ZS PRACTICAL/ iE Ts 7 4s Beene LOIS HARRIONThe Evolution of Nursing ® CHAPTER OVERVIEW This chapter provides an introduction to nursing as a whole. It includes a brief history of nursing as well as definitions of nursing formulated by nursing leaders and nursing organiza- tions. Educational preparation, professional organizations, and guidelines for nursing practice serve as a basis for understand- ing what nursing is and how it is organized. Finally, because nursing isa part of an ever-changing society, a brief discussion of current trends in nursing is also included, © OBJECTIVES Upon completion of this chapter, the reader should be able to: ©. Describe the evolution of nursing and nursing education from early civilization to the twentieth century. ™@ List the major developments of practical/vocational nursing. © Discuss six people important to the development of nursing, © Describe the purpose, role, and responsibilities of the practical/vocational nurse. ™ Discuss the Standards of Practice as described by the American Nurses Association and the Canadian Nurses Association. ® Define the purposes of nursing professional organizations. © Describe expanded career roles and functions of nurses. ® Describe the three categories of nursing actions.2 CHAPTER 1 KEY TERMS Accreditation Holistic Approved program Illness Health Wellness INTRODUCTION AHISTORICAL BACKGROUND The Early Ci Nursing is difficult to describe clearly or to define. When the question is asked, many different responses are given. Each person provides an answer based on his or her own personal experience and knowledge of nursing at that time. As you progress toward graduation and as you practice nursing after graduation, those definitions will change, reflect- ing changes within yourself as you learn about and experience nursing. Most basically defined, nursing is the care of others. That care in- volves any number of activities, ranging from carrying out complicated technical procedures to something as seemingly simple as holding a hand. All nursing actions focus on the person receiving care and area blend of both the art and the science of nursing. The science of nursing is the underlying knowledge base for patient care. The art of nursing is. the more personal application of that knowledge to help others reach | maximum function and quality of life. Nursing evolved over many years, influenced by attitudes toward the: sick and the methods available. Changes in the way people live, the interrelationship of people with their environments, the search for knowledge and truth, and technological advances have all made nuts~ ing and nursing education both what they are and what they will be Nursing evolves as society and health care needs and policies change Nursing responds and adapts to these changes, meeting new chal: lenges as they arise. From the beginning of time, the nurse has been regarded as a caregi ‘This role has traditionally been defined by the groups, communities, es in which nursing was practiced. Health care and nursing a$ The Evolution of Nursing 3 In 5000 Bc there were few references to nursing. Illness, an abnor- mal process in which aspects of the social, emotional, or intellectual condition and function of a person are diminished or impaired, was considered to be directly related to disfavor with God. Early peoples believed that a person became sick when an evil spirit entered the body, and that the presence of a good spirit kept disease away. In early civilizations, people believed that illness had supernatural causes, The theory of animism was developed in an attempt to under- stand the cause of the mysterious changes in bodily functions. This theory was based on the belief that everything was alive with invisible forces and endowed with power. Good spirits brought health; evil spirits brought sickness and death. The roles of the physician and the nurse were separate and distinct. Medicine men performed witchcraft on the affected part of the body to induce the bad spirits to leave the body. Some of the techniques involved the use of frightening masks, noises, incantations, vile odors, charms, spells, and even sacrifices. The physician was the medicine man, and other modes of treatment included chanting, inspiring fear, or opening the skull to release evil spirits. Men assisted the medicine men in treating illnesses. They used purgatives, emetics, application of hot and cold substances, cauterization, cupping, blistering, and massage. Few women assisted the medicine men; women most assisted in child- Pitth. The nurse usually was the mother who cared for her family during sickness by providing physical care and herbal remedies. This nurturing and caring role of the nurse has continued to the present. The Babylonians were intellectually, socially, and scientifically well developed. Many wars brought misery, suffering, illness, and injury to their people. There is evidence that some form of medical service existed and that laypersons provided this service. It is believed that these caregivers were usually men. If they were women, they were Probably of low status because the actions of Babylonian women were dominated by men. Pe eo Hidorews, according to the Talmud and the Old Testa- i his er misfortunes and illnesses to Caos wrath, They Bera) and wen - eee a eqnaiiion of physical, cman erence men te slous belicfs with the hygienic: practicesthi as a nt eee > actices that were required from iptivity. These practices included themame 4 Hellenic CHAPTER 1 foods. They prevented the spread of communicable disease by burning infected garments and scrubbing the home of those infected with the disease. Nurses were mentioned occasionally in the Talmud as persons caring for the sick in their homes. This appears to have been a demon- stration of the first public health/home care movement. Ancient records of early Egyptian civilization describe nursing procedures, such as feeding a patient, a recipient of a health care service, with tetanus and dressing wounds. Records of pre-Christian India detail the establishment of hospitals where the sick were cared for. The report described a body of atten- dants, probably male, who were of good behavior, who were distin- guished for purity and cleanliness of habits, and who were clever, skillful, and endowed with kindness. They bathed patients, made beds, and were always willing to do whatever they could to assist the sick. ization By 500 Bc the Hellenic civilization showed keen intellect, independent thinking, democratic action, and a thirst for knowledge and truth. Medicine, the art and science of the diagnosis, treatment, and preven- tion of disease and the maintenance of good health, progressed from, the belief that demons and spirits caused human ills to the founding of temples suitable for rest and restoration of health. These temples, often referred to as hospitals, resembled our health centers of today; they had spas, mineral springs, bath gymnasiums, and treatment and con- sultation rooms. The religious influence was still present in the form of prayer, thanks offerings, and rituals. Priestesses served as attendants and cared for the sick. Pregnant women and people with incurable diseases were not admitted. Hippocrates, born in 460 Bc on the island of Cos in the Mediter- ranean, was a brilliant, progressive physician and teacher. He rejected the belief in the supernatural origin of disease and adopted a system of physical assessment, observation, and record keeping as an integral part of patient care. As his patient-centered care approach and medical ethics were adopted, Hippocrates was named the “Father of Medicine” and is credited with the Hippocratic oath, which is still taken by physi- cians today. The work of Hippocrates is the basis for the holistic, of oF pertaining to the whole; considering all factors, as holistic medicine, approach to patient care. The Creek influence on the care of the sick changed the approach! The Evolution of Nursing influence was still prevalent but with an emphasis on the poor, the sick, the widowed, and the children. The Christian Influence With the beginning of Christianity, nursing began to have a formal and more clearly defined role. Led by the belief that love and caring for others were important, women called deaconesses made the first organized visits to sick people, and members of male religious orders gave nursing care and buried the dead. Both male and female nursing orders were founded during the Crusades. Deacons and deaconesses were designated by the Roman bishops to assist the church by providing services such as visiting sick women in their homes and watching over the sick in the hospitals. One of the first deaconesses, Phoebe, performed nursing functions about ap 60. She was known as a visiting nurse, attending the sick and poor in their homes. Another Roman woman, Fabiola, spent her wealth and time nursing the sick and poor. She is credited with providing the first free hospital in Rome in ap 390. Monastic and military orders were charged with caring for the sick over the next 1,000 years, but the decline of Roman civilization hindered the progress made in Greece and Rome. Famine, disease, war, and the emphasis on survival resulted in an increased need to care for the sick and poor, but the ongoing battles between the church and state hin- dered the development of any one approach to patient care. Care of the sick was performed by both men and women. Female religious orders Were concerned with the care of the sick and needy, but the concern for religious problems took priority. Male military personnel served the medical needs of soldiers on the battlefield. At the beginning of the sixteenth century, society changed from one with a religious orientation to one that emphasized warfare, exploration, and expansion of knowledge. Many monasteries and convents closed, leading to a tremendous shortage of people to care for the sick. To meet this need, women who had committed crimes were recruited into nurs- Ang in lieu of serving jail sentences. Along with a poor reputation, nurses teceived low pay and worked long hours in unfavorable conditions, The Nineteenth Century In the early nineteenth century, hospitals were overcrowded, and there was a lack of trained and qualified people who were interested in caring