ARSI UNIVERSITY NURSING DEPARTMENT
FOUNDATION OF NURSING I
By: Mohammed A (B.Sc. N, MSc N.)

Outline
At the end of this chapter you will be able to know;-
Overview about emerging of Nurse
Historical Background Of Nursing
Definition Of Nursing
Religious and Civilization Influence On Nursing
The history of Nursing in Ethiopia
Nursing as a profession rather than occupation

Overview
 Nursing were existed since the beginning of time as informal act of caring
 Changes in the population make-up, consumer demands, technology, and
economics are some of the key factors that have influenced how nursing
has evolved.
 Although nursing has come a long way from the day of strictly providing
bedside care, it is by no means anywhere near its full maturity.
 In fact, nursing will continue to change and evolve as will the world.

Historical Background Of Nursing
A. Early Definitions of Nursing
 A nurse is a person who nourishes, fosters, and protects—a person who is
prepared to care for the sick, injured, and aged.
 In this sense, “nurse” is used as a noun and is derived from the Latin
nutrix, which means “nursing mother.”
 Dictionary definitions of nurse include such descriptions as “suckles or
nourishes,” “to take care of a child or children,”
 Due to this origin, it is understandable that people generally have
associated nursing with women.

B. Modern definition by theorists
Florence Nightingale (1820-1910)
The founder of modern nursing and Mother of Modern Nursing
Born on May 12, 1820 in Florence, Italy
Lady with the Lamp
She developed the first formal training program for nurses.
She focused on the role of the nurse in preventing and curing
disease through sanitary techniques.
Nightingale was responsible for major reform in hygiene and
sanitary practices.

Modern definition by theorists
She define Nursing as that act of utilizing the environment of the
patient to assist him/her in his/her recovery.
 She compiled notes of her visits to hospitals, her observations of
sanitation practices and entered Deaconesses School of Nursing at
Kaiserswerth, Germany for 3 months.

Modern definition by theorists
 Educative period of Nursing Began in June 15, 1860 when Florence
Nightingale School of Nursing opened at St. Thomas Hospital in
London, where 1st program for formal education of Nurses began and
contributed growth of Nursing.

Modern definition by theorists
 In 1860, she created a school of nursing, which was the model for most
nursing education in England.
 The school was organized around three components:
1) a trained matron with undisputed authority over all members of
the staff,
2) a planned course of theoretical and practical training, and
3) a home attached to the hospital in which carefully selected
students were placed in the care of “sisters” responsible for their
moral and spiritual training.

Modern definition by theorists
(The English term “sisters” used for secular nurses reflects
nursing’s religious history.)
Nightingale established educational standards for the
students – she concerned herself not just with health care
needs but with human needs.

Modern definition by theorists
 (1859), wrote in detail about the concept of the aesthetic and seemed
to realize the relationship of certain qualities as health and beauty.
 She suggested that: "Nursing is an art, and if it is to be made an art, it
requires as exclusive devotion, as hard a preparation, as any painter’s
or sculptor’s work, for what is having to do with the living body - the
temple of God’s spirit? It is one of the fine Arts; I had almost said the
finest of the fine Arts". (Cited in Donahue 1996:501)

Modern definition by theorists
 Mallison (1993:7) emphasizes in the difficulty to express by writing the
multidimensional whole of nursing as she suggests that:
 “Nursing like dance or painting is not primarily an art of the written word. It
is partly Kinesthetic - transmitted in facial expressions, posture, touch,
silences, gestures, timing, intent. Attempts to pin it down with language is
like chasing butterflies: It's most beautiful in motion, flitting freely outside
the net of words".

Modern definition by theorists
 Henderson (1966:39) stated that: "the unique function of the nurse is to
assist the individual sick or well, in the performance of those activities
contributing to health or its recovery (or to a peaceful death) that he
would perform unaided if he had the necessary strength, will or
knowledge, and to do this in such a way as to help him to gain
independence as rapidly as possible" and she went on to describe what
are these activities(cited in Lister 1997).

Modern definition by theorists
 Just as Florence Nightingale made a significant impact on the course
nursing has taken, so have many other individuals.
 Some of them were ;-
Peplau (1952),Abdellah(1960),Orlando(1961), Hall (1962), Levine
(1966),Johnson(1968),Rogers(1970),Orem(1971,King(1971), Neuman (1972)
, Patterson & Zderad (1976), Leininger (1978), Watson (1979) , Parse (1981)
, Erickson (1983) and Benner (1989).

Modern definition by theorists
 Nursing is an art and a science.
 The two form a synergistic relationship, the sum of which is much greater
than each entity individually.
 The art that is manifested in the caring and compassionate provision of
care cannot stand without the scientific knowledge base that validates
nursing actions and vice versa
 To develop a scientific knowledge base, nursing had to define its
boundaries.

Modern definition by theorists
 Another closely related activity that helps to define nursing’s theoretical
foundation is research.
 After theories are developed, they must be tested through research to
confirm their validity and reliability.
 Ultimately, research results contribute to evidence-based nursing
practice (i.e., nursing practice based on proven result vs. intuition or
unplanned trial and error).

Definition Of Nursing
 NURSING (as an art);-
Is the art of caring sick and well individual.
It refers to the dynamic skills and methods in assisting
sick and well individual in their recovery and in the
promotion and maintenance of health.
It involves the creative application of knowledge in the
service of people.

Definition Of Nursing
NURSING (as a science);-
It is the “body of abstract knowledge” arrived through
scientific research and logical analysis.
Is the scientific knowledge and skills in assisting individual to
achieve optimal health.
 It is the diagnosis and treatment of human responses to actual or
potential problem(ANA 1980).

Definition Of Nursing
Nursing (as a profession)
a calling in which its members profess to have
acquired special knowledge by training or experience,
or both so that they may guide, advise or save others
in that special field.

Definition Of Nursing
Definition Of Nursing By WHO and ICN;-
Nursing encompasses autonomous and collaborative care of
individuals of all ages,families,groups and communities sick or
well in all setting. It includes promotion of health, prevention of
illness and the care of ill, disabled and dying people.
One who advise and instruct individuals, families, groups and
communities in the prevention, treatment of illness and diseases
and in the promotion of health.

Religious and Civilization Influence On Nursing
 Religious has played a significant role in the development of nursing.
 Although most of the world's religious encourage benevolence but
firstly it was Christianity which exerts it's a fact over care provision to
people, it gave the value like self-sacrificing , spiritual calling, and
devotion to duty and hard work.
 In ancient periods (B.C.500) ruling class of that time or usually priest
were physician.
 The site of healthcare was temple/church.

Religious and Civilization Influence On Nursing
In the Bible, a woman named Phoebe is identified as the first
deaconess, a word meaning servant or helper
Deaconess cared for widows, orphans, and the sick. Olympias, a
woman of Constantinople, set up a hospital to care for the sick.
In Rome, Marcella established a monastery for those in need of
care. Fabiola, who was converted to Christianity by Marcella,
established hospitals for the sick poor.

Religious and Civilization Influence On Nursing
 In the middle Ages, the traditional role of the religious groups in
caring for the ill was continued by various orders of monks and nuns
 When the crusade attempted to regain Jerusalem from Muslim
control, the Knights Hospitalers, and order of religious workers who
cared for the injured and fought to protect them, marched with the
armies.
 During this time, unfortunately, the knowledge of hygiene and
sanitation gained by Greek, Roman, Egyptian, and other ancient
civilizations was forgotten

Religious and Civilization Influence On Nursing
 There was no growth or development in knowledge regarding care
of the sick.
 Throughout the Middle Ages and into the Reformation, religious
orders ran almost all of the hospitals and provided most of the
nursing care in Europe.
 With the advent of the Reformation and the presence of Protestant
religious groups, the nature of these orders changed. Women
might join for a limited period of time, rather than devoting the
entire lifetime to service.

Religious and Civilization Influence On Nursing
 They were again referred to as deaconess, the term used in the
early church.
 For example, a church order of deaconesses was organized by
Pastor Theodor Fleidner in Kaiserswerth, Germany called the
Sisters of Mercy of the Church of England.
 Another order established St. John’s House, an Anglican
Hospital in London.

Religious and Civilization Influence On Nursing
 The Protestant Nursing groups were comprised totally of
women, and only one nursing order made up of men, the
Brothers Hospitalers of St. John, remained in the Catholic
Church.
 The Muslim religion has a similar tradition of service to others
in the name of Allah.

Religious and Civilization Influence On Nursing
 One of the most famous name in Arab nursing is Rufaida Bint-e-Saad
alAslameya, the first nurse in the Islam and Eastern world.
 Rufaida accompanied Prophet Mohammed(PBUH) during his wars,
participating in many battles.
 She was responsible all taking care of the wounded and dying soldiers,
establishing a field hospital that had system of movable tents to assist
the wounded and diseased warriors, she highly focused on hygiene and
the environment she also led a group of volunteer female nurses during
wars.

Religious and Civilization Influence On Nursing
 She was an advocate for health care health education, end disease
prevention.
 Rufaida design codes of ethics for nursing and medical care.
 since she received her clinical expertise from her father who was a
physician, she established a school where she taught Muslim women
nursing, first aid, and emergency care, this school was the first nursing
school in the Middle East.

Religious and Civilization Influence On Nursing
 War has also put its effect on the nursing field.
 During Crimean war the work of Florence Nightingale played an
important role to increase the worth of nurse in providing health care
to patients.
 Nurse become necessary character to meet the needs of patients.
 Florence Nightingale and her team transformed the military hospital
by sitting up laundry, kitchen, recreational centers, and reading rooms.

Religious and Civilization Influence On Nursing
 Before mid 1800s nursing was without education, organization, and
social status.
 Woman was only to serve her family as a housewife.
 In 19th century this attitude was totally revolved by the work of
Nightingale.

The history of Nursing in Ethiopia
Even though Ethiopia is one of the oldest countries in the
world, introduction of modern medicine was very late.
Health care of communities and families was by Hakim
(wogesha or traditional healers).
Modern nursing in Ethiopia started in the later part of the
19th century by Swedish Missionaries who came to Eritrea
in 1866.

The history of Nursing in Ethiopia
Ethiopian nurses came from a variety of backgrounds and
during the World War II Swedish nursing and medical
personnel were recruited to support Ethiopia’s health care
workforce.
During this time the World Health Organization (WHO) sent
a physician and nurse to train auxiliary nurses in Ethiopia.

The history of Nursing in Ethiopia
Princess Tsehai, the Emperor’s daughter, first national nurse
in Ethiopia
In 1908 Minlik II hospital was established in the capital of
Ethiopia. The hospital was equipped and staffed by Russians.
Around 1928 elderly women were recruited and were given
short term training to serve as nurses and midwives.

The history of Nursing in Ethiopia
Later hospital building was continued which raised the need to
train health auxiliaries and nurses.
 In 1949 the first School of Nursing (The Ethiopian Red Cross) was
opened in the former Haile Selassie I Hospital (Now Yekatit 12
Hospital beginning of the modern nurses’ education).
Students were recruited from 8th grade and the training duration
was 3 ½ years.

The history of Nursing in Ethiopia
In 1954 Hailesellasie I Public Health College was established in
Gondar to train health officer, community health nurses and
sanitarians to address the health problem of most of the rural
population.
In line with this, the Centralized school of Nursing formerly
under Ministry of health and recently under Addis Ababa
University Medical Faculty and Nekemit School of nursing are
among the senior nurse’s training institutions.

The history of Nursing in Ethiopia
During the regimen of 'Dergue', the former bedside and
community health nursing training was changed to
comprehensive nursing In 1977 who can function at all levels of
health institutions.
The academic entry requirement at this time was raised to 12th
grade completion and the duration shortened to 2 ½ years.

The history of Nursing in Ethiopia
 Thus the training of community nurses was discontinued.
 After the dawn fall of the Derge regime, since 1991, the training duration
reduced by ½ years to only 2 years and the comprehensive form of training
changed to specialized form of training.
 The training of different types of nurses then started for two years in most
training institutions and begins to train clinical nurses, public health nurses
& midwives.
 However this fragmented form of training is not appreciated by most
faculty members of the respective institutions.

The history of Nursing in Ethiopia
In 1950s the Ethiopian Nurses Association (ENA) was established,
which became a member of the International Council of Nurses
(ICN) in 1957 (Ali, 2011).
One of ENA’s key goals is working with the HIV/AIDS program in
Ethiopia while providing nursing leadership and regulation.
Currently, nurses are the largest health care workforce in Ethiopia
and they hold various positions such as researchers, educators,
clinicians and managers.

The history of Nursing in Ethiopia
In primary health care centers, physicians have been replaced
by nurses and they are primarily responsible for health
promotion, prevention, and cure and also for providing
rehabilitation services (Ali, 2011).
They also play an active role in the prevention and care of
HIV/AIDS through counselling, supervision and research.

The history of Nursing in Ethiopia
 Some of the challenges faced by ENA include lack of standards for
clinical practice, the inability to self-regulate, lack of integration
between clinical practice and education and limited opportunities for
continuing education. (Ali, 2011)
 ENA's recent activities have focused on building its organizational
structure, governance and membership, advocating for professional
regulation and improving nursing pre- and in-service education (CNA,
2014).

The history of Nursing in Ethiopia
An additional higher health professional training institution was
also established in Jimma(1983) to train health professionals
using educational philosophy of community based and team
approach.
A remarkable event to be mentioned in the history of nursing in
Ethiopia is the launching of post basic baccalaureate program
in nursing in1994 in the former Jimma institute of health
science (now Jimma University).

The history of Nursing in Ethiopia
At present, there are a number of governments owned and NGO and
private owned Universities/schools/Colleges offering nursing
education in the country in Level II, IV, BSc, MSc and Ph.D. level.
At the end of the training period, regional health bureau of respective
region registered and licensed them to practice the profession in the
country through the health professionals' council and COC exam.

Nursing as a profession rather than occupation
Nursing is a profession.
 A profession is a calling that requires special knowledge and skilled
preparation.
 A profession is generally distinguished from other kinds of occupation
by:
a) Its requirement of prolonged specialized training acquiring a body of
knowledge pertinent to the role to be performed and
b) An orientation of the individual to ward service, either to community
or organization.

Nursing as a profession rather than occupation
 Profession is defined as "a vocation requiring advanced training and
usually involving mental rather than manual work, as teaching,
engineering, especially medicine, law“
 Professions are those occupations possessing a particular
combination of characteristics generally considered to be the
expertise, autonomy, commitment, and responsibility.
 A profession is an occupation based on specialized intellectual study
and training, the purpose of which is to supply skilled services with
ethical components and others.

Nursing as a profession rather than occupation
Criteria of a profession
Professional status is achieved when an occupation involves practice
A profession carries great individual responsibility and based up on
theoretical Knowledge.
The privilege to practice is granted only after the individual was
completed a standardized program of highly specialized education
and has demonstrated an ability to meet the standards for practice.

Nursing as a profession rather than occupation
The body of specialized knowledge is continually developed and
Evaluated through research.
The members are self organized and collectively assume the
responsibility of establishing standards for education and practice.
Professional Development
Professional development in Nursing can be viewed in relation
to specialized education, Knowledge base, Ethics, and autonomy.

Comparison between Profession and occupation
Occupation Profession
• Training may occur on job • Education takes place in College and
university
• Length of training varies • Education is definite and prolonged
• Value, beliefs and Ethics are not
features of preparation
• Value beliefs, and Ethics are integral
preparation
• Commitment & personal identification
strong
• Commitment & personal Identification
vary
• Works are autonomous • Works are supervised
• People unlikely to change jobs • Peoples often change Jobs
• Accountability rests with individual • Accountability rests with employees

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