NURSING YESTERDAY AND TODAY

1
CHAPTER 15

• NURSING YESTERDAY AND TODAY

2
Nursings Public Image

• 25 years ago, society perceived nurses in
  gender-linked task-oriented terms
• Popular media have improved somewhat in the
  portrayal of nursings image

3
Nursing Defined

• 1859 Nightingale
• 1950 Henderson
• 1963 Rogers
• 2002 American Nurses Association

4
Nursing Leaders

• Florence Nightingale
• Lillian Wald
• Margaret Sanger
• Adelaide Nutting
• Mildred Montag
• Mary Elizabeth Mahoney
• Virginia Henderson

5
Florence Nightingale
6
Florence Nightingale

• Best known of the nursing leaders
• Was considered the founder of modern nursing
• Innovative thinker
• Acted as a change agent

7
Background

• Born in Florence, Italy, in 1820
• Father saw to her education
• Always showed an interest in the welfare of those
  less fortunate
• Insisted in going to Kaiserworth to become
  trained as a nurse

8
Crimean War

• Nightingale was commissioned to go to the Crimea
  to investigate the conditions and make
  improvements
• She found a disaster

9
Changes in Care

• Nightingale and nurses cleaned environment
• Delivered nursing care
• Wrote letters to families

10
The Nightingale School

• This was an independent educational institution
• Her book, Notes on Nursing What it is and what
  it is not, set the fundamental principles of
  nursing

11
Health-Care Reform

• Nightingale kept statistical records
• These records convinced the British to make
  reforms
• Her work marked the beginning of modern military
  nursing
• Her work led to hospital reform

12
Lillian Wald
13
Background

• Born in Ohio
• Attended the New York Hospital School of Nursing
• Thought she wanted to continue in medical school
  and entered Womens Medical College in New York

14
The Visiting Nurses

• Wald and Brewster established a settlement house
  in New Yorks Lower East Side
• They built an independent nursing practice
• Eventually, they developed a respected reputation
  among hospitals and physicians

15
The Henry Street Settlement House

• Established 2 years later
• Grew into a well-organized social service system
• Multiple services were available

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Other Accomplishments

• Developed school health nursing
• Organized the Childrens Bureau
• Nursing Service Division of the Metropolitan Life
  Insurance Company

17
Margaret Sanger
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Background

• Born in Corning, New York
• Attended the White Plains Hospital School of
  Nursing
• Worked at the Manhattan Eye and Ear Hospital
• Married and became a homemaker

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Advocate and Social Reformer

• Sanger was concerned about the working conditions
  of people who lived in poverty
• A major strike in Lawrence, Massachusetts,
  influenced her life
• She intervened on behalf of the children

20
Sanger the Public Health Nurse

• Sanger was assigned to maternity cases on the
  Lower East Side
• While caring for a young mother who had attempted
  to self-abort, Sanger began to see a need for
  education in family planning

21
Reform

• Sanger worked toward making contraceptive
  information available to women
• She opened the first birth control clinic in the
  United States
• Sanger was arrested she walked to the
  courthouse, refusing to ride

22
Creation of Planned Parenthood

• Sanger established Planned Parenthood
• Today this organization offers birth control
  information and family planning counseling

23
The Feminist

• Sanger can be considered an early feminist
• She was independent and assertive at a time when
  it was not considered politically correct for a
  woman to be outspoken
• She used her nursing background to promote
  political change

24
Adelaide Nutting
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Background

• Nutting was the first graduate of the Johns
  Hopkins School of Nursing
• As a nursing student she won an essay contest
• She became a close friend of Isabel Hampton, the
  director of the Johns Hopkins School of Nursing

26
Nursing Education

• Nutting developed the prototype for diploma
  school education
• She added a background in the basic sciences
• Nutting believed that the profession needed
  autonomy to advance

27
Major Contributions

• Nutting created the Department of Nursing and
  Health at Teachers College at Columbia University
• She became the first professor of nursing in the
  world
• She was instrumental in developing university
  education for nursing

28
Mildred Montag
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Background

• Developed the curriculum for associate degree
  nursing programs
• Proposed two levels of nursing
• Described a curriculum to educate what she
  referred to as the technical nurse

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Contributions to Nursing

• Associate degree nursing (ADN) education has
  exerted a profound impact on nursing education
• ADN is the primary model for basic RN education

31
Contributions to Nursing

• Montags major achievement was to shift nursing
  education from hospital, service-based facilities
  to institutions of higher learning

32
Mary Elizabeth Mahoney
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Background

• She was born free on May 7, 1845, in Dorchester,
  Massachusetts
• She showed an interest in nursing during her
  adolescence
• She worked for 15 years at the New England
  Hospital for Women and Children
• She was as a cook, held a janitors position, and
  spent time as a washerwoman and an unofficial
  nurse's assistant

34
Education

• At the age of 33, she applied to the hospitals
  nursing program and was accepted as a student
• 16 months later, Mary and four white students
  completed the rigorous course
• She ended her nursing career as director of an
  orphanage in Long Island, New York

35
Contributions to Nursing

• Recognized the need for nurses to work together
  to advance the status of black nurses within the
  profession
• Cofounded the National Association of Colored
  Graduate Nurses (NACGN)

36
Virginia Henderson
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Background

• Born in 1897 in Kansas City, Missouri
• Attended the U.S. Army School of Nursing
• Continued her career in public health

38
Nurse Educator

• Attended Columbia Teachers College
• Joined the faculty
• In 1953 joined the Yale School of Nursing
  Faculty, where she remained for 40 years

39
Contributions to Nursing

• She published the four-volume Nursing Studies
  Index
• She pioneered the work that is considered the
  essence of modern nursing
• Her most important writing, The Principles and
  Practice of Nursing, is considered the equivalent
  of Nightingales work

40
Contributions

• Henderson actively participated in nursing
  organizations
• Sigma Theta Tau International Nurses Honor
  Society named its library in honor of her
  contributions

41
Hendersons Legacy

• Recognized as the first lady of nursing
• Many colleagues refer to her as the 21st century
  Florence Nightingale
• She represents the essence and the spirit of
  nursing to all of us

42
Men in Nursing
43
Early History

• Early Egyptian priests practiced nursing
• The first nursing school started in India in 250
  BC, and only men were considered pure enough to
  be nurses
• Nursing was practiced by men during the Byzantine
  Empire

44
The 19th Century

• Male and female slaves served as nurses
• During the Civil War, the Confederate army used
  men as nurses, whereas the Union army used women
• In 1863 the Alexian Brothers opened the first
  hospital in this country and educated men as
  nurses

45
The 20th Century

• The ANA first admitted nurses to its membership
  in 1930
• Men were not allowed to serve as nurses in the
  military until the conclusion of the Korean War
• Today the number of men in nursing is increasing,
  resuming their historical role as caregivers

46
PROFESSIONAL ORGANIZATIONS
47
American Nurses Association (ANA)

• Works for improvement of health standards
• Availability of health-care services
• Fosters high standards for nursing

48
ANAs Social Policy Statement

• The social context of nursing practice
• The nature and scope of nursing practice
• Specialization in nursing practice
• Regulation of nursing practice
• The ethics of nursing practice reviewed by the
  House of Delegates

49
American Nurses Association (ANA)

• Stimulates and promotes the professional
  development of nurses
• Advances nurses economic and general welfare

50
National League for Nursing(NLN)

• Membership is open to other health professionals
  and interested consumers, not just nurses
• Participates in test services, research, and
  publication
• Lobbies actively for nursing issues
• Currently working with ANA and other nursing
  organizations on health-care reform.

51
National League for Nursing Accreditation
Commission

• Accredits colleges and schools of nursing

52
National Organization for Associate Degree
Nursing (NOADN)

• Associate degree nursing programs prepare the
  largest number of new graduates for RN licensure
• Began in 1986

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Role of NOADN

• Strong educational programs
• Dynamic education of students in a variety of
  settings
• Emphasis on life-long learning
• Continued articulation with colleges and
  universities

54
Specialty Organizations

• Nurses may join specialty organizations
• Provide nurses with information regarding
  standards of practice and evidence-based practice
  within specialty areas

55
Educating Nurses

• Practical Nursing programs
• Diploma programs
• Associate degree programs
• Baccalaureate degree programs

56
Educating Nurses

• Masters degree programs
• Doctoral programs
• External degree programs
• Continuing education

57
Nursing Theory
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What is Theory?

• Word theory comes from Greek theoria
• Means to contemplate
• Provides an explanation of why something happens
  the way it does

59
Nursing Theory

• Nurses use theory to help them think critically
  and to make decisions supported by scientific
  principles
• Nursing theory provides a knowledge base for
  decision-making

60
Reasons for Nursing Theory

• Throughout history, most nursing care has been
  built on tradition and intuition
• Many consumers do not understand what nursing is
  and what nurses do
• Nurses need to conduct research to validate
  nursing actions

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Common Concepts in Nursing Theory

• Person
• Health
• Nursing
• Environment

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Nursing Theory as a Basis for Practice

• In the middle of the 20th century, nurses
  believed theories from other disciplines could
  enhance nursing practice
• These theories could not define or describe
  nursing practice

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Nurse Theorists

• An interest in defining nursing knowledge
  increased
• Graduate programs produced nurses with an
  interest in research and theory development

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Nurse Theorists

• Started creating philosophies, or systems of
  basic principles, and conceptual models
• Described ideas and their relationships to one
  another to explain nursing

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Role of Nurses in Research

• Practicing nurses play a major role in
  identifying researchable patient problems
• Help gather data for research

66
Current Trends

• Aging baby boomers
• Emphasis on economics

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Changes

• Historical perspective
• Managed care
• Insurance

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Effect on Nursing

• Elimination of positions
• Changes in the practice environment
• Quality-of-care issues
• Nursing shortage

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Effect on Nursing

• Preventing patient care errors
• Emphasis on outcomes
• Changing competencies

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Changing Competencies

• Critical thinking skills
• Understanding of systems
• Care management

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Changing Competencies

• Team-building and communication skills
• Negotiating, collaborating, conflict management
  skills
• Cultural competency

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Changing Competencies

• Flexibility
• Technological competence
• Business skills

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Communicating Nursings Role
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TriCouncil

• ANA, NLN, AACN, AONE
• Designed a campaign to communicate the
  contributions of nurses

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Three Areas

• Nurses as resource people
• Nurses as health-care coordinators
• Nurses as expert practitioners

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Using Nursing Influence

• Carry your license
• Use your special training and experience
• Become a double agent
• Network with and empower colleagues

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Using Nursing Influence

• Eliminate the enemy within
• Focus on operations
• Organize as a supportive group

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Conclusion
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Conclusion

• Nursing has a rich and exciting history
• Nursing is cyclical
• Nursing is diverse
• Nursing deals with individuals, their health, and
  their environments
• To meet the needs of the future, nurses need to
  become involved in theory development and
  research

80
Conclusion

• Nurses need to take the lead in movement toward a
  clearer identity and role delineation of the
  profession
• To achieve nursing goals, the value of nursing
  and acceptance of its professional status must be
  recognized