Najmiah C.

Mira-ato BSN 11- C December 10, 2018

Four Essential Features of a Contemporary Nursing

Common concepts of nursing modeling: a metaparadigm

A metaparadigm contains philosophical worldviews and concepts that are unique to a discipline and
defines boundaries that separate it from other disciplines. A metaparadigm is intended to help guide
others to conduct research and utilize the concepts for academia within that discipline. The nursing
metaparadigm consist of four main concepts: person, health, environment, and nursing.

• The person (Patient)

• The environment

• Health

• Nursing (Goals, Roles Functions)

Each theory is regularly defined and described by a Nursing Theorist. The main focal point of nursing out
of the four various common concepts is the person (patient).

History of Nursing

Nursing in ancient times

• Ancient history shows records of nursing.What we know about the care of the sick in ancient
times has been discovered through songs and findings of archaeologists.People were interested
in the mysteries of life,birth,disease and death.Men lived very close to nature;life was very
simple;people made few changes except when men were compelled to do so.Men attributed
spiritual value to all natural objects,believing that objects in nature such as trees or rivers had
spirit or soul.Objects in nature became friends such as water and trees,while storms and
poisonous plants became enemies.Attitudes changed according to man's ability to control
nature.They thanked friendly harmless objects for their help and tried to cooperate with the
unfriendly,threatening situations.

• Disease was believed to be caused by evil spirits within the body.The body had to undergo
unpleasant experiences to get rid of these evil spirits.Men thought disease was caused by their
failure to satisfy the gods, or was punishment for their sins.These ideas are still prevalent today
even among highly civilized and intelligent people.

• People were ignorant of the laws of nature.People were beaten to get rid of evil spirits;sudden
fright,loud noises and magic ceremonies were also used to get rid of evil spirit.Holes on the
bodies were made for the evil spirits to escape.Sacrifices were offered as a treatment.Care was
given by the man who knew the signs and symptoms of evil spirits and knew what to do in
 certain conditions.He wore a strange dress and used magic words.He took his role as a priest.He
attempted to understand and control the forces of health and disease.The skill of primitive men
in fighting disease has given us many medical and surgical
treatments.Massage,fomentation,triphining,bone setting,amputations,hot and cold
baths,abdominal sections and heat to control haemorrhage are some of the skills gained from
primitive men.

Nursing in Egypt

• During 1500 B.C. Egyptians used Castor oil and lead and copper salts as remedies for
diseases.There were well specialised doctors for eyes and tooth.They had good knowledge of
community health.There were planned cities and public baths.They had underground drains and
midwives for deliveries.

Nursing in Greece and Roman Medicine

• People in Greece believed that medicine was of divine origin and was represented by many
gods.Apollo,the sun god,represented health and medicine,his son Aesculapius, was the god of
healing and his daughter, Hygeia, was the goddess of health.Temples were built for gods.A priest
physician was in charge of it.People came to the temple and believed that during their sleep god
would appear and prescribe them treatment.They used special diets and massage bath.

• Hippocrates gave scientific views to medicine.He was known as the father of medicine.He taught
doctors signs and symptoms of diseases.The treatment was based on diagnosis.He developed
ways of doing physical examination and taking histories.Stress was given on good health by
giving good diet, fresh air and maintaining cleanliness.He gave instructions in hot
applications,poultices,cold sponge for fever,fluid for kidney diseases and mouth washes.Rome
learnt a lot from Greece about medicine.Rome built good sanitation,good roads and
bridges.There were pubic baths for men and women;drinking water was brought by channel or
large pipes.Drainage system and sewage were made.They built market places and hospitals.

• Old women and men of good character did nursing in those days.

Nursing in India

• The earliest Indian medicine was Ayur Veda Medicine found in Veda 5000 B.C.About 1400 B.C.
Charaka,the father of medicine,wrote a book on internal medicine.From these books we learn
the hospitals were large and well equipped.Surgery had advanced to a high level.Doctors and
attendants or nurses had to be people of high moral character.King Ashoka B.C.226-250,built
monasteries and houses for travellers;hospitals for men and animals were founded.Hygienic
practise was adapted;cleanliness of body was a religious duty.First importance was given to
prevention of diseases.Doctors and nurses were expected to be skillful and trustworthy.They had
to keep their nails short.Nurses were usually men or old women.

Nursing in Modern times

• The modern form of nursing was started by Florence Nightingale.Before that,it was influenced by
religious groups.In the 15th and 16th centuries,nursing was dominated in Europe by religious
bodies including Benedictine and Augustinian sisters,Franciscan brothers and sisters of
charity.Original motivation for caring for the sick was in order to ensure one's salvation by
engaging in self-sacrificing work.That is why nursing was considered as a noble work.Today,the
salvation has been replaced by a desire to serve people,nation and the world with the help of
scientific technology.

• Actually, Florence Nightingale (1820-1910) revived nursing during her life time. She said,
"Nursing is to help the patient to live."

• She was one of the most influential reformers of her time.Even today,her writings remain as
relevant as they were 120 years ago.Her own practical experiences combined with her own aims
for the nursing profession gave her a greater insight into problems of hospital administration
than her contemporaries.Her social position enabled her to give ideas to the committees,which
controlled the voluntary hospitals in those days.But above all,she had the determination to use
every weapon she possessed including charm and social pressure to achieve the objective she
had in mind,thus becoming the greatest publicist the profession has ever had.After the Crimean
War of 1854,nursing could never be the same again.Florence Nightingale's adventure in
Crimea,drew public attention on an enormous scale to the problems of nursing role in
transforming the recruitment,training and practice of the new profession

Middle Ages

• Throughout history, nursing and healing have been closely entwined. Unfortunately, during
the Middle Ages, the patriarchal society and the Roman Catholic Church condemned female
healers because of their immense influence on the community. Women found themselves
victims of cruel and unjustified acts of persecution, such as being tortured and burned at the
stake, because they were labeled “witches” by the society. This phenomenon started in the
heart of Europe and soon spread throughout many countries in the world, including the
United States of America. Furthermore, it caused the degradation of women, and
subsequently nurses, for centuries afterward.

Roman Catholic Church

• The Roman Catholic Church had a lot of power during the early Middle ages (500 AD-1000
AD) and late Middle ages (1000-1500) (Donahue, 1985, 123-140). By the early Middle Ages,
the church was a “highly organized institution” and the most powerful person in the west
was the pope (Donahue, 1985, 123). Because religion was indeed a significant part of the
lives of the people in the Middle Ages, the Church had power over the people’s daily lives
and ideology concerning social life. It was a popular religious view that women are evil by
nature primary because of the Original Sin of Eve, substantiated by the Genesis of the Holy
 Bible (Burkhardt and Nathaniel, 2002, 11). It was the woman’s role to be Man’s helper or
assistant. Women were considered inferior to men, but as nuns and/or nurses, women were
well-respected (Burkhardt and Nathaniel, 2002, 11). Nurses were considered saints because
of all of the care they provided to the suffering. In regards to healthcare, the Church
established hospitals, including the Santo Spirito Hospital of Rome,

Religious Orders

The Catholic elites provided hospital services because of their theology of salvation that good
works were the route to heaven. The same theology holds strong into the 21st century. In
Catholic areas, the tradition of nursing sisters continued uninterrupted. Several orders of nuns
provided nursing services in hospitals. A leadership role was taken by the Daughters of Charity of
Saint Vincent de Paul, founded in France in 1633. New orders of Catholic nuns expanded the
range of activities and reached new areas. For example, in rural Brittany in France, the Daughters
of the Holy Spirit, created in 1706, played a central role. New opportunity for nuns as charitable
practitioners were created by devout nobles on their own estates. The nuns provided
comprehensive care for the sick poor on their patrons' estates, acting not only as nurses, but
took on expanded roles as physicians, surgeons, and apothecaries. The French Catholics in New
France (Canada) and New Orleans continued these traditions. During the French Revolution,
most of the orders of nurses were shut down and there was no organized nursing care to replace
them However the demand for their nursing services remained strong, and after 1800 the sisters
reappeared and resumed their work in hospitals and on rural estates. They were tolerated by
officials because they had widespread support and were the link between elite physicians and
distrustful peasants who needed help.

Renaissance of nursing and the dark ages of nursing

Between 1500 and 1860 (A.D.) politics, the Renaissance all affected nursing. As nursing was not
valued as an intellectual endeavor it lost much of its economic support and social status at the
start of the Renaissance. The deterioration of Catholicism which had supported the
monasteries, hospitals, and nursing was led to the climax of its decay by the Protestant
Reformation. A widespread movement of suppression of monasteries occurred similar to that in
England which was brought about by Henry (VIII) who had used the advantage of Protestantism
to free himself from Papal authority. The King used his revolt of the church based on the Roman
Catholic Church refusal to sanction his divorce. He destroyed over 600 monasteries during his
Protestant revolt. The immediate result of the monastic dissolution was the hospitals and inns
were suddenly snatched away form a public dependent upon them for many centuries. Which
caused the poor to be without any principle organized system of relief. An additional effect of
the Reformation was the complete withdrawal of medicine from the monastery to the
University. Thus medicine found a refuge that was denied to nursing. Medical advancement had
been assured while the techniques of nursing remained unchanged in the guardianship of
brothers, and nuns who continued practicing nursing. The Protestants viewed the woman's
place as being in the home raising children. Industrial class women took in work or went out to
work. As nursing was not considered acceptable even to the industrial classes nurses were
usually immoral, drunken, illiterate, and/or prostitutes. Nurses were considered to be the
lowest level of human society. A decline in the quality of public service for the sick was
noticeable towards the end of the middle ages. It took about 200 years for the public to
recognize the need to pay for quality nursing care to restart vocational desirability. The public
first had to separate nursing from domestic service in which it had become deeply entangled.
Mismanagement, inadequacy, suffering and deliberate exploitation made things worse. Civil
appointees who were men undertook leadership and withheld authority from women - who
then lost control over nursing. Matrons were put in charge of secular riff raff who were taken on
as nurses. The word "Sister" was retained to please the public for amongst the rich and poor it
had come to be associated with the sympathy and encouragement of the monastic nuns. The
latter half of the period between 1500 to 1860 A.D. saw nursing conditions at their worst and
has been called the dark period of nursing. New hospitals had been built but quickly became
places of horror as unsanitary conditions caused them to be a source of epidemics and disease.
Furthermore a taxation upon windows caused windows to be bricked up in places of the poor
and hospitals thus removing natural lighting and fresh air thus creating further a situation which
bred disease and epidemics.

Nursing in Colonial America

When the pilgrim fathers and mothers landed in Plymouth, they did not introduce the art
of nursing into the New World.There were, according to Nutting, Jesuit Fathers and Catholic
Sisters who established mission hospitals in the southwestern part of North America as far
back as the 17th Century. The pilgrim families brought their household remedies with them
– nursing was the responsibility of female family members.
If you were sick you were cared for in the home. Women were responsible for caring for
members of their family as well as friends, and neighbors. Family-centered sickness care
remained traditional until the nineteenth century. When illness occurred the last place you
wanted to be was in what passed for a hospital. If you had a family to care for you, you
remained at home. Caring for ill family members was the responsibility of women. As
Revesby points out caring for ill and aged family members was considered “a woman’s self-
sacrificing service to others”.
Colonial households treated most illnesses by long standing household remedies; a
physician – if one was available -w as called only if the illness was considered severe
otherwise home remedies were used the earliest immigrants brought many home
remedies such as herbs and other family remedies with them. Knowledge of healing
practices was usually handed down within the family. Some traditional drugs were available
locally and the wealthy could also afford imported chemicals and plants. Often, those who
cared for the sick – whether physician or family ‘nurse’ – had to use whatever was available
around them.

Florence Nightingale
12 May 1820 – 13 August 1910) was an English social reformer and statistician, and the founder
of modern nursing.
Nightingale came to prominence while serving as a manager and trainer of nurses during
the Crimean War, in which she organized care for wounded soldiers. She gave nursing a
favorable reputation and became an icon of Victorian culture, especially in the persona of "The
Lady with the Lamp" making rounds of wounded soldiers at night
Recent commentators have asserted Nightingale's Crimean War achievements were
exaggerated by media at the time, but critics agree on the importance of her later work in
professionalizing nursing roles for women. In 1860, Nightingale laid the foundation of
professional nursing with the establishment of her nursing school at St Thomas' Hospital in
London. It was the first secular nursing school in the world, and is now part of King's College
London. In recognition of her pioneering work in nursing, the Nightingale Pledge taken by new
nurses, and the Florence Nightingale Medal, the highest international distinction a nurse can
achieve, were named in her honor, and the annual International Nurses Day is celebrated
around the world on her birthday. Her social reforms included improving healthcare for all
sections of British society, advocating better hunger relief in India, helping to abolish
prostitution laws that were harsh for women, and expanding the acceptable forms of female
participation in the workforce.
Nightingale was a prodigious and versatile writer. In her lifetime, much of her published work
was concerned with spreading medical knowledge. Some of her tracts were written in simple
English so that they could easily be understood by those with poor literary skills. She was also a
pioneer in the use of info graphics, effectively using graphical presentations
of statistical data much of her writing, including her extensive work on religion and mysticism,
has only been published posthumously.

Crimean war
Florence Nightingale's most famous contribution came during the Crimean War, which became
her central focus when reports got back to Britain about the horrific conditions for the
wounded. On 21 October 1854, she and the staff of 38 women volunteer nurses that she
trained, including her aunt Mai Smith, and 15 Catholic nuns (mobilized by Henry Edward
Manning) were sent (under the authorization of Sidney Herbert) to the Ottoman Empire.
Nightingale was assisted in Paris by her friend Mary Clarke. They were deployed about
295 nautical miles (546 km; 339 mi) across the Black Sea from Balaklava in the Crimea, where
the main British camp was based. After Nightingale sent a plea to The Times for a government
solution to the poor condition of the facilities, the British Government commissioned Isambard
Kingdom Brunel to design a prefabricated hospital that could be built in England and shipped to
the Dardanelles. The result was Renkioi Hospital, a civilian facility that, under the management
of Dr. Edmund Alexander Parkes, had a death rate less than 1/10th that of Scutari. Stephen
Paget in the Dictionary of National Biography asserted that Nightingale reduced the death rate from
42% to 2%, either by making improvements in hygiene herself, or by calling for the Sanitary
Commission. For example, Nightingale implemented hand washing and other hygiene practices in the
war hospital in which she worked.
Florence Nightingale, an angel of mercy. Scutari hospital 1855. During her first winter at Scutari, 4,077
soldiers died there. Ten times more soldiers died from illnesses such
as typhus, typhoid, cholera and dysentery than from battle wounds. With overcrowding,
defective sewers and lack of ventilation, the Sanitary Commission had to be sent out by the British
government to Scutari in March 1855, almost six months after Nightingale had arrived. The commission
flushed out the sewers and improved ventilation. Death rates were sharply reduced, but she never
claimed credit for helping to reduce the death rate. In 2001 and 2008 the BBC released documentaries
that were critical of Nightingale's performance in the Crimean War, as were some follow-up articles
published in The Guardian and the Sunday Times. Nightingale scholar Lynn McDonald has dismissed
these criticisms as "often preposterous", arguing they are not supported by the primary sources.
Nightingale still believed that the death rates were due to poor nutrition, lack of supplies, stale air and
overworking of the soldiers. After she returned to Britain and began collecting evidence before the Royal
Commission on the Health of the Army, she came to believe that most of the soldiers at the hospital
were killed by poor living conditions. This experience influenced her later career, when she advocated
sanitary living conditions as of great importance. Consequently, she reduced peacetime deaths in the
army and turned her attention to the sanitary design of hospitals and the introduction of sanitation in
working-class homes (see Statistics and Sanitary Reform, below).
The status of medical knowledge at that time was limited - what treatment or remedies were
ordered by the physician could be administered by the family member providing nursing care.
Mary Jane Seacole OM (née Grant; 1805 – 14 May 1881) was a British-Jamaican business woman and
nurse who set up the "British Hotel" behind the lines during the Crimean War. She described this as "a
mess-table and comfortable quarters for sick and convalescent officers", and provided succor for
wounded servicemen on the battlefield. She was posthumously awarded the Jamaican Order of Merit in
1991. In 2004 she was voted the greatest black Briton.
She acquired knowledge of herbal medicine in the Caribbean. When the Crimean War broke out, she
applied to the War Office to assist but was refused. She travelled independently and set up her hotel and
assisted battlefield wounded. She became extremely popular among service personnel, who raised
money for her when she faced destitution after the war.
After her death, she was largely forgotten for almost a century but today is celebrated as a woman who
successfully combated racial prejudice. Her autobiography, Wonderful Adventures of Mrs. Seacole in
Many Lands (1857), is one of the earliest autobiographies of a mixed-race woman, although some
aspects of its accuracy have been questioned. The erection of a statue of her at St Thomas' Hospital,
London on 30 June 2016, describing her as a "pioneer nurse", has generated controversy. Earlier
controversy broke out in the United Kingdom late in 2012 over reports of a proposal to remove her from
the UK's National Curriculum.
Nursing in the civil war

At the start of the Civil War, there were no organizations of trained nurses in the United States. It took
the devastation of the Crimean War (1854), seven years prior, and the appointment of England’s
Florence Nightingale (1820-1910) in an official capacity to lay the foundation for modern nursing
concepts and trained nursing care. While at Selimiye (Scutari) Barracks Hospital in Turkey, she clearly
demonstrated the need for trained nursing care to support not only physicians’ and surgeons’ work, but,
most importantly, to help with the sanitary, social and psychological needs of servicemen. Nightingale’s
work cleared the path for middle and upper class women to seek a nursing career as an acceptable
lifestyle. Women played a significant role in the Civil War. They served in a variety of capacities, as
trained professional nurses giving direct medical care, as hospital administrators, or as attendants
offering comfort. Although the exact number is not known, between 5,000 and 10,000 women offered
their services. For the first two years the introduction of females into a male medical system was its own
civil war.

Educator and social reformer Dorothea Lynde Dix (1802-1887), who had dedicated her life to improving
the conditions of people in prisons, poor houses and, particularly, mental institutions volunteered for
service. On June 10, 1861, she was appointed Superintendent of Female Nurses of the Union Army by
Secretary of War Simon Cameron. She was empowered to create a volunteer nurse corps and regulate
supplies that were donated to the troops. She and her appointed nurses were given no military rank. The
60-year-old Dix was not trained in nursing but had extraordinary organizational skills and was well
acquainted with tackling resistant political and social forces. On July 24, 1862, Circular Order No. 8 was
issued laying down Dix’s strict requirements for appointment in her nurse corps. Candidates were to be
between 35 and 50 years old, obedient to rules, matronly persons of experience with good character and
strong health. Compensation was 40 cents a day and a three-month minimum period of service was
required.