The Evolution of Nursing Jeanelle F. Jimenez RN, BSN, CCRN Chapter 1 Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2 History of Nursing and Nursing Education Care of the Sick During Early Civilization  Illness was considered to be directly related to disfavor with God. Primitive people believed people became sick when an evil spirit entered the body. Good spirit kept disease away.  Medicine men performed witchcraft to induce bad spirits to leave the body.

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 3 Care of the Sick During Early Civilization  Babylonians Intellectually, socially, and scientifically well developed Lay persons provided medical service, usually men  Ancient Hebrews Attributed their misfortunes and illnesses to God’s wrath; depended on God to restore health Combined health and dietary practices from their religious beliefs with hygienic practices Prevented the spread of communicable disease History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 4 Care of the Sick During Early Civilization  Ancient Egypt Established hospitals Physicians were skillful at treating fractures Became well acquainted with organs of the body during embalming Developed a number of drugs and procedures such as surgery History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 5 History of Nursing and Nursing Education Care of the Sick During Early Civilization  Ancient Indians Established hospitals Attendants were males from India  Clever and skillful  Kind with good behavior  Bathed patients, made beds, and attended to patients’ needs

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 6 Care of the Sick During Early Civilization  Ancient Greece Hellenic  Established temples (hospitals) o Spas, mineral springs o Bath gymnasiums o Treatment and consultation rooms  Religious influence continued o Prayer, offerings of thanks, and rituals History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 7 Care of the Sick During Early Civilization  Ancient Greece (continued) Hippocrates  Brilliant, progressive physician  “Father of Medicine”  Rejected the supernatural origin of disease  Adopted a system of physical assessment, observation, and record keeping  Hippocratic Oath (oath taken by physicians)  Work is basis for the holistic approach to patient care History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 8 Care of the Sick During Early Civilization  Ancient Greece (continued) Promoted public health and safety; emphasis on the poor, sick, widowed, and children Deacons and deaconesses visited the sick in their homes, prisons, and hospitals Hippocrates: “Father of Medicine” and basis for holistic approach to patient care. History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 9 History of Nursing and Nursing Education Care of the Sick During Early Civilization  Early Christians Emphasis on care of the poor, sick, widowed, and children Deacons and deaconesses designated by bishops to provide care in homes of the sick Deaconess Phoebe considered a visiting nurse Fabiola provided the first free hospital in Rome in 390 AD

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 10 Nursing Education in the 19th Century aka The Dark Ages of Nursing  Hospitals Overcrowded No trained or qualified people  Women of “proper upbringing” did not work  Nurses ended up being “inferior” and “undesirable” lower-class women Place to contract disease rather than be cured  Poor hygienic practices  Unchecked infection  Dirty physical conditions History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 11 Nursing Education in the 19th Century  Lutheran Order of Deaconesses Established the first real school of nursing Located in Kaiserwerther, Germany Florence Nightingale attended this school History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 12 Nursing Education in the 19th Century  Florence Nightingale Changed condition of the hospitals  Cleaned units, washed clothes regularly, provided sanitary conditions  Through her patience, dedication, and empathetic treatment, made a psychologic change  “Lady with the lamp” o Carried a lamp to light her way through the rows of beds of the injured and sick History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 13 Nursing Education in the 19th Century  Nursing from occupation to profession Florence Nightingale began the reformation of nursing from occupation to profession by establishing the Saint Thomas Hospital School of Nursing in London  1 year training  Formal instruction and practical experience  “Register” o Beginning of control over nursing graduates and standard of practice History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 14 Nursing Education in the 19th Century  Development of nursing education in the United States During the time that Florence Nightingale was active in Europe, the same kinds of patient care problems were occurring in America In 1849, Pastor Theodore Fliedner of Germany traveled to America with four highly trained nurse-deaconesses Established the first Protestant hospital in the United States  Pittsburgh Infirmary in Pittsburgh, PA History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 15 Nursing Education in the 19th Century  Development of nursing education in the United States Most early nursing programs were supported by large hospitals.  First three schools of nursing in the United States o Bellevue Hospital School of Nursing, New York o Connecticut Training School, New Haven o Boston Training School at Massachusetts General Hospital, Boston History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 16 Nursing Education in the 19th Century  Development of nursing education in the United States American Society of Superintendents of Training Schools of Nursing  Established by Isabelle Hampton Robb and Lavinia Dock  Goal was to set education standards for nurses  Code of ethics was adopted by the society o Nightingale Pledge History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 17 Changes in Nursing During the 20th Century  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 History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 18 Changes in Nursing During the 20th Century  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 History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 19 Changes in Nursing During the 20th Century  World War II Increased demand for nurses Cadet Nurse Corps was established 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 History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 20 Changes in Nursing During the 20th Century  Contemporary nursing 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 History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 21 Changes in Nursing During the 20th Century  Contemporary nursing 1965: American Nurses Association o Education should take place in institutions of learning o Many hospital-based nursing programs were disbanded o Trend was changed from “training” nurses to “educating” nurses History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 22 Changes in Nursing During the 20th Century  Certification The nurse is granted recognition for competency in a specific area of nursing. Eligibility  Current RN license  Minimum 2 years’ experience in the designated area  Currently practicing in the designated area Some areas include gerontologic, medical-surgical, psychiatric and mental health, and adult nurse practitioner History of Nursing and Nursing Education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 23 History of Nursing and Nursing Education Nursing in the 21st Century  Demographic changes  Women’s health care issues  Men in nursing  Human rights  Medically underserved  Threat of bioterrorism

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 24 Development of Practical/Vocational Nursing in the United States 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

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 25 Development of Practical/Vocational Nursing in the United States Attendant Nurses  Two other programs patterned after Ballard School Thompson Practical Nursing School; Brattleboro, Vermont; 1907 Household Nursing Association School of Attendant Nursing; Boston; 1918  Focus continued to be on home nursing care and light housekeeping duties  No hospital experience

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 26 Development of Practical/Vocational Nursing in the United States Practical Nursing Programs  Before 1940, practical nursing schools had few controls, little educational planning, and minimal supervision  Between 1948 and 1954, 260 practical nursing programs were opened  Students in these programs provided nursing service while they were obtaining their education and training

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 27 Development of Practical/Vocational Nursing in the United States Organizational Influence  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)

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 28 Development of Practical/Vocational Nursing in the United States Organizational Influence  National Federation of Licensed Practical Nurses (NFLPN ) Founded by Lillian Kuster in 1949 Membership is limited to LVNs and LPNs  National League for Nursing 1961; established a Department of Practical Nursing Programs Developed an accreditation service for PN programs; Council of Practical Nursing Programs

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 29 Development of Practical/Vocational Nursing in the United States Additional Credentialing  Approved program One that meets minimum standards set by the respective state agency Ensures that a given program  Meets the needs of the student  Has adequate course content and qualified faculty  Is of sufficient length  Has adequate facilities  Provides clinical experience

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 30 Development of Practical/Vocational Nursing in the United States Additional Credentialing  Accreditation Program voluntarily seeks a review by a given organization to determine whether the program meets the preestablished criteria of that organization Standards are usually far higher than required by the state

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 31 Development of Practical/Vocational Nursing in the United States Contemporary Practical/Vocational 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

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 32 Development of Practical/Vocational Nursing in the United States Contemporary Practical/Vocational Nursing Education  Articulation Procedure that allows nursing programs to work together to plan their curricula to decrease duplication of learning experiences LPN/LVN to RN RN to BSN

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 33 Development of Practical/Vocational Nursing in the United States Events That Changed Practical/Vocational Nursing  The need for trained caregivers  World War I  The self-taught practical nurse  The Great Depression  Duties of licensed practical/vocational nurses  Position Paper of the American Nurses Association

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 34 Development of Practical/Vocational Nursing in the United States Licensure for Practical/Vocational 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

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 35 Development of Practical/Vocational Nursing in the United States Licensure for Practical/Vocational Nursing  Laws that monitor the licensed practical/vocational nurse Licensing for practical nurses in the United States was begun in 1914 by Mississippi  By 1955, all states had passed licensing laws State Board Test Pool  NLN Education Committee established a testing mechanism for all states and administered the exam several times a year

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 36 Development of Practical/Vocational Nursing in the United States Licensure for Practical/Vocational Nursing  Laws that monitor the licensed practical/vocational nurse National Council Licensing Examination for Practical Nurses (NLCEX-PN)  Computerized examination  Receive score of “passed” or “has not passed” Interstate endorsement  Reciprocity between states o Licensing in other jurisdictions can be obtained without repeating the NCLEX-PN

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 37 Health Care Delivery Systems Health Care System Defined  The complete network of agencies, facilities, and all providers of health care in a specified geographical area Patient, patient’s family, community, current technology, government agencies, medical professionals, third-party participants  Goal is to achieve optimal levels of health care

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 38 Health Care Delivery Systems Health Care System Defined  Wellness/illness continuum The range of a person’s total health; ever changing Wellness: A dynamic state of health in which an individual progresses toward a higher level of functioning, achieving an optimal balance between internal and external environment  Highest level of optimal health Illness: A diminished or impaired state of health  Opposite end of spectrum from wellness

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 39 Health Care Delivery Systems Health Care System Defined  Maslow’s model of health and illness Developed by Abraham Maslow  He believed that an individual’s behavior is formed by his attempts to meet his basic needs o Physiological, safety and security, love and belongingness, esteem, self-actualization Hierarchy or pyramid o Some needs must be meet before advancing to other needs

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 40 Figure 1-5 Maslow’s hierarchy of needs.

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 41 Health Care Delivery Systems Health Care System Defined  Health promotion and illness prevention U.S. Department of Public Health  Identify what types of diseases are most prevalent, which age groups are affected by certain illnesses, and which illnesses are predominant  Direct efforts toward developing treatment of the illness, establishing methods to decrease its spread, and isolating its cause  Focus has now shifted from curing the problem to preventing it

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 42 Health Care Delivery Systems Health Care System Defined  Continuity of care Ensuring the continuation of care from one setting to another Understanding what procedures are done, why, and by whom is a discouraging and often impossible task for patients already bewildered and frightened by medical conditions that threaten their well-being

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 43 Health Care Delivery Systems Delivery of Patient Care  Extremely humanistic activity Delivery of services by human beings to human beings  Treatment of disease and injury  Prevention of disease  Restoration of optimal wellness through rehabilitation  Maintenance of a desirable level of wellness  Care of the chronically ill  Provision of assistance to the patient in self-care  Patient education

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 44 Health Care Delivery Systems Delivery of Patient Care  Participants in the health care system Professional health care specialists Registered nurse Licensed practical/licensed nurse Additional caregivers  Social worker, physical therapist, dietitian, respiratory therapist Technologists and medical technicians

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 45 Health Care Delivery Systems Delivery of Patient Care  Economic factors affecting health and illness Rising health care costs Aging population Advancement of technology Health care insurance Malpractice insurance Miscellaneous factors  People avoid preventive and routine care and are seen only in crisis situations

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 46 Delivery of Patient Care  Economic factors affecting health and illness Changes in delivery system  Case management  Cross-training  Additional trends o Multisystem health care chains o Health maintenance organizations (HMOs) Health Care Delivery Systems

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 47 Health Care Delivery Systems Delivery of Patient Care  Environmental factors affecting health and illness Social and physical environmental factors do not necessarily cause illness, but they do influence the development or progression of an illness Social: Financial hardship, lifestyle, social pressures, etc. Physical: Stress, conflict, smoking, weight, etc.

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 48 Health Care Delivery Systems Delivery of Patient Care  Expectations of the patient and health care team Health promotion  Preventive medicine through education Patients’ rights  Patients expect to be treated with dignity and compassion and have their rights respected Health care providers’ rights  Expect that patients will actively participate in their care as much as possible

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 49 Health Care Delivery Systems Delivery of Patient Care  Interdisciplinary approach to health care Care plan  Document that outlines the individual needs of the patient and the approach of the health care team in meeting these needs Communication  Good communication is essential for the exchange of information among the members of the health care team

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 50 Figure 1-6 A nurse collaborating with other members of the interdisciplinary health care team. (From Lindeman, C.A., McAthie, M. [1999]. Fundamentals of contemporary nursing practice. Philadelphia: Saunders.)

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 51 Health Care Delivery Systems Delivery of Patient Care  Interdisciplinary approach to health care Documentation  Any form of documentation is the permanent record of the patient’s progress and treatment  It is the formal and legal record of care received by the patient and the patient’s response to that care  Provides a progress record of treatment  Provides a history of events

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 52 Nursing Care Models Four Major Concepts  Nursing Encompasses the roles and actions of the nurse  Patient The individual receiving the care  Health The area in which the patient fits on the wellness/illness continuum  Environment The setting for the nurse-patient interactions

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 53 Contemporary Practical/Vocational Nursing Care Practical/Vocational 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

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 54 Objectives and Characteristics of Practical/Vocational Nursing Education  To acquire the specialized knowledge and skills needed to meet the health care needs of patients in a variety of settings  To be a graduate of a state-approved practical/vocational nursing program  To take and pass the NCLEX-PN examination  To acquire a state license to practice Contemporary Practical/Vocational Nursing Care

Mosby items and derived items © 2011, 2006, 2003, 1999, 1995, 1991 by Mosby, Inc., an affiliate of Elsevier Inc.Slide 55 Roles and Responsibilities of the Licensed Practical/Vocational Nurse  Recognizes the LPN/LVN’s role in the health care delivery system and articulates that role with those of other health care team members  Maintains accountability for one’s own nursing practice within the ethical and legal framework  Serves as a patient advocate  Accepts their role in maintaining and developing standards of practice in providing health care  Seeks further growth through education opportunities Contemporary Practical/Vocational Nursing Care