Chapter 1
Evolution of Nursing
Practice
Nursing History
 Nursing history is a vivid testimony,
meant to incite, instruct, and inspire
today’s nurses.
• (American Association for the History of
Nursing, 2002)
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Nursing History
 The study of nursing history enables the
nurse to better understand current
professional issues.
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Historical Overview
 The practice of nursing predates
recorded history.
 Prehistoric human remains show
evidence that most human groups
provided care for their sick and wounded.
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Evolution of Nursing
 Early Civilizations
• Records date back to 4000 BC, to primitive
societies in which mother-nurses worked
with priests.
• In 2000 BC, the use of wet nurses is
recorded in Babylonia and Assyria.
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Ancient Greece
 Ancient Greeks built temples to honor
Hygiea, the goddess of health.
 Priestesses attended to those housed in
the temples.
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Roman Empire
 Hospitals were first established in the
Eastern Roman Empire (Byzantine
Empire).
 Hospitals in the West were primarily
religious, and charitable institutions were
housed in monasteries and convents.
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Middle Ages
 By the 11th and 12th centuries, formal
medical education for physicians in a
university setting had become required.
 Military, religious, and lay orders of men
continued to provide nursing care.
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Renaissance (1400–1550 AD)
 Expansion of the world through
exploration.
 Emerging interest in arts and sciences.
 Establishment of universities.
 Males continue to provide care.
 Women discouraged from leaving home.
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The Protestant Reformation
1500–1700 AD
 Catholic hospitals in many European
countries were dissolved.
 The sick no longer had institutional care.
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Age of Enlightenment/Industrial
Revolution (1800s)
 Medical schools were founded.
 Barbers functioned as surgeons,
performing leeching, giving enemas, and
extracting teeth.
 Nursing was considered unseemly for
women.
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Religious Influences
 Role of religious influences started in
India (800-600 BC).
 Male nurse-priests in Greece and Ireland
(3 BC).
 Deaconesses of Kaiserwerth trained in
nursing.
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Religious Influences
 Nursing Sisters of the Holy Cross
• Founded in LeMans, France, 1841.
• St. Mary’s Academy established in Bertrand,
Michigan, 1844.
• Changed to Saint Mary’s College and moved
to Notre Dame, South Bend, Indiana, 1855.
• First to respond to need for nurses during
the Civil War.
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Florence Nightingale
Founder of Modern Nursing
 Received her training at Kaiserwerth
Institute.
 Role in Crimean War forged the future of
nursing practice and nursing education.
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Florence Nightingale
 Established the Nightingale Training
School of Nurses at St. Thomas Hospital
in London.
 Introduced theory-based knowledge and
clinical skill building.
 Recognized the influence of
environmental factors on health.
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Florence Nightingale
 Believed in the need for a body of
knowledge that was distinct from medical
knowledge.
 Care individualized based on client’s
needs and preferences.
 Maintaining confidentiality.
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Nursing and the Civil War
 Nursing care provided by the Sisters of
Mercy, Daughters of Charity, Dominican
Sisters, and the Franciscan Sisters of the
Poor.
 Women volunteered to care for both
Union and Confederate soldiers.
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Nursing and the Civil War
 Dorothea Dix
• Superintendent of the Female Nurses of the
Army
 Clara Barton
• Attempted to sponsor war relief.
• Organized the Red Cross,1881.
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The Women’s Movement
 Women’s suffrage helped to advance not
only the rights of women, but also the
nursing profession.
 More women attended colleges and
universities.
 Limited number of university-based
nursing programs were available.
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Nursing Pioneers and Leaders
 Establishment of public health nursing.
 Provision of rural health care services.
 Advancement of nursing education.
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Nursing Pioneers and Leaders
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Mary Breckinridge
Jane Delano
Lavinia Dock
Martha Franklin
Annie Goodrich
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Nursing Pioneers and Leaders
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Amelia Greenwald
Mamie Hale
Mary Mahoney
Harriet Neuton Phillips
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Nursing Pioneers and Leaders
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Adelaide Nutting
Linda Richards
Isabel Hampton Robb
Margaret Sanger
Shirley Titus
Adah Belle Thomas
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Nursing in the 20th Century
 Landmark reports in medical and nursing
education
 Blue Cross and Blue Shield
 Visiting Nurses Association
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Landmark Reports
 Flexner Report
• Goal was to increase accountability in
medical education.
• Adalaide Nutting presented a similar
proposal to study nursing education.
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Early Insurance Plans
 American philosophy of health care for all
contributed to the growth of insurance
plans.
 Concepts of third-party payments and
prepaid health insurance were instituted.
 Lillian Wald suggested the establishment
of a national health insurance plan.
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Blue Cross and Blue Shield
 Joint venture between hospitals,
physicians, and the general public.
 Blue Cross endorsed by the American
Hospital Association, 1933.
 Blue Shield endorsed by the American
Medical Association, 1938.
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Visiting Nurses Association
 Lillian Wald worked with the Metropolitan
Life Insurance Company to expand
visiting nursing services of the Henry
Street Settlement, 1901.
 Chicago Visiting Nurse Association laid
the groundwork for nursing protocols.
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Landmark Reports in Nursing
Education
 Goldmark Report: Nursing and Nursing
Education in the United States.
• Identified major weakness of hospital-based
training programs to be that of placing needs
of the institution before the needs of the
student.
• Report concluded that nursing education
should occur in the university setting.
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Landmark Reports in Nursing
Education
 Brown Report: Nursing for the Future and
Nursing Reconsidered: A Study for
Change, 1948.
• This report by Esther Lucille Brown stated
moving nursing education to the university
setting would better fill the need for nurses
to demonstrate greater professional
competence.
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Landmark Reports in Nursing
Education
 Institute of Research and Service in
Nursing Education Report
• Establishment of practical nursing under
Title III of the Health Amendment Act of
1955.
• Practical nursing schools proliferated in the
United States to meet the increased need for
nursing services.
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Other Health Care Initiatives
 Medicare and Medicaid introduced to
provide health care services to the
elderly and indigent.
 The Nurse Training Act (1964) provided
federal funds to expand enrollment in
schools of nursing and to construct
nursing schools.
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Selected Legislation
 Health Maintenance Organization Act
(1973)
 Rural Health Clinic Service Act (1977)
 Omnibus Budget Reconciliation Act
(1980)
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Other Health Care Initiatives
 Education and Practice: Contemporary
Reports
• National Commission on Nursing (1980) to
study nursing education and related issues.
• Institute of Medicine (1979): Nursing and
Nursing Education: Public Policies and
Private Actions focused on the need for
continued federal funding of nursing
education.
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Other Health Care Initiatives
 Recommendations of the Secretary’s
Commission on Nursing (1988)
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Nurse compensation
Health care financing
Nurse decision making
Development, use, and maintenance of
nursing resources
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Other Health Care Initiatives
 Health People Initiatives 2010
• Increase quality and years of healthy life.
• Eliminate health disparities.
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Healthy People Initiatives 2010
 Enabling Goals
• Promote healthy behaviors.
• Promote healthy and safe communities.
• Improve systems for personal and public
health.
• Prevent and reduce diseases and disorders.
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Alternative Methods of Health
Care Delivery
 Collaborative health care services and
innovative settings for the delivery of
health care are currently being developed
by nurses.
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Collaboration Among Nurses
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Costs and Quality Controls
 Tax Equity Fiscal Responsibility Act
(TEFRA), 1982
 Joint Commission on the Accreditation of
Heathcare Organizations (JCAHO)
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Health Care Reform
 Determination of nurse-client ratios in
skilled nursing facilities.
 Prohibiting of acute care hospitals from
assigning unlicensed personnel to
perform nursing functions.
 Evidence-based practice among diverse
health care settings.
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The Future of Nursing
 Developing evidence-based practice.
 Monitoring safe practice in a restructured
health care environment.
 Designing systems that will enhance
collaborative planning.
 Implementing actions and policies to
address the changes.
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