Nursing in the 20th CenturyPrepared by kamala Uprety

MN 1st Year ,LNC

Introduction

Nursing began as a desire to keep people healthy and to provide comfort and assurance to the sick.

Although the general goals of nursing have remained relatively the same over the centuries, ever-advancing science and the changing of society’s needs have deeply influenced the practice of nursing.

Dimension of Nursing Nursing as an ART

“Nursing…its very essence lies in the creative imagination, the sensitive spirit, and the intelligent understanding that provides the very foundation for effective nursing care”. Donahue(1985)

Nursing as a SCIENCE

Nightingale identified nursing as a scientific discipline separate from medicine

Educational foundation and basic college credit in scientific disciplines R/T nursing

Evolution of Nursing Before 19th century 19th century 20th century Contemporary image

Lady with the LampThe image of Florence Nightingale is a self

sacrificing young women with no desire or need of money, rest or recognition. Actually she was a courageous, liberated, independent women who may be credited with leading nursing out of the Dark Ages. She had strong convictions about what nsg should be and fought hard to see that certain clinical & educational standards were maintained. Even today the image of Florence Nightingale as the “Lady with the Lamp” remains perhaps the most popular public image of the founder of modern nursing.

Early Twentieth-Century Nursing The arrival of nursing as a profession and a

"calling" and the central importance of nurses to hospitals was clearly evidenced in the architecture of grand and imposing nursing schools that were attached to hospitals.

They were deliberately designed with impressive entrances and private rooms, as well as lobby and recreational areas of gymnasiums, swimming pools, and tennis courts to attract women who were, in the words of the Board of Governors of the New York Hospital Training School, "women of refinement" (Kingsley, 1988, p. 69).

20th century

Nursing evolved toward a scientific, research-based defined body of nursing knowledge and practice.

Affiliation of nursing education with universities

Expanded and Advanced Practice roles Nursing specializations evolved Specialty nurse organizations were formed

Historical Development of Nursing image

1. Angel of Mercy--Self-sacrificing, moral, noble

2. Girl Friday--Subservient, physician handmaiden

3. Heroine--Brave, dedicated 4. Wife/Mother--Maternal, passive, domestic 5. Sex Object--Sensual, romantic,

promiscuous

Nursing as Angel of Mercy In the early 1900s nurse as

viewed as honorable , moral, spiritual, self- sacrificing, & ritualistic.

Angel of Mercy image, idealizing nurse and making them a token of exemplary moral purity.

Nurse involved in a dual search: 1) success & meaning in nursing. 2) happiness & fulfillment through love & marriage

The 1930s—Nursing As Angel of Mercy

On a grander scale, Warner Brother's The White Angel (1936), chronicled the

professional life of Florence Nightingale. Endorsed by the American Nurses'

Association (ANA), The White Angel clearly portrayed Nightingale's persistence

and head-to-head confrontation with medicine.

Image of Girl Friday (1920-1929) With the passage of the womens’

suffrage reform in1919, women entered a new domain of professional endeavors&activities. At the same time, nursing education regulations were lowered and students were exploited as cheap labor, literally staffing entire hospitals. Nurses were described as “faithful, dependent, cooperative, long suffering, & sub servient.”In films of this era, nurse were not cast as career nurses.Nursng as simply a means to an end.

Nursing as heroin image(1930-1945) Nursing was acknowledged

as a worthy& important profession that enabled women to earn an honorable living. Nurses were identified as educated& owning certain abilities such as courageous, chivalrous, fearless, reasonable, clear- headed, humanitarian& magnanimous.

The 1940s—Nurse As Heroine The story of American nurses trapped on Bataan by

the Japanese (1999) tells via their diaries and interviews the gritty, difficult, and heroic story of these nurses who served on Bataan.

Nursing was depicted on a 1940 Australian stamp as a larger-than-life figure looking over a soldier, a sailor, and an aviator; in Costa Rica's 1945 stamp of Florence Nightingale and Edith Cavell; and in the 1945 commissioning of the USS Higbee, a U.S. Navy destroyer named in honor of a Navy nurse (Donahue, 1985).

Nursing image of mother(1946-1965

It may have been a natural development after world war II that a major goal for many American women was to stay home & care for children. Nurses during this period were chronicled as maternal, compassionate ,un assertive, submissive, &domestic. Postwar society would not support independent & autonomous women.

Nursing in the Anti-Establishment Era of the 1960s

Media images and art Television—Nurse as background figure to

physicians Movies—Nurse as power figure, cruel Canvas—Nurse as worried, angry

Nurses in the 1960s (Reality)

Served in the forefront of public health

Central in development of CCUs and performing hemodialysis

First nurse practitioner programs began

Salaries inadequate compared with those of other less trained American workers

Sex object image(after 1966)Nurses were increasingly depicted

as being sexually promiscuous, self –indulgent, superficial,& unreliable. Nurses become sexual mascots for health care teams & seen in x-rated movies. They were often depicted as more interested in linen closet trips than in professional growth & development. Nurses were portrayed as cold, Uncaring, power hungry& unmotivated persons .

Nursing in the 1980s to 1990s Media—Movies portrayed nurses as

nonjudgmental, caring, knowledgeable, and heroic

Advertisements portrayed nurses as sex objects

Art portrayed nurses as caring Architecture portrayed the importance of

nursing through impressive buildings for schools of nursing

Nursing in the 1980s to 1990s Artistic views of nursing during this period

focused on caring. In the Vietnam War Women's Memorial, the

central figure is the nurse in battle fatigues cradling the head of a soldier for whom she is providing care.

Evident in the bronze statue is the fatigue of the nurse and her care for this dying soldier.

20th century During the twentieth century nurses made

tremendous advancements in the areas of education, practice, research, and technology.

Nursing as a science progressed through education, clinical practice, development of theory, and rigorous research.

Today nurses continue to be challenged to expand their roles and explore new areas of practice and leadership.

20th century Leaders The early leaders were consistent in their wish to

improve the educational program in these schools because of their feeling that the professional nurse could not fulfill her responsibilities to the patient and the community until she was really prepared to do so.

Early leaders are: Isabel Adams Hampton,Sophia palmer, Mary

Adelaide Nutting, Lillian Wald, MLary Eliza Mahoney, Mary Sewell Gardner, Annie W. Goodrich, Isabel Maitland Stewart etc.

Early leaders

Isabel Adams Hampton

Isabel Adams HamptonSupritendent of nurses at the illinosis training school & the John Hopkins school for nurses. She become the first president of the society of superitendents of school of nurses.

Sophia Palmer: A founder of the new York state nurses Association & campaigner for Nurses licensure in New York. She become the 1st editor of the American Journal of Nursing. She authored a history of nursing, as well as other nursing text books & journal article.

Cont. Mary Adlaide Nutting: Appointed head of the

department of nursing & health at teachers college of Columbia university. She become the world’s 1st professor of nursing.

Isabel Mitiland stewart: A professor of nursing teachers college of columbia university. She worked tirelessly for the establishment of a standardized nursing curriculum. She insisted on the need for nursing research to give the profession a solid scientific base.

Lillian Wald: From her work providing home nursing care & teaching home nursing to immigrant women on New York city’s lower side. She went on to found the Henry Street settlement & the 1st visiting nurse Association.

Annie W. Good rich: pioneer leaders who actively helped nursing develop from apprenticeship to profession.

She was president of the International Council of Nurses from 1912-1915.

She had always been interested in public health and in 1916 became director of the visiting Nurse Service of the Henry Street Settlement

Nursing organizationAlumnae Association

As the nursing schools developed, the alumnae formed associations; the first were those of Bellevue (1889), Illinois training School (1891), and Johns Hopkins(1892). These groups had joined together to become the Nurses’ Associated Alumnae of the United States and Canada. The purpose was to embrace the general betterment of the profession.

American Nurses’ Association:In 1911, Alumnae Association is replaced by the name “American Nurses’ Association”. Throughout the years the American Nurses’ Association has continued to help the individual nurse. Uniform licensing laws in the states have been developed in order to protect both the nurse and the public.

Nursing organizationNational League of Nursing Education:A professional

organization in nursing that fostered excellence in nursing education, research, engaging in policy making and advocacy efforts related to nursing education and promoting faculty development. It was the precursor to the National League for Nursing. NLNE made numerous attempts to redesign diploma nursing education program. In 1917, 1919, 1927, 1937, NLNE published standard curriculum for school of nursing.

Organization of Public Health Nurses:In 1911, a joint committee was appointed by the two national nurses’ organizations, the American Nurses’ Association and the Society of Superintendents of Training Schools, for the purpose of standardizing nurses’ services outside the hospital.

Development in Nursing Service Private Duty Nursing

The hospitals retain the nurse on their payroll and collect the fee for services rendered.

With the introduction of the eight-hour day, twenty-four hours of private hospitals became quite expensive. In hourly nursing, the nurse, like the doctor, will go from patient to patient carrying our procedures which require nursing skill, leaving the simpler tasks to an attendant or member of the family.

Nursing service in the U.S. Government

In 1918, Lucy Minnigerode of the American Red Cross was loaned to the United States Public Health Service to study its nursing needs. She was appointed the first superintendent of nurses in the Marine Hospitals in 1919 and was the first nurse to hold an official position in the United States Public Health Service.

Nursing service in the ArmyIn 1901, an Act of Congress provided for a permanent Army Nurse Corps. When the Army Nurse Corps was organized, Dr, McGee was placed at the head of it, but she soon resigned her position to Mrs. Dita H. Kinney because she thought a nurse should head the corps.

Nursing Service in the NavyDuring the civil war, catholic nurses of the Sisters of charity went abroad a river steamer captured from the confederates to care for the wounded. That nurses were employed at the Naval Hospital in Norfolk, Virginia, to care for the sick and wounded of the Spanish-American War.

They had only a verbal agreement that should be reimbursed for travel expenses and receive moderate pay.

Nursing Education University Schools of Nursing

In 1909, some nursing schools became actual university schools, the superintendent being a full professor occupying the chair of nursing. Minnesota was the first school of nursing organized as an integral part of a university

Education of the Public Health Nurse

In 1914 Miss Nutting offered regular postgraduate courses in Public Health Nursing at Teachers College in affiliation with Henry Street Settlement.

This was successful and soon Boston took up the special training of public health nursing which, by 1914, had developed into an eight months’ course at Simmons College. Later other centers, mostly university schools, developed public health courses.

Early 1900s 1920s-1930s 1940s-1950s 1960s - present

Practical nursing Practical nursing Practical nursing Practical nursing

Nightingale schools

Diploma schools Diploma schools Diploma schools

Diploma schools BSN BSN BSN

Postgraduate education

POSTGRADUATE education, edD for nurses

Master’s degree, Doctorates for Nurses

Master’s degree and CNL, Phd, DNSc, ND, DNP

AND- Associate degree in nursing, BSN- Bachelor’s of science in nursing:

CNL: Clinical nurse leader: DNP- doctorate of nursing practice

DNSc – doctorate of nursing science, EdD- doctorateof education:

ND- nursing doctorate: PhD- doctorate of philosophy.

Economic Welfare of NursesThe Economic welfare Committee of the

International Council of Nurses was established in 1947, and its primary responsibility was outlined to be that of securing information about:

Professional recognition which has been granted to nurses and other aspects of professional and economic welfare and

Economic conditions of nurses throughout the world in regard to salaries , pensions and working conditions.

Concept of Nursing 3 stages of the concept of nursing:

disease centered, patient centered and human health centered

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.

Tasks of Nursing Relieving pains Maintaining health Restoring health Promoting health and wellness

Body of Nursing knowledge

Fundamental knowledge:physical sciencefundamental medical psychological and social science

Knowledge specific to nursing:clinical nursing: fundamental nursing, specialty nursing, community nursingnursing managementnursing education

History of Nursing in Nepal In 1947 BS, Bir Hospital was established but service was

provided by foreign doctors and compounders as there were no nurses to give patient care. The hospital authorities realized the need for nurses and midwives to provide care to hospitalized patients. Hence, 4 ladies were sent to India.

The seed for nursing was sown in Nepal in 1985 B.S when 4 ladies were sent to India to study 18 months midwifery training. These ladies after their graduation in 1987 B.S, joined Bir hospital as nurses.

• Ms Dharma Devi Kansakar

• Ms Vidhyawati Kansakar

• Ms Radha Devi Kansakar

• Ms Bishnu Devi Mali

Then in 2009 B.S (1952 AD), 2 ladies were sent to India again for nursing training for the first time. After completing the training they joined nursing school In Surendra bhawan and started teaching nursing.

• Dr. Uma Devi Das

• Ms. Rukmini Charan Shrestha In 2013 BS (1956 AD), 1st School of Nursing was established

at Surendrabhawan with a training program of 3.5 yrs by the joint effort of Juanita Flemming, RN, a missionary nurse and Ms DM Ross, WHO nurse educator from England. Mrs Lamoo Amatya was the incharge of this school, then called co-ordinator.

In 2016 BS (1959 AD), another School of Nursing was opened at Surendrabhawan under UMN under the guidance of Ms Margaret Fleming and Ms Premi Kacchhap.

Until 2018 BS (1961 AD), girls under SLC could enter nursing

In 2021 BS (1964 AD) 1st ANM training school was established in Bharatpur.

In 2023 BS (1966 AD) ANM training school established at Biratnagar

In 2026 BS (1968 AD) ANM training school established at Nepalgunj

In 2026 BS (1969AD), girls after SLC could enter nursing

After 1972 In 2029 BS (1972 AD) Nursing education came under

TU, IOM and was renamed as PCL course.

• Training school was renamed as Nursing campus

• Course changed from 3.5 yrs to 3 yrs

• Significant changes were brought in the nursing program and the curriculum (50% theory and 50% practical)

• Liberal art subjects (English, Nepali, Introduction to Nepal, Psychology) were added in nursing curriculum as compulsory subject to enhance language abilities and knowledge of behavioral science. This was thought to increase understanding of human behavior and communication skill.

• Applied science subjects (Physics, chemistry, biology) were added to help the students learn advancement in scientific knowledge and technology.

• The addition of new subjects and shortening of the duration changed the image of nursing from its highly technical image to a more academic oriented professional education with a sound theoretical knowledge.

After 2029 BS (1972 AD), PCL Nursing was offered by TU, IOM• SLC pass became compulsory for entrance into

nursing• PCL Nursing was given equivalent status to other

certificate level program under TU.

This created a positive impact on the image of nursing. PCL nursing could now enter bachelor level program offered in humanities after passing one or more subjects in social science in certificate level.

After 2029 BS (1972AD)• Nursing program changed from annual to

semester system• Theory and practical hours translated to credit

system• Evaluation system was formative type• TU, IOM took the responsibility of

• Conducting final university exams

• Issuing certificate to graduates

• Standardization of nursing curriculum

Before 2029 BS, Nepal nursing council was the governing body for final examination

In 2030 BS (1973 AD), Princess Prekshya Rajya Laxmi joined nursing education. This encouraged the girls from privileged class to study nursing.

In 2035 BS (1978 AD), BN started in Mahaboudha Nursing campus (now MNC)

2035-2044 BS, BN program had 3 speciality• Midwifery• Adult nursing• Child health nursing

From 2036 BS (1980 AD) • Semester system was changed to annual system

again• Evaluation was summative type

In 2041 BS, BN curriculum was revised to 2 stream, hospital nursing and community nursing.

Extension of ANM/CMA campus to nursing campus:• 2038 BS (1981 AD): ANM campus Biratnagar to

Biratnagar Nursing Campus• 2041 BS (1984 AD): CMA campus Pokhara to

Pokhara Nursing Campus• 2043 BS (1986 AD): CMA campus Birjung to

Birjung Nursing Campus• 2044 BS (1987 AD): ANM campus Nepalgunj to

Nepalgunj Nursing Campus

In 2043 BS (1986 AD), nursing education was opened to male students (10% seats). After 4 batch, male intake was discontinued because of the role ambiguity faced by them in clinical area.

In 2044 BS (1987 AD), PCL nursing curriculum was revised to make it PHC oriented. This change occurred in response to the Alma Ata Declaration (1978), health for all by 2000 by promoting primary health care

In 2046 BS (1989 AD), Bir Hospital Nursing campus opened under the affiliation of TU, IOM

After 2047 BS, education remained no longer only the state responsibility, education for health professional opened to private sector.

1970s to 1980s AD: Nursing teaches with bachelors and masters degree were sent to India and abroad for further education

• 2 nursing teachers returned with Phd degree from USA

• 21 nursing teachers returned with Masters degree from India and UK.

1980s AD is remembered as the capability building decade for nursing teachers. This resulted in quality nursing education, revised curriculum, better classroom teaching and improved clinical supervision.

In 2052 BS, (1995 AD), MN program started

• 2052 BS (1995 AD): Women’s health and development

• 2058 BS (2000 AD): Adult Health Nursing

In 2053 BS (1996 AD), BPKIHS Dharan, a deem university started 4 years B.Sc Nursing program.• 1st batch: 20 students (10 male and 10 female)• 2nd batch: 10 students (because of shortage of faculty)• 3rd batch onwards only females

From 2008 AD: M.Sc Nursing started NEC report 2049 (BS) recommended to move all PCL program

out of University and hand bring it under CTEVT by 2057 BS. It also recommended all bachelor level program to a 3 calendar years.

All other universities have implemented this except TU, IOM. IOM is in the process of its implementation. The 3 year curriculum has been developed and approved. Due to lack of faculty in peripheral campuses for basic science, the implementation has been delayed.

 

Highlights

1950’s• Code of Ethics (ANA)

• 1st CNS programs

• Nursing Research first published (1952)

1960’s• Post BSN programs

increase

• Nursing researchers pioneer clinical investigations

• International Nursing Index categorizes worldwide nursing articles

Highlights

1970’s• NP in expanded roles

gain national visibility• Nurses Coalition for

Action in Politics formed• ANA creates AAN to

honor outstanding nurses• Nurse theorist come into

national spotlight

1980’s• MS and Doctorate

programs increase

• Prof. Nursing journals increase

• More nurses are nationally “certified” in 17 specialty areas

• NIH has a National Center for Nrsg. Res.

References Bhattarai ,S.(2010) Trends & Issues in Nursing1st

edition, Makalu Publication house Crisp,J. & Tylor, C.Potter & Perry’s (2009)

Fundamental of Nursing, 3rd edition, chatsward, Elsevier Australia: Libby Houston

Deloughery,G.L.(1991) Issues & Trends in Nursing 1st edition , Mosby- year book

HLMC(1995) Fundamental of Nursing 1st edition, Suraj printing press, Dillibazaar

Potter,P.A. &Perry, A. G.(2007) Basic Nursing:Essential for Practice 6th edition, India: Elsevier India Pvt. Ltd.

Retrieved from http://en wikipedia.org/ wiki/ timeline_of_nursing_history

Retrieved from http://www.authorstream.com /presentationreynel 89-1357208-history of nursing

Retrieved from http:// www.slideshare.net/ jed22 cute/ history & evolution of nursing- 17672136

Retrieved from http://www.powerhouse.com

Central Message for All NursesEach nurse forms the image of

nursing every day