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Historical Perspective

• Nursing has undergone dramatic changes in response to societal needs and influences
• Nursing's beginnings reveal its continuing struggle for autonomy and professionalization
• Recurring themes such as women's roles and status, religious values, war, societal attitudes, and visionary nursing leadership have influenced nursing practice

Women's Roles

• Traditional female roles such as wife, mother, daughter, and sister have always included the care and nurturing of other family members
• Since the beginning of time, women have cared for infants and children, nursing could be said to have its roots in "the home"
• The care provided was generally related to physical maintenance and comfort
• The traditional nursing role has always entailed humanistic caring, nurturing, comforting, and supporting

Religion

• Religion has played a significant role in the development of nursing
• The Christian premise of "love thy neighbor as thyself" and Christ's parable of the Good Samaritan influenced the West
• Early religious values such as self-denial, spiritual calling, and devotion to duty and hard work, have dominated nursing throughout its history
• Commitment to these values often resulted in exploitation and few monetary rewards for nurses
• Nurses themselves believed it was inappropriate to expect economic gain from their "calling"

War

• Wars have accentuated the need for nurses
• Florence Nightingale addressed this problem
• Nightingale and her nurses transformed military hospitals by setting up sanitation practices, including handwashing and regularly washing clothing
• Nightingale reduced the mortality rate in the Barrack Hospital in Turkey from 42% to 2% in 6 months
• During the American Civil War, nurses emerged who were notable for their contributions to a country torn by internal strife
• Harriet Tubman (1820-1913) was known as "The Moses of Her People" for her work with the Underground Railroad, and nursed the sick and suffering of her own race during the Civil War (1861-1865)
• Sojourner Truth (1797-1883) was an abolitionist, Underground Railroad agent, preacher, and women's rights advocate.
• Sojourner Truth was a nurse for over 4 years during the Civil War and worked as a nurse and counselor for the Freedmen's Association following the war
• Dorothea Dix (1802-1877) was the Union's Superintendent of Female Nurses during the Civil War.

Societal Attitudes

• Society's attitudes affect nursing as a profession
• Prior to the mid-1800s, nursing lacked organization, education, or social status
• The prevailing attitude was that a woman's place was in the home and that no respectable woman should have a career
• The role for the Victorian middle-class woman was that of a wife and mother
• Any education was to make her a pleasant companion to her husband and a responsible mother to her children
• Nurses in hospitals were poorly educated, and some were incarcerated criminals
• A literary portrayal described one nurse who "cared" for the sick by neglecting them, stealing from them, and physically abusing them
• This portrayal greatly influenced the negative image and attitude toward nurses up to contemporary times
• The "guardian angel" or "angel of mercy" image arose in the latter part of the 19th century, because of Florence Nightingale work during the Crimean War
• Born to a wealthy and intellectual family, Nightingale believed she was "called by God to help others and improve the well-being of mankind"

Nursing Leaders

• Florence Nightingale contributions to nursing are well documented
• Nightingale achievements in improving the standards for the care of war casualties in the Crimea earned her the title "lady with the Lamp"
• Her efforts in hospitals and in producing and implementing public health policies made her an accomplished political nurse
• Nightingale was the first nurse to exert political pressure on government
• Nightingale's contributions to nursing education is perhaps her greatest achievement
• She is also recognized as nursing's first scientist-theorist for her work Notes on Nursing: What It Is, and What It Is Not (1860/1969)
• Nightingale used the money to develop the Nightingale Training School for nurses which opened in 1860
• The school served as a model to other training schools with nurses traveling to manage hospitals and institute nurse-training programs
• She worked tirelessly until her death at age 90
• Known as a passionate statistician, she conducted extensive research and analysis and is referred to as the first nurse researcher
• Her record keeping proved that her interventions dramatically reduced mortality rates among soldiers during the Crimean War
• Clara Barton (1812-1912) organized the Red Cross, which linked with the International Red Cross when the U.S. Congress ratified the Geneva Convention in 1882
• Barton's responsibility was to organize the nursing services
• Linda Richards (1841–1930) was known as America's first trained nurse
• Richards introduced nurse's notes and doctor's orders as well as initiated the practice of nurses wearing uniforms
• She is also credited for her pioneering work in psychiatric and industrial nursing
• Mary Mahoney (1845–1926) was the first African American trained nurse/ professional nurse
• The ANA gives a Mary Mahoney Award biennially in recognition of contributions in interracial relationships
• Lillian Wald (1867–1940) founded the Henry Street Settlement and Visiting Nurse Service (circa 1893)
• The Settlement provided nursing and social services and organized educational and cultural activities
• She is considered the founder of public health nursing
• Lavinia L. Dock (1858–1956) was active in the protest movement for women's rights that resulted in the U.S. Constitution amendment allowing women to vote in 1920
• Margaret Sanger, (Nurse activist) considered the founder of Planned Parenthood, was imprisoned for opening the first birth control information clinic in Baltimore in 1916
• Mary Breckenridge practiced midwifery in England, Australia, and New Zealand
• Breckenridge founded the Frontier Nursing Service in Kentucky in 1925 to provide family-centered primary health care to rural populations

Men in Nursing

• Men have worked as nurses dating as far back as the Crusades
• Steve Miller organized the "Men in Nursing" group of male nurses in Chicago in 1971
• In 1981, the group was renamed American Assembly for Men in Nursing with the purpose of providing a framework to meet and discuss factors that affect men as nurses
• Members of the AAMN discussed ways to the change the image of men in nursing in both recruitment and retention from 2009-2010
• The theme, "Do what you love and you'll love what you do" led to AAMN's initiative -"20 x 20 Choose Nursing."
• The initiative has the goal of increasing the enrollment of men in nursing programs from the currently 10% to 20% by 2020 (Anderson, 2011)
• Luther Christman was the first man to be a dean at a university school of nursing, first president of ANA, first man elected to American Academy of Nursing named "Living Legend" and first man inducted into ANA's Hall of Fame
• Men comprised 9.6% of the nation's nursing workforce in 2011
• The nursing profession and nursing education need to address issues concerning barriers met by men in nursing
• Improved recruitment and retention of men and other minorities into nursing will strengthen the profession
• Barriers exist for men in nursing, including the lasting nursing image of femininity creating the assumption that only homosexual men enter nursing
• Additional barriers include a lack of male role models in nursing and caring styles differences between men and women
• Suspicion surrounding intimate touch is also a barrier

Nursing Education

• Nursing education is controlled by state boards of nursing and professional organizations
• Curriculum was originally specialized for hospital practice
• Now curriculum is more varied in practice settings and includes critical thinking, health promotion and maintenance
• Two entry levels include RNs or LPN/LVN
• All RNs in the US take the same licensure examination, named the National Council Licensure Examination (NCLEX-RN), regardless of educational preparation
• Mutual recognition is a regulatory model that allows for multistate licensure under one license which enter into these agreements are called compact states
• Nurses who have trained in other countries may be granted registration after successfully completing the NCLEX
• Both licensure and registration must be renewed regularly in order to remain valid
• All nursing programs and schools must be approved/accredited by the board and/or accreditation agencies
• Accreditation is a voluntary, peer review process
• Accredited programs meet standard requirements that are evaluated through written self-studies and on-site visitation by peer examiners
• Different types of education include practical or vocational nursing, registered nursing, graduate nursing, continuing education, and in-service education
• Registered nursing includes Diploma programs, Associate Degrees, and Baccalaureate programs
• Graduate nursing includes Masters and Doctoral degrees
• Changes in healthcare practices cause nurses who hold a baccalaureate degree generally experience more autonomy, responsibility, participation in institutional decision making, and career advancement than the nurse prepared with a lower degree
• Doctoral programs began in the US in the 1960s
• Most nurses chose related fields like education, psychology, sociology, and physiology before that year
• Two primary doctoral degrees in nursing are PhD and DNP (doctor of nursing practice)
• Nurses who earn a PhD generally assume faculty roles in nursing education programs or work in research programs
• DNP is the highest degree for nurse clinicians, while a doctorate in related fields such as education or public health are still highly relevant depending on the nurse's practice role
• Continuing education refers to formalized experiences designed to enhance the knowledge or skills of practicing professionals
• Courses are more specific, can be shorter in length, and participants may receive certificates of completion or specialization
• It is the responsibility of all practicing nurses to engage in career-long continuing education to keep abreast of scientific and technological changes, especially to maintain and promote quality health care
• Some states require nurses to obtain a certain number of contact hours, typically ranging from 15 - 30 hours per 2-year license renewal period
• In-service education programs are employer-sponsored and aim to increase the knowledge of skills of employees while validating continued competence in procedures

Contemporary Nursing Practice

• About 150 years ago, Florence Nightingale defined nursing as "the act of utilizing the environment of the patient to assist them in their recovery"
• Nightingale considered a clean, well-ventilated, and quiet environment essential for recovery
• She raised the status of nursing through education
• Virginia Henderson was one of the first modern nurses to define nursing
• Henderson said, "assisting the individual who is sick or well, in the performance of activities contributing to health, to regain independence as rapidly as possible is at the core of nursing."
• Henderson saw the nurse as concerned with both healthy and ill individuals, acknowledging that nurses interact with clients even when recovery may not be feasible, and mentioned the teaching and advocacy roles of the nurse
• Latter half of the 20th century theorists developed their own theoretical definitions of nursing that go beyond common definitions
• Themes common to definitions of nursing include caring, art, science, client-centered services, a holistic approach, adaptation, health promotion, health maintenance, and help/healing, and Nursing is described as a helping profession
• ANA describes nursing as "direct, goal-oriented, and adaptable to the needs of the individual, the family, and community during health and illness"
• In 1980 (ANA), nursing was defined as the "diagnosis and treatment of human responses to potential health problems
• The 2003 edition of Nursing's Social Policy Statement states that "Nursing is the protection, promotion, and optimization of health and abilities, preventing illness and injury, lessening suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations"
• Research continues to explore caring within nursing

Recipients of Nursing Care

• Consumers are individuals, people in groups, or communities that use a service or commodity
• People who use health care products or services are consumers of health care
• Patient is a person who is waiting for or undergoing medical treatment and care
• The word "patient" comes from a Latin word meaning "to suffer" or "to bear," and implies passivity
• Many recipients of nursing care are not ill, instead focused on health promotion and prevention of illness
• Nurses interact with family members and significant others to provide support, information and comfort, as well as to care for someone in need
• Nurses are increasingly using the term client to refer to those receiving care
• This word helps to recognize that a person engages the advice or service of another who is qualified to provide this service
• Clients presents the receivers of health care as collaborators in their care, accepting responsibilities for their own health

Scope of Nursing

• Nurses care for three types of clients: individuals, families, and communities
• Areas of nursing practice revolve around the promotion of health, prevention of illness, restoration of health, and care for the dying

Health and Wellness

• Nurses promote wellness to people who are both healthy and ill
• Improvement of nutrition and physical activity, preventing drug and alcohol misuse, restricting smoking, and preventing accidents and injury in the home and workplace

Preventing Illness

• The goal of all illness prevention programs is maintain optimal health by preventing the disease in question
• Nursing activities that prevent illness include immunizations, prenatal and infant care, prevention of sexually transmitted infections

Restoring Health

• Nurses help ill clients through the disease to recovery phase
• Nursing activities include providing care, administering medicine, giving baths, doing procedures, examining feces for occult blood, consulting with other professionals and teaching recovery activities

Dying

• Providing comfort and care for the dying, and helping the support system of those in need
• Nurses may work within homes, hospice, or other facilities

Additional Aspects of Nursing

• Nurses are powerful and vital advocates for health needs, and are often on the frontlines, looking at all aspects of treatment
• Nurses, as essential members of multidisciplinary teams, provide high quality, patient-centered health care
• Locations to work include acute/long term care homes, client homes, and ambulatory or community clinics
• Nurses have increased autonomy in certain fields, particularly where need is high

Nurse Practice Acts

• Legal acts regulate the practice of nursing to protect the public although differ in various jurisdictions
• Nurses are responsible for knowing their state's law and how it governs their practice
• These establish professional parameters, with standards set through the ANA

Roles and Functions

• Nurses may act through many roles including caregivers, communicators, teachers, advocates, and counselors
• More expanded roles include that of charge agent, leaders, managers, case managers, and consumers of research

Professionalism and Education

• Caregiver nursing actions may involve full care for the dependent patient, partial care for a somewhat able patient, or providing only education and assistance to aid in attaining overall wellness
• Nurses perform full care encompassing physical, psychosocial, cultural, spiritual, and developmental needs, while providing directly or through delegation
• The nursing process provides the structure by which nursing actions are performed
• Communication is integral towards identifying a patient problem, sharing verbally or in writing and overall quality of care
• Clarity is essential by the nurse
• Expanded career paths include a nurse practitioner (NP), a certified nurse specialist (CNS), certified nurse anesthetist (CRNA), certified nurse midwife (CNM), researcher, or educator
• Desired outcomes of nursing are professionalism, characterized by specialized academics, unique knowledge including abilities, a serving directionality, constant research and analysis, ethical consideration, complete autonomy, and a professional organization
• A desired of goal of nursing is professionalism, which necessitates specialized education, a unique body of knowledge, including specific skills and abilities; a service orientation; ongoing research; a code of ethics; autonomy; and a professional organization
• Professionalization is the act of acquiring and maintaining these qualities
• The nursing practice revolves around a unique skillset that includes framework to give aid, policy and self conduct
• A key differentiation is that nursing is not for profit, differentiating itself from an entrepreneurial entity
• The nature of knowledge is constantly challenged through education and the requirement of ethical conduct
• Autonomy relies upon the capacity to regulate oneself according to set standards, such as policy
• Many facets of the field are affected by external factors and need to advocate within their organizations

Socialization

• Socialization is the act where people learn to become members of groups by adopting roles and behaviors
• The goal of professional socialization is to instill all values required for survival, such as norms, values, and beliefs regarding behaviors
• Fellow students often enhance professional socialization and create environments that can be molded into what is desired for scholastic efforts
• Benner's serves to determine the phase and degree of socialization that one has gone through, but comes primarily from experience
• Common standards of nursing act as a guide in legalities, standards of the profession, ethics, and NSNA conduct

Influences & Organizations

• The field is affected by a number of factors such as economics, health care policy, demographics, or family structure
• As a result collective bargaining as well as local unions form
• Organizations include groups like the American Nurses' association, the Canadian Nurses association, the National league for nursing, The international council of nurses, the national student nurses association, and sigma theta tau