History of Health Care & History of Health Care & NursingNursing

Rasheed Ahmed KhanRasheed Ahmed KhanNursing instructorNursing instructor

ION(DUHS)ION(DUHS)

NURSING: DEFINITIONSNURSING: DEFINITIONS Nursing (as an art)Nursing (as an art) Is the art of caring sick and well individual. It refers to Is the art of caring sick and well individual. It refers to the dynamic skills and methods in assisting sick and the dynamic skills and methods in assisting sick and well individual in their recovery and in the promotion well individual in their recovery and in the promotion and maintenance of health. It involves the creative and maintenance of health. It involves the creative application of knowledge in the service of people application of knowledge in the service of people Nursing (as a science)Nursing (as a science) It is the “body of abstract knowledge” arrived through It is the “body of abstract knowledge” arrived through scientific research and logical analysis. scientific research and logical analysis. Is the scientific knowledge and skills in assisting Is the scientific knowledge and skills in assisting individual to achieve optimal health. It is the diagnosis individual to achieve optimal health. It is the diagnosis and treatment of human responses to actual or potential and treatment of human responses to actual or potential problem.problem.

Cont …………Cont …………

Nursing (as a professionNursing (as a profession))

Profession- a calling in which its members profess to Profession- a calling in which its members profess to have acquired special knowledge by training or have acquired special knowledge by training or experience, or both so that they may guide, advise or experience, or both so that they may guide, advise or save others in that special field.save others in that special field.

Florence NightingaleFlorence Nightingale

Nursing is the act of utilizing the environment of the Nursing is the act of utilizing the environment of the patient to assist him in his recovery. patient to assist him in his recovery.

Cont ……….Cont ……….

Virginia HendersonVirginia Henderson

Nursing is the act of assisting the individual, sick or well, Nursing is the act of assisting the individual, sick or well, in the performance of those activities contributing to in the performance of those activities contributing to health or its recovery (or to a peaceful death) that he health or its recovery (or to a peaceful death) that he would perform independently if he had the necessary would perform independently if he had the necessary strength, will, or knowledge, and to do this in such a way strength, will, or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.as to help him gain independence as rapidly as possible.

Cont ………..Cont ………..Canadian Nurses Association (CNA)Canadian Nurses Association (CNA)

Nursing is a dynamic, caring, helping relationship in which Nursing is a dynamic, caring, helping relationship in which the nurse assist the client to achieve and obtain optimal the nurse assist the client to achieve and obtain optimal health. – 1987 health. – 1987 Themes that are common to these definition: Themes that are common to these definition: • • Nursing is caring Nursing is caring • • Nursing is an art Nursing is an art • • Nursing is a science Nursing is a science • • Nursing is client-centered Nursing is client-centered • • Nursing is holistic Nursing is holistic • • Nursing is concerned with health promotion, health maintenance, Nursing is concerned with health promotion, health maintenance, andand health restoration health restoration • • Nursing is a helping profession Nursing is a helping profession

Cont ……..Cont ……..

American Nurses Association (ANA)American Nurses Association (ANA)

1973 1973

Nursing is direct, goal oriented, and adaptable to the needs Nursing is direct, goal oriented, and adaptable to the needs of the individual, the family, and community during health of the individual, the family, and community during health and illness. and illness.

1980 1980

Nursing is the diagnosis and treatment of human responses Nursing is the diagnosis and treatment of human responses to actual or potential health problems. to actual or potential health problems.

Cont ……..Cont ……..19951995

ANA acknowledge four essential features of contemporary ANA acknowledge four essential features of contemporary nursing practice: nursing practice:

• • Attention to the full range of human experiences andAttention to the full range of human experiences and

responses to health and illness. responses to health and illness.

• • Integration of objective data with knowledge gained from Integration of objective data with knowledge gained from

understanding of the client or group’s subjective experience. understanding of the client or group’s subjective experience.

• • Application of scientific knowledge to the processes of Application of scientific knowledge to the processes of

diagnosis and treatment. diagnosis and treatment.

• • Provision of caring relationship that facilitates health andProvision of caring relationship that facilitates health and

healing. healing.

Nurse: DefinitionNurse: Definition

NurseNurse

• • Comes from a Latin word “to nourish” or “to cherish Comes from a Latin word “to nourish” or “to cherish

• • One who cares for the sick, the injured, and the physically,One who cares for the sick, the injured, and the physically, mentally, and emotionally disabled mentally, and emotionally disabled • • One who advise and instruct individuals, families, groupsOne who advise and instruct individuals, families, groups and communities in the prevention, treatment of illness andand communities in the prevention, treatment of illness and diseases and in the promotion of health. diseases and in the promotion of health. • • An essential member of a health team who cares forAn essential member of a health team who cares for individuals, families and communities in disease and illnessindividuals, families and communities in disease and illness

prevention andprevention and in the promotion ofin the promotion of health. health.

Patient: DefinitionPatient: Definition

PatientPatient

• • Comes from a Latin word, “to Suffer” or “to Bear” Comes from a Latin word, “to Suffer” or “to Bear”

• • An individual who is in the state of physical, mental, andAn individual who is in the state of physical, mental, and

emotional imbalanceemotional imbalance

• • An individual who seeks for nursing assistance, medicalAn individual who seeks for nursing assistance, medical

assistance, or for surgery due to illness or a disease. assistance, or for surgery due to illness or a disease.

• • Is an individual who is waiting or undergoing medical orIs an individual who is waiting or undergoing medical or

surgical care. One who is physically or mentally disabled.surgical care. One who is physically or mentally disabled.

History of Health Care and Nursing History of Health Care and Nursing in in

Ancient civilizationsAncient civilizations

Ancient civilizationsAncient civilizations The first nurse – the first motherThe first nurse – the first mother Illness was seen as “magic” “sin” orIllness was seen as “magic” “sin” or

“ “punishment”punishment” Guidelines of behavior becameGuidelines of behavior became

rules. rules were to protect peoplerules. rules were to protect people

and guarantee group survivaland guarantee group survival Old Testament refers to dietary,Old Testament refers to dietary,

hygiene and health laws for thehygiene and health laws for the

HebrewsHebrews There was no organized nursingThere was no organized nursing

carecare

Evolution of NursingEvolution of Nursing

As an instinctive response to the desire to keep healthy,As an instinctive response to the desire to keep healthy,

the sick the sick Responsibility – nurturing children, care of the elderlyResponsibility – nurturing children, care of the elderly

and the sick and the sick Education – Through trial & error and informationEducation – Through trial & error and information

sharing, intuition sharing, intuition Religions – accepting the illness butReligions – accepting the illness but Superstition & magic Superstition & magic

Ancient SocietiesAncient Societies Nomadic Nomadic Solidarity for mutual protection Solidarity for mutual protection Belief in the power of GodsBelief in the power of Gods Black and white magic Black and white magic Ingenious techniques of health practices,Ingenious techniques of health practices, Med & Surg treatments, Massage, fomentation,Med & Surg treatments, Massage, fomentation,

trephining, bone setting, amputation, hot and cold baths. trephining, bone setting, amputation, hot and cold baths.

ANCIENT BABYLONIANSANCIENT BABYLONIANS

Code Of HammurabiCode Of Hammurabi 1st record on the medical practice1st record on the medical practiceEstablished the medical fees Established the medical fees Discouraged experimentation Discouraged experimentation Specific doctor for each disease Specific doctor for each disease Right of patient to choose treatment between the use Right of patient to choose treatment between the use

of medicine, or surgical procedureof medicine, or surgical procedure

No organized nursing care. No organized nursing care.

ANCIENT EGYPTIANSANCIENT EGYPTIANS Art Of Embalming Art Of Embalming By river Nile. Healthiest & most advanced By river Nile. Healthiest & most advanced Priest physicians - Belief in evil spirits Priest physicians - Belief in evil spirits Imhotep – A surgeon, architect, priest, magician) Imhotep – A surgeon, architect, priest, magician) A system of community planning (hygiene, sanitation, A system of community planning (hygiene, sanitation,

embalming, dentistry) embalming, dentistry) Women assisted ‘priest- physician’ as priestess/ midwives/Women assisted ‘priest- physician’ as priestess/ midwives/

wet-nurses wet-nurses Dissection – Prohibited. Hence no further progress Dissection – Prohibited. Hence no further progress Documentation about 250 diseases and treatments Documentation about 250 diseases and treatments

HEBREWHEBREW Motivated servant of God Motivated servant of God ‘‘Mosaic code’- Isolation, hygiene, rest & sleep, hrs ofMosaic code’- Isolation, hygiene, rest & sleep, hrs of work, disposal of excreta, disinfection, regulations towork, disposal of excreta, disinfection, regulations to check animals before slaughtering/ eating check animals before slaughtering/ eating Religion ‘Do not eat meat past the 3 rd day’ Religion ‘Do not eat meat past the 3 rd day’ King gave health power to ‘priest physician’ King gave health power to ‘priest physician’ Priest physician – took the role of health inspectorPriest physician – took the role of health inspectorBasic nursing practices were existed. Basic nursing practices were existed.

Cont ………Cont ………

Purification of man and his food Purification of man and his food The ritual of Circumcision – on the 8th day after birth The ritual of Circumcision – on the 8th day after birth Mosaic Law Mosaic Law Meant as a survival for health and hygienic reason only Meant as a survival for health and hygienic reason only Use of pharmacologic drugs Use of pharmacologic drugs

ANCIENT CHINAANCIENT CHINA By the Yellow river By the Yellow river Confucius – Patriarchal role Confucius – Patriarchal role Importance to rule of etiquette Importance to rule of etiquette Value of family as a unit Value of family as a unit Women inferior to men Women inferior to men ‘‘Yang’ & ‘Yin’ – Active (male) & passive (female) force Yang’ & ‘Yin’ – Active (male) & passive (female) force 2000 BC – Dissection done, circulation, pulse, elaborate2000 BC – Dissection done, circulation, pulse, elaborate

materia medica, importance to hygiene materia medica, importance to hygiene

Cont……..Cont…….. Rule of physical exam – ‘Look, listen, ask and feel’ Rule of physical exam – ‘Look, listen, ask and feel’ Baths to reduce feverBaths to reduce fever 1000 BC - Sen Lung (Father of medicine), used veg and1000 BC - Sen Lung (Father of medicine), used veg and

animal drugs, vaccination, physiotherapy, treated syphilisanimal drugs, vaccination, physiotherapy, treated syphilis

and gonorrhea and gonorrhea 1200 BC - Liver diet for anemia, 1200 BC - Liver diet for anemia, Hence nursing was impossibleHence nursing was impossible

ANCIENT INDIANANCIENT INDIAN First civilizations were highly developedFirst civilizations were highly developed

1500 BC1500 BC Ayurveda Ayurveda

Explains hygiene, disease prevention, major/ minor Explains hygiene, disease prevention, major/ minor surgery, children’s disease, inoculation, materia medica, surgery, children’s disease, inoculation, materia medica, disease of CNS & GUS disease of CNS & GUS

1400 BC- Sushruta1400 BC- Sushruta

‘‘Father of Surgery’ in India. Charaka wrote ‘Internal Father of Surgery’ in India. Charaka wrote ‘Internal medicine’medicine’

ANCIENT INDIANANCIENT INDIAN King Ashoka (272 – 236 BC) King Ashoka (272 – 236 BC)

Public hospitals with male nurses and some older women, Public hospitals with male nurses and some older women, hospitals for animals. Universities (monasteries) of Taxila hospitals for animals. Universities (monasteries) of Taxila & Nalanda (Bihar) & Nalanda (Bihar)

Nurses should have 3 qualities – high standards, skills and Nurses should have 3 qualities – high standards, skills and trustworthinesstrustworthiness

1 AD 1 AD

Superstition & magic replaced by more up-to-date practice. Superstition & magic replaced by more up-to-date practice.

But medicine remained in the hands of priest physician, But medicine remained in the hands of priest physician, who refused to touch blood and pathological tissue who refused to touch blood and pathological tissue

ANCIANT INDIANANCIANT INDIAN

1000 AD1000 AD

Brahmin influences gained strength and re-Brahmin influences gained strength and re-established itself. Buddhism declined. Brahmins established itself. Buddhism declined. Brahmins were priest physicians were priest physicians

Rigid Hindu caste system. No dissection. Rigid Hindu caste system. No dissection. Superstition and magic replaced practice of Superstition and magic replaced practice of medicine medicine

ANCIENT GREEKANCIENT GREEK

Apollo (son of God) – God of health Apollo (son of God) – God of health Asculapus (son of Apollo) – God of healing Asculapus (son of Apollo) – God of healing Epigone – (Asculapus’ wife) – The soother Epigone – (Asculapus’ wife) – The soother Hygeia – (daughter of Asculapus ) – Goddess of health Hygeia – (daughter of Asculapus ) – Goddess of health Temples – became social, intellectual and medical centersTemples – became social, intellectual and medical centers Aristotle – differentiated arteries from vein Aristotle – differentiated arteries from vein

Hippocrates in the 5th centuryHippocrates in the 5th century• • Known as “Father of Medicine”Known as “Father of Medicine” Hippocratic oath is from himHippocratic oath is from him Said Illness had specific causes: black bile, yellowSaid Illness had specific causes: black bile, yellow

bile and red bilebile and red bile Developed terms prognosis, diagnosis, cureDeveloped terms prognosis, diagnosis, cure Diagnosis—identifying disease scientificallyDiagnosis—identifying disease scientifically Prognosis—predicting possible outcomePrognosis—predicting possible outcome Cure— restoration of healthCure— restoration of health

NURSES à function of untrained slaves NURSES à function of untrained slaves

ANCIENT ROMANSANCIENT ROMANS Medical advances borrowed from Greece after they Medical advances borrowed from Greece after they

conquered it conquered it Clung to superstitions Clung to superstitions Had good hygiene and sanitation Had good hygiene and sanitation Made drainage systems, drinking water aqueduct,Made drainage systems, drinking water aqueduct,

public baths, hospitals (for soldiers and slaves) public baths, hospitals (for soldiers and slaves) Men & women of good character did nursing Men & women of good character did nursing Two classes Two classes Patricians Patricians Plebicians Plebicians

Nursing in Early Christian EraNursing in Early Christian Era

Women began nursing as an expression of ChristianityWomen began nursing as an expression of Christianity

(acts of mercy)(acts of mercy) Women were recognized (first recording in history) asWomen were recognized (first recording in history) as

important members of communityimportant members of community Phoebe considered the first Deaconess and visiting nursePhoebe considered the first Deaconess and visiting nurse Fabiola started the first public hospital in RomeFabiola started the first public hospital in Rome

Early Middle Ages (AD 476-1000)Early Middle Ages (AD 476-1000)“Dark Ages”“Dark Ages”

Learning stopped and Christianity retreated behind theLearning stopped and Christianity retreated behind the

walls of monasteries due to the wars occurring in the landwalls of monasteries due to the wars occurring in the land

(The Roman Empire collapsed)(The Roman Empire collapsed)Focus was on care and comfort (foundation of nursing) Focus was on care and comfort (foundation of nursing)

science declinedscience declinedNursing care was controlled by the Catholic ChurchNursing care was controlled by the Catholic Church

High Middle Ages (1000-1475)High Middle Ages (1000-1475)

Small states emerged after warsSmall states emerged after warsCatholic Church became dominantCatholic Church became dominantMedicine declinedMedicine declinedMonastatic orders began with strict discipline, ObedienceMonastatic orders began with strict discipline, Obedience

and devotionand devotionMonasteries became the place for education of medicine Monasteries became the place for education of medicine and nursing. But Too strict > Diminished interest in work and nursing. But Too strict > Diminished interest in work > decline of monasteries between 9th and 10th century.> decline of monasteries between 9th and 10th century.

Cont ……..Cont …….. 12th – 16th century – Ruled by religious order 12th – 16th century – Ruled by religious order Nursing done by dedicated women, who took vows, Nursing done by dedicated women, who took vows,

but could not leave or get married. but could not leave or get married. Also nursing brothers. Also nursing brothers. Age – Between 16 – 24 yrs Age – Between 16 – 24 yrs

The CrusadesThe Crusades

• • Europe rose to reclaim the Holy Land from the MuslimsEurope rose to reclaim the Holy Land from the Muslims• • Hospitals developed on the battlefieldsHospitals developed on the battlefields• • Knight Hospitaliers of St. John’s of Jerusalem cared for theKnight Hospitaliers of St. John’s of Jerusalem cared for the injuredinjured• • Knights organized nursing careKnights organized nursing care• • Had a probationary period before you could wear the Had a probationary period before you could wear the “ “white” robes of knighthoodwhite” robes of knighthood• • Nursing became acceptable for women and encouraged by Nursing became acceptable for women and encouraged by Catholic ChurchCatholic Church

The Bubonic Plague (1347-1350)The Bubonic Plague (1347-1350)

Ended the middle agesEnded the middle agesWas very deadlyWas very deadlyGerms carried by ratsGerms carried by ratsKilled ¼ of the entire world populationKilled ¼ of the entire world population““ring around the rosy”ring around the rosy”

Renaissance (1400-1600) “Rebirth”Renaissance (1400-1600) “Rebirth”

Interest increased in science and discovery;Interest increased in science and discovery;medicine increasedmedicine increasedNursing declinedNursing declined

The ReformationThe Reformation

Led by Martin LutherLed by Martin LutherThe birth of protestantism; end of dominance of theThe birth of protestantism; end of dominance of the Catholic ChurchCatholic ChurchWomen remained subordinate, women did not workWomen remained subordinate, women did not work outside the homeoutside the home““Wayward” women of low status became “nurses”Wayward” women of low status became “nurses” instead of going to jailinstead of going to jail

18th, early 19th centuries18th, early 19th centuries

The sick and poor were in great numbers ”change” was The sick and poor were in great numbers ”change” was needed, the stage was set for those with “social” visionneeded, the stage was set for those with “social” vision

19th century19th centuryEra of social reform for prisons, public health and care ofEra of social reform for prisons, public health and care of

the poorthe poorPastor Theodur Fliedner opened the Kaiserwerth Pastor Theodur Fliedner opened the Kaiserwerth

Deaconess Institute—the first REAL nursing schoolDeaconess Institute—the first REAL nursing school

Its most famous student:Its most famous student:

Florence Nightengale (1820-1910)Florence Nightengale (1820-1910)

Florence NightingaleFlorence NightingaleMother of Modern NursingMother of Modern NursingWent to Kaiserwerth for 3 monthsWent to Kaiserwerth for 3 monthsOn Oct. 21, 1854, left with 38 women for the Crimean War,On Oct. 21, 1854, left with 38 women for the Crimean War,

British casualties were high; within 6 months, death rate cutBritish casualties were high; within 6 months, death rate cut

in halfin halfMade rounds at night with a lamp “Lady of the Lamp”Made rounds at night with a lamp “Lady of the Lamp”Opened the Nightingale School of Nursing in 1860 whereOpened the Nightingale School of Nursing in 1860 where

she stressed good food, clean air and sanitationshe stressed good food, clean air and sanitationWrote textbooks on nursingWrote textbooks on nursingWrote famous “Notes on Nursing” Some of her ideas areWrote famous “Notes on Nursing” Some of her ideas are

still valid todaystill valid today

Late 19th Century, 20 Century to NOWLate 19th Century, 20 Century to NOW

Civil War shaped nursing by dramatizing the need for Civil War shaped nursing by dramatizing the need for

nursing carenursing careClara Barton established hospitals for both sides and for allClara Barton established hospitals for both sides and for all

colors of people; later founded the American Red Crosscolors of people; later founded the American Red CrossBellevue Hospital 1873 opened the New York TrainingBellevue Hospital 1873 opened the New York Training

School modeled after Nightingale schoolSchool modeled after Nightingale schoolLinda Richards first U.S. Trained nurse, 1873Linda Richards first U.S. Trained nurse, 1873Mary Mahoney first black nurse trained in 1879Mary Mahoney first black nurse trained in 1879