development followed by Bahawalpur, Hyderabad and
Multan, Lady Reading Hospital Peshawar, Civil Hospital Karachi,
Mayo Hospital Lahore.
• In 1951: LHV Training extended to 02years, one year midwifery
and second in nursing emphasized on community nursing.
 HISTORY OF NURSING EDUCATION IN
PAKISTAN
Every year 1800-2000 Registered Nurses, 1200-
1300 Midwives Nurses and 300-400 Lady Health
Visitors are produced in the country.
 THE 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.
 THE FUTURE OF NURSING
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.
 REFERENCES
1. Craven, R. F., & Hirnle, C. J. (2000). Fundamentals of
Nursing: Human Health and Function. (3rd ed.). New York:
Lippincott.
2. Delaune, S. C., & Ladner, P. K. (2002). Fundamentals of
Nursing:Standards and Practice. (2nd ed.) Canada: Delmar.
3. Erb, G. K., B. (2000). Fundamentals of Nursing: Concepts,
Process and Practice (5th ed.) Addison: Wesley.
4. Potter, P. A & Perry, A. G. (2003). Basic Nursing: Essentials for
Practice (5th ed.) St. Louis: Mosby.