Evolution of Nursing and Health Care
At the end of this lecture the student will
be able to:
1. Define nursing as an art and a science.
2. Define the history.
3. Identify the importance of nursing history
2. Identify major historical and social events
that have shaped current nursing practice.
3. Describe Florence Nightingale’s impact on
current nursing practice.
Evolution of Nursing and Health Care
4. Discuss the contributions of early leaders
in American nursing.
5. Discuss the impact of selected landmark
reports on nursing education and practice.
6. Relate the social forces of nursing’s
evolution to the current status of advanced
practitioners
History can be defined as:
“A study of events from the past leading up
to the present time”
Evolution of Nursing and Health Care
Definition of Nursing
Nursing is an art and a science by which people are
assisted in learning to care for themselves whenever
possible and cared for by others when they are unable
to meet their own needs.
- Nursing’s early history was heavily influenced by
religious organizations and the need for nurses to care
for soldiers during wartime.
THE IMPORTANCE OF STUDYING
NURSING HISTORY
1-Helping to understand the societal forces and
issues facing the profession.
2-Gaining an appreciation of the role the
profession played in the healthcare system.
3-Describing the influence of societal trends on the
development of nursing as a profession.
4-Identifying the contributions of selected leaders
in the nursing profession.
HISTORICAL OVERVIEW
To understand the present status of nursing, it is
necessary to have a base of historical knowledge
about the profession. By studying nursing history,
the nurse is better able to understand such issues
as autonomy (being self-directed), unity within
the profession, supply and demand, salary,
education, and current practice.
HISTORICAL OVERVIEW
Through consultation and exchange of information, nurses demonstrate
their roles as autonomous professionals.
HISTORICAL OVERVIEW
The study of nursing history offers another
advantage—learning where the profession has
been and its advancements. Empowerment is
the process of enabling others to do for
themselves. Only when nurses are empowered
are they truly autonomous.
HISTORICAL OVERVIEW
Graduating Class (1900) of Touro Infirmary Training School for
Nurses
HISTORICAL OVERVIEW
Empowerment and autonomy go together and
are necessary for nursing to bring about positive
changes in health care today. Power is not
authority— authority is power.
HISTORICAL OVERVIEW
Learning from the past is the major reason
1-For studying history. Ignoring nursing’s history
can be detrimental to the future of the profession.
2-By applying the lessons gained from a
historical review, nurses will indeed be a vital
force in the new millennium.
Evolution of Nursing
Nursing has evolved with the development of
civilization of mankind. The following for a
discussion of nursing from early civilizations to
the present era of advanced nursing practice and
health care reform.
Evolution of Nursing
Early Civilizations
The evolution of nursing dates back to 4000
BC, to primitive societies in which mothernurses worked with priests. In 2000 BC, the use
of wet nurses is recorded in Babylonia and
Assyria.
Evolution of Nursing
Ancient Greece
The ancient Greeks built temples to honor Hygiea, the
goddess of health. These temples were more like health
spas rather than hospitals in that they were religious
institutions governed by priests. Priestesses (who were
not nurses) attended to those housed in the temples.
The nursing that was done by women was performed in
the home.
Evolution of Nursing
Roman Empire
Hospitals were first established in the Eastern
Roman Empire (Byzantine Empire). St. Jerome
was responsible, through one of his disciples,
Fabiola, for introducing hospitals in the West.
Evolution of Nursing
Western hospitals were primarily religious and
charitable institutions housed in monasteries
and convents. The caregivers had no formal
training in therapeutic modalities and
volunteered their time to nurse the sick.
Evolution of Nursing
Middle Ages
Hospitals in large Byzantine cities were staffed
primarily by paid male assistants and male
nurses.
During the medieval era, these hospitals were
established primarily as almshouses, with care of
the sick being secondary.
Evolution of Nursing
-Medical practices in Western Europe remained
basically unchanged until the 11th and 12th
centuries, when formal medical education for
physicians was required in a university setting.
Although there were not enough physicians to
care for all the sick, other caregivers were not
required to receive any formal training.
Evolution of Nursing
The dominant caregivers in the Byzantine
setting were men; however, this was not true in
the rural parts of the Eastern Roman Empire
and in the West. In these societies, nursing was
viewed as a natural nurturing job for women.
Evolution of Nursing
Renaissance
-During the Renaissance (AD 1400–1550),
interest in the arts and sciences emerged. This
was also the time of many geographic
explorations by Europeans. As a result, the
world literally expanded.
Evolution of Nursing
Renaissance
During the Renaissance (AD 1400–1550),
interest in the arts and sciences emerged. This
was also the time of many geographic
explorations by Europeans. As a result, the world
literally expanded.
Evolution of Nursing
Because of renewed interest in science,
universities were established, but no formal
nursing schools were founded. Because of social
status and customs, women were not
encouraged to leave their homes; they continued
to fulfill the traditional role of nurturer/caregiver
in the home.
Evolution of Nursing
Enlightenment and Industrial Revolution
The Industrial Revolution introduced technology
that led to a proliferation of factories. Conditions
for the factory workers were deplorable. Long
hours, grueling work, and unsafe conditions
prevailed in the workplace. The health status of
laborers received little, if any, attention.
Evolution of Nursing
Medical schools were founded, including the
Royal College of Surgeons in London in 1800. In
France, men who were barbers also functioned
as surgeons by performing procedures such as
leeching, giving enemas, and extracting teeth.
Evolution of Nursing
At the end of the 18th century, there were no
standards for nurses who worked in hospitals. In
the early to mid-1800s, nursing was considered
unseemly for women even though some hospitals
(almshouses) relied on women to make beds,
scrub floors, and bathe the poor. Most nursing
care was still performed in the home by female
relatives of the ill.
Evolution of Nursing
Religious Influences
The strong influence of religions on the
development of nursing started in India (800–600
BC) and flourished in Greece and Ireland in 3 BC
with male nurse-priests.
Religious Influences
In 1836, Theodor Fleidner revived the Church
Order of Deaconesses to care for those in a
hospital he had founded. These deaconesses of
Kaiserwerth became famous because they were
the only ones formally trained in nursing. Pastor
Fleidner had a profound influence on nursing
because Florence Nightingale received her
nurse’s training at the Kaiserwerth Institute.
Evolution of Nursing
Florence Nightingale
1820 Florence Nightingale born.
She is considered the founder of modern
nursing. She grew up in a wealthy upper-class
family in England during the mid-1800s. Unlike
other young women of her era.
Evolution of Nursing
Florence Nightingale 12 -5- 1820 - 13 -8- 1910.
Evolution of Nursing
-Nightingale received a thorough education including
Greek, Latin, history, mathematics, and philosophy. She
had always been interested in relieving suffering and
caring for the sick.
-Social mores of the time made it impossible for her to
consider caring for others because she was not a
member of a religious order. She became a nurse over
the objections of society and her family.
Evolution of Nursing
Florence Nightingale in the Crimea
Evolution of Nursing
-After completing the 3-month course of study at
Kaiserwerth Institute, Nightingale became active
in reforming health care. The advent of Britain’s
war in the Crimea presented the stage for
Nightingale to further develop the public’s
awareness of the need for educated nurses.
Evolution of Nursing
-The implementation of her principles in the
areas of nursing practice and environmental
modifications resulted in reduced morbidity and
mortality rates during the war.
-Nightingale forged the future of nursing
education as a result of her experiences in
training nurses to care for British soldiers.
Evolution of Nursing
-She established the Nightingale Training School
of Nurses at St. Thomas’ Hospital in London. ----This was the first school for nurses that provided
both theory-based knowledge and clinical skill
building. She revolutionized not only the
public’s perception of nursing but also the
method for educating nurses.
Evolution of Nursing
Some of Nightingale’s novel beliefs about
nursing education were:
• A holistic framework inclusive of illness and
health
• The need for a theoretical basis for nursing
practice
• A liberal education as a foundation for nursing
practice
Evolution of Nursing
• The importance of creating an environment that
promotes healing
• The need for a body of nursing knowledge that
was distinct from medical knowledge
Evolution of Nursing
Nightingale introduced many other concepts that,
though unique in her time, are still used today. She
advocated:
(2) having a systematic method of assessing
clients;
(2) individualizing care on the basis of the
client’s needs and preferences.
(3) maintaining confidentiality.
Evolution of Nursing
-Nightingale also recognized the influence of
environmental factors on health. She advocated
that nurses provide clean surroundings with
fresh air and light to improve the quality of care
(Nightingale, 1969).
Nightingale believed that nurses should be
formally educated and should function as client
advocates.
Nursing Leaders
American nursing’s history is rich with many
outstanding leaders.
Influential nursing leaders, such as Lillian Wald,
Jane Delano, Isabel Hampton Robb, Annie
Goodrich, Adelaide Nutting, and Lavinia Dock,
were instrumental in the advancement of nursing
education and practice.
Landmark Reports in Nursing Education
• In 1923, the Goldmark report concluded that,
for nursing to be on equal footing with other
disciplines, nursing education should occur in
the university setting.
• The Brown report (1948) addressed the need
for nurses to demonstrate greater professional
competence by moving nursing education to
the university setting.
Selected Legislation
•The Health Maintenance Organization Act of
1973 provided an alternative to the private
health insurance industry.
Education and Practice: Contemporary Reports
• Contemporary reports issued by the National
Commission on Nursing, the Institute of
Medicine, and the Secretary’s Commission on
Nursing focused on the areas of nursing
education, practice, and nursing’s role in health
care financing policies.
Nurses making a presentation before a state legislature. Considering the
issues for which historic nursing leaders worked, what challenges do you
think merit your participation in the health care debate?
• Developments such as alternative methods of
health care delivery, evidence-based practice,
and the efforts devoted to health care reform
have led to diversified nursing roles.
• As the nursing profession continues to evolve
and respond to the challenges within the health
care system, nurses will remain responsive to
societal needs
A component of the professional role of nurses is the delivery of
highly skilled care to clients. In what ways can nurses build on these
skills so as to achieve full autonomy and empowerment as members
of the health care team?