History of Nursing

1. History of Nursing Denise Filiatrault RN, BSN, MNc

2. Objectives • Describe the evolution of nursing and nursing education • Discuss significant changes in nursing • Identify nursing leaders • Identify major organizations • Identify components of the health care system • Define nursing • Define roles and responsibilities of the LPN and RN

3. Illness? • Early records • Illness = standing with God • Medicine man & witchcraft • Evil spirits • Hippocrates (born 460 BC) • Rejected ‘supernatural’ • Holistic care origins • Hippocratic Oath “Do no harm”

4. 19th Century • Hospitals Overcrowded • No training • Nurses lower class women • Unkempt • Poor hygiene practices • Dirty conditions

5. In small groups answer…. • What standards did Florence Nightingale contribute to nursing, and how have they affected the standards of the nursing profession today? • What impact did WWI and WWII have on nursing? • Why did professional nursing organizations develop in the twentieth century, and what is their purpose today? • What characteristics define the LPN/LVN role?

6. Early Nursing Education • Attendant Nurses • The Ballard School • First school for training practical nurses • Started in 1892 in Brooklyn, NY • 3 months’ duration • Trained students to care for the chronically ill, invalids, children, and the elderly • Main emphasis was on home care • Cooking, nutrition, basic science, basic nursing procedures • Graduated as attendant nurses

7. Nursing Education • Lutheran Order of Deaconesses • Established the first real school of nursing • Located in Kaiserwerther, Germany • Florence Nightingale attended this school • http://www.nytimes.com/learning/general/onthisday/bday/0512.html

8. Nursing Education • Florence Nightingale • Changed condition of the hospitals • Cleaned units, washed clothes regularly, provided sanitary conditions • Through her patience, dedication, and empathetic treatment, made a psychological change • “Lady with the lamp” • Carried a lamp to light her way through the rows of beds of the injured and sick

9. Nursing from Occupation to Profession • Contributions of Florence Nightingale • Defined nursing as both an art and a science • Differentiated nursing from medicine • Identified personal needs of patient and role of nurse in meeting them • Established standards for hospital management • Established nursing education and nursing as a respected occupation for women

10. Nursing from Occupation to Profession • Contributions of Florence Nightingale • Stressed the need for continuing education for nurses • Recognized two components of nursing—health and illness • Recognized nutrition as important to health • Instituted occupational and recreational therapy for sick people • Maintained accurate records/beginning of nursing research

11. Nursing Education in the USA • Most early nursing programs were supported by large hospitals. • First three schools of nursing in the United States • Bellevue Hospital School of Nursing, New York • Connecticut Training School, New Haven • Boston Training School at Massachusetts General Hospital, Boston • Goal was to set education standards for nurses • Code of ethics was adopted by the society • Nightingale Pledge

12. Nursing in the USA • Nursing licensure • First laws were established in 1903 • Protect the public • North Carolina, New Jersey, and New York were first states • Isabelle Hampton Robb and Mary Adelaide Nutting • Developed a program at Columbia University to train and develop teachers of nursing

13. Nursing • World War I • Increased demand for nurses • Army School of Nursing was established • Training focused on “service to the patient” rather than on comprehensive care • Most nurses returned to previous jobs after the war

14. Nursing • World War I and World War II • Increased demand for nurses • Army School of Nursing was established • Training focused on “service to the patient” rather than on comprehensive care • Nurses stayed in the military after the war • Civilian nursing: low pay, long shifts, atrocious conditions • Military nursing: prestige, good pay, and opportunity for advancement

15. Nursing Education • Characteristics of health care changed rapidly as health care became an industry • Growth and diversity became the major emphasis • Beginning of contemporary nursing with specialized nursing care adapted to areas • Private duty, school nursing, industrial nursing, nurse anesthesia, and nurse-midwifery

16. Nursing Education • Association of Practical Nurse Schools • Founded in 1941 • Dedicated to practical nursing • Planned the first standard curriculum for practical nursing • 1942: changed name to the National Association of Practical Nurse Education (NAPNE) • 1959: changed name to National Association for Practical Nurse Education and Service (NAPNES)

17. Nursing • 1961: National League for Nursing • established a Department of Practical Nursing Programs • Developed an accreditation service for PN programs; Council of Practical Nursing Programs • 1965: American Nurses Association • Education should take place in institutions of learning • Many hospital-based nursing programs were disbanded • Trend was changed from “training” nurses to “educating” nurses

18. Contemporary Nursing Education • Nursing programs are offered by various organizations: high schools, trade or technical schools, hospitals, junior and community colleges, universities, private education agencies • Length of programs: 12 to 18 months • Skills, theory, and clinical practice • National Council Licensing Examination for Practical Nursing (NCLEX-PN) • Examination for licensure as LPN

19. Nursing • Licensing laws • Protect the public from unqualified persons practicing in almost any field or profession • Jurisdictions • Area such as a state that has the legal power to regulate nursing licensure and practice • State board of nursing

20. Nursing as a Profession & Discipline • Practice in a wide variety of settings. • Develop a specific body of knowledge. • Conduct and publish nursing research. • Recognize role in promoting health. • Use nursing knowledge as base for nursing practice.

21. Aims of Nursing • To promote health • To prevent illness • To restore health • To facilitate coping with disability or death

22. Additional Roles of the Nurse • Caregiver • Communicator • Teacher/Educator • Counselor • Leader • Researcher • Advocate • Maybe a cheerleader too?

23. Practical Nursing Defined • The activity of providing specific services to patients under direct supervision of a licensed physician or dentist and/or RN • Assist individuals, sick or well, in the performance of those activities contributing to health, to their recovery, or to a peaceful death • Educated to be a responsible member of a health care team, performing basic therapeutic, rehabilitative, and preventive care for anyone who needs it

24. Role of the Nurse: 1887 • In addition to caring for your 50 patients, each nurse will follow these regulations:  • Daily sweep & mop the floors of your ward, dust the patient's furniture & windowsills. • Maintain an even temperature in your ward by bringing in a scuttle of coal for the day's business. • Each nurse on day duty will report every day at 7 a.m. & leave at 8 p.m. except on the Sabbath on which day you will be off from 12 noon to 2 p.m. • Graduate nurses in good standing with the director of nurses will be given an evening off each week for courting purposes or two evenings a week if you go regularly to church. • The nurse who performs her labors and serves her patients and doctors without fault for five years will be given an increase of five cents a day, providing there are no hospital debts outstanding.

25. In a small group: Discuss the Roles • Patient/Client • Physician • Physician Assistant • Residents - Fellows • ARNP • Registered nurse • LPN/LVN • Nurses Aid • Physical therapists & Occupational Therapists • Respiratory therapists • Dietician • Case Manager • Radiology technician • Pharmacists • Janitor/Housekeeping • Phlebotomist • Social workers • Nurse Managers • House supervisors

26. In a small group: • Discuss how a multidisciplinary approach to patient care is affected by the influences of other disciplines, economic factors, environmental issues, and expectations of the patient. • How does the nurse fit into this realm?

27. In Class Activity • Can I have a *not shy* volunteer?

28. Expanded Educational Roles • Clinical nurse specialist (CNS) • Nurse practitioner (DNP, ARNP) • Nurse anesthetist (CRNA) • Nurse–midwife • Nurse educator • Nurse administrator • Nurse researcher • Nurse entrepreneur • Nurse Lawyer (RN, JD)

29. Educational Preparation Entry Level Graduate Level RN – MN MN PhD now DNP CNS ARNP CRNA • LPN • LPN-RN • RN • RN-BSN • BSN

30. Distribution - Nursing Education http://bhpr.hrsa.gov/healthworkforce/rnsurveys/rnsurvey2004.pdf

31. Advance Practice

32. Nursing Research • Systematic inquiry to develop knowledge about issues of importance to the nursing profession • Evidence-based practice projects • Replications of current reseach • Research integration through systematic review • Multisite and interdisciplinary studies • Increased focus on health disparities

33. Nursing Research • Evidence-based practice (EBP) • Basing clinical decisions on best possible evidence—especially high-quality research • Level of Evidence • Which is stronger? • Professional opinion vs. Randomized Control Trial • Wikipedia vs. Medline

34. Goals of Research • Improve care of people in clinical setting. • Study people and the nursing process. • Education • Policy development • Ethics • Nursing history • Develop greater autonomy and strength as a profession. • Provide evidence-based nursing practice.

35. Components of a Research Journal Article • Abstract • Introduction • Methods • Results • Discussion • References

36. Nursing Role in EB Research • Read widely and critically • Attend professional conferences • Learn to expect evidence that a procedure is effective • Become involved in a journal club • Pursue and participate in EBP projects

37. Nursing Research Related Websites

38. Homework for Next Week • Go to one of the above websites and look around. • Post on the discussion board something interesting you found. • See next week’s Required Assignment for details