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Chapter 7How Practical/Vocational Nursing

Evolved




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Chapter 7Lesson 7.1




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Learning Objectives

• Describe the role of self-definedpractical nurses throughout history

• Discuss four major events thatinfluenced changes in practical nursing

• Identify the year and place the first

school of practical nursing was founded




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Self-proclaimed Nurse

• Those who, from the beginning of time,chose to care for individuals who were

ill, injured, dying, or having babies• Most often the individual doing this work

was someone who seemed to have a

“gift” or “touch” for helping others duringa medical crisis




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Early Practical NurseTraining Programs

• Carefully limited teaching to thosethings that would be known by a good

homemaker or a competent maid• Training included information that would

in no way compete with that of the

physicians of the time




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Modern Practical Nurses

• Two major changes – A gradual increase in the required formal

knowledge base

– A requirement for licensing to practice practicalnursing

• Taught basic skills during the educationalprogram

• After licensing, the LPN/LVN is permitted toperform complex nursing skills, as delegatedby the registered nurse (RN) and allowed bythe nurse practice act


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Why Learn about NursingHistory?

• Reading nursing history helps you seeyour place among the many centuries of

women and men who have given care,relief, and support to the sick

• Knowing about the changes that

occurred in nursing, you will be ready tobetter understand and adapt to changesin the future



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Nursing in Ancient Cultures

Ancient Egypt • No direct evidence exists of nursing in Egypt

• Written records of procedures used in ancient Egyptwere probably those of the male attendants whoassisted the priests in caring for the ill

• Egyptian physicians were considered skillful at

treating fractures• The custom of embalming enabled the Egyptians to

become well acquainted with organs of the body



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Babylonians• Intellectually, socially, and scientifically well

developed• Many wars brought them misery, illness, and

injury

• There is evidence of some kind of medical

and nursing service• The men dominated women and men did the

primary care of those who were sick andinjured



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Ancient Hebrews

• Illness and misfortune were blamed on God’s

wrath according to the Old Testament andTalmud

• They had houses for the sick and homes forthe aged, and began many practices of

personal hygiene and public sanitation• Combined health and dietary practices

according to religious beliefs



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Ancient Greece• Hippocrates

– The “father of modern medicine” – Translated teachings that were once the secrets of priests

into a textbook of medicine

– Introduced patient-centered care, medical ethics, a methodof assessment, and a system of observing symptoms andapplying carefully reasoned principles to care

• Temples were built for restoration of health

• Priestesses served as attendants to care forthe sick



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Nursing in Early and MiddleAges

Age of Christianity

(1st to 5th Centuries)

• Rome established military hospitals; relativesand friends did much of the practical nursingof the day

• As Christianity grew, nursing developed as a

form of Christian charity• Christian nurses, including both men and

women, cared for members of their own sex



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Dark Ages and Middle Ages

(476 –1000 AD and 1000 –1475 AD)

• Both men and women were involved innursing

• Female religious orders took care of the sickand poor, and male orders served on the

battlefield• The Knights Hospitalers was an interesting

group of monks: a military order trained tofight as well as tend the sick and wounded



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The Renaissance (1400-1600 AD)

• A time for rebirth of learning

– The information of the ancient Greeks andRomans was sought and put to use

• The disciplines of anatomy, physiology, andscientific healing were developed

• It was a cruel age marked by neglect of thepoor, homeless, and ill



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17th and 18th Centuries

• Hospital care did not exist in the North

American colonies• Family members cared for those who became

ill

• Untrained persons, and those in a fewreligious orders, did nursing

• First hospital in America built in Philadelphia




Nursing duringIndustrialization

• Increase in diseases

– Movement of people to cities

– Unhealthy working conditions – Child labor

– Overcrowding

– Unhygienic conditions in hospitals

• Ignaz Philipp Semmelweis

– A Hungarian obstetrician, first developed and usedantiseptic methods in 1847




Nursing in the19th Century

• Overcrowded, dirty, unventilatedhospital wards

• Nursing was an inferior, undesirableoccupation

• Lay people, often criminals and widows,

replaced religious nursing attendants• Drinking on duty and accepting bribeswas common




Growth of Practical Nursing

• First School of Nursing founded in1836

• Kaiserswerth Deaconess Institute in

Germany

• Most famous pupil of this school wasFlorence Nightingale




Growth of Nursing:Florence Nightingale

• Born in Florence, Italy (1820-1910)

• Graduated from Kaiserswerth Deaconess

Institute• Became superintendent of The Institution for

the Care of Sick Gentlewomen in DistressedCircumstances in London

• Appointed to the task of organization andsupervision of nurses during the CrimeanWar

• Became known as “The Lady with the Lamp”




Growth of Nursing:Florence Nightingale

• First Nightingale Training School ofNursing in England (1860)

• Strict admission standards thatemphasized high moral character andintelligence

• Graduates went to work in far-off places




Learning Objectives

• Identify the year and place the firstschool of practical nursing was founded

• Name the year in which licensing forpractical nursing first began

• Present the rationale for your personal

stand on entry into nursing practice




Growth of Nursing in America

• 1849: First hospital and nursing schoolestablished in Pennsylvania

• 1861-1865: Civil War

• 1881: First chapter of American RedCross established

• 1892: First school of practical Nursingfounded in United States




Growth of Nursing in America

• Home nursing before World War I

• Practical nurses also assumed the role

of midwife

• Move toward public health nursing in19th century

– Henry Street Settlement

– Lillian Wald




Growth of Nursing in America:20th Century

• Monitoring of practical nursing by statesbegan (1903)

• National League of Nursing Education – Developed a nationwide system of

standardization of nursing requirements for

practical nursing• Mississippi: First state to require

licensure for practical nurses





• World War I

• Smith Hughes Act of 1917

• Depression of the 1930s

• World War II





• First licensing of practical nurses (1914)

• Practical nursing responsibilities increase

after World War II• Practical nursing duties outlined (1944)

• Joint Committee on Practical Nurses andAuxiliary Workers in Nursing Services

recommended use of the title “licensedpractical nurse” (1949)

• The committee differentiated between thetasks of the RN and the LPN





• Public Law 911 (1956)

• American Nurse’s Association recommends

4-year collegiate RN and 2-year technicalLPN programs (1965)

• Unlicensed assistive personnel hired forpatient care (1990s)

• First computerized adaptive testingintroduced in 1994 (NCLEX-PN® Examination)



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“Entry into Practice” Issues

• Nursing shortage: concern for patientsafety

• Differences between RNs and LPNs

• Most appropriate entry educationallevel: ADN, BSN, or MSN?

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