Nursing in the 20th Century

Prepared by kamala Uprety

MN 1st Year ,LNC
Introduction
Nursing began as a desire to keep people
healthy and to provide comfort and
assurance to the sick.
Although the general goals of nursing have
remained relatively the same over the
centuries, ever-advancing science and the
changing of society’s needs have deeply
influenced the practice of nursing.
 Dimension of Nursing
Nursing as an ART Nursing as a SCIENCE
“Nursing…its very Nightingale identified
essence lies in the nursing as a scientific
creative imagination, discipline separate from
the sensitive spirit, and medicine
the intelligent
Educational foundation
understanding that
and basic college credit
provides the very
in scientific disciplines
foundation for
R/T nursing
effective nursing
care”. Donahue(1985)
Evolution of Nursing
Before 19th century
19th century
20th century
Contemporary image
 Lady with the Lamp
The image of Florence Nightingale is a self
sacrificing young women with no desire or
need of money, rest or recognition. Actually
she was a courageous, liberated,
independent women who may be credited
with leading nursing out of the Dark Ages.
She had strong convictions about what nsg
should be and fought hard to see that certain
clinical & educational standards were
maintained. 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
Early Twentieth-Century Nursing
The arrival of nursing as a profession and a
"calling" and the central importance of nurses to
hospitals was clearly evidenced in the architecture
of grand and imposing nursing schools that were
attached to hospitals.
They were deliberately designed with impressive
entrances and private rooms, as well as lobby and
recreational areas of gymnasiums, swimming pools,
and tennis courts to attract women who were, in the
words of the Board of Governors of the New York
Hospital Training School, "women of refinement"
(Kingsley, 1988, p. 69).
20th century
Nursing evolved toward a scientific,
research-based defined body of nursing
knowledge and practice.
Affiliation of nursing education with
universities
Expanded and Advanced Practice roles
Nursing specializations evolved
Specialty nurse organizations were formed
Historical Development of Nursing
image
1. Angel of Mercy--Self-sacrificing, moral,
noble
2. Girl Friday--Subservient, physician
handmaiden
3. Heroine--Brave, dedicated
4. Wife/Mother--Maternal, passive, domestic
5. Sex Object--Sensual, romantic,
promiscuous
Nursing as Angel of Mercy
In the early 1900s nurse as
viewed as honorable , moral,
spiritual, self- sacrificing, &
ritualistic.
Angel of Mercy image,
idealizing nurse and making
them a token of exemplary
moral purity.
Nurse involved in a dual
search: 1) success & meaning
in nursing. 2) happiness &
fulfillment through love &
marriage
The 1930s—Nursing As Angel
of Mercy
On a grander scale, Warner Brother's The
White Angel (1936), chronicled the
professional life of Florence Nightingale.
Endorsed by the American Nurses'
Association (ANA), The White Angel
clearly portrayed Nightingale's persistence
and head-to-head confrontation with
medicine.
Image of Girl Friday (1920-1929)
With the passage of the womens’
suffrage reform in1919, women
entered a new domain of
professional endeavors&activities.
At the same time, nursing
education regulations were lowered
and students were exploited as
cheap labor, literally staffing entire
hospitals. Nurses were described as
“faithful, dependent, cooperative,
long suffering, & sub servient.”In
films of this era, nurse were not
cast as career nurses.Nursng as
simply a means to an end.
Nursing as heroin image(1930-1945)
Nursing was acknowledged
as a worthy& important
profession that enabled
women to earn an honorable
living. Nurses were
identified as educated&
owning certain abilities such
as courageous, chivalrous,
fearless, reasonable, clear-
headed, humanitarian&
magnanimous.
The 1940s—Nurse As Heroine
The story of American nurses trapped on Bataan by
the Japanese (1999) tells via their diaries and
interviews the gritty, difficult, and heroic story of
these nurses who served on Bataan.
Nursing was depicted on a 1940 Australian stamp as
a larger-than-life figure looking over a soldier, a
sailor, and an aviator; in Costa Rica's 1945 stamp of
Florence Nightingale and Edith Cavell; and in the
1945 commissioning of the USS Higbee, a U.S.
Navy destroyer named in honor of a Navy nurse
(Donahue, 1985).
 Nursing image of mother(1946-1965
It may have been a natural
development after world war
II that a major goal for many
American women was to stay
home & care for children.
Nurses during this period
were chronicled as maternal,
compassionate ,un assertive,
submissive, &domestic.
Postwar society would not
support independent &
autonomous women.
Nursing in the Anti-Establishment
Era of the 1960s
Media images and art
Television—Nurse as background figure to
physicians
Movies—Nurse as power figure, cruel
Canvas—Nurse as worried, angry
Nurses in the 1960s (Reality)
Served in the forefront of public health

Central in development of CCUs and

performing hemodialysis

First nurse practitioner programs began

Salaries inadequate compared with those of

other less trained American workers
Sex object image(after 1966)
Nurses were increasingly depicted
as being sexually promiscuous,
self –indulgent, superficial,&
unreliable. Nurses become sexual
mascots for health care teams &
seen in x-rated movies. They
were often depicted as more
interested in linen closet trips
than in professional growth &
development. Nurses were
portrayed as cold, Uncaring,
power hungry& unmotivated
persons .
Nursing in the 1980s to 1990s
Media—Movies portrayed nurses as
nonjudgmental, caring, knowledgeable, and
heroic
Advertisements portrayed nurses as sex
objects
Art portrayed nurses as caring
Architecture portrayed the importance of
nursing through impressive buildings for
schools of nursing
Nursing in the 1980s to 1990s
Artistic views of nursing during this period
focused on caring.
In the Vietnam War Women's Memorial, the
central figure is the nurse in battle fatigues
cradling the head of a soldier for whom she
is providing care.
Evident in the bronze statue is the fatigue of
the nurse and her care for this dying soldier.
20th century
During the twentieth century nurses made
tremendous advancements in the areas of
education, practice, research, and
technology.
Nursing as a science progressed through
education, clinical practice, development of
theory, and rigorous research.
Today nurses continue to be challenged to
expand their roles and explore new areas of
practice and leadership.
20 century Leaders
th

The early leaders were consistent in their wish to

improve the educational program in these schools
because of their feeling that the professional nurse
could not fulfill her responsibilities to the patient
and the community until she was really prepared to
do so.
Early leaders are:
Isabel Adams Hampton,Sophia palmer, Mary
Adelaide Nutting, Lillian Wald, MLary Eliza
Mahoney, Mary Sewell Gardner, Annie W.
Goodrich, Isabel Maitland Stewart etc.
Early leaders
Isabel Adams Hampton
Supritendent of nurses at the illinosis training
school & the John Hopkins school for nurses.
She become the first president of the society
of superitendents of school of nurses.
Sophia Palmer: A founder of the new York
state nurses Association & campaigner for
Nurses licensure in New York. She become
the 1st editor of the American Journal of
Nursing. She authored a history of nursing, as
well as other nursing text books & journal
article.
Cont.
Mary Adlaide Nutting: Appointed head of the
department of nursing & health at teachers
college of Columbia university. She become
the world’s 1st professor of nursing.
Isabel Mitiland stewart: A professor of
nursing teachers college of columbia
university. She worked tirelessly for the
establishment of a standardized nursing
curriculum. She insisted on the need for
nursing research to give the profession a solid
scientific base.
Lillian Wald: From her work providing home
nursing care & teaching home nursing to immigrant
women on New York city’s lower side. She went on
to found the Henry Street settlement & the 1st visiting
nurse Association.
Annie W. Good rich: pioneer leaders who actively
helped nursing develop from apprenticeship to
profession.
She was president of the International Council of
Nurses from 1912-1915.
She had always been interested in public health and
in 1916 became director of the visiting Nurse
Service of the Henry Street Settlement
 Nursing organization
Alumnae Association
As the nursing schools developed, the alumnae formed
associations; the first were those of Bellevue (1889),
Illinois training School (1891), and Johns Hopkins(1892).
These groups had joined together to become the Nurses’
Associated Alumnae of the United States and Canada. The
purpose was to embrace the general betterment of the
profession.
American Nurses’ Association:In 1911, Alumnae
Association is replaced by the name “American Nurses’
Association”. Throughout the years the American Nurses’
Association has continued to help the individual nurse.
Uniform licensing laws in the states have been developed
in order to protect both the nurse and the public.
 Nursing organization
National League of Nursing Education:A professional
organization in nursing that fostered excellence in nursing
education, research, engaging in policy making and
advocacy efforts related to nursing education and
promoting faculty development. It was the precursor to the
National League for Nursing. NLNE made numerous
attempts to redesign diploma nursing education program. In
1917, 1919, 1927, 1937, NLNE published standard
curriculum for school of nursing.
Organization of Public Health Nurses:In 1911, a joint
committee was appointed by the two national nurses’
organizations, the American Nurses’ Association and the
Society of Superintendents of Training Schools, for the
purpose of standardizing nurses’ services outside the
hospital.
Development in Nursing Service
Private Duty Nursing
The hospitals retain the nurse on their payroll
and collect the fee for services rendered.
With the introduction of the eight-hour day,
twenty-four hours of private hospitals became
quite expensive. In hourly nursing, the nurse,
like the doctor, will go from patient to patient
carrying our procedures which require nursing
skill, leaving the simpler tasks to an attendant
or member of the family.
Nursing service in the U.S. Government
In 1918, Lucy Minnigerode of the American
Red Cross was loaned to the United States
Public Health Service to study its nursing
needs. She was appointed the first
superintendent of nurses in the Marine
Hospitals in 1919 and was the first nurse to
hold an official position in the United States
Public Health Service.
Nursing service in the Army
In 1901, an Act of Congress provided for a permanent Army
Nurse Corps. When the Army Nurse Corps was organized,
Dr, McGee was placed at the head of it, but she soon
resigned her position to Mrs. Dita H. Kinney because she
thought a nurse should head the corps.
Nursing Service in the Navy
During the civil war, catholic nurses of the Sisters of charity
went abroad a river steamer captured from the confederates
to care for the wounded. That nurses were employed at the
Naval Hospital in Norfolk, Virginia, to care for the sick and
wounded of the Spanish-American War.
They had only a verbal agreement that should be reimbursed
for travel expenses and receive moderate pay.
Nursing Education
University Schools of Nursing
In 1909, some nursing schools became actual
university schools, the superintendent being
a full professor occupying the chair of
nursing. Minnesota was the first school of
nursing organized as an integral part of a
university
Education of the Public Health Nurse
In 1914 Miss Nutting offered regular
postgraduate courses in Public Health
Nursing at Teachers College in affiliation
with Henry Street Settlement.
This was successful and soon Boston took
up the special training of public health
nursing which, by 1914, had developed into
an eight months’ course at Simmons College.
Later other centers, mostly university
schools, developed public health courses.
Early 1900s 1920s-1930s 1940s-1950s 1960s - present

Practical nursing Practical nursing Practical nursing Practical nursing

Nightingale Diploma schools Diploma schools Diploma schools

schools

Diploma schools BSN BSN BSN

Postgraduate POSTGRADUATE Master’s degree, Master’s degree

education education, edD Doctorates for and CNL, Phd,
for nurses Nurses DNSc, ND, DNP
AND- Associate CNL: Clinical nurse DNSc – doctorate ND- nursing
degree in nursing, leader: DNP- of nursing science, doctorate: PhD-
BSN- Bachelor’s of doctorate of EdD- doctorateof doctorate of
science in nursing: nursing practice education: philosophy.
Economic Welfare of Nurses
The Economic welfare Committee of the
International Council of Nurses was
established in 1947, and its primary
responsibility was outlined to be that of
securing information about:
Professional recognition which has been granted
to nurses and other aspects of professional and
economic welfare and
Economic conditions of nurses throughout the
world in regard to salaries , pensions and
working conditions.
Concept of Nursing
3 stages of the concept of nursing:
disease centered, patient centered and human health
centered
International Council of Nurses, in 1973, nursing is
to assist the individual, sick or well, in the
performance of those activities contributing to health
or its recovery , preventing disease or peaceful death.
The American Nurses Association, in 1980, nursing
is the diagnosis and treatment of human responses to
actual or potential health problems.
Tasks of Nursing
Relieving pains
Maintaining health
Restoring health
Promoting health and wellness
Body of Nursing knowledge

Fundamental knowledge:
physical science
fundamental medical
psychological and social science
Knowledge specific to nursing:
clinical nursing: fundamental nursing,
specialty nursing, community nursing
nursing management
nursing education
History of Nursing in Nepal
In 1947 BS, Bir Hospital was established but service was
provided by foreign doctors and compounders as there were
no nurses to give patient care. The hospital authorities
realized the need for nurses and midwives to provide care to
hospitalized patients. Hence, 4 ladies were sent to India.
The seed for nursing was sown in Nepal in 1985 B.S when 4
ladies were sent to India to study 18 months midwifery
training. These ladies after their graduation in 1987 B.S,
joined Bir hospital as nurses.
• Ms Dharma Devi Kansakar
• Ms Vidhyawati Kansakar
• Ms Radha Devi Kansakar
• Ms Bishnu Devi Mali
Then in 2009 B.S (1952 AD), 2 ladies were sent to India
again for nursing training for the first time. After completing
the training they joined nursing school In Surendra bhawan
and started teaching nursing.
• Dr. Uma Devi Das
• Ms. Rukmini Charan Shrestha
In 2013 BS (1956 AD), 1st School of Nursing was established
at Surendrabhawan with a training program of 3.5 yrs by the
joint effort of Juanita Flemming, RN, a missionary nurse and
Ms DM Ross, WHO nurse educator from England. Mrs
Lamoo Amatya was the incharge of this school, then called
co-ordinator.
In 2016 BS (1959 AD), another School of Nursing was
opened at Surendrabhawan under UMN under the
guidance of Ms Margaret Fleming and Ms Premi
Kacchhap.
Until 2018 BS (1961 AD), girls under SLC could enter
nursing
In 2021 BS (1964 AD) 1st ANM training school was
established in Bharatpur.
In 2023 BS (1966 AD) ANM training school established
at Biratnagar
In 2026 BS (1968 AD) ANM training school established
at Nepalgunj
In 2026 BS (1969AD), girls after SLC could enter
nursing
After 1972
In 2029 BS (1972 AD) Nursing education came under
TU, IOM and was renamed as PCL course.
• Training school was renamed as Nursing campus
• Course changed from 3.5 yrs to 3 yrs
• Significant changes were brought in the nursing
program and the curriculum (50% theory and 50%
practical)
• Liberal art subjects (English, Nepali, Introduction to
Nepal, Psychology) were added in nursing
curriculum as compulsory subject to enhance
language abilities and knowledge of behavioral
science. This was thought to increase understanding
of human behavior and communication skill.
• Applied science subjects (Physics, chemistry,
biology) were added to help the students learn
advancement in scientific knowledge and
technology.
• The addition of new subjects and shortening of
the duration changed the image of nursing from
its highly technical image to a more academic
oriented professional education with a sound
theoretical knowledge.
After 2029 BS (1972 AD), PCL Nursing was
offered by TU, IOM
• SLC pass became compulsory for entrance into
nursing
• PCL Nursing was given equivalent status to other
certificate level program under TU.
This created a positive impact on the image
of nursing. PCL nursing could now enter
bachelor level program offered in humanities
after passing one or more subjects in social
science in certificate level.
After 2029 BS (1972AD)
• Nursing program changed from annual to
semester system
• Theory and practical hours translated to credit
system
• Evaluation system was formative type
• TU, IOM took the responsibility of
• Conducting final university exams
• Issuing certificate to graduates
• Standardization of nursing curriculum
Before 2029 BS, Nepal nursing council was the
governing body for final examination
In 2030 BS (1973 AD), Princess Prekshya Rajya
Laxmi joined nursing education. This encouraged
the girls from privileged class to study nursing.
In 2035 BS (1978 AD), BN started in Mahaboudha
Nursing campus (now MNC)
2035-2044 BS, BN program had 3 speciality
• Midwifery
• Adult nursing
• Child health nursing
From 2036 BS (1980 AD)
• Semester system was changed to annual system
again
• Evaluation was summative type
In 2041 BS, BN curriculum was revised to
2 stream, hospital nursing and community
nursing.
Extension of ANM/CMA campus to nursing
campus:
• 2038 BS (1981 AD): ANM campus Biratnagar to
Biratnagar Nursing Campus
• 2041 BS (1984 AD): CMA campus Pokhara to
Pokhara Nursing Campus
• 2043 BS (1986 AD): CMA campus Birjung to
Birjung Nursing Campus
• 2044 BS (1987 AD): ANM campus Nepalgunj to
Nepalgunj Nursing Campus
In 2043 BS (1986 AD), nursing education was opened
to male students (10% seats). After 4 batch, male
intake was discontinued because of the role ambiguity
faced by them in clinical area.
In 2044 BS (1987 AD), PCL nursing curriculum was
revised to make it PHC oriented. This change occurred
in response to the Alma Ata Declaration (1978), health
for all by 2000 by promoting primary health care
In 2046 BS (1989 AD), Bir Hospital Nursing campus
opened under the affiliation of TU, IOM
After 2047 BS, education remained no longer only the
state responsibility, education for health professional
opened to private sector.
1970s to 1980s AD: Nursing teaches with bachelors and
masters degree were sent to India and abroad for further
education
• 2 nursing teachers returned with Phd degree from USA
• 21 nursing teachers returned with Masters degree from
India and UK.
1980s AD is remembered as the capability building decade for
nursing teachers. This resulted in quality nursing education,
revised curriculum, better classroom teaching and improved
clinical supervision.
In 2052 BS, (1995 AD), MN program started
• 2052 BS (1995 AD): Women’s health and development
• 2058 BS (2000 AD): Adult Health Nursing
In 2053 BS (1996 AD), BPKIHS Dharan, a deem university
started 4 years B.Sc Nursing program.
• 1st batch: 20 students (10 male and 10 female)
• 2nd batch: 10 students (because of shortage of faculty)
• 3rd batch onwards only females
From 2008 AD: M.Sc Nursing started
NEC report 2049 (BS) recommended to move all PCL
program out of University and hand bring it under CTEVT by
2057 BS. It also recommended all bachelor level program to a
3 calendar years.
All other universities have implemented this except TU, IOM.
IOM is in the process of its implementation. The 3 year
curriculum has been developed and approved. Due to lack of
faculty in peripheral campuses for basic science, the
implementation has been delayed.
Highlights
1950’s 1960’s
• Code of Ethics (ANA) • Post BSN programs
• 1st CNS programs increase
• Nursing Research first • Nursing researchers
published (1952) pioneer clinical
investigations
• International Nursing
Index categorizes
worldwide nursing
articles
Highlights 1980’s
• MS and Doctorate
1970’s programs increase
• NP in expanded roles • Prof. Nursing journals
gain national visibility increase
• Nurses Coalition for • More nurses are
Action in Politics nationally “certified”
formed in 17 specialty areas
• ANA creates AAN to
honor outstanding • NIH has a National
nurses Center for Nrsg. Res.
• Nurse theorist come
into national spotlight
References
Bhattarai ,S.(2010) Trends & Issues in Nursing1st
edition, Makalu Publication house
Crisp,J. & Tylor, C.Potter & Perry’s (2009)
Fundamental of Nursing, 3rd edition, chatsward,
Elsevier Australia: Libby Houston
Deloughery,G.L.(1991) Issues & Trends in Nursing
1st edition , Mosby- year book
HLMC(1995) Fundamental of Nursing 1st edition,
Suraj printing press, Dillibazaar
Potter,P.A. &Perry, A. G.(2007) Basic
Nursing:Essential for Practice 6th edition, India:
Elsevier India Pvt. Ltd.
Retrieved from http://en wikipedia.org/ wiki/
timeline_of_nursing_history
Retrieved from http://www.authorstream.com
/presentationreynel 89-1357208-history of
nursing
Retrieved from http:// www.slideshare.net/
jed22 cute/ history & evolution of nursing-
17672136
Retrieved from http://www.powerhouse.com
Central Message for All Nurses
Each nurse forms the image of
nursing every day