HISTORY OF DEVELOPMENT OF NURSING PROFESSION

INTRODUCTION
The word `history means a chronological record or account of past events and development. It is to understand the changes that occurred in terms of religion, economy and politics in the various cultures of the world through the ages and how these changes influenced nursing and brought it to the present day status of a profession. Nursing is an art and a science. The nursing profession like other careers has undergone many changes. So I would like to go in detail regarding the historical development in nursing profession.

DEFINITION OF NURSING
According to ICN (International Council Of Nurses), Nursing is the unique function of a nurse that is to assist the individual ,sick or well in the performance of those activities contributing to health or its recovery(or to a peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge.

THE GENESIS OF NURSING

Ancient history reveals no records of nursing in pre-historic times. What we know is by the findings of Archaeologists. Pre-historic man lived close to the nature and soon associated spiritual values to all natural objects, believing that thing like tree or river had a spirit or soul. Such a religion is known as Animism. According to them sickness comes due to following causes: y y y y Black magic Sorcery Breaking a taboo Bodily invasion of evil spirit

To get rid of these, the body had to be made unpleasant for them by starving, beating and nauseous medicines. The medicine man was one who paid close attention to signs and symptoms and thus knew what to do in some conditions. His influence increased, he took up the role of priest, and he was known as priest-physician. Contribution of primitive man towards nursing: Massage Fomentations Trephining Bone setting Amputation Hot and cold baths
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Abdominal sections Heat to control haemorrhage

INFLUENCE OF ANCIENT CULTURAL PRACTICES ON HEALTH CARE

After pre-historic period, writing was invented. Archaeological findings and Bible presentations help us to study the contributions of the ancient cultures. SUMERIANS When the Sumerians moved into the land between the River Tigris and Euphrates, they had developed a system of writing, a set of laws and advanced culture. They worshipped evil spirits as Gods and built temples to them hoping to please them so that disease and misfortune would be eradicated. The Medicine man became the Priest-physician who stayed in the temple. BABYLONIANS (Present IRAQ) 4000 to 3000 B.C They worshipped Bel or Marduk, who was identified with the planet Jupiter. Bel was a cruel God who frequently craved for human blood in return for his favour. Hammurabi, the king of Babylonia, developed a Code of laws. He tried to prevent the sufferings of the helpless and to reduce the cost of the medical care. Doctors were severely punished for their wrong treatments. They believed that illnesses were caused by sin and anger from God. Temples became centers for medical care. An animal was kept near the sick person so that the devil could enter into it, then the animal was dissected to study the liver. Contributions towards medicine: -Many clay models are found to describe liver, gallbladder etc. - Team approach was used. It consists of priest physician, nurse, pharmacist. PERSIANS (PERSIA- Present IRAN) Persians were a group of Iranian tribes. Cyrus the great was the leader of Persians. Zoroaster was religions head. His teaching Zoroastrianism is still practiced in Iran and India by Parsees who are descendants of Iranis of Persia. They believed in the theory of evil spirit of diseases and practiced spiritual assistance to cure illness. Their Holy book, the Avesta contained the ceremonial rules relating to the natural laws of birth and death and also stressed the principles of public health and sanitation. They played music in order to cure illness. After a person`s death his body was fastened to the roof of a special high tower called `Tower of Silence. Birds picked the flesh and bones dropped into the pit below. They had 3 types of practitioners:
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i. ii. iii.

Those who treat with knife and heal were called surgeons. Those who treat with herbs and heal were called physicians. Those who treat with prayer and holy words and heal were called Dasture who were very popular.

Women enjoyed equal rights and freedom in education, status and property rights. ANCIENT EGYPT The oldest medical records are from Egypt. Records regarding diseases, drugs, surgery were preserved in papyrus paper. The early Egyptians believed in life after death, thus they developed the art of embalming and bandaging the body to preserve it. Such an embalmed body is known as mummy. Women in Egypt had no career but had some freedom. The mother had a position of authority. Women of high rank became priestesses in the temples and some of them assisted the priest-physician in caring for the sick. Medical laws became fixed codes and stated what a doctor could or could not do. Their religion forbids dissection and hence research could not be carried on and medicine as a science declined. ANCIENT HEBREWS The best resource book on the history of the Hebrews is the Old Testament of the Bible. They believed in one true God. Moses was one of the divinely motivated servant of God. Many rules and regulations in regard to social and religious custom and health and sanitary practices are compiled into Mosaic Code. It include principles of personal hygiene related to Isolation, hygiene, rest & sleep, hours of work, disposal of excreta, disinfection, regulations to check animals before slaughtering/ eating. Priest-physician took the role of health inspector. Houses of Hospitality, the fore runners of inns, hotels, hospitals were plentiful. Visiting and caring for the sick was a religious duty. A nurse`s role included midwifery. ANCIENT AMERICANS Archaeological findings had revealed different highly developed cultures of Ancient America. There were different tribes or civilization such as Mayas and Aztecs, Incas. The priest- physicians were medical advisors and pharmacists. Contributions towards medicine: They used all the ancient system of treating patients such as bloodletting, sweating, amputation, splinting, setting of bones, poultice, trephining and bandaging.

ANCIENT CHINESE In China, medicine and surgery were practiced long before the Christian era. They were allowed to practice dissection and so had good descriptions of internal organs and blood circulations. Their slogan was Look, Listen, Ask and Feel and it was the rule for physical examinations. They believed in certain superstition such as certain diseases due to evil spirit for which they used bloodletting treatment. Women had no freedom. Old women were respected. Contributions towards medicine: They used vegetable and animal drugs, vaccination, physiotherapy, treated syphilis and gonorrhoea. Baths to reduce fever, liver diet for anemia, seaweed for thyroid disorders. Acupuncture and Acupressure was popular and now it is practiced all over the world. INDIANS The earliest records of Indian medicine are to be found in the sacred books or Vedas. The Ajur-Veda is thought to have been given by Brahma and it is divided into a number of parts, which deals with prevention and cure of diseases in medicine, surgery, children`s diseases etc. Sushruta known as the Father of Surgery in India wrote one book in surgery. Charaka wrote one on Internal medicine. Evidences from this books shows that doctors and attendants (nurses) were people of high moral character and hospitals were large and well equipped. King Ashoka (272 B.C.-236 B.C) built public hospitals with male nurses and some older women, hospitals for animals and universities (monasteries) of Taxila & Nalanda (Bihar). Prevention of disease became a matter of first importance and hygienic practices were adopted. By 1 A.D. superstition and magic had been somewhat replaced by more up-to-date practice. But, medicine remained in the hands of the priest-physicians who refused to touch blood or pathological tissue. About 1000 A.D. as the Brahmin influence gained strength and re-established itself, Buddhism declined. The rigid Hindu caste system flourished. On religious grounds, any kind of physical contact with the non-caste people and mlecha was considered contamination to Brahmins who were also the priest-physician. Dissection was forbidden. Superstition and magic, thus replaced the up-to-date practice of medicine. In 2000 A.D. Mohammadans invaded India. This accelerated the process of decline of medicine. ANCIENT GREEKS The early Greeks believed medicine was of divine origin and was represented by many gods.
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Apollo (son of God) God of health

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o o o

Aesculapius (son of Apollo) God of healing Epigone (Aesculapius`s wife) The soother Hygeia (daughter of Apollo) Goddess of health

Temples were built for these gods. Priest-physician was in charge. People came here not only to worship the God but the sick came for treatment and cure. The unclean such as the dying and obstetrical patients were not allowed to come in or to remain in the temple grounds. After 170 A.D. special buildings were erected for these patients. These were regarded as the first European hospitals. Hippocrates is known as the Father of medicine. Contribution of Hippocrates He taught that doctors should observe their patients and then come to a conclusion as to the cause. He taught that treatment should be based on the diagnosis. He developed the ways of doing physical examinations and of taking their history He stressed on equilibrium of body, mind & environment. He stressed fresh air, cleanliness and good diet for health. His writings gave instructions about hot applications, poultices, cold sponging for fever, fluids for kidney diseases and mouthwashes. He suggested the use of music and work to occupy the attention of mental patients. The caduceus, symbol of medical profession is one of the gifts from the Greeks. It composed of the staff of the traveler, entwined with serpents signifying rejuvenated knowledge and wisdom and at the apex of the staff are two wings of Mercury for speed.

THE CADUCEUS ANCIENT ROMANS Medical advances are borrowed from Greece after they conquered it. They made drainage systems, drinking water aqueducts, public baths for men and women and public dispensaries. The early hospitals were made for soldiers and slaves. Old women & men of good character did the nursing.
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THE IRISH CELTS They developed several medical laws and practiced moist heat in their treatment and believed in attending to the `peace of mind` of their patients. The practice of medicine was regulated by Brehon laws, according to which every physician in Ireland was to keep one door of his house open at all times, so that the sick and the injured might be brought in. The physician was required to refund the fees if he failed to heal a patient. The status of a woman was high and she was treated with reverence.

EFFECTS OF SPIRITUAL DEVELOPMENT OF NURSING

EARLY MIDDLE AGE (500-1000 A.D.)

AND

SOCIAL

FORCES

ON

THE

The era begins with the fall of the mighty Roman Empire and it is called the dark ages in history. Barbaric tribes invaded Rome and the entire infrastructure were destroyed by them, thus leaving many homeless. According to the felt needs 3 protective units developed: y y y MONASTICISM During the dark ages many of the monks and nuns proved themselves to be good organizers and administrators .One outstanding monk St. Benedict of Nursia. The Benedictine Rule was developed to meet their needs. I became one of the most active organizations for social work. As the monastries became wealthier they gained more freedom and political power. When they were criticized they made their rules stricter and thus many lose interest. As a result, between the 9th and 10th centuries the monasteries went into decline. FEUDALISM Following the fall of Rome, much of the agricultural land was controlled by a class of gentle farmers. The homeless turned to these landlords for protection. Thus an ancient system known as feudalism, but modified by Christian ideals, came into existence along with monasticism. GUILDS This was the first organisation of workmen and tradesmen who were not attached to monastic or feudal groups. They received protection, social insurance, sickness insurance etc. Monasticism Feudalism Guilds

The guild methods have been followed in nursing and medical teachings. This form of guilds served as foundation for modern labour unions in an organized manner. LATE MIDDLE AGES (1000- 1500A.D.) CRUSADES The Crusades were a series of wars between Christians and Muslims for control of the Holy Land. (Palestine, Israel, Lebanon, Syria, etc.) Influence of crusades in nursing: -In 1244- there are approximately 19,000 hospital in Western Europe -There is spread of leprosy -Thousand years after Jesus Christ there was no attempt to organized nursing. Three (3) Types of Organization 1.Military 2.Religious 3. Secular MILITARY NURSING ORDERS Knight Hospitalers are the men who went to battle and then retired to nurse the sick. Knight of St. John are also known as Knights Hospitaller, a Christian organization that began as an Amalfitan hospital founded in Jerusalem in 1080 to provide care for poor, sick or injured pilgrims to the Holy Land. After the Western Christian conquest of Jerusalem in 1099 during the First Crusade it became a religious/military order under its own charter, and was charged with the care and defense of the Holy Land. Two patron saints of nurses stem from this period. St. John of God and St. Camillus de Lellis both started out as soldiers, and later turned to nursing. St Camillus started the sign of the redcross which is still used today, and developed the first ambulance service. The Order of St. Lazarus of Jerusalem originated in a leper hospital run by hospitaller brothers, founded in the twelfth century by the crusaders of the Latin Kingdom. It was originally established to treat virulent diseases such as leprosy. RELIGIOUS ORDER Institutions were managed by the clergy and throughout the dark and middle ages the hospital and nursing systems were connected with religious bodies. Nurses were provided by the male and female monastic orders. Names of the oldest foundations which still survive, such as the Hotel Dieu in Paris, St Thomas's and St.Bartholomew's in London, the order of St Augustine, and (in the form of a modern revival) that of St John of Jerusalem, sufficiently indicate the original religious connexion. Nurses wore regular clothes no uniform .Care of the sick- done by volunteers like St. Catherine of Sienna, her lamp represented the sick at Sienna.

SECULAR ORDER The Third Order of Saint Francis (Francis of Assisi) was a secular order whose members devoted their time and energy to enhancing the lives of their friends and neighbours in the communities where they lived. Caring for the sick was one of the order's important activities, with both men and women serving as nurses. There were many Catholic orders caring for the sick during the Middle Ages. Even the secular orders were associated with the Church. Educated by apprenticeship, lacking knowledge of hygienic measures, and practicing under very primitive conditions, the care provided was, none the less, humane and caring.

RESPONSE OF NURSING TO THE NEEDS OF SOCIETY

RENAISSANCE Interests in arts and science emerged, rise of progress in arts & culture but not in moral & religious values. Geographical explorations done by Europeans. Bubonic Plague epidemic killed 25 to 50% Europe`s population. The society was filled with thieves due to social deprivations. Care of the sick was entrusted to those who were proven guilty of a crime or theft. Caretakers were not given humane facilities like food & quarters, so all the more they got buried into evil deeds like stealing the patient`s foods, accepting bribe. Need for care of sick and poor escalated. Hospitals were for the weak, aged, contagious disease, physically and mentally ill. A fee was charged for the hospitalizations, etc. INDUSTRIAL REVOLUTION The growing pains of the Reformation, forced thinkers and philosophers to reevaluate their ideas and values. During the four hundred years the living was nearly unbearable, some scholars, reformers and inventors were paving the way for a new world order. It arrived with the onset of the Industrial Revolution. This was a time of free thought, individualism, and the beginning of capitalism and democratic forms of government. The Industrial Revolution gradually brought forth a more equitable living style for the people. However, it was not without its own growing pains. Capitalists were protected by law in his exploitation of workers. There were child labor and sweet shops where disease and accidents were the norm. Mother Mary Catherine Mc Auley, founded the Sisters of Mercy, religious order emphasizing in nursing the poor and sick. Emancipation of women-fight for human right was a step in developing nursing into a profession. Proliferation of factories with introduction of technology. In France, they practiced: - barbers functioned as surgeons. -Leeching, giving enemas and tooth extraction -women make beds, scrubs floors and bathe the poor in alms houses.
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-factory workers endured long hours of work. -Medical schools were founded Royal College of Surgeon in London (1800). -End of 18th Century- no standards for nurses working in the hospitals. THE REFORMATION The religious upheaval led by Martin Luther destroyed the unity of Christian faith. The wrath of Protestantism swept away everything connected with Roman Catholicism in schools, orphanages and hospitals. Properties of hospitals and schools were confiscated. Nurses fled for their lives. In England, hundreds of hospitals were closed. There were no provisions for the sick, no one to care for the sick. Nursing became the work of the least desirable of women who took bribes from patients, stole the patient`s food and used alcohol as a tranquilizer. They worked seven days a week, slept in cubbyhole near the hospital ward or patient and ate scraps of food when they could find them. Nursing sank to its lowest level .Medical instruction continued along primitive lines. POLITICAL REVOLUTIONS The ambitions of the Kings led to war and the spirit of national competition. The poverty which followed the wars brought a discontentment that flared up in a series of equally great revolutions: The American Revolution (1775-1783) The French Revolution (1789-1795) The Latin American Revolution (1800-1825)

These revolutions changed the attitude of people towards human inequality. They began to think in terms of equality and rights of individuals.

HUMANITARIANS
St.Vincent de Paul (1576-1660): He became the outstanding philanthropist of his time. His work set the pattern for modern social work. To prevent begging he built municipal lodging houses, started trade schools, and formed colonies where these people could learn to support themselves. John Howard (1727-1789): He had an experience, as a prisoner of war, in a prison in France. After his release he set out to see other jails and submitted reports regarding the condition of jails to the rulers. As a result he witnessed many changes in the condition of the jails. Elizabeth Fry (1780-1845): She was responsible for bringing about changes so that better care could be given to women and children in Newgate prison in London. In 1840 with the help of her sister and daughter, she succeeded in organizing the
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`Protestant Sisters of Charity`, a group of women who did hospital visiting. Later the name changed to Protestant Nursing Sisters. Dorothea Lynde Dix (1802 - 1887): She was an American activist on behalf of the indigent insane who, through a vigorous program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums. During the Civil War, she served as Superintendent of Army Nurses. IMAGE OF NURSING The image of nursing has been and continues to be colorfully presented and distorted in all forms of expression in the society. HISTORICAL DEVELOPMENT OF NURSING`S IMAGE Credit is given to Florence Nightingale for the written history and development of modern nursing. The image of nursing may also have its roots in the Victorian Age during which she lived. At that time men were the laborers and the bread winners and almost all women were socialized into becoming wives, mothers and housekeepers. Nursing was perceived as women`s work a natural extension of all of the altruistic qualities valued in women. In the hospital setting nurses were recognized as physical extenders. Unlike today, physicians by the late 1800s were exclusively males and nurses were females. The expectations of nurses were altruism, sacrifice and submission. These expectations were not just encouraged but were demanded. The usual image of Florence Nightingale is of a self sacrificing young woman with no desire or need for money, rest or recognition. Even today the image of Florence Nightingale as the Lady with the lamp remains perhaps the most popular public image of the founder of modern nursing. Linkage between Mass Media and Nursing Image: Extensive research on the image of the nursing profession has been done by Kalisch and Kalisch. They identify six periods during which distinct corresponding images of the nursing profession can be seen.Because of its pervading influence, emphasis will be placed on the effect that mass media had on the image of nursing during these periods. Period 1: ANGEL OF NURSING (1854-1919) In the pioneer days of nursing there were two prominent images of nurses. One image, in a novel by Charles Dickens, was Sairy Gamp, the poorly educated alcoholic nurse who worked in primitive conditions primarily performing domestic chores. The second prevailing image was Florence Nightingale, the original Angel of Mercy. In the early 1900s nurses were viewed as honorable, moral, spiritual, self sacrificing and ritualistic. In First World War media representations continued the Angel of Mercy image, idealizing nurses and making them a totem of exemplary moral purity. During the Angel of Mercy era, nurses appeared in a substantial number of literary endeavors. Nurse heroines were characterized as being involved in a dual search.  Success and meaning through nursing.
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 Happiness and fulfillment through love and marriage. This dichotomous representation often resulted in a mixed image from 1916 to 1918, the nursing profession received its greatest attention in the propaganda films of First World War. Nurse were consistently cast as Red Cross nurses and represented as almost mythical womanhood. Films were generated from Hollywood emphasized nursing as it was during the war. The war provided an improvement of the profession`s image in novels. Period 2: GIRL FRIDAY (1920-1929) With the passage of the Women`s suffrage reform in 1919, women entered a new domain of professional endeavors and activities. The invention and use of aircraft in war, as well as chemical warfare, resulted in new problems in the health field. The influenza epidemic also increased the importance of instructing nurses in the area of home nursing. Nurses were described as faithful, dependent, co-operative, long suffering and subservient. Their careers culminate in marriage, which represented a woman`s only legitimate destiny. This attitude was conveyed in the enterprises of Hollywood in which nursing was depicted as a conscientious and admirable job choice, but accepted only until time for marriage. In films of this era nurse heroines were not cast as career nurses. Nursing was simply a means to an end. Period 3: HEROINE (1930-1945) For the next 15 years, nursing was acknowledged as a worthy and important profession that enabled women to earn an honorable living. Nurses were identified as educated and owning certain abilities. Adjectives such as courageous, chivalrous, fearless, reasonable, clear headed, humanitarian and magnanimous were used to illustrate and portray nurses. Period 4: MOTHER (1946-1965) It may have been a natural development after Second World War that a major goal of many American women was to stay home and care for children. Nurses during this period were chronicled as maternal compassionate, unassertive, submissive and domestic. During the 1950s television programs usually portrayed nurses as worthy of respect and appreciated for their skills. They were depicted in roles subordinate to physicians and employed in positions that they would easily surrender for marriage or children. Work as a nurse was often seen as a means to obtain amenities such as vacations or luxuries for the home and family. Period 5: SEX OBJECT (1966-1982) After 1966, the mother image of the nurse, which was popular in the mid 1940`s changed to the sex object image. Nurses were increasingly depicted as being sexually promiscuous, self-indulgent, superficial and unreliable. Nurses became sexual mascots for health care teams and were seen in X-rated movies. Eventually nurses were portrayed as cold, uncaring, power hungry and unmotivated persons and the once honored and virtuous film image of the nurse was a thing of the past. During this decade, nurse figures were cast primarily in series that accentuated the medical model and made physicians seem almost superhuman. In films of these years, nurses were undervalued and poorly represented. Their contributions to health care were not addressed.
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The 1970`s represent the lowest point in film history for the nursing profession. Certainly nurses were not portrayed as altruistic, intelligent and virtuous. Instead a new nurse characterization appeared- that of the malevolent and sadistic personally. The mass media of the 1980`s did not improve the image of the profession. Movies such as Terms of Endearment endorse the image of the cold-hearted, punitive, sadistic nurse who derives pleasure from client suffering. Period 6: CAREERIST (1983-Present) The careerist has become the new image for the mid 1980`s and 1990`s portraying nurses as intelligent, logical, progressive, sophisticated, empathetic and assertive. Men and women in the nursing profession are dedicated to providing the highest standards of health care at the greatest expanse of excellence to the consumer. The factor contributing to the enhanced image of nursing in the careerist period is the collaborative practice that has encouraged nurses and physicians to practice in tandem for the quality of care for all, with nurses being recognizes as the pivotal provider for entry into the health care system. The ultimate image of nursing as we approach the millennium, is for nursing is to: Touch the hearts of the homeless and abandoned by working for change in the policy of local health agencies.  Enhance the minimum level of education for all nurses by involving in collaboration with community business and political and social endeavors.  Expand the involvement of political integration by visualizing total health care as the responsibility of the entire community.  Enlighten the public through all forms of media of the positive dynamics of nursing by showcasing personal stories as shared by clients. NURSES OR NURSINGS IMAGE OF ITSELF The individual nurse`s attitudes, behaviors and interactions constitute nursing`s self image.

Self Image Psychology

In addition to her contribution to nursing theory, the late Martha Rogers (1914-1994) made a major contribution of nursing through her presentation of nursing through her presentation of principles regarding self image psychology. These principles focus on the self concept of the individual nurse. Tracy explored specific principles of the self concept model and the two basic principles are as follows;1. The law of belief: - This major principle of the model declares that whatever an individual strongly believes is actualized. This principle is commonly known as the `self fulfilling prophecy. Everything an individual subconsciously believes becomes reality. 2. The responsibility/ achievement relationship: - This model states that an individual experiences a confident self-concept, the attitude of being in control and achievement in equal proportions to the willingness and ability of that individual to take responsibility for her or his own life without blaming external factors.
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PROFESSIONAL PRIDE:Nurses frequently become trapped in one particular image. They may believe that to be a `real nurse one must work I a hospital providing direct client care and that when one moves away from the bedside or the hospital setting, status as a `real nurse is lost. Nurses must begin to educate members of the profession, the public and nursing students that `real nurses are involved in a variety of interesting and valuable professional activities in many diverse settings. The belief that is acceptable not to be at the bedside must be generated, discussed, encouraged and disseminated. Real nurse also work in jails, homes, clinics, hospice, settings, colleges, industries, private business, reservations and in rural and urban area. Nurses participate in all areas of life. MEN AND THE IMAGE OF NURSING:In the field of nursing, male nurses are often considered social misfits unable to fit into a real man`s job. But when reviewing nursing history, one finds repeated documentation that men were the first nurses to experience large-scale conventional education in western civilization. Until the late nineteenth century, nursing was considered as much a male profession as a female one. Several circumstances led to the decline and near extinction of men in nursing. Ironically Florence Nightingale was partly responsible because she consciously defined nursing as female. She worked hard to establish nursing as a worthy career for respectable women and largely ignored the historical contributions of men. The Industrial Revolution is also responsible for the lingering gender-specific stereotypes that exist within nursing today. Science, technology and business became the accepted standards for aspiring men in the nineteenth century. Men choose medicine and women choose nursing. As previously mentioned, a reason often cited for the continued voluntary exclusion of men from nursing, is the image of profession as feminine and nurturing. This image creates difficulty for some men who might otherwise be attracted to the field. During the 1990`s however the increase in pay and prestige has influenced the public`s attitude shift concerning men in nursing. Today more than 40% of both men and women would approve of nursing as a career choice for their sons. STRATEGIES FOR IMPROVING THE IMAGE OF NURSING IN THE 1990`s

The strategies for improving the image of nursing in the 1990`s are as follows:1. Collective Bargaining:It is the process by which unions participate in administrative divisions involving the terms of employment and the price of labor. Most nurses seek improvements in salaries, hours and overall working conditions. Thus collective bargaining for a time became an attractive possibility as a positive and powerful organizational tool.

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2. Computer Technology:The image of nursing can be influenced by the increase in computer technology. Documentation, care planning, quality management, committee work and administrative records can be computerized. Nurses save time by accessing a computerized system. 3. Elimination of Internal Sexism:It is suggested that increasing the number of male nurses will make the profession a different one.The nursing profession and practice will also take on an improved public image by having more balance between men and women. 4. Development of Internal Media Committees:Internal media, in the form of catalogs, brochures, newsletters, annual reports, advertisements, films and educational materials are important to any health care institutions relations but should be viewed as having equal importance to the image of nursing. It is suggested that the health care facilities should have an internal media committees and actively review all materials, paying special attention to the effect these materials have on the image of nursing. 5. External Media Committees:The mass medias have the most pervasive influences on the public attitudes and opinions in contemporary life. Numerous nurses and group of nurses suggest that external nursing media committees be organized within every hospital, every school of nursing and at each level of every nursing organization. These media watch groups must take responsibility for monitoring the media for all references to nursing. The groups must respond to the media for positive and negative referrals to nursing. It should be their responsibility to write letters to producers, television networks and advertisers. 6. Education:One area that has done little to verify the profession relates to educational levels. Entry into practice is remarkably controversial and divisive both inside and outside the profession. There are many educational differences among nurses, it is confusing for the public and often for future nurses themselves. 7. The 7 C s of Image Building:The foundation of nursing, its strategy for image building and its version for the future can be portrayed in the following seven Cs:  Compassionate- Caring with one`s whole being for another being.  Committed- Giving of one`s self for the total journey.  Collaborative- Being open to share the responsibility, the rewards and the criticism.  Creative- Stepping out beyond the limits for the belief of what can be.  Change agent- Willing to risk for opportunity and learn through trial and error.  Competent- Achieving the most with the least, relying on the knowledge of and belief in who you are.  Collegiality- Sharing the responsibility among the colleagues.
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8. Marketing:As the nursing profession works to upgrade its image, marketing strategies are important. It is crucial that nursing services, nursing programs and the nursing profession be strategically marketed to a wide range of audiences to promote nursing excellence and to project an achievement oriented, professional image of nursing. Stanton and Stanton suggest that the following important areas are critical wonder to market nursing as a positive, powerful profession: Marketing of a more positive image. Marketing of the profession as a collective group. Marketing of nursings unique role in health care delivery. Marketing of the profession in general to attract qualified candidates and to retain existing professionals. Educating entry-level professionals to marketing strategies. Successful marketing of nursing products and services that have been used, tested and evaluated. Through research and education, evaluating marketing trends in relation to their effect on nursing 9. Dress for Success:In the business world there are dresses for success. To be successful in business, one plays by the rules. Dress is a powerful form of self expression. Regardless of how talented or how technically knowledgeable one is, professional image and credibility can be either strengthened or sabotaged by the image one projects to others. NURSES RESPONSIBILITIES FOR IMPROVING ITS OWN IMAGE a) Recognize that an image problem does exist and that each individual nurse has a responsibility to improve the profession`s image. b) Strengthen involvement in professional organization, collectively nursing is extremely powerful. c) Provide all nurses including staff nurses to become salaried staff members rather than hourly wage earners. d) Become politically active and knowledgeable. e) Write and submit feature, stories on nurses for local media. f) Demand that nurse authors be considered for editing health columns. g) Provide technical assistance to the media. h) Create public forums-spend a day with a nurse. i) Have nurse`s present educational talks at local shopping malls, public education series. j) Improve the community image, Volunteer for community sponsored activities. k) Revise and update nursing career literature, especially books in schools and public libraries that introduce the profession to prospective nurses. l) Establish schools of nursing as research and information centres for people experiencing critical health care issues eg. AIDS, homelessness. m) Be self confident, it will command respect. n) Be positive.
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o) Share the positive aspects of the nursing profession with others. p) Learn to describe nursing responsibilities in clear, non technical terms. q) Continue to develop alternative nursing education programs designed for adult learner nurses to advance their education. r) Increase visibility.

MODERN NURSING
Progress in medicine and science during the past three centuries has increased the interested for better nursing service and nursing training. New scientific facts were discovered and many new precision instruments such as the stethoscope, microscope and thermometer came into use. In order to keep up with the many changes it was necessary to increase the educational facilities for students of medicine. Likewise a new type of nurse who was trained in the art of carrying out these techniques was required. The person who responded to this call was one of those rare and gifted persons named Florence Nightingale. FLORENCE NIGHTINGALE (12 MAY 1820 - 13 AUGUST 1910) She came to be known as "The Lady with the Lamp", was a pioneer of modern nursing, a writer and a noted statistician. She was born into a rich, upper-class well-connected British family at the Villa Colombaia, Florence, Grand Duchy of Tuscany, and was named after the city of her birth. Florence's older sister was named Parthenope. Her parents were William Edward Nightingale (1794-1875) and Frances Nightingale ne Smith (1789-1880). William Nightingale was born William Edward Shore. Fanny's father (Florence's maternal grandfather) was the abolitionist William Smith. Inspired by what she took as a Christian divine calling, experienced first in 1837 at Embley Park and later throughout Florence's life, she committed herself to nursing (though discouraged by her parents). This demonstrated a passion on her part, and also a rebellion against the expected role for a woman of her status, which was to become a wife and mother. In those days, nursing was a career with a poor reputation, filled mostly by poorer women. Florence Nightingale's most famous contribution came during the Crimean War, which became her central focus when reports began to filter back to Britain about the horrific conditions for the wounded. By 1859, she set up the Nightingale Training School at St. Thomas 'Hospital on 9 July 1860. The first trained Nightingale nurses began work on 16 May 1865 at the Liverpool Workhouse Infirmary. She also campaigned and raised funds for the Royal Buckinghamshire Hospital Aylesbury, near her family home. Nightingale`s Beliefs:  Holistic framework inclusive of illness and health  Need for theoretical basis  Liberal Education as foundation for nursing practice  Importance of creating an environment that promotes healing  Need for the body of nursing knowledge distinct from medical knowledge
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Nightingale`s Concept:  Having systematic method of assessing patient  Individualized care on the basis of patients needs and preferences.  Maintaining confidentiality.  Nurses should be formally educated and function as client advocate.  Adequate ventilation has also been regarded as a factor contributing to changes of the patient's process of illness recovery. In her environmental theory the following factors are present in the patient's environment:  Pure or fresh air  Pure water  Sufficient food supplies  Efficient drainage  Cleanliness  Light (especially direct sunlight) Any deficiency in one or more of these factors could lead to impaired functioning of life processes or diminished health status. CRIMEAN WAR (1854-1856) The war was between Turkey and Russia. France and Russia had adequate help to take care of wounded sick soldiers through religions sisters. But it was England who suffered a lot. An appeal was made to the public. Florence Nightingale was waiting for this chance. In two days she set with 38 nurses to meet the wounded at Dardenells. Miss Florence with her team of nurses landed at Scutari. They took care of the wounded soldiers. She opened library and post office for soldiers. Florence Nightingale proved to be an excellent commander. She accepted the responsibility of nursing the soldiers and did things no one else could or would do. She spent her evenings visiting the sick, writing letters to the soldier`s families.

HISTORY OF NURSING IN INDIA

DEVELOPMENT OF HOSPITALS AND NURSING SERVICES By the end of the 19th century there were 4 types of hospitals which came into existence. They were military hospitals, civilian hospitals, hospitals where European religious orders provided nursing staff and Protestant mission hospitals.

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MILITARY HOSPITALS In 1664 the East Indian Company helped to start a hospital for soldiers at Fort St.George, Madras. Nursing in military hospitals were carried on by soldiers, male orderlies and the menial staff. CIVILIAN HOSPITALS The need for attending to women during childbirth was felt by the colonial authorities as they noticed the heavy mortality among Indian women during childbirth. In 1871 Government general hospital Madras undertook plan to train nurses. For this nurses were brought from England to train nurses. The first batch of 6 students was trained in diploma in midwifery later this plan was changed to general nursing and midwifery. Lying-in hospitals in Calcutta were established. In 1844, the lying-in hospital in Madras was started. In 1843, the first hospital of Jamsetjee Jeejeebhoy group of hospitals was started in Bombay. DUFFERIN HOSPITALS Although in the late 19th century lying-in hospitals were functioning they were over crowded. Most of the upper caste women could not make use of the medical facilities because of caste and fear of pollution. There were not enough women doctors or nurses to attend to them in homes. So the Queen Victoria asked Lady Dufferin to look into the problem. She was able to raise funds from friends and affluent people for the medical education of women and later for training of nurses. In 1885, The National Association for supplying Female Medical Aid to the women of India was established. This is called the Dufferin Fund. MISSION HOSPITALS Mission hospitals were the first hospitals to provide the training of Indians as nurses. Religions taboos and prejudice against nursing career had prevented parents from sending their daughters to nursing course. So only those converted Christians joined the nursing courses, in the beginning. NURSING EDUCATION Nursing education in India begin with the brief period of six months .The basic programme for combined general nursing and midwifery developed rapidly after 1871.The need for theory as well as practical experience was felt. The training for general nursing was extended to 2 years and then 3 years before the student went on for midwifery training. By the end of 19th century a large number of training schools which belonged to mission hospitals were started. In 1908, Trained Nurses Association was formed to standardize the training schools for nurses.
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The present basic programme for nursing education throughout India consists of a three- year programme in general nursing and midwifery. Uniformity of training is maintained by recognition of schools, which meet the standards and requirement s by the Indian Nursing Council. Post-certificate courses were offered to prepare Indian nurses for responsible positions in hospitals and schools of nursing. These originated at the College of Nursing, New Delhi; C.M.C. Hospital, Vellore; and the Government General Hospital, Madras. The first four year basic Baccalaureate Degree programme was established in 1946 at the Colleges of Nursing in Delhi and Vellore. In 1963, the School of Nursing in Trivandrum instituted the first post-certificate Bachelor Degree programme. The first Master`s Degree course, a two year postgraduate programme, was begun in 1960 at the College Of Nursing in Delhi in India. M.Phil in nursing is offered at RAK College of Nursing, Delhi. Ph.D. programme is also available in M.A.H.E Manipal, Institute of health sciences, Mangalore and College of Nursing, Vellore. AUXILIARY NURSING The use of Auxiliary Nursing personnel to ease the shortage of professional nurses had been common in some countries when it was first put into practice in India. She functions in community than in hospital. A two year programme for Auxiliary nurse midwife was first established in 1951 at St.Mary`s Hospital, Punjab. In 1977, the ANM course was completely revised by the Indian Nursing Council and expanded to include subjects like sociology, psychology, Health, Education, Communication skills and other subjects .Among the three components of nursing,(Curative, promotive and preventive), a lion`s share in prevention and promotion is carried out by Health Worker Female. REGISTERATION OF NURSES As training for nurses, midwives, and health visitors progressed, the need for legislation to provide basic minimum standards in education and training was felt. It was also felt that registration would give greater professional status. In 1926 Madras State formed the first Registration Council. STATE REGISTERATION COUNCILS State Registeration Council are to inspect and accredit schools of nursing in their state, conduct examinations, prescribe rules of conduct, take disciplinary actions etc. THE INDIAN NURSING COUNCIL Indian Nursing Council (INC) Act was passed by the Parliament in 1947. The INC was constituted to establish a uniform standard of education for nurses, midwives, health visitors and auxiliary nurse midwives.
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COMMUNITY HEALTH NURSING In India community health nursing had its beginning when the terrible conditions under which children were born were recognized as a cause for the high mortality rate. The first attempt to train dais were carried out by missionaries as early as 1886. A further step forward was taken in 1946 when community health nursing was integrated in the basic programme of the new degree courses which were started at the College of Nursing, Delhi and the School of Nursing, C.M.C Hospital, Vellore, under the University of Madras.

NURSING ORGANISATIONS
In the early 20th century many countries established National Nursing Associations. They are:  Trained Nurses Associations of India  Nurses League of Christian Medical Association of India  Catholic Nurse`s Guild of India  Evangelical Nurse`s Fellowship of India  Nursing Research Society of India  Satellite Conference of Neuro-nurses of India  The Academy for Nursing Studies Trained Nurses Associations of India: In 1908, Trained Nurses Associations of India was formed as it was felt that other graduate nurses were needed to uphold the dignity and honour of the nursing profession. The Honorable Florence Macnaughton was the first President. In 1912, the TNAI became affiliated with the ICN. In 1917, it was officially registered under the Societies Act XXI of 1860.The two associations worked together until 1922 when they joined together under the title Trained Nurses Associations of India. The head office is located in New Delhi. The official organ of the TNAI is the Nursing Journal of India; monthly publication. The association has established within its jurisdiction the following organizations: 1. Health visitor`s league 2. Midwives and ANM association 3. Student Nurses Association

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Nurses League of Christian Medical Association of India: It was founded in 1931 as Nurse`s auxiliary of CMAI. It has been set for the training of nurses. Members of this organisation have contributed to professional nursing by writing and translating nursing textbooks in English, Tamil, Telugu, Urdu and Hindi. Catholic Nurse`s Guild of India: This is an organisation formed in response to a call made by Pope Pius XII in 1956 to unite all catholic nurses into a Guild. It provides moral protection and enables the members spiritually, professionally, socially and economically. The Lotus and the Lamp is the national magazine of CNGI. Evangelical Nurse`s Fellowship of India: It is a movement begun in 1946 by nurses who firmly believed that spiritual care is an integral part of comprehensive nursing, as man is essentially a biological, psycho-social and spiritual being. `Nurses Link` is the official publication issued bimonthly by ENFI. Nursing Research Society of India: It was established in 1986 to promote research within and around nursing environment. Membership is open to nurses having post graduation qualifications. The first newsletter was released in July 1989. Satellite Conference of Neuro-nurses of India: This originated as a subsection of Neurological Society of India in 1979.The main objective of the association is to set high standards of neuro-nursing in the country. The conferences of the association are held as part of the annual conference of NSI. They provide a forum for nurses working in neuro centers to discuss and work out solutions for their problems. The Academy for Nursing Studies: It is an organization that aims at improving the quality of nursing in India. It started in 1993 and is located at Hyderabad. The Indian Journal of Nursing and Midwifery is the official publication of the organization.

CURRENT TRENDS IN NURSING STATUS

The social significance of Nursing as a profession or career becomes more and more interesting, when one studies the history of nursing. The present nurse no more plays only caring service in the ward, but she is multifacet; multi-aspect worker from health care; preventive care to community health care.
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Registered nurses are the largest group of healthcare providers. By 2010 an anticipated national shortage of nurses put the nursing workforce in critical condition.

NURSING IN THE FUTURE

Many new trends in nursing are likely to develop in the near future. Some can be predicted with certainty while others may be unexpected. Renewal of our license, or repeat registration, may be a major change which would directly affect us as a graduate nurse. Clinical practice in nursing will be affected by the development of more scientific measurements of vital signs, monitors, intensive care units and increasing numbers of disposable items. It is expected that every nurse through her experience, intelligence must develop an aptitude for research, development and writing, thereby contributing to the progress nursing in future. Now the attitude of health is changing. Awareness of rights, status to health has come to the mankind. Peoples role in health care is very significant, at the same time there is growing awareness of key role among health planners and implementers. Changes in examinations for licensure of professional nurses can be foreseen. One of the recommendations by the `High Power Committee on Nursing`, however, is to have the Indian Nursing Council establish a National Examination system for nursing with in a period of ten years. Thus, nursing examinations throughout the nation would all be the same.

SUMMARY
History gives clue to cause and result of social development .History of nursing is inter-woven with the general history. Each nurse in her own way may contribute the progress of nursing as a career and profession.

CONCLUSION
Hereby I conclude with this topic. I would like to thank Mr.Sriram Sir who gave me this opportunity and also for his guidance.

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BIBLIOGRAPHY
1. R. K.Manelkar. History of Nursing. First Edition. Mumbai: Vora Medical Publications; 2001.p.1,p.67,p.43-49. 2. C. P. Thresyamma. Fundamentals of Nursing Procedure Manual For General Nursing And Midwifery Course. Revised Edition. New Delhi: Jaypee Brothers; 2002.p.3. 3. Board Of Nursing Education Nurses league CMAI (South India Branch). A New Text Book for Nurses in India. Fourth Edition. Chennai: B.I. Publications; 2000.p.8-19, p.25-36, p.37-39, p.39-42. 4. Andrey Jean Berman, GlenoraErb, Barbara Kozier. Fundamentals of Nursing. Sixth Edition. Delhi: Pearson Education; 2003.p.3 5. T K Indrani. History of Nursing. First Edition. New Delhi: J P Brothers; 2004.p.13-24, p.24-26, p.2627. 6. Priscilla Le Mone, Carol Lillis, Carol Taylor. Fundamentals of Nursing the Art & Science of Nursing Care. Fourth Edition. Philadelphia: Lippincott Publications; 2001.p.7-8, p.20-21. 7. Ann.J.Zwemer. Professional Adjustments and Ethics for Nurses in India. Sixth Edition. Chennai: B. IPublications: 1995.p.275-278. NURSING JOURNALS 8. Rajnikanth. A.M Inspiration for Nurses. Nurses of India.2005. June; Vol. 6.no.6.p.8, 9. 9. What Nurses & National Nurses Associations can do to Combat Counterfeit Medicines.Nurses of India. 2005. April; Vol. 6.no.4.p.5. 10. Sandra Millon Underwood. Culture, Diversity and Health: Responding To The queries of Inquisitive Minds. Journal of Nursing Education. 2006. July; Vol. 45.no.7.p.281-286. 11. Rasika.S.Jayasekara.The History of Nursing Services and Education in Srilanka and the Effects on Developing Professionalism. Journal of Nursing Education.2006.September:Vol. 45.no.9.p.391-395. 12. Florence Nightingale Some Lesser Known facts Nightingale Nursing Times. 2005. May; Vol. 1.no.1.p.21-23. INTERNET SOURCE 13. http://en.wikipedia.org/wiki/Nursing 14. http://www.britannica.com/EBchecked/topic/422718/nursing/36766/History-of-nursing 15. nursingplanet.com/.../development-of-nursing-education-in-india 16. allnurses.com/...nursing.../historical-factors-influenced 17. nursingcrib.com/nursing.../historical-evolution-of-nursi...

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