Chapter 1 The Evolution of Nursing

Chapter 1 The Evolution of Nursing
Nursing come from Latin word “nutricus” which means “nourishing” Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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. Few women assisted the medicine men. They assisted women in childbirth.

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 In the Jewish religion, kosher dietary laws require strict separation of dairy and meat.Babylonian King wrote code of laws designed tto The inspection of all meats and the careful selection and preparation of all foods are required. How do Jewish customs prevent the spread of infection and disease? Nurses were mentioned occasionally in the Talmud as persons caring for the sick. Prevented infection by burning infected garments & scrubbing the home of the infected Babylon King wrote code of laws designed to protect people ill Defined legal Defined legal limitations placed on caregivers Concept carried Concept carried through history

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 What evidence is there of nursing care in the Ancient Egyptian culture? What actions did these nurses perform? Written record of procedures were probably written by attendants (nurses) who assisted priestsWrittend Detailed instruction for daily nursing care recording pulse, using splints & bandages hollow reeds for urinary catheter

Care of the Sick During Early Civilization Ancient Greece Hellenic Established temples (hospitals) Spas, mineral springs Bath gymnasiums Treatment and consultation rooms Religious influence continued Prayer, offerings of thanks, and rituals In the Hellenic era, priestesses served as attendants and cared for the sick. Why were pregnant women and those with disease not admitted to the spas or mineral baths?

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

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 Changed care of ill from mysticism to public health & safety Religious influence prevalent with emphasis on the poor, sick, widowed, & children Re

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. What Greek influences on the care of the sick changed the approach from one of mysticism to that of public health and safety? Hippocrates provided the first ethical guide for medical conduct, known as? Hippocratic Oath

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 Phoebe was a Roman woman in about 60 AD Fabiola was a wealthy Roman woman who used her own money and donated her own time to care for the sick and the poor.

Dark Ages Learning in all disciplines disintegrated
People lost ability to read Nursing care friends & relatives No scientific basis for care given Medical theory disintegrated Jewish scholars maintained written work of others Served as translator Kept records in convents & monasteries Monks & nuns continue to care for sick No reading, work of Hippocrates useless

Hospitals of Dark Age No way to meet basic need of ill
Windows too high to open No fresh air Plumbing, heating, & lighting were non-existent Linens washed at river Time of plagues and infectious diseases Not wash away infectious material

Renaissance Period Nursing not moving forward
Scientific methods of Greeks was restarted Disciplines of anatomy, physiology, & scientific healing Tradition of unselfish service to humanity almost vanished St. Vincent de Paul, organized the Sisters of Charity More interested in music & art, scientific method & basic principles of medicine Split catholic church Monasteries & convents abolish no one to care for sick

Seventeenth & Eighteenth Centuries
US. Family members took care of sick Almshouses for the poor Pest houses for contagious people Protect the healthy not care for sick Medicine less developed in US Physicians not well trained 1st hospital built in Philadelphia d/t Ben Franklin Medical advances slow Treatment brandy, whiskey, emetics, purgatives, & bleeding

Nursing Education in the 19th Century 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 Hospitals were overcrowded and lacked trained and qualified people to care for the sick and infirm. Women Women ignorant gin-soaked, and sometimes prostitution Sairy Gamp accepted bribes Aided dying by remving pillow & bed clothes acc Discuss why women who were engaged in prostitution or women from religious orders were those chosen to provide nursing care.

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 Who opened the first school of nursing?

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 psychological change “Lady with the lamp” Carried a lamp to light her way through the rows of beds of the injured and sick Advanced education for women modern & ancient languages, history,composition, & philosophy became superintendent of King’s College heard news about Crimean War casualties Went to Crimean with 38 nurses found overcrowded filthy hospitals, no beds, no furniture, no eating utensils, no medical supplies, no blankets, linens, soap or lamps Death rate went from 420/1000 t0 22/ What training did Florence Nightingale possess that qualified her as a superintendent at a charity hospital? What influence did Florence Nightingale have on the hospital environment during the Crimean War? Why was Florence Nightingale known as the “Lady with the lamp”?

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” Beginning of control over nursing graduates and standard of practice Nighjingale wanted Nursing to be taught as separate entitiy. Duties not same as Dr Started to make nursing an acceptable profession for all women Believed in treating the patient not the disease The nursing program at St. Thomas Hospital in London functioned separately from the hospital to ensure a focus toward nursing education. What is the Nightingale Plan?

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 The American Revolution and the Civil War caused severe casualties, which caused a demand for nurses. What was Theodore Fliedner’s effect on the education of nurses?

Civil War Era South - Prejudice about women working in hospitals
Male opposition Died because of poorly trained medical corps Southern women offered services Most of nursing done by infantrymen assigned to the task North – Women offered their services as nurses Dorothea Lynde Dix appointed superintendent of nurses Dorothea Dix teacher and advocate for better conditions for mental patients First First hoptials for mentally ill established

Clara Barton collected supplies for soldiers
Requested women under 30 Plain-looking Wearing simple brown or black dresses without bows, curl, jewelry, or hoop skirts Clara Barton collected supplies for soldiers started the American Red Cross Civil War was push needed to establish nurse-training school

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 Bellevue Hospital School of Nursing, New York Connecticut Training School, New Haven Boston Training School at Massachusetts General Hospital, Boston Opened in 1873 & followed Nightingale plan Based on apprenticeship rather than education Stiudent nurse living conditions, working hours, & responsibilities horridous Required to sign contracts in return for courses of lectures, on-the-job training, & minimal allowance What caused a shortage of nurses following the Civil War?

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 Nightingale Pledge What were Hampton’s and Robb’s goals for the nursing profession? They followed the American Medical Association (AMA) model and developed a code of ethics for nurses. What is the Nightingale Pledge?

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

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 The Army and Navy Nurse Corps sought nurses who had good moral character and professional qualifications. Pneumonia epidemic USA Need for nurses here

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 Cadet Nurse Corps provided a quick training program for nurses and a way to serve their country. Why did many Cadet Nurses stay in the military instead of working as civilian nurses?

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

Changes in Nursing During the 20th Century Contemporary nursing 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 The ANA took the stance that Robb and Nutting had proposed back in 1903 that nursing education should take place in an institution of learning. ANA 2 levels of nursing RN has a BSN Technical nursing has an associated degree Assistants to nurses: preservice programs in vocational education than on the job training

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 In 1976 the ANA offered certification testing for RNs. Why might a nurse want certification?

Nursing in the 21st Century Demographic changes Women’s health care issues Men in nursing Human rights Medically underserved Threat of bioterrorism Demographics: more elderly, more chronic illness, more inner-city health care centers versus rural clinics Women’s health care issues: management of menopause, new vaccinations (HPV), preventative care and oncologic care specific to women Men in nursing: see Chapter 41 Human rights: Patient’s bills of rights Medically underserved: high health care costs, homelessness, unemployment. Advanced practice nurses are one answer to some of these problems. Threat of bioterrorism: Disaster preparedness for nuclear, chemical, and biologic attacks. Nurses function in the roles of triage, crisis response team members, and vaccination research.

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 What was the main emphasis of the Ballard School?

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 The Thompson School is still in operation and is NLN accredited. A total of 36 practical nursing schools were opened during the first half of the 20th century.

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 Increased demand for nurses & excellent bedside care done by practical nurse

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) Set standards for practical/vocational nursing practice, promote & protect the interess of practicalvocational nurses & educate & inform the general public about prac/voca nursing

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 For 20 years the NLN and the NAPNES provided accreditation services for nursing programs. The NAPNES no longer provides this service.

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 How does the state ensure the welfare of the public? Approval is required for the program to operate.

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 What does the term “accreditation” mean? Why would an organization want the review organization’s recommendation?

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 Discuss the NCLEX-PN examination.

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 How do these programs proceed to high levels of education?

Career Advancement Career ladder Recognizes the clinical expertise of the nurse and provides a mechanism for providing the nurse with financial compensation and opportunities for advancement Many institutions have options for career advancement for those nurses who do not want to further their education at an institution but through their facility. Can you describe this advancement process?

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 In 1940 many practical nurses were self-taught and met the needs of the country but lacked education. Why were nurses trained for home care hired by hospitals during the Great Depression? What caused the delineation between the LPN/LVN role and the RN role?

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

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

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 Licensing in other jurisdictions can be obtained without repeating the NCLEX-PN Licensing laws for nursing are established in all states. What is interstate endorsement?

Contemporary Practical/Vocational Nursing Care
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 What are the roles and responsibilities of the LPN/LVN? Discuss the difference between the LPN/LVN role and the RN role.

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 What are the objectives of LPN/LVN nursing education?

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 Discuss the definition adapted from NAPNES and several states’ nurse practice acts that define the LPN/LVN.

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 The LPN/LVN is an integral member of the team of health care professionals within the overall system.

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 What is the Wellness/Illness Continuum?

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 Physiological, safety and security, love and belongingness, esteem, self-actualization Hierarchy or pyramid Some needs must be meet before advancing to other needs How does an individual’s value system affect the level of need according to Maslow’s hierarchy of needs?

Maslow’s hierarchy of needs.
Figure 1-5 What are examples that would pertain to each level of the pyramid? Maslow’s hierarchy of needs.

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 How does the lack of prenatal care affect the mortality rate for the mother and the infant?

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 Discuss continuity of care. How does patient autonomy affect continuity of care?

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 What does delivery of patient care involve other than the treatment of disease?

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 Discuss the roles of the following: Professional health care specialists Registered nurses LPN/LVNs Additional caregivers Technologists and medical technicians

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 What is expected to cause national health care expenditures of $2.6 trillion by 2010? What measures can be taken by the nation to curb these expenditures?

Delivery of Patient Care Economic factors affecting health and illness Changes in delivery system Case management Cross-training Additional trends Multisystem health care chains Health maintenance organizations (HMOs) How would cross-training help to curb costs? How have HMOs affected the health care system?

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. How do social factors influence our physical health? Discuss how early recognition of environmental factors and prompt intervention can decrease or minimize a negative impact.

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 How has health promotion affected the delivery of patient care? Discuss patient’s rights. What are the health care provider’s rights?

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 What is the interdisciplinary approach to the development of a patient care plan?

Nursing Care Models Four Major Concepts Nursing Patient Health
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 What are four concepts nursing leaders developed to focus on nursing models?

Figure 1-6 (From Lindeman, C.A., McAthie, M. [1999]. Fundamentals of contemporary nursing practice. Philadelphia: Saunders.) A nurse collaborating with other members of the interdisciplinary health care team.

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

Chapter 1 The Evolution of Nursing

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