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History of Nursing

Dione Blas Rey R. Abogadie MAN, RN

Clinical Instructor

Since the beginnings of time, nursing has been shaped by different cultures and societies and by the changes within those societies. The word nursing derives its meaning from the Latin word nutricius which means nourishing. Therefore, in the ancient world nursing was viewed as a role of caring for the family and not a profession.

In the world history of nursing, roots can be traced to religion, mythology, and Eastern and Western societies. The ancient Egyptians utilized perhaps the first formal nurses, hiring them to assist in childbirth. It is from these beginnings that today s midwives evolved. Among the Greeks and Romans, it was believed that gods and goddesses influenced healing.

There was a deity for almost every human biological function. The women of the family of Asklepios were mythological nurses. The world s history of nursing records Hygeia as being the goddess of health. In the Roman Empire, Roman noblewomen cared for the sick. However, in some cultures the care of the sick was not a revered enterprise and was a task of prostitutes.

During the middle ages, the focus of the world history of nursing changed and became centralized around religious orders. Care of the sick was seen as a function of the church. Nursing care was provided by both men and women and was segregated by sex with persons caring for others of the same gender.

War has had the greatest influence upon the world history of nursing, for historically it has been through war that the demand for nurses has been the greatest. Perhaps the person who has been ascribed the distinction of having changed the world history of nursing the most was Florence Nightingale.

Nursing continues to evolve and be shaped as a body of science and has made great professional strides since its inception. The world history of nursing reveals that nurses, whether formal or informal have long filled a needed place in society. Nurses now are needed more than ever before. Now, as today s nurses shape the world history of nursing, we look forward to the respect the profession deserves.

I. Period of Intuitive Nursing/Medieval Period Nursing was untaught and instinctive. It was performed of compassion for others, out of the wish to help others. Nursing was a function that belonged to women. It was viewed as a natural nurturing job for women. She is expected to take good care of the children, the sick and the aged. No caregiving training is evident. It was based on experience and observation.

Primitive men believed that illness was caused by the invasion of the victim s body of evil spirits. They believed that the medicine man, Shaman or witch doctor had the power to heal by using white magic, hypnosis, charms, dances, incantation, purgatives, massage, fire, water and herbs as a mean of driving illness from the victim. Trephining drilling a hole in the skull with a rock or stone without anesthesia was a last resort to drive evil spirits from the body of the afflicted.

II. Period of Apprentice Nursing/Middle Ages Care was done by crusaders, prisoners, religious orders Nursing care was performed without any formal education and by people who were directed by more experienced nurses (on the job training).This kind of nursing was developed by religious orders of the Christian Church. Nursing went down to the lowest level -wrath/anger of Protestantism confiscated properties of hospitals and schools connected with Roman Catholicism.

- Nurses fled their lives; soon there was shortage of people to care for the sick - Hundreds of Hospitals closed, there was no provision for the sick, no one to care for the sick - Nursing became the work of the least desirable of women prostitutes, alcoholics, prisoners Pastor Theodore Fliedner and his wife, frederika established the Kaiserswerth Institute for the training of Deaconesses (the 1st formal training school for nurses) in Germany. - This was where Florence Nightingale received her 3month course of stude in nursing.

III. Period of Educated Nursing/Nightingale Era 19th20th century The development of nursing during this period was strongly influenced by: a.) trends resulting from wars Crimean, civil war b.) arousal of social consciousness c.) increased educational opportunities offered to women. Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit female nurses to provide care for the sick and injured in the Crimean War.

In 1860, The Nightingale Training School of Nurses opened at St. Thomas Hospital in London. - The school served as a model for other training schools. Its graduates traveled to other countries to manage hospitals and institute nurse-training programs. - Nightingale focus vision of nursing Nightingale system was more on developing the profession within hospitals. Nurses should be taught in hospitals associated with medical schools and that the curriculum should include both theory and practice. - It was the 1st school of nursing that provided both theory-based knowledge and clinical skill building. Nursing evolved as an art and science Formal nursing education and nursing service begun

FACTS ABOUT FLORENCE NIGHTINGALE Mother of modern nursing. Lady with the Lamp because of her achievements in improving the standards for the care of war casualties in the Crimean war. Born may 12, 1800 in Florence, Italy Raised in England in an atmosphere of culture and affluence Not contended with the social custom imposed upon her as a Victorian Lady, she developed her self-appointed goal: To change the profile of Nursing She compiled notes of her visits to hospitals and her observations of the sanitary facilities, social problems of the places she visited.

Noted the need for preventive medicine and god nursing Advocated for care of those afflicted with diseases caused by lack of hygienic practices At age 31, she entered the Deaconesses School at Kaiserswerth inspite of her family s resistance to her ambitions. She became a nurse over the objections of society and her family.

Worked as a superintendent for Gentlewomen Hospital, a charity hospital for ill governesses. Disapproved the restrictions on admission of patients and considered this unchristian and incompatible with health care Upgraded the practice of nursing and made nursing an honorable profession for women. Led nurses that took care of the wounded during the Crimean war Put down her ideas in 2 published books: Notes on Nursing, What It Is ans What It Is Not and Notes on Hospitals. She revolutionized the public s perception of nursing (not the image of a doctor s handmaiden) and the method for educating nurses.

IV. Period of Contemporary Nursing/20th Century Licensure of nurses started Specialization of Hospital and diagnosis Training of Nurses in diploma program Development of baccalaureate and advance degree programs

Scientific and technological development as well as social changes mark this period. a. Health is perceived as a fundamental human right b. Nursing involvement in community health c. Techological advances disposable supplies and equipments d. Expanded roles of nurses was developed e. WHO was established by the United Nations f. Aerospace Nursing was developed g. Use of atomic energies for medical diagnosis, treatment h. Computers were utilized-data collection, teaching, diagnosis, inventory, payrolls, record keeping, billing. i. Use of sophisticated equipment for diagnosis and therapy.

A.1.1. Early Beliefs and Practices (Diseases and their causes and treatment were shrouded with mysticism and superstitions.) 1. Beliefs about causation of disease: another person (an enemy or a witch) evil spirits 2. Belief that evil spirits could be driven away by persons with powers to expel demons. Belief in special gods of healing, with the priest -physician (called word doctors ) as intermediary. If they used leaves or roots, they were called herb doctors ( herbolarios )

Early Care of the Sick The early Filipinos subscribed to superstitious belief and practices in relation to health and sickness. Herb men were called herbicheros meaning one who practiced witchcraft. Persons suffering from diseases without any identified cause were believed bewitched by mangkukulam or mangagaway . Difficult childbirth and some diseases (called pamao ) were attributed to nunos . Midwives assisted in childbirth. During labor, the mabuting hilot (good midwife) was called in. If the birth became difficult, witches were supposed to be the cause. To disperse their influence, gunpowder were exploded from a bamboo cane close to the head of the sufferer.

Health Care During the Spanish Regime The religious orders exerted their efforts to care for the sick by building hospitals in different parts of the Philippines. The earliest hospitals were: Hospital Real de Manila (1577) it was established mainly to care for the Spanish king s soldiers, but also admitted Spanish civilians; founded by Gov. Francisco de Sande. San Lazaro Hospital (1578) founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy. Hospital de Indios (1586) established by the Franciscan Order; service was in general supported by alms and contributions from charitable persons. Hospital de Aguas Santas (1590) established in Laguna; near a medicinal spring, founded by Brother J. Baustista of the Franciscan Order. San Juan de Dios Hospital (1596) founded by the Brotherhood of Misericordia and administered by the Hopsitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general health service to the public.

Nursing During the Philippine Revolution Josephine Bracken, wife of Jose Rizal- installed a field hospital in an estate house in Tejeros; provided nursing care to the wounded night and day Rosa Sevilla de Alvero- converted their house into quarters for the Filipino soldiers; during the Philippine-American War that broke out in 1899 Dona Hilaria de Aguinaldo- wife of Emilio Aguinaldo; organized that Filipino Red Cross under the inspiration of Mabini Dona Maria Agoncillo de Aguinaldo- second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during the revolution, President of the Filipino Red Cross branch in Batangas Melchora Aquino (Tandang Sora) nursed the wounded Filipino soldiers and gave them shelter and food

Capitan Salome a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat Agueda Kahabagan- revolutionary leader in Laguna, also provided nursing services to her troops Trinidad Tecson ( Ina ng Biak-na-Bato )- stayed in the hospital at Biak na Bato to care for wounded soldiers

Hospitals and nursing schools  Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)  It was ran by the Baptist Foreign Mission Society of America.  Miss Rose Nicolet, a graduate of New England Hospital for Women and Children in Boston, Massachusetts was the first superintendent for nurses.  It moved from its present location to Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of the school in 1942.  In April 1944 graduate nurses took the first Nurses Board Examination at the Iloilo Mission Hospital.

Philippine General Hospital School of Nursing (Manila, 1907) PGH began in 1901 as a small dispensary for Civil officers and Employees in the City of Manila and later grew as a Civil Hospital. In 1906, Mary Coleman Masters, an educator advocated for the idea of training Filipino girls for the profession of nursing with the approval of Government officials, she first opened a dormitory for Girls enrolled at the Philippine Normal Hall and the University of the Philippines.

In 1907, with the support of Governor General Forbes and the Director of Health and among others, she opened classes in nursing under the Auspices of the Bureau of Education. Admission was based on an entrance examination. The applicant must have completed elementary education to the seventh grade. Julia Nichols and Charlotte Clayton taught the students nursing subjects. American physician also served as lecturers. In 1910, the Act No. 1976 modified the organization of the school placing it under the supervision of the Department of Health. The Civil Hospital was abolished and the Philippine General Hospital was established.

St. Luke s Hospital School of Nursing (Quezon City, 1907) The hospital is an Episcopalian Institution. It began as a small dispensary in 1903. In 1907, the school opened with three girls admitted. These three girls had their first year in combined classes with the PGHSchool of Nursing and St. Paul s Hospital School of Nursing. Miss Helen Hicks was the first principal. Mrs. Vitaliana Beltran was the first Filipino superintendent of nurses and Dr. Jose Fores was the first medical director of the hospital.

Mary Johnston Hospital and School of Nursing (Manila, 1907) It started as a small dispensary on Calle Cervantes (now Avenida). It was called the Bethany Dispensary and funded by the Methodist Mission for the relief of suffering among women and children. In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley and Gertude Dreisbach, organized the Mary Johnston School of Nursing. The nurses training course began with three Filipino young girls fresh from elementary as their first students.

Philippine Christian Mission Institute Schools of Nursing The United Christian Missionary Society of Indianapolis, Indiana- a Protestant organization of the disciples of Christ operated three schools of nursing: Sallie Long Read Memorial Hospital School of Nursing (Laoag Ilocos Norte, 1903) Mary Chiles Hospital School of Nursing (Manila, 1911) The hospital was established by Dr. WN Lemon in a small house on Azcarraga, Sampaloc, Manila. In 1913, Miss Mary Chiles of Montana donated a large sum of money with which the preset building at Gastambide was bought. The Tuason Annex was donated by Miss Esperanza Tuason, a Filipino Philantropist.

Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912) San Juan de Dios Hospital School of Nursing (Manila, 1913) In 1913, through the initaiative of Dr. Benito Valdez, the board of inspectors and the executive board of the hospital passed a resolution to open school of nursing. The school has been run by the Daughters of Charity since then. Sister Taciana Tinanes was the first Directress of the School

Emmanuel Hospital School of Nursing (Capiz, 1913) In 1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo to Capiz for the purpose of opening a hospital. Miss Rose Nicolet assisted him. The school offered a 3-year training course for an annual fee of Php 100.00. Miss Clara Pedrosa was the first principal Southern Islands Hospital School of Nursing (Cebu, 1918) The hospital was established in 1911 under the Bureau of Health. The school opened in 1918 with Anastacia Giron-Tupas as the orginizer. Miss Visitacion Perez was the first principal

Other Schools of Nursing 1.Zamboanga General Hospital School of Nursing (1921) 2.Chinese General Hospital School of Nursing (1921) 3.Baguio General Hospital School of Nursing (1923) 4.Manila Sanitarium Hospital and School of Nursing (1930) 5.St. Paul School of Nursing in Iloilo City (1946) 6.North General Hospital and School of Nursing (1946) 7.Siliman University School of Nursing (1947)

The FIRST Colleges of Nursing in the Philippines University of Santo Tomas-College of Nursing (1946) In its first year of existence, its enrolees were consisted of students from different school of nursing whose studied were interrupted by the war. In 1947, the Bureau of Private Schools permitted UST to grant the title Graduate Nurse to the 21 students who were of advance standing from 1948 up to the present. The college has offered excellent education leading to a baccalaureate degree. Sor Taciana Trinanes was its first directress. Presently, Associate Professor Glenda A. Vargas, RN, MAN serves as its Dean.

Manila Central University-College of Nursing (1947)

The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and served as the clinical field for practice. Miss Consuelo Gimeno was its first principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its Dean.

University of the Philippines Manila-College of Nursing (1948) The idea of opening the college began in a conference between Miss Julita Sotejo and UP President. In April 1948, the University Council approved the curriculum, and the Board of Regents recognized the profession as having an equal standing as Medicine, Engineering etc. Miss Julita Sotejo was its first dean. Presently, Professor Josefina A. Tuason, RN, MAN, DrPh is once more reappointed as the Dean of UP Manila College of Nursing

Criteria of a Profession Nursing is gaining recognition as a profession. Profession has been defined as an occupation that requires extensive education or a calling that requires:
special knowledge, skill, and preparation.

A profession is generally distinguished from kinds of occupations by

(a) its requirement of prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed; (b) an orientation of the individual toward service, either to a community or to an organization (c) ongoing research (d) a code of ethics (e) autonomy (f) a professional organization

Two terms related to profession need to be differentiated: Professionalism refers to professional character, spirit, or methods. It is a set of attributes, a way of life that implies responsibility and commitment. Nursing professionalism owes much to the influence of Florence Nightingale. Professionalization- is the process of becoming professional, that is, of acquiring characteristics considered to be professional.

ARTICLE VI Nursing Practice

Section 28. Scope of Nursing. - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any health care setting. It includes, but not limited to, nursing care during conception, labor, delivery, infancy, childhood, toddler, preschool, school age, adolescence, adulthood, and old age.

As independent practitioners, nurses are primarily responsible for the promotion of health and prevention of illness. A members of the health team, nurses shall collaborate with other health care providers for the curative, preventive, and rehabilitative aspects of care, restoration of health, alleviation of suffering, and when recovery is not possible, towards a peaceful death. It shall be the duty of the nurse to:

(a) Provide nursing care through the utilization of the nursing process. Nursing care includes, but not limited to, traditional and innovative approaches, therapeutic use of self, executing health care techniques and procedures, essential primary health care, comfort measures, health teachings, and administration of written prescription for treatment, therapies, oral topical and parenteral medications, internal examination during labor in the absence of antenatal bleeding and delivery. In case of suturing of perineal laceration, special training shall be provided according to protocol established;

(b) establish linkages with community resources and coordination with the health team; (c) Provide health education to individuals, families and communities; (d) Teach, guide and supervise students in nursing education programs including the administration of nursing services in varied settings such as hospitals and clinics; undertake consultation services; engage in such activities that require the utilization of knowledge and decision-making skills of a registered nurse; and (e) Undertake nursing and health human resource development training and research, which shall include, but not limited to, the development of advance nursing practice;

Provided, That this section shall not apply to nursing students who perform nursing functions under the direct supervision of a qualified faculty: Provided, further, That in the practice of nursing in all settings, the nurse is duty-bound to observe the Code of Ethics for nurses and uphold the standards of safe nursing practice. The nurse is required to maintain competence by continual learning through continuing professional education to be provided by the accredited professional organization or any recognized professional nursing organization: Provided, finally, That the program and activity for the continuing professional education shall be submitted to and approved by the Board.