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CHAPTER 1: Introduction to Nursing as a Science and Discipline Nemia T. Alimbuyugin, PhD, MAN, RN Professor  Historical Evolution of Nursing 1. Period of Medieval Untaught and instinctive It was performed out of compassion for others, out of the wish...

CHAPTER 1: Introduction to Nursing as a Science and Discipline Nemia T. Alimbuyugin, PhD, MAN, RN Professor  Historical Evolution of Nursing 1. Period of Medieval Untaught and instinctive It was performed out of compassion for others, out of the wish to help others Function or work that belonged to women Viewed as a natural nurturing job for women Expected to take good care of the children, sick and the aged They believed that the medicine man – shaman or witch doctor had the power to heal By using white magic, hypnosis, charms, and dances. Spells, laxatives, massage, fire, water and herbs as a means of driving illness from the victim Trephining – drilling a hole in the skull with a rock or stone  2. Period of Middle Ages / Apprentice Nursing Care was done by Crusaders, Prisoners, Religious orders Nursing care was performed without any formal education Job training given by more experienced nurses This kind of nursing was developed by religious orders of the Christian Church Nursing went down to the lowest level, wrath/anger of Protestantism removed properties of hospitals and schools connected with Roman Catholic Nurses discontinued their services, soon there was a shortage of people to care for the sick Hundreds of hospitals closed, and there was no provision for the sick, no one to care for the sick. Nursing became the work of the least desirable of women- Prostitutes, Alcoholics, and Prisoners. Pastor Theodore Fliedner and his wife, Fredericka established the Kaiserswerth Institute for the Training Deaconesses ( the 1st training school for nurses in Germany ) – this was where Florence Nightingale received her 3 months course of study in Nursing 3. Period of Educated Nursing / Nightingale Era 19th – 20thcentury The development of nursing during this period was strongly influenced by, a. Trends resulting from wars Crimean Civil War b. Arousal of social consciousness c. Increased educational opportunities offered to women F. Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit female nurses to provide care for the sick and injured in the Crimean war In 1860, The Nightingale Training School of Nurses opened  at St. Thomas Hospital in London. the school served as a model for other training schools, the graduates travelled to other countries to manage hospitals and institute nurse – training programs  Nightingale's focus is on the vision of nursing, which is to develop the profession within hospitals. Nurses should be taught in hospitals associated with medical schools and the curriculum should include both theory and practice  History of Nursing Theory The late 1800- first nursing theories appeared when a strong emphasis was placed on nursing education (Alligood, 2018) In 1860, Florence Nightingale defined nursing in her “Environmental Theory” as “the act of utilizing the environment of the patient to assist him in his recovery.” In the 1950s, there is a consensus among nursing scholars that nursing needed to validate itself through the production of its own scientifically tested body of knowledge.  History of Nursing Theory  In 1952, Hildegard Peplau’s theory of Interpersonal Relations that emphasizes the nurse-client relationship as the foundation of nursing practice.  In 1955, Virginia Henderson’s nursing Need Theory conceptualized the nurse’s role as assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs. History of Nursing Theory In 1960, FayeAbdellah- In 1968, Dorothy Johnsonpioneered “Typology of 21 Nursing theBehavioral System Modeland upheld the fostering of efficient and Problems” that shifted the focus effective behavioral functioning in of nursing from a disease- the patient to prevent illness. centered approach to a patient- centered approach. In 1962, Ida Jean Orlandoemphasized thereciprocal relationship between In 1970 , Martha Rogersviewednursing patient and nurseand viewed the as both a science and an artas it professional function of nursing as provides a way to view the unitary finding out and meeting the patient’s human being, who is integral with the immediate need for help. universe.  History of Nursing Theory 1971 1971 1972 1979 1979 In 1971, Dorothea In 1971, Imogene In 1972, Betty In 1979, Sr. Callista In 1979, Jean Oremstates in her King‘s Theoryof Neumanin her Royviewed the Watsondeveloped theory that nursing Goal attainment theory states that individual as a set of the philosophy of care is required if states that the nurse many needs exist, interrelated systems caring highlighted the client is unable is considered part of and each may who strives to humanistic aspects to fulfill biological, the patient’s disrupt client maintain the of nursing as they psychological, environment, and balance or stability. balance between intertwine with developmental, or the nurse-patient Stress reduction is these various scientific knowledge social needs. relationship is for the goal of the stimuli. and nursing meeting goals system model of practice. towards good nursing practice. health.  NURSING THEORY A group of interrelated concepts that are developed from various studies of disciplines and related experiences. Aims to view the essence of nursing care Theories are specifically contributed by different nursing theorists from different times and ages. Ex. In the 19th century, Florence Nightingale projected a valuable relationship between health and environmental factors like fresh air, sunlight, and ventilation.  The Lady With A Lamp  Florence made rounds to visit and check patients in Scutari always brought her lamp at night when she visited the wounded and sick Crimean War.  What Happened to the Hospital in Scutari?  The soldiers were dying because the condition of the hospital was very poor.  There were not enough lights coming from windows and fresh air was not in proper circulation.  The place was very dirty, rats and other pests were roaming around the insides of the hospital.  The water source was also very scarce.  Florence made changes to all of these during her time. The International Council for Nurses (ICN, 2002) states that “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 Definition also key nursing roles 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 response, and Scope of Nursing: - A person shall be deemed to be practicing nursing within the meaning of this Act when he/she singly or in collaboration with another, initiates and performs nursing services to individuals, families and communities in any healthcare setting. Nursing is a “dynamic discipline. It is an art and a science of caring for individuals, families, groups, and communities geared toward promotion of health, prevention of illness, alleviation of suffering and assisting clients to face death with dignity and peace. It is focused on assisting the client as he or  Theory  is a set of concepts, definitions, relationships, and assumptions that project a systematic view of phenomena and propositions that provide an orderly way to view phenomena  a creative and rigorous structuring of ideas that projects a tentative, purposeful, and systematic view of phenomena”. A theory makes it possible to & quote; organize the relationship among the concepts to describe, explain, predict, and control  COMPONENTS 1) Concepts  Ideas and mental images that help to describe phenomena 2) Definitions  Convey the general meaning of the concepts 3) Assumptions  Statements that describe concepts 4) Phenomenon  Aspect of reality that can be consciously sensed or experienced  Models Constructed of theories and conceptsUsed to help nurses assess, plan, and implement patient care by providing a framework within which to workHelp nurses achieve uniformity of care Proposition Explain relationships between concepts. Theory Vs. Model Theory aset of statements that is developed through a process of continued abstractions. It is a generalized statement aimed at explaining phenomenon.Model - l is a purposeful representation of reality. Paradigm A model that explains the linkages of science, philosophy, and theory accepted and applied by the discipline Domain The view or perspective of the disciplineIt contains the subject, central concepts, values and beliefs, phenomena of interest, and the central problems of the discipline How Nurses Use Theory in Everyday Practice Make decisions Organize 1 Understand 2 Analyze 3 about nursing interventions 4 Predict outcomes Evaluate patient Plan patient care 5 6 of care outcomes How do Student Nurses begin to use Nursing Theories? WHAT IS THE NATURE OF WHAT DOES IT MEAN TO KNOWLEDGE NEEDED FOR ME TO PRACTICE THE PRACTICE OF NURSING? NURSING?  Current Trends That What is The Link Between Nursing Theory and The Influence Nursing Theory Research Process? Medical Science Theory provides direction Nursing Education for nursing research Professional Nursing Relationships of components in a theory Organizations help to drive the research Evolving Research questions for Approaches understanding nursing Global Concerns Indicate a spiral relationship between the Consumer Demands two Technologies Classification of Concepts : Discrete: Identify categories or classes of phenomenon Ex. patient, nurse, &environment Continuous: Allows the classification of dimensions/ of an observation or phenomenon across a continuum Ex. temperature, pain Two Types of Concepts: A.Descriptive (conceptual) – refers to the accepted meaning of the term already used like the definition we find on the dictionaries B.Operational (stipulative) – refers to the specific use or definition of the term within the theory. It is how a word or concept is used in the theory and how it is defined by a particular theorist in his/her theory.  Characteristics of a theory: Systematic, logical and coherent There must be an orderly reasoning and no contradictions between and among concepts. There must be proper sequencing of ideas and theoretical assertions Creative structuring of ideas We said that concepts are the building blocks of a theory and that they are the mental images resulting from one’s experiences and perceptions. Therefore, when these concepts are interrelated, they created different ways of looking at a particular event phenomenon, event or object Tentative in nature A theory can change overtime implying that it is evolving, and dynamic. As more researches and studies are done, and as they are enriched by practice, theory can change, However, there are also  Classification of Nursing Theories By Abstraction - 3 Major Categories Grand Nursing Theories are abstract, broad in scope, and complex, therefore requiring further research for clarification. Middle-Range Nursing Theories More limited in scope (as compared to grand theories) and present concepts & propositions at a lower level of abstraction, address a specific phenomenon in nursing. Practice-Level Nursing Theories Practice nursing theories are situation specific theories that are narrow in scope & focuses on a specific patient population at a specific time. Practice-level nursing theories provide frameworks for nursing interventions & suggest outcomes or the effect of nursing practice.  By Goal Classification of Nursing Theories Orientati on Theory  2. Provide the foundations Importance of 1. Aim to describe, of nursing practice, help to predict and explain generatefurtherknowledge Nursing the phenomenon and indicate in which Theories of nursing. direction nursing should develop in the future. 4. Help provide better 5. The main exponent of 3. Help to distinguish patient care, enhanced nursing – caring-cannot what should form the professional status for be measured. It is vital to basis of practice by nurses, improved communication between have the theory to explicitly describe nurse, & guidance analyze and explain what nursing. for research and education. nurses do. 7. Maintain 6. Establish a professional unique body of boundaries in knowledge. nursing.  WHAT OTHER FAMOUS PERSONS SAID ABOUT THE THEORY Parker (2001) Organize, Potter (2004) Set of coherent set of concepts and Blackwell (2005) Reasoned concepts, definitions, proposed explanation of an their relationship to each relationships and occurrence or of something other that offers assumptions that project that will occur or be produced, descriptions, explanations, for which absolute proof is and predictions about a systematic view of lacking. phenomena. Phenomena. Kozier Mosby (2006) It is an abstract Delauneand Ladner statement formulated to predict, (2008) Supposition (2006) Set of concepts explain or describe the or system of ideas and propositions that relationships among concepts, provide early way to view constructs an event.It is tested that is proposed to by observation and research using a phenomenon. factual data. explain a phenomenon. THE DEVELOPMENT OF NURSING THEORIES 1) General Systems Theory Describes how to break whole things into parts and then to learn how the parts work together in “systems” These concepts may be applied to different kinds of systems.e. Molecules in Chemistry, Cultures in Sociology, and Organs in Anatomy, and Health in Nursing. THE DEVELOPMENT OF NURSING THEORIES 2.) Adaptation Theory  as the adjustment of living matter to other living things and to environmental conditions. THE DEVELOPMENT OF NURSING THEORIES 3.)Social Adaptation Refers to the Adjustment and Adaptation of humans to other individuals and community groups working together for a common purpose.  Hans Selye’s General Adaptation Syndrome (GAS) Theory Proposes that 4 Stages are involved in Adapting to Stress to Alarm, Fight-or-Flight, Exhaustion, Return to Normal THE DEVELOPMENT OF NURSING THEORIES NURSING THEORIES 4.)Developmental Theory  It outlines the process of human growth and development as orderly and predictable.  Beginning with conception and ending with death.  The progress and behaviours of an individual within each stage are unique.  The growth and development of an individual are influenced by:  Heredity, Temperament, Emotional and physical Environment, Life Experiences, and Health Status. History and Philosophy of Science Science means knowledge coming from the Latin word scientia. It refers to any systematic knowledge or practice in a discipline of 1. Rationalism (scope of knowledge) emphasizes the importance of a priori reasoning as the appropriate method for advancing knowledge. A pri'ori reasoning uses deductive logic by reasoning from the cause to an effect or from a generalization to a particular instance. An example in nursing is to reason that a lack of social support (cause) results in hospital readmission (effect). This causal reasoning is a theoretical assertion until tested & disproven. The traditional approach proceeds by explaining hospitalization with a systematic explanation (theory) of a given phenomenon. Theoretical assertions derived by deductive reasoning are then subjected to experimental testing to corroborate the theory. Rationalist Reynolds (1971) labeled this approach the theory-then- research strategy.  If the research findings fail to correspond with the theoretical assertions, additional research is conducted or modifications are made in the theory and further tests are devised; Otherwise, the theory is discarded in favor of an alternative explanation. Popper (1962) argued that science would evolve more rapidly through devising research to refute new ideas. For example, his point is simple; you can never prove that all individuals without social support have frequent rehospitalizations, because there might be one individual who presents with no rehospitalization. A single person with no social support that does not have a readmission disproves the theory that all individuals with a lack of social support have hospital readmissions. From Popper’s perspective, “research consists of generating general hypotheses and ' then attempting to refute them”. Thus, the hypothesis that a lack of social support results in hospital readmission would be the topic of interest to be refuted. The rationalist view is most clear in the work of Einstein, the theoretical physicist, who made extensive use of mathematical equation in developing this theories.  The theories Einstein constructed offered an imaginative framework, which has directed research in numerous areas.- As Reynolds (1971) noted, if someone believes that science is a process of inventing descriptions of phenomena, the appropriate strategy for theory construction is the theory- then-research strategy Reynolds’ view, “as the continuous interplay between theory construction (invention) and testing with empirical research progresses, the theory becomes more precise and complete as a description of nature and, therefore, more useful for the goals of science” - 2. Empiricism The empiricist view is based on the central idea that scientific knowledge can be derived only from sensory experience (i., seeing, feeling, hearing facts). Francis Bacon received credit for popularizing the basis for the empiricist approach to inquiry. believed that scientific truth was discovered through generalizing observed facts in the natural world called the inductive method, is based on the idea that the collection of facts precedes attempts to formulate generalizations, or as Reynolds called it, the research-then-theory strategy. One of the best examples to demonstrate this form of logic in nursing has to do with formulating differential diagnoses. Formulating a differential diagnosis requires collecting the facts and then devising a list of possible theories to explain the facts. The strict empiricist view is reflected in the work of the behaviorist. Skinner - 1950 asserted that advances in the science of psychology could be expected if scientists would focus on the collection of empirical data. ‘ cautioned against drawing premature inferences and proposed a moratorium on theory building until further facts were collected. Skinner’s (1950 as cited by Alligood, 2018) approach to theory construction was clearly inductive. His view of science and the popularity of behaviorism have been credited with influencing psychology’s shift in emphasis from the building of theories to the gathering of facts between the 1950 and 1970s (Snelbecker, 1974 as cited by Alligood). The difficulty with the inductive mode of inquiry is that the world presents an infinite number of possible observations, and, therefore, scientists bring their own ideas to their experiences to decide what to observe and what to exclude (Steiner, 1977) as cited by Tan, 2019)  With induction it is important not to end the observations too soon and arrive at a premature conclusion that is faulty. 3. Positivism -Early Twentieth Century Views During the first half of this century, philosophers focused on the analysis of theory structure, whereas scientists focused on empirical research. There was minimal interest in the history of science, the nature of scientific discovery, or the similarities between the philosophical view of science and the scientific methods, a term first used by Comte, emerged as the dominant view of modern science. Modern logical positivists believed that empirical research and logical analysis (deductive and inductive) were two approaches that would produce scientific knowledge The logical empiricists offered a more lenient view of logical positivism and argued that theoretical propositions (proposition affirms or denies something) must be tested through observation and experimentation. This perspective is rooted in the idea that empirical facts exist independently of theories and offer the only basis for objectivity in science. In this view, objective truth exists independently of the researcher, and the task of science is to discover it, which is an inductive method.  Conceptual Model - is a representation of a system that uses concepts and ideas to form said representation. Conceptual modeling is used as a way to describe physical or social aspects of the world in an abstract way. Conceptual models or frameworks are representations of an idea or body of knowledge based on the understanding or perception of a person or a researcher on a certain topic, phenomena or theory. They can be represented through a diagram or in narrative - form which shows how concepts are interrelated Use/purpose of conceptual models: 1. To provide an organizing structure for the research design and methods 2. To guide the development and testing of interventions and hypotheses based on the tenets of the theory 3. To explain the study results and place the findings within the context of science in a specific field of investigation. A conceptual model or theoretical framework provides a coherent, unified and orderly way of envisioning related events or processes relevant to a discipline (Fawcett 2005) Conceptual Framework vs. Theoretical Framework CONCEPTUAL It is a structure of concepts or theories which are pulled together as a map for the study THEORETICAL It is a structure of concepts which exist or tested in the literature, a ready – made map for the study Structure of Nursing Knowledge  The requirement for a body of specialized knowledge for recognition of nursing as a profession was a driving force in the twentieth century. Nurses play a big role in the health of the nation early in the twentieth century.  Studies of nursing were legislated and conducted by sociologists who recommended that nursing be developed as a profession. The criteria for a profession provided guidance in this process (Bixler & Bixler, 1959; Kalish & Kalish, 2003).  The criterion that called for specialized nursing knowledge and knowledge structure was a particularly important driving force in recognition of nursing as a profession (Bixler & Bixler, 1959). The criterion reads : Utilizes in its practice a well-defined and well- organized body of specialized knowledge [that] is on the  Significance of the Discipline & Profession Nursing Theory Makes research findings meaningful and credible. Nursing theory is necessary for nurses to make valid, safe and accurate decisions and to demonstrate it is a unique contribution to nursing care. While a thorough body of practical knowledge is indispensable, nursing theory is, still essential. helps avoid a random approach to client care and guides the nurse in making pertinent observations, analyzing deviations from normal, and planning nursing care activities (Tan, 2019). How Does Domain Relate To Nursing Theory ? - Nursing has identified its domain in a paradigm that includes four linkages METAPARADIGM OF NURSING Greek: “meta”- with “paradeigma” - pattern NURSING PARADIGMS: are patterns or models used to show a clear relationship among the existing theoretical work Is set of theories or ideas that provide structure for how a discipline should function For a Nursing discipline , these theories consist of 4 basic concepts that address the patient as a whole , the patient’s health and well-being , the patient’s environment and the nursing responsibilities 1. MAN Our interpretation of the metaparadigm. Person is an individual who is unique , with their own personal set of values, beliefs, and the ideologies. This person will also have their own cultural identity, which may not always coincide with the value system of others. 2. HEALTH Refers to the quality of It is also including the health and wellness of access the [patient has to the patient. health care  3. Environment Includes both internal and external factors related to the patient. This may include the interactions patients have with visitors as well as their surroundings 4. Nursing Refers to the nurse and how he or she apply their knowledge and skills when caring for patients. “Fundamental Patterns of Knowing in Nursing”. In 1978, Barbara Carper published the article titled “Fundamental Patterns of Knowing in Nursing”. - now a classic publication with a profound effect on the discipline, Carper identified four patterns of knowing: empirical, personal, ethical, and aesthetic. - provides an overview of these four patterns of knowing, along with additional knowing patterns that inform the development and practice of nursology.  position of authority. Leaders in What Is a Nurse nursing inspire and influence Leader? others to achieve their maximum potential. They use applied leadership in nursing by drawing upon critical thinking skills to manage a team.  Nurse leaders take a broad view of how daily tasks impact the overall goals of the health care organization. They communicate expectations to their team and motivate them to achieve predetermined goals. Nurses can lead from various organizational areas if they project the necessary  Leadership Qualities in Nursing They must be flexible enough to adapt to technological changes, fluctuating payment methods, new treatment modalities, and regulatory and legislative environments. Critical skills for effective nursing leadership include: Communication and Collaboration: These skills can reduce miscommunication, encourage shared decision making, and provide a sense of working together toward common goals. Education and Quality of Practice: Continued professional development allows leaders in nursing to keep pace with the ever-changing health care environment while striving for excellence by supporting quality, evidence-based practice. Environmental Health and Resource Utilization: Leadership in nursing ensures that patient care can be provided effectively in a safe and healthy environment while promoting wellness among all health care staff.  Leadership Qualities in Nursing Professionalism and Other nursing Ethics and Professional Leadership: Leaders in leadership skills, Practice Evaluation: nursing build vital Influential nurse leader relationships and collaborate such as displaying model ethical practices with various health care compassion and to guide decisions, teams on sensitive topics. empathy, can assist Using critical thinking skills display honesty by being allows those in nursing the nurse leader in accountable for their leadership roles to analyze developing actions, and evaluate decisions impacting the interpersonal their adherence to organization. They then professional practice clearly explain the rationale relationships and standards. in a manner that encourages gaining respect in staff support. their role. 7 Leadership Styles in Nursing The nurse’s educational background, personality, and work The Transformational nurse leader works environment may influence their to inspire nurses to achieve a greater vision nursing leadership style. Each type by helping with strength development. This of nurse leader role can be nursing leadership style works well with valuable when utilized in the right mentoring. setting. The Autocratic nurse leader makes A Laissez-faire leadership style quick decisions with little input from puts faith in every facet of a well- employees and excels at task oiled machine. This method may delegation. This nursing leadership style may be most effective in an work well with experienced teams or emergency. self-directed nurses. 7 Leadership Styles in Nursing The Democratic nurse leader is The Servant nurse leadership style collaborative and focuses on team focuses on employee development and success. This nurse leader might excel individual needs. This method works in quality improvement roles but may well with goal-driven environments or not be effective in situations requiring as a nurse educator. independent decisions. The Situational leadership style is the most adaptable since it analyzes the situation and The Transactional nurse leader does determines the appropriate approach. This well with short-term goals by focusing nurse leader is flexible enough to modify their approach based on the organization or on efficiency and performance. This individual’s needs. This style works well with task-oriented style reduces errors and nursing students but may divert from the works well with tight deadlines. organization’s long-term goals.  Projecting leadership skills in nursing that influences others can allow a nurse to lead without being assigned a specific leadership position. The aspiring nurse leader might: Seek out a mentor or become one Volunteer for committee roles Examples of Become involved in the community Take educational courses Stay current on the latest health care trends Leadership Get involved with public policy in Nursing A nurse aspiring for a nursing leadership role can get a certification or obtain additional degrees specific to nursing leadership to increase their knowledge base and expand upon professional development. But a title and the education aren’t enough to create an effective leader. Nurses and other health care staff need to believe their contributions make a difference in the organization.  Why Is Nurse Leadership Important? Nurse leaders make a difference in workplace culture and drive positive changes in health care legislation. When a team admires the qualities of their leader, it boosts morale and promotes a psychologically safe workplace, which leads to higher job satisfaction and retention rates. Influential leaders in nursing ensure that the organization's vision is communicated to the nursing staff while mentoring the nursing leadership of tomorrow.  History of Nursing in the Philippines Stems from the caregiving provided by women, priests, and herb doctors during precolonial Philippines. Even though women did not have much opportunity to be formally educated in schools because only a limited number of Filipino women received primary education in charitable institutions established by Spaniards, this trend continued during the Spanish colonial era. During the Philippine revolution, Filipino women also became the providers of care for wounded revolutionaries. During the American period in the Philippines, Filipino women were given the chance to become educated as nurses, guided by their American nurse and missionary mentors, until nursing became a full-pledged profession in the Philippines, a professional career not only for modern-day women in the country but also for men in the Philippines. The advance of nursing in the Philippines as a career was pioneered by a culture of care which was intrinsic in the Filipino people. This was also the case even before Spanish colonization in communities. The way the health system was delivered also evolved.  History of Nursing in the Philippines Early Philippines Early beliefs of health and illness in the Philippines were in conjunction with beliefs of mysticism and superstitions.[The cause of a disease was believed to be either another person, who was an enemy, or a witch, or evil spirits. Filipinos were careful not to upset other people or the evil spirits for the good of their health. These evil spirits could be driven away by people with the power to banish demons: priests or herb doctors. Filipinos who became sick were usually cared for by their female family members or friends in the home. People thought health was directly related to many superstitions and legends. Back then, there were no medical professionals, but men known to practice magic and the supernatural. These herb men were known as “herbicheros.” Victims who suffered from unidentified illnesses were thought to be cursed by witches and wizards known as “mangkukulam/mangagaway.” Dangerous birthing and “pamao” were thought to come from “nunos”. While in labor, the “mabuting hilot” (good midwife) was usually present. If the birth became too dangerous, bad omens and evil sorcerers were thought to be the cause. Exploding gunpowder from a bamboo cane near the head of  History of Nursing in the Philippines Spanish colonial rule During Spain's colonial rule (1521-1898) the Philippine education system offered distinct and unequal opportunities for Filipinos based on gender. An example of this sexism was allowing only limited numbers of women to receive primary education in Spanish charitable institutions. Without an education women were unable to gain much knowledge or power. The knowledge of caring for others came from family members and personal experience with the sick. Nursing other individuals was seen as a task, not a job or a profession. During the Spanish regime, many specialized hospitals were established to care for the Spanish king’s soldiers and civilians. To many elite Filipinos, the Spanish colonial hospitals were places where those who were not so fortunate to have homes, spent their last days until death.  History of Nursing in the Philippines Philippine Revolution At the time of the Philippine Revolution many women transformed their homes into quarters to nurse Filipino soldiers and revolutionaries. One of these women was Melchora Aquino, also known as the "mother of the Philippine Revolution". In her old age of about 80, Aquino was a supporter of the revolution by providing food and shelter to the revolutionists. She provided care for those who became sick or wounded. However, a few days after the revolution began, she was arrested by the Spaniards for providing care to the rebels. Because she did not reveal any information to the Spanish about the location of the rebel leader, Aquino was deported to Guam in the Marianas. After six years of exile, she was able to return in 1903, when the Philippines finally gained independence from the Americans. Aquino’s work caring for the ill and the wounded during the revolution has brought comparisons to the British Florence Nightingale Both these women cared for soldiers during war and paved the way for nursing practice.  History of nursing in the Philippines American colonial rule  The Union Mission Hospital Training School for nurses (Now Central Philippine College of Nursing ) which was established in 1906, is the first and oldest running nursing school and college in the Philippines.  Although the Philippines had gained independence from Spain, the United States began to instill their power upon the islands, and a conflict broke out between the Filipinos and the Americans. This was the start of the Philippine–American War. The presence of Americans played a vital role in influencing the development of nursing into a profession. Nurses and missionaries from the United States came to act as nurse mentors for the Filipina women. Nursing education, like teaching and missionary work in the Philippines, provided white American women with a sense of purpose in the colony. This influence then continued with the building of many hospitals where American nurses took charge and Filipino women began to learn under careful eyes.  History of Nursing in the Philippines Post-colonial Philippines  After World War II, when Manuel Roxas assumed the presidency of the Republic of the Philippines on July 4, 1946, it officially marked the end of colonialism between the US and the Philippines.  Like much of the rest of the world, the Philippine islands were in ruins and Roxas was determined to rebuild his country. He made it clear to his constituents that the new government was still going to rely heavily on US financial support in order to rehabilitate its national economy.  Roxas’ first attempts to balance the Philippines' budget included collecting unpaid taxes, reducing expenses and promoting foreign trade, which would include the exportation of Filipino nurses.  Already trained by Americans, Filipino nurses were the perfect candidates to assist the US and other countries experiencing post-World War II shortages. At the time in the Philippines, there were also rumours of a nursing shortage; however, this was questionable, due to the expanding health programs, inefficient use of nurses' time and skills, and loss of qualified nurses to other countries. By the mid-1960s,  Filipino nurses were entering the US by the thousands. The benefit to the travelling nurses was that they were able to make nearly 20 times as much as they had earned back home.  Part of this money would be sent back to their families as remittance, which would boost the Philippine economy.  A negative effect of the high exportation rate was that the nurses were adding to their own country's nursing shortage problem. The Philippines also faced losing one of its greatest sources of social capital: educated workers. The negative effects were also seen in the US, as American salaries decreased because Philippine nurses who newly arrived would work the same job at a lower wage.  History of Nursing in the Philippines Early 1900s Many US states passed reforms in licensure for nurses. Decreased training mandates were created, as well as stricter adequacies for getting into a nursing institution. For instance, one prerequisite was at least one year of high school education. The idea of having students work in a more active role prior to seeing patients was a new idea that was beginning to pay off. In the Philippines, it was also the early 1900s when the first school for nursing was established. The program of study was still shattered and unclear. Only a few students were enrolled informally in this kind of education. A legislation or law was needed at the time, contributing to the establishment of the "First True Nursing Law" in 1919.[The Filipino Nurses Association was founded on September 2, 1922, which was later renamed to Filipino Nurses Association in 1966.[  History of Nursing in the Philippines Today The Philippines is the leader in exporting nurses to meet the demands of the United States and other developed nations. It has been argued, however, that the Philippines' persistent production of nurses for the global market is a state strategy to develop an export industry for economic development. Things such as immigration services and nursing licensing authorities encourage the production of nurses for export.  Education 1.The first two years of general education is grounded on liberal arts that strengthen the values and character of the person as a caregiver. 2.The language of instruction in all local institutions is English. This prepares the student for licensure both locally and internationally. This also gives the nurses access to ever-growing literature in the health sciences. 3.The community skills, competence and confidence in the use of English certainly contribute to healthcare in any setting. 4.The curriculum also strengthens the students' capabilities to participate in research in nursing and other health sciences, provides flexibility in the openness to the use of new teaching approaches, and encourages active involvement in extension work that reaches out to the other sectors. 5. All registered nurses in the Philippines are required to have a Bachelor’s degree in Nursing.  Education The first pursuit to constitute the nursing practice was made by the Director of Health in 1913 but was not officially enacted by the Filipino legislature. In 1915, Act No. 2493 was made known; this amended Gov Ph Act 310 so nursing could be practised. This law allowed "for the registration of graduate nurses under the Bureau of Health" (Philippines). Pre-qualifications were not mandatory to become an RN since nurses simply signed up. Each candidate, however, needed to be at least 20 years of age at the time of sign-up and be of adequate health and upstanding character. A law that allowed the practice of nursing was reformed in April 1919. Act 2808, also known as "the First True Nursing Law", established the Board of Examiners for Nurses. The first board exam for nurses was given in 1920.  Education Today, nurses must acquire their degrees through a combination of competency-based and community- oriented courses. The Philippine curriculum has several advantages compared with those of other Asia Pacific Economic Cooperation (APEC) institutions. This kind of education offers much more than a solely skill-based curriculum can (Rogado 229). The four-year requirement to earn a bachelor's degree in nursing meets the minimum entry  Education The Professional Regulation Commission(PRC) oversees the licensing of registered nurses as authorized by the Philippine Nursing Act of 2002. The Professional Regulatory Nursing Board implements and enforces the Nursing Act. The board is composed of a chairperson and six additional members, all of whom are nurses with at least a Master’s degree and ten years of nursing experience. The board inspects nursing schools, conducts licensure examinations, issues and monitors certificates of licensure, promulgates a code of ethics, participates in recognizing nursing specialty organizations, and prescribes guidelines and regulations governing the profession under the Nursing Act. Characteristics of a Theory tT Thank You for listening.. Thank you for Listening…