Frequently Asked Questions
Chapter 1: Evolution of Nursing Practice

Why is it necessary to study the history of nursing?

Studying the history of nursing provides lessons to help promote better understanding of the importance of the role of autonomy and empowerment for the advancement of the profession.

How did nursing evolve from ancient Greek through the 20th century?

The earliest records demonstrate that family members provided nursing care at home, a practice that has continued throughout the ages. Male nurses and attendants provided care during the Middle Ages, particularly in Europe. By the 19th century, Catholic nuns and Protestant deaconesses served as nurses in Europe and the United States. Florence Nightingale, the founder of modern nursing, established nursing as a unique body of knowledge, distinct from medicine. She stressed the importance of manipulating the environment to promote healing.

Women subsequently served as nurses in several wars, beginning with the Civil War. Nurses were involved in the women’s movement in the late 19th and early 20th centuries and were leaders in health care reform their advocacy for children and families. During the 20th century, American nurses standardized nursing education, improved nursing care, developed theories, and conducted research.

How did American nurses improve the health of military personnel during wartime early in America’s history?

Women volunteered to care for both Union and Confederate soldiers during the Civil War; but Dorothea Dix, as Superintendent of the Female Nurses of the Army, organized them. Clara Barton also served in the Civil War and later founded the Red Cross in the United States. Jane Delano served during World War I and later worked for the Red Cross. Annie Goodrich was the dean of the Army School of Nursing after World War I and later became the first dean of the Yale University School of Nursing. Amelia Greenwald pioneered international public health nursing after serving in several field hospitals during World War I.

Who were the nurses responsible for the development of public health nursing?

Lillian Wald was the founder of the Henry Street Settlement Service in New York City and is considered the first community health nurse. She advocated for immigrant families and children. Lavinia Dock was a visiting nurse at the Henry Street Settlement Service and later the first editor of the American Journal of Nursing. Mary Breckinridge founded the Frontier Nursing Service in the early 19th century, lowering the childbirth mortality rate in the areas she served. Margaret Sanger advocated dissemination of information about birth control in the early 20th century and was the first president of the International Planned Parenthood Federation.

Who were the nurses responsible for the development of nursing education and nursing organizations and for the advancement of nursing as a profession?

Isabel Hampton Robb was an early advocate for shorter working days for student nurses and was involved in founding the American Nurses Association and the National League for Nursing. Adelaide Nutting was the first director of the Department of Nursing and Health at Teachers College, Columbia University in New York City and an early advocate of college preparation for nursing. Linda Richards developed 10 nursing schools, introduced nurse’s notes and physician’s orders into the medical record, and introduced the nurse’s uniform. Shirley Titus, executive director of the California State Nurses’ Association during the 1940s, was the first to advocate economic security and collective bargaining for nurses.

Who were the nurses responsible for the advancement of African-American nursing?

In 1908 Martha Franklin founded the National Association of Colored Graduate Nurses, an organization that later merged with the American Nurses Association. Mamie Hale was instrumental in improving the education and qualifications for nurse midwives, thus decreasing the mortality rates of mothers and infants. Mary Mahoney, the first African-American professional nurse, encouraged nursing toward cultural diversity. Adah Belle Thomas was a public health nurse in the early 20th century who emphasized equal rights for African-American nurses in the Army Nurse Corps and the American Red Cross.

How have “Landmark Reports” improved nursing education and nursing practice?

The 1910 Flexner report was responsible for the standardization and improvement of medical education. The 1923 Goldmark report identified the apprenticeship form of education as detrimental to quality nursing education. The 1948 Brown report recommended that nursing education be moved from the hospital to the university. The 1955 Institute of Research and Service in Nursing report recommended the establishment of associate degree and practical nursing programs to solve a nursing shortage in post-World War II America. The National Commission on Nursing report of 1980 recommended improving clinical education for nursing students, moving nursing education into the university, involving nurses in institutional decision making, and improving working conditions for nurses. The 1979 Institute of Medicine study, Nursing and Nursing Education: Public Policies and Private Actions, urged continued federal funding for nursing education to provide funding for nurse educators, researchers, and administrators, as well as for rural health and advanced practice nurses.

What has been the influence of the federal government on nursing education and practice?

The United States federal government has provided funding to increase nursing education programs, thereby addressing nursing shortages and expanding the role of the nurse. Title III of the Health Amendment Act of 1955 provided funds for associate degree and practical nursing programs. The Nurse Training Act of 1964 provided federal funds to expand enrollments in nursing schools. Amendments to Title XVII of the Social Security Act in 1977 provided for direct reimbursement to nurse practitioners. The Omnibus Budget Reconciliation Act of 1980 provided for direct reimbursement to nurse midwives in rural clinics.

What have been the social forces affecting modern nursing?

Throughout the ages, nursing care has been defined as a service rather than as a profession. Women first provided nursing care on the battlefield during the Crimean War and the American Civil War. The need for nurses to have training to provide care was obvious after both of these wars. Nursing was seen as a woman’s occupation that offered little power and poor pay. The passage of Medicare and Medicaid laws in the 1960s improved access to health care but led to shortages of physicians and nurses. Nursing shortages, technical advances in medicine, the feminist movement, and federal legislation empowered nurses to expand their roles and increase their voices in the health care system. Nurses continue to advocate for the poor and the vulnerable and are collaborating with other health professionals in quality control efforts and developing evidence-based practice.