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Chapter 1
Evolution of Nursing and Health Care
Fundamentals of Nursing: Standards & Practices, 2E
Copyright 2002 by Delmar, a division of Thomson Learning 1-3
Nursing ...
Is an art and a scienceFocuses not on illness but rather on
a client’s response to illnessPromotes health and helps clients
move to a higher level of wellness
Copyright 2002 by Delmar, a division of Thomson Learning 1-4
Historical Overview
To understand the present status of nursing, it is necessary to have a base of historical knowledge about the profession.
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Evolution of Nursing
Early CivilizationsAncient GreeceRoman EmpireMiddle AgesRenaissanceEnlightenment and Industrial
Revolution
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Florence Nightingale
Was the founder of modern nursing Completed a 3-month course of study at
the Kaiserwerth Institute Reduced mortality and morbidity during
Britain’s Crimean War Established the Nightingale Training
School in London
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Nursing and the Civil War
America’s need for nurses increased dramatically during the Civil War.
Catholic sisters cared for soldiers. Dorothea Dix was appointed
Superintendent of the Female Nurses of the Army in 1861.
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Nursing Pioneers
Clara Barton Lillian Wald Jane Delano Isabel Hampton Robb Annie Goodrich Adelaide Nutting Lavinia Dock
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Nursing Leaders
Mary Breckinridge Martha Franklin Amelia Greenwald Mamie Hale Mary Mahoney
Harriet Neuton Phillips
Linda Richards Margaret Sanger Shirley Titus Adah Belle Thoms
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Nursing in the 20th Century
Flexner Report:• study of 155 medical schools in 1910• resulted in significant changes in
medical education• Adalaide Nutting proposed a similar
study for nursing education.
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Visiting Nurses Associations• In 1901, the Metropolitan Life
Insurance Company entered into an agreement with the Henry Street Settlement to provide nursing services.
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• In 1912, the Chicago Visiting Nurse Association developed a list of standing orders for nurses to follow in providing home care.
• These orders were used to direct nursing care in the absence of physician’s orders.
• This set the precedent for nursing protocols.
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Landmark Reports in Nursing Education• Goldmark Report• Brown Report• Institute of Research and Service in
Nursing Education Report
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Selected Legislation• Nurse Training Act (1964)• Health Maintenance Organization Act
of 1973• Amendments to the Social Security Act
allowed nurse practitioners to be paid directly for their services.
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• Rural Health Clinic Service Act of 1977• Omnibus Budget Reconciliation Act of
1980
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Contemporary Reports on Education and Practice• National Commission on Nursing• Nursing and Nursing Education: Public
Policies and Private Actions• Secretary’s Commission on Nursing
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Social Forces Affecting Nursing
1960s:• health care services enhanced by
Medicare and Medicaid• nursing and physician shortages• the inception of nurse practitioners• Focus on health maintenance
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1970s:• Professional autonomy for nurses was being
debated.• Nursing theories were being developed.• Nursing education was being integrated into
the university setting.• Nurses were becoming more politically
active through professional organizations.
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1980s:• Nurses became more specialized and
autonomous.• Nurse practitioners were being more
widely accepted by the general public.• Expanded roles for nurses were
developed in response to greater demands for nursing services.
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1990s:• The aging population called for more nursing
involvement with the elderly.• Nurses were increasingly involved in
shaping policies for health care reform.• Nursing was a stronger advocate for
vulnerable populations: the elderly, those living in poverty, the homeless, those with HIV and AIDS.
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Healthy People Initiatives• Healthy People: The Surgeon
General’s Report on Health Promotion and Disease Prevention in 1979
• Healthy People 2000 Objectives• Healthy People 2010
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The Future of Nursing
Nursing leaders need to• communicate nursing’s position(s) on health care
reform• develop evidence-based practice that can be uniformly
adopted in diverse nursing care settings• monitor safe practice in a restructured health care
environment• implement policies to address the changes occurring in
the nursing labor market
