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Chapter 1The Evolution of
Professional Nursing
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We need to realize and to affirm anew that nursingis one of the most difficult arts. Compassion mayprovide the motive, but knowledge is our onlyworking power. Perhaps, too, we need to
remember that growth in our work must bepreceded by ideas, and that any conditions whichsuppress thought, must retard growth. Surely wewill not be satisfied in perpetuating methods andtraditions. Surely we shall wish to be more and
more occupied with creating them. M. Adelaide Nutting, 1925
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Prehistoric Period
Health beliefs
All natural phenomena, including illnesses, were
the work of the gods Health practices
Engaged in acts intended to deter evil gods and
demons
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Early Civilization
Egypt Health beliefs and practices
Valued personal health; preventive measures takento appease the gods
Developed specific laws on cleanliness, food useand preservation, drinking, exercise, sexualrelations, and a pharmacopoeia with more than 700
natural remedies Nursing
Little information available
Women were hired by privileged families to care for
the sick and to assist with childbirth; Shiphrah andPuah were midwives who saved the baby Moses
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Early Civilization
Palestine
Health beliefs and practices
Developed the Mosaic Code, one of the firstorganized methods of disease control and prevention
Nursing
Little information available
Nursing and medical care were provided in the home
by male Hebrew priests and women (usually widows
or maidens) who focused on both physical and
spiritual healing and comfort
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Early Civilization
Greece Health beliefs
Believed that the gods and goddesses of Greek mythology
controlled health and illness Temples built to honor Asclepius, the god of medicine, were
designated to care for sick
Medical Science Asclepius carried a staff intertwined with serpents, representing
wisdom and immortality; staff was the model for medicalcaduceus
Hippocrates considered the father of medicine
Hippocrates was the first to attribute disease to natural causes
rather than supernatural causes and curses of the gods
Scientific approach; patient-centered approach
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Early Civilization
India Health beliefs and practices
Vedas (2000-1200 BC), sacred Hindu books, were the source ofinformation about health practices
Focused on the use of magic, charms, herbs, and spices to curedisease and remove demons
Medical science Developed procedures to perform major and minor surgical
operations Recorded extensive information about childhood diseases,
prenatal care, and conditions of the urinary and nervoussystems
Nursing Hindu physicians performed major and minor surgeries including
limb amputations, cesarean deliveries, and suturing wounds Women did not work outside the home
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China
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Early Civilization
China Health beliefs
Teachings of Confucius (531-479 BC) had a powerfulimpact on health practices
Believed in the yin and yang philosophy; animbalance between the two would result in ill health
Health practices Used treatments to promote health and harmony
including acupuncture, hydrotherapy, massage, andexercise
Used drug therapy to manage disease conditions andrecorded over 1000 drugs
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Early Civilization
Rome
Adapted health and medical practices from thecountries conquered and physicians enslaved (27BC-476 AD)
Established the first military hospital in Europe inRome
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The Renaissance and the Reformation
Period Major advancements in medicine: pharmacology,
chemistry, and medical knowledge
Dark ages of nursing Religious orders became almost extinct as a result of
dissension between Roman Catholic Christians andProtestant sects
Nursing no longer appealed to women of high socialstatus; hospital care was regulated to common women,
prisoners, thieves and drunks Nursing became an undesirable job with poor pay, long
hours, and strenuous work that was considered menial
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The Renaissance and the Reformation
Period Social conditions
Famine, plague, filth, and crime ravaged Europe
Nursing orders were established out of greatconcern for social welfare
Sisters of Charity - recruited young women for nurse
training, developed educational programs, and cared
for abandoned children
St. Vincent de Paul - established the Hospital for the
Foundling to care for orphaned and abandoned
children
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The Colonial American Period
Mexico
First colonists in Mexico were members of
Catholic religious orders Hospital of the Immaculate - first hospital in
North America, built in 1524 in Mexico City; first
medical school built at the University of Mexico
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Colonial North America
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The Colonial American Period
Colonial America
Health care was sadly deficient; life expectancy
was low, plagues such as yellow fever andsmallpox were a constant threat
Physicians were poorly trained and used crude
methods of treatment such as bleeding and
purgatives
Through the efforts of Benjamin Franklin,
Pennsylvania Hospital was the first hospital built
in the United States in 1751
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Florence Nightingale
Early nursing career
Family opposed her interest in nursing at first,
then she was permitted to pursue nurse training
1851 - Attended a 3-month nurse-training
program at the Institute of Deaconesses at
Kaiserwerth, Germany
1854 - Began training at the Harley Street Nursing
Home; served as the superintendent of nurses at
Kings College Hospital in London
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Florence Nightingale
Crimean War
1854 - Accepted an assignment to lead a group of 38nurses who were sisters and nuns from variousCatholic and Anglican orders to the Crimea to workat the Barracks Hospital in Scutari
Despite deplorable conditions, the army doctors atfirst refused her assistance
Eventually the doctors, in desperation, called for herhelp
Purchased medical supplies, food, and linen; set up akitchen; instituted laundry services; initiated social
services; spent up to 20 hours each day providing
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The Lady With the Lamp
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Florence Nightingale
Major accomplishments Demonstrated the value of aseptic techniques and
infection control procedures
Honored for her contributions to nursing research
Demonstrated the value of political activism to affect
health care reform
Established the first nursing school in England
Honored as the founder of professional nursing services,initiated social services, spent up to 20 hours each day
providing nursing care
Introduced principles of asepsis and infection control, a
system for transcribing doctors orders, and a system tomaintain atient records
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Mary Seacole
Jamaican nurse who played a major role in the
Crimean War
Denied the opportunity to join Nightingales nursingbrigade because she was black
Opened a lodging house with her own money to care
for sick and wounded soldiers
Contributed to the control of the cholera epidemic
with extensive knowledge in tropical medicine
Honored by the Jamaican government and the
British Commonwealth with a medal for saving
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Mary Seacole
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Nursing in the United States
The Civil War Period
The Civil War or the War between the States(1861-1865)
No army nurses and no organized medical corps whenthe war began
Dorothea Dix - Appointed to organize militaryhospitals, provide trained nurses, and disperse
supplies; she received no official status and no salaryfor this position
6 million people hospitalized during the war - 425,000for war casualties; vast majority for disease epidemics
181 African-American nurses, both men and women,
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Nurses Pictured With Civil War Soldiers
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Field Hospitals with MDs and Nurses
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Nursing in the United States
African-American nurses made important contributions Harriet Tubman cared for wounded soldiers and conducted an
underground railroad to lead slaves to freedom
Sojourner Truth, known for her abolitionist efforts as well as her nursing
efforts, was an advocate of clean and sanitary conditions so patients could
heal
Susie King Taylor, though hired in the laundry, worked full-time as a nurse
on the battlefront with no pay or pension; not considered an official Union
Army nurse
Volunteer nurses who made important contributions Clara Barton operated a war relief program; credited with founding the
American Red Cross
Louisa May Alcott authored detailed accounts of the experiences
encountered by nurses during the war for a newspaper publication entitled
Hospital Sketches
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Nursing in the United States
Number of nurse training schools increasedafter the war Offered little classroom education
On-the-job training occurred in the hospital wards Students were used as supplemental hospital staff
1890 - Establishment of African-Americanhospitals and nursing schools gained
momentum John D. Rockefeller established the first school of
nursing for African-American women at the AtlantaBaptist Seminary, now known as Spelman College
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Nursing in the United States
1900 to World War I
Advances in the nursing profession
By 1910 most states passed legislation requiring nurseregistration before entering practice
Required entry level for nursing students was
upgraded to high school graduate
Nurse training programs improved to include a morecomprehensive course of study
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Nursing in the United States
Lillian Wald developed a viable practice for public healthnursing (The Henry Street Settlement) located in the LowerEast Side of New York City
Purpose was to provide well-baby care, health education,disease prevention, and treatment of minor illnesses Nursing practice at the Henry Street Settlement formed the
basis for public health nursing in the United States
Developed the first nursing service for occupational health
(Metropolitan Life Insurance Company) Prevention of disease in workers to promote productivity Sliding-scale fee
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Lillian Wald
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Nursing in the United States
World War I and the 1920s
Advances in medical care and public health
Improved hospital care and surgical techniques Discoveries in pharmacology - insulin and the precursor to
penicillin
Environmental conditions improved; serious epidemics of
the previous century became nonexistent
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Nursing in the United States
Advances in nursing Nurses served honorably during WWI
Nurse anesthetists made their first appearance as part of
front-line surgical teams U.S. Public Health Service sought the assistance of a nurse to
establish nursing services at military outposts
American Red Cross, founded by Clara Barton in 1882,
became more active in urban settings as well as rural
communities
Mary Breckenridge established the Frontier Nursing Service
(FNS) in 1925 in rural Kentucky to assist disadvantaged
women and children; documented the impact of nursing
services on improving the health of communities; well
known for midwifery services
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Nursing in the United States
Legislation
Sheppard-Towner Act - first legislation to assist special
populations and provided public health nurses with
resources to promote health and well-being of women,infants, and children
The Great Depression (1930-1940)
Social issues
American economy disintegrated with over 6 million people
unemployed
Nurses also were forced to join the ranks of the
unemployed
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Nursing in the United States
Legislation
New Deal enacted to rescue the country and
provided for medical care and other services for the
large numbers of indigent people
Social Security Act of 1935 affected health care and
provided avenues for public health nursing
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Nursing in the United States
Main purposes of the Social Security Act
National age-old insurance system
Federal grants to states for maternal and child welfare services
Vocational rehabilitation services for the handicapped Medical care for crippled children and blind people strengthen
public health services
A Federal-state unemployment system
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Nursing in the United States
World War II
Legislation
Programs enacted to expand nursing education andincrease the number of nurses in all military branches
Advances in nursing
Nursing became an essential part of the military
advance Nurses recognized as an integral part of the military
and attained officer rank
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Nursing in the United States
Post World War II (1945-1950)
Social issues
Unemployment dropped to all-time lows Women were encouraged to return to childbearing and
marriage rather than continue employment outside the
home
Advances in nursing
Demonstrated value to the armed services during the
Korean War
Emerged as a true profession with minimum national
standards for nursing education established
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Nursing in the United States
By 1950 all states had adopted the State Board Test Pool
Number of nursing baccalaureate programs grew
Associate-degree programs developed in community and juniorcolleges
Legislation
Nurse Training Act of 1943: first instance of federalfunding to support nurse training Hill-Burton Act: provided funding to construct hospitals; created
a hospital construction boom that increased the demand forprofessional nurses
African-American nurses were barred from membership in theANA due to segregation laws; all barriers were dropped in theearly 1960s
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Nursing in the United States
Nursing in the 1960s
Legislation had a major and lasting impact on nursingand health care
Community Mental Health Centers Act of 1963
Medicaid, Title XIX of the Social Security Act, 1965
Medicare, Title XVIII of the Social Security Act, 1965
Impact of Medicare reimbursement on nursing
Hospital occupancy increased resulting in an increased needfor hospital nurses
Nursing embraced the hospital setting as the usual practicesite
Home health movement was initiated
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Nursing in the United States
Nursing in the 1970s
Influenced by the womens movement, nursesdemanded fairer wages and better working conditions
Hospitals continued to be the focus of nursingeducation and practice
Nurses were instrumental in developing communityprograms including hospice programs, birthing
centers, and adult day care centers Nurse practitioners began to be recognized as viable,
cost-effective providers of comprehensive healthservices
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Nursing in the United States
Nursing in the 1980s Types of patients needing health care changed
Increasing numbers of homeless and indigent
Emergence of acquired immune deficiency syndrome (AIDS) Spiraling health care costs became an issue
Diagnosis-related group (DRGs) system for reimbursement was
instituted
Hospitals were forced to increase efficiencies and reduce
patients length of stay Case management emerged as a new area of nursing
specialization
Outpatient and ambulatory services grew
Enrollment in manage care plans and health maintenance
organizations grew
Advanced nurse practitioners increased in popularity
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Nursing in the United States
Nursing practice began to move from the hospital setting to
community settings
Disease prevention and health promotion gained importance
Medical care continued to advance Organ transplantation
Resuscitation and support of premature infants
Medical specialties flourished
Medical technology flourished
Inadequate funding for public health programs became an
issue
Scholars suggested that nursing research needed to be
focused on substantive information to guide practice
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Nursing in the United States
Nursing in the 1990s
Growing concerns about the health of the nation
Healthy People 2000 initiative
Increasing focus on health promotion and disease preventionactivities
Influence of the AIDS epidemic New procedures for infection control were required
Universal Precautions were mandated
Exposure to hazardous materials Workplace chemicals and radioactive substances created health
risks
Employee training was instituted across all industries
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Nursing in the United States
Managed care movement
Focus moved from acute care to prevention and primary care
Emphasis on outpatient, ambulatory, and home services
Massive downsizing of hospital nursing staff and increase inunlicensed assistive personnel
Increasing demand for community health nurses and advanced
practice nurses
Changing nursing requirements for the 1990s and beyond
Focus on health risk assessments based on family and
environmental issues
Focus on health promotion and disease prevention
Promote counseling and health education
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Nursing in the United States
Nursing in the 21st century
Challenges facing professional nurses
Changing duties and responsibilities
Nursing shortage
Public concern over patient safety and quality of care
Core competencies required by professional nurses Critical thinking
Communication
Assessment
Leadership
Technical Skills
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Nursing in the United States
Knowledge required by professional nurses
Health promotion/disease prevention
Information technology
Health systems
Public policy
Consumer issues in health care
Access
Quality Cost
Accountability
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Nursing in the United States
Changes in society
Aging population
Intercultural population
Consumer health value
Need for a well trained work force
AACN (2000) reports 7.4% faculty vacancy rate; average full time faculty
over 50 years of age; average age of doctorally prepared faculty 55.9
Nurse Reinvestment Act signed into bill August 2002 to provide funds
for nursing education, recruitment, and retention
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Nursing in the United States
Opportunities for professional nurses (2.6 million
members)
Evidence-based practice
United efforts to shape health care United efforts to address the nursing shortage