An Extensive Look: Nursing: The Past, Present and Future of a Challenging Profession for Women

 “Live for something. Do good, and leave behind you a monument of virtue that the storm of time can never destroy. Write your name in kindness, love and mercy, on the hearts of the thousands you come in contact with year by year. You will never be forgotten. No. Your name, your deeds, will be as legible on the hearts you leave behind as the stars on the brow of evening. Good deeds will shine as the stars of heaven…” ~ FlorenceNightingale

The history of the nursing profession has been immersed not only in chronological primitive events to current day, but in cultural and societal beliefs that influenced the world; and although it never repeats itself with complete duplication, there are patterns and trends affected by unique forces and factors that have led to paths similar to that seen in earlier years, yet uniquely different. Author Lewenson (2004) commented, “Understanding nursing history helps us to comprehend current issues in nursing and anticipate future trends in the profession.”

            Some of the first descriptions of assistants tending to the health needs of others occurs as early as the first century AD when Pliny the younger (63-113) as well as the Greek physician Soranus (98-138), both wrote of the use of midwives in childbirth. Pomeroy (1995) discussed midwives as being, “InRomethe skilled midwives, like the physicians, were likely to be Greek” (p. 169). Traditionally, it was the woman who prepared herbal remedies and treated illnesses even though they were viewed as second class citizens.

            From the beginning of time, women have cared for infants and children; thus, nursing could be said to have its roots in the home. Religion also had a significant role in the development of nursing. During the third and fourth centuries, wealthy matrons of theRoman Empireconverted to Christianity and used their homes to provide for the sick. Throughout history, inadequacy of care during the Crimean, American Civil and World Wars has accentuated the need for nurses. Nursing, during the 16th century, changed from having a religious orientation to human welfare and expanding the body of nursing knowledge. Taylor, Lillis and LeMore (2005) believed that,  “Religious organizations closed leading to a shortage of people to care for the sick. It was during this time that women of ill repute were recruited into the nursing profession in lieu of serving jail sentences for their crimes” (p. 5).

            Nursing’s origin can be seen as part of a time line that correlates to the issues currently plaguing in this century. In an article published in the Virginia University School of Nursing, Keeling (2007) stated that “…nursing’s origins are found in the woman’s role of caring for the sick. Women have traditionally filled the roles of caregiver of the sick throughout history.”

            The Bible referred to many occurrences during this time dating back as far as 1450-1410 BC that would be considered a function of nursing and public health. Midwives are referenced in the Exodus in the Proverbs 31 and described a woman who helped the poor and the needy. Another description was written in the book of Acts which told the story of Tabitha who was recognized for her reputation of being a helper of the poor, compassionate and resourceful.

            During the Roman era 31BC-476 AD, Roman armies developed mobile war nursing units. These moveable hospitals provided care to the troops. They consisted of a series of tents that gave way to permanent buildings next to combat areas that were developed into primitive types of hospitals. Though most nurses in those days were slaves, servants, or family members, the nursing position appeared to be strengthened. 

            The Middle Ages (476-1453 AD) served as a transition between ancient and modern civilizations. Nursing during this era was mostly influenced by Christianity, with the beginning of deaconesses, or female servants caring for the sick. These individuals would only care for the needs of the women in the early church, while deacons cared only for the men. It appeared that different social classes performed diverse women’s work during this era. Barber (1994) expressed that, “In the Middle Ages, for example and in the 18th century, elegant ladies passed their time spinning and embroidering silks, not for sale but for conspicuous use at court” (p. 210).

            During this time religious groups built public hospitals to serve the poor. The earliest documentation of clinical decision making in nursing was in the 17th century by the French Sisters of Charity. They were untrained helpers, nuns and mostly servants who were considered nurses. Bevis & Watson (1989) explained their prescribed course of study included supervision of patient care as well as lectures, quizzes, and religious exercises. Lundy and Janes (2001) discussed that, “…in 1633, St. Vincent de Paul founded the Sisters of Charity inFrance, an order of nuns that visited the sick in their homes. These early nuns became the first organized visiting nurse service, which are widespread throughout theUnited Statestoday.”

The concept of humanism in nursing can be traced to the ancient Greeks by noting the importance that they placed on understanding human  interrelationships especially within the context of social order. Pomeroy (1995) noted that during the classical times an older Athenian woman would seek work in her community out side the home in the form of basic care of a child, “A hymn to Demeter, probably composed in the seventh century B.C., describes how a freely elderly woman may seek employment as a child nurse or a domestic” (p. 44). In this period of time, from birth a girl was not expected to learn how to read or write, nor was she expected to earn an education. Therefore, history has proven that from the time of womanhood regardless of social class, a woman worked primarily indoors or near the house. Their daily concerns revolved around the producing of clothing, nursing ill slaves and the caring for young children while preparing food for the family.

            Socrates (470-399 BC), Plato (384-345 BC), and Aristotle (384-322 BC) believed that we can glimpse into the understanding of human nature by studying what humans do and the way they interact, especially interactions that are directed to doing good or evil towards others. Hippocrates, the father of medicine, was a key figure in this Hellenic civilization. He separated medicine from the supernatural and initiated its scientific foundation. Hippocrates became influential and stated that illness was a natural process. This turned the healing idea away from the spiritual to physical causes.

The stories of women in our culture resonate as a journey through time and trial for equality, individual freedom, and hope. Hope rests close to the heart of health care; it is a belief in powerful healing, and hope for a better community that encourages so many women and to better the places in which they live through health care.

Florence Nightingale was one of the most memorable individuals, and known by many as “The Lady with the Lamp” and “The Founder of Modern Nursing.” She is most remembered as a pioneer of nursing and a reformer of hospital sanitation methods. When her sanitary reform was implemented, the mortality rate declined. Unknown too many, however, was her use of new techniques of statistical analysis, such as during the Crimean War when she plotted the incidence of preventable deaths in the military. She developed the polar area diagram to dramatize the needless deaths caused by unsanitary conditions and the need for reform. With her analysis, Florence Nightingale revolutionized the idea that social phenomena could be objectively measured and subjected to mathematical analysis. In 1860 she established theNightingaleSchoolatSt. ThomasHospitalinLondonwhere nurses would be trained and was the first woman to receive this honor.

 Another great woman in the profession was Mary Ann Bickerdyke who was described by Stein (2006) as a woman who, “…had received training in botanic and homeopathic medicine…been engaged in private-duty nursing.” Bickerdyke was only woman allowed in Sherman’s camps became known simply as “Mother Bickerdyke” to thousands of Union soldiers, famous for her ability to bypass bureaucracy, scrounge together supplies, and help run army field hospitals. She was known as the most colorful and resourceful Civil War nurse.  She worked as a botanic physician in and organized many hospitals inCairo. By the end of the war, with the help of the U.S. Sanitary Commission, Bickerdyke had built about three hundred hospitals and helped the wounded on nineteen battlefields.

     

When women in history had to deal with discrimination in the workplace a Hospital was built and its primary focus was on women in the medical field. TheNew EnglandHospitalfor Women and Children was founded by Dr. Marie Zakrzewska and Ednah Dow Cheney. It was, for more than a century, a teaching hospital where women doctors and nurses could study and practice medicine and women could receive treatment from female doctors. Constructed over a 58 year period (1872-1930), this was the oldest remaining example of the hospitals that were run by and for women during the latter half of the 19th and early part of the 20th century. The hospital was established in an effort to overcome the obstacles that stood in the way of women entering medical practice.

            Woman during this time in history had to deal with many different types of social prejudices whether it was sexual, racial or gender. Ashley (1975) commented that, “Instead of openly questioning sexual prejudice directed toward nurses, leaders, without public protest, accepted it and lived silently with the results…Born and nourished by separatism, the nineteenth century solution to sexual discrimination, the hospital, by the time of its centennial in 1912, was facing conflict over integration and the challenge of justifying its existence as an all-woman’s hospital.”

Clara Barton known as “The Angel of the Battlefield,” expanded her concept of soldier aid, traveling to organize a program for locating men listed as missing in action. Through interviews with Federals returning from Southern prisons, she was often able to determine the status of some of the missing and notify families. By the end of the war Barton had performed most of the services that would later was associated with the American Red Cross, which she founded in 1881. Faust stated, “For 3 years she followed army operations throughout theVirginiaTheaterand in theCharleston,S.C., area. At this time she formed her only formal Civil War connection with any organization when she served as superintendent of nurses in Maj. Gen. Benjamin F. Butlers command.”

Linda Richards wasAmerica’s first trained nurse and devoted her life to the work of caring for the sick and suffering after hearing of the need of nurses in the Civil War. She began her work atBostonCityHospital, but was disappointed she when realized her work to be only that which today is being considered a maid. She also opened the first training school for nurses in Japan and started a nurse training school at the Methodist Episcopal Hospital inPhiladelphia. Richards was also the first president of the first professional organization for nurses, the American Society of Superintendents of Training Schools. In addition, she was recognized for introducing the idea of keeping records of patient care and initiating the use of nursing uniforms in practice.

            As time progressed emerging practice dilemmas began to emerge. It became clear that in history women were considered the primary foundation of the field of nursing. Yet, as men entered this profession, it became obvious that there was an inequality between men and women in the workplace. In addition, an article in City Hall news stated, “Men are climbing the nursing career ladder much quicker than women, despite the fact that most women have longer experience in the profession and better nursing qualifications” according to new research from the independent Policy Studies Institute. Despite the central role of the nurse in hospitals, decision making was vested in managers and physicians, who were men.

            Discrimination in nursing may occur regarding racial or ethnic background, gender or sex, sexual orientation and age. Nancy Kaleda (2008), “Yet, it refuses to end a discriminatory practice that for decades has denied registered nurses equal retirement benefits.” 

            Therefore, racial and ethnic discrimination remains a problem in society as a whole and unfortunately, health care systems are not immune to these problems. Brandy (2008), a third year nursing student commented on the discrimination of women in nursing by explaining “how African American women had no rights during WWII and in the Korean War to the point of not being able to serve their country in the military as a nurse.” Although, there are indications that nurses have moved into greater acceptance of all individuals in advance of some other portions of society, concerns about discrimination still remain.

            A survey pertaining to minority nurses was published by the ANA which indicated that many believe that they have been adversely affected by discrimination in nursing profession. Some concerns cited were the perception that others questioned their capabilities, ethnic backgrounds were reasons that they were passed over for promotions.

 Mary Eliza Mahoney was known as the first African American professionally trained registerednurse in theUnited States. The National Association of Colored Graduate Persons established the Mary Mahoney Award in 1936 to honor her nursing contributions. Bolden (1996) mentioned that, “The award continues to recognize individuals who have made significant contributions in interracial relationships.”

            Consequently, Fitzpatrick (1997) commented that, “In many respects, the role of the nurse in the hospital could be compared to that of a mother charged with the responsibility for the care of a family. (p.821)” As time progressed, there became a need to develop independence among the nursing profession and to develop both intellect and leadership capabilities within this community.

            The Journal of Professional Nursing (2003) stated, “ “It is important for a student to study the history of nursing due to the fact that, “History promotes critical thinking skills as students question historical events and explore how these events may have altered the profession.” The basic knowledge a nurse must possess and apply on a daily basis is reading, document use, writing, math skills, oral communication, working with others, computer use and the willingness to continuous learning. It is crucial to be able to apply nursing theories, some management and leadership abilities.

            The rapid expansion of knowledge in the technological and psychosocial sciences means today nurses obtain only a basic foundation for practice in undergraduate programs. Each new graduate has the responsibility to learn to apply and expand their knowledge in the specific work role and setting.     Nursing candidates must prepare by a rigorous course of training that includes a thorough grounding in anatomy, physiology, pharmacology, the cause and treatment of disease, the intricacies of nutrition and diet, surgical skills, and a variety of techniques pertaining to patient care. Many nurses also prepare for more specialized work, such as the care of newborn infants, maternity patients, or the mentally ill, or for duties in the operating room.        

            Nursing is a unique profession with many levels of clinical practice ranging from technical to advanced practice Higher education for nurses begin at the entry levels as per Angi Mohr, Assistant V.P of Nursing at Unity Health Center pointed out, “Training for a career as a registered nurse can be met by several means: a two-year course at a junior college or a four-year degree program at a college or university.” Emphasis on college education for nurses is on the upsurge, because greater knowledge is required to apply the latest methods of diagnosis and therapy. Training includes both classroom study and actual hospital practice, and the graduate must still be examined and licensed by the state. This applies also to women in religious orders who train and work as nursing sisters.

The Atlanta Baptist Female Seminary was founded in 1881 when the first eleven students met with founders Sophia B. Packard and Harriet E. Giles in the basement of the oldest Negro Baptist church called theFriendshipBaptistChurch. But the useful lives alluded to in writings by the founders was very much in keeping with an African proverb, “Teach a woman and you teach a nation.” 1886 Spelman Seminary renamedSpelmanCollegeestablished the first nursing program for African Americans.

            There are other aspects that a trained nurse must focus on. Although many patients face significant physical needs, their mind and spirit may be ill as well. Three facets make up an individual: physical, mental, and spiritual. To provide optimal holistic care, the care nurse must take into consideration each of these three aspects. But most importantly, the care nurse must recognize that spiritual care begins with oneself. Spirituality is one such area of patient care that, when addressed, can reap positive benefits for both the patient and the healthcare provider. O’Brien (1999) stated, “In years past, spiritual care was generally not considered a dimension of nursing therapeutics. With the advent of the holistic health movement, however, together with the notion of holistic nursing, assessment of an ill person’s spiritual needs, and in some cases the practice of spiritual care, became recognized as legitimate activities within the domain of nursing” (p.118).

            Angi Mohr, Assistant V.P of Nursing at Unity Health Center when asked about the social support and spiritual aspects of nursing stated, “The biggest thing is just being there…a hand on a shoulder…a simple prayer” She felt that as a nurse, there is a need to meet the spiritual needs of a patient. It begins being open to other religions other than her own. She commented that, “It may be as simple as identifying a spiritual need and finding a way to meet that need for the patient.”

            Nursing has become a therapeutic and caring discipline whose practice is based on nursing knowledge, the sciences, and the humanities, and is guided by the ANA Code of Ethics. Within a variety of roles and in multiple settings, nurses collaborate with clients and members of the interdisciplinary health care team to provide high quality client care and to facilitate improvement in health care delivery systems. Nursing is a vital force in society’s culture whose roles affect and are affected by current and emerging issues in health care. Knowledge derived from research, other scholarly activities, and societal trends provide direction for the evolving practice of nursing.  Clare (1993) acknowledged, “The culture taught in nursing schools, with professional ideals of autonomy, empowerment, and reflective practice clashes with the “highly bureaucratic institutions in the health care system” (p.1034).

            As nursing students are involved in the clinical and academic environments it is believed that ethical principles are a necessary guide to professional development. NSNA (2001) reported, “Students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide nursing care. The clinical setting presents unique challenges and responsibilities while caring for human beings in a variety of health care environments.” Each woman, upon entering the profession, inherits a measure of responsibility and trust in the profession and the corresponding obligation to adhere to standards of ethical practice and conduct set by the profession.

            Along with the code of ethics there is a philosophy that is upheld by nurses. Brencick and Webster (2000), together described the concept of the meaning of an accepted nursing philosophy stating, “…encourage the health profession to embrace a more holistic approach to healthcare in this enlightening outlook that envisions a synchronistic relationship between technology and caring.” There is a need to demonstrate how a return to the humanities that can help reestablish the individual’s identity in a system that currently treats each patient as a piece of paper with a number on it. It is crucial for women to encourage the health profession to incorporate a holistic approach to healthcare that envisions a simultaneous connection between science, technology and caring.

            The key element of nursing is a holistic approach that serves to counteract the reductionism of medicine that has inadvertently been undermined. Although many nurses have attempted to maintain past clinical practices, work pressures, staff turnover, the cutting of wages and the hiring of lower paid licensed nurses impeded their aspirations and, too often, nurses in management have not shown the leadership their predecessors did in the 19th century.

There are two sides to the problem: more nurses are leaving the profession and fewer people are entering the profession. Both reflect massive failures of national policy.

            Nursing also suffers from a training bottleneck. In 2005, fully 150,000 qualified applicants were turned down atU.S.schools of nursing both associate and baccalaureate degrees due to insufficient faculty and classroom or lab space, or lack of clinical sites. The problem is mainly teachers of nursing, combined with the fact that nurse training programs are often money losers for community colleges and universities, so too few slots are offered.

            In conclusion, the field of nursing has and continues to face significant challenges for women regarding their own identity. Nursing, a scientific discipline, requires creativity in its execution. The art of nursing lies in the application of concepts and principles of nursing theory to the design of individualized care using the nursing process. It is a scientific discipline that takes a holistic approach to the diagnosis and treatment of potential and actual responses to illnesses.  The goal of nursing is to lessen the effects of illness, promoting comfort and healing and assisting patients whether that is an optimum state of health or a dignified death.

Being a woman in today’s nursing field is never easy but can be very rewarding…when you’re a nurse you know that every day you will touch a life or a life will touch yours…

References

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School of Nursing: Philosophical Beliefs. Retrieved April 30, 2008, from http://www.atkinson.yorku.ca/NURS/philosophy.htm

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2 Comments »

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