The Evolution of Professional Nursing



The Evolution of Professional Nursing


Susan R. Jacob, PhD, MSN, RN




Key Terms



Clinical nurse leader (CNL)


A master’s degree–educated RN who assumes accountability for client care outcomes through the assimilation and application of research-based information to design, implement, and evaluate client plans of care. The CNL is a provider and a manager of care at the point of care to individuals and cohorts or populations. The CNL designs, implements, and evaluates client care by coordinating, delegating, and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals (AACN Updated White Paper on the Role of the Clinical Nurse Leader, July 2007).


Doctor of nursing practice (DNP)


A practice-focused doctoral degree in nursing. The degree that is recommended by the American Association of Colleges of Nursing (AACN) for all advanced practice nurses by 2015.


Clinical nurse specialist (CNS)


An advanced practice nurse who possesses expertise in a defined area of nursing practice for a selected client population or clinical setting. The CNS functions as an expert clinician, educator, consultant, researcher, and administrator.


Florence Nightingale (1820 to 1910)


Considered the founder of organized, professional nursing. She is best known for her contributions to the reforms in the British Army Medical Corps, improved sanitation in India, improved public health in Great Britain, use of statistics to document health outcomes, and the development of organized training for nurses.


Professional nurse


A specially trained professional that addresses the humanistic and holistic needs of patients, families, and environments and provides responses to patterns and/or needs of patients, families, and communities to actual and potential health problems. The professional nurse has diverse roles, such as health care provider, client advocate, educator, care coordinator, primary care practitioner, and change agent (Katz et al, 2009).



We thank Shiphrah A. Williams-Evans, PhD, APRN, BC for her contribution to this chapter in the 4th edition.




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Additional resources are available online at:


http://evolve.elsevier.com/Cherry/


Vignette


Toba Kamotu is a 17-year-old African-American college freshman who has been treated for depression for the past year at a local mental health center. It has also been reported that she suffered from anorexia and bulimia, in that she was vomiting frequently. Her treatment consisted of Zoloft 100 mg once daily and psychotherapy sessions once each week. Toba also had been complaining of somatic pain for the past 6 months. The pain radiated up her right leg and had a “pins and needles sensation.” Her therapist told her that these symptoms sometimes accompany depression and would dissipate as her depression improved. The pain in her leg kept her awake at night and was affecting her ability to study.


Toba’s college roommate was a nursing student who insisted that she be seen for her physical complaints. Because Toba had no insurance, she knew that her access to care would be limited. Therefore, she was reluctant to seek health care services. The clinic that she preferred did not take Medicaid or medical assistance patients of any kind. Her roommate asked one of her nursing professors what Toba should do, and the professor referred them to a clinic that provided care to individuals in the community who had limited funds. Toba called immediately but was told that the earliest available appointment would be 2 months later. She made the appointment and placed her name on a waiting list to be seen earlier.


Within 2 weeks, Toba awakened vomiting and complaining to her roommate of feeling very hot. She was unable to walk because of excruciating pain in her right leg and was taken to the hospital by ambulance. When she arrived, her temperature was 103° F. A computed tomography (CT) scan was performed that indicated she had a liver mass measuring 10 cm. On biopsy the mass was determined to be malignant. Dr. Tabitha Winthrop, her oncologist, recommended chemotherapy to decrease the size of the mass so that surgery could be performed. It was also speculated that if this therapy worked, she could become a candidate for liver transplant and would be placed on the transplant list. Toba was placed under the care of the palliative care team, an interprofessional group of health professionals that was coordinated by an advanced practice nurse who was nationally certified by the National Board for Certification of Hospice and Palliative Nurses. The palliative care team consisted of a clinical nurse leader, clinical nurse specialist, and a registered nurse (RN), all nationally certified in palliative and hospice nursing; a counselor; medical director; case manager; and a representative from pastoral care. In this case, a child life specialist was also included as part of the team, as a result of the patient’s age. Palliative care at this institution was defined as treatment of any patient who was experiencing a life-altering, debilitating, and/or life-threatening illness or injury. Toba was definitely experiencing a condition that would alter her life as an adolescent and might eventually become debilitating and life threatening, depending on the disease process and treatment options.


The palliative care team assists with symptom management and assessment of family dynamics, and provides emotional and spiritual support. The team also assists the patient to set goals to maintain her optimal level of functioning throughout treatment, with consideration of cultural aspects of care, in addition to discharge planning and communication deficits that are prominent in patients who are undergoing life-altering experiences. The ultimate goal is to maintain the highest optimal functioning and provide the highest-quality comprehensive care.


Florence Nightingale and Mary Seacole were trailblazers who began the work of organized nursing. Since their time, nursing has evolved into a profession that is focused on meeting the needs of the people it serves and preparing providers who can meet those needs. This vignette demonstrates just one instance of how a variety of nurse providers can assist in enhancing the quality of care.




Chapter Overview


Throughout the pages of recorded history, nursing has been integrated into every facet of life. A legacy of human caring was initiated when, according to the book of Exodus, two midwives, Shiphrah and Puah, rescued the baby Moses and hid him to save his life. This legacy of caring has progressed throughout the years, responding to psychologic, social, environmental, and physiologic needs of society. Nurses of the past and present have struggled for recognition as knowledgeable professionals. The evolution of this struggle is reflected in political, cultural, environmental, and economic events that have sculpted our nation and world history (Catalano, 2012).


In the beginning, men were recognized as health healers. Women challenged the status quo and transformed nursing from a mystical phenomenon to a respected profession (Catalano, 2012). Florence Nightingale and Mary Seacole played major roles in bringing about changes in nursing. Using the concept of role modeling, these women demonstrated the value of their worth through their work in fighting for the cause of health and healing. During the twentieth century, nurses made tremendous advancements in the areas of education, practice, research, and technology. Nursing as a science progressed through education, clinical practice, development of theory, and rigorous research. Today nurses continue to be challenged to expand their roles and explore new areas of practice and leadership. This chapter provides a brief glimpse of health care practices and nursing care in the prehistoric period and early civilization and then describes the evolution of professional nursing practice. Box 1-1 summarizes some of the important events in the evolution of nursing.



BOX 1-1   IMPORTANT EVENTS IN THE EVOLUTION OF NURSING




1751 The Pennsylvania Hospital is the first hospital established in America.


1798 The U.S. Marine Hospital Service comes into being by an act of Congress on July 16. It is renamed the U.S. Public Health Service in 1912.


1840 Two African-American women, Mary Williams and Frances Rose, who founded Nursing Sisters of the Holy Cross, are listed as nurses in the City of Baltimore Directory.


1851 Florence Nightingale (1820-1910) attends Kaiserswerth to train as a nurse.


1854 During the Crimean War, Florence Nightingale transforms the image of nursing. Mary Seacole, a black woman from Jamaica, West Indies, nurses during the same time.


1861 The outbreak of the Civil War causes African-American women to volunteer as nurses. Among these women are Harriet Tubman, Sojourner Truth, and Susie King Taylor.


1872 Another school of nursing opens in the United States: the New England Hospital for Women and Children in Boston, Massachusetts.


1873 Linda Richards is responsible for designing a written patient record and physician’s order system—the first in a hospital.


1879 Mary Mahoney, the first trained African-American nurse, graduates from the New England Hospital for Women and Children in Boston, Massachusetts.


1882 The American Red Cross is established by Clara Barton.


1886 The Visiting Nurse Association (VNA) is started in Philadelphia; Spelman College, Atlanta, Georgia, establishes the first diploma nursing program for African Americans.


1893 Lillian Wald and Mary Brewster establish the Henry Street Visiting Nurse Service in New York.


1896 The Nurses’ Associated Alumnae of the United States and Canada is established.


1898 Namahyoke Curtis, an untrained African-American nurse, is assigned by the War Department as a contract nurse in the Spanish-American War.


1899 The International Council of Nurses (ICN) is founded.


1900 The first issue of the American Journal of Nursing is published.


1901 The Army Nurse Corps is established under the Army Reorganization Act.


1902 School of nursing is established in New York City by Linda Rogers.


1903 The first nurse practice acts are passed, and North Carolina is the first state to implement registration of nurses.


1908 The National Association of Colored Graduate Nurses is founded; it is dissolved in 1951.


1909 Ludie Andrews sues the Georgia State Board of Nurse Examiners to secure African-American nurses the right to take the state board examination and become licensed; she wins in 1920.


1911 The American Nurses Association (ANA) is established.


1912 The U.S. Public Health Service and the National League for Nursing (NLN) are established.


1918 Eighteen black nurses are admitted to the Army Nurse Corps after the armistice is signed ending World War I.


1919 Public Health Nursing is written by Mary S. Gardner. A public health nursing program is started at the University of Michigan.


1921 The Sheppard-Towner Act is passed providing federal aid for maternal and child health care.


1922 Sigma Theta Tau is founded (becomes the International Honor Society of Nursing in 1985).


1923 The Goldmark Report criticizes the inadequacies of hospital-based nursing schools and recommends increased educational standards.


1924 The U.S. Indian Bureau Nursing Service is founded by Elinor Gregg.


1925 The Frontier Nursing Service is founded by Mary Breckenridge.


1935 The Social Security Act is passed.


1937 Federal appropriations for cancer, venereal diseases, tuberculosis, and mental health begin.


1939 World War II begins.


1941 The U.S. Army establishes a quota of 56 African-American nurses for admission to the Army Nurse Corps. The Nurse Training Act is passed.


1943 An amendment to the Nurse Training bill is passed that bars racial bias.


1945 The U.S. Navy drops the color bar and admits four African-American nurses.


1946 Nurses are classified as professionals by the U.S. Civil Service Commission. The Hospital Survey and Construction Act (Hill-Burton) is passed.


1948 The Brown Report discusses the future of nursing.


1948 Estelle Osborne is the first African-American nurse elected to the board of the ANA. The ANA votes individual membership to all African-American nurses excluded from any state association.


1949 M. Elizabeth Carnegie is the first African-American nurse to be elected to the board of a state association (Florida).


1950 The Code for Professional Nurses is published by the ANA.


1952 National nursing organizations are reorganized from six to two: ANA and NLN.


1954 The Supreme Court decision Brown v. Board of Education asserts that “separate educational facilities are inherently unequal.”


1965 The Social Security Amendment includes Medicare and Medicaid.


1971 The National Black Nurses Association is organized.


1973 The ANA forms the American Academy of Nursing.


1974 The American Assembly of Men in Nursing is founded.


1978 Barbara Nichols is the first African-American nurse elected president of the ANA. M. Elizabeth Carnegie, an African-American nurse, is elected president of the American Academy of Nursing.


1979 Brigadier General Hazel Johnson Brown is the first African-American chief of the Army Nurse Corps.


1985 Vernice Ferguson, an African-American nurse, is elected president of Sigma Theta Tau International.


1986 The Association of Black Nursing Faculty is founded by Dr. Sally Tucker Allen.


1990 Congress proclaims March 10 as Harriet Tubman Day in the United States, honoring her as a brave African-American freedom fighter and nurse during the Civil War.


1990 The Bloodborne Pathogen Standard is established by OSHA.


1991 Healthy People 2000 is published.


1993 The National Center for Nursing Research is upgraded to the National Institute of Nursing Research within the National Institutes of Health.


1994 NCLEX-RN®, a computerized nurse-licensing examination, is introduced.


1996 The Commission on Collegiate Nursing Education is established as an agency devoted exclusively to the accreditation of baccalaureate and graduate-degree nursing programs.


1999 Beverly Malone, the second African-American president of the ANA, is named Deputy Assistant Secretary for Health, Department of Health and Human Services, Office of Public Health and Science.


1999 The IOM releases its landmark report: To Err Is Human: Building a Safer Health System.


2000 M. Elizabeth Carnegie is inducted into the ANA Hall of Fame. The American Nurses Credentialing Center gives its first psychiatric mental health nurse practitioner examination. Healthy People 2010 is published. The AACN reports a faculty vacancy rate of 7.4% among the 220 nursing schools that responded to a survey. According to the AACN, the average age of full-time faculty is older than 50 years of age; the average age of doctorally prepared professors is 55.9 years of age.


2001 Beverly Malone is appointed General Secretary, Royal College of Nursing, London. The Health Care Financing Administration (HCFA) becomes the Centers for Medicare & Medicaid Services (CMS).


2002 Johnson and Johnson Health Care Systems, Inc. launches The Future of Nursing, a national publicity campaign to address the nursing shortage.


2002 To address the nursing shortage, the Nurse Reinvestment Act is signed into law by President George W. Bush.


2002 Significant funding is obtained for geriatric nursing initiatives.


2003 The American Nurses Foundation launches an “Investment in Nursing” campaign to deal with the nursing shortage.


2003 The IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses is released.


2003 The AACN White Paper on the Role of the Clinical Nurse Leader is published.


2005 The CCNE decides that only programs that offer practice doctoral degrees with the Doctor of Nursing Practice (DNP) title will be eligible for CCNE accreditation.


2005 The NLN offers and certifies the first national certification for nurse educators; the initials CNE may be placed behind the names of those certified.


2006 The AACN approves essentials of doctoral education for advanced nursing practice (DNP) (www.aacn.nche.edu/DNP/pdf/Essentials.pdf).


2007 The Commission on Nurse Certification, an autonomous arm of the AACN, begins certifying clinical nurse leaders (CNLs).


2008 The Commission on Collegiate Nursing Education begins accrediting DNP programs.


2010 The Patient Protection and Affordable Care Act (Public Law 111-152) is passed.


2010 The Health Care and Education Affordability Reconciliation Act is passed.


2011 The IOM Report The future of nursing: leading change, advancing health is released.


From AACN, 2003; Carnegie, 1995; Deloughery, 1998; Donahue, 1999; Kalisch and Kalisch, 1995; IOM, 2003; 2011.




Early Civilization


Egypt


Ancient Egyptians are noted for their accomplishments in health care at an early period in civilization. They were the first to use the concept of suture in repairing wounds. They also were the first to be recorded as developing community planning that resulted in a decrease in public health problems. One of the main early public health problems was the spread of disease through contaminated water sources. Specific laws on cleanliness, food use and preservation, drinking, exercise, and sexual relations were developed. Health beliefs of Egyptians determined preventive measures taken and personal health behaviors practiced. These health behaviors were usually carried out to accommodate the gods. Some behaviors were also practiced expressly to appease the spirits of the dead (Catalano, 2012). The Egyptians developed the calendar and writing, which initiated recorded history. The oldest records date back to the sixteenth century bc in Egypt. A pharmacopoeia that classified more than 700 drugs was written to assist in the care and management of disease (Ellis and Hartley, 2012). As in the case of Shiphrah and Puah, the midwives who saved the baby Moses, nurses were used by kings and other aristocrats to deliver babies and care for the young, older adults, and those who were sick.




Greece


From 1500 to 100 bc, Greek philosophers sought to understand man and his relationship with the gods, nature, and other men. They believed that the gods and goddesses of Greek mythology controlled health and illness. Temples built to honor Aesculapius, the god of medicine, were designated to care for the sick. Aesculapius carried a staff that was intertwined with serpents or snakes, representing wisdom and immortality. This staff is believed to be the model of today’s medical caduceus. Hippocrates (460 to 362 bc), considered the “Father of Medicine,” paved the way in establishing scientific knowledge in medicine. Hippocrates was the first to attribute disease to natural causes rather than supernatural causes and curses of the gods. Hippocrates’ teachings also emphasized the patient-centered approach and use of the scientific method for solving problems (Catalano, 2012).




China


The teachings of the Chinese scholar Confucius (551 to 479 bc) had a powerful effect on the customs and practices of the people of ancient China. Confucius taught a moral philosophy that addressed one’s obligation to society. Several hundred years after his death, Confucius’ philosophy became the basis for Chinese education and government. Central to his teachings were service to the community and the value of the family as a unit. However, women were considered inferior to men.


The early Chinese also placed great value on solving life’s problems. Their belief about health and illness was based on the yin and yang philosophy. The yin represented the feminine forces, which were considered negative and passive. The yang represented the masculine forces, which were positive and active. The Chinese believed that an imbalance between these two forces would result in illness, whereas balance between the yin and yang represented good health (Ellis and Hartley, 2012). The ancient Chinese used a variety of treatments believed to promote health and harmony, including acupuncture. Acupuncture involves insertion of hot and cold needles into the skin and underlying tissues to manage or cure conditions (such as pain, stroke, or breathing difficulty) and ultimately to affect the balance of yin and yang. Hydrotherapy, massage, and exercise were used as preventive health measures (Giger and Davidhizar, 2004). Baths were used to reduce fever, and bloodletting was used to release evil spirits from the body (Ellis and Hartley, 2012).




The Middle Ages


The Middle Ages (476 bc to 1450 ad) followed the demise of the Roman Empire (Walton et al, 1994). Women used herbs and new methods of healing, whereas men continued to use purging, leeching, and mercury. This period also saw the Roman Catholic Church become a central figure in the organization and management of health care. Most of the changes in health care were based on the Christian concepts of charity and the sanctity of human life. Wives of emperors and other women considered noble became nurses. These women devoted themselves to caring for the sick, often carrying a basket of food and medicine as they journeyed from house to house (Bahr and Johnson, 1997). Widows and unmarried women became nuns and deaconesses. Two of these deaconesses, Dorcas and Phoebe, are mentioned in the Bible as outstanding for the care they provided to the sick (Freedman, 1995).


During the Middle Ages, physicians spent most of their time translating medical essays; they actually provided little medical care. Poorly trained barbers, who lacked any formal medical education, performed surgery and medical treatments that were considered “bloody” or “messy.” Nurses also provided some medical care, although in most hospitals and monasteries, female nurses who were not midwives were forbidden to witness childbirth, help with gynecologic examinations, or even diaper male infants (Kalisch and Kalisch, 1986). During the Crusades, which lasted for almost 200 years (from 1096 to 1291), military nursing orders, known as Templars and Hospitalers, were founded. Monks and Christian knights provided nursing care and defended the hospitals during battle, wearing a suit of armor under their religious habits. The habits were distinguished by the Maltese cross to identify the monks and knights as Christian warriors. The same cross was used years later on a badge designed for the first school of nursing and became a forerunner for the design of nursing pins (Ellis and Hartley, 2012).



The Renaissance and the Reformation Period


Following the Middle Ages came the Renaissance and the Reformation, also known as the rebirth of Europe (the fourteenth to sixteenth centuries ad). Major advancements were made in pharmacology, chemistry, and medical knowledge, including anatomy, physiology, and surgery. During the Renaissance, new emphasis was given to medical education, but nursing education was practically nonexistent.


The Reformation that began in Germany in 1517 was a religious movement that resulted in a dissention between Roman Catholics and Protestants. During this period, religious facilities that provided health care closed. Women were encouraged toward charitable services, but their main duties included bearing and caring for children in their homes. Furthermore, hospital work was no longer appealing to women of high economic status, and the individuals who worked as nurses in hospitals were often female prisoners, prostitutes, and drunks. Nursing was no longer the respected profession it had once been. This period is referred to as the “Dark Ages” of nursing (Ellis and Hartley, 2012).


During the sixteenth and seventeenth centuries, famine, plague, filth, and horrible crimes ravaged Europe. King Henry VII eliminated the organized monastic relief programs that aided the orphans, poor, and other displaced people. Out of great concern for social welfare, several nursing groups, such as the Order of the Visitation of St. Mary, St. Vincent de Paul, and the Sisters of Charity, were organized to give time, service, and money to the poor and sick. The Sisters of Charity recruited intelligent young women for training in nursing, developed educational programs, and cared for abandoned children (Ellis and Hartley, 2012).



The Colonial American Period


The first hospital and the first medical school in North America were founded in Mexico—the Hospital of the Immaculate Conception in Mexico City and the medical school at the University of Mexico. During this time in the American colonies, individuals with infectious diseases were isolated in almshouses or “pesthouses” (Ellis and Hartley, 2012). Procedures, such as purgatives and bleeding, were widely used, leading to shortened life expectancy. Plagues, such as scarlet fever, dysentery, and smallpox, caused thousands of deaths. Benjamin Franklin, who was outspoken regarding the care of the sick, insisted that a hospital be built in the colonies. He believed that the community should be responsible for the management and treatment of those who were ill. Through his efforts, the first hospital, called the Pennsylvania Hospital, was built in the United States in Philadelphia in 1751 (Ellis and Hartley, 2012).

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