(Source: Wikipedia)
HISTORY OF NURSING
In fifth century BC, Hippocrates was one of the first people in the world to study healthcare, earning him the title of "the father of modern medicine".[1][2]Western European concepts of nursing were first practiced by male Catholic monks who provided for the sick and ill during the Dark Ages of Europe.
During 17th century Europe, nursing care was provided by men and women serving punishment. It was often associated with prostitutes and other female criminals serving time[citation needed]. They had a reputation for being drunk and obnoxious, a view amplified by the doctors of the time to make themselves seem more important and able[citation needed]. It was not until Florence Nightingale, a well-educated woman from a wealthy class family, became a nurse and improved it drastically that people began to accept nursing as a respectable profession. Other aspects also helped in the acceptance of nursing. In 1853 Theodore Fliedner set up a hospital where the nurses he employed had to be of good nature. Many people were impressed with this facility, and because of it, the British Institute of Nursing Sisters was set up.
Prior to the foundation of modern nursing, nuns and the military often provided nursing-like services.[3] The religious and military roots of modern nursing remain in evidence today in many countries, for example in the United Kingdom, senior female nurses are known as sisters. It was during time of war that a significant development in nursing history arose whenEnglish nurse Florence Nightingale, working to improve conditions of soldiers in the Crimean War, laid the foundation stone of professional nursing with the principles summarised in the book Notes on Nursing. Other important nurses in the development of the profession include: Mary Seacole, who also worked as a nurse in the Crimea; Agnes Elizabeth Jones andLinda Richards, who established quality nursing schools in the USA and Japan, and Linda Richards who was officially America's first professionally trained nurse, graduating in 1873 from the New England Hospital for Women and Children in Boston.
New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12 September 1901. It was here in New Zealand that Ellen Doughertybecame the first registered nurse. North Carolina was the first state in the United States to pass a nursing licensure law in 1903.
Nurses in the United States Army actually started during the Revolutionary War when a general suggested to George Washington that the he needed female nurses "to attend the sick and obey the matron's orders. In July 1775, a plan was submitted to the Second Continental Congress that provided one nurse for every ten patients and provided that a matron be allotted to every hundred sick or wounded".
Nurses have experienced difficulty with the hierarchy in medicine that has resulted in an impression that nurses' primary purpose is to follow the direction of physicians.[5] This tendency is certainly not observed in Nightingale's Notes on Nursing, where the physicians are mentioned relatively infrequently, and often in critical tones—particularly relating to bedside manner.[6]
In the early 1900s, the autonomous, nursing-controlled, Nightingale era schools came to an end – schools became controlled by hospitals, and formal "book learning" was discouraged. Hospitals and physicians saw women in nursing as a source of free or inexpensive labor. Exploitation was not uncommon by nurse’s employers, physicians and educational providers. Nursing practice was controlled by medicine.[7]
The modern era has seen the development of nursing degrees and nursing has numerous journals to broaden the knowledge base of the profession. Nurses are often in key management roles within health services and hold research posts at universities.
[edit]World War I
Before the late 19th century, and into the early 20th century, women doing nursing work were generally members of religious orders or were effectively domestic servants, with the same lowly social status, caring for the sick either in private homes or at charity hospitals serving the poor. Florence Nightingale's efforts to improve nursing standards in the mid-nineteenth century increased interest in occupational improvements that would benefit patients, with particular importance given to military settings. In 1860, Florence Nightingale's work resulted in Queen Victoria's order for a hospital to be built to train Army nurses and surgeons, the Royal Victoria Hospital. The hospital opened in 1863 inNetley and admitted and cared for military patients. Beginning in 1866, nurses were formally appointed to Military General Hospitals. TheArmy Nursing Service (ANS) oversaw the work of the nurses starting in 1881. These military nurses were sent overseas beginning with theFirst Boer War (often called Zulu War) from 1879 to 1881.[8] They were also dispatched to serve during the Egyptian Campaign in 1882 and the Sudan War of 1883 to 1884. During the Sudan War members of the Army Nursing Service nursed in hospital ships on the Nile as well as the Citadel in Cairo. Almost 2000 nurses served during the second Boer War, the Anglo-Boer War of 1899 to 1902, alongside nurses who were part of the colonial armies of Australia, Canada and New Zealand. They served in tented field hospitals. 23 Army Nursing sisters from Britain lost their lives from disease outbreaks.[9]
Sporadic progress was made on several continents, where medical pioneers established formal nursing schools. But even as late as the 1870s, "women working in North American urban hospitals typically were untrained, working class, and accorded lowly status by both the medical profession they supported and society at large". Nursing had the same status in Great Britain and continental Europe before World War I.[10]
Hospital nursing schools in the United States and Canada took the lead in applying Nightingale's model to their training program mes:
standards of classroom and on-the-job training had risen sharply in the 1880s and 1890s, and along with them the expectation of decorous and professional conduct[11]
By the beginning of World War I, military nursing still had only a small role for women in Britain; 10,500 nurses enrolled in Queen Alexandria's Imperial Military Nursing Service (QAIMNS) and the Princess Mary's Royal Air Force Nursing Service. These services dated to 1902 and 1918, and enjoyed royal sponsorship. There also were Voluntary Aid Detachment (VAD) nurses who had been enrolled by the Red Cross.[12]The ranks that were created for the new nursing services were Matron-in-Chief, Principal Matron, Sister and Staff Nurses. Women joined steadily throughout the War. At the end of 1914, there were 2,223 regular and reserve members of the QAIMNS and when the war ended there were 10,404 trained nurses in the QAIMNS.[13]
When Canadian nurses volunteered to serve during World War I, they were made commissioned officers by the Royal Canadian Army before being sent overseas,[14] a move that would grant them some authority in the ranks, so that enlisted patients and orderlies would have to comply with their direction. Canada was the first country in the world to grant women this privilege. At the beginning of the War, nurses were not dispatched to the casualty clearing stations near the front lines, where they would be exposed to shell fire. They were initially assigned to hospitals a safe distance away from the front lines. As the war continued, however, nurses were assigned to casualty clearing stations. They were exposed to shelling, and caring for soldiers with "shell shock" and casualties suffering the effects of new weapons such as poisonous gas, as Katherine Wilson-Sammie recollects in Lights Out! A Canadian Nursing Sister’s Tale.[15] World War I was also the first war in which a clearly-marked hospital ship evacuating the wounded was targeted and sunk by an enemy submarine or torpedo boat, an act that had previously been considered unthinkable, but which happened repeatedly (see List of hospital ships sunk in World War I). Nurses were among the casualties.
Canadian women volunteering to serve overseas as nurses overwhelmed the army with applications.[16] A total of 3,141 Canadian "nursing sisters" served in the Canadian Army Medical Corps and 2,504 of those served overseas in England, France and the Eastern Mediterranean at Gallipoli, Alexandria and Salonika. By the end of the First World War, 46 Canadian Nursing Sisters had given their lives.[17] In addition to these nurses serving overseas with the military, others volunteered and paid their own way over with organizations such as theCanadian Red Cross, the Victorian Order of Nurses, and St. John Ambulance. The sacrifices made by these nurses during the War in fact gave a boost to the women's suffrage movement in many of the countries that fought in the war. The Canadian Army nursing sisters were among the first women in the world to win the right to vote in a federal election; the Military Voters Act of 1917 extended the vote to women in the service such as Nursing Sisters.
[edit]World War II
[edit]United States
As Campbell (1984) shows, the nursing profession was transformed by World War Two. The profession contained a basic tension between the tender loving care provided sick people, on the one hand, and the well-trained efficient specialists on the other was a historic tension in the nursing profession that was partially resolved by the war. The military wanted well-trained efficient specialists. All the services used enlisted men to handle the routine care of sick patients are wounded patients, and use their nurses as officers who were trained specialists. In military units, male doctors supervised female nurses, and both were officers, while the women in practice supervised large numbers of enlisted men. Although enlisted medic could become an officer, it was not easy, and none could become a nurse. Indeed there were no male nurses in the American military until years later. Army and Navy nursing was highly attractive and a larger proportion of nurses volunteered for service higher than any other occupation in American society. The nation responded by a dramatic increase in the numbers and functions of nurses, and a moderate modest increase in their pay scales, with the expansion powered by the training of 200,000 nurses aides by the Red Cross, and the creation of a temporary new government agency, the Cadet Nurse Corps, which enrolled 170,000 young women in speeding up training programs in the nation's 1200 nursing schools. About 5% five percent of the Cadet nurses, and Army nurses were black, but the Navy refused to accept black nurses until it was forced to admit a handful by the White House near the end of the war. The black Army nurses were used in all-black units, handle and to handle medical services for prisoners of war.[18][19]
The public image of the nurses was highly favorable during the war, as the simplified by such Hollywood films as "Cry 'Havoc'" which made the selfless nurses heroes under enemy fire. Some nurses were captured by the Japanese,[20] but in practice they were kept out of harm's way, with the great majority stationed on the home front. However 77 were stationed in the jungles of the Pacific, where their uniform consisted of "khaki slacks, mud, shirts, mud, field shoes, mud, and fatigues."[21][22] The 20,000 nurses in Europe were safely behind the lines. They had two missions one provide technical nursing services to military hospitals and second to train and the male Army medics and male pharmacy mates in the Navy. These men handled front line nursing care, and also staffed home front hospitals, where the nurses directly supervised them. The medical services were large operations, with over 600,000 soldiers, and ten enlisted men for every nurse. Nearly all the doctors were men, with women doctors allowed only to examine the WAC. Forward medical units, were emergency surgery was undertaken, was done without the benefit of nurses. Well behind the battlefield, the nurses worked in evacuation hospitals, primarily in the role of supervising the medics and the Navy’s pharmacy mates. The closer to the front, the more flexible and autonomous was the nurse’s’ role. The women wanted to be much closer to the front, but they had too weak a voice to counter the Pentagon’s highly protective attitude.[23]
Down to 1942, the American Red Cross controlled access to the military. The Red Cross was controlled by civilian men, professional experts and social work and fundraising. The new leaders emerging from the war had learned command skills, maneuvering in complex bureaucracies, the taste of equal pay an officer status, and autonomy within military medical system. New technical skills validated their demands for an autonomy as they learned and employed in crisis situations the latest trauma and medical techniques and technologies. The military nurses returned home as the nation’s experts in blood transfusion and the application of new drugs like penicillin. When the nurses returned home they used the previously powerless American Nurses Association to take control of the nursing profession.[23]
[edit]Britain
During World War II, nurses belonged to Queen Alexandra's Imperial Military Nursing Service (QAIMNS), as they had during World War I, and as they remain today. (Nurses belonging to the QAIMNS are informally called "QA"s.) Members of the Army Nursing Service served in every overseas British military campaign during World War II, as well as at military hospitals in Britain. At the beginning of World War II, nurses held officer status with equivalent rank, but were not commissioned officers. In 1941, emergency commissions and a rank structure were created, conforming with the structure used in the rest of the British Army. Nurses were given rank badges and were now able to be promoted to ranks from Lieutenant through to Brigadier.[24] Nurses were exposed to all dangers during the War, and some were captured and became prisoners of war.
[edit]Germany
Germany had a very large and well organized nursing service, with three main organizations, one for Catholics, one for Protestants, and the DRK (Red Cross). In 1934 the Nazis set up their own nursing unit, the Brown Nurses, absorbing one of the smaller groups, bringing it up to 40,000 members. It set up kindergartens, hoping to seize control of the minds of the younger Germans, in competition with the other nursing organizations. Civilian psychiatric nurses who were Nazi party members participated in the killings of invalids, although the process was shrouded in euphemisms and denials.[25]
Military nursing was primarily handled by the DRK, which came under partial Nazi control. Front line medical services were provided by male medics and doctors. Red Cross nurses served widely within the military medical services, staffing the hospitals that perforce were close to the front lines and at risk of bombing attacks. Two dozen were awarded the highly prestigious Iron Cross for heroism under fire. They are among the 470,000 German women who served with the military.[26]
[edit]Definition
Although nursing practice varies both through its various specialties and countries, these nursing organizations offer the following definitions:
Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.— x , x
The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death.—x, x
Nursing is the protection, promotion, and optimization of health and abilities; prevention of illness and injury; alleviation of suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.—x, x
The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.—x, x
[edit]Nursing as a profession
The authority for the practice of nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level.
The aim of the nursing community worldwide is for its professionals to ensure quality care for all, while maintaining their credentials, code of ethics, standards, and competencies, and continuing their education.[27] There are a number of educational paths to becoming a professional nurse, which vary greatly worldwide, but all involve extensive study of nursing theoryand practice, and training in clinical skills.
Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individual's physical, emotional, psychological, intellectual, social, and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals.
In order to work in the nursing profession, all nurses hold one or more credentials depending on their scope of practice and education. A Licensed practical nurse (LPN) (also referred to as a Licensed vocational nurse, Registered practical nurse, Enrolled nurse, and State enrolled nurse) works independently or with a Registered nurse. The most significant differentiation between an LPN and RN is found in the requirements for entry to practice, which determines entitlement for their scope of practice, for example in Canada an RN requires a bachelors degree and a LPN requires a 2 year diploma. A Registered nurse (RN) provides scientific, psychological, and technological knowledge in the care of patients and families in many health care settings. Registered nurses may also earn additional credentials or degrees. In the USA, in addition to the LPN, Registered nurses can earn 2 different degrees that qualify a nurse for the title RN. The title RN AND is awarded to the nurse who has completed a 2 year undergraduate academic degree awarded by community colleges, junior colleges, technical colleges, and bachelor's degree-granting colleges and universities upon completion of a course of study usually lasting two years. The title RN BSN is awarded to the nurse who has earned an American four year academic degree in the science and principles of nursing, granted by a tertiary education university or similarly accredited school. After completing either the LPN or either RN education programs in the USA graduates are then eligible to sit for the a licensing examination to become a nurse, the passing of which is required for the nursing license.
RN's may also pursue different roles as advanced practice registered nurses.
Nurses may follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting.
Around the world, nurses have been traditionally female. Despite equal opportunity legislation nursing has continued to be a female dominated profession.[28] For instance, in Canada and America the male-to-female ratio of nurses is approximately 1:19.[29][30] This ratio is represented around the world. Notable exceptions include: Francophone Africa, which includes the countries of Benin, Burkina Faso, Cameroon, Chad, Congo, Ivory Coast, the Democratic Republic of Congo, Djibouti, Guinea, Gabon, Mali, Mauritania, Niger, Rwanda, Senegal, andTogo, which all have more male than female nurses.[31] In Europe, in countries such as Spain, Portugal, Czechoslovakia, and Italy, over 20% of nurses are male.[31]
[edit]Regulation of practice
The practice of nursing is governed by laws that define a scope of practice, generally mandated by the legislature of the country or area within which the nurse practices. Nurses are held legally responsible and accountable for their practice. The standard of care is that of the "prudent nurse."
[edit]Nursing theory and process
Main articles: Nursing theory and Nursing process
Nursing practice is the actual provision of nursing care. In providing care, nurses implement the nursing care plan using the nursing process. This is based around a specific nursing theory which is selected based on the care setting and population served. In providing nursing care, the nurse uses both nursing theory and best practice derived from nursing research.
In general terms, the nursing process is the method used to assess and diagnose needs, plan outcomes and interventions, implement interventions, and evaluate the outcomes of the care provided. Like other disciplines, the profession has developed different theories derived from sometimes diverse philosophical beliefs and paradigms or worldviews to help nurses direct their activities to accomplish specific goals.
[edit]Practice settings
Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work inoccupational health settings (also called industrial health settings), free-standing clinics and physician offices, nurse-led clinics, long-term care facilities and camps. They also work oncruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate, Inc. helping in a variety of clinical and administrative issues.[32] Some are attorneys and others work with attorneys as legal nurse consultants, reviewing patient records to assure that adequate care was provided and testifying in court. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing, agency nursing or travel nursing. Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software.
[edit]Work environment
Internationally, there is a serious shortage of nurses.[33] One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. De Lucia, Otto, & Palmier (2009) [34] concluded, "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MSDs. In short, the nursing work system often exceeds the limits and capabilities of human performance. HF/E research should be conducted to determine how these overloads can be reduced and how the limits and capabilities of performance can be accommodated. Ironically, the literature shows that there are studies to determine whether nurses can effectively perform tasks ordinarily performed by physicians. Results indicate that nurses can perform such tasks effectively. Nevertheless, already overloaded nurses should not be given more tasks to perform. When reducing the overload, it should be kept in mind that under loads also can be detrimental to performance (Mack worth, 1948). Both overloads and under loads are important to consider for improving performance." [34] Each county/ state in which a nurse is licensed has laws concerning how many patients one nurse can tend to(depending on the acuity of the patients needs)
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