American Nursing has a marvelous history full of forward thinking women and radical idea shakers. While some current nurse academicians claim a change in name is needed to draw men to its ranks in order to promote and foster change for the image of nursing, men have a robust history in nursing extending back to the middle ages and persisting to the present day. Their lengthy nursing history is largely eclipsed by our current view of nursing , its gender breakdown, and nursing's present cultural context [See Image of Nursing]. While it is impossible to separate nursing from the history of women in general in our culture,  it is possible to follow the history unique to the profession and in it see the history of our men. Nursing holds at its core a tradition of caring and responsibility at great personal sacrifice. We have in our collective history stories of nuns caring for the poor, infirm and outcast; Prostitutes able to travel safely at night to assist difficult births; the poet Walt Whitman and writer Louisa May Alcott;  America's first trained nurse educated by America's first female trained doctor; the first women in the military; the first women given rank in the military; an imprisoned first contraceptive provider, early 20th century public health nurses providing the only medical contact for Manhattan's teaming poor, rugged horse riding frontierswomen  determined and rising to their own challenge to reverse the #One cause for mortality  in rural america in the 1930s [thus changing the practice of obstetrics],  and the visionaries of our profession of  the 1970s creating the role of Nurse Practitioners the purpose of which was to extend healthcare to underserviced populations.  Our rich history gives reason for pride, and a radical tradition  to which we must set our sights. To this end, it is the feeling of this writer that all our national schools of nursing must include a mandatory semester on the History of Nursing, and another on Basic Economics involving American Health Care, and the principal tenets of these courses must be referred to in subsequent semesters. If we are not educated on our mutualhistory, and not knowledgeable of economics involving our profession and the industry in which it is found and manipulated, we can not be forceful and educated participants but are instead educated to remain instead outsiders to our own destiny. These two areas, nursing history and basic health care economics,  are just as important tools our nation's nurses,as important as the technical skills required to do the job, for they assure the ability to AFFECT the job, and those who oversee its education and management.

Course Schedule, Content Objectives, Course Content On-line
 

MODULE 1:Ý Part IÝÝ
 

Historical perspectives/development of professional nursing.

HISTORICAL DEVELOPMENT OF NURSING
A. Nursing - "The oldest of the arts and the youngest of the professions"

1. Derived from Latin word "nutricius" - which means nourishing:
2. Evolved from art of comfort, care and nurturance to a synthesis of the art with science and technology of today.

B.ÝÝÝÝ ANCIENT TIMES
Historically, it was difficult to differentiate between role of a physician or nurse as most differences were based on male and female roles of that day. (medicine man; herb woman)

1. Babylonians

a. Earliest document of laws governing practice of med: 1900 B.C. "'Code of Hammurabi"
b. regulated sanitation, practice of surgery, differentiated between practice on human & Vet med, fees for surgery and penalties for violators of the code.
c. nonspecific record of nursing; however, references to tasks traditionally provided by nurses-, interesting that women were the exclusive property of men.
2.Ý Egyptians
a. physicians treated internal diseases, fractured bones and wounds
b. wrote oldest textbook of medicine "Ebers papyrus" 1550 B.C. describing many diseases known today and a list of 700 substances that were used as drugs.
c. hired women, later known as midwives to attend births; & used wet nurses to suckle and care for infant children of wealthy - first recorded nurses.
3. Hebrews
ÝÝÝÝÝÝÝ a. practiced preventative medicine during 1200-600 B.C. called theÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝÝ Mosiac Health Code
ÝÝÝÝÝÝÝ b. code included: quarantine of those with infectious illnesses, quarantined ÝÝÝÝÝÝÝcontaminated wells, forbade eating of pork (which prevented trichinosis); use of different sets of dishes for meat meals and milk meals minimized contamination from wooded bowls and other utensils.
ÝÝÝÝÝÝÝ c. Care of the sick and aged a religious responsibility of the pious
4. Greeks
ÝÝÝ a.Ý incorporated both mvthology and reality ? Hygiea was goddess of healthÝ and revered by some as the embodiment of the nurse.
ÝÝÝ b. Hippocrates (400 B.C.) first to separate medicine from religion; called theÝÝFather of Medicine; believed illness had natural rather than magical or mysticalÝcauses.
5. Romans

a. Dominated ancient world after 300 B.C. using much of the Greek knowledge of health.
b. constructed a network of aqueducts and sewers which brought fresh water and sanitation in Rome
c. Roman noblewoman, including wives of emperors cared for sick

6. Africans
ÝÝÝ a.Ý identified women with functions of a midwife, herbalist, and wet nurse.
ÝÝÝ b.Ý cared for children and elderly
7. Chinese
ÝÝÝ a. no mention of nurses in writings
ÝÝÝ b. contribution to healthcare includes 365 herbal remedies; & acupunctureÝÝÝÝÝÝÝÝ forÝtreatments
ÝÝÝ c. published Nei Ching (Canon of Medicine) which details 4 steps to examination - look, listen, ask and feel
C. Dawn of Christianity (0-500 A.D.) Christian value of "Love thy neighbor as thy self" had great impact on the development of nursing from this point on.

1. Care mostly hygienic and comfort measures, care of the sick and distressed seen as a duty of all Christian men and women
2. The earliest orders of women workers were called deaconesses (one who ministers to the needs of others:); they shared activities with men in all works of the community; a rare exception for womenís rights that are not seen again until 1960's AD.!!!!

ÝÝÝ a. Phoebe, 60 A.D. - a friend of St. Paul and named as a deaconess inÝthe New Testament; nursed the poor in their homes - the first visiting nurse!
ÝÝÝ b. Marcella - most famous of Roman matrons to care for the sick poor
ÝÝÝ c. Fabiola - developed first public hospital in Rome in 390 AD. for sick- poor, some call her the Patron Saint of Nursing
ÝÝÝ d. Paula - built hospitals and hospices for pilgrims to and hospitals for sickÝalong road to Bethlehem
Ý
D. Middle Ages (500-1500 A-D.) Period of feudalism, monasticism (withdrawal from society for sanctification of one's soul) and Islam(encouraged study of medicine and introduced new methods of healthcare for the sick)
1. Early part known as the DARK AGES
ÝÝÝ a. progress in knowledge about disease and human body slowed during thisÝanti-intellectualism period
ÝÝÝ b. the work of the deaconess group was suppressed
ÝÝÝ c. Christian Church in conflict with scientific thought and education
ÝÝÝ d. women were once again in a subordinate position; however could achieve dignity as a nun
2. Health in the Middle Ages,

a. First medical school built in Lyons, France (Hotel Dieu or Godís House) in 542 A.D.; its earliest nurses were "fallen women" and widows, and eventually men called brothers assisted with the nursing.
b. a 12'th Century midwife, Trotuala, wrote a famous book-, "Trotuala on the cure of diseases of women"
c. the Black Death (Bubonic Plague) occurred in the 14th Century; thought to have been one of the most devastating crises in human history- 25 % of -pop of world died

3. Late Middle Ages (1000 - 1500) The period of the Crusades

a. religious orders developed to care for the sick; military male nursing
b. order of the Knights Hospitalers of St. John of Jerusalem (1099) developed the first charts to maintain information about the treatments given to the patients in their care;: Augustinian Sisters worked at Hotel Dieu and are considered to be the oldest purely nursing order of Sisters in existence
c. monks and nuns cared for the sick but care was segregated by sex;
d. first identifiable organization of nurses.
e. hospitals developed but were places to keep, not cure, patients;
f. practice of using individuals of low character became more common- and persisted for a long time (even Nightingales time)
g. physicians began to visit patients in hospitals for the first time

Ý
E. Renaissance and Reformation (1400-1600) Period of humanism and a revival of learning yet one of the darkest Periods in nursing
1. Saw a renewal of pagan superstition and witchcraft and great medical advancements
a. Andreas Vesalius corrected over 200 mistakes in the works of Galen on anatomical knowledge
b. Leonardo da Vinci made his accurate illustrations of the body
c. William Harvey experiments on circulation

2.Ý Majority of hospitals operated by Catholics were closed or taken over by Protestants except in the Catholic countries.
ÝÝÝ a. caused tremendous shortage of nurses to care for sick, and poor; no oneÝto replace the religious orders
ÝÝÝ b. women were sent to work as nurses in lieu of serving jail sentences
ÝÝÝ c. Henry VIII actually closed all hospitals in England between 1538-1540Ýbecause they were Catholic
ÝÝÝ d. public outcry eventually lead to the city of London assuming responsibilityÝfor the hospitals and developed a trend of civilian control of hospitals and the beginning of lay nursing in England; spread to other Protestant countries.
3.ÝÝ Hospitals decayed with outbreaks of epidemics, mismanagement and unsanitary conditions
ÝÝÝ a. men were given leadership appointments and withheld authority from the women (matrons) who we in charge of the "nurses" of the day.
ÝÝÝ b. women had no control in hospital management and there was no nursing organization as such
ÝÝÝ c. some consider this period where the most complete and general masculine supremacy in the history of health care occurred
d. Lying-in hospitals were developed so physicians who studied obstetrics in their medical curriculum could care for the pregnant women
b.Ý Semmelweis (1818-1865) noted that the clinic where midwives cared for mothers had a lower mortality rate than the clinic where medical students practiced. Handwashing seemed to make the difference but germ theory had not been discovered as yet. When Semmelweiss demanded that the medical students wash their hands after autopsies and before care for women in labor, he was regarded as insane.
5. In the Catholic country of France, St. Vincent de Paul (1576-1660 developed an order called the Sisters of Charity who visited the sick in their homes and provided nursing care and spiritual help. St. Vincent provided lectures to the sisters that remain one of best presentations on nursing ethics. This order also took on the responsibility for caring for abandoned children, establishing homes for the insane and teaching in schools
6. Nursing conditions were at their worst where religious thought was not a motivation. Such nurses were usually illiterate, rough, and oftentimes, immoral, alcoholic; if a woman could not make a living from gambling or vice, she might become a nurse. If the woman worked as a nurse, she worked long hours (24-48 hours) with poor pay, filthy working conditions, and certainly no social life or esteem.
Ý
F.Ý Birth of Modern Nursing - the Nightingale Period (1820-191 0)
1. Pastor Theodore Fliedner established the Deaconess Institute in Kaiserwerth, Germany in 1836 to revive the concept of deaconesses to care for the sick in the Lutheran church.
2. Florence Nightingale
·Ý She was born into the British upper-class in a family who traveled throughout Europe. She received a classical education to that of a man of her day; she was aware of the inadequate care of sick but family pressure kept her from actively pursuing involvement in hospitals. Her mother "took to her bed" for a month when Florence first announced her intention to study nursing and work to improve the care of the sick.
Attendance of the program at Kaiserswerth for 3 mo. and in Paris with the Sisters of Charity provided her with more nursing education than virtually any other woman in Europe at the time. After these experiences, she assumed the administrative position as superintendent of the Establishment for Gentlewomen in Distressed Circumstances in London
The Crimean War and newspaper accounts of the poor care provided to sick and injured soldiers triggered a strong public demand for better care for the army. Because of her social position, and personal acquaintance with the British Prime Minister, she was asked to recruit women to go to nurse the soldiers. She began her crusade for changes in the care, of sick and wounded by being very selective about the women she took with her; before her arrival, - 42-60 % of men died from disease rather than wounds; within 6 months the mortality rate dropped to 2% due to her efforts; her use of numbers caused her to be called the founder of statistics. She also ensured that newspaper reporters knew what was being done so the British public would know what changes good nursing care could provide. It is now believed that she developed chronic typhus while in the Crimean area.
Founder of modern nursing education: St. Thomas Hospital School of Nursing in London was founded with money donated by the British public after the Crimean was, and Nightingale personally oversaw the selection of the students, the matrons, and the educational program. The Nightingale Museum is now at St. Thomas Hospital.
Published "Notes on Nursing - What It Is and What It Is Not" in 1859
first to use term: holism
Strongly felt nurses should be trained and supervised by nurses, not physicians
·Ý Go to this website NOW: http://www.dnai.com/~borneo/nightingale
·Ý Development of Nursing in U.S.
Web site of interest: American Association for the History of Nursing: http://www.aahn.org
1. Nursing was as crude and problematic as in Europe; initially nursing was provided by family members, widows or spinsters in the community. Each community usually had at least one woman who was a skilled herbalist.
2. Philadelphia Hospital in Philadelphia in 1751 that carries the title of the first American hospital. It was designed solely for the curative care of the sick and Benjamin Franklin assisted in its development
3. The formation of AMA in 1847 led to reform and advancement of medicine

* Flexner Report (1910) helped standardize medical education and closed many so-called medical schools that had only 3 months of education; no direct patient contact; and did not require any previous formal schooling.
* Religious orders developed programs throughout the U.S as early as 1809 by the Sisters of Charity founded by Elizabeth Seton; again, these hospitals were usually better than non-religious hospitals because of the type of nurses used.
* Public hospitals remained facilities for the destitute who had no family to care for them.

4. Civil War (1861-1865)

* Wide use of newspapers and reports about the conditions of the wounded led to increased public interest in the supplies and care available to the wounded.
* Black, white, rich, poor, single and married women cared for the sick and wounded; The U.S. Sanitary Commission was responsible for the hospitals for the Northern armies, and the female nurses were volunteers.
* The need for cleanliness, competent physicians, and a group of female nurses all became priorities for both armies
* prominent women during this period

* Dorothea Dix - pioneer crusader for the mentally ill; founded the first state psychiatric hospital in Trenton, NJ; appointed Superintendent of Women Nurses in the Army
* Sojourner Truth - nurse, abolitionist, -underground railroad agent, itinerant preacher, feminist and humanitarian
* Harriet Ross Tubman- nurse, conductor of underground railroad
* Susie King Taylor - teacher, nurse, learned to read & write in secret, taught black refugee children
* Clara Barton - independently operated to care for both Northerners and Southerners; a lay nurse but became the leader in the development of the American Red Cross in 1881

G. Nursing Education

* training schools for nurses were developed although conflict arose regarding whether nurses should be trained and supervised by physicians or nurses. This was very different from Britain, where Nightingale still ruled the developing profession. No similar American nurse of influence was seen.
 
 

* "Famous trio" of nursing schools opened patterned -after the Nightingale plan

a. Bellevue Training School in New York- at Bellevue Hospital
b.Connecticut Training School at New Haven Hospital
c. Boston Training School at Mass General Hospital

1. Melinda Ann (Linda) Richards was first "trained nurse" in the U.S. in 1873 from the New England Hospital for Women and Children in Boston
2. Mary Eliza Mahoney was first black trained nurse in 1879 from the Boston school
 
 

* Spellman Seminary in Atlanta, Ga in 1896, was first nursing school for blacks

American Journal of Nursing established as the first professional nursing journal in 1900
American Nurses Association created in 1911
Ý
H. Prominent Nurses
1. Isabel Hampton Robb
presented paper in 1893 on lack of uniformity in nursing education; led to development of the American Society of Superintendents of Training Schools for Nurses (eventually became National League for Nursing in 1912)
2. Lillian Wald
founded "Henry Street Settlement" to provide health care to the neighborhood; form first nursing specialty group,"National Organization of Public Health Nurses"; established the first school nurse program to improve the health of the children; active in politics at local, state, and national levels to improve the health status of children and workers.
3. Mary Adelaide Nutting
first nursing professor in the world; fostered initial movement toward undergraduate and graduate degrees in nursing
4. Margaret Sanger
pioneer in birth control; opened clinic which was beginning of Planned Parenthood
5. Lavinia Dock
feminist and actively involved in womenís rights issues and the suffrage movement for right to vote; nursing historian
6. Annie Goodrich
First dean of Army Nurse Corps; nursing author
7. Mary Breckinridge
Founder of the Frontier Nursing Service in 1925; first formal nurse-midwifery program in the US; provided nursing care to people living in the hills of Kentucky
Ý
I. Twentieth Century - Nursing as a Profession
Army Nurse Corp established in 1901 and Navy Nurse Corps in 1908; nurses served in WW1 although they were neither officers or enlisted personnel
Time of social injustice and social awakening;
·ÝÝÝÝÝÝÝÝ Racial discrimination present in education, hospitals, and society in general
·ÝÝÝÝÝÝÝÝ Women couldn't vote until 1919, and some nurses were very active in the politics of getting the vote
Ý
Sigma Theta Tau founded by 6 nursing students at Indiana Training School for Nurses in 1922
Ý

1. Goldmark Report in 1923 on Nursing and Nursing EducationÝ advocated schools of nursing be placed in university settings; nurses should not be used as labor in hospitals instead of using licensed graduate nurses. This report did not have the same impact on nursing education that the Flexner Report had had on medical education. Many mail-order diploma nursing programs, programs of 6 months-1yr. remained active.

Ý
2. Depression of 1929-1937
a. nurses shifted from home care to hospital based care as family resources for private nurses decreased; the nursing profession went from one of independent contractors to hourly employees
b. unemployment nationwide which led to hospitals decreasing their use of students to staff hospitals and hire more graduate nurses; graduate nurses often worked for room and board, plus a very small salary
Ý
3. World War II Years

a. Lanham Act of 1941 provided funding for nursing education (dorms, libraries, classrooms, etc.)

This was the first federal money spent for nursing education and provided for consistent educational programs in all schools of nursing (military services wanted consistent knowledge base)
 

* Lucille Petry becomes Assistant Surgeon General: highest post held by a nurse at that time

Nurses served in WW II in all theatres of war - saw medical advancements that included blood transfusions, antibiotics, malaria treatment, trauma care and rehabilitation

* Some nurses were wounded, died or captured asÝ POWS in the Pacific (had been assigned to bases in the Phillipines)

Committee appointed in 1942 to develop the State Board Test Pool Exam for consistent licensing of nurses throughout the US
Ý
5. Post War

a. nursing shortage became acute due to the "baby boom", construction of new hospitals; and married nurses quitting and becoming housewives. Nursing assistants and LPN's were developed, and team -nursing is promoted nation wide ; during the war the civilian population had become used to going to the hospital for care, since the few civilian physicians no longer made house calls routinely
b. Long hours, low pay and large workloads cause the ANA to authorize state units to form collective bargaining units - very controversial
c. c. 1950 -All states using state board exams; reciprocity possible when moving from state to state
d. Discrimination still exist for black nurses in education and work opportunities

Korean War (1950-195I)
a. Mobile Army Surgical Hospital (MASH) units implemented
b. explosion of technology from military uses to civilian hospitals
ADN education introduced in 1952
Journal of Nursing Research 1952
ICU,'s, premie nurseries introduced, emergency rooms became more sophisticated
Civil rights movement let toward the beginning of racial equality in nursing eduacation, health care and nursing organizations
1953 National Association of Nursing Students formed
Ý
7. 1965 ANA Position Paper on Entry into Practice
·Ý all nursing education to take place in institutions of higher learning and BSN as minimum preparation for the professional nurse and the ADN as minimum preparation for the technical nurse.
Ý
8. Up to the present
a. unparalleled growth of hospitals and health care industry through the 1980ís
b. increasing costs of health care push for cost containment and limits on reimbursement for care from the government and insurance companies (DRGís)
c. nurses begin to be more specialized and more highly educated; certification in a specialty became valued
d. Medicare (1966) and Medicaid pass to provide care for elderly, poor and disabled; amendments broaden the population covered until many chronic conditions are included
e. nurses begin to be employed outside the hospital in increasing number, the greatest change since before the Great Depression
f. primary nursing introduced in 1970 gives way to managed care and patient care associates, and other staffing changes made to try to lower the cost of providing care"

Syllabus
College of Nursing | University of Texas at TylerÝ Copyright © 2001, Last UpdateÝ
January, 2002

Nurses in The Military:
Cherry Ames, War Nurse:Fiction Meets Reality  some cool images, lots of links, mostly military nurses info
HISTORY OF THE ARMY NURSE CORPS (Slide Presentation with Narration) Military Nurses, some great shots

General Nursing History Links:
Nurses and Nursing    Links to Nursing and nurses in women's history, including pioneer women nurses.
American Nursing Hall of Fame Inductees
Significant Events in the History of Nursing  A timeline 1836 to present
AAHN Nursing History 2000 Calendar
American Association for the History of Nursing Homepage
The Center for Nursing Historical Inquiry  Links and archived photographs
Center for The Study of The History of Nursing
History of Public Health Nursing
History of the Frontier Nursing Service"Up until the 1930s, an American woman was more likely to die in childbirth than from any other disease, except tuberculosis. The mortality rate was particularly high for pregnant women in rural areas where hospitals and qualified medical care were scarce. Breckinridge recognized this concern and succeeded in one of the pioneering attempts to bring professionalized health care to rural-America. "
Black Nurses in History
Men in American Nursing History
Open Directory Project  Nursing History Links including and beyond those above
Visiting Nurses of Phila, [The Daily Activities of the
Visiting Nurses fo 19th and 20th century] History and links
Virginia Nursing History
Nursing History Links From  Dianne BROWNson's Nursing Notes Webpages

International Nursing Links
According to reviews of Japanese nursing and medical history, modern nursing in Japan was established in 1885 when a physician who was influenced by Nightingaleís concept of nursing started the first training school for nurses (Doona, 1996; Hisama, 1996; Kodama, 1984, 1994; Kusakari, 1989; Long, 1984; Nakahara, 1997; Tierney & Tierney, 1994). Although the ideal of nursing as both an art and science was introduced early on, public perception of nurses has not reflected nurses as independent practitioners with unique skills. Nurses have been perceived as being educated and caring, but also subservient to physicians. Furthermore, nursing work has been described using negative terminology such as "hard, dirty, dangerous, low salary, few holidays, minimal chance of marriage and family, and poor image" (Katsuragi, 1997; Tierney & Tierney, 1994)."
NURSING AROUND THE WORLD: JAPAN - PREPARING FOR THE CENTURY OF THE ELDERLY. Janet Primomo PhD, RN Presented at NursingWorld.org