Chapter 2

The History Behind the

Development of Professional
Nursing

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Nursing in Ancient Civilizations
(Before AD 1)
• Primitive beliefs
– Soul as separate entity, spirits caused illness
• Hindi
– Hygiene linked to health
– Nursing interventions became basis for holistic
nursing practice

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Nursing in Ancient Civilizations
(Before AD 1) (cont’d)
• Egypt
– Derived therapies from plants, animals, minerals
• India
– Qualification of nurse
• Knowledge of drug preparation
• Cleverness
• Devotion to patients
• Purity of body and mind

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Nursing in Ancient Civilizations
(Before AD 1) (cont’d)
• Babylonians
– First sliding scale for payment
• China
– Balance of energy -/+ or yin/yang
– Principles of physical examination
• Look, listen, ask, feel

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Nursing in Ancient Civilizations
(Before AD 1) (cont’d)
• Persia
– Beautiful hospitals with specialized wards
• Palestine
– Natural cures and outlines for food inspection, vital
statistic records, infectious disease quarantine
followed by fumigation
• Greece
– Hippocrates
• Outlined role of physicians, set standards for
bathing, bandaging, other cures
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Nursing in Ancient Civilizations
(Before AD 1) (cont’d)
• Rome
– Health restored by Gods
– Care reserved for soldiers
• Northern Europe
– Use of herbs
– “White and Black magic”

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Nursing in Ancient Civilizations
(Before AD 1) (cont’d)
• Germany
– Established expertise in treating wounds, obstetrical
care, treating animals

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Question
• Is the following statement true or false?
• Ancient civilizations believed that illness was caused by
spirits, evil, magic, and the gods.

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Answer
• True
• Rationale: Many of the ancient civilizations believed that
illness and health were the works of evil spirits, the gods,
magic, and other forces.

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Nursing in the Early Christian Era
(AD 1–500)
• Roman Matrons
– Earliest nurses were church deaconesses
– Phoebe: mother of visiting nursing
– First hospitals, shelters, hospices, asylums, nursing
hospitals

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Nursing in the Early Christian Era
(AD 1–500) (cont’d)
• Advances in Greece
– Aretaeus
• Introduction of cleanliness, skin care, mouth care,
pain control, care for febrile and excitable patients
• Use of music to soothe
– First maternity hospital, home for dying

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Nursing in the Middle Ages (500–1500)
• Monks, Nuns jointly cared for sick
• Hildegarde
– Wrote books that contained accurate physiology of
reproductive, circulatory, nervous system

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Nursing in the Middle Ages (500–1500)
(cont’d)
• The Crusades and nursing knights
– Order of St. John consisted of men devoted to
charitable work
• Formed cottage hospitals, convalescent homes,
nursing training
• Separate hospital for lepers

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Nursing in the Middle Ages (500–1500)
(cont’d)
• Religious orders of nursing for women
– Structured approach to care of ill
– Vows of poverty, chastity, obedience
– Greed, epidemic led to depletion of resources

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Question
• Nursing care during the Middle Ages was primarily
provided by which group of individuals?
A. Single and lower-class women
B. Shaman and witches
C. Prisoners and guards
D. Nuns and monks

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Answer
• D. Nuns and monks
• Rationale: Nuns, monks, deaconesses, or members of
religious sects provided the vast amount of nursing care
in the Middle Ages.

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The Establishment of Nursing in Europe,
England, and the New World (1500–1819)
• Hospitals removed from church governess
• First required white uniform
– Eventually changed to black dress, white apron,
white cap
• Control of hospitals became responsibility of cities
• Overcrowding, long work hours

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Nursing in the New World
• First Jesuits hospital opened
• The Hospital of the Immaculate Conception
• Treatment consisted of superstition, prayer
• 1700s brought hospital reform

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The Movement of Nursing to a
Respectable Profession (1820–1917)
• Elizabeth Fry
– Established program for women prisoners to make,
sell goods to improve living conditions of children
born in prison
– Referred Florence Nightingale to Kaiserworth
(German training program for nurses)
• Fredrike Fliedner
– Provided clinical, theoretical instruction on art of
nursing

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The Movement of Nursing to a
Respectable Profession (1820–1917)
(cont’d)
• Catherine McAuley
– Led formation of Religious Sisters of Mercy
– Spiritual focused perspective
• Focus was on spiritual love, calm, restorative
environments, safety and comfort, health
education, collaboration, care of self

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The Movement of Nursing to a
Respectable Profession (1820–1917)
(cont’d)
• Appearance of first nursing manuals
– Specific instructions on how to do procedures, use of
equipment
– Stressed importance of attending to patient
psychological needs, maintaining health of caregivers

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The Movement of Nursing to a
Respectable Profession (1820–1917)
(cont’d)
• Philadelphia Dispensary established
– Focused on disease prevention
• Founding, establishment of residential insane asylum,
hospitals, visiting nurse programs, schools and
orphanages

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The Movement of Nursing to a
Respectable Profession (1820–1917)
(cont’d)
• Use of the word Pflegerin (nurse)
– Nursing Society of Philadelphia was founded
• Home maternity services
• Home, school on cooking, obstetrics
• Clinical instruction in client homes

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Florence Nightingale and the Birth of
Nursing as a Profession
• Florence Nightingale
– Reformed patient care, established nursing as
profession
– Superintendent of Nursing Staff during Crimean War
– Transformed hospitals, reduced mortality rate

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Florence Nightingale and the Birth of
Nursing as a Profession (cont’d)
• Florence Nightingale
– Establishment of “Nightingale fund”
– Elevated profession
– Nursing as an art
• Mary Seacole
– Provided shelter, relaxation, food to civilians
– Prescribed medicines

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Florence Nightingale and the Birth of
Nursing as a Profession (cont’d)
• Lillian Wald, Mary Brewster opened Nurses’ Settlement
House in New York City
– Used term “public health nurse”
– Founded Henry Street Settlement House

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Civil War Nursing
• Began when women transformed ballrooms of their
homes into wards
• Dorothea Dix
– Founded first American army nursing corps
• Clara Barton
– Founded American Red Cross

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Question
• Is the following statement true or false?
• Florence Nightingale reduced mortality rates of
soldiers injured during the Crimean War.

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Answer
• True
• Rationale: Florence Nightingale was a nurse during the
Crimean War and she provided clean, well-ventilated
buildings and nutritious meals for the patients. The
mortality rate of 40% declined to 2% after the
implementation of Nightingale’s reforms.

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American Hospital Training Programs and
Diploma Schools
• Establishment of first nursing training programs
• Proliferation of nursing education programs
• Baccalaureate programs
• Associate’s Degree Programs

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The American Public Health Movement
• Public health nursing
– Formal client records
– Cooperation with other groups providing community
care

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Other Social Reform Movements
• William Booth founded Salvation Army
• Jane Addams established Hull House in Chicago
• Christian Associations of young men, women formed to
build character, provide community services

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Nursing during the Early 20th Century,
The World Wars, and The Post–World War
II Era (1890–1960)
• State registration of nurses, licensing examination
requirements
• Government campaigns to recruit women into nursing
• Army, navy nursing corps
• Nursing education reform
– Diploma, associate’s, bachelor’s programs
– Nursing shortage

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Nursing in the Modern Era (1960–1999)
• Increases in illicit drug use, sexually transmitted disease,
continued nursing shortages
• ANA Position Paper on Education
• Growth of nursing education programs
• Rising health care costs, health care disparities
• Midlevel providers, bedside nursing shortages
• Medicare, Medicaid, managed care

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Nursing in the Modern Era (1960–1999)
(cont’d)
• Unlicensed assistive personnel
• Patient-focused care
• Clinical pathways
• Standardized nursing care plans
• RN role changes
– Collaborative relationships
• Negative image of nursing

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Question
• Tell whether the following statement is true or false:
• Low pay scale, military service, and hospital bed
expansion are factors that have contributed to the
shortage of nurses during the past decade.

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Answer
• True
• Rationale: Factors over the past decade that helped to
create a nursing shortage include nurses joining the
military, taking jobs that had higher pay, and hospitals
adding more beds to their facilities. The addition of more
beds increased the number of nurses needed to staff the
floors.

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Media Portrayals of Professional Nurses
• Rigid and cold
• Intense drive to satisfy sexual needs
• Sex object
• Desire to marry a physician, flirtatious relationships with
male physicians
• Dysfunctional lives

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Media Portrayals of Professional Nurses
(cont’d)
• Selfless martyr
• Complicity
• Men in nursing as being effeminate
• Subservient to physicians who believe that nurses are
unworthy to be treated as equal members of the health
care team
• Setting for a lesser profession or stuck in a dead-end job

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Nursing in the First Postmodern Era
(2000–Present)
• Older adults now live longer
• Economic disparities
• Rising health care costs
• Specialty certification
• Evidence-based standards
• Image of nursing continues to evolve

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The Future of Nursing
• Efforts to elevate profession of nursing continue
• Establishment of nursing’s own “body of knowledge”
• Greater need for highly educated nurses
• Continued showcasing of communication, collaboration,
compassion, confidence, clinical, cognitive skills

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