After studying this chapter, the reader will be able to: 1. Summarize health practices throughout the course of history. 2. Analyze the effect of historic, political, social, and economic events on the development of nursing. 3. Describe the evolution of professional challenges experienced by nurses of diverse ethnic, racial, and educational backgrounds. 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. 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). Additional resources are available online at: http://evolve.elsevier.com/Cherry/ 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. 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. 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. Questions to Consider While Reading This Chapter 1. What were the challenges faced by nurses historically? 2. How has access to care and managed care affected professional nursing practice? 3. What are the challenges facing nurses in the twenty-first century? 4. What areas of nursing specialization enhance patient care? 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. 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. From 1400 to 1200 bc, the Hebrews migrated from the Arabian Desert and gradually settled in Palestine, where they became an agricultural society. Under the leadership of Moses, the Hebrews developed a system of laws called the Mosaic Code. This code, one of the first organized methods of disease control and prevention, contained public health laws that dictated personal, family, and public hygiene. For instance, laws were written to prohibit the eating of animals that were dead longer than 3 days and to isolate individuals who were thought to have communicable diseases. Hebrew priests took on the role of health inspectors (Ellis and Hartley, 2012). 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). Dating from 3000 to 1500 bc, the earliest cultures of India were Hindu. The sacred book of Brahmanism (also known as Hinduism), the Vedas, was used to guide health care practices. The Vedas, considered by some to be the oldest written material, emphasized hygiene and prevention of sickness and described major and minor surgeries. The Indian practice of surgery was very well developed. The importance of prenatal care to mother and infant was also well understood. Public hospitals were constructed from 274 to 236 bc and were staffed by male nurses with qualifications and duties similar to those of the twentieth-century practical nurse (Ellis and Hartley, 2012). 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 Roman Empire (27 bc to 476 ad), a military dictatorship, adapted medical practices from the countries they conquered and the physicians they enslaved. At the end of the Dark Ages, there were a series of holy wars, including the Crusades. The first military hospital in Europe was established in Rome to care for the injured. Military nursing orders that were made up exclusively of men were developed to care for the injured. They were very well organized and dedicated, and they wore suits of armor for protection with the emblem of the red cross. (Catalano, 2012; Walton et al, 1994). The Romans practiced advanced hygiene and sanitation and emphasized bathing (Ellis and Hartley, 2012). 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 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 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).
The Evolution of Professional Nursing
Chapter Overview
Early Civilization
Egypt
Palestine
Greece
India
China
Rome
The Middle Ages
The Renaissance and the Reformation Period
The Colonial American Period
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
