HISTORY OF NURSING international and national

This gives an introduction to the evolution of nursing profession

1. HISTORY OF NURSING BY E. CHAULUKA

2. LEARNING OBJECTIVES Define the following terms: Nursing Nurse Patient. Define Nursing according to Florence Nightingale, Virginia Henderson, Canadian Nurses Association Describe the evolution of Nursing Discuss the selected aspects of history of Nursing

3. DEFINITION OF NURSING NURSING: Is an art and a science As an art, “ as a professional nurse you provide care artfully with compassion, caring and respect for each patient’s dignity and personhood. As a science it Involves the creative application of knowledge in the service to people OLIVEIRA, Margaret de; et.al.  The Art and Science of Nursing.  Multidisciplinary Scientific Journal. Special Edition of Health. Year 02, Issue 11, Vol. 04, pp. 18-23, November of 2017. ISSN: 2448-0959

4. Definitions of nursing Florence Nightingale defined nursing as: “an art of utilising the environment of the patient to assist him/her in recovery.”(Kozier et al,2008)

5. Virginia Henderson Henderson defined Nursing as “ an art of assisting the individual sick or well in performance of those activities contributing to health or its recovery or to peaceful death”.(Kozier et al, 2008)

6. Canadian Nurses Association (CAN) CAN defines nursing as: “ a dynamic, caring, helping relationship in which the nurse assist the client to achieve and obtain optimal health”.

7. What are the common themes?

8. COMMON THEMES Nursing is caring An art A science Client centred Concerned with health promotion, maintanance and health restoration A helping profession

9. Definition of a Nurse Nurse comes from a Latin word “to nourish” or to “cherish” One who cares for the sick, the injured, the physically and mentally and emotionally disabled One who advises, instructs individuals, groups ,and communities in the prevention, treatment, of illness and diseases and in the promotion of health.

10. Patient Comes from a Latin word “to suffer” or to “bear” An individual who is in a state of physical, mental and emotional imbalance.

11. INTRODUCTION - HISTORY OF NURSING Nursing has evolved over years Contemporary or present Nursing is different from the past but issues affecting the profession today are connected to our history. Developing a sense of nursing’s evolution provides the background necessary to understand current nursing practice.

12. Historic evolution Nursing in some way has existed throughout history Nursing began probably as women intuitively took the role of caring. Nursing practiced within families and not considered as a vocation. Nursing emerged as individuals developed the desire and ability to nurture and provide care.

13. Pre-Christian Era The role of nurse emerged during the ancient cultures of Babylonians, Egyptian. Recipients of care were people of the wealthy families. If done outside wealthy homes – care was given by slaves. Subservient roles for women and nurses were rooted in sexual discrimination. Cultural attitudes towards the sick combined with low status of women provided major obstacles to nursing (Dolan et al 1983 as cited by Claven & Hirnley 1992 p.6)

14. Early Christian era Evidence of nursing became apparent during this period Women performed roles that reflect todays nursing practice. Provision of hygiene, good nutrition and comfort were central focus. Influence of Christianity raised nursing’s social position by placing value on human life & individuality Compassion, charity and willingness to serve were qualities associated with nurses Deaconesses were designated to perform such services .

15. CONTRIBUTION OF THE GREEKS The Greeks made significant contribution to the care of the sick and to a certain extent to the nursing profession. Hippocrates the father of medicine credited for developing assessment standards and also rejecting the notion that disease had supernatural causes .

16. Middle-age period Poverty critical at this time but nursing continued to shape the purpose and direction of health care. The influence of Christianity enhanced the profession. The influence of Christianity also improved the status by attracting intelligent individuals from respected families. Male and female orders founded e.g. knights of Saint John of Jerusalem also known as knights of hospitalers). Provided care to the sick, homeless and injured.

17. The Renaissance Recognition for need of nurses continued Poverty and lack effective sanitation resulted in serious health problems Inadequate personnel delayed move towards nursing education.

18. The Reformation Nursing experienced severe set back Dispersion of religious orders the main providers of health care led to deterioration in hospital conditions & nursing care Attempts to improve nursing education delayed .

19. 18 th Century Revolutions and epidemics led to expansion of nursing roles Prevention of illness became primary focus Continued poor sanitation & low standards of living increase the need for public health Nurses worked in poor conditions Fewer nurses chose to enter the profession.

20. 19 th Century Nursing again influenced by religion Caring image of nurses was believed to be a calling to the profession

21. 19 th Century Nursing again influenced by religion Caring image of nurses was believed to be a calling to the profession

22. SELECTED ASPECTS OF HISTORY IN NURSING People made significant contribution to the development of Nursing.

23. Theodor Freidner 1836 Opened a small hospital and training school in Kaiserwerth, Germany Florence Nightingale founder of modern nursing trained at this school

24. Florence Nightingale (1820-1910) Her contribution are numerous and far reaching Achievements in improving standards of care for the war casualties in the Crimea, earned her title “ Lady with the Lamp” First practicing epidemiologist( statistical analyses connected with poorSanitation brought major reforms in hygiene, sanitation ,nursing practice Mortality reduced from 42%-2.%

25. Nightingale’s Contribution to nursing First nurse to exert political pressure on government Contribution to nursing education – recognised as nursing’s first scientist, theorist for her work “Notes on nursing: what it is and what it is not” Designated Superintendent of English Hospital in Turkey

26. Florence Nightingale Florence linked five environmental factors that assisted with recovery( i.e. pure or fresh air, pure water, efficient drainage, cleanliness, light especially sunlight) Recognised that nutrition is an important part of nursing. Her vision of nursing included public health and health promotion She used her honorarium (£4500) to develop Nightingale Training school for nurses in 1860 Nightingale still serves as a model for nurses today

27. Dorothea Dix (1802-1887) Established Nurse corps in USA Superintendent of female nurses working in the Army hospitals Not a nurse but an advocate for mentally ill Lobbied for state legislatures and saw the birth of American mental asylums Nurses continue to be offered opportunities in the armed forces

28. Clara Barton (1812-1912) A school teacher who volunteered during the American Civil war Responsible for organising nursing services Barton noted for establishing American Red Cross which later linked with International Red Cross. Red Cross still exist today offering care to victims of disaster

29. Linda Richards (1841-1930) America’s first trained nurse Known for introducing nurses notes and doctor’s orders Initiated the practice of nurses wearing uniform Credited for her pioneer work in psychiatric and Industrial nursing

30. Mary Mahoney (1845-1926) First African American professional nurse Worked constantly for the acceptance of African Americans in nursing and for the promotion of equal opportunities. American Nurses Association gives a Mary Mahoney Award twice a year in recognition of significant contribution in interracial relationship.

31. Lilian Ward (1867-1940) Considered the founder of public health nursing Lilian and her colleague Mary Brewster were first to offer trained nursing service to the New York slums School nursing established as part of visiting nursing Visiting nurse association has become essential health component in the society.

32. Margaret Sanger (1879-1966) A public health nurse in New York Has had a lasting impact on women’s health care Was imprisoned for opening first birth control information clinic in America Considered the founder of Planned Parenthood

33. Aspects of events influencing nursing Women’s role and status Religion (Christian values) War Societal attitudes Visionary nursing leadership Struggle for autonomy and profession

34. Societal influence on nursing EXTERNAL FORCES Demographic changes Population shift Increased life span Higher incidences of chronic diseases Diabetes, Long term illnesses e.g. AIDS

35. Influence of today’s health care system delivery Health care delivery system complex and highly regulated ( primary care/health promotion, preventive, secondary acute care, tertiary care, Restorative and continuing care) Biomedical research Provision of Evidence –Based care

36. HISTORY OF NURSING IN MALAWI

37. How nursing has evolved in Malawi Nursing has evolved from an era when it was only regarded as an art to a period when it was recognized as an art and a science and a profession. Health services brought by missionaries Had problems like malaria’ Had to come with doctors and nurses to help them. The history can traced back to 1928 when it was recorded that men and women who helped in hospital work were given instructions as dressers, orderlies, hospital assistants under the auspices of Medical Council formed in 1926 .

38. Progression of Nurse training The first world war also influenced the need for more nurses and health facilities for the wounded. Expatriate nursing professionals were responsible for the provision of care. These nurses were also responsible for caring government officials In 1936, 2 British nurses were placed in Zomba to train African Nursing personnel. (assistant nurses),Some form of organised training of auxiliary nurses for class three midwives began in 1947. The training was established by Nyasaland Midwives Ordinance Board Training were conducted in Tumbuka and Chichewa Educational standard 3

39. Hospital Institutions BY 1931 the following hospitals were recorded as training institutions Nkhotakota Blantyre Mision Zomba Mlanda Livingstonia

40. Training Institutions Mulanje Mission 1930 Zomba Government Hospital 1931 Malamulo Seventh Day1932 Church of Scotland Blantyre 1932 Phalombe Mission 1946 Ekwendeni Mission Hospital 1946 Likuni Mission Hospital 1947 St. Joseph Hospital Nguludi 195 6

41. Progression of nursing in Malawi 1950 the Midwives Board started training Enrolled Classes 11 midwives Training given in English- Education requirement std 6. 9 institutions provided the training during the 1950’s. These were Mulanje Mission, Zomba General Hospital, Malamulo, Church of Scotland Blantyre, Phalombe Mission, Ekwendeni, Likuni Mission and St Joseph.

42. Training Institutions By 1956 the following hospitals were recognised as training centres for Enrolled Nurses/ midwives: Trinity in Chiromo Malamulo St Johns in Mzuzu St Joseph in Nguludi, Phalombe Likuni St Luke’s Zomba General Hospital St Anne’s in Nkhotakota

43. Training schools These institutions trained enrolled nurses for two years and one year midwifery 2 year midwifery training was given at Ekwendeni, St Annie’s in Nkhotakota and Mulanje Hospital Eventually these schools started offering one year post basic midwifery course Entry requirement was Junior certificate The following institutions eventuary closed Mlambe, Likuni and St Annie’s

44. Progression of Nurse training 1958 - Enrolled nurse/midwives training started at Zomba School of Nursing Before 1965 Registered Nurses were trained abroad in countries like Germany, Israel, United Kingdom. 1965 - Registered Nurse/Midwives at Blantyre School of Nursing Nurses and Midwives Council under an Act of Parliament was established in 1965. Aim of the Council was to ensure that Malawians got the best nurse & midwifery training by setting standards for training, registration and clinical practice The body regulated the minimum knowledge to be acquired like Anatomy &Physiology, Sociology, pharmacology communication,

45. Progression on nursing The programme prepared the learner to be a competent practitioner in both rural and urban setting The student was expected to register with the Nurses &Midwives Council. The entry qualification was MSCE with credits in Biology, English, Physical Science, Mathematics. In 1979 the school moved from Blantyre to Lilongwe and became the 4 th constituent of the University of Malawi.

46. Progression continues 1983 the first Diploma graduate nurses completed their training at Kamuzu College of Nursing. 1987 MoH re-opened the upgrading course to Registered Nursing Program but later BSN merged with KCN Post Basic Courses for Enrolled nurse midwives in Community Nursing, Pyschiatric Nursing were offered by Malawi College of Health Sciences. Post Basic course in Community health was offered to Registered Nurses at KCN. 1996 - BSc in Nursing started at KCN 1999 - BSc in Nursing Education (post basic training).

47. Progression continues 2000 - BSc in Midwifery (post basic) 2008 – Master of Science in Midwifery Program commenced 2008 - BSc in Nursing and Midwifery- an integrated programme 2009-Mzuzu University- BSc in Nursing and Midwifery- an integrated programme

48. continued 2010-MSc in Reproductive Health and Child health 2011-MSc in Nursing Education and MSc in Community Health Kamuzu College Nursing collaborating With Daeyang Nursing College accrediting Diploma in nursing started in 2011. 2013- DCN - BSc in Nursing and Midwifery- an integrated programme to replace the Diploma programme. 2013- PhD in Nursing- KCN

49. Challenges facing Nursing Profession in Malawi Critical shortage of personnel-nurses and midwives Poor attitudes among nurses and midwives Challenges with nurse and midwifery training-capacity Deployment and retention issues for nurses and midwives-motivation

50. Challenges facing Nursing Profession in Malawi Lack of equipment and material resources in health care settings Changes in disease burden-HIV and AIDS, TB, Cancers Policy issues (Health related and other policies) Gender and cultural issues

51. THANK YOU ENJOY YOUR STAY AT DAEYANG

52. REFERENCES OLIVEIRA, Margaret de; et.al. The Art and Science of Nursing. Multidisciplinary Scientific Journal. Special Edition of Health. Year 02, Issue 11, Vol. 04, pp. 18-23, November of 2017. ISSN: 2448-0959. Kozier. B., Berman. A., Snyder. S. J., Erb. G. (2008) Fundamentals of Nursing Concepts, Process, and Practice 8 th edition. Pearson Prentice Hall Potter. P.A., Perry. A. G. (2009) Fundamentals of Nursing. 7 th ed. Mosby Elsevier. Taylor.C., Lillis. C., Leman. P (1993) Fundamentals of Nursing. The art and science of nursing care. J. P. Lippincott Company.