Volunteer nurses from The American red cross during flu epidemic (1918). Original image from Oakland Public Library. Digitally enhanced by rawpixel.

VAST HISTORY OF NURSING ON ALL CONTINENTS, 300 AD

The history of nursing dates from the period. The Roman Empire endeavored to build a hospital in each town under its rule, leading to a high requirement for nurses to provide medical care alongside the doctors.

The profession of nursing became considerably more prominent in Europe in the middle ages, due to the drive for medical care from the Catholic Church. In this period, many advancements and innovations took place, which eventually went on to form the base of modern nursing, as we know it.

The first Spanish hospital was built in the late 500s to early 600s in Merida, Spain, with the intent to care for sick individuals regardless of ethnic origin or religion. Several others were created in the following history of nursing, centuries later their upkeep was neglected until Emperor Charlemagne began to restore them and update the supplies and equipment in the 800s.

Throughout the history of nursing the 10th and 11th centuries, the nursing profession expanded due to changes in rulings in Europe. Hospitals began to be included as part of monasteries and other religious places and the nurses provided a range of medical care services, as was required, even beyond traditional healthcare in the history of nursing. This all-encompassing model gained popularity and continues to be responsible for the wide range of duties a nurse is responsible for today.

The first known documents that mention history of nursing as a profession were written approximately 300 AD. 

HISTORY OF NURSING IN THE MIDDLE AGES

History of nursing in the middle ages
History of nursing in the middle ages

When taking a glimpse at nursing in the Middle Ages, there was a myriad of advancements and innovations that were implemented within the nursing industry during these years, helping to form some of the roots of modern nursing. During this period of time, the industry was still largely based on religion, with the vast majority of available nurses consisting of nuns and even monks. Hospitals functioned in a myriad of ways, housing lepers and refugees among the typical sick and injured patients. It was due to this that a nurse’s role within the hospital involved a wider range of duties than may be seen today.

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Around the late 500’s to early 600’s, the first Spanish hospital was created in Merida, Spain, with many of its nurses being supplied by the Catholic church. They were explicitly told to care for all of the sick, no matter their nation of origin or the religion they belonged to.

While many of these European hospitals began to fall into disrepair in the 800’s, Emperor Charlemagne came to the decision to restore and equip these hospitals with all of the latest medical equipment of that time. The Emperor also demanded that hospitals should be attached to every cathedral and monastery within Europe, which helped to spur demand for even more nurses.

It was during the dawn of the 10th and 11th centuries that nursing began to expand, due primarily to a number of different rulings in the history of nursing within Europe. For one, monasteries started housing hospitals inside their premises, as well as a separate infirmary, though this was only to be used by those that identified as religious.

Within these monasteries, nurses were made to provide patients with any type of service that they asked for or required, even outside of general health care services. This model of nursing became increasingly popular throughout many countries, primarily of Germany and France, providing the general outline for how nurses are expected to treat their patients today. Nurses were often asked to provide assistance and care by traveling to neighboring areas in order to make house calls.

Not only did many monasteries house hospitals, it was also around this time that each church was required to have a hospital contained within the structure. However, these churches were more difficult to maintain than their monastery counterparts, due in large part to the fact that monasteries existed within the countryside, while churches were often set in the city, meaning that more people would require the services of the nurses and doctors.

As such, the priest within each church was required to assist with the hospital that resided within their church. This proved successful in both the short and long term and allowed Germany to craft well over 150 hospitals between the years 1200 and 1600, expanding the role of nurses within Europe dramatically.

The history of nursing in the mid-1000s also saw a rise in what is known as charitable houses, as they were brought over to England by the Normans during their conquest and eventual capture of that very country. This type of health care facility was different from those of churches and monasteries, due in large part to nurses providing certain richer customers with alms and other medicines. The alms, in particular, were utilized in burial preparations, thus becoming highly sought after. This style of aid was distinctly new from anything seen in the past and seemed to usher in a new era of nursing.

Unfortunately, as Europe entered the beginning of the 17th century, the history of nursing as a whole became exceedingly diminished for a wide variety of reasons. For one, most monasteries were shut down during the Protestant reformation, as well as the hospitals within them.

The nuns that had been working as nurses were made to leave the profession and stay at home. It was due to this that nursing largely stagnated between the 17th and 18th centuries in Europe, as there were simply not enough hospitals available. However, in the few areas of Europe in which Protestant rule had not spread and Catholics still retained control, the role of nurses remained largely the same, diminished only in numbers.

In fact, those that practiced nursing were beginning to develop new services as well, particularly the act of offering care to those within the estate of their patron’s. While staying at the estate, these nurses would often be required to perform the duties typically undertaken by apothecaries, physicians and surgeons.

While nursing faced more tumultuous times during the years to come, nurses remained in demand more than ever and were often tasked with administering certain health care services to patients that might have been wary of the care provided by actual doctors.

That being said, the roots of modern nursing began to take shape in the 18th and 19th centuries. During these years, Britain and North America were at the forefront of innovation within the industry, though with each introducing different forms of nursing to the market.

FLORENCE NIGHTINGALE AND THE INTRODUCTION TO MODERN NURSING

Florence Nightingale in the history of nursing
Florence Nightingale by Jerry Evans is licensed under CC-BY-SA 2.0

When looking at the rise of modern nursing within Europe, it’s important to note that Florence Nightingale helped to change the nature of the profession forever. Around the early to late 1900’s, nursing was becoming more important than ever, as nurses were needed on the front lines of the many wars being waged, from the Crimean War to the Civil War. Nurses were sent to attend to the sick and wounded soldiers in battle.

Florence Nightingale began her illustrious nursing career as a nurse within the Crimean War that took place in the mid 1850’s, tending to injured soldiers on the battlefield. During this time, deaths from injuries were commonplace, due to the lack of general hygiene and the huge amount of fatal infections that resulted from these wounds.

Upon encountering this, Nightingale asked for and received aid from the British government that allowed for much better hygiene throughout the battlefield and nearby hospital. It was due to this that the rate of death from infections dropped drastically in but a short period of time.

Throughout the rest of her life, Nightingale advocated for sanitary living conditions for patients, as well as providing similar designs to be implemented within hospitals, an ideal that has spread throughout the entirety of the nursing profession throughout the following years.

HISTORY OF NURSING WITHIN EUROPE

HISTORY OF MODERN NURSING WITHIN EUROPE
HISTORY OF MODERN NURSING WITHIN EUROPE

It was because of the influence of Florence Nightingale that nursing as a profession became what it is today, though both Europe and the U.S. offered different advancements throughout the period leading up until now. As for Europe, the nursing profession flourished when, in 1860, Nightingale opened the very first nursing school in London, which was known as the Florence Nightingale School for Nurses.

This helped to pave the way for more and more schools to be founded and opened officially for prospective nurses to receive actual training and education for the field they were entering, thus providing roots for modern nursing.

While Florence Nightingale is one of the most popular nurses in history, it is not to be believed that she was the only notable figure in the field of nursing. In fact, there were a few others that helped to provide advancements to nursing in the 1800’s.

For instance, Clarissa Harlowe Barton was a nurse who founded the American Red Cross soon after the Civil War, while Linda Richards and Agnes Elizabeth Jones helped to create a number of nursing schools throughout the U.S. and Japan during the mid to late 1800’s. These women worked tirelessly to provide high quality health care to anyone that needed it, providing the model for nursing that still exists today.

Within Europe, Germany, France and Britain were at the forefront of bringing nursing into the modern age. Germany brought back what are known as deaconesses in the early 1800’s. A deaconess is basically a nurse in charge of providing health care for other women in the area. Despite the fact that deaconesses had all but vanished for a few centuries before then, they were brought back by Theodor Fliedner in 1836 when he opened a deaconess motherhouse situated nearby the Rhine river.

This move allowed for the floodgates to open in Germany, popularizing this form of nursing. By the dawn of the 20th century, there were reportedly well over 5,000 deaconesses in all of Europe, primarily Germany. This number swelled to nearly 50,000 by the late 1950’s. In fact, deaconesses were even found to be located in other countries as well, such as the U.S. and Canada.

As for France, they also seemed keen on contributing to the nursing profession in the late 1800’s and early 1900s. In France, nursing was still largely centered around religion. Within the nearly 1,500 hospitals located all throughout France, the nursing staff was comprised of well over 10,000 Catholic nuns in 1870.

This number increased even more so in the next 40 years to 15,000. However, at the dawn of the 20th century, the French government moved to create a system wherein hospitals were more heavily secularized, in order for hospitals to receive the proper support that they needed from outside of the church. This allowed for a better quality of care for all patients.

The first World War gave a huge boom to nursing within the country. While many of the nurses that joined the ranks during this time were untrained and seemed to leave the profession not long after the war ended, it brought about a larger focus on nursing by France that was missing before then, which was further signified by the offering of a national diploma in nursing in the year 1922.

It’s also important to note how important nursing came to be within all military situations over the years. Queen Victoria of England began to assign Military General Hospitals to be made in the 1860s, starting with that the Royal Victoria Hospital. This move was largely brought about because of the necessity for nursing during Crimean War.

These military hospitals were developed solely to provide care to soldiers and military patients. As such, many nurses throughout Europe started being appointed directly to these hospitals around that time.

However, one thing that still stood out was that many of the available nurses at the time were simply untrained, in both the profession and in how to deal with the exceedingly adverse conditions brought about during the time of war. While the health care being administered was useful and still helped to save lives, it was becoming clear that nurses would need to undergo some sort of training to become better equipped to handle any type of condition.

HISTORY OF NURSING IN THE U.S.

American Red Cross nurses (1917). Original from Library of Congress. Digitally enhanced by rawpixel for the history of nursing.
American Red Cross nurses (1917). Original from Library of Congress. Digitally enhanced by rawpixel. by Library of Congress is licensed under CC-CC0 1.0

Nursing within the United States took a decidedly different path than in similar countries. Due to the absence of a stronghold of Catholicism within America, the nursing field was not comprised of nuns. Nursing officially began in the early 1700’s when the first almshouse was opened in Philadelphia.

However, many of the hospitals that were created in the ever-expanding United States throughout the next 2 centuries were largely derived because of the fear from local governments of diseases spreading to the more wealthy population. Therefore, they did not receive the proper funding that would have allowed for the training of nurses.

It should also be noted that the only roles for a nurse within these hospitals during this period of time revolved primarily around tending to the elderly and those with sicknesses, such as the flu and the common cold. These almshouses were rarely equipped to deal with any actual illnesses that needed to be treated immediately.

However, most nurses spent their time tending to soldier’s wounds within the Civil War, as well as joining the American Red Cross soon after the war. It wasn’t until the dawn of the 20th century that actual progress and modernization within the field of nursing began to take place.

There were a number of factors that contributed to the general rise in nursing. The first of these revolved around the state of the nursing schools that had already existed at this time. While these schools were somewhat useful at training nurses, they were solely controlled by nurses.

Although this did have its advantages, they did not have enough resources to properly innovate and advance the overall profession. This was changed in 1900 when schools became controlled by hospitals instead, allowing for a more hands-on approach to training, which proved highly useful in giving prospective nurses the necessary tools to train efficiently.

Before this, nurses-in-training would only learn through the medical books that they were taught with. This change in schooling allowed for a bigger emphasis to be placed on earning a nursing degree, which paved the way for a total of 294,000 trained nurses, in the late 1920’s, in comparison to around 150,000 untrained nurses. At this time, most of these nurses were women.

One of the more ambitious nursing programs brought to America was Frontier Nursing Service, which was founded by Mary Breckinridge. This organization was designed to provide nursing care to poor citizens living in the more rural areas of the U.S., further expanding the scope and definition of all that nursing entailed.

History of Nursing in Africa

The development of nursing education in Africa has evolved through three cardinal periods, namely, pre-colonial, colonial and post-colonial periods except in Ethiopia. In the pre-colonial days in Nigeria and South Africa, not much is known about nursing. However, like in Europe and the rest of the world, nursing care took the form of experimental practice arising from the sick and the wounded, especially in certain parts of the countries where inter and intra-tribal wars frequently occur.

Badge of the General Nursing Council for England and Wales (badge) in history of nursing
History of Nursing: Badge of the General Nursing Council for England and Wales (badge) by Egerton Burnett Limited is licensed under CC-BY-NC-SA 4.0

The training of nurses and midwives in Africa was then regulated by the Nursing and Midwives Board established by the ordinances which were inaugurated. The Nursing and Midwifery Council of the three countries took cognizance of the National Policy on Education in developing sound educational principles essential to the preparation of nurses to function independently and/or as members of interdisciplinary and intersectoral teams.

History of Nursing in Africa owing to the British colonial influence in the African region, the concept of regulating the health professions extended from South Africa throughout the continent.

Nursing and midwifery professions were the first professions to be established on the African continent and to ensure statutorily recognized education and training centers, statutorily recognized curricula, statutory nursing examinations, and statutory certification of nurses (Searle et al., 2009).

South Africa has its own Florence Nightingale in Sister Henrietta Stockdale, who established a great nursing school in Kimberly in the 1880s. Not only was she the first to establish modern professional training standards, at least for white South African women, but she also provided the profession with its founding charter. Her influence was felt and appreciated from Cape Town in the South to Bulawayo in the North (Marks, 1994).

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The independent states of Botswana, Lesotho, Swaziland, Zimbabwe, Zambia and Malawi have British colonial influence on the development of nursing and midwifery.

The statutory provision of state registration for nurses and midwives which was enacted in the Cape Colony in 1891 was voluntary.

The Cape Colony hospital boards entrenched the concept of requiring that all trained nurses and midwives appointed to posts under their control be registered so that standards of education and training, and level of competence, responsibility, and accountability, could be verified and disciplinary control exercised legally (Searle et al., 2009). Other colonies, Natal (1899), Transvaal, and Orange River (1904), requested assistance from the Cape Colony.

The authorities responsible for Southern Rhodesia (Zimbabwe) and Malawi required all trained nurses and midwives appointed to posts under their jurisdiction to be registered with the Colonial Medical Council of the Cape Colony. Zambia recruited nurses from Great Britain, South Africa, and Zimbabwe, and few Zambian personnel were sent to these countries for training.

When Nigeria became a formal colony under the British Administration in 1914, nursing was among the first recognized and accepted professions in the British colony.

The immediate benefit was the recognition of the overwhelming need for Nursing and Midwifery Services in all its colonies the government of Britain. Nursing and midwifery practice was given its prime position, because of its relevance and direct impact on the lives, health, and well-being, of the army, administrators, their families, and society in general.

The British government, therefore, made efforts to modernize post-Crimean-Crimean nursing education and practice in the colony in line with the wind of change that was blowing across Britain due to the results of the post Crimean War.

The training of nurses and midwives in the country then was regulated by the Nursing and Midwives Board of Nigeria established by the Ordinance of 1930 and inaugurated in June 1931. In 1952, the University College Hospital, Ibadan established its School of Nursing with Mrs. Bell, a graduate of Florence Nightingale School of Nursing, St Thomas Hospital, London and a nurse tutor from Britain, as the first principal of the school.

The minimum basic education entry was a full secondary education. However, for reasons unknown, the minimum acceptable educational qualifications were Standard VI and Government Class IV perhaps for other government nursing schools, due to a limited number of qualified candidates.

At the end of the training, the graduates obtained the State Registered Nurse (SRN) Certificate of the Nursing Council of England and Wales. The training at the School of Nursing, University College Hospital, Ibadan was recognized for the British State Registered Nurse (SRN) Certificate, thus the tone for higher and better nursing education in the country started to have a facelift (Koyejo, 2008).

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