INTRODUCTION
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 also key nursing roles.
“The use of clinical judgement in the provision of care to enable people to improve, maintain, or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability, until death”.
Definition
Nursing is the promotion, and optimization of health and abilities; prevention of illness or injury; alleviation suffering through the diagnosis and treatment of human responses; and advocacy in health care for individuals, families, communities, and populations.
BEFORE THE COMMON ERA
Nursing has existed in various forms in every culture, although the definition of the term and the practice of nursing have changed greatly over time. The oldest sense of the word in the English language is found from the 14th century and referred to a woman employed to suckle and generally care a younger child. The former being known as a wet nurse and the latter being known as a dry nurse.
Prehistoric people suffered similar conditions to what are suffered today. The early humans may have taken part in the care of the sick. At the ‘home’ it was often the female relatives who would do the day-to-day care tasks and hence she ought to have been the nurse in ancient times.
Early manuscripts on nursing focus on the role of children's nursemaids and wet nurses, roles carried out exclusively by women. The sick were cared for at home. There is some evidence 3that the professions of nursing and midwifery have existed for many years in some form or other.
One of the earliest references to women as “Nurses” is to be found in the Bible (about 500 BC) and this information might have been from older sources, may be as early as 800 BC.
Further evidence suggests that midwives had a similar role to those of today, in assisting with birth.
These midwives/nurses also knew the arts of bandaging, dressing, use of oil, wine and balsam and had rules of diet and used purgatives. Not only did they care for the ill, but they performed operations, administered sleeping draughts, made artificial limbs and carried out isolation to prevent infections from spreading.
Eastern civilizations were ahead of the west in understanding and caring for health. According to Susruta, the code of surgical nursing forbids the services of a female nurse; even the sight of a female is undesirable. Emperor Asoka of northern India (around 225 BC) built 18 hospitals (and medical schools) in which older women and men nursed patients.
In Homer's Iiiad, a story written around 1,300 BC, is the first recorded women nurse: Hekamede. She was to wash away the clotted blood on the battlefield. The Greeks believed that Asklepios' two sons and six daughters were famed in the arts of healing. Still it is doubtful that women would have played an important role in caring for the sick. There were priestesses at the altars, women orderlies who directed the bath attendants and porters, and midwives; however, women were of no great account among the Greeks at this time. In the battle fields nursing was undertaken of the wounded by trained nurses who could anticipate the doctor's desire for necessary information - perhaps an early indication that nursing was led by the medical profession - and these were probably women. Hippocrates omitted any discussion of nurse training. Women midwives (omphalotomai-navel cutters) at this time were also common, but not trained and did not work with doctors.
Slave girls assisted the Roman physicians who were also slaves. As the empire grew hospitals were built, some of which could admit up to 200 patients (one hospital for every three legions). Most of the nurses would have been men called conttubernalis (tent 4companion - from the time when field hospitals were in tents). Roman soldiers were also taught first aid to enable them to nurse their comrades on the battle field.
In Coluella, a civilian hospital (valetudinarium), the Bailiffs wife was instructed to keep the valetudinarium clean, to air the wards so that the sick would find their rooms healthy, and watch over the ill. Fabiola a wealthy Roman woman devoted her life for the sick (Fig. 1.1). By the time of her death in 399, Fabiola had made nursing the sick and poor fashionable in Roman society.
At this time, in cities, towns and villages, care was not organized. There were many quacks and charlatans. Alice Shevyngon, a maidservant left her master and took to curing people with sore eye. It appears the ‘ophthalmic nursing’ was more profitable for Alice. Nursing became fashionable; but the Church insisted that the way to cure was through prayer and fasting, asking for the help of saints and belief in miracles. The new aristocratic nurses relied on divine help as did the nuns, built hospitals and worked in them as nurses. Queen Matilda, or Maud, wife of Henry I (1110) carried on the nursing tradition, founding hospital for lepers in London.
During the reformation period many ‘heretics’ were burnt as witches, including uncloistered monks and nuns, who cared for the sick. This period also saw Knight Tempellar, who were mostly warriors, look after the sick and suffering (Fig. 1.2).5
Without the nuns (expelled from their convents and aristocratic interest dwindling) the character of nursing changed. Nuns were replaced by local women and the Mother Superior by ‘Matron’ who was responsible for the ‘sister’ and to see they did their work properly. Most of these duties were domestic.
Camillus de Lellis, a priest born at Bucchianico, Abruzzi, Italy, in 1550 became the patron Saint of Nurses.
Nurses Pay
By 1700 two types of people worked in the hospitals—paid and unpaid. Pay was low, with the Matron getting cash and the nurses being paid in a variety of other ways, such as bread and beer. It is not surprising that some nurses took money from patients without considering it as being wrong.
During 1837-1901 St. Thomas Hospital paid its sisters 37 pounds per year and nurses 25. At St. George's hospital sisters were paid 21 pounds and nurses 16. Everyone got six pounds of bread a week, two pints of table beer daily and a shilling a day for board and wages. At Guy's hospital, to help prevent the nurses taking the patients' money, sisters were paid 50 pounds per year and 6nurses 30. Nurses pay was equivalent to a cotton operative and a sisters no better than an untrained teacher.
NURSING IN THE ARMED FORCES
The army nursing service began in a limited way after Crimea war (1854 - 1856) when the first female trained nurses were attached to the Army Medical school Hospitals, first at Netley then at Woolwich The service was reorganized after the Boer War (1899 - 1902) under the patronage of Queen Alexandra (wife of Edward VII) and became the Queen Alexandra Imperial Military Nursing Service. After the First World War, the royal Air Force developed its own medical service to which was attached the princess Mary Royal Air Force Nursing Service.
NURSING IN INDIA
The first nursing school in the world was started in India in about 250 BC. Only men were considered “pure” enough to become nurses. The Charaka states these men should be, “of good behaviour, distinguished for purity, possessed of cleverness and skill imbued with kindness, skilled in every service a patient may require, competent to cook food, skilled in bathing and washing the patient, rubbing and massaging the limbs”.
The Indian mutiny in India of 1857 prompted Nightingale that care of the soldiers is a must. It was for this purpose the Royal Commission was appointed in 1859. In 1868, a sanitary department was established. In March 1888, ten qualified British nurses arrived in India to look after the British Army in India. In 1905, during the British rule in India, missionary nurses arrived as members of Missionary Medical Association. This was the very start of formalized nursing service in India. Gradually, the increasing need of adequately trained nurses led to creation of South India Examining Board in 1911 and the North India Examining Board in 1912. It was the mission hospital nursing leaders who laid the foundation of systematic Nursing education in India. State-wise councils started 7developing from 1935 onwards and by 2001, 19 State-wise registration councils came into existence. Indian Nursing Council (INC) Act was passed by the Parliament in 1947. The Nursing Council upgraded the educational requirements which permitted only matriculated candidates to seek admission to the schools.
The Central Government granted an approval to the Bhore Committee's (1946) recommendations by starting two colleges of Nursing in Delhi (1946) and Vellore (1947). This provided university degree level courses. With the efforts of Professor S. Radhakrishnan (the then Chairman of University Education Commission), Nursing education in the country was integrated into the system of higher education.
TOWARDS REGISTRATION
It was in the area of mental health that the first nationally recognized qualifications came in existence. Other opposition came from hospital administrators and doctors who thought that ‘newfangled registered nurses’ would ‘eat into’ some of their livelihood.
In 1902, because of the concern about the deaths of women in childbirth, it was decided that midwives should be registered with a central board. The supporters of nurse registration saw this as an opportunity to persuade the government to set up a committee to investigate the registration of nurses. The committee agreed in principle but recommended two registers, one for those with a complete training and one for the less highly trained-a proposal implemented nearly 40 years later.
The early days were stormy with disagreements between the government and profession about the standards required for registration and which hospitals should be accepted as training hospitals.
New Zealand was the first country to regulate nurses nationally, with adoption of the Nurses Registration Act on the 12th of September, 1901. Ellen Dougherty was the first Registered Nurse. North Carolina was the first state in the United States to pass a nursing licensure law in 1903.8
FLORENCE NIGHTINGALE (Fig. 1.3)
She was the second daughter of William Edward Nightingale and Frances Smith. She was educated largely by her father. Throughout her life she read widely in many languages. On Feb 7, 1837 she believed that she had heard the voice of God informing her that she had a mission, but it was not until nine years later that she realized what the mission was.
In 1846, a friend sent Nightingale the Year Book of the Institution of Protestant Deaconesses at Kaiserswerth, Germany, which trained country girls of good character to nurse the sick. Four years later she entered the institution and went through the full course of training as a nurse. In 1853 she was appointed superintendent of the Institution for the care of Sick Gentlewomen, in London.
The Crimean war broke out in March 1854, and the British were dismayed by the disgraceful conditions suffered by sick and wounded British soldiers. Nightingale volunteered at once and left in three days for Constantinople, taking three nurses with her.
9The party left England on Oct. 21, 1854, and entered the barrack Hospital at Scutari on November 5. She changed the whole face of nursing and the battle field hospital.
After the war Nightingale returned to England. But she refused official transport home and every kind of public reception. The Indian mutiny turned Nightingale's interest to the health of the army in India, and for that purpose another royal commission was appointed in 1859. This resulted in 1868 in the establishment of a sanitary Department in the India office.
From 1857 Nightingale had lived, mainly in London, as an invalid. It has never been shown that Florence Nightingale had any organic illness; her invalidism may have been partly neurotic and partly intentional. Her sight gradually failed and in 1901 she became completely blind. In 1907 the king conferred on her the Order of Merit - the first woman ever to receive it. Florence Nightingale died in 1910.