History and Evolution
of Nursing
Trends and Changes
Early History
 Ancient writings in Greece, Rome, Egypt and India refer to
persons dedicated to caring for the sick, injured, making
herbal remedies, and midwives for new mothers
 Nurses are mostly household servants, part of the military
or members of religious orders.
 12th century the Knights of St. Thomas a group of vowed
Englishmen with the purpose of tending to the sick,
wounded and burying fallen crusade soldiers
Plague Doctors
 Separate occupation from the
surgeon-barber and town physician
 Hired to care for people inflicted
with bubonic plague (black death)
and dispose of the bodies
 Kept quarantined from the rest of
the town and village
Contract for a plague doctor: Pavia, Italy 1479
 Clause 1. The community of Pavia and its council shall provide the sum of 30 florins





per month to Master Giovanni de Ventura.
Clause 4. The community of Pavia and its council shall provide Dr. Ventura with an
adequate house in an adequate location, completely furnished.
Clause 5. The community of Pavia and its council shall continue to pay Master
Giovanni Ventura for a period of two months after the termination of his
employment.
Clause 6. The said Master Giovanni shall not be bound or held under obligation
except only in attending the plague patients. Giovanni must treat all patients and visit
infected places as it shall be found to be necessary.
Clause 9. The said Master Giovanni shall not be able to ask a fee from anyone, unless
the plague victim himself or his relatives shall freely offer it.
Clause 14. Said Master Giovanni would have and should be obliged to do his best
and visit the plague patients twice or three times or more times per day, as it will be
found necessary.

(http://web.mac.com/mloret/iWeb/apeuro06/Plague%20Doctor.html)
The Reformation
 Diminished role of nursing
care provided by religious
orders as convents and
monasteries were closed in
countries hostile to the
Catholic Church
(www.angelfire.com/fl/EeirensFaerieTales/NursingDeclineHist
ory, 2010)
•Early application of science in explanation of health and disease
•Illustrations of human anatomy
•Rudimentary explanations from vivisections
Victorian Era
 Attending to the ill in poor houses
and sanatoriums was done by
prostitutes and prisoners
 Sairey Gamp (Charles Dickens’
novel Martin Chuzzlewitt) the
unpleasant domestic nurse . (Dickens,
1843)
 Mrs. Beeton's Book of Household
Management, 1861, places nurses
in the chapter ‘domestic servants’
(www.victorianlondon.org/professionsandtrades, 2010)
Contemporary Events
 1796: Jenner inoculates people with cow pox to prevent
small pox – trend towards science of vaccines
 1858: Publication of Gray’s Anatomy: Descriptive and Surgical
 1860s: Louis Pasteur proves broth does not spontaneously
spoil without microorganisms
 Beginning of the germ theory
 1856-1863: Bro. Gregor Mendel charted genetic
patterns in pea plants (work rediscovered in 1930s)
 1867: Joseph Lister performed surgery using carbolic acid
for antiseptic surgery
 1901: Landsteiner categorized blood types for successful
transfusions
Florence Nightingale
 Considered the founder of modern nursing,
applied statistics, epidemiology, hospital
administration and sanitary engineering, plus
was a social reformer
 Highly-educated and from a wealthy family
 Went from goodwill hospital visitor to nurse
 Trained in hospital at Kaiserwerth Germany and
with Sisters of Charity in Paris
•1860, Opened college level St. Thomas school of nursing in London
•Wanted nurses to be upper-class and educated women who
cared for the sick and wounded for altruistic reasons
(Tomey and Alligood, 2006)
Nightingale’s Work
• In 1859, wrote Notes on nursing:What it is and what
it is not, the first textbook and nursing theory
• A social reformer who petitioned politicians for better
conditions for the poor and soldiers, and more career
opportunities for women
• Organized district nursing in London in partnership
with businessman and MP William Rathbone
Nightingale in the Crimean War
 With 38 women volunteers,
Nightingale travelled to
Turkey in 1854 to help the
sick and wounded English
soldiers in camps
 Her statistics proved more
soldiers died from
preventable infections than
from battle injuries
•An example of one of her pie charts, she
 Improved the camp’s
visually depicted more soldiers dying
sanitation and lowered the from infections then from battle injuries.
mortality rate from
(www.uh.edu/engines/epi1712.htm, 2010)
infections 42% to 2%
Her Nursing Practice
 The body heals itself, disease is the body’s way of repairing
itself after exposure to poison or decay
 Nurses should be proper women who are single, chaste, and
live without alcohol, tobacco and dancing
 Nursing is to create an environment where healing can
occur
 Fresh air, clean water, removal of waste, moderate room
temperatures
 Exposure to pollutants perpetuates illness
 Create an atmosphere of rest and protect patient from
worry
Her writings
 Nightingale did not write about human anatomy or
microorganisms in her book. She wrote about maintaining a
clean and healing environment. The chapters to Notes on
Nursing are as follows:
Preface
Ventilation and Warming
Health of Houses
Petty Management
Noise
Variety
Taking Food
What Food?
Bed and Bedding
Light
Cleanliness of Rooms And Walls
Personal Cleanliness
Chattering Hopes And Advices
Observation of the Sick
Conclusion
Appendix
Notes on Nursing
 Notes on Nursing was not a comprehensive guide for
trained nurses, but was written to help any women
provide better care for sick persons at home
•
‘The following notes are by no means intended as a . . . manual
to teach nurses to nurse. They are meant simply to give hints for
thought to women who have personal charge of the health of others.
Every woman . . . in England has, at one time or another of her life,
charge of the personal health of somebody, whether child or
invalid,--in other words, every woman is a nurse’
(Nightingale, Notes on Nursing, Preface, 1859)
Select Quotes
 Air: ‘The very first canon of nursing, the first and the last thing
upon which a nurse's attention must be fixed, the first essential
to a patient, without which all the rest you can do for him is as
nothing, with which I had almost said you may leave all the rest
alone, is this: TO KEEP THE AIR HE BREATHES AS PURE AS
THE EXTERNAL AIR, WITHOUT CHILLING HIM.
(Nightingale, Notes on Nursing, Ch 1, 1859)
• Every nurse ought to be careful to wash her hands very
frequently during the day.
(Nightingale, Notes on Nursing, Ch 11, 1859)
Select Quotes
 Light: Second only to their need of fresh air is their need of light;
that, after a close room, what hurts them most is a dark room. And
that it is not only light but direct sun-light they want.
(Nightingale, Notes on Nursing, Ch. 9, 1859)
 Music: Wind instruments, including the human voice, and stringed
instruments, capable of continuous sound, have generally a beneficent
effect--while the piano-forte, with such instruments as have no
continuity of sound, has just the reverse. The finest piano-forte playing
will damage the sick, while an air . . . will sensibly soothe them.
(Nightingale, Notes on Nursing, Ch.4, 1859)
Nursing in the Civil War Era
 No organized nursing profession prior to the 1860s in
the United States
 Confederate and Union armies during the Civil War
recruited nurses to treat injured soldiers
 First use of shrapnel to injure multiple people at once
 More people needed to treat the injured
 Gangrene infections
 Catholic Sisters formed and staffed make-shift tent
hospitals
 Efficient, clean and devoted to their patients
 Men and women volunteers
 Sojourner Truth, Harriet Tubman and Walt Whitman
Dorothea Dix (1802-1887)
 Originally a school teacher
who in 1841 became a
reformer for treatment of
the mentally ill
 Within 10 years visited
>300 jails and >500
almshouses
 Advocated for mentally ill
persons to be removed
from jails/almshouses and
be placed in public
hospitals
•By 1880, <1% of prison
population were the mentally ill
•Union’s superintendent for
nurses during the Civil War
Clara Barton 1821 - 1912
 Teacher and U.S. patent office clerk
prior to volunteering for the War
 While travelling in Switzerland she
read the works of Henry Dunant
about treating all war wounded
 She founded the American Red
Cross in 1881 (biggest single charity
in the U.S. today) to aid victims of
disasters
“Angel of the Battlefield”
 Also championed prison reform,
• Collected and distributed
women’s voting, education and civil
supplies for Civil War soldiers
rights movements
•Formed a tent hospital
•Direct care for wounded men

(www.redcross.org/museum/history/claraBarton.asp,
2011)
Formation of Education
 1873: three nursing schools opened in NY, CT, and MA
 Based on the St. Thomas model
 Segregated, limited opportunities for Black and Jewish
Americans
 Three nursing schools for men (often to work in mental health
institutions by 1898. Little changed for men until after 1950s)
 At the turn of the century majority of nurses were trained in
hospital apprentice programs
Professional Organizations
 Establishment of Official Groups
 Formation of the National League of Nurses (1893)
 American Nurses Association (1896)
 International Council of Nurses (1899)
 National Association of Colored Graduate Nurses (1908)
 Early discussions for professional standards and training
 Address lack of uniformity and inadequate curriculums in
nursing schools
 Consider a state registration of nurses
Emergence of Public Health Nurses
 Nightingale created ‘district nursing’ in London where a
nurse was assigned to overall health of a neighborhood
 Lillian Wald – Working in poverty stricken
neighborhoods in NYC, she formed the outreach clinic
The Henry Street Settlement (1893)
 health education, lifestyle education, infant/children
checkups, home visits, sanitation improvements
 Racial equality, all services were integrated
 Founding member of the NAACP
 Jessie Scales and Elizabeth Tyler established The Stillman
House in the African-American districts of NYC
alongside Ms. Wald
Women’s Health – early 1900s
 Mary Breckinridge – midwife who
founded Frontier Nursing Service to
extend healthcare to women and
infants in poverty stricken areas of
the rural Appalachian Mountains
 Meticulous record keeper and
patient educator
 Lower infant mortality rate than
today’s national average
•Margaret Sanger – Advocated for the rights over
contraception and reproductive control
-Founder of Planned Parenthood
-Supported the eugenics movement
Contemporary Events
 World War I – Militaries internationally mobilized nurses to
provide care wounded soldiers
 1920: U.S. Congress approved nurses as ranked military
 Spanish Influenza Pandemic (1918) – H1N1 virus infected
over 30% of the world’s population (1.86B) and killed over
50 million (may be as high as 100 million)
 In 1928 Alexander Fleming incidentally discovered bacteria
did not grow around penicillium notum mold, further work
put Penicillin antibiotics into mass production by 1948
 During the Great Depression and WWII President Roosevelt
designated funds in SSA & CWA for public health projects
 Dr. Jonas Salk polio vaccine was made public in 1955
Professional and Societal Evolutions
 1940s – proliferation of hospitals led to staffing
shortages and strained working conditions
 Hospitals start to become the biggest employer of nurses
 1947: Nurses gain status as commissioned officers in the
U.S. military
 Segregation ended in corps
 men allowed as military nurses in 1954
 1950s – formation of associates degree as abbreviated
education from community colleges to increase supply of
practicing nurses
 1950-1960s - formation of nursing process, theories,
nurse specialties and graduate degrees

(Young and Patterson, 2007)
Contemporary Events
 1965 – President Johnson and Congress pass Medicare and
Medicaid to fund healthcare for the elderly and poor
 Remains single largest funder of hospitals and nursing homes
 1971 – Pres. Nixon approves presence of for-profit managed
healthcare business model
 1980s to present –
 emergence of technology and specialized technicians and
professionals
 Increasing cost and decreasing access to healthcare
 Slow infusion of men and minorities into nursing
 Proliferation in lifestyle related illnesses in population
Contemporary Issues in Nursing
 Uneven allocation of funding for patient care
 Mismatch of employment availability comes in waves
 Projected long-term shortage
 Stable career myth
 Prevalent view of nurses as skilled labor in servant role
and not as independent professionals
 Blurred professional boundaries, roles and images
 Don’t let Hollywood inform the public on nurse’s image
and role. It’s wrong almost every time.
 Finding the nursing presence in technology dominant
interventions
Nursing as a Profession
 Profession vs. Occupation
 Job, career, or occupation signify a person’s primary
work for income
 Profession - a vocation to espouse the knowledge,
principles and duty of a chosen identity with a
designated purpose of work
 Nursing and nurses contain features of both
 Distinct education pathways for entry
 Various attitudes in practicing nurses
 Diverse and dynamic roles
 Role and capabilities tied to employer
Features of a Profession
 Abraham Flexner, Richard Hall and committees and
provided definitions of professionalism.
 All professions include themes of:
 A sense of service to the public good
 Specialized theories begat intellectual and practical knowledge
 Control over own practice and code of conduct
 Internal Barriers ?
 External Barriers ?
 Breakthroughs ?
Nursing’s Professional Standards
 Nursing’s Social Policy Statement: summarizes the
relationship between the nursing profession and society
 Obligation to recipients
 Scope and Standards of Practice: Outlines the expectations
of a member’s practice
 Establish competencies and requirements of care
 Code of Ethics: Guides the profession’s and members’
decisions toward greater principles and duties
Features of the Nursing Profession
 Lucie Kelly PhD. RN listed 8 characteristics of the nursing
profession
 1. Services are vital to humanity
 2. Special body of knowledge
 3. Practitioners are accountable for own work and decisions
 4. Practitioners are educated at institutions of higher learning
 5. Practitioners are relatively independent, autonomous
 6.Practitioners are motivated by service to others and
consider their work as an important part of their lives
 7. Presence of code of conduct and ethics guides decisions of
practitioners
 8. Organization encourages high standards
References
Chitty, K. and Black, B. (2011). Professional nursing: Concepts and
challenges (6th ed).
Maryland Heights, MO: Saunders
Dickens, C. (1843) Martin Chuzzlewitt. London: Oxford
European History (2010). Retreived online homepage.mac.
Com/mloret/apeuro/Personal48
Nightingale, F. (1859) Notes on nursing: What it is and what it is not. New
York: Appleton
American Red Cross (2011) Retrieved online from
www.redcross.org/museum/history/claraBarton.asp
Tomey, A & Alligood, M (2006). Nursing theorists and their work. St.
Louis: Mosby
Victorian History (2010). Retrieved online www.victorianlondon.org
Young, L. and Paterson, B. (2007). Teaching nursing: Developing a studentcentered learning environment. Philadelphia, PA: Lippincott