NU PROFESSIONAL NURSING. Unit III - HISTORY OF NURSING University of Nebraska Medical Center College of Nursing Missy Ofe Fleck-Asst.

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1 NU PROFESSIONAL NURSING Unit III - HISTORY OF NURSING University of Nebraska Medical Center College of Nursing Missy Ofe Fleck-Asst. Professor I. Pre-Christianity - Early History (? AD) A. Prehistoric - religion important; superstition; witchcraft, medicine man. B. 30 BC AD 1. Isolated areas of progress (a) Egypt - discovery of the relationship of dirty conditions to disease (b) Greece - Hippocrates (c) Jewish Culture - importance of cleanliness (d) Babylonia - primitive health care (e) Chinese Medicine - yin and yang balance II. Middle Ages (500 AD- 1500) A. Influences of religion B. Protestant revolution III. Renaissance ( ) A. Reformation - Catholic countries - not much change; Protestant countries arose; religious orders closed; Dark Ages for Nursing B. Men disappeared from nursing C. No formal nursing education IV. Age of Enlightenment ( ) A. Industrial revolution B. Education emphasized C. Sisters of Charity D. American Revolution V. 1800's A. Health problems - yellow fever, typhoid, T.B. B. Health developments - improved diagnosis, anesthesia, x-ray, principles of asepsis C. Nursing practice - period of Florence Nightingale D. Wars 1. Civil War (1861) - volunteer nursing, American Red Cross; birth of the nursing profession in America 2. Spanish/American War - nurses eventually in demand

2 NU E. Nursing Education 1. Influence of Nightingale 2. Schools - students provide cheap labor ( pupil nurses ); higher admission standards; increase in number (4 in 1800 to 1,400 in 1900); no independent financial base; first school for black nurses opens. F. Nursing Organizations Visiting Nurse Societies lead by Lillian Wald; Community Health Nursing - Henry Street Settlement in American Society of Superintendents of Training Schools for Nurses (NLN); Legal Registration = Higher Educational Standards (lead by Lavinia Dock). VI A. Military Nursing 1. Army Nurse Corp established in WWI ( ) (a) Shortage of trained nurses (b) Army School of Nursing established in 1918 (c) Influenza epidemic ( ) B. Social Conditions th Amendment to U.S. Constitution (1919) 2. Depression ( ) - no job for graduate nurses 3. WPA (1935) provides funds for hospitals without schools of nursing. 4. Immigration 5. WWII ( ) (a) Shortage of nurses (b) Army - Navy Act gave officer status (c) Medical advances - MASH, drug development, quicker ambulation (d) GI Bill expanded to cover nurses (e) African-Americans and men admitted/employed C. Nursing Practice 1. Laws passed requiring licensure for practice. 2. Labor Unions (1920's 's) better job benefits. 3. Professional organizations - ANA, NLN 4. Public Health Nursing; Private Nursing Duty; Frontier Nursing Service D. Studies 1. Goldmark Report Committee on Grading Nursing Schools (Nursing Schools Today and Tomorrow) (a) Lanham Act of 1941 (b) Nurse Training Act of Brown Report 1948

3 NU E. Nursing Education 1. Focus was on technical skills. 2. Nurse s training programs financially drained hospitals. 3. First university to offer nursing education-university of Minnesota No uniform standards for curriculum; first NLN accredited school focused on setting some standards for nursing. VII Present A. Health Care Advances 1. Medical advances 2. More community health centers especially for impoverished groups 3. Increased public awareness 4. Increased government involvement (HIPAA in 2003) 5. Hospitals increase in number and services 50-70's then decrease in 80's; increase in specialty clinics/hospitals in 90's & 2000's; home based services in 90's 6. Economic crisis in 90's - increased political involvement; universal health care - health promotion/disease prevention; 9-11 incident with the World Trade Centers caused another economic crisis 7. In FY 2003, health care consumed 15.3% of the GNP ($1.7 trillion) to provide health care to over 250 million people; this is the second leading governmental expense B. Wars (Korean, Vietnam, Desert Storm, & Wars on Iraq & Afghanistan) 1. Development of ICU s 2. Increased expertise and knowledge of nurses 3. Threat of biological and chemical warfare in late 90's & 2000's C. Practice 1. Shortage of nurses in 50's and 60's; lessened in late 70's; returned in late 80's; areas of nursing shortages in the 90's. Most hospitals in 2004 average a 13% nurse vacancy rate (about 126,000 vacancies nationwide). Projected shortage of 800,000 nurses nationwide by the year (a) Women s movement - variety of professions and jobs, th anniversary of the 19 th amendment, U.N. World Beijing (b) Nurses return to work place (c) Men enter profession as well as culturally diverse individuals (d) Nurses expand responsibilities (e) Shortage of nurses

4 NU Increased opportunities for nurses in expanded roles. 3. More nurses involved in politics; presidential endorsement by ANA; ANA denounces proposed medicaid/medicare cuts; nurses becoming senators 4. Cost-containment measures, managed care; capitation (a) Patient Safety Act of 1997 (b) Average length of hospital stay (LOS) in 1985 was 7.1 days. In 2004, the average LOS is 4.5 hours! 5. Violence in epidemic proportions - 1 million violent crimes/year in the workplace; for nursing, the ER sees workplace violence. 6. APN s as legitimate providers of health care, barriers include state laws and the AMA R/T scope of practice, reimbursement and prescriptive authority (a) Effective 1/1/98, Clinton signed bill allowing direct reimbursement of NP s/cns s in all geographic/practice settings. 7. Hospitals/institutions offering sign-on bonuses (AKA loan forgiveness) 8. Disaster concerns since 1993 World Trade Center bombing and the 1995 Oklahoma City bombing; Bioterrorism threats, especially smallpox, since ; nurses must be knowledgeable and prepared to provide prompt, quality care to clients and help prevent further contamination or exposure to the disease (Bioterrorism/Disaster Readiness Plans). Endemic disease concerns as well (SARS). D. Research 1. More studies, research journals and money for grants 2. Research leads to theory development of nursing E. Studies/Documents 1. Toward Quality of Nursing Recommended a national investigation of nursing education that would place emphasis on the criteria for high quality patient care. Surgeon General report that projected the need for more and better prepared nurses. 2. Lysaught Report National Commission for the Study of Nursing and Nursing Education (NCSNNE). Focused on supply and demand for nurses, nursing roles and functions, nursing education, and nursing as a career and how these relate to the social system that provides care to the public. 3. Nursing: A Social Policy Statement Described the social responsibility and roles of the nurse in the American health care system.

5 4. National Commission on Nursing Focused on outdated image of nursing, confusion in types of educational preparation, interface of nursing education and practice, nurses professional relationships with other health team members, effective management of nursing resources and the maturing of nursing as a self-determining profession. Development of masters/doctoral programs for nurses. 5. Nursing s Agenda for Health Care Reform Submitted by nurses; focused on restructuring the health care system, decreasing costs, increasing accessibility and promoting quality of care. 6. Nursing s Social Policy Statement Presents clinical nursing practice as it evolved according to society s health needs; underscores ANA s affirmation of the BSN preferred educational trajectory. F. Nursing Education 1. NLN and AACN become accrediting units for schools/colleges of nursing. 2. ANA endorses BSN education Position Paper. 3. Demand for nurses in 50's and 60's, and 2000's - AD programs. 4. Diploma programs from 82% to 28% of nursing programs. 5. BSN programs increase (including RN to BSN, BSN to PhD, & accelerated BSN programs). 6. Masters and doctorate programs expanded; Federal funding steadily falls. 7. Nursing colleges in 2000 lack space, faculty, and funding; U.S. nursing schools turned away 6,000 qualified applicants in the year FY 2002-Nurse Reinvestment Act-expands scholarships for student nurses, offers grants for nursing schools, and includes loan-forgiveness programs for nurses who work in disadvantaged areas or who earn advanced degrees. 9. FY 2005 (Oct. 2004) ANA supporting a $63 million increase for all Health Resources and Services Administration (HRSA) programs, including the Nurse Reinvestment Act. 10. FY 2006-House of Representatives asking for $24 million (16% increase) in funding for nursing workforce development programs. G. Nursing Image 1. Public and professional media; 60% of health care services in 2004 is provided by nursing. 2. High touch vs. high tech 3. Graying of American nurses-average age of a practicing RN in 2003 was 43 years old; average faculty RN is 52 years old. 4. Do nursing demographics parallel the effects of globalization? Are nurses delivering culturally competent care? 5. Mandatory overtime concerns what are those issues? 6. Short staffing would you send a loved one to the hospital without staying with them? There is a direct correlation with adequate staffing/ratio patterns and positive patient outcomes! California is currently the only state to have a staff-ratio law (1:4/5).