HISTORY AND TRENDS IN

PROFESSIONAL NURSING IN
ZAMBIA

Prepared By: N. K. Hichilema

Faculty of Nursing & Midwifery
Sciences (LAMU)
HOW DID NURSING START?
WHERE DID IT BEGIN?
WHO FOUNDED NURSING?
WHAT IS NURSING?
______________________________?
 SPECIFIC
OBJECTIVES
 Explain the nursing care in ancient time
 Explain the foundation of modern nursing
Elaborate the nursing profession during 19th and 20th
centuries
State the current trends affecting the nursing
profession
 INTRODUCTION
• Before one can fully grasp the nature of nursing or define its
practice, it is helpful to understand the roots and
influencing factors that shaped its growth over time.

• Nursing to day is far different from nursing as it was

practiced 50 years ago, and it takes a vivid imagination to
envision how the nursing profession will change as we move
forward in to the 21st century.

• To comprehend present-day nursing and at the same time

prepare for future, one must understand not only past
events but also contemporary nursing practices.
 Introduction
◦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 society’s needs have deeply influenced the practice
of nursing.

◦However, considering the long history of nursing, it was not

until fairly recently that nurses received a formal nursing
education.
 The Renaissance Image of Nursing
The Nurse as Servant

o There was a radical change from the image of the

selfless nurse that had developed in the Middle
Ages.
o Care of the ill was delegated to servants and those
unable to find any other means of support.
o The hospitals of this time were overwhelmed by
deadly disease and filled with death; those who
worked in them were seen as corrupt and unsavory.
 NURSING IN ANCIENT TIME
o In some early cultures, the provision of nursing care was assigned to females
because women provided nurturing to their infants and it was assumed that
they could provide the same care to the sick and injured
o Women of lowest social standing, Wayward women of low status, instead of
going to prison, they were asked to serve as nurses.
o In other ancient societies, however, men were designated to care for the sick, because they
were considered priests, spiritual guides or “medicine men.”
 NURSING IN ANCIENT TIME
◦There was no formal education available in primitive societies, so the earliest
nurses learned the tricks of the trade via oral traditions that were passed
down from one generation to the next.
◦They also learned how to nurse patients back to health through trial and
error
and by observing others who cared for the sick.
◦The earliest nurses used plants and herbs to heal and believed that evil spirits
and magic could affect one’s health.
◦ Illness was often viewed as a sign that something was done to offend the
priests
or gods.
 CONT.
. was the first to maintain
◦The Egyptian healthcare system
medical records starting at around 3000 B.C.
◦ Egyptian society was also the first to classify medications
and develop plans to maintain people’s health.
◦ In ancient Rome, during the early Christian era, deaconesses
were selected by the church to provide care for the sick.
◦Deaconesses had some education and were selected by the
church’s bishops to visit and care for the sick in their homes. The
deaconess Phoebe is considered to be the first “visiting nurse” who
provided expert home nursing care.
 NURSING IN MEDIEVAL AND EARLY
MODERN EUROPE
◦During the Renaissance period from 1500 to 1700, a growing
interest in science and technology led to advances in medicine and
public health.
◦At the time, the rich paid for their sick to be cared for at home, while
the poor were cared for in hospitals. By the time many poor people
arrived at hospitals, they were already very ill, so they often died in
the hospitals.
◦ Being hospitalized had negative connotations for most people,
as hospitals were considered places where people went to die.
 CONT..
◦Following the Protestant Reformation, monasteries and convents
were closed, and the lands were seized. “Common” women who were
too old or ill to find other jobs started caring for the sick.
◦ Although there were a few hospitals in Protestant Europe, there
were no regular system of nursing.
◦ Female practitioners cared for neighbours and family, but their
work was unpaid and unrecognized.
◦In Catholic areas, however, the tradition of nursing nuns continued
uninterrupted.
 Foundations of Modern Nursing
◦Modern nursing began in the 19th century in Germany and Britain.
◦ The practice had spread worldwide by about 1900. British social
reformers advocated for the formation of groups of religious women
to staff existing hospitals in the first half of the 19th century.
◦ Two influential women in the field of nursing during this time
period were Elizabeth Fry and Florence Nightingale.
 Modern Nursing
•Florence Nightingale era
• Began in June 15, 1860 when Florence Nightingale school of Nursing opened at
St. Thomas Hospital in London England, where 1st program for formal education of
Nurses began and contributed growth of Nursing in the US

• FACTORS THAT INFLUENCED DEVELOPMENT OF NURSING EDUCATION:

• Social forces
• Trends resulting from war
• Emancipation of women
• Increased educational opportunities

• FLORENCE NIGHTINGALE
• Mother of Modern Nursing
• Lady with the Lamp
• Born on May 12, 1820 in Florence, Italy
• Her SELF-APPOINTED GOAL – to change the profile of Nursing
• She compiled notes of her visits to hospitals, her observations of sanitation
practices and entered Deaconesses School of Nursing at Kaiserswerth,
Germany for 3 months.
◦Florence Nightingale was a philanthropist from a wealthy English family who studied
nursing under the direction of Pastor Fliedner in Germany.
◦ Nightingale forever changed the practice of nursing.
◦At the time, it was unusual for an upper-class woman to care for the sick, but Nightingale felt
a calling to serve humanity.
◦When the Crimea War broke out in 1854, Nightingale was appalled to discover that the
mortality rate of British troops was 41% and that the British army lacked nurses.
◦Owing to Nightingale’s efforts, the number of deaths among British soldiers decreased
dramatically within months.
◦When Nightingale returned to England, she was hailed a heroine. She then established
the Nightingale School of Nursing at St. Thomas’s Hospital in London, offering education
for professional nurses.
 EDUCATIVE PERIOD

• THE CONCEPTS OF FLORENCE NIGHTINGALE ON NURSING

SCHOOL:
• School of Nursing should be self-supporting not
subject to the whimps of the Hospital.
• Have decent living quarters for students and pay Nurse
instructors
• Correlate theories to practice
• Support Nursing research and promote continuing
education for nurses
• Introduce teaching knowledge that disease could be eliminated
by cleanliness and sanitation and Florence Nightingale likewise
did not believed in the Germ Theory of Bacteriology.
• Wrote Notes on Nursing, “What it is and what it is not.”
 Florence Nightingale’s Contributions to Nursing
Changed negative image of Nursing to a positive one
Contributions
• Trained women for future work
• Selective- only those with upstanding characteristics for a potential
nurse
• Identifying client’s needs and how nurses could meet them
• Improving sanitation conditions for sick & injured in the filed and
hospitals
• Reduced death rate of British soldiers
• Establishing nursing education-Provided classroom & clinical (skills)
teaching
• Advocated for life-long nursing education
• Good documentation
 The 19th and 20th Centuries
◦In the late 19th century, nursing professionalized rapidly
in the United States.
◦Women who had served as nurses during the Civil War
realized the importance of a formal nursing education
and played a crucial role in establishing the first nurse
training schools.
◦Hospitals began setting up nursing schools that
attracted women from both working-class and middle-
class backgrounds.
 Cont..
◦The first permanent school of nursing founded in the United States
was the nurse training school at the Women’s Hospital of
Philadelphia, which was established in 1872.
◦During the second half of the 20th century, the number of
graduate programs in nursing grew rapidly.
◦ Graduate nursing programs focusing on clinical specialties laid
the basis for the expansion of advanced practice nursing.
◦ By the end of the 1960s, there were 1,343 nursing schools with
1,64,545 nursing
students enrolled, according to the National Student Nurses
Association (NSNA)
 Joining the future nursing
◦From the beginning of mankind, people have performed the functions we know
now as nursing care.
◦Nursing has come a long way since its early days, when nurses were untrained and
looked down upon by the rest of society.
◦Today’s nurses are well educated and have earned the trust and respect of the
public.
◦ The history of nursing shaped our current healthcare system, but nurses must
continue to monitor developments in science and technology, as well as changes in
society to determine how to help the needs of the future.
HISTORY OF NURSING IN ZAMBIA
• In Zambia, the modern field of
medicine, including nursing, was
introduced by the missionaries
in the 17thCentury
• The Lusaka Central Hospital
was the first to train nurses
• The first Zambian woman to
come for nursing training was
Mrs Kapelwa Mwanangúmbi
Sikota from Lusaka
HISTORY OF NURSING IN ZAMBIA
• At the time of independence in 1964, thre were only few
nurses practicing in the entire country with a population
of about 3.4 million.
• The hospitals were understaffed and nursing lacked
professional and social status.
• In 1991, the National Health Committee
emphasized the integration of curative and
preventive medicine at all levels
• As a result, the General Nursing Council (GNC) was
established in 1957 to regulate the standards of nursing
education.
CURRENT STATUS OF NURSING IN ZAMBIA
• According to the WHO, the number of
nurses per 10,000 population in Zambia
is 0.8 nurse to 1,000 population
• 16 nurses per 10,000 or low-income
countries
• (WHO, It has one of the lowest Human
Development Index (0.481, ranking 164
in the world), the second lowest for
Southern Africa, after Mozambique
with regard to the number of nurses
 CURRENT STATUS OF NURSING IN ZAMBIA
• Zambia’s nurse-to-population
ratio is 0:875, including registered
nurses and midwives.
• The WHO recommends a nurse-
to-patient ratio of 1:500.
CURRENT STATUS OF NURSING IN ZAMBIA
• There are 1.3376 million
registered nurses/midwives and
auxiliary nurse midwives in
Zambia, according to GNC data.
• Zambia is short of 20, 000 nurses
to service over 15 million people.
Minister of Health Chitalu Chilufya
said Government plans to recruit 30,
000 nurses by 2030 to meet the
deficit (WHO).
 Number of Institutions Providing
Nursing Education and Nursing Workforce
in Zambia(2019)

•Govt Schools- 24
•Private – 29
•Faith based - 07
•BSc – 12
•MSc- 4
 History of Nursing Education in Zambia
• 17 C – First health services were provided by the missionaries
from the 17th century who came to spread the gospel and saw
the need to help the needy
• 18 C - Nursing education started in the 18th century
• ANM programme started
• 1900 - Mbeleshi hospital was opened with training of female
helpers in hygiene skills and went round villages providing
information on hygiene
• 1936 - first training for medical Assistants was opened in Lusaka
and later converted to RN program – Lusaka School of Nursing
• 1947 - Chikankata started the Medical assistant course for girls
and in 1956, the midwifery school was opened at Chikankata
• 1950 - Northern Rhodesia Nurses Association founded by Dora
Norman in 1950 and was registered in 1951 by the ICN
• 1952 - St Francis Hospital was opened in Katete to train Medical
Assistants both male and female
• 1964 - Liewellyn school of Nursing in Kitwe with Miss Lois m.
Bell as WHO Advisor for RN program
• 1965 - The act was passed for the establishment of GNC and
enacted in 1997 as an Act of 1997 No. 23
• 1976 - Post Basic Nursing was established for nurse tutors &
Public Health Nurses
 History of Nursing Education in Zambia
• 1982 - Chipata School of Nursing was officially opened training
enrolled nurses and midwives & upgraded to RN in 1998
• 2004 – The Masters of Science in Nursing (MscN) degree
program was established
• 2008 – the MOH established a direct Entry Midwifery
program to curb the shortage of midwives with Chipata
School pioneering
• 2016 - The PhD in Midwifery and Clinical Nursing programs
 TRENDS IN NURSING
•The simple meaning of trend is
‘movement in a particular
direction’.
•The trends in nursing education
are the cornerstones for the
dynamic nature of nursing
profession.
 TRENDS IN NURSING
• Nursing trends:-refers to
direction towards which the
different nursing events have
moved or are moving as well as
the opinion in & around nursing
that are found in & about
nursing profession.
 TRENDS IN NURSING
• Trends in nursing that is
currently taking place in any
area of nursing which affects the
profession as a whole are:-
 Social change
Change in other profession
Nursing informatics
High technology etc
 TRENDS IN NURSING
• Social change
• Nursing profession serves to
meet the need of the society
particularly the needs related to
health & well being.
• The changes in society will
influence and bring about
changes in nursing profession.
 TRENDS IN NURSING
• Change in other profession
• Medical profession is a fast changing profession &
the era of specialization & super specialization has
come.
• Modern health care facility like ICU, Renal unit,
Organ transplant unit etc, have far advanced
resulting in newer diagnostic equipment such as
scanner, New drugs, monitoring system in field of
health care all over the world.
TECHNOLOGY & NURSING
• Nursing Informatics:
• “science and practice (that)
integrates nursing, its
information and knowledge,
with management of
information and
communication
technologies.”
High Tech - High Touch
Approach
Present day nursing
education is preparing
students to maintain
the human element of
nursing care with the
help of sophisticated
technology and
gadgets.
 Advanced Educational Technology:
• Advanced educational technology
media like projectors, Smart
boards, computer models and
simulation labs are now widely
used
• Nursing students widely use
smartphones, tablets and android
applications
• Android apps provide
information to the fingertips of
the students
Animations & Cinematic
Technology:
• Animations are now widely
used .
• Video assisted teachings with
the help of animation are being
widely .
• Nursing procedures, physical
examination, breath sounds
and stages of labor can be
made clear and thorough this .
 STUDENT POPULATION
• Enrolment of Men as
Nursing Students:
• Nursing was considered as
a female profession at least
in India.
• In present generation the
trend is changing. In the past
few decades the number of
males enrolled for Nursing
has increased.
 Changing demography of Nursing Students:
• In older days nursing care
was provided by nun sisters
and many of the major
hospitals were established
by missionaries.
• Present day nursing
students represents a
diverse population in terms
of gender, age and socio
economic status.
 EVIDENCE BASED PRACTICE:
• EBP is defined as “a
problem-solving
approach to clinical care
that incorporates the
conscientious use of
current best evidence
from well-designed
studies.
 Clinical Instruction – Training
the Trainers:
• Over a period of time
more emphasis is given
on clinical nursing
education.
• Nursing faculty is now
taking up responsibility
& accountability to
patient care.
EVALUATION SYSTEM
• University Based Education:
Registered Nursing and other courses were offered
in Schools of Nursing that were not affiliated to any
University.

• B Sc. Nursing and MSc. Nursing courses are being

offered to nursing students in Colleges of Nursing
which is either affiliated to, or a constituent of a
university.
 Innovative Evaluation
•Strategies:
Innovative evaluation strategies
like ‘Objective Structured Clinical
Evaluation’ (OSCE), Rubrics, are
now widely being used.
• OSCEs are widely used to
evaluate clinical skills
and competencies.
• In clinical nursing education,
rubrics are used to objectively
assess student performance and
it focuses on aspects of patient
safety.
 QUALITY
•ASSURANCE
Educational Quality
Assurance: The trend of
educational quality assurance
has emerged recently.
• In Zambia nursing
education is flourishing in
an unprecedented manner,
naturally this will lead to the
dilution in the quality of
nursing education.
 Advanced Nursing
• Nurses
Coursesin clinical area is also
now focusing on their career
advancements by continuing
nursing education programs
and in-service education.
• Higher studies in abroad is
also becoming more
popular
• There is a high demand for;
Nurse Practitioner, Clinical
Nurse Specialist, MPhil and
 Research in Nursing Education:
• Research has become a major
area in curriculum. Action
research and the use of
qualitative methodologies in
research is getting wider
acceptance now.
• Educational research focuses
on enhancement of the
teaching and learning process.
E Learning & Online Education:
• E learning and online education
are becoming important which
increases the scope of universal
learning.
• Education is becoming
accessible in the tips of every
nurse by the technological
advancements and the
implementation of e learning in
nursing
Interprofessional Education (IPE)
•The need of collaborative
practices among health
care professionals led to
the emergence of IPE.
•Individuals from different
professions learn
together
SUMMARY
 CONCLUSION:
• Trends are changes that takes place and become
vogue.
• The technological changes, changes in
demographics and health patterns have
contributed to various trends in nursing
education.
• The dynamic nature of nursing education strive
to enhance the quality of care, the core of
nursing.
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