The Evolution of Nursing Chapter 1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc

The Evolution of Nursing

Chapter 1Chapter 1

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

History of Nursing and Nursing EducationHistory of Nursing and Nursing Education

• Care of the Sick During Early Civilization Illness was considered to be directly related to

disfavor with God.• Primitive people believed people became sick when an

evil spirit entered the body.

• Good spirit kept disease away. Medicine men performed witchcraft to induce bad

spirits to leave the body.


• Care of the Sick During Early Civilization Babylonians

• Intellectually, socially, and scientifically well developed

• Lay persons provided medical service, usually men Ancient Hebrews

• Attributed their misfortunes and illnesses to God’s wrath; depended on God to restore health

• Combined health and dietary practices from their religious beliefs with hygienic practices

• Prevented the spread of communicable disease



• Care of the Sick During Early Civilization Ancient Egypt

• Established hospitals

• Physicians were skillful at treating fractures

• Became well acquainted with organs of the body during embalming

• Developed a number of drugs and procedures such as surgery



• Care of the Sick During Early Civilization Ancient Greece

• Hellenic Established temples (hospitals)

o Spas, mineral springso Bath gymnasiums o Treatment and consultation rooms

Religious influence continuedo Prayer, offerings of thanks, and rituals




• Care of the Sick During Early Civilization Ancient Indians

• Established hospitals

• Attendants were males from India Clever and skillful Kind with good behavior Bathed patients, made beds, and attended to patients’

needs


• Care of the Sick During Early Civilization Ancient Greece (continued)

• Hippocrates Brilliant, progressive physician “Father of Medicine” Rejected the supernatural origin of disease Adopted a system of physical assessment, observation,

and record keeping Hippocratic Oath (oath taken by physicians) Work is basis for the holistic approach to patient care



• Care of the Sick During Early Civilization Ancient Greece (continued)

• Promoted public health and safety; emphasis on the poor, sick, widowed, and children

• Deacons and deaconesses visited the sick in their homes, prisons, and hospitals

• Hippocrates: “Father of Medicine” and basis for holistic approach to patient care.




• Care of the Sick During Early Civilization Early Christians

• Emphasis on care of the poor, sick, widowed, and children

• Deacons and deaconesses designated by bishops to provide care in homes of the sick

• Deaconess Phoebe considered a visiting nurse

• Fabiola provided the first free hospital in Rome in 390 AD


• Dark Ages Learning in all disciplines disintegrated People lost ability to read Nursing care friends & relatives No scientific basis for care given Medical theory disintegrated Jewish scholars maintained written work of others

• Served as translator

• Kept records in convents & monasteries

• Monks & nuns continue to care for sick


• Hospitals of Dark Age No way to meet basic need of ill Windows too high to open No fresh air Plumbing, heating, & lighting were non-existent Linens washed at river Time of plagues and infectious diseases


• Renaissance Period Nursing not moving forward Scientific methods of Greeks was restarted Disciplines of anatomy, physiology, & scientific

healing Tradition of unselfish service to humanity almost

vanished St. Vincent de Paul, organized the Sisters of Charity


• Seventeenth & Eighteenth Centuries

• US. Family members took care of sick

• Almshouses for the poor

• Pest houses for contagious people

• Protect the healthy not care for sick

• Medicine less developed in US

• Physicians not well trained

• 1st hospital built in Philadelphia d/t Ben Franklin

• Medical advances slow Treatment brandy, whiskey, emetics, purgatives, &

bleeding


• Nursing Education in the 19th Century Hospitals

• Overcrowded

• No trained or qualified people Women of “proper upbringing” did not work Nurses ended up being “inferior” and “undesirable” lower-

class women

• Place to contract disease rather than be cured Poor hygienic practices Unchecked infection Dirty physical conditions



• Nursing Education in the 19th Century Lutheran Order of Deaconesses

• Established the first real school of nursing

• Located in Kaiserwerther, Germany

• Florence Nightingale attended this school



• Nursing Education in the 19th Century Florence Nightingale

• Changed condition of the hospitals Cleaned units, washed clothes regularly, provided

sanitary conditions Through her patience, dedication, and empathetic

treatment, made a psychological change “Lady with the lamp”

o Carried a lamp to light her way through the rows of beds of the injured and sick



• Nursing Education in the 19th Century Nursing from occupation to profession

• Florence Nightingale began the reformation of nursing from occupation to profession by establishing the Saint Thomas Hospital School of Nursing in London

1 year training Formal instruction and practical experience “Register”

o Beginning of control over nursing graduates and standard of practice



• Nursing Education in the 19th Century Development of nursing education in the United

States• During the time that Florence Nightingale was active in

Europe, the same kinds of patient care problems were occurring in America

• In 1849, Pastor Theodore Fliedner of Germany traveled to America with four highly trained nurse-deaconesses

• Established the first Protestant hospital in the United States

Pittsburgh Infirmary in Pittsburgh, PA



• Civil War Era South - Prejudice about women working in hospitals Male opposition Died because of poorly trained medical corps Southern women offered services Most of nursing done by infantrymen assigned to the

task

North – Women offered their services as nurses Dorothea Lynde Dix appointed superintendent of

nurses


• Requested women under 30

• Plain-looking

• Wearing simple brown or black dresses without bows, curl, jewelry, or hoop skirts

• Clara Barton collected supplies for soldiers started the American Red Cross

• Civil War was push needed to establish nurse-training school



States• Most early nursing programs were supported by large

hospitals. First three schools of nursing in the United States

o Bellevue Hospital School of Nursing, New Yorko Connecticut Training School, New Haveno Boston Training School at Massachusetts General

Hospital, Boston




States• American Society of Superintendents of Training

Schools of Nursing Established by Isabelle Hampton Robb and Lavinia Dock Goal was to set education standards for nurses Code of ethics was adopted by the society

o Nightingale Pledge



• Changes in Nursing During the 20th Century Nursing licensure

• First laws were established in 1903

• Protect the public

• North Carolina, New Jersey, and New York were first states

• Isabelle Hampton Robb and Mary Adelaide Nutting Developed a program at Columbia University to train and

develop teachers of nursing



• Changes in Nursing During the 20th Century World War I

• Increased demand for nurses

• Army School of Nursing was established

• Training focused on “service to the patient” rather than on comprehensive care

• Most nurses returned to previous jobs after the war



• Changes in Nursing During the 20th Century World War II

• Increased demand for nurses

• Cadet Nurse Corps was established

• Nurses stayed in the military after the war Civilian nursing: low pay, long shifts, atrocious conditions Military nursing: prestige, good pay, and opportunity for

advancement



• Changes in Nursing During the 20th Century Contemporary nursing

• Characteristics of health care changed rapidly as health care became an industry

• Growth and diversity became the major emphasis

• Beginning of contemporary nursing with specialized nursing care adapted to areas

Private duty, school nursing, industrial nursing, nurse anesthesia, and nurse-midwifery



• Changes in Nursing During the 20th Century Contemporary nursing

• 1965: American Nurses Association o Education should take place in institutions of learningo Many hospital-based nursing programs were

disbandedo Trend was changed from “training” nurses to

“educating” nurses



• Changes in Nursing During the 20th Century Certification

• The nurse is granted recognition for competency in a specific area of nursing.

• Eligibility Current RN license Minimum 2 years’ experience in the designated area Currently practicing in the designated area

• Some areas include gerontologic, medical-surgical, psychiatric and mental health, and adult nurse practitioner




• Nursing in the 21st Century Demographic changes Women’s health care issues Men in nursing Human rights Medically underserved Threat of bioterrorism


Development of Practical/Vocational Nursing in the United StatesDevelopment of Practical/Vocational Nursing in the United States

• Attendant Nurses The Ballard School

• First school for training practical nurses

• Started in 1892 in Brooklyn, NY

• 3 months’ duration

• Trained students to care for the chronically ill, invalids, children, and the elderly

• Main emphasis was on home care Cooking, nutrition, basic science, basic nursing

procedures

• Graduated as attendant nurses



• Attendant Nurses Two other programs patterned after Ballard School

• Thompson Practical Nursing School; Brattleboro, Vermont; 1907

• Household Nursing Association School of Attendant Nursing; Boston; 1918

Focus continued to be on home nursing care and light housekeeping duties

No hospital experience



• Practical Nursing Programs Before 1940, practical nursing schools had few

controls, little educational planning, and minimal supervision

Between 1948 and 1954, 260 practical nursing programs were opened

Students in these programs provided nursing service while they were obtaining their education and training



• Organizational Influence Association of Practical Nurse Schools

• Founded in 1941

• Dedicated to practical nursing

• Planned the first standard curriculum for practical nursing

1942: changed name to the National Association of Practical Nurse Education (NAPNE)

1959: changed name to National Association for Practical Nurse Education and Service (NAPNES)



• Organizational Influence National Federation of Licensed Practical Nurses

(NFLPN)

• Founded by Lillian Kuster in 1949

• Membership is limited to LVNs and LPNs National League for Nursing

• 1961; established a Department of Practical Nursing Programs

• Developed an accreditation service for PN programs; Council of Practical Nursing Programs



• Additional Credentialing Approved program

• One that meets minimum standards set by the respective state agency

• Ensures that a given program Meets the needs of the student Has adequate course content and qualified faculty Is of sufficient length Has adequate facilities Provides clinical experience



• Additional Credentialing Accreditation

• Program voluntarily seeks a review by a given organization to determine whether the program meets the preestablished criteria of that organization

• Standards are usually far higher than required by the state



• Contemporary Practical/Vocational Nursing Education Nursing programs are offered by various

organizations: high schools,trade or technical schools, hospitals, junior and community colleges, universities, private education agencies

Length of programs: 12 to 18 months Skills, theory, and clinical practice National Council Licensing Examination for Practical

Nursing (NCLEX-PN) • Examination for licensure as LPN



• Contemporary Practical/Vocational Nursing Education Articulation

• Procedure that allows nursing programs to work together to plan their curricula to decrease duplication of learning experiences

• LPN/LVN to RN

• RN to BSN



• Career Advancement Career ladder

• Recognizes the clinical expertise of the nurse and provides a mechanism for providing the nurse with financial compensation and opportunities for advancement



• Events That Changed Practical/Vocational Nursing The need for trained caregivers World War I The self-taught practical nurse The Great Depression Duties of licensed practical/vocational nurses Position Paper of the American Nurses Association



• Licensure for Practical/Vocational Nursing Licensing laws

• Protect the public from unqualified persons practicing in almost any field or profession

Jurisdictions• Area such as a state that has the legal power to

regulate nursing licensure and practice State board of nursing



• Licensure for Practical/Vocational Nursing Laws that monitor the licensed practical/vocational

nurse• Licensing for practical nurses in the United States was

begun in 1914 by Mississippi By 1955, all states had passed licensing laws

• State Board Test Pool NLN Education Committee established a testing

mechanism for all states and administered the exam several times a year



• Licensure for Practical/Vocational Nursing Laws that monitor the licensed practical/vocational

nurse• National Council Licensing Examination for Practical

Nurses (NLCEX-PN) Computerized examination Receive score of “passed” or “has not passed”

• Interstate endorsement Reciprocity between states

o Licensing in other jurisdictions can be obtained without repeating the NCLEX-PN


• Roles and Responsibilities of the Licensed Practical/Vocational Nurse Recognizes the LPN/LVN’s role in the health care

delivery system and articulates that role with those of other health care team members

Maintains accountability for one’s own nursing practice within the ethical and legal framework

Serves as a patient advocate Accepts their role in maintaining and developing

standards of practice in providing health care Seeks further growth through education opportunities

Contemporary Practical/Vocational Nursing CareContemporary Practical/Vocational Nursing Care


• Objectives and Characteristics of Practical/Vocational Nursing Education To acquire the specialized knowledge and skills

needed to meet the health care needs of patients in a variety of settings

To be a graduate of a state-approved practical/vocational nursing program

To take and pass the NCLEX-PN examination To acquire a state license to practice




• Practical/Vocational Nursing Defined The activity of providing specific services to patients

under direct supervision of a licensed physician or dentist and/or RN

Assist individuals, sick or well, in the performance of those activities contributing to health, to their recovery, or to a peaceful death

Educated to be a responsible member of a health care team, performing basic therapeutic, rehabilitative, and preventive care for anyone who needs it


Health Care Delivery SystemsHealth Care Delivery Systems

• Health Care System Defined The complete network of agencies, facilities, and all

providers of health care in a specified geographical area

• Patient, patient’s family, community, current technology, government agencies, medical professionals, third-party participants

Goal is to achieve optimal levels of health care



• Health Care System Defined Wellness/illness continuum

• The range of a person’s total health; ever changing

• Wellness: A dynamic state of health in which an individual progresses toward a higher level of functioning, achieving an optimal balance between internal and external environment

Highest level of optimal health

• Illness: A diminished or impaired state of health Opposite end of spectrum from wellness



• Health Care System Defined Maslow’s model of health and illness

• Developed by Abraham Maslow He believed that an individual’s behavior is formed by his

attempts to meet his basic needso Physiological, safety and security, love and

belongingness, esteem, self-actualization

• Hierarchy or pyramido Some needs must be meet before advancing to other

needs


Figure 1-5Figure 1-5

Maslow’s hierarchy of needs.



• Health Care System Defined Health promotion and illness prevention

• U.S. Department of Public Health Identify what types of diseases are most prevalent, which

age groups are affected by certain illnesses, and which illnesses are predominant

Direct efforts toward developing treatment of the illness, establishing methods to decrease its spread, and isolating its cause

Focus has now shifted from curing the problem to preventing it



• Health Care System Defined Continuity of care

• Ensuring the continuation of care from one setting to another

• Understanding what procedures are done, why, and by whom is a discouraging and often impossible task for patients already bewildered and frightened by medical conditions that threaten their well-being



• Delivery of Patient Care Extremely humanistic activity

• Delivery of services by human beings to human beings Treatment of disease and injury Prevention of disease Restoration of optimal wellness through rehabilitation Maintenance of a desirable level of wellness Care of the chronically ill Provision of assistance to the patient in self-care Patient education



• Delivery of Patient Care Participants in the health care system

• Professional health care specialists

• Registered nurse

• Licensed practical/licensed nurse

• Additional caregivers Social worker, physical therapist, dietitian, respiratory

therapist

• Technologists and medical technicians



• Delivery of Patient Care Economic factors affecting health and illness

• Rising health care costs

• Aging population

• Advancement of technology

• Health care insurance

• Malpractice insurance

• Miscellaneous factors People avoid preventive and routine care and are seen

only in crisis situations


• Delivery of Patient Care Economic factors affecting health and illness

• Changes in delivery system Case management Cross-training Additional trends

o Multisystem health care chainso Health maintenance organizations (HMOs)




• Delivery of Patient Care Environmental factors affecting health and illness

• Social and physical environmental factors do not necessarily cause illness, but they do influence the development or progression of an illness

• Social: Financial hardship, lifestyle, social pressures, etc.

• Physical: Stress, conflict, smoking, weight, etc.



• Delivery of Patient Care Expectations of the patient and health care team

• Health promotion Preventive medicine through education

• Patients’ rights Patients expect to be treated with dignity and

compassion and have their rights respected

• Health care providers’ rights Expect that patients will actively participate in their care

as much as possible



• Delivery of Patient Care Interdisciplinary approach to health care

• Care plan Document that outlines the individual needs of the patient

and the approach of the health care team in meeting these needs

• Communication Good communication is essential for the exchange of

information among the members of the health care team


Nursing Care ModelsNursing Care Models

• Four Major Concepts Nursing

• Encompasses the roles and actions of the nurse Patient

• The individual receiving the care Health

• The area in which the patient fits on the wellness/illness continuum

Environment• The setting for the nurse-patient interactions


Figure 1-6Figure 1-6

A nurse collaborating with other members of the interdisciplinary health care team.

(From Lindeman, C.A., McAthie, M. [1999]. Fundamentals of contemporary nursing practice. Philadelphia: Saunders.)



• Delivery of Patient Care Interdisciplinary approach to health care

• Documentation Any form of documentation is the permanent record of

the patient’s progress and treatment It is the formal and legal record of care received by the

patient and the patient’s response to that care Provides a progress record of treatment Provides a history of events

Documents

The Evolution of Nursing Chapter 1 Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc