LOGO Evolution Of Nursing Masoud khodaveisi References Contemporary Nursing Issues, Trends, & Management, 2014 Barbara Cherry, Susan R. Jacob CHAPTER 1 The Evolution of Professional Nursing, Page 1 Evolution Of Nursing Nursing is a dynamic profession that has evolved into a theory, research, and evidence-based practice. From its unorganized and variably defined beginnings, to a profession based on the framework of competence, autonomy, determination, and human caring has developed. • The challenges and opportunities have paralleled the path of world history and have brought about significant changes in the profession. Evolution Of Nursing From the men who opened the path, to the women who brought dignity and respect to their philosophy of caring, to the pioneers who brought unity to the profession plagued by a history of racism, sexism, and sometimes disgrace, nursing has become recognized as critical to the health of the nation. Despite myriad challenges, the practice of nursing has been distinguished and qualified by the intellect, skill, commitment, and contribution of countless sisters, deaconesses, and individuals, such as Seacole, Dix, Barton, Wald, Breckenridge, and Nightingale. Evolution Of Nursing The nursing profession has the capacity to effect far reaching changes in the health care system. Close proximity to patients and scientific understanding of care across the health care continuum from health promotion to disease prevention to coordination of care give nurses the unique ability to lead in the improvement and redesign of the health care system. Evolution Of Nursing Research has linked nursing care to the safety of patients. Nurses will continue to increase knowledge, manage technology, and maintain ethical standards to provide high-quality, patientcentered, safe care to individuals, families, communities, and populations throughout the world. Evolution Of Nursing Nurses are crucial in preventing medication errors, reducing infection rates, and facilitating patients‟ transition from hospital to home. Significant nursing contributions to creating a quality, patient-centered health care system that is accessible, equitable, evidence based, and sustainable will require transforming the work environment, scope of practice, education, and numbers of nurses. Evolution Of Nursing Through periods of war, socioeconomic change, and health care reform, nurses have played a vital role in initiating change to improve the health care arena. Nurses have provided the integrity to maintain the quality of care in all health care settings. Evolution Of Nursing The evolution of the practice from the treatment of disease to health promotion and disease prevention has led the way in determining the type of providers needed to care for patients in the future. This evolution will continue to provide the foundation for the scope of practice, educational curricula, scholarship, and research necessary for nurses to lead and manage the health care environment of the future. Important Events In The Evolution Of Nursing 1751 The Pennsylvania Hospital is the first hospital established in America. 1798 The U.S. Marine Hospital Service comes into being by an act of Congress on July 16. It is renamed the U.S. Public Health Service in 1912. 1840 Two women, Mary Williams and Frances Rose, who founded Nursing Sisters of the Holy Cross, are listed as nurses in the City of Baltimore Directory. 1851 Florence Nightingale Kaiserswerth to train as a nurse. (1820-1910) attends Important Events In The Evolution Of Nursing 1854 During the Crimean War, Florence Nightingale transforms the image of nursing. 1861 The outbreak of the Civil War causes women to volunteer as nurses. 1872 Another school of nursing opens in the United States: the New England Hospital for Women and Children in Boston, Massachusetts. Important Events In The Evolution Of Nursing 1873 Linda Richards is responsible for designing a written patient record and physician‟s order system the first in a hospital. 1879 Mary Mahoney, the first trained nurse, graduates from the New England Hospital for Women and Children in Boston, Massachusetts. 1882 The American Red Cross is established by Clara Barton. 1886 The Visiting Nurse Association (VNA) is started in Philadelphia; Spelman College, Atlanta, Georgia, establishes the first diploma nursing program for Americans. Important Events 1893 Lillian Wald and Mary Brewster establish the Henry Street Visiting Nurse Service in New York. 1896 The Nurses‟ Associated Alumnae of the United States and Canada is established. 1898 Namahyoke Curtis, an untrained nurse, is assigned by the War Department as a contract nurse in the SpanishAmerican War. 1899 The International Council of Nurses (ICN) is founded. 1900 The first issue of the American Journal of Nursing is published. Important Events 1901 The Army Nurse Corps is established under the Army Reorganization Act. 1902 School of nursing is established in New York City by Linda Rogers. 1903 The first nurse practice acts are passed, and North Carolina is the first state to implement registration of nurses. 1908 The National Association of Colored Graduate Nurses is founded; it is dissolved in 1951. Important Events 1909 Ludie Andrews sues the Georgia State Board of Nurse Examiners to secure nurses the right to take the state board examination and become licensed; she wins in 1920. 1911 The American established. Nurses Association (ANA) is 1912 The U.S. Public Health Service and the National League for Nursing (NLN) are established. 1918 Eighteen black nurses are admitted to the Army Nurse Corps after the armistice is signed ending World War I. Important Events 1919 Public Health Nursing is written by Mary S. Gardner. A public health nursing program is started at the University of Michigan. 1921 The Sheppard-Towner Act is passed providing federal aid for maternal and child health care. 1922 Sigma Theta Tau is founded (becomes the International Honor Society of Nursing in 1985). 1923 The Goldmark Report criticizes the inadequacies of hospital-based nursing schools and recommends increased educational standards. Important Events 1924 The U.S. Indian Bureau Nursing Service is founded by Elinor Gregg. 1925 The Frontier Nursing Service is founded by Mary Breckenridge. 1935 The Social Security Act is passed. 1937 Federal appropriations for cancer, venereal diseases, tuberculosis, and mental health begin. 1939 World War II begins. 1941 The U.S. Army establishes a quota of 56 nurses for admission to the Army Nurse Corps. The Nurse Training Act is passed. Important Events 1943 An amendment to the Nurse Training bill is passed that bars racial bias. 1945 The U.S. Navy drops the color bar and admits four African-American nurses. 1946 Nurses are classified as professionals by the U.S. Civil Service Commission. The Hospital Survey and Construction Act (Hill-Burton) is passed. 1948 The Brown Report discusses the future of nursing. 1948 Estelle Osborne is the first nurse elected to the board of the ANA. The ANA votes individual membership to all African-American nurses excluded from any state association. Important Events 1949 M. Elizabeth Carnegie is the first nurse to be elected to the board of a state association (Florida). 1950 The Code for Professional Nurses is published by the ANA. 1952 National nursing organizations are reorganized from six to two: ANA and NLN. 1954 The Supreme Court decision Brown v. Board of Education asserts that “separate educational facilities are inherently unequal.” Important Events 1965 The Social Security Amendment includes Medicare and Medicaid. 1971 The National Black Nurses Association is organized. 1973 The ANA forms the American Academy of Nursing. 1974 The American Assembly of Men in Nursing is founded. 1978 Barbara Nichols is the first nurse elected president of the ANA. M. Elizabeth Carnegie, a nurse, is elected president of the American Academy of Nursing. Important Events 1979 Brigadier General Hazel Johnson Brown is the first chief of the Army Nurse Corps. 1985 Vernice Ferguson, a nurse, is elected president of Sigma Theta Tau International. 1986 The Association of Black Nursing Faculty is founded by Dr. Sally Tucker Allen. 1990 Congress proclaims March 10 as Harriet Tubman Day in the United States, honoring her as a brave freedom fighter and nurse during the Civil War. 1990 The Blood borne Pathogen Standard is established by OSHA. Important Events 1991 Healthy People 2000 is published. 1993 The National Center for Nursing Research is upgraded to the National Institute of Nursing Research within the National Institutes of Health. 1994 NCLEX-RN®, a computerized examination, is introduced. nurse-licensing 1996 The Commission on Collegiate Nursing Education is established as an agency devoted exclusively to the accreditation of baccalaureate and graduate-degree nursing programs. Important Events 1999 Beverly Malone, the second president of the ANA, is named Deputy Assistant Secretary for Health, Department of Health and Human Services, Office of Public Health and Science. 1999 The IOM releases its landmark report: To Err Is Human: Building a Safer Health System. 2000 M. Elizabeth Carnegie is inducted into the ANA Hall of Fame. The American Nurses Credentialing Center gives its first psychiatric mental health nurse practitioner examination. Healthy People 2010 is published. Important Events The AACN reports a faculty vacancy rate of 7.4% among the 220 nursing schools that responded to a survey. According to the AACN, the average age of fulltime faculty is older than 50 years of age; the average age of doctorally prepared professors is 55.9 years of age. 2001 Beverly Malone is appointed General Secretary, Royal College of Nursing, London. The Health Care Financing Administration (HCFA) becomes the Centers for Medicare & Medicaid Services (CMS). Important Events 2002 Johnson and Johnson Health Care Systems, Inc. launches The Future of Nursing, a national publicity campaign to address the nursing shortage. 2002 To address the nursing shortage, the Nurse Reinvestment Act is signed into law by President George W. Bush. 2002 Significant funding is obtained for geriatric nursing initiatives. 2003 The American Nurses Foundation launches an “Investment in Nursing” campaign to deal with the nursing shortage. 2003 The IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses is released. Important Events 2003 The AACN White Paper on the Role of the Clinical Nurse Leader is published. 2005 The CCNE decides that only programs that offer practice doctoral degrees with the Doctor of Nursing Practice (DNP) title will be eligible for CCNE accreditation. 2005 The NLN offers and certifies the first national certification for nurse educators; the initials CNE may be placed behind the names of those certified. 2006 The AACN approves essentials of doctoral education for advanced nursing practice (DNP). Important Events 2007 The Commission on Nurse Certification, an autonomous arm of the AACN, begins certifying clinical nurse leaders (CNLs). 2008 The Commission on Collegiate Nursing Education begins accrediting DNP programs. 2010 The Patient Protection and Affordable Care Act (Public Law 111-152) is passed. 2010 The Health Care and Education Affordability Reconciliation Act is passed. 2011 The IOM Report The future of nursing: leading change, advancing health is released. Nursing education in Iran Nursing education in Iran: Past, present, and Future The history of modern nursing education in Iran Rasoul Tabari Khomeiran a, Cecil Deans History Of Modern Nursing Education In Iran • The development of nursing in Iran has been influenced by historical, religious, cultural and economic variables. • As with many other developing countries, such as China, Taiwan and Lebanon, modern nursing was introduced to Iran by Western missionaries. Along with their religious duties, the missionaries initiated medical services for local residents and trained a small number of Iranian women in the care of sick people in hospitals. History Of Modern Nursing Education In Iran In 1916, eleven years after the introduction of the first nursing school in the Middle East in Lebanon, an American missionary established Iran‟s first nursing school, in Tabriz, which offered a program that largely met the local hospital‟s needs and focused on the practical aspects of nursing. The graduates from the Tabriz school contributed significantly to the distribution of ideas emanating from the American model of nursing. It remained the only nursing program in Iran until 1935 when the government established four new nursing schools: in Mashhad, Shiraz, Rasht and Tehran. The graduates of these schools were called „doctor assistants‟, in recognition of the then-accepted view of nurses as handmaidens, and doctors as holding a superior place in the community. History Of Modern Nursing Education In Iran Over the years, under the influence of British trained nurses, Iranian‟s nursing education system underwent a gradual shift from the American nursing model to the British nursing model. During this time, the influence of British nursing practice on the Iranian nursing profession was profound and far reaching. As with their colleagues in western countries, the nurses who trained under this system were influenced by Florence Nightingale who had had a major impact upon nursing practice. History Of Modern Nursing Education In Iran The Islamic revolution and its subsequent „„Cultural Revolution‟‟ brought about many changes in the higher education system. The nursing education scheme, largely based upon the British system, was replaced by a reconstructed academic system, and nursing curricula were revised. At the time, some nursing schools were affiliated to the Ministry of Culture & Higher Education [MCHE] (now the Ministry of Science, Research & Technology [MSRT]), while some were affiliated to the Ministry of Health (MoH). During this period, there was an increased demand for practical nurses due to the Iran–Iraq war and an acute shortage in skilled nurses across the country. History Of Modern Nursing Education In Iran In order to meet this demand and generate a rapid increase in the nursing workforce over a short period, the three-year nursing programs were replaced with a twoyear basic nursing program. The graduates of the two-year basic program were then able to take a competitive nationwide examination to determine their eligibility to enroll in an additional twoyear program leading to a baccalaureate degree in nursing. History Of Modern Nursing Education In Iran Those nurses who had been educated under the earlier three-year programs were offered an additional one-year program that would qualify them for a baccalaureate degree. In 1987, the temporary subsidence of high demand for nurses meant the two-year programs were abrogated, and the basic nursing program was consolidated to create a four-year nursing program. History Of Modern Nursing Education In Iran As mentioned earlier, the Islamic revolution had a major impact on Iran‟s higher education sector, including nursing education. One significant change was the integration of religious beliefs within the nursing education program to fulfill the spiritual needs of the community the applicants planned to serve. Another major change came from the recommendation that nursing care may be improved when it is delivered by nurses of the same sex as the patient, and, despite the fact that nursing was traditionally perceived in Iran as a female profession, this recommendation resulted in changes to the distribution gender of applicants, with increasing numbers of males motivated to select nursing as their career. History Of Modern Nursing Education In Iran In the past two decades, the growth and development of nursing schools has been determined and influenced by various pieces of government legislation. In response to the need created by rapid post-war development to supply an adequate workforce for the health care sector, the medical section of the MCHE was incorporated into the MoH in 1985. As a result of the nationwide restructuring of higher education, the medical education section, alongside treatment affairs, undergone supervision of a new established authority called Ministry of Health & Medical Education (MoHME). History Of Modern Nursing Education In Iran In that year, all nursing schools affiliated to the former MoH (non-university-affiliated schools) and schools affiliated to the former MCHE were integrated into the MoHME. These changes led to a significant increase in medical education placements and subsequently the number of student admissions. These changes, which enhanced the establishment of higher education institutes all over the country, were largely accomplished by ongoing appeals from political parties and resulted in a considerable increase in the number of nursing schools in Iran. History Of Modern Nursing Education In Iran From the late 1980s, budget considerations together with an over-supply of nursing graduates forced the MoHME and government to revise policies regarding the admission of nursing students. A comprehensive evaluation of the viability of nursing programs resulted in the closure of a number of smaller nursing schools. Simultaneously, a number of other nursing schools were urged to close their part-time programs and decrease the number of students admitted to full-time programs. These measures resulted in a considerable decrease in the total number of nursing student admissions over last decade. The Iranian nursing education system Due to the large number of general applicants for the limited number of university places in Iran, applicants to all courses including medical and medical-related courses such as nurse education programs are required to have passed the competitive National Higher Education Entrance Examination (NHEEE). Although there is no passing score for the NHEEE, applicants who attain high rankings have a higher probability in gaining entry to university and their desired course of study. Generally, the highest ranked students select the more socially prestigious courses, such as medicine, dentistry or pharmacology. The Iranian nursing education system Lower ranking students have limited choice and often select courses, including nursing, most often without any particular motivation or interest. The rationale for selecting a university course, even one that is not a first preference, is that it attracts a grant to study in university which is perceived by the general public as prestigious and a significant social advantage; however, in some disciplines with a clinical component, there may be some negative consequences. The Iranian nursing education system In Iran, the government regulates nursing and other health discipline education through a series of education plans. The nursing education plan, approved by MoHME‟s Nursing Council, sets a national standard for nursing education for the whole country. The plan includes the aims, scope and contents of nursing education in all education programs, and all nursing schools must consider the plan when implementing nurse education activities. Each nursing school, however, has a right to develop its own curriculum guidelines based upon the national nursing education plan. These guidelines include a description of learning and teaching methods, types of assessment, evaluation and examination requirements. The Iranian nursing education system Nurse education programs are offered through two different cost systems. The first is through the state sector MSUs, which are affiliated to and supervised by MoHME. The state sector system provides an equal opportunity to everyone, irrespective of wealth and income level, to study at an Iranian university. In the state sector MSUs, nursing education (and all other higher education) is free of charge for students, although they must pay for their books and other study expenses. In addition, many students attending MSUs are entitled to grants through a loan from the welfare bureau of MoHME, with repayments required once the graduate is employed. The Iranian nursing education system The second cost system is offered through the nongovernment nationwide Azad University (AU) in more than sixty nursing schools is available in large and small cities all over the country. Although there is no exact number available for student enrolments in the AU nursing programs, it estimated that these student enrolments exceed those in the state sector nursing schools. The Iranian nursing education system In Iran, students can study nursing across all higher education levels from bachelor to doctoral. However, unlike some western countries, Iran does not differentiate by rank within licensed nursing personnel, and Registered Nurse (RN) is the only professionally recognized rank. Upon successful completion of nurse education programs, graduates are automatically granted the status of RN, which is the minimum legal and educational requirement for professional nursing practice. As RNs are trained as generalists rather than specialists, they are eligible to practice in any ward of the hospital. The Iranian nursing education system Although continued education programs are offered to nurses, and they are evaluated by their managers on an annual basis, currently there is no renewal system for RNs. Consequently, almost every nurse‟s registration status continues automatically, unless the nurse engages in actions that require disciplinary intervention. The Iranian nursing education system Two other categories of health workers are employed alongside and assisting RNs: Komak Behyar (associated nurse assistant) and Behyar (nurse assistant). These health workers complete their unique training programs in the non-higher education system. Komak Behyar: associated nurse assistant The Komak Behyar, in terms of organizational structure, is the most junior member of the health care delivery team in direct contact with patients. Following a short-time, vocational training hospital-based course, which varies in length between two months and six months and is conducted by RNs, the Komak Behyar is employed generally to satisfy the patients‟ needs by performing basic nursing tasks. Behyar: nurse assistant The Behyar, to a large extent, is equivalent to the assistant nurse in other countries. The Behyar is able to provide primary nursing care independently and is engaged in more advanced nursing care under RN supervision. There are two types of Behyar training programs. One enrolls high school graduates through an exclusive competitive examination held by MoHME and has a one-year curriculum. Behyar: nurse assistant The other admits high school first-year students and has a three-year curriculum. Graduates of Behyari programs are awarded a tertiary diploma. In some wards, such as outpatient clinics, and in some less developed areas of the country, the Behyar are the primary nursing workforce relied upon to provide nursing care. Baccalaureate programs In Iran, the baccalaureate program is the basic nursing program at the academic level and the only avenue leading to registration as a professionally registered nurse. The goal of this program is to produce competent nurses with the necessary theoretical knowledge and technical skill to provide high quality general nursing care. The centralized four-year baccalaureate program produces graduates who are generalist nurses and constitutes the backbone of the nurse education system in Iran. Baccalaureate programs As with all other university-based programs, high school graduates are admitted to these programs on the basis of their ranking in the competitive NHEEE. Currently, there are approximately 100 baccalaureate nursing programs (each with at least 130 credits) offered in MSUs and AU courses across the country. Baccalaureate programs The learning environment for students engaged in baccalaureate programs is shared between classroom, hospital, community and other educational settings. The percentage of classroom time in the total program is about 40%; hospital time (including working in community based health-care delivery settings) is about 54%; and miscellaneous educational activities (including laboratory settings activities) occupy less than 6% of the program. Master programs The first Master of Nursing program in Iran was established in 1988. By 2004, the number of these programs, which are mainly affiliated with major MSUs in metropolitan cities, has increased to fourteen. The aim of the Master of Nursing program is to prepare competent nurses who are able to act as nurse educators, conduct clinical research and manage health care delivery settings. Enrolment in a Master of Nursing program requires the applicant to hold a Bachelor of Nursing degree and to have successfully completed the MoHME-developed annual competitive examination. Master programs The exam consists of key nursing areas, including adult medical–surgical, obstetric-gynecological, pediatrics, community health nursing, as well as measurement of the applicant‟s ability to read and comprehend nursing professional literature in the English language. Master programs In Iran, the Master of Nursing is a three-year classroom and clinical program containing about 43 compulsory and optional credits in total. The focus of classroom teaching centres upon student participation in student and faculty-led seminars and roundtable discussions. Master of Nursing degrees are available in two fields: nursing education and nursing management. Master programs Each field has four different specialties, including medical/surgical nursing, mental health nursing, paediatric nursing and community health nursing. Master of Nursing curricula focus mainly on educational units rather than practical units, and include core basic, clinical and functional courses. Master programs Employment in an academic setting, in comparison to clinical setting, has more financial benefits in Iran; therefore, many Master of Nursing graduates prefer to pursue careers in the academe rather than service sector, in contrast to western countries (Emerson and Records, 2005). Master of Nursing graduates comprise the majority of nursing school faculties, and many new graduates work in clinical areas only because the academic positions have been filled by ex-graduates. Despite this trend, many nursing managers allege that the current focus on educational courses in Master of Nursing programs rarely prepares a person to be a good clinician. Doctoral programs The framework and foundation of the first doctoral nursing program in Iran was laid out in 1995 at Tabriz University of Medical Sciences. In the eleven years since that first PhD program officially began, the number of programs has grown to seven. These programs are 4.5 years in length and consist of 52 credits, including 20 credits for dissertation. Doctoral programs The programs present somewhat of a blend of the US and UK models, in that they require course work fewer than American programs and have a focus on the students‟ research throughout the program. The students accepted into the doctoral programs are Master of Nursing graduates who have been successful in both an annual competitive nationwide examination (developed by MoHME) and an interview with a panel of nursing experts. Doctoral programs The purpose of the doctoral program is to prepare graduates for a lifetime of intellectual inquiry and creative scholarship and research, and to further the extension of nursing knowledge in Iran. Graduates from the programs are expected to be knowledgeable professionals who are able to provide invaluable insights into nursing issues, thereby improving the nursing care status in the health care system. Doctoral programs Currently, around twentyfive nurses have completed the PhD program the majority of whom have eventually assumed faculty roles in baccalaureate and masters‟ programs across the country. Because the field of nursing suffers from an acute shortage of doctorally prepared faculty, there has been a growth in the number of doctoral programs in Iran, and metropolitan MSUs are now seeking approval from the High Council of Higher Education Planning (HCHEP) and MoHME to establish PhD programs.