History and Evolution of Nursing

1. History and Evolution of Nursing Trends and Changes

2. Early History • Ancient writings in Greece, Rome, Egypt and India refer to persons dedicated to caring for the sick, injured, making herbal remedies, and midwives for new mothers • Nurses are mostly household servants, part of the military or members of religious orders. • 12th century the Knights of St. Thomas a group of vowed Englishmen with the purpose of tending to the sick, wounded and burying fallen crusade soldiers

3. Plague Doctors • Separate occupation from the surgeon-barber and town physician • Hired to care for people inflicted with bubonic plague (black death) and dispose of the bodies • Kept quarantined from the rest of the town and village

4. Contract for a plague doctor: Pavia, Italy 1479 • Clause 1.  The community of Pavia and its council shall provide the sum of 30 florins per month to Master Giovanni de Ventura. • Clause 4.  The community of Pavia and its council shall provide Dr. Ventura with an adequate house in an adequate location, completely furnished.   • Clause 5.  The community of Pavia and its council shall continue to pay Master Giovanni Ventura for a period of two months after the termination of his employment. • Clause 6.  The said Master Giovanni shall not be bound or held under obligation except only in attending the plague patients. Giovanni must treat all patients and visit infected places as it shall be found to be necessary. • Clause 9.  The said Master Giovanni shall not be able to ask a fee from anyone, unless the plague victim himself or his relatives shall freely offer it. • Clause 14.  Said Master Giovanni would have and should be obliged to do his best and visit the plague patients twice or three times or more times per day, as it will be found necessary. • (http://web.mac.com/mloret/iWeb/apeuro06/Plague%20Doctor.html)

5. The Reformation • Diminished role of nursing care provided by religious orders as convents and monasteries were closed in countries hostile to the Catholic Church (www.angelfire.com/fl/EeirensFaerieTales/NursingDeclineHistory, 2010) • Early application of science in explanation of health and disease • Illustrations of human anatomy • Rudimentary explanations from vivisections

6. Victorian Era • Attending to the ill in poor houses and sanatoriums was done by prostitutes and prisoners • SaireyGamp (Charles Dickens’ novel Martin Chuzzlewitt) the unpleasant domestic nurse . (Dickens, 1843) • Mrs. Beeton's Book of Household Management, 1861, places nurses in the chapter ‘domestic servants’ (www.victorianlondon.org/professionsandtrades, 2010)

7. Contemporary Events • 1796: Jenner inoculates people with cow pox to prevent small pox – trend towards science of vaccines • 1858: Publication of Gray’s Anatomy: Descriptive and Surgical • 1860s: Louis Pasteur proves broth does not spontaneously spoil without microorganisms • Beginning of the germ theory • 1856-1863: Bro. Gregor Mendel charted genetic patterns in pea plants (work rediscovered in 1930s) • 1867: Joseph Lister performed surgery using carbolic acid for antiseptic surgery • 1901: Landsteiner categorized blood types for successful transfusions

8. Florence Nightingale • Considered the founder of modern nursing, applied statistics, epidemiology, hospital administration and sanitary engineering, plus was a social reformer • Highly-educated and from a wealthy family • Went from goodwill hospital visitor to nurse • Trained in hospital at Kaiserwerth Germany and with Sisters of Charity in Paris • 1860, Opened college level St. Thomas school of nursing in London • Wanted nurses to be upper-class and educated women who cared for the sick and wounded for altruistic reasons • (Tomey and Alligood, 2006)

9. Nightingale’s Work • In 1859, wrote Notes on nursing: What it is and what it is not, the first textbook and nursing theory • A social reformer who petitioned politicians for better conditions for the poor and soldiers, and more career opportunities for women • Organized district nursing in London in partnership with businessman and MP William Rathbone

10. Nightingale in the Crimean War • With 38 women volunteers, Nightingale travelled to Turkey in 1854 to help the sick and wounded English soldiers in camps • Her statistics proved more soldiers died from preventable infections than from battle injuries • Improved the camp’s sanitation and lowered the mortality rate from infections 42% to 2% • An example of one of her pie charts, she visually depicted more soldiers dying from infections then from battle injuries. • (www.uh.edu/engines/epi1712.htm, 2010)

11. Her Nursing Practice • The body heals itself, disease is the body’s way of repairing itself after exposure to poison or decay • Nurses should be proper women who are single, chaste, and live without alcohol, tobacco and dancing • Nursing is to create an environment where healing can occur • Fresh air, clean water, removal of waste, moderate room temperatures • Exposure to pollutants perpetuates illness • Create an atmosphere of rest and protect patient from worry

12. Her writings • Nightingale did not write about human anatomy or microorganisms in her book. She wrote about maintaining a clean and healing environment. The chapters to Notes on Nursing are as follows: Preface Ventilation and Warming Health of Houses Petty Management Noise Variety Taking Food What Food? Bed and Bedding Light Cleanliness of Rooms And Walls Personal Cleanliness Chattering Hopes And Advices Observation of the Sick Conclusion Appendix

13. Notes on Nursing • Notes on Nursing was not a comprehensive guide for trained nurses, but was written to help any women provide better care for sick persons at home • ‘The following notes are by no means intended as a . . . manual to teach nurses to nurse. They are meant simply to give hints for thought to women who have personal charge of the health of others. Every woman . . . in England has, at one time or another of her life, charge of the personal health of somebody, whether child or invalid,--in other words, every woman is a nurse’ (Nightingale, Notes on Nursing, Preface, 1859)

14. Select Quotes • Air: ‘The very first canon of nursing, the first and the last thing upon which a nurse's attention must be fixed, the first essential to a patient, without which all the rest you can do for him is as nothing, with which I had almost said you may leave all the rest alone, is this: TO KEEP THE AIR HE BREATHES AS PURE AS THE EXTERNAL AIR, WITHOUT CHILLING HIM. (Nightingale, Notes on Nursing, Ch 1, 1859) • Every nurse ought to be careful to wash her hands very frequently during the day. (Nightingale, Notes on Nursing, Ch 11, 1859)

15. Select Quotes • Light: Second only to their need of fresh air is their need of light; that, after a close room, what hurts them most is a dark room. And that it is not only light but direct sun-light they want. (Nightingale, Notes on Nursing, Ch. 9, 1859) • Music: Wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect--while the piano-forte, with such instruments as have no continuity of sound, has just the reverse. The finest piano-forte playing will damage the sick, while an air . . . will sensibly soothe them. (Nightingale, Notes on Nursing, Ch.4, 1859)

16. Nursing in the Civil War Era • No organized nursing profession prior to the 1860s in the United States • Confederate and Union armies during the Civil War recruited nurses to treat injured soldiers • First use of shrapnel to injure multiple people at once • More people needed to treat the injured • Gangrene infections • Catholic Sisters formed and staffed make-shift tent hospitals • Efficient, clean and devoted to their patients • Men and women volunteers • Sojourner Truth, Harriet Tubman and Walt Whitman

17. Dorothea Dix (1802-1887) • Originally a school teacher who in 1841 became a reformer for treatment of the mentally ill • Within 10 years visited >300 jails and >500 almshouses • Advocated for mentally ill persons to be removed from jails/almshouses and be placed in public hospitals • By 1880, <1% of prison population were the mentally ill • Union’s superintendent for nurses during the Civil War

18. Clara Barton 1821 - 1912 • Teacher and U.S. patent office clerk prior to volunteering for the War • While travelling in Switzerland she read the works of Henry Dunant about treating all war wounded • She founded the American Red Cross in 1881 (biggest single charity in the U.S. today) to aid victims of disasters • Also championed prison reform, women’s voting, education and civil rights movements • (www.redcross.org/museum/history/claraBarton.asp, 2011) • “Angel of the Battlefield” • Collected and distributed supplies for Civil War soldiers • Formed a tent hospital • Direct care for wounded men

19. Formation of Education • 1873: three nursing schools opened in NY, CT, and MA • Based on the St. Thomas model • Segregated, limited opportunities for Black and Jewish Americans • Three nursing schools for men (often to work in mental health institutions by 1898. Little changed for men until after 1950s) • At the turn of the century majority of nurses were trained in hospital apprentice programs

20. Professional Organizations • Establishment of Official Groups • Formation of the National League of Nurses (1893) • American Nurses Association (1896) • International Council of Nurses (1899) • National Association of Colored Graduate Nurses (1908) • Early discussions for professional standards and training • Address lack of uniformity and inadequate curriculums in nursing schools • Consider a state registration of nurses

21. Emergence of Public Health Nurses • Nightingale created ‘district nursing’ in London where a nurse was assigned to overall health of a neighborhood • Lillian Wald – Working in poverty stricken neighborhoods in NYC, she formed the outreach clinic The Henry Street Settlement (1893) • health education, lifestyle education, infant/children checkups, home visits, sanitation improvements • Racial equality, all services were integrated • Founding member of the NAACP • Jessie Scales and Elizabeth Tyler established The Stillman House in the African-American districts of NYC alongside Ms. Wald

22. Women’s Health – early 1900s • Mary Breckinridge – midwife who founded Frontier Nursing Service to extend healthcare to women and infants in poverty stricken areas of the rural Appalachian Mountains • Meticulous record keeper and patient educator • Lower infant mortality rate than today’s national average • Margaret Sanger – Advocated for the rights over contraception and reproductive control • Founder of Planned Parenthood • Supported the eugenics movement

23. Contemporary Events • World War I – Militaries internationally mobilized nurses to provide care wounded soldiers • 1920: U.S. Congress approved nurses as ranked military • Spanish Influenza Pandemic (1918) – H1N1 virus infected over 30% of the world’s population (1.86B) and killed over 50 million (may be as high as 100 million) • In 1928 Alexander Fleming incidentally discovered bacteria did not grow around penicilliumnotum mold, further work put Penicillin antibiotics into mass production by 1948 • During the Great Depression and WWII President Roosevelt designated funds in SSA & CWA for public health projects • Dr. Jonas Salk polio vaccine was made public in 1955

24. Professional and Societal Evolutions • 1940s – proliferation of hospitals led to staffing shortages and strained working conditions • Hospitals start to become the biggest employer of nurses • 1947: Nurses gain status as commissioned officers in the U.S. military • Segregation ended in corps • men allowed as military nurses in 1954 • 1950s – formation of associates degree as abbreviated education from community colleges to increase supply of practicing nurses • 1950-1960s - formation of nursing process, theories, nurse specialties and graduate degrees • (Young and Patterson, 2007)

25. Contemporary Events • 1965 – President Johnson and Congress pass Medicare and Medicaid to fund healthcare for the elderly and poor • Remains single largest funder of hospitals and nursing homes • 1971 – Pres. Nixon approves presence of for-profit managed healthcare business model • 1980s to present – • emergence of technology and specialized technicians and professionals • Increasing cost and decreasing access to healthcare • Slow infusion of men and minorities into nursing • Proliferation in lifestyle related illnesses in population

26. Contemporary Issues in Nursing • Uneven allocation of funding for patient care • Mismatch of employment availability comes in waves • Projected long-term shortage • Stable career myth • Prevalent view of nurses as skilled labor in servant role and not as independent professionals • Blurred professional boundaries, roles and images • Don’t let Hollywood inform the public on nurse’s image and role. It’s wrong almost every time. • Finding the nursing presence in technology dominant interventions

27. Nursing as a Profession • Profession vs. Occupation • Job, career, or occupation signify a person’s primary work for income • Profession - a vocation to espouse the knowledge, principles and dutyof a chosen identity with a designated purpose of work • Nursing and nurses contain features of both • Distinct education pathways for entry • Various attitudes in practicing nurses • Diverse and dynamic roles • Role and capabilities tied to employer

28. Features of a Profession • Abraham Flexner, Richard Hall and committees and provided definitions of professionalism. • All professions include themes of: • A sense of service to the public good • Specialized theories begat intellectual and practical knowledge • Control over own practice and code of conduct • Internal Barriers ? • External Barriers ? • Breakthroughs ?

29. Nursing’s Professional Standards • Nursing’s Social Policy Statement: summarizes the relationship between the nursing profession and society • Obligation to recipients • Scope and Standards of Practice: Outlines the expectations of a member’s practice • Establish competencies and requirements of care • Code of Ethics: Guides the profession’s and members’ decisions toward greater principles and duties

30. Features of the Nursing Profession • Lucie Kelly PhD. RN listed 8 characteristics of the nursing profession • 1. Services are vital to humanity • 2. Special body of knowledge • 3. Practitioners are accountable for own work and decisions • 4. Practitioners are educated at institutions of higher learning • 5. Practitioners are relatively independent, autonomous • 6.Practitioners are motivated by service to others and consider their work as an important part of their lives • 7. Presence of code of conduct and ethics guides decisions of practitioners • 8. Organization encourages high standards

31. References Chitty, K. and Black, B. (2011). Professional nursing: Concepts and challenges (6thed). Maryland Heights, MO: Saunders Dickens, C. (1843) Martin Chuzzlewitt. London: Oxford European History (2010). Retreived online homepage.mac. Com/mloret/apeuro/Personal48 Nightingale, F. (1859) Notes on nursing: What it is and what it is not. New York: Appleton American Red Cross (2011) Retrieved online from www.redcross.org/museum/history/claraBarton.asp Tomey, A & Alligood, M (2006). Nursing theorists and their work. St. Louis: Mosby Victorian History (2010). Retrieved online www.victorianlondon.org Young, L. and Paterson, B. (2007). Teaching nursing: Developing a student-centered learning environment. Philadelphia, PA: Lippincott