Nursing is an art and a science by which people are assisted
in learning to care for themselves whenever possible and cared for by others when they are unable to meet their own needs. Nursing has evolved from an unstructured method of caring for the ill to a scientific profession. The result has been movement from the mystical beliefs of primitive times to a “high-tech, high-touch” era.
Nursing combines art and science. Using scientific knowledge
in a humane manner, nursing combines critical thinking skills with caring
behaviors. Nursing requires a delicate balance of promoting clients’
independence and dependence. Nursing focuses not on illness but rather on the client’s response to illness. Nursing promotes health and helps clients move to a higher level of wellness.
This aspect of nursing also includes assisting a client with a terminal illness to maintain comfort and dignity in the final stage of life.
The evolution of nursing dates back to 4000 BC, to primitive societies in which mother-nurses worked with priests. In 2000 BC, the use of wet nurses is recorded in Babylonia and Assyria.
The ancient Greeks built temples to honor Hygiea, the goddess of health. These temples were more like health spas rather than hospitals in that they were religious institutions governed by priests. Priestesses (who were not nurses) attended to those housed in the temples. The nursing that was done by women was performed in the home.
Hospitals were first established in the Eastern Roman Empire (Byzantine Empire). St. Jerome was responsible, through one of his disciples, Fabiola, for introducing hospitals in the West. Western hospitals were primarily religious and charitable institutions housed in monasteries and convents. The caregivers had no formal training in therapeutic modalities and
volunteered their time to nurse the sick.
Hospitals in large Byzantine cities were staffed primarily by paid male assistants and male nurses. During the medieval era, these hospitals were established primarily as almshouses, with care of the sick being secondary. Medical practices in Western Europe remained basically unchanged until the 11th and 12th centuries, when formal medical education for physicians
was required in a university setting.
Although there were not enough physicians to care for all the sick, other caregivers were not required to receive any formal training. The dominant caregivers in the Byzantine setting were men; however, this was not true in the rural parts of the Eastern Roman Empire and in the West. In these societies, nursing was viewed as a natural nurturing job for women.
During the Renaissance (AD 1400–1550), interest in the arts and sciences emerged. This was also the time of many geographic explorations by Europeans. As a result, the world literally expanded. Because of renewed interest in science, universities were established, but no formal nursing
schools were founded. Because of social status and customs, women were not encouraged to leave their homes; they continued to fulfill the traditional role of nurturer/caregiver in the home.
Enlightenment and Industrial Revolution
The Industrial Revolution introduced technology that led to a proliferation of factories. Conditions for the factory workers were deplorable. Long hours, grueling work, and unsafe conditions prevailed in the workplace. The health status of laborers received little, if any, attention.
Medical schools were founded, including the Royal College of Surgeons in London in 1800. In France, men who were barbers also functioned as
surgeons by performing procedures such as leeching, giving enemas, and
At the end of the 18th century, there were no standards for nurses who worked in hospitals. In the early to mid-1800s, nursing was considered unseemly for women even though some hospitals (almshouses) relied on
women to make beds, scrub floors, and bathe the poor. Most nursing care was still performed in the home by female relatives of the ill.
Modern nursing was forged by the contributions of many outstanding nurses through the years. The establishment of public health nursing, the provision of rural health care services, and the advancement of nursing education occurred as a result of the works of nurse pioneers, who are discussed below. Note that the term trained nurse was used historically as the predecessor of registered nurse.
During World War I, Jane Delano, a graduate of Bellevue School of Nursing and former American Nurses Association president, took one of the first stances that created a division among nursing leaders. In 1912, physicians wanted the Red Cross to put untrained nursing aides at their sides to assist with war casualties. Physicians, not nurses, would train the aides in caring for the sick.
Delano was opposed to the aide education plan because it violated the educational standards already established by nursing. This position pitted Delano against Annie Goodrich and Adelaide Nutting. The Red Cross recognized Delano’s leadership abilities and dropped the aide plan.
Delano was active in the Army Nurse Corps until she resigned her Army position in 1912 to work full time with the Red Cross. She died during wartime service in Europe.
Annie Goodrich was influential in national and international
nursing issues. During World War I, the supply of civilian nurses was greatly depleted because of the Army’s need for trained nurses. Goodrich pushed for the establishment of an Army training school for nurses, which she envisioned as a model for other schools of nursing. She then was appointed dean of the Army School of Nursing. As an advocate of college-based educational nursing programs, Goodrich became the first dean of Yale University School of Nursing.
Adelaide Nutting was a nursing educator, historian, and scholar. She actively campaigned for nurses being educated in university settings and was the first nurse to be appointed to a university professorship. In 1910, Nutting was appointed to direct the newly established department of nursing and health at Teachers College, Columbia University in New York City. This department was established to prepare nurses for teaching and supervision in nurse training schools, for administration in hospitals, and for work in preventive and social aspects of nursing.
An influential leader in American nursing education was Lavinia Dock, who graduated from Bellevue Training School for Nurses in 1886. In her early nursing practice, she worked at the Henry Street Settlement House
in New York City providing visiting nursing services to the indigent. She wrote one of the first nursing textbooks, Materia Medica for Nurses. Dock wrote many other books and was the first editor of the American Journal of Nursing (AJN). Dock was a political activist who in 1914 encouraged nurses to unite when physicians objected to reforming labor laws to include nursing students.
American nursing’s history is rich with many outstanding leaders. Following is a discussion of some other nursing pioneers in America. Information is presented in alphabetical, not chronological, order.
In 1925, Mary Breckinridge introduced a system for delivering health care to rural America. She created a decentralized system for primary nursing care services in the Kentucky Appalachian Mountains. This system, the Frontier Nursing Service, lowered the childbirth mortality rate in Leslie County, Kentucky, from the highest in the nation to below the national average.
Martha Franklin was one of the first people to advocate racial equality in nursing. She was the only African American graduate of her class at Women’s Hospital Training School for Nurses in Philadelphia. In 1908,
Franklin organized the National Association of Colored Graduate Nurses (NACGN), which advocated that black nurses meet the same standards required of other nurses to prevent a double standard based on race. In 1951, the NACGN merged with the American Nurses Association (ANA).
Amelia Greenwald was a pioneer in public health nursing on the international scene. In 1908, she entered the Touro Infirmary Training
School for Nurses in New Orleans, Louisiana. After graduation, Greenwald
studied psychiatric and public health nursing. She served as Chief Nurse in
several field hospitals during World War I. In 1923, she accepted the challenge of establishing a school of nursing in Poland. She received the Polish Golden Cross of Merit for her contributions to the welfare of the people. Greenwald was a catalyst for international public health nursing.
In 1942, Mamie Hale was hired by the Arkansas Health Department to upgrade the educational programs for midwives. Hale, a graduate of Tuskegee School of Nurse-Midwifery, gained the support of granny midwives, public health nurses, and obstetricians. Through education, Hale decreased superstition and illiteracy of those functioning as midwives. Hale’s efforts resulted in improved mortality rates for both mothers and infants.
America’s first African American professional nurse, Mary Mahoney, was a noted nursing leader who encouraged a respect for cultural diversity. Today, the ANA bestows the Mary Mahoney Award in recognition of
individuals who make significant contributions toward improving relationships among multicultural groups.
Harriet Neuton Phillips
Harriet Neuton Phillips was the first known graduate of the Women’s Hospital of Philadelphia. A 6-month training course for nurses had been
established by Dr. Ann Preston in 1861. Although no formal diplomas were
awarded, the graduate nurses worked in the hospital and did private duty
nursing in homes. Thus, Harriet Phillips can claim the title of the first
American nurse to receive a training certificate. As a pioneer in community
nursing, she worked with Chinese immigrants in San Francisco and with Native Americans in Wisconsin.
In 1873, the first diploma from an American training school for nurses was awarded to Linda Richards. Richards founded or reorganized 10 hospital-based training schools for nurses. She introduced the practice of keeping nurses’ notes and physicians’ orders as part of medical records. Also,
Richards began the practice of nurses wearing uniforms. As the first
Superintendent of Nurses at Massachusetts General Hospital, she demonstrated that trained nurses gave better care than those without formal nursing education.
In 1912, Margaret Sanger, a nurse living in New York City, became concerned with women who had too many children to support. She coined the phrase “birth control” and began writing about contraceptive measures.
Sanger fought to revise legislation that prohibited dissemination of information about contraception. Sanger was not afraid of controversy and spent one month in jail for distributing information on birth control.
As a true activist, Sanger made birth control an issue and fought for the rights of poor women. She understood the relationship between
poverty, overpopulation, and high infant and maternal mortality rates. Sanger founded the American Birth Control League and was the first president of the International Planned Parenthood Federation.
Shirley Titus received a diploma from St. Luke’s Hospital School of Nursing in San Francisco in 1915. During her career, Titus served as dean of the School of Nursing at Vanderbilt University and in 1940 was the executive director of the California State Nurses’ Association. She advocated
improved economic security for nurses. Some of the many approaches to economic security for which she campaigned were malpractice insurance coverage, improved salaries and benefits, and collective bargaining.
Adah Belle Thoms
Adah Belle Thoms was a crusader for improved relationships among persons of all races. In the early 1900s, she became acting director of nursing of the Lincoln School for Nurses in New York when African Americans rarely held high level positions (Chinn, 1994). Thoms was one of the first to recognize public health as a field of nursing. She campaigned for equal rights for black nurses in the American Red Cross and the Army Nurse Corps.