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2ND SEMESTER SY 2014-2015

NCM 100 FUNDAMENTALS OF NURSING

REVIEW: OVERVIEW OF THE PROFESSIONAL NURSING PRACTICE The following illustrates varied levels of proficiency according to Patricia Benner (Novice to Expert

Nursing Model)a. Novice: a beginning nursing student or any nurse who has not had enough real life experienceb. advanced beginner: the advanced beginner can marginally demonstrate acceptable performance when it comes to carrying out skills essential to the professionc. Competent: competence is reflected by the nurse who has had the same or who has been in the same job for 2-3 yearsd. Proficient: the proficient nurse is able to perceive situations as a whole or holistically and manages nursing care rather than performing tasks. A proficient nurse is one who has been in the same job for 3-5 yearse. Expert: the expert nurse no longer relies on rules and guidelines to connect understanding of a situation to an appropriate action. The expert nurse has an intuitive and analytical grasp of the situation and is able to find the best fit solution to a problem.

HISTORY OF NURSING

Period of Intuitive Instinct, natural Nursing Intuitive nursing was practiced since prehistoric times among primitive tribes and lasted through the

early Christian era. Nursing was untaught and instinctive. It was performed out of compassion for others, out of wish of to help others.

Beliefs and Practices of Prehistoric Man He was a nomad wanderer, traveller. His philosophy of life was “the best for the most” and he was

ruled by the law of self preservation maintenance, survival. Nursing was a function that belonged to women. She took good care of the children, the sick and the

aged. Traditional female roles of wife, mother, daughter, and sister have always included the care and

nurturing of other family members. From the beginning of time, women have cared for infants and children; thus, nursing could be said to have its roots in “the home”.

He believed the illness was caused by the invasion of the victim’s body of evil spirits through the use of black magic or voodoo.

He believed that medicine men called “shaman” or witch doctor had the power to heal by using white magic. Among others the shaman used hypnosis, charms, dances, incantations ritual recitation of charms or spells to produce magical effect, purgatives cleansing/purifying, massage, fire, water and herbs as a means of driving illness from the victim. He also practiced “trephining” opening the skull to release evil spirit.

As civilization grew, temples became the centers of medical care because of the belief that illness was caused by sin and God’s displeasure.

Nursing in the Near East Man’s mode of living changed from a nomadic style to an agrarian society to an urban community life Man developed a means of communication and the beginnings of a body of scientific knowledge Nursing remained the duty of slaves, wives, sisters or mothers

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The care of the sick was still closely related to religion, superstition and magic. Astrology and numerology were also used in medical practice

The place saw the three great religious ideologies: Judaism, Christianity and Islam

Contributions of Ancient Civilizations to Medicine and Nursing1. Babylonia

Code of Hammurabi – provided laws that covered every facet of Babylonian life including medical practice. The medical regulations established fees, discourages experimentation, recommended specific doctors for each disease, and gave each patient the right to choose between the use of charms, medications or surgical procedure to cure his disease. There was no mention of nurses or nursing.

2. Egypt The Egyptians introduced the art of embalming which enhanced their knowledge of human

anatomy They developed the ability to make keen observation and left a record of 250 recognized diseases There was no mention nurses, hospitals, or hospital personnel. Slaves and patients families nursed

the sick.

3. Israel Moses is recognized as the “Father of Sanitation”. He wrote the five books of the Old Testament

which emphasizes the practice of hospitality to strangers and acts of charity help (Genesis, Old Testament)

Promulgated laws of control on the spread of communicable disease and the ritual of circumcision of the male child (Leviticus)

Referred to nurses as midwives, wet nurses or child’s nurses whose acts where compassionate and tender outpouring of maternal instincts.

4. Rome The first organized visiting of the sick began with the establishment of the order of the Deaconesses.

They endeavoured to practice the corporal works of mercy:o Feed the hungryo Give water to the thirstyo Clothed the nakedo Visit the imprisonedo Shelter the homelesso Care of the sicko Bury the dead

Rome (Personalities and Organizations)o Phoebe – was the first deaconesses and visiting nurseo Marcella – was considered the first educator. She taught the care of the sick to her followerso Paula – one of the most learned woman of this period. She built shelters for pilgrims a person

who journeys to a sacred place as an act of religious devotion and hospital for the sick


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o Fabiola – wealthy matron of the Roman Empire, gave up her early pleasures and lavished her immense wealth on the poor and sick. Through her efforts the first general public hospital was built in Rome –NOSOCOMIUM- a place for the sick. She gave her fortune to the needy

o Parabolani – provided an opportunity for the male nurses in the early church period. They took care of the sick and buried the dead.

5. GREECE The Greek God Asklepios was the chief healer Hygeia, daughter of Asklepios, was goddess of health and was revered holy by some as the

embodiment of the nurse Nursing was the task of untrained slaves The Greeks introduced the caduceus, the insignia of the medical profession today Hippocrates came to be known as the “Father of Medicine”

6. CHINA Used massage, hydrotherapy, and exercise as preventive health measures They also used many herbs, minerals and acupuncture to heal the sick

7. AFRICA The nurturing functions of the nurse included roles as midwifes, herbalist, wet nurse, and carer for

children and the elderly

8. INDIA Early hospital were staffed by male nurses who were required to meet four qualifications:

o Knowledge of the manner in which drugs should be prepared for administrationo Clevernesso Devotedness to the patient, ando Purity of mind and body

Indian women served as midwives and nursed ill family members

Period of Apprenticeship Nursing

This period extends from the founding of religious nursing orders in the Crusades which began in the 11th century and ended in 1836, when Pastor Fliedner and his wife established the Kaiserweth Institute for the training of Deaconesses a woman elected to serve as an assistant in a church (a training school for nurses) in Germany

It is called the period of on-the-job training. Nursing care was performed without any formal education and by people who were directed by more experienced nurse. Religious orders of the Christian Church were responsible for the development of this kind of nursing.

The Crusades The Crusades were holy wars waged in an attempt to recapture the Holy Land Israel from the Turks

who denied pilgrims permission to visit the Holy Sepulcher a place for sacred relics. Military religious orders established hospitals that were staffed with men.


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Military Religious Orders: Knights of St John of Jerusalem (Italian) – devoted to religious life and nursing Teutonic Knights (Germany) – established tent hospitals for the wounded Knights of St. Lazarus (Germany) – was primarily for the nursing care of lepers in Jerusalem after

Christians had conquered the city. Dedicated themselves to the care of people with leprosy, syphilis and chronic skin conditions.

The Alexian Brothers – were members of a monastic order founded in 1348. They established the Alexian Brothers Hospital School of Nursing, the largest school of nursing under a religious order. It operated exclusively for men. In the United States, the school closed in 1969.

The Rise of Secular OrdersDuring this period, there were also the rise of Religious Nursing Orders for Women. Only by entering a convent could she follow a career obtain an education, and perform acts of charity that her faith taught would help her gain grace in heaven. Queens, princesses and other ladies of royalty founded many religious orders.

Secular Orders:1. Orders of St. Francis of Assisi (1200-present)

First Order – founded by St. Francis himself Second Order (Poor Clares) – founded by St. Clare of Assisi Third Order (Tertiary Order) – composed of members who devoted their time to performance of

acts of mercy in their communities, most provided nursing care in homes and hospitals

2. The Beguines – composed of lay nurses who devoted their lives to the service of suffering humanity. It was founded in 1170 by a priest, Lambert Le Begue.

3. Other Secular Orders : Oblates, Benedictines, Ursulines, Augustinians

Important Personages during this period: St. Clare – founder of the Second Order of St. Francis, took vows of poverty, obedience service and

chastity; gave nursing care to the sick and the afflicted. St. Elizabeth of Hungary – known as the Patroness of Nurses she was the daughter of Hungarian king.

She used all her wealth to make the lives of the poor happy and useful. She built hospitals for the sick and the needy.

St. Catherine of Siena – the first “Lady with a Lamp”. She was the 25th child of a humble Italian parents. She pledged her life to service at the age of seven and was referred to as little saint. She was a hospital nurse, prophetess, researcher and a reformer of society and the church.

The Bubonic Plague (1347-1350)• Ended the middle ages• Was very deadly• Germs carried by rats• Killed ¼ of the entire world population

The Dark Period of Nursing Down Fall of Nursing This extends from the 17th century to the 19th century from the period of reformation until the US Civil

War


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The religious upheaval disruption, disturbance led by Martin Luther destroyed the unity of the Christian faith

Protestantism wept away everything connected with Roman Catholicism in schools, orphanages and hospitals

There were no provisions for the sick, no one cared for the sick Nursing became the work of the least desirable women

o Women who took bribes from patientso Stole the patient’s foodo Used alcohol as tranquilizero They worked 7 days a week, slept in cubbyhole near the hospital ward or patient and ate scraps

of food when they could find themo These women were personified in a Charles Dickens novel Martin Chuzzlewit as Sairey Gamp

and Betsy Preg. She “cared” for the sick by neglecting them, stealing from them, and physically abusing them.

o Hospitals become gloomy and look like cemetery 18th to 19th century, social reforms changed the roles of nurses, based on the beliefs of Florence

Nightingale. Undertook nurse’s training at the age 31 despite opposition of family. Organize nursing care for the military hospital in Turkey during the Crimean War. After the war, she returned to England, where she established a training school for nurses and wrote books about health care and nursing education

Florence Nightingale elevated the status of nursing to a respected occupation, improved the quality of nursing care, and founded modern nursing education. Nurses were viewed as noble, compassionate, moral, religious, dedicated and self-sacrificing.

Societal Attitudes – Before the mid-1800s, nursing was without organization, education, or societal status; the prevailing attitude was that a woman’s place was in the home and that no respectable woman should have a career.

Reforms during the Dark PeriodSeveral Leaders sought to bring reforms

John Howard – a prison reformer, he helped improved the living conditions in prisons and gave prisoners renewed hope.

Mother Mary Aikenhand – established the Irish Sister of Charity to bring back into nursing the dedication of the early Christian era

Pastor Theodor Fliedner and Frederika Munster Fliedner – established the institute for the Training of Deaconesses at Kaiserwerth, Germany, the first organized training school for nurses. Requirements for entering the school were:

o A character reference from a clergymano A certificate of health from a physician, ando Permission from their nearest relative

Nursing in AmericaPre-Civil War Nursing

Madame Jeanne Mance was the first laywoman who worked as a nurse in North America. She founded the hotel Dieu of Montreal, a log cabin hospital

Elizabeth Seton, an American, founded the Sisters of Charity at Emmitsberg, Maryland in 1809


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American Reforms in Nursing The Nurse Society of Philadelphia organized a school of nursing under the direction of Dr. Joseph

Warrington in 1839. Nurse were trained on the job and attended some preparatory courses Women’s Hospital in Philadelphia established a 6 month course in nursing to increase the nurse’s

knowledge while they worked.

Nursing During the Civil WarThe American Medical Association during the Civil War created the Committee on Training of Nurses. It was designated to study and make recommendations with regards to the training of nurses. Doctors realized the need for qualified nurses

Important personages at the time Dorothea Lynde Dix – she was appointed as Superintendent of Female Nurses for the US government Clara Barton (1812-1912)– was a school teacher who volunteered as a nurse during the American Civil

War. She founded the American Red Cross

Period of Educated Nursing Birth of formal educationThis period began on June 15, 1860 when the Florence Nightingale School of Nursing opened at St. Thomas Hospital in London. The development of Nursing during this period was strongly influenced by:

Trends resulting from wars An arousal of social consciousness The emancipation liberation of women Increased educational opportunities for women

Facts about Florence Nightingale Recognized as the “Mother of Modern Nursing” she was also known as the “Lady with Lamp” Born on May 12, 1820 in Florence, Italy Raised in England in an atmosphere of culture and affluence; learned languages, literature,

mathematics and social graces Her education was rounded out by a continental tour Compiled notes of her visits to hospitals and her observations of the sanitary facilities, social problems

of the places she visited. Advocated for care of those afflicted with the diseases caused by lack of hygienic practices At age 31, she overcame her family’s resistance to her ambitions. She entered the Deaconess School Worked as superintendent for Gentlewoman During illness Disapproved the restrictions on admission of patients and considered the unchristian and incompatible

with health care Upgraded the practice of nursing and made nursing an honourable profession for gentlewomen Led the nurses that took care of the wounded during the Crimean War Put down her ideas in two published books: Notes on Nursing and Notes on Hospitals

Other Important Personages during this Period: Linda Richards (1841-1912) – first graduate nurse in the US; graduated on September 1, 1873. She is

known for introducing nurse’s notes and doctor’s orders. She also initiated the practice of wearing uniforms.


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Dr. William Halsted – designed the first rubber gloves Caroline Hampton Robb – the first to wear rubber gloves while working as an operating room nurse Establishment of nursing organizations :

o American Nurses Associationo National League for Nursing Education

Isabel Hampton Robb – the first principal of the John Hopkins Hospital School of Nursing Clare Louise Maas – engaged in medical research on yellow fever during the Spanish-American War Development of private duty nursing, settlement house nursing, school nursing, government service of

nurses, and prenatal and maternal health nursing Age of Specialization – began in the first decade of the 20th century Preparation of a standard curriculum based on educational objectives for schools of nursing (1913-

1937) Edith Cavell – known as “Mata Hari”, served the wounded soldiers during World War I Mary Mahoney (1845-1926) – was the first African American professional nurse. She constantly

worked for the acceptance of African Americans in nursing and for the promotion of equal opportunities.

Lilian Wald – is considered the founder of public health nursing. Wald and Mary Brewster were the first to offer trained nursing services to the poor in the New York slums.

Lavinia L. Dock (1858-1956) was a feminist. Prolific writer, political activist, suffragette, and a friend of Wald. She participated in protest movements for women’s rights that resulted in the 1920 passage of the 19th amendment to the US constitution which granted women the Right to vote.

Margaret Higgins Sanger (1879-1966) – a public health nurse in New York, has had a lasting impact on women’s health care. Imprisoned for opening the first birth control information clinic in America, she is considered the founder of Planned Parenthood.

Mary Breckinridge (1881-1965) – a notable pioneer nurse, established the Frontier Nursing Service (FNS). In 1981, she worked with the American Committee for Devastated France, distributing food, clothing, and supplies to rural villages and taking care of sick children.

Period of Contemporary Nursing This covers the period after World War II to present. Scientific and technological developments as well

as social changes marked this period: Establishment of the World Health Organization April 7, 1948 by the UN to assist in fighting disease by

providing health information and improving nutrition, living standards and environment condition of all people.

Use of atomic energy for medical diagnosis and treatment Utilization of computers for collecting data, teaching, establishing diagnosis, maintaining inventory,

making payrolls, record keeping and billing Use of sophisticated equipment for diagnosis and therapy The advent of space medicine also brought about the development of aerospace nursing Health was perceived as a fundamental mental right. Laws were legislated to provide such right Nursing involvement in community health Technological advances, such as the development of disposable supplies and equipment, have relieved

the nurse from numerous tedious tasks Development of expanded role of the nurse; the nurse is constantly assuming responsibilities in patient

care which were formerly the sole prerogative of the physician


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History of Nursing in the PhilippinesEarly Beliefs and Practices (Diseases and their causes and treatment were shrouded with mysticism and superstitions.)

Beliefs about causation of disease:o Another person (an enemy or a witch)o Evil Spirits

People believed that evil spirits could be driven away by persons with powers to expel demons People believed in special gods of healing, with the priest-physician (called word-doctors) as

intermediary. If they used leaves or roots, they were called herb doctors (herbiolarios)

Early Care of the Sick The early Filipinos subscribed to superstitious belief and practices in relation to health and sickness.

Herb men were called “herbicheros” meaning one who practiced witchcraft. Persons suffering from diseases without any identified cause were believed bewitched by

“mangkukulam” or “mangagaway”. Difficult childbirth and some diseases (called “pamao”) were attributed to “nunos”. Midwives assisted

in childbirth. During labor, the “mabuting hilot” (good midwife) was called in. If the birth became difficult, witches were supposed to be the cause. To disperse their influence, gunpowder were exploded from a bamboo cane close to the head of the

sufferer.

Healthcare During the Spanish RegimenThe religious orders exerted their efforts to care for the sick by building hospitals in the different parts of the Philippines

Hospital Real de Manila (1577) – it was established mainly to care for the Spanish king’s soldiers, but also admitted Spanish civilians; founded by Gov. Francisco de Sande.

San Lazaro Hospital (1578) – founded by Brother Juan Clemente and was administered for many years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy.

Hospital de Indios (1586) – established by the Franciscan Order; service was in general supported by alms and contributions from charitable persons.

Hospital de Aguas Santas (1590) – established in Laguna; near a medicinal spring, founded by Brother J. Baustista of the Franciscan Order.

San Juan de Dios Hospital (1596) founded by the Brotherhood of Misericordia and administered by the Hopsitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general health service to the public.

Nursing During the Philippines RevolutionProminent persons involved in nursing work:

Josephine Bracken, wife of Jose Rizal- installed a field hospital in an estate house in Tejeros; provided nursing care to the wounded night and day

Rosa Sevilla de Alvero- converted their house into quarters for the Filipino soldiers; during the Philippine-American War that broke out in 1899

Dona Hilaria de Aguinaldo- wife of Emilio Aguinaldo; organized that Filipino Red Cross under the inspiration of Mabini


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Dona Maria Agoncillo de Aguinaldo- second wife of Emilio Aguinaldo; provided nursing care to Filipino soldiers during the revolution, President of the Filipino Red Cross branch in Batangas

Melchora Aquino (Tandang Sora) –nursed the wounded Filipino soldiers and gave them shelter and food

Capitan Salome – a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when not in combat

Agueda Kahabagan- revolutionary leader in Laguna, also provided nursing services to her troops Trinidad Tecson (“Ina ng Biak-na-Bato”)- stayed in the hospital at Biak na Bato to care for wounded

soldiers

Hospitals and Schools of Nursing Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)

It was ran by the Baptist Foreign Mission Society of America. Miss Rose Nicolet, a graduate of New England Hospital for Women and Children in Boston, Massachusetts was the first superintendent for nurses. It moved from its present location to Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of the school in 1942. In April 1944 graduate nurses took the first Nurses Board Examination at the Iloilo Mission Hospital.

Saint Paul’s Hospital School of Nursing (Manila, 1907)The hospital was established by the Archbishop of Manila, Jeremiah Harty under the supervision of the Sisters of St. Paul de Chartres located in Intramuros. It provided general hospital services. It opened its training school for nurses in 1908, with Mother Melanie as superintendent and Miss Chambers as Principal.

Philippine General Hospital School of Nursing (Manila, 1907)PGH began in 1901 as a small dispensary for Civil officers and Employees in the City of Manila and later grew as a Civil Hospital. In 1906, Mary Coleman Masters, an educator advocated for the idea of training Filipino girls for the profession of nursing with the approval of Government officials, she first opened a dormitory for Girls enrolled at the Philippine Normal Hall and the University of the Philippines.

St. Luke’s Hospital School of Nursing (Quezon City, 1907)The hospital is an Episcopalian Institution. It began as a small dispensary in 1903. In 1907, the school opened with three girls admitted. These three girls had their first year in combined classes with the PGH School of Nursing and St. Paul’s Hospital School of Nursing. Miss Helen Hicks was the first principal. Mrs. Vitaliana Beltran was the first Filipino superintendent of nurses and Dr. Jose Fores was the first medical director of the hospital.

Mary Johnston Hospital and School of Nursing (Manila, 1907)It started as a small dispensary on Calle Cervantes (now Avenida). It was called the Bethany Dispensary and funded by the Methodist Mission for the relief of suffering among women and children. In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley and Gertude Dreisbach, organized the Mary Johnston School of Nursing. The nurses’ training course began with three Filipino young girls fresh from elementary as their first students.

Philippine Christian Mission Institute Schools of NursingThe United Christian Missionary Society of Indianapolis, Indiana- a Protestant organization of the


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disciples of Christ operated three schools of nursing: Sallie Long Read Memorial Hospital School of Nursing (Laoag Ilocos Norte, 1903)

Mary Chiles Hospital School of Nursing (Manila, 1911)The hospital was established by Dr. WN Lemon in a small house on Azcarraga, Sampaloc, Manila. In 1913, Miss Mary Chiles of Montana donated a large sum of money with which the preset building at Gastambide was bought. The Tuason Annex was donated by Miss Esperanza Tuason, a Filipino Philantropist.

Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912)

San Juan de Dios Hospital School of Nursing (Manila, 1913)In 1913, through the initaiative of Dr. Benito Valdez, the board of inspectors and the executive board of the hospital passed a resolution to open school of nursing. The school has been run by the Daughters of Charity since then. Sister Taciana Tinanes was the first Directress of the School

Emmanuel Hospital School of Nursing (Capiz, 1913)In 1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo to Capiz for the purpose of opening a hospital. Miss Rose Nicolet assisted him. The school offered a 3-year training course for an annual fee of Php 100.00. Miss Clara Pedrosa was the first principal

Southern Islands Hospital School of Nursing (Cebu, 1918)The hospital was established in 1911 under the Bureau of Health. The school opened in 1918 with Anastacia Giron-Tupas as the orginizer. Miss Visitacion Perez was the first principal

Other Schools of Nursing1.Zamboanga General Hospital School of Nursing (1921)2.Chinese General Hospital School of Nursing (1921)3.Baguio General Hospital School of Nursing (1923)4.Manila Sanitarium Hospital and School of Nursing (1930)5.St. Paul School of Nursing in Iloilo City (1946)6.North General Hospital and School of Nursing (1946)7.Siliman University School of Nursing (1947)

First Colleges of Nursing in the Philippines University of Santo Tomas-College of Nursing (1946)

In its first year of existence, its enrolees were consisted of students from different school of nursing whose studied were interrupted by the war. In 1947, the Bureau of Private Schools permitted UST to grant the title Graduate Nurse to the 21 students who were of advance standing from 1948 up to the present. The college has offered excellent education leading to a baccalaureate degree. Sor Taciana Trinanes was its first directress. Presently, Associate Professor Glenda A. Vargas, RN, MAN serves as its Dean.

Manila Central University-College of Nursing (1947)The MCU Hospital first offered BSN and Doctor of Medicine degrees in 1947 and served as the clinical


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field for practice. Miss Consuelo Gimeno was its first principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its Dean.

University of the Philippines Manila-College of Nursing (1948)The idea of opening the college began in a conference between Miss Julita Sotejo and UP President. In April 1948, the University Council approved the curriculum, and the Board of Regents recognized the profession as having an equal standing as Medicine, Engineering etc. Miss Julita Sotejo was its first dean. Presently, Professor Josefina A. Tuason, RN, MAN, DrPh is once more reappointed as the Dean of UP Manila College of Nursing

Nursing Leaders in the Philippines Anastacia Giron-Tupas – First Filipino nurse to hold the position of Chief Nurse Superintendent;

founder of the PNA Cesaria Tan – First Filipino to receive a masters degree abroad Socorro Sirilan – pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief

Nurse Rosa Militar – pioneered in School health nursing education Sor Ricarda Mendoza – pioneer in nursing education Socorro Diaz – first editor of the PNA magazine called “The Message” Conchita Ruiz – first full-time editor of the PNA magazine called “The Filipino Nurse” Loreto Tupaz – dean of Philippine Nursing; regarded as the Florence Nightingale of Iloilo


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