HISTORY OF

NURSING

NAZARETH N. PATINDOL
BSN 1B
INTRODUCTION
Nursing today is far different from nursing as it was practiced years
ago, and it is expected to continue changing during the 21st century. To
comprehend present-day nursing and at the same time prepare for the
future, one must understand not only past events but also contemporary
nursing practice and the sociologic and historical factors that affect it.

HISTORICAL PERSPECTIVES
Nursing has undergone dramatic change in response to societal needs
and influences. A look at nursing’s beginnings reveals its continuing struggle
for autonomy and professionalization. In recent decades, a renewed interest
in nursing history has produced a growing amount of related literature. This
section highlights only selected aspects of events that have influenced
nursing practice. Recurring themes of women’s roles and status, religious
(Christian) values, war, societal attitudes, and visionary nursing leadership
have influenced nursing practice in the past. Many of these factors still exert
their influence today.

Women’s Roles
Traditional female roles of wife, mother, daughter, and sister have
always included the care and nurturing of other family members. From the
beginning of time, women have cared for infants and children; thus, nursing
could be said to have its roots in “the home.” Additionally, women, who in
general occupied a subservient and dependent role, were called on to care
for others in the community who were ill. Generally, the care provided was
related to physical maintenance and comfort. Thus, the traditional nursing
role has always entailed humanistic caring, nurturing, comforting, and
supporting.

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Religion
Religion has also played a significant role in the development of
nursing. Although many of the world’s religions encourage benevolence, it
was the Christian value of “love thy neighbor as thyself” and Christ’s parable
of the Good Samaritan that had a significant impact on the development of
Western nursing. During the third and fourth centuries, several wealthy
matrons of the Roman Empire, such as Fabiola, converted to Christianity and
used their wealth to provide houses of care and healing (the forerunner of
hospitals) for the poor, the sick, and the homeless. Women were not,
however, the sole providers of nursing services.

The Knights of Saint Lazarus (established circa 1200) dedicated

themselves to the care of people with leprosy, syphilis, and chronic skin
conditions. From the time of Christ to the mid-13th century, leprosy was
viewed as an incurable and terminal disease. Battman/Corbis.

During medieval times, there were many religious orders of men in

nursing. For example, the Alexian Brothers organized care for victims of the
Black Plague in the 14th century in Germany. In the 19th century, they
followed the same traditions as women’s religious nursing orders and
established hospitals and provided nursing care. The deaconess groups,
which had their origins in the Roman Empire of the third and fourth centuries,
were suppressed during the Middle Ages by the Western churches. However,
these groups of nursing providers resurfaced occasionally throughout the
centuries, most notably in 1836 when Theodor Fliedner reinstituted the
Order of Deaconesses and opened a small hospital and training school in
Kaiserswerth, Germany. Florence Nightingale received her “training” in
nursing at the Kaiserswerth School. Early religious values, such as self-denial,
spiritual calling, and devotion to duty and hard work, have dominated nursing
throughout its history. Nurses’ commitment to these values often resulted in
exploitation and few monetary rewards. For some time, nurses themselves
believed it was inappropriate to expect economic gain from their “calling.”

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War
Throughout history, wars have accentuated the need for nurses.
During the Crimean War (1854–1856), the inadequacy of care given to soldiers
led to a public outcry in Great Britain. The role Florence Nightingale played in
addressing this problem is well known. She was asked by Sir Sidney Herbert
of the British War Department to recruit a contingent of female nurses to
provide care to the sick and injured in the Crimea. Nightingale and her nurses
transformed the military hospitals by setting up sanitation practices, such as
hand washing and washing clothing regularly. Nightingale is credited with
performing miracles; the mortality rate in the Barrack Hospital in Turkey, for
example, was reduced from 42% to 2% in 6 months . During the American Civil
War (1861–1865), several nurses emerged who were notable for their
contributions to a country torn by internal strife. Harriet Tubman and
Sojourner Truth provided care and safety to slaves fleeing to the North on
the Underground Railroad. Mother Biekerdyke and Clara Barton searched
the battlefields and gave care to injured and dying soldiers. Noted

Societal Attitudes
Society’s attitudes about nurses and nursing have significantly
influenced professional nursing. Before the mid-1800s, nursing was without
organization, education, or social status; the prevailing attitude was that a
woman’s place was in the home and that no respectable woman should have
a career.

The role for the Victorian middle-class woman was that of wife and
mother, and any education she obtained was for the purpose of making her
a pleasant companion to her husband and a responsible mother to her
children. Nurses in hospitals during this period were poorly educated; some
were even incarcerated criminals. Society’s attitudes about nursing during
this period.

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 Another image arising in the early 19th century that has affected
subsequent generations of nurses and the public and other professionals
working with nurses is the image of doctor’s handmaiden. This image evolved
when women had yet to obtain the right to vote, when family structures were
largely paternalistic, and when the medical profession portrayed increasing
use of scientific knowledge that, at that time, was viewed as a male domain.
Since that time, several images of nursing have been portrayed. The heroine
portrayal evolved from nurses’ acts of bravery in World War II and their
contributions in fighting poliomyelitis—in particular, the work of the
Australian nurse Elizabeth Kenney.

Other images in the late 1900s include the nurse as sex object,
surrogate mother, and tyrannical mother. During the past few decades, the
nursing profession has taken steps to improve the image of the nurse. In the
early 1990s, the Tri-Council for Nursing (the American Association of Colleges
of Nursing, the American Nurses Association [ANA], the American
Organization of Nurse Executives, and the National League for Nursing
[NLN]) initiated a national effort, titled “Nurses of America,” to improve the
image of nursing. Launched in 2002, the Johnson & Johnson corporation
continues their “Campaign for Nursing’s Future” to promote nursing as a
positive career choice. Through various outreach programs, this campaign
increases exposure to the nursing profession, raises awareness about its
challenges (e.g., nursing shortage), and encourages people of all ages to
consider a career in nursing.

Nursing Leaders
Florence Nightingale, Clara Barton, Linda Richards, Mary Mahoney,
Lillian Wald, Lavinia Dock, Margaret Sanger, and Mary Breckinridge are
among the leaders who have made notable contributions both to nursing’s
history and to women’s history. These women were all politically astute
pioneers.

NIGHTINGALE (1820–1910) The contributions of Florence Nightingale to

nursing are well documented. Her achievements in improving the standards
for the care of war casualties in the Crimea earned her the title “Lady with
the Lamp.” Her efforts in reforming hospitals and in producing and
implementing public health policies also made her an accomplished political
nurse: She was the first nurse to exert political pressure on government.
Through her contributions to nursing education— perhaps her greatest
achievement—she is also recognized as nursing’s first scientist-theorist for
her work Notes on Nursing: What It Is, and What It Is Not (1860/1969).

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 Nightingale was born to a wealthy and intellectual family. She believed
she was “called by God to help others and to improve the well-being of
mankind”. She was determined to become a nurse despite opposition from
her family and the restrictive societal code for affluent young English women.
Nightingale’s vision of nursing changed society’s view of nursing. She
believed in personalized and holistic client care. Her vision also included
public health and health promotion roles for nurses. It is easy to see how
Florence Nightingale still serves as a model for nurses today.

Clara Barton (1821–1912) was a schoolteacher who volunteered as a

nurse during the American Civil War. Her responsibility was to organize the
nursing services. Barton is noted for her role in establishing the American Red
Cross, which linked with the International Red Cross when the U.S. Congress
ratified the Treaty of Geneva (Geneva Convention). It was Barton who
persuaded Congress in 1882 to ratify this treaty so that the Red Cross could
perform humanitarian efforts in time of peace.

Linda Richards (1841–1930) was America’s first trained nurse. She

graduated from the New England Hospital for Women and Children in 1873.
Richards is known for introducing nurse’s notes and doctor’s orders. She also
initiated the practice of nurses wearing uniforms. She is credited for her
pioneering work in psychiatric and industrial nursing.

Mary Mahoney (1845–1926) was the first African American professional

nurse. She graduated from the New England Hospital for Women and
Children in 1879. She constantly worked for the acceptance of African
Americans in nursing and for the promotion of equal opportunities. The ANA
gives a Mary Mahoney Award biennially in recognition of significant
contributions in interracial relationships.

Lillian Wald (1867–1940) is considered the founder of public health

nursing. Wald and Mary Brewster were the first to offer trained nursing
services to the poor in the New York slums. Their home among the poor on
the upper floor of a tenement, called the Henry Street Settlement and Visiting
Nurse Service, provided nursing services, social services, and organized
educational and cultural activities. Soon after the founding of the Henry
Street Settlement, school nursing was established as an adjunct to visiting
nursing.

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 Lavinia L. Dock (1858–1956) was a feminist, prolific writer, political
activist, suffragette, and friend of Wald. She participated in protest
movements for women’s rights that resulted in the 1920 passage of the 19th
Amendment to the U.S. Constitution, which granted women the right to vote.
In addition, Dock campaigned for legislation to allow nurses rather than
physicians to control their profession. In 1893, Dock, with the assistance of
Mary Adelaide Nutting and Isabel Hampton Robb, founded the American
Society of Superintendents of Training Schools for Nurses of the United
States, a precursor to the current National League for Nursing.

Margaret Higgins Sanger (1879–1966) a public health nurse in New

York, has had a lasting impact on women’s health care. Imprisoned for
opening the first birth control information clinic in America, she is considered
the founder of Planned Parenthood. Her experience with the large number
of unwanted pregnancies among the working poor was instrumental in
addressing this problem.

Mary Breckinridge (1881–1965) After World War I, a notable pioneer

nurse, established the Frontier Nursing Service (FNS). In 1918, she worked
with the American Committee for Devastated France, distributing food,
clothing, and supplies to rural villages and taking care of sick children. In 1921,
Breckinridge returned to the United States with plans to provide health care
to the people of rural America. In 1925, Breckinridge and two other nurses
began the FNS in Leslie County, Kentucky. Within this organization,
Breckinridge started one of the first midwifery training schools in the United
States.

Men in Nursing
Men have worked as nurses as far back as before the Crusades.
Although the history of nursing primarily focuses on the female figures in
nursing, schools of nursing for men existed in the United States from the late
1880s until 1969. Male nurses were denied admission to the Military Nurse
Corps during World War II based on gender. It was believed at that time that
nursing was women’s work and combat was men’s work.

In 1971, a nurse who practiced in Michigan, Steve Miller, formed an

organization called Men in Nursing.

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 In 1974, Luther Christman organized a group of male nurses in Chicago.
The two groups reorganized into the National Male Nurses Association with
the primary focus of recruiting more men into nursing. In 1981, the
organization was renamed the American Assembly for Men in Nursing
(AAMN). The purpose of the AAMN is to provide a framework for nurses, as
a group, to meet to discuss and influence factors that affect men as nurses.
In 2009 and 2010, members of the AAMN discussed ways to change the image
of men in nursing in both recruitment and retention. They subsequently
introduced the theme “Do what you love and you’ll love what you do”. This
idea led to the AAMN initiative “20 × 20 Choose Nursing,” which has the goal
of increasing the enrollment of men in nursing programs nationally from the
current 10% to 20% by 2020 (Anderson, 2011).

Luther Christman (1915–2011), one of the founders of the AAMN,

graduated from the Pennsylvania Hospital School of Nursing for Men in 1939
and did experience discrimination while in nursing school. He accomplished
many firsts: the first man nominated for president of the ANA, the first man
elected to the American Academy of Nursing (he was named a “Living
Legend” by this organization), and the first man inducted into ANA’s Hall of
Fame for his extraordinary contributions.
Men comprised 9.6% of the nation’s nursing workforce in 2011 (U.S.).
Men do experience barriers to becoming nurses. For example, the nursing
image is one of femininity, and nursing has been slow to neuter this image.
As a result, many people may believe that only homosexual men enter
nursing, which is not true. Other barriers and challenges for male nursing
students include the lack of male role models in nursing and caring (e.g.,
differences in caring styles between men and women) and suspicion
surrounding intimate touch (MacWilliams, Schmidt, & Bleich, 2013). The
nursing profession and nursing education need to address these issues.
Improved recruitment and retention of men and other minorities into nursing
will strengthen the profession.