Historical Perspectives of Nursing and

Concepts of Nursing

Ns. Zahrah Maulidia S., Skep., M.Kep

Pada Tahun 1820  Abad Ke 21

Florence Nightingale pelopor perawat

modern
Penulis dan ahli statistik. Ia dikenal
dengan nama Bidadari Berlampu (The
Lady With The Lamp)
Florence Nightingale menghidupkan
kembali konsep penjagaan kebersihan
rumah sakit dan kiat-kiat juru rawat.
Fifteenth to Nineteenth Century
Many monasteries and convents closed,
leading to a tremendous shortage of people
to care for the sick.
Women who had committed crimes were
recruited into nursing in lieu of serving
sentences.
The only acceptable nursing role was within
a religious order where services were
provided as part of Christianity charity.
Born: 12 May 1820)
Florence, Grand Duchy
of Tuscany
Died: 13 August 1910
(aged 90)
Park Lane, London,
United Kingdom
Profession: Nurse and
Statistician
Institutions: Selimiye
Barracks, Scutari
Specialism: Hospital
hygiene and sanitation
Known for: Pioneering
modern nursing
Fifteenth to Nineteenth Century
Period of Nightingale
Florence Nightingale was born in
1820 in a wealthy family;

Period of Nightingale
her education included the mastery
of several ancient and modern
language, literature, philosophy,
history, science, mathematics,
religion, art and music;
Fifteenth to Nineteenth Century
Period of Nightingale
she was determined to become a nurse since
she believed she was “called by God to help
others and to improve the well-being of
mankind”;
she visited Kaiserswerth and received
nurse’s training at 1850 for three months;
Fifteenth to Nineteenth Century
Period of Nightingale
the outbreak of the Crimean War gave
Nightingale an opportunity for achievement;
Nightingale and her nurses transformed the
military hospitals by setting up diet kitchens,
a laundry, recreation centers, and reading
rooms, and organizing classes for orderlies;
Fifteenth to Nineteenth Century
Period of Nightingale
after the war, Nightingale established the
Nightingale Training School for Nursed at
St. Thomas’ hospital in London; the school
served as a model for other training school;
as the founder of modern nursing, Florence
Nightingale established the first nursing
philosophy based on health maintenance
and restoration.
Early Civilization
India
In ancient India, early hospitals were
staffed by male nurses who were required to
meet four qualifications: knowledge of the
manner in which drugs should be prepared
for administration, cleverness, devotedness
to the patient, and purity of mind and body.
Christianity
With the beginning of Christianity, nursing
began to have a formal and more clearly
defined role.
Led by the belief that love and caring for
others were important, women made the
first visits to sick people, male gave nursing
care and buried the dead.
Nursing became a respected vocation.
Middle Ages
More hospitals were built.
Nurses delivered custodial care and
depended on physicians for direction.
Nurse midwifery, as one of the oldest
nursing roles, flourished.
Much nursing care was provided by monks
and nuns, which was segregated by sex.
 Fifteenth to Nineteenth
Century

The extensive population growth in cities,

the lack of hygiene and sanitation and the
increasing poverty in urban centers resulted
in serious health problem.
Society changed from one with a religious
orientation to one that emphasized warfare,
exploration, and expansion of knowledge.
Keperawatan di Masa Kuno

Masyarakat Indonesia beranggapan bahwa penyakit itu

disebabkan oleh perbuatan makhluk halus yang jahat  dukun.
Pengobatan mantra-mantra dan bahan-bahan tertentu yang
tidak terbukti khasiatnya.
Dari segi keperawatan, orang yang sakit hanya dirawat oleh
kaum wanita yang berlandaskan kepada naluri keibuan ( mother
instinc).
Tidak ada catatan  kaum pria ikut serta melakukan
perawatan dengan alasan kaum pria tidak mempunyai kasih
sayang yang cukup untuk merawat orang sakit.
Keperawatan di Masa Penjajahan
Perkembangan keperawatan banyak dipengaruhi oleh konsep-
konsep keperawatan dari Negeri Belanda.
Pemerintah Belanda yang mendirikan dinas kesehatan khusus
tentara (saat itu disebut MGD) dan dinas kesehatan rakyat (saat
itu disebut BGD).  merekrut perawat dari penduduk pribumi.
Perawat yang dalam bahasa Belanda disebut Velpleeger
menjalankan tugasnya sebagai perawat dengan dibantu oleh
penjaga orang sakit yang disebut Zieken Opposer.
Organisasi profesi perawat pertama dibentuk di Surabaya pada
tahun 1799, organisasi tersebut bernama Perkoempoelan Zieken
Velpleeger / Velpleester Boemi Poetra (disingkat PZVB Boemi
Poetra).
Profesi Perawat Pada Masa
Pra Kemerdekaan

Jenjang pendidikan lulus SD + 1 tahun pendidikan

keperawatan.
Lulusan disebut JURU KESEHATAN ( DK ).

Pada Masa Tahun 1950 - 1960

Jenjang pendidikan lulus SD + 4 tahun pendidikan keperawatan.

Lulusan disebut JURU RAWAT ( DK ).
Pada Masa Tahun 1960 - 1967

Jenjang pendidikan, PENJENANG KESEHATAN ( PK ).

Lulusan SMP + 4 tahun pendidikan keperawatan.
Lulusan disebut MANTRI KESEHATAN.

Pada Masa Tahun 1967 - 1972

Jenjang pendidikan, PENJENANG KESEHATAN ( PK ).

Lulusan SMP + 3 tahun pendidikan keperawatan.
Kurikulum lebih lengkap
Lulusan disebut MANTRI KESEHATAN.
Pada tanggal 14 Maret 1973 lahir Organisasi Profesi Keperawatan yang
bernama Persatuan Perawat Nasional Indonesia (PPNI).

Pada Masa Tahun 1970 - 1978

Jenjang pendidikan menjadi SEKOLAH PENGATUR RAWAT (SPR).

Lulusan SMP + 3 tahun pendidikan keperawatan.
Kurikulum dan praktik lebih lengkap
Lulusan disebut PENGATUR RAWAT.
Pada Masa Tahun 1978 - 2000
Jenjang pendidikan berubah lagi menjadi, SEKOLAH PERAWAT KESEHATAN
(SPK).
Lulusan SMP + 3 tahun pendidikan keperawatan.
Lulusan disebut PERAWAT KESEHATAN.
 Pada Masa Tahun 1984 – Sekarang
(tinggal sedikit)
Jenjang pendidikan, AKADEMI KEPERAWATAN (AKPER).
Lulusan SMU + 3 tahun pendidikan keperawatan.
Kurikulum ilmu keperawatan vokasional Lulusan disebut AHLI MADYA
KEPERAWATAN
(Bsc/Amd.Kep).
Pada Tahun 1990 – 1999
PSIK (Program Studi Ilmu Keperawatan) di Universitas Indonesia
dibuka.
Lulusan SMU + 5 tahun pendidikan keperawatan.
Kurikulum ilmu keperawatan profesional
Gelar Akademik yaitu S.Kp (Sarjana Keperawatan).
Pada Tahun 1994, 1996 - sekarang

Dibuka Program Studi Ilmu Keperawatan (PSIK) di PTN yang

lain misalnya :
UNAIR, UGM, UNIBRAW, UNHAS, UNDIP, UNPAD, UNSRI,
USU, dll termasuk yang PTS.

Upaya untuk merubah Profesi Perawat dari tingkat Vokasional

menuju ke Profesional
Pada Tahun 2000

PSIK di PTN berubahstatus menjadi

Fakultas Ilmu Keperawatan (FIK) dengan
perubahan model kurikulum
 Jenjang Akademik ditempuh dalam 8 semester dengan gelar
Sarjana Keperawatan (S.Kep).
 Jenjang profesi ditempuh dalam 2 semester praktikum profesi
dengan gelar Ners ( Ns )
 S.Kep., Ns
Pada Tahun 2004
FIK – UI, dibuka Program Pendidikan Spesialis Keperawatan
dengan bidang studi:
 Spesialis Keperawatan Medikal Bedah
 Spesialis Keperawatan Jiwa
 Spesialis Keperawatan Maternitas
 Spesialis Keperawatan Komunitas

Jenjang pendidikan Spesialis dari Ners ditempuh dalam 6 semester ( 3

tahun )
Gelarnya : Ns. M.Kep. Sp. KMB, Kep.J, Mat, Kom
Dari jenjang – jenjang pendidikan tersebut
diatas, maka Depdiknas menetapkan jenjang
Profesi :
 SPK VOKASIONAL
 Akper
 S Kep.Ners  Profesional
 D-IV : Pendidik. Pendidikan D-3 + 1 tahun
Untuk jenjang S Kep. Ners dalam Akreditasi
Profesi ditetapkan dalam Keputusan Menpan
sebagai Perawat Ahli dengan syarat :
Ijazah Ners + Diklat Teknis dan Uji
Kompetensi sehingga bersertifikat sebagai
Perawat Ahli.
DASAR HUKUM PRAKTEK
KEPERAWATAN MANDIRI
 UU No. 40 tahun 2004 ttg Sistem Jaminan Sosial Nasional
 UU No. 36 tahun 2009 ttg kesehatan
 UU No. 24 tahun 2011 ttg BPJS
 UU No. 36 TAHUN 2014 TTG TENAGA KESEHATAN
 UU No. 23 tahun 2014 ttg Pemerintahan Daerah
 UU NO 38 TAHUN 2014 TTG KEPERAWATANUU
No. 38 Th 2014 ttg Keperawtan.pdf
 Permenkes 46 thn 2013 Registrasi tenaga kesehatan
 Permenkes 148 thn 2010 ttg ijin penyelenggaraan praktek perawat
 KepMenKes no 279 ttg pedoman upaya penyelenggaraan
perkesmas
 Keputusan Menteri Kesehatan Nomor 908/MENKES/SK/VII/2010
ttg pedoman penyelenggaraan keperawatan keluarga
Stages of Nursing
Development of modern nursing
In the early twentieth century, a movement
toward a scientific, research-based defined
body of nursing knowledge and practice
was seen;
Stages of Nursing
Development of modern nursing
Nursing Education:
in 1923, the Rockefeller Foundation funded
a survey on nursing education, which
recommended that nursing schools be
independent of hospital and on a college
level;
in 1924, one of the schools of nursing was
set up at Yale University;
Stages of Nursing
Development of modern nursing
Nursing practice:
by 1920’s, nursing specialization was
developing;
the concept of the clinical nurse specialist
arose;
from period of Nightingale, the system of
nursing management has been improving.
Nursing in China
Ancient nursing practice
the concept of holism; care on the basis of
differential diagnosis;
From the middle period of 19th century to
the middle of the 20th century
During the latter half the 20th century
Concept of Nursing
3 stages of the concept of nursing:
disease centered, patient centered and
human health centered
International Council of Nurses, in 1973,
nursing is to assist the individual, sick or
well, in the performance of those activities
contributing to health or its recovery ,
preventing disease or peaceful death.
Concept of Nursing
The American
Nurses
Association, in
1980, nursing is
the diagnosis and
treatment of
human responses
to actual or
potential health
problems.
Tasks of Nursing
Relieving pains
Maintaining health
Restoring health
Promoting health and
wellness
 Body of Nursing knowledge
Fundamental knowledge:
physical science
fundamental medical
psychological and social science
Knowledge specific to nursing:
clinical nursing: fundamental nursing,
specialty nursing, community nursing
nursing management
nursing education
 Characteristics of a Profession
Has practitioners who are motivated by altruism
Can be taught through a process of professional
education.
Is basically intellectual (as opposed to physical).
Improves its techniques by the use of scientific
method.
Functions autonomously.
Nursing as a Profession, Kelly,1981

The services provided are vital to humanity

and the welfare of society.
There is a special body of knowledge which
is continually enlarged through research.
The services involve intellectual activities;
individual responsibility (accountability) is
a strong feature.
Nursing as a Profession, Kelly,1981

Practitioners are educated in institutions of

higher learning.
Practitioners are relatively independent and
control their own policies and activities
(autonomy).
Practitioners are motivated by service
(altruism) and consider their word an
important component of their lives.
Nursing as a Profession, Kelly,1981

There is a code of ethics to guide the

decisions and conduct of practitioners.
There is an organization (association) which
encourages and supports high standards of
practice.
 Dimensions of Nursing
Practice

Clinical Nursing:
fundamental nursing, to meet basic needs of
clients;
specialty nursing, based on nursing science
and specialty theories, knowledge and skills;
Community-based health care, directed
toward a specific population or group
within the community
 Dimensions of Nursing
Practice

Nursing Education:
based on nursing science and education theories;
controlled by the state education and health care guide.
Nursing Management:
systematic management of factors as nursing
professional staff, technologies, equipment,
information, financing.
Nursing Research:
 Forms of nursing in
hospital

Case management：cared by some fixed

nurses
Functional nursing：centered by orders
Nursing in groups：
Primary nursing：
Systematic holistic nursing：philosophy,
responsibility, forms
 NURSING
HISTORY,
EDUCATION
AND
ORGANIZATION
Nursing: An Art…A Science
By using scientific knowledge in a humane
way, nursing combines rational, scientific
methods with caring behavior.
Nursing focuses not on the illness but the
client’s response to illness.
Historical Overview

Nursing is an ancient profession that has

evolved alongside human civilization.
Religion heavily influenced this evolution.
Many early hospitals were tied to organized
religion.
During the industrial revolution, scientific
methods became more important.
Nightingale’s Accomplishments

Demonstrated the value of nursing care in

reducing morbidity rates in the Crimean War
Established the Nightingale School for Nurses
at St. Thomas’ Hospital in London
Advocated the principles of cleanliness and
nutrition in promoting health
Developed public awareness of the need for
nurses.
The Civil War & Nursing

America’s tragic conflict underscored the

need for nursing.
Clara Barton (1821-1912) volunteered her
nursing skills and organized the Red Cross in
the United States after the war.
Pioneers of Nursing

Lillian Wald: First community health nurse.

Isabel Hampton Robb: Founded nursing organizations.
Adelaide Nutting: First nurse appointed as university professor.
Lavinia Dock: Author of early textbooks.
Mary Breckenridge: Serviced rural America.
Mamie Hale: Educator of midwives.
Mary Mahoney: America’s first African-American nurse.
Linda Richards: America’s first trained nurse. (Note: The term
trained nurse preceded registered nurse).
“Practical” Nursing

Women who
cared for
others, but
who had no
formal
education,
often called
themselves
“practical
nurses.”
Early Practical Nursing Schools

Ballard School. Opened in 1892 in New York

City by the YMCA.
Thompson Practical Nursing School.
Established 1907 in Brattleboro, Vermont.
Still operating today.
Household Nursing School. Founded in 1918
in Boston.
Nursing Education Changes

The Goldmark Report: Published in 1923, this

report concluded that for nursing to be on an equal
footing with other disciplines, nursing education
should occur in the university setting.
Institute of Research and Science
in Nursing Education Report: Resulted in the
establishment of practical nursing under Title III of
the Health Amendment Act of 1955. This led to a
growth in practical nursing schools in the U.S.
Nursing Education: LP/VNs

LPNs (Licensed Practical Nurses) and LVNs

(Licensed Vocational Nurses) work under the
supervision of an RN or other licensed provider such
as a physician or dentist.
Education is focused on basic nursing skills and
direct client care.
Educated in community colleges, hospitals,
vocational programs.
Nursing Education: RNs
RNs (Registered Nurses) may operate autonomously
and may supervise LP/VNsLVNS.
Education is focused on basic nursing skills and
direct client care.
Educated in universities, community colleges,
hospitals.
Diploma Programs

Typically 3 years in length and offered by

hospitals.
Graduates receive diploma rather than a
college degree.
Program emphasizes basic skills particularly
suited for hospital clients.
Such programs contribute 6% of nurse
graduates.
 Nursing Organizations
American Nurses Association (ANA)

Purpose: To improve the quality of nursing care.

Established 1911.
Establishes standards for nursing practice.
Establishes a professional code of ethics.
Develops educational standards
Oversees a credentialing system.
Influences legislation affecting health care.

For RNs only.

Publications: American Journal of Nursing; American Nurse
Nursing Organizations
National Association for Practical Nurse Education
and Service, Inc. (NAPNES)

Purpose: To improve the quality, education, and recognition of

nursing schools and LP/VNs in the U.S.
Established 1941.
Provides workshops, seminars, and continuing-education programs.
Evaluates and certifies continuing-education programs of others.
Provides individual student professional liability insurance program.
 Nursing Organizations
National Federation of Licensed Practical
Nurses, Inc. (NFLPN)
Purpose: Provide leadership for LP/VNs.
Established 1949.
Encourages continuing education.
Establishes principles of ethics.
Represents and speaks for LP/VNs in Congress.
Offers members best type of low-cost insurance.

For LPs/VNs.
Publication: AJPN (quarterly newsletter)
 Nursing Organizations
National League for Nursing (NLN)
Purpose: To identify the nursing needs of society and to
foster programs designed to meet these needs.
Established 1952.
Accredits nursing education programs.
Conducts surveys to collect data on education programs.
Provides continuing-education programs.

Open to all nurses and non-nurses.

Publication: Nursing & Health Care.
 Nursing Organizations
National Council of State Boards of Nursing, Inc. (NCSBN)
Purpose: Provides an organization through which boards of nursing act
together on matters of common interest and concern.
Established 1978.
Develops and administers licensure examinations for RN and LP/VN
candidates.
Maintains a national disciplinary data bank.
Serves as the national clearinghouse of information on nursing
regulation.

Publications: Issues; NCLEX-RN Program Reports; NCLEX-PN Program

Reports.