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Historical Perspectives of Nursing

and Concepts of Nursing

Characteristics of nursing profession;
Florence Nightingales deeds and her
Contributions to nursing science;
Concept and Dimensions of Nursing
Historical Perspectives of Nursing

Nursing began as a desire to keep people
healthy and to provide comfort and
assurance to the sick.
Although the general goals of nursing have
remained relatively the same over the
centuries, ever-advancing science and the
changing of societys needs have deeply
influenced the practice of nursing.

Stages of Nursing
Nursing from Ancient times to the
nineteenth century
Early Civilization
Middle Ages
Fifteenth to Nineteenth Century

Early Civilization
Egyptian physicians are believed to have
specialized in certain diseases (such as
internal diseases, fractured bones, and
wounds). They also hired women, later
known as midwives, to assist with
childbirth. These women were the first
records nurses.

Early Civilization
The Greeks believed in Apollo, the
Greek god of healing and prayed to him for
magic cures for their illness.
400 B.C., the famous Greek physician
Hippocrates believed that disease had
natural, not magical, causes.

Early Civilization
Roman Empire
After 300 B.C., early physicians
built on the groundwork of their Egyptian
and Greek predecessors.
The Romans are best known for
advances in the health of the public.

Early Civilization
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.

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
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.

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
The only acceptable nursing role was within
a religious order where services were
provided as part of Christianity charity.

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
she visited Kaiserswerth and received
nurses training at 1850 for three months;

Fifteenth to Nineteenth Century

Period of Nightingale
the outbreak of the Crimean War gave
Nightingale an opportunity for
Nightingale and her nurses transformed the
military hospitals by setting up diet
kitchens, a laundry, recreation centers, and
reading rooms, and organizing classes for

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.

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
in 1924, one of the schools of nursing was
set up at Yale University;

Stages of Nursing
Development of modern nursing
Nursing practice:
by 1920s, nursing specialization was
the concept of the clinical nurse specialist
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
Association, in
1980, nursing is
the diagnosis and
treatment of
human responses
to actual or
potential health

Tasks of Nursing
Relieving pains
Maintaining health
Restoring health
Promoting health and

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
Is basically intellectual (as opposed to physical).
Improves its techniques by the use of scientific
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
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

Dimensions of Nursing
Clinical Nursing:
fundamental nursing, to meet basic needs of
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
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
Case management cared by some fixed
Functional nursing centered by orders
Nursing in groups
Primary nursing
Systematic holistic nursing philosophy,
responsibility, forms

Case management

Functional nursing

Shifts of nurses:
day/night shift


Nursing in groups
Group A

Group B


Nursing: An ArtA 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
clients 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
During the industrial revolution, scientific
methods became more important.

Florence Nightingale
The founder of modern nursing.
She established the first school for nurses that
provided theory-based knowledge and clinical
Encouraged the belief that there is a body of
nursing knowledge distinct from medical

Nightingales 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

The Civil War & Nursing

Americas 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: Americas first African-American nurse.
Linda Richards: Americas first trained nurse. (Note: The term
trained nurse preceded registered nurse).

Practical Nursing
Women who
cared for
others, but
who had no
often called

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,

Diploma Programs
Typically 3 years in length and offered by
Graduates receive diploma rather than a
college degree.
Program emphasizes basic skills particularly
suited for hospital clients.
Such programs contribute 6% of nurse

Associate Degree
2-year program offered through community colleges
or as options at four-year universities.
Graduate receives Associate Degree in Nursing
Program stresses basic skill preparation with clinical
practice occurring increasingly in community-based
institutions (e.g. ambulatory
settings, schools and clinics).
Such programs contribute 60% of nurse graduates.

Baccalaureate Degree
Typically 4 years in length, offered through colleges
and universities.
Graduate receives Bachelor of Science in Nursing
Emphasizes preparation for practice in nonhospital
settings, broader scientific content, and systematic
problem-solving tools for autonomous and
collaborative practice.
Such programs contribute 34% of all nursing

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
Maintains a national disciplinary data bank.
Serves as the national clearinghouse of information on nursing
Publications: Issues; NCLEX-RN Program Reports; NCLEX-PN Program