Nursing

Throughout history nursing has played an essential role in society as a profession that embodies the preservation and restoration of health along with thecare of the terminallly ill. With records from early in the first millenniumA.D., ancient cultures referred to nurses as attendants who prepared and administered medicines, cared for the physical needs of patients,and knowingly followed physician's orders. While still focused on the same basic desire to provide wellness, comfort, care, and assurance to the sick, the role of the nurse has evolved into one of the most crucial support functions of modern medicine.

The influences of an everchanging society have promoted the radical developments in nursing throughout time. First seen as a role suitable only for uneducated women or slaves in ancient times, Christianity along with other religious orders soon helped the nurse gain respect as the role of caregiver to the sick became an increasingly prominent practice. The Christian Church brought the formation of the Order of the Deaconesses in the first century a group similar to public health or visiting nurses. This happened at a time when caringfor the sick was a Christian duty, "a sacred vocation based upon Christ's actual command." The love and brotherhood of Christianity also led to the establishment of the first nursing order by the Augustinian Sisters during the Middle Ages. With the approach of the Protestant Reformation in England, monastic medicine (care given by monasteries and the monks and nuns who live there)and the nursing orders of the sixteenth century were destroyed, leaving hospitals overcrowded with the only care for the sick provided by illiterate, indigent women. Chaos ruled until the early eighteenth century when voluntary hospitals offered some relief for England, and the continued presence of nursingorders in Europe aided those in need. Reformation of societal factors, including prisons and social welfare during this dark period led to the organization of new nursing orders to supply improved, humane services where none existed before.

While the first nursing order with a systematic educational program was established in the sixteenth century by the Sisters of Charity, continued growth of cities along with the emergence of epidemics led to an increased need for formal training apart from the church to meet the demand for more nurses. To help meet this need, a special nursing school, La Source was founded by Countess Agénor de Gasparin in 1859 near Lausanne in Switzerland. The countess introduced nursing as a vocation that should be salaried all without the presence of religious vows.

The Crimean War (1854-1856) produced the founder of modern nursing, Florence Nightingale. Born into an affluent family, her stature helped structure nursing into an orderly work force during the war, and in 1860, Nightingaleestablished her renowned school of nursing at St. Thomas' Hospital in London. Similar in thought to the countess, Nightingale observed nursing as a career and a calling, rather than a religious vocation. Her high expectations inducted thousands of students into a profession she thought demanded intelligence and impeccable morals and behavior. The Nightingale Training Schools infiltrated Britain, Canada, Australia, and New Zealand, in addition to influencingthe education of nurses in the United States.

As Nightingale's values of nursing traveled overseas, the United States was in the midst of the Civil War (1861-1865). Bringing care to the soldiers on the battlefields was led by many nurses, but Clara Barton would ultimately stimulate the growth of nursing in this country due to her role as founderof the American Red Cross. Her cause was initiated by Swiss banker, JeanHenri Dunant, who after witnessing the Battle of Solferino on June 24, 1859, was determined that no soldier would go without medical support. His founding of the International Red Cross in 1864 instigated the developmentof nurses' training throughout the world. This catalyst also brought about the Women's Central Relief Committee. Led by Dr. Elizabeth Blackwell, aformer associate of Nightingale's, this group of women was dedicated to serving several needs of the war, including, identifying the army's nursing needs, and creating "a bureau for the examination and registration of nurses." Their persistence led to the organization of the National Sanitary Commission that would guide the government to oversee medical support for the army.

Although religious orders still dominated nursing in parts of Europe throughout the early nineteenth century, the United States placed proper education and training of lay nurses as a top priority. Hospitals became the accepted route for preparation and employment, and nursing schools throughout America andCanada began to follow the Nightingale vision of providing classroom instruction and clinical practice. Mary Agnes Snively established the Canadian Nurses' Association (CNA) in 1884, and the Nurses Associated Alumni of the UnitedStates, which later became the American Nurses' Association (ANA) was foundedin part by Isabel Hampton Robb in 1886.

With the emergence of professional organizations and the Red Cross serving asthe nursing profession's liasion to the world, a need to further prove theirprofessional identity was provoked as oppposition surfaced from physicians and other rivalries within the vocation itself. In order to protect and definetheir status, high standards were set with strict entrance requirements, prescribed curricula, and licensing regulations for the profession. The United States became the touchstone of nursing as they moved into the twentieth century with national nursing organizations and state governments working togethertoward defining standards and educational requirements these efforts led tothe first registry law in 1938 by New York State which established the difference between the registered nurse, who had met state requirements for a licensed professional nurse, and the less rigorous training requirements of the practical nurse.

Advancement in the world of medicine and public health launched the nursing profession into the twentieth century. The Goldmark Report, funded by the Rockefeller Foundation in the early 1900s, resulted in expansion of nursing programs at Yale University, Vanderbilt University, and the University of Toronto.Alternatives to the hospital diploma setting has become a reality as education in senior colleges and universities has became standard worldwide. Nursingprograms include: the associate degree (ADN) program that lasts two years and is offered by junior or community colleges with a focus on the technical elements of nursing; and the four-year baccalaureate program with curriculum including liberal arts and sciences and clinical experience which leads to a bachelor or science degree in nursing (BSN). Although each program is unique, the interaction and collaboration of all three are reinforced by state mandates for articulation agreements in the United States. The practical nurse (LPN)or vocational nurse (LVN) is also an approved program that is offered by high schools, community colleges, vocational schools, and a variety of health care agencies throughout the country.

Opportunities continue to increase for the nurse as a need for their expertise escalates. The profession has met the demand for its changing role with anincreasing number employed in long-term care, home health care, ambulatory and school-based clinics, health maintenance organizations, and community nursing centers. In addition to their presence on medical/surgical units or intensive care units, nurses teach in schools, serve in executive positions, conduct research, and work alongside physicians in joint practices. While historically a profession typically occupied by women, the twentieth century has seenthe entrance of more men to nursing roles in the emergency room, critical care, and surgical settings. Trends in the United States also include the growthof graduate nursing education, which prepares nurse practitioners, nurse anesthetists, nurse-midwives, and clinicians for numerous specialties.

As science and technology continue to flourish, so will the demand for the advancement of nursing. With a abundance of organizations across the world to guide their efforts and shape policy, including the National League of Nursingin the United States, the incentives for a career in nursing will continue to proliferate and match the opportunities offered by other professions.

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