The Study of Nursing History 2 Reflections

CHAPTER© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION ReflectionsNOT FOR SALE OR DISTRIBUTION

2 Deborah Judd © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE ORPast–1800 DISTRIBUTION Nurses are generally male or are sisters NOTin a religious FOR order SALE OR DISTRIBUTION 1500–1800 Hospitals are associated with religious organizations

1543 Andreas Vesalius© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC revolutionizesNOT study FOR of SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION human anatomy and dissection

© Jones &1600 Bartlett 1610 Learning, 1620 LLC1630 1640 1650 ©1660 Jones 1670& Bartlett 1680 Learning, 1690 LLC NOT FOR SALE1600–1800 OR DISTRIBUTIONNo formally trained nurses, but people in nursing roles include:NOT FOR SALE OR DISTRIBUTION • Orderlies in mental hospitals • Lay midwives • Wetnurses • Servitude caregivers © Jones & Bartlett Learning, LLC• Monks and sisters © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1660–1800 • Significant bouts of infectious disease due to a lack of understanding of sanitation • Unhealthy individuals are cared for and die at home

1600–1850 Pesthouses and poorhouses are places for the sick to go to be isolated from the public © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1618–1643 William Harvey studies and describes circulation

1618–1648 Thirty Years’ War in Europe

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION OUR NURSING HERITAGE: KEY PEOPLE Ancient civilizations contributed to health knowledge; while there were key people involved, in most cases we focus on key groups of people. Their ideas contributed to health care despite the © Jonesscientific & Bartlett limitations Learning, of the time. LLCThese notions influence health© care Jones even into & theBartlett 21st century. Learning, LLC NOT FOREarly SALECivilization OR DISTRIBUTIONIllness associated with evil NOT FOR SALE OR DISTRIBUTION Gods determine life course/experiences Healing as an art: only certain individuals entitled to serve Community or family involved in rituals © Jones & Bartlett Learning,Ancient Egyptian LLC Priests viewed© Jones as healers & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Practice ofNOT mummification FOR SALE and ORdeath DISTRIBUTION rituals Organs separated from body and preserved Dental health a concern Sophisticated procedures done with limited technology Far Eastern© Jones & Bartlett ConceptLearning, of yin LLC and yang © Jones & Bartlett Learning, LLC NOT FOR SALE OREnergy DISTRIBUTION work NOT FOR SALE OR DISTRIBUTION Acupuncture Use of herbal medicines Islamic Concept that evil causes disease and suffering © Jones & Bartlett Learning, LLCPrinciples based on Galen’s© and Jones Hippocrates’s & Bartlett application Learning, LLC NOT FOR SALE OR DISTRIBUTIONof the Four Humors to medicineNOT FOR SALE OR DISTRIBUTION Canon of medicine Noted minor differences in infectious diseases Chemistry advances: instillation, sublimation for © Jones & Bartlett Learning, LLC medicines© Jones & Bartlett Learning, LLC NOT FOR SALE ORGrecian DISTRIBUTION AesculapiusNOT and FOR three of SALE his daughters: OR DISTRIBUTION Hygeia, Meditrina, and Panacea Aristotle: heart as the soul of body, vessels from heart Galen’s concept of human anatomy © Jones & Bartlett LinkedLearning, Empedocles LLC to Four Humors, applied ©to medicineJones & Bartlett Learning, LLC NOT FOR SALE ORHippocrates: DISTRIBUTION father of medicine NOT FOR SALE OR DISTRIBUTION Roman Practices derived from Greek, Galen’s influence Wealthy entitled to medical care, poor are not Medieval Cultures Emergence of hospitals: mostly for the poor, chronically ill © Jones & Bartlett Learning, LLCLay caregivers, both male and© Jonesfemale & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Determining What a Nurse Is 11

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Each chapterNOT FOR in this SALE book OR will DISTRIBUTION connect NOT FOR SALE OR DISTRIBUTION nursing heritage events, key people, trends, and historical happenings to nursing in the United States from early colonial days © Jonesto & the Bartlett present Learning,time. Basic information LLC on © Jones & Bartlett Learning, LLC NOT FORearly SALE civilizations OR DISTRIBUTION and cultures prior to NOT FOR SALE OR DISTRIBUTION the migration of colonial settlers to the New World is briefly examined, providing opportunity to discover significant groups of people who have influenced aspects of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the nursing and medical profession as we ◆◆ Departure of the Pilgrim Fathers from Delft Haven, 1620 NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION know it today. Many nameless individuals followed their conscience to freedom and the opportunity for self and others. America was founded on ethical and moral principles ensuring superlative “life, liberty, and happiness,” albeit not without sacrifice, patience, dili- gence, ©suffering, Jones and& Bartlettinequality. Learning, LLC © Jones & Bartlett Learning, LLC ImageryNOT andFOR Historical SALE HappeningsOR DISTRIBUTION allow for particular individual experiencesNOT FOR to aug SALE- OR DISTRIBUTION ment the relevant historical trend or concept discussion. Timelines in Chapters 4 through 12 provide visual maps for key events; key people and their accomplishments are also briefly outlined at the beginning of these chapters. Topics for further exploration, discussion ques- © Jonestions, & Bartlett book lists, Learning, and suggested LLC key words/phrases for Internet© Jones exploration & Bartlett are provided Learning, at LLC NOT FORthe SALE end of the OR chapters DISTRIBUTION to support and stimulate further studyNOT where FOR time SALE and interest OR permit.DISTRIBUTION The current chapter offers insights on what a nurse might be, presents ideas on nursing historical inquiry and outcomes, offers acumens on how to initiate and complete historical investigation, and identifies possibilities for information acquisition with focus on use of the © Jones & Bartlett Learning,Internet for LLCcollaborative research endeavors.© Jones The information & Bartlett and Learning,“dialogues” of LLC this history NOT FOR SALE OR DISTRIBUTIONbook should facilitate a better understandingNOT of FORthe heritage SALE of AmericanOR DISTRIBUTION nurses.

Determining What a Nurse Is The term© Jones nurse has& Bartlett evolved Learning,over the centuries. LLC Donahue (1996) describes© nursing Jones activi & Bartlett- Learning, LLC ties as NOThaving FOR existed SALE since theOR dawn DISTRIBUTION of civilization and, although closely NOTassociated FOR with SALE OR DISTRIBUTION medicine, caretaking or nursing actually antecedes it:

The oldest of arts and the youngest of professions . . . it has gone through many stages and has been an integral part of societal movements. . . . The history of nursing has been one of © Jones & Bartlettfrustration, Learning, ignorance and LLC misunderstanding . . . . It is a© great Jones epic involving& Bartlett trials Learning, and tri- LLC NOT FOR SALEumphs, OR romance DISTRIBUTION and adventure . . . . It is the story of anNOT occupational FOR SALE group whoseOR DISTRIBUTION status

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC has alwaysNOT been FOR affected SALE by ORthe prevalent DISTRIBUTION standards of NOT FOR SALE OR DISTRIBUTION humanity. The great turning points in world progress have also been important turning points in nursing. . . . In any context concerning the genesis of nursing, there is considerable content that refers to the history of nursing © Jones &as anBartlett episode Learning,in the history LLCof women. . . . The fullest © Jones & Bartlett Learning, LLC NOT FORdevelopment SALE OR of DISTRIBUTIONnursing was not possible [or realized] NOT FOR SALE OR DISTRIBUTION without education and knowledge of the social conditions and needs of the day. (p. 2–3)

Today when the word nurse is spoken, it may imply © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC many different things. It might refer to a registered nurse NOT FOR SALE ORor DISTRIBUTIONan advanced practice nurse, but all too oftenNOT it is aFOR term SALE OR DISTRIBUTION that describes “some other” healthcare worker. It is not uncommon for an individual to call a medical office and speak with “the nurse,” who in actuality is often a medical assistant (MA) or certified nurse assistant (CNA).© Jones The &word Bartlett “nurse” Learning,is derived from LLC the Latin “nutrire,” meaning© to Jones nourish. & It Bartlett Learning, LLC originatesNOT from aFOR Latin SALE noun “nutrix,” OR DISTRIBUTION which is defined as nursing mother. In NOTearly erasFOR this SALE OR DISTRIBUTION noun described women who were wet nurses—females having the ability to nourish infants at the breast, a natural female activity necessary to ensure better survival. In a time when sanitation and infection were little understood, both were significant causes of maternal and © Jonesinfant & morbidityBartlett andLearning, mortality. LLCThe wet nurse noun, “nourrice,”© Jones is an Old & FrenchBartlett idiom Learning, that LLC NOT FORrefers SALEto a woman OR who DISTRIBUTION suckles a child; it is very similar to the MiddleNOT FOREnglish SALE word “nutrix” OR DISTRIBUTION or “nutricis’’ and the Latin root designation “nutrire.” The original English words were nouns and described an individual rather than an activity, but in the mid-1500s the term became a verb and eventually described someone who took care of the sick. Since then, the word “nurse” has © Jones & Bartlett evolvedLearning, to mean LLC a caretaker of the sick who© has Jones opportunities & Bartlett and responsibilities Learning, LLCvery dif- NOT FOR SALE ORferent DISTRIBUTION than in previous centuries (Online EtymologyNOT FOR Dictionary, SALE 2012). OR DISTRIBUTION Within the profession we use the term nurse to describe nurses who are licensed as (a) registered nurses (RNs), (b) practical nurses © Jones & Bartlett Learning,(LPNs), LLC and/or (c) vocational nurses© Jones (LVNs). & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONIn general, the LVN and LPN haveNOT the FORability SALE OR DISTRIBUTION to perform most tasks and skills that a RN can; the actual roles of these specific nurses are dependent on the nurse practice act of © Jones & Bartlett Learning, LLC the state where© they Jones practice & Bartlettas well as Learning,their LLC NOT FOR SALE OR DISTRIBUTION national certificationNOT level.FOR LVNs/LPNsSALE OR usually DISTRIBUTION

Determining What a Nurse Is 13

Those who could heal for reasons unknown were often little acknowl- © Jones &edged Bartlett or understood. Learning, Because LLC most © Jones & Bartlett Learning, LLC NOT FOR believedSALE ORonly DISTRIBUTIONGod could heal, nur- NOT FOR SALE OR DISTRIBUTION turers and healers were shunned, punished, or even put to death. Many, mostly women healers, were labeled © Jones & Bartlett Learning,witches, aLLC label generally connoting © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONan “evil” individual with powers that NOT FOR SALE OR DISTRIBUTION harmed rather than healed. Despite this prevailing belief, in other cultures witches were considered healers, as were© sorcerers; Jones witches& Bartlett had no Learning, physical tools, LLC so their ability to heal appeared© Jones to come & Bartlett Learning, LLC fromNOT intangible FOR inner SALE strength. OR uDISTRIBUTION NOT FOR SALE OR DISTRIBUTION

are more task-oriented than their collaborative peer, the RN, who has additional educational © Jonesexpertise & Bartlett in assessment, Learning, critical LLC thinking, pharmacology, ©and Jones infusion & therapy.Bartlett Of Learning, course, LLC NOT FORwhat SALE is obvious OR DISTRIBUTIONis the length of education and clinical instructiveNOT FOR experience; SALE each OR levelDISTRIBUTION of nursing has specific, legally defined roles and responsibilities. Many believe “a nurse is a nurse is a nurse.” How might the 2010 Institute of Medicine (IOM) recommendations that 80% of RNs are baccalaureate (BSN) prepared by 2020, affect this discussion of what a nurse is and the future of nursing? © Jones & Bartlett Learning,In 1893, LLC Lystra Gretter, an American nursing© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONinstructor, scripted what is known as theNOT Night -FOR SALE OR DISTRIBUTION ingale Pledge. It was based on what she knew about nursing from Florence Nightingale and other nurse leaders of the period and reflected her knowledge© Jones of the & HippocraticBartlett Learning, Oath. The title LLC © Jones & Bartlett Learning, LLC reflectsNOT the respectFOR SALE nurses ORhad for DISTRIBUTION Nightingale, NOT FOR SALE OR DISTRIBUTION yet it should be noted that it was not authored by Florence Nightingale herself. TheOath of Hip- pocrates influenced Gretter’s conception of this © Jonesnursing & Bartlett vow and Learning, was an explanation LLC of nursing © Jones & Bartlett Learning, LLC ◆◆ A Universal Symbol of Care NOT FORcare SALE and duty OR in DISTRIBUTIONthat era. NOT FOR SALE OR DISTRIBUTION

14 chapter 2 u Reflections

A blog posting at allnurses.com (2012) discussed: What is the difference between the RN and the LPN? The majority of responders were LPNs who were continuing their edu- © Jonescation, & Bartlett and some Learning, had worked LLC for a long time in the LPN/LVN© Jones role. Pay & variances Bartlett were Learning, LLC NOT FORdiscussed SALE as OR well DISTRIBUTIONas practice responsibilities. This is what nursesNOT believe FOR theSALE differences OR DISTRIBUTION might be: 1. Many LPNs/LVNs work in extended care facilities or rural areas. 2. LPNs/LVNs cannot do an initial patient assessment or develop the patient care plan. © Jones & Bartlett Learning,3. LVNs/LPNs LLC will not hang the first bag of© IV Jonesblood and & they Bartlett do not Learning,do any IV push LLC meds. NOT FOR SALE OR 4.DISTRIBUTION Someone suggested the following analogy:NOT The FOR difference SALE between OR DISTRIBUTION a LPN and a RN is the equivalent of the difference between an enlisted service member and an officer. 5. Despite the differences in degree and education, there is no appreciable difference in cognitive skills, competency, or proficiency in the workplace. 6. All RNs© Jonesneed to show& Bartlett respect forLearning, one another, LLC work collaboratively rather than© Jones antag- & Bartlett Learning, LLC onistically,NOT FORand represent SALE theOR caring DISTRIBUTION profession responsibly within theirNOT individual FOR SALE OR DISTRIBUTION scope of practice. A similar discussion might be debated as entry educational level of the RN (associate versus baccalaureate) is considered. u © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The pledge was based on prevailing Christian beliefs and suggested the nurse’s obliga- tion to self, the profession, and society while describing the devotion nurses should have to the physician and his work. The pledge itself is grounded in the “practice of ‘swearing in’ a © Jones & Bartlett memberLearning, of a guild LLC or profession [based upon© professionalJones & Bartletttenets] . . . it Learning, is still continued LLC as NOT FOR SALE ORa traditionDISTRIBUTION in some professional schools [today]”NOT (The FOR “Nightingale SALE OR Pledge”, DISTRIBUTION n.d.). Currently there has been a trend to not celebrate nursing graduate accomplishments with a ceremony involving the Nightingale Pledge and/or School of Nursing pin. The tradition of “capping” was changed in an earlier era, and it will be interesting to see if these movements continue into the future.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC The NOTNightingale FOR Pledge SALE is asOR follows: DISTRIBUTION NOT FOR SALE OR DISTRIBUTION I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my © Jones &power Bartlett to maintain Learning, and elevate LLC the standard of my profession,© andJones will hold & Bartlett in confidence Learning, all LLC NOT FORpersonal SALE matters OR DISTRIBUTION committed to my keeping and all family affairsNOT coming FOR to SALE my knowledge OR DISTRIBUTION in

Determining What a Nurse Is 15

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC theNOT practice FOR of my SALE calling. ORWith DISTRIBUTIONloyalty will I endeavor NOT FOR SALE OR DISTRIBUTION to aid the physician, in his work, and devote myself to the welfare of those committed to my care. (American Nurses Association [ANA], 2012, para. 2)

© Jones & BartlettKuhse (1997) Learning, describes LLCcaring as central to all © Jones & Bartlett Learning, LLC NOT FORhuman SALE existence, OR DISTRIBUTION but at the same time, it is a concept NOT FOR SALE OR DISTRIBUTION that is often indefinable with words:

“Cura” (care) is a language term of antiquity and can describe two very different ideas: on the one hand, it © Jones & Bartlett Learning,[has the LLC connotation of] worry, trouble,© anxietyJones and & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONpersonal inclination—an emotional response;NOT FORon the SALE OR DISTRIBUTION other, it had connotations of providing for—of doing for the other . . . caring not only [connotes] concern, compassion, worry, anxiety and burden; there are ◆◆ Nightingale Pledge also strong connotations of inclination, fondness and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC affection; of commitment to a person, an ideal or a cause; . . . ofNOT FOR carefulness, SALE that OR is, DISTRIBUTIONof attention to detail, of responding sensitivelyNOT to the FOR situation SALE OR DISTRIBUTION of the other; . . . of looking after or providing for the other. (p. 145)

For the nursing profession today, these associated terms still have relevance and reflect © Jonesboth & Bartlett the art and Learning, science of how LLC efficient, professional nurses© Jonescare. Jean & WatsonBartlett (1985) Learning, defined LLC NOT FORa nurse’s SALE work OR as DISTRIBUTION transpersonal caring that demands “the nurseNOT is FOR able toSALE form a OR union DISTRIBUTION with the other person on a level that transcends the physical . . . [ensuring] there is a freeing of both persons from their separation and isolation” during a health event (p. 66). Nursing is a profession associated with caring; © Jones & Bartlett Learning, LLC nurses© Jones should ¬ Bartlett only be concernedLearning, with LLC the tasks NOT FOR SALE OR DISTRIBUTION and/orNOT skills FOR needed SALE by the OR individual DISTRIBUTION client, but also with a moral ideal that ensures desired or anticipated goals. Caring behaviors assist in the enhancement and protection of individual human dignity and eliminate © Jones & Bartlett Learning,the patient LLC as an object of care. It is© importantJones & for Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONnurses today (individually and collectively)NOT FORto appre SALE- OR DISTRIBUTION ciate how the concept of caring influences personal perception of the nursing profession and how it per- suades societal conception of the profession. Most © Jones & Bartlett Learning, LLC people honestly do not© Jones understand & Bartlett what a nurse Learning, is or LLC NOT FOR SALE OR DISTRIBUTION what a nurse does toNOT accurately FOR care.SALE Our OR image DISTRIBUTION and

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Virginia Henderson (1960) concludes the following about the nurse’s role and caring. Her theory of nursing delineates 14 basic needs that require attention for a person to heal © Jonesand & toBartlett be healthy: Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE “The nurse’s OR DISTRIBUTIONbasic care is the same whether the patientNOT is considered FOR SALE physically OR or DISTRIBUTION mentally ill. In fact the two cannot be separated for emotion has a physical effect and physical changes affect the state of mind” (p. 17). “Basic nursing care is designed as a guide for the midwife attending a healthy © Jones & Bartlett Learning,mother, a nurse LLC in a psychiatric service, where© Jones many &patients Bartlett are physically Learning, capable LLC of NOT FOR SALE OR selfDISTRIBUTION care, and a nurse in a unit for major surgeryNOT FOR where SALE patients OR are, DISTRIBUTIONat least for a brief period, extremely dependent physically” (p. 19). “Not only is the nurse’s role said to change from one decade to another, but to vary with the situation . . . the nurse may be forced to assume the role of physician, social worker,© physical Jones therapist, & Bartlett sometimes Learning, functioning LLC as a cook or plumber in order© toJones supply & Bartlett Learning, LLC the patient’sNOT obvious FOR SALEneed” (pp. OR 20–21). DISTRIBUTION NOT FOR SALE OR DISTRIBUTION “[T]he nursing needed by the individual is affected by age, cultural background, emotional balance and the patient’s physical and intellectual capacities. All of these should be considered in the nurse’s evaluation” (p. 31). © Jones & “TheBartlett unique Learning, function of the LLC nurse is to assist the individual,© Jones sick or well, & Bartlett in the perfor Learning,- LLC NOT FORmance SALE of activities OR DISTRIBUTION [interventions] contributing to health ofNOT its recovery FOR (or SALE to a peaceful OR DISTRIBUTION death)” (p. 22). Henderson assumes that these caring interventions are based upon standardized cognitive and technical skills, which each individual nurse utilizes in an artful and scientific manner. u © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

identity suffer immensely because we have not fully understood or studied the history of our profession and the effect the past has on our future. Jo Ann Ashley (1976) believed that nursing’s identity© Jones was misunderstood & Bartlett because Learning, nurses LLC did not take the time to wholly© Jones study and & Bartlett Learning, LLC comprehendNOT historical FOR eventsSALE in OR our DISTRIBUTIONpast. Nursing’s challenge then might be toNOT establish FOR an SALE OR DISTRIBUTION identity that eliminates aspects of inferiority associated with gendered care and elevates the profession based on the moral nature of caring and the attentiveness nurses provide through evidence-based practice. Relationships are the essence of care provided in “the moment.” © Jones &Koloroutis Bartlett (2004) Learning, has developed LLC a model of caring for ©nurses Jones and &organizations. Bartlett Learning, It is LLC NOT FORbased SALE upon the OR assumption DISTRIBUTION that caring relationships significantlyNOT FOR impact SALE nurse–patient OR DISTRIBUTION

Finding a Better Way: Historical Observations and Outcomes 17

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC outcomes.NOT “The FOR nurse–patient SALE OR relationship DISTRIBUTION is the cornerstone of ProfessionalNOT Nursing FOR Prac SALE- OR DISTRIBUTION tice . . . Nurses voice a fierce commitment to the values of caring, advocacy, collaboration, safety, and seeking what is in the best interest of patients and families they serve” (p. 117). In addition, “an important condition for promoting the nurse–patient relationship is to under- © Jonesstand & Bartlett the nature Learning, and scope ofLLC nursing . . . A profession is© characterized Jones & Bartlett by extended Learning, edu- LLC NOT FORcational SALE preparation, OR DISTRIBUTION a well-defined body of knowledge andNOT specialized FOR SALE skills uniqueOR DISTRIBUTION to the professional role” (Koloroutis, p. 122). Today nurses practice in three realms: 1. Delegated practice [when] the nurse carries out entrusted function [using] his or her © Jones & Bartlett Learning,knowledge, LLC experience, and judgment© Jonesto confirm & . . . Bartlettthe order Learning, is appropriate LLC and safe NOT FOR SALE OR DISTRIBUTION2. Independent practice [when nurses NOTassess FORand intervene] SALE forOR the DISTRIBUTION purpose of promoting health and healing. Focus is on the patient’s response to actual or potential problems 3. Interdependent practice [comprises] nurse initiated communication with other members of the healthcare team to assure [that] the full scope of interdisciplinary expertise and© Jonesservices . . . & Bartlettcoordinate Learning, and integrate LLC with the plan of care. (Koloroutis,© Jones 2004, & pp. Bartlett Learning, LLC 124–125)NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Finding a Better Way: Historical Observations © Jonesand & Bartlett Outcomes Learning, LLC © Jones & Bartlett Learning, LLC NOT FORThe SALE future OR of DISTRIBUTION nursing is dependent upon the belief NOTthat no FOR nurse SALE walks alone—there OR DISTRIBUTION is always a nurse who has walked before and subsequently there will continually be a nurse that follows. A nurse is always present in his or her scope of practice and the context of care. During each era of American nursing, the nursing practice environment is described in © Jones & Bartlett Learning,relation to oneLLC of seven concept trends and© Jones an assumption & Bartlett is made Learning, that the progression LLC of NOT FOR SALE OR DISTRIBUTIONnursing embraces our professional diversityNOT of FORgender, SALE generation, OR culture/tradition,DISTRIBUTION creed, ethnicity, sexual orientation, and sociopolitical affiliation. Dock and Stewart (1925) suggest that nurses initiate and advance “higher degrees of consideration for those who are helpless or oppressed, kindliness and sympathy for the unfortunate and for those who suffer, toler- ance for© those Jones of differing & Bartlett religion, Learning, race, color, LLC etc.—all tend to promote activities© Jones which & areBartlett Learning, LLC primarilyNOT humanitarian” FOR SALE (p. 3). OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION With the surge of academic research during the 1940s, it was determined that advance- ments and developments in medicine and health care might be diminishing professional aspects of nursing: The need for research was determined as an essential solution to gen- © Joneserate & Bartlett new knowledge Learning, and substantiate LLC the work of nurses and© Jones their ability & Bartlett to provide Learning, the best LLC NOT FORcare SALE for society. OR DISTRIBUTIONThis history of nursing includes conceptsNOT about FOR “nursing SALE practice, OR DISTRIBUTIONnursing

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONservices, nursing service administration,NOT FOR SALE OR DISTRIBUTION nursing education, and the individual nurse” on the quality and access to health care throughout the heritage of America © Jones & Bartlett Learning, LLC (Kalisch & Kalisch,© Jones 2004, & p.Bartlett 385). Nursing Learning, LLC NOT FOR SALE OR DISTRIBUTION professionalismNOT has FOR evolved SALE from aOR process DISTRIBUTION of basic housekeeping, sanitation, nutri- tion, nurturing, and/or personal care to a complex process of technical and cognitive skills interwoven with the art of compas- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC sion and the science of evidence-based NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION practice based on a variety of knowing ways. Nursing research can be seen from the historical perspective as well as a quantitative or qualitative one. This trend- and era-based text approaches nursing practice based on historical events and the progression of the profession as shaped by those circumstances and experiences.© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC FlorenceNOT Nightingale FOR SALE is a name OR that DISTRIBUTION many associate with the phrase “pioneerNOT of modern FOR SALE OR DISTRIBUTION nursing.” Nightingale used observation to identify problem areas in patient care during the Crimean War; she recognized possible solutions and eventually ascertained if those solutions were feasible and effective (in effect, performed research). Many other individuals have done © Jonesas she & did,Bartlett recording Learning, their findings LLC in journals and notes for those© Jones who might & Bartlettsomeday needLearning, or LLC NOT FORwant toSALE know whatOR DISTRIBUTIONthey thought or discovered. Ideas and experimentationNOT FOR SALEled to interesting OR DISTRIBUTION and useful philosophies/techniques that advanced medicine generally and helped define nursing practice specifically. Today, registered nurses (RNs) utilize the nursing process in clinical settings; it © Jones & Bartlett isLearning, actually a method LLC of deduction and reasoning© Jones which & Bartlett Learning, LLC NOT FOR SALE ORcan DISTRIBUTION lead RNs to improve practice through dailyNOT nursing FOR SALE OR DISTRIBUTION observation, intervention, and witnessed outcome(s). Nightingale was an innovator as well as an early nurse researcher. Many of her ideas about nursing then have become© Jones part of nursing & Bartlett now. Her Learning, journals eventually LLC © Jones & Bartlett Learning, LLC became knownNOT as FOR Notes SALE on Nursing: OR WhatDISTRIBUTION It Is and What NOT FOR SALE OR DISTRIBUTION It Is Not (the 1946 publication was officially a facsimile of her 1860 publication). As you review some of her notes in the Historical Happenings section, contemplate how © Jonesmany & ofBartlett her original Learning, thoughts, beliefs,LLC and positions have © Jones & Bartlett Learning, LLC NOT FORbeen incorporatedSALE OR intoDISTRIBUTION our nursing practice today. NOT FOR SALE OR DISTRIBUTION

Finding a Better Way: Historical Observations and Outcomes 19

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC EarlyNOT civilizations FOR SALE and peoplesOR DISTRIBUTION have relatively little NOT FOR SALE OR DISTRIBUTION or no documentation about the actual work of medical workers—physicians, midwifes, nurses, or healers. Much of what we now understand as their work is the result of © Joneshistorical & Bartlett research Learning, and study LLC in the fields of sociology,© Jones & Bartlett Learning, LLC NOT FORanthropology, SALE OR and DISTRIBUTION archeology. Schmidt and Brown (2012) NOT FOR SALE OR DISTRIBUTION describe historical research as a process of “examining events or people to explain and understand the past to guide the present and future” (p. 197). In essence, past lived experiences generate relevancy and meaning to nurses © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC today; they are considered lessons from the past, but how NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION have they determined the future of nursing? For historical research, multiple ideas and questions could be generated; for the most part, however, individuals or groups of people are identified who either witnessed the events or were ◆◆ Florence Nightingale reliable© historians Jones &of Bartlettthe events Learning, communicated LLC to them © Jones & Bartlett Learning, LLC (SchmidtNOT & Brown,FOR SALE2012, pp. OR 206–207). DISTRIBUTION Most historical NOT FOR SALE OR DISTRIBUTION research tells a story based on distinct circumstances or situations with a premise based on one specific question. This current historical work is a compilation of many stories and situations, resulting in a historiography on the topic of American nursing; it encompasses many © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

20 chapter 2 u Reflections

Florence Nightingale (1860) wrote: The following notes are by no means intended as a rule of thought by which nurses can © Jones & teachBartlett themselves Learning, to nurse, stillLLC less as a manual to teach nurses© toJones nurse. They & Bartlett are meant Learning, LLC NOT FOR SALEsimply to OR give DISTRIBUTION hints for thought to women who have personalNOT charge FOR of the SALE health ORof DISTRIBUTION others . . . If, then every women must, at some time or other of her life, become a nurse, i.e., have charge of somebody’s health, how immense and how valuable would be the produce of her united experience if every women would think how to nurse. (preface) 1. Disease as reparative process: “It is an effort of nature to remedy a process of poi- © Jones & Bartlett Learning,soning LLC or of decay, which has taken place© Jones weeks, months,& Bartlett sometimes Learning, years before LLC- NOT FOR SALE OR DISTRIBUTIONhand, unnoticed” (p. 5). NOT FOR SALE OR DISTRIBUTION 2. Disease suffering: “The symptoms generally considered to be inevitable and incident to the very disease are very often not the symptoms of the disease at all, but of something quite different—of the want of fresh air, or of light, or of warmth, or of quiet, or of cleanliness, or of punctuality and care in the administration of diet, of ©each Jones or of all & of Bartlett these” (p. 5). Learning, LLC © Jones & Bartlett Learning, LLC 3. Nursing little understood: “It has been said that every woman makes a good nurse. I NOTbelieve FOR on the SALE contrary, OR that theDISTRIBUTION very elements of nursing are all but unknownNOT . . . The FOR SALE OR DISTRIBUTION very elements of what constitutes good nursing are as little understood for the well as they are for the sick” (p. 6). 4. Keep the air within as pure as the air without: “Even in admitting air into the patient’s room or ward, few people ever think, where that air comes from . . . the windows © Jones & Bartlettnever opened; Learning, the shutters LLC are kept shut; and the fireplace© Jonesis boarded & up. Bartlett No breath Learning, LLC NOT FOR SALEof fresh OR air DISTRIBUTION can by possibility enter into that room. It is quiteNOT ripe FOR to breed SALE small-pox, OR DISTRIBUTION scarlet fever, diphtheria, or anything else you please.” (p. 8). 5. Cleanliness: “Without cleanliness, within or without your house, ventilation is com- paratively useless. In certain foul districts of London, poor people used to object to open windows . . . because of the foul smells that came in . . . you cannot have the house pure with the dung heaps under the windows. There are other ways of having © Jones & Bartlett Learning,filth LLC inside a house, old papered walls© Jonesof years standing, & Bartlett dirty carpets, Learning, uncleansed LLC NOT FOR SALE OR DISTRIBUTIONfurniture . . . and people so accustomedNOT [that FOR they] SALE take every OR disease DISTRIBUTION as a matter of course, “as from the hand of Providence” . . . [never entertaining] the idea of pre- serving the health of their household as a duty” (p. 16). 6. Health of Houses: “There are five essential points. Secure pure air; pure water; efficient drainage; cleanliness; and light. You think these things trifle or exaggerated ©[but] Jones I have &known Bartlett cases of Learning, [severe] hospital LLC pyaemia to be [from contamination].© Jones & Bartlett Learning, LLC NOTThey wentFOR on SALE thinking ORthat theDISTRIBUTION sufferer has scratched his thumbs or was inNOT with allFOR SALE OR DISTRIBUTION the servants who had whitlows, or that something was ‘much about this year’; I will tell you it was that the slops were emptied into the foot pans;—it was that the uten- sils were not rinsed;—it was that the chamber crockery was rinsed with dirty water; it was that the beds were never properly shaken, aired, or changed . . . Now all of this © Jones & Bartlettis not fancy Learning, but fact” (pp. LLC 17–18). u © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Finding a Better Way: Historical Observations and Outcomes 21

During the late 19th century, an article in the St. Paul’s Monthly Magazine delineated nurse opportunity and responsibility of the time. The following excerpt discussed wom- © Jones &en’s Bartlett ability to Learning, contribute to LLCand participate in the specialized© Jones work of & medicine. Bartlett Learning, LLC NOT FOR SALEA collateral OR DISTRIBUTION advantage of the practice of nursing as a professionNOT FOR would SALE undoubtedly OR DISTRIBUTION be felt, in that it would develop in one typical example the relation of men and women’s work to each other. Waiving the question whether woman might or might not be capable, with man’s advantages, of doing man’s work, it surely will not be denied that © Jones & Bartlett Learning,a sphere LLC of action would be preferable© in Jones which she & wouldBartlett not have Learning, to compete LLC with him, but in which her own peculiar endowments would give her special advantage . . . it NOT FOR SALE OR DISTRIBUTIONwill, no doubt, be found, in the courseNOT of their FOR scientific SALE training, OR that DISTRIBUTION women discover special aptitudes for particular branches of professional knowledge and practice, and the science of medicine itself in time will be benefitted by the fruitful co-operation of the two orders of workers. © JonesIt is, perhaps, & Bartlett not too much Learning, to hope that LLC if this experiment of mutual help© succeeds, Jones & Bartlett Learning, LLC it may stimulate attempts in other departments of labour, monpolised by the stronger NOTsex, or whichFOR have SALE been theOR objects DISTRIBUTION of a rivalry tending to lower both the qualityNOT and FORthe SALE OR DISTRIBUTION remuneration of the work done. (Haddon, 1871, p. 461) u

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC different questions, such as: “Why did we do this?” or “How did/does this affect . . . ?” His- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION torical research tends to identify the economics or politics in regards to social, traditional, or cultural contexts of a specified period of time or amongst a designated group of individuals. The first scholarly journal, Nursing Research, was not published until the early 1950s (Kalisch & Kalisch, 2004). Prior to that time, the American Journal of Nursing (AJN), first © Jones & Bartlett Learning,published in LLC October 1900, provided information© Jones to nurses& Bartlett in the United Learning, States about LLC social, NOT FOR SALE OR DISTRIBUTIONmedical, and nursing matters of interest.NOT Several FOR members SALE of OR the AssociatedDISTRIBUTION Alumnae of Trained Nurses of the United States authored articles and a variety of advertisers were solic- ited. These writings enabled nurses to document their nursing science and activities and eventually led to the development of nursing theory and scientific/academic research. Research conducted© Jones and published & Bartlett in journals Learning, such as LLCthe AJN is intended to improve© Jonesthe future & ofBartlett Learning, LLC nursingNOT through FOR promotion SALE ofOR new DISTRIBUTION and better ways; it generally does not lookNOT back FOR into theSALE OR DISTRIBUTION past as a way to know and learn. Over the last 30 years, however, historical research has become more popular in the nursing field (Fitzpatrick, 2007). In the first edition of AJN, we find important historical nursing ideas and interventions © Jonesthat & Bartlett have affected Learning, nursing to LLC the present day. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

22 chapter 2 u Reflections

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC 1. LaviniaNOT Lloyd FOR Dock SALE discussed OR educationalDISTRIBUTION reform: NOT FOR SALE OR DISTRIBUTION To have laws passed regulating our profession is only to do on a large scale what we now do in a small way in our voluntary constitutions and bylaws. . . . To be effective, a compulsory law must not only provide the penalty for disobedience, but make provi- sion for enforcing this penalty and defraying the costs. . . . What, then do we want to © Jones & Bartlettdo? To establish Learning, a recognized LLC standard of professional education . . . to© Jones &establish Bartlett a State Learning, LLC NOT FOR SALEsociety OR and DISTRIBUTIONthen determine minimum qualifications to beNOT exacted FOR in preliminary SALE OR and DISTRIBUTION professional training. . . . We have, as nurses, a fair average standard of two years’ general training. . . . We are [now] developing a three years general training . . . [with a] six weeks theoretical course in nursing, concluded by giving a diploma (Dock, 1900, pp. 8–10) © Jones & Bartlett Learning,2. An anonymous LLC student wrote: © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Miss Richards has felt that there was NOTa great FOR need forSALE intelligent OR trained DISTRIBUTION women. In many institutions for the insane . . . with the many changes that have come in nursing methods . . . No woman in the profession has yielded a broader influence as an organizer and reformer. She has set her hand [and] improved conditions for [mental health patients and their nurses]. She has entered into this branch of work with the spirit of a philanthro- pist,© Jones giving her & vast Bartlett experience Learning, for the alleviation LLC of the condition of this most pitiful© Jones class & Bartlett Learning, LLC ofNOT people.” FOR (“Miss SALE Linda Richards,” OR DISTRIBUTION 1900, p. 13) NOT FOR SALE OR DISTRIBUTION 3. Katherine De Witt discussed the changes from the old to the new and the benefit for society: Many women can remember the relief brought by the corpulent old auntie, who used to © Jones & Bartlettcome with Learning, the Klapper Storch LLC [white stork] and take up all© the Jones household & workBartlett as it fell Learning, LLC NOT FOR SALEfrom theOR mother’s DISTRIBUTION hands, cooking for her husband, dressingNOT the children, FOR andSALE keeping OR all DISTRIBUTION things running smoothly, often performing these duties with the baby on her arm. Why are such doctors and nurses not seen today? —they were helpful, kindly, skil[l]ful, and filled a need. Because present civilization and modern science demand a perfection along each line of work formerly known. © Jones & Bartlett Learning, Useful LLC as the old nurse was . . . the ©new Jones nurse is &more Bartlett useful, at Learning, least to the patient LLC NOT FOR SALE OR DISTRIBUTIONherself, and ultimately to the family andNOT community. FOR Her SALE sphere ORis more DISTRIBUTION limited, but her patient receives better care than was possible under the old time regime. (DeWitt, 1900, pp. 14–15) De Witt further explains that nurses will find a particular area of expertise and specialty such as surgical or management; their proficiency will affect what kind of work they do. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC She professes this to be the beginning of “specialties in nursing” (p. 14). NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 4. Eliza Moore wrote about visiting nurses; her experience was with the Visiting Nurses Association of Chicago at the turn of the century: The actual nursing done by visiting nurse; is not done in a primitive way, hospital meth- © Jones & Bartlettods are followed Learning, as closely LLC as possible . . . economy is one of© the Jones first lessons. . . . our & Bartlett hos Learning,- LLC pitals are so well equipped that we do not realize how abundant the supplies have been NOT FOR SALEuntil weOR have DISTRIBUTION to do without them. Most homes they visit NOThave the FOR bare necessitiesSALE OR and DISTRIBUTION

Finding a Better Way: Historical Observations and Outcomes 23

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOTthe nurse FOR is obligedSALE to ORgo back DISTRIBUTION to her linen closet and NOT FOR SALE OR DISTRIBUTION get [those things she needs] before she can make the patient comfortable. First, the baby must be bathed and dressed with attention to eyes, mouth and cord. The temperature © Jones & Bartlettand pulse Learning, of the mother LLC is taken. A bath with an exter- © Jones & Bartlett Learning, LLC NOT FOR SALEnal ORdouche DISTRIBUTION of bichloride solution given, the bed made, NOT FOR SALE OR DISTRIBUTION and hair combed. The nurses carry with them oakum pads [for sanitary napkins] . . . The nurse may leave ever so many instructions, but she is never sure they will be obeyed. © Jones & Bartlett Learning, SurgicalLLC cases are dressed as often© as Jones necessary; & in Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONsome cases surgical patients have beenNOT visited FOR every SALE OR DISTRIBUTION day for more than a year and the dressings supplied. Baths and enemas are given, the doctors directions carried out, and the patient is made comfortable for the day or night. If a patient is too sick to be left in ◆◆ Lillian Wald ©charge Jones of one & Bartlettof the family, Learning, an emergency LLC nurse will © Jones & Bartlett Learning, LLC NOTbe sent FOR by theSALE association. OR DISTRIBUTION [They often] have the NOT FOR SALE OR DISTRIBUTION poorest accommodations possible and endure great privations. People must be taught some rules of hygiene and sanitation, and something of how to care for their sick. Mothers are often ignorant of the very simplest care of the children, © Jones & Bartlettand a fewLearning, sensible directions LLC will be of great care. Phthisis© Jones [TB with & wastingBartlett systemic Learning, LLC NOT FOR SALEsymptoms] OR DISTRIBUTION patients rarely sleep alone; in most cases severalNOT children FOR will SALE be found OR occu DISTRIBUTION- pying the same bed, and almost never is there any disinfection of the sputum. (Moore, 1900, pp. 17–19)

Rolfe (1998) suggests that nurses should be able to “carry out personal research studies © Jones & Bartlett Learning,into their own LLC practice . . . However it is far© Jonesfrom simple, & Bartlett and the notion Learning, of the practitioner- LLC . . . NOT FOR SALE OR DISTRIBUTIONresearcher raises a number of complex methodologicalNOT FOR SALE and practical OR DISTRIBUTION problems The very notion of nurses subjectively researching their own practice is alien to the dominant research paradigm” (p. vii). Nursing research becomes complicated as it involves patients and situations that cannot always be controlled. Much of nursing research today involves studying individuals in situations where variables might potentially reduce the validity and generality of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC findings when scrutinized by “strict” research methodology and design. Nurses need to iden- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION tify a dominant paradigm about how to generate and disseminate nursing knowledge while still considering values, beliefs, and an attentive premise of the profession. Historical research and qualitative study designs complement the value of quantitative research in nursing. Historical reflection adds significance to our professional philosophical nursing knowl- © Jonesedge & Bartlett as we better Learning, define, distinguish, LLC and identify nursing’s© relationships Jones & concerningBartlett Learning,research, LLC NOT FORknowledge, SALE OR theory, DISTRIBUTION and practice (Rolfe, 1998, p. 3). Just overNOT a decade FOR afterSALE Rolfe’s OR counsel, DISTRIBUTION

24 chapter 2 u Reflections

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONthe nursing profession is still determiningNOT just FORhow it SALE OR DISTRIBUTION can incorporate rational knowledge with other ways of knowing to facilitate best professional clinical/practice judgment based on both the science and art of © Jones & Bartlett Learning, LLC nursing. Knowledge based© Jones on hard &science Bartlett consists Learning, of LLC NOT FOR SALE OR DISTRIBUTIONcause and effect analysis,NOT while FOR soft SALE science OR depends DISTRIBUTION more on correlation and probability to show substan- tial relationships. With the progression of nursing educational tracts, role development has occurred in such a way to allow for a variety of doctoral-prepared nurses © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC who can benefit and promote the profession now NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and into the future. Evidence derived from tradition, authority, trial and error, personal experiences, intuition, borrowed evidence, and scientific research are all used to guide nursing practice © Jones & Bartlett Learning,(Schmidt LLC & Brown, 2012, pp. 4–5).© ManyJones early & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONnurse leaders and reformists believedNOT the FOR same, SALE OR DISTRIBUTION and their efforts improved the profession and initiated an era of scholarly research and nursing discovery that continues today. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Historical Happenings

Victor Robinson (1946) records the following about women and nursing in White Caps: The Story of Nursing. Remember that this reflection is from just after World War II and the © Jones & Bartlett Learning,early years of LLC women’s social emancipation.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Woman is an instinctive nurse, taught by Mother Nature. The nurse has always been a necessity, thus lacked social status. In primitive times she was a slave, and in the civilized era a domestic. Overlooked in the plans of legislators, and forgotten in the curricula of pedagogues, she was left without protection and remained without education. She was not ©an Jonesartisan who & couldBartlett obtain Learning, the help of a hereditaryLLC guild; there was no Hanseatic© Jones & Bartlett Learning, LLC LeagueNOT for FORnurses. DrawnSALE from OR the DISTRIBUTION nameless and numberless army of poverty, theNOT nurse FOR SALE OR DISTRIBUTION worked as a menial and obeyed as a servant. Denied the dignity of a trade, a devoid of professional ethics, she could not rise above the degradation of her environment. It never occurred to the Aristotles of the past that it would be safer for the public welfare if nurses were educated instead of lawyers. The untrained nurse is as old as the human race; the © Jones & trainedBartlett nurse Learning, is a recent discovery. LLC (p. ix) u © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Ancient Civilizations and Their Contributions to Nursing 25

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC AncientNOT FOR Civilizations SALE OR DISTRIBUTION and Their ContributionsNOT FOR SALE OR DISTRIBUTION to Nursing Many early healers were men frequently bestowed with “power” to heal. Regardless © Jonesof & nursing’s Bartlett perspective Learning, on thisLLC type of healing today, there© Jones is documentation & Bartlett to Learning,support LLC NOT FORa variety SALE of ORways DISTRIBUTION of healing over the millennia. AccordingNOT to the FOR Indian SALE Board ORof Alterna DISTRIBUTION- tive Medicines (2010), there are more than 100 systems of alternative or complimentary practices still in use today that are the direct result of ancient customs and beliefs (para. 3). These might include healing based on spiritual faith and hope, astrology, aromatherapy, © Jones & Bartlett Learning,herbalism, manipulation,LLC chiropractic/osteopathic© Jones strategies,& Bartlett therapeutic Learning, touch/massage, LLC NOT FOR SALE OR DISTRIBUTIONmagnetotherapy, physical energy field work,NOT acupressure/acupuncture, FOR SALE OR DISTRIBUTION homeopathy, reflex- ology, meditation, naturopathy, and yoga/movement. The United States government has created the National Center for Complementary and Alternative Medicine (NCCAM) as a result of the recognized benefits of complimentary or alternative medicine (CAM) to that of© accepted Jones Western & Bartlett medicine. Learning, Their current LLC collaborative efforts© with Jones the National & Bartlett Learning, LLC Institutes of Health (NIH) are to promote medical research and study into actual health NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION (NCCAM, n.d.). Some early researchers might be considered unethical by today’s standards, but during the eras in which they lived their ways of knowing and finding answers were the norm. For thousands of years, medical care and tradition were much the same. A selected review of © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC some interesting aspects of ancient medicine and healing follows. You may wish to pursue a NOT FORmore SALE thorough OR review DISTRIBUTION of each of these civilizations (and others)NOT to FOR glean SALE additional OR informa DISTRIBUTION- tion about the progression of nursing and health care and the influence of these cultures upon modern care.

© Jones & Bartlett Learning,Ancient EgyptianLLC Healers © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONEarly Egyptian healing was based NOTon myths, FOR legends, SALE and OR the DISTRIBUTION power of the reigning pharaoh in conjunction with the magicians or medicine men of the time. The familiar story of Moses and the seven plagues demonstrates the faith of the people in their healers and leaders: Moses initiated the various plagues because the Pharaoh would not willingly release the Israelites© Jones from servitude& Bartlett and bondage.Learning, Pharaoh’s LLC magicians “could not stand© Jonesbefore Moses & Bartlett Learning, LLC becauseNOT of the FOR boils; SALEfor the boilsOR wereDISTRIBUTION upon all the Egyptians” (Exodus 9:11NOT King James FOR ver SALE- OR DISTRIBUTION sion). In all the plagues the healers could not heal or reverse the suffering. Over time, and with increasing knowledge, medicine men and/or magicians were no longer as revered as Egyptian healers in the same way. Trueman (2012b) shares a 15th century © JonesB.C. & Bartlett poem about Learning, illness: LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

26 chapter 2 u Reflections

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC And sicknessNOT FOR has crept SALE over OR me, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION My limbs have become heavy, I cannot feel my own body. If the master-physicians come to me, © Jones &I gain Bartlett no comfort Learning, from their LLC remedies. (para. 4) © Jones & Bartlett Learning, LLC NOT FORAncient SALE Egyptians OR DISTRIBUTION believed in life after death and many NOTof their FOR cultural SALE traditions OR andDISTRIBUTION activities reflected the journey from birth to life beyond death. Embalming as we know it today is the result of techniques used to mummify a body so that it could stay in the tomb while the glorified spirit could be in the world of the living gods each day and return to the © Jones & Bartlett tombLearning, at night. LLC Artifacts found in the tombs© wereJones frequently & Bartlett items ofLearning, daily life; they LLC were NOT FOR SALE ORneeded DISTRIBUTION for the afterlife. The pharaoh (king)NOT was FORthe only SALE mortal OR who DISTRIBUTION could approach the gods on earth, and he was often considered to be in the image of a god. Priests used magic to heal and “wise women” were especially able to heal. Scholars (doctors) practiced medicine in collaboration with religion; often, a “spell” would be recited as a bandage and salve were applied.© Jones Healers &promoted Bartlett a healthy Learning, diet necessary LLC for life, especially to ensure© Jones fertility. & Bartlett Learning, LLC They understoodNOT FOR the circulatorySALE OR system DISTRIBUTION moved blood, water, and air throughoutNOT the FOR body SALE OR DISTRIBUTION and that excess wekhedu (waste substances) caused disease and clogged veins. Pus, another form of wekhedu, was believed to cause illness and even death if it was not purged from the body. Archeological findings substantiate interventions that utilized splints, sutures, surgical © Jonesinstruments, & Bartlett needles, Learning, clysters (enema LLC bags), measuring vessels,© tweezers,Jones & and Bartlett other medical Learning, LLC NOT FORinstruments SALE (Bleiberg, OR DISTRIBUTION 2000). NOT FOR SALE OR DISTRIBUTION Greek Medicine Asclepius (to cut open) is the Greek god of medicine or healing; his daughters Hygieia (hygiene), Panacea (universal remedy), Acesco (the healing process), Aglaea (beauty), and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Meditrine (medicine) are familiar as modern medical terminology. Asclepius is often depicted NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION with a snake, as nonpoisonous snakes were frequently found in the temples where the sick and injured lay recovering or dying. The medical caduceus closely resembles the staff or rod of Asclepius, but with a winged staff rather than the simple straight staff. There is speculation that the staff may also represent the rod held© byJones Moses & or Bartlettthat it signifies Learning, the tree LLCof life and the serpent in the Garden© Jones of Eden. & Bartlett Learning, LLC Another presumptionNOT FOR is SALE that the OR rod DISTRIBUTIONis one that was placed upon the skin as anNOT intervention FOR SALE OR DISTRIBUTION to encourage the filarial worm (roundworm) to retreat from the infected body. Regardless of the philosophy one accepts, the rod/staff and snake/worm are symbols of healing with Greek origins. Medical science of the time identified signs and symptoms of disease, which © Jonesare considered& Bartlett relevant Learning, in regards LLC to an epidemiologic perspective.© Jones Common & Bartlett diseases Learning, and LLC NOT FORinfectious SALE processes OR DISTRIBUTION were identified in skeletal remains, as NOTwere various FOR geneticSALE conditions. OR DISTRIBUTION

Ancient Civilizations and Their Contributions to Nursing 27

Egyptian Medicine: A number of archeological findings support medical science and © Jones &advanced Bartlett treatments Learning, beyond LLC the spells and © Jones & Bartlett Learning, LLC NOT FORmagic. SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 1. Here is a spell that was spoken to a mother with child: “These words are to be spoken over the sick person. ‘O Spirit, male of © Jones & Bartlett Learning,female, LLC who lurks hidden in my flesh© andJones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONin my limbs, get out of my flesh. Get NOTout of FOR SALE OR DISTRIBUTION my limbs! Come! You who drives out evil things from my stomach and my limbs. ◆◆ The Edwin Smith papyrus, the world's oldest surviving He who drinks this shall be cured just as surgical document. the© Jonesgods above & Bartlett were cured” Learning, (Trueman, LLC © Jones & Bartlett Learning, LLC 2012a,NOT para. FOR 9). SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2. An interesting remedy for balding: “Fat of lion, fat of hippo, fat of cat, fat of croco- dile, fat of ibex, fat of serpent, are mixed together and the head of the bald person is anointed with them (Trueman, 2012b, para. 10). © Jones &3. BartlettEgyptians Learning,knew about some LLC physiological concepts such© Jones as blood & and Bartlett circulation. Learning, An LLC NOT FOR SALEancient OR Egyptian DISTRIBUTION wrote this on the Papyrus Ebers: NOT FOR SALE OR DISTRIBUTION 46 vessels go from the heart to every limb, if a doctor places his hand or fingers on the back of the head, hands, stomach, arms or feet then he hears the heart [pulses]. The heart speaks out of every limb. There are 4 vessels to his nostrils, 2 give mucus and 2 give blood; there are 4 vessels in his forehead; there are 6 vessels that lead to the arms; there are 6 © Jones & Bartlett Learning,vessels LLC that lead to the feet; there are 2© vessels Jones to his & testicles Bartlett [and] Learning, it is they which LLC give NOT FOR SALE OR DISTRIBUTIONsemen; there are 2 vessels to the buttocks.NOT (Trueman, FOR 2012b,SALE para. OR 13) DISTRIBUTION 4. Embalming was a significant accomplishment of the Egyptians and is the basis of body preservation techniques today. Herodotus described this technique from the 5th century B. C.: “First they took a crooked piece of metal and with it draw out some of© the Jones brain through & Bartlett the nostrils Learning, and then LLCrinse out the rest with drug. Next© Jones they make & Bartlett Learning, LLC a NOTcut along FOR the sideSALE of the OR body DISTRIBUTION with a sharp stone and take out the wholeNOT contents FOR of SALE OR DISTRIBUTION the abdomen. After this the fill the cavity with myrrh, cassia and other spices and the body is placed in natron for 70 days” (Trueman, 2012b, para. 16). 5. The Ebers Papyrus contains this treatment for cancer: Recounting a ‘”tumor against © Jones & Bartlettthe god Xenus,’Learning, it recommends LLC ‘do thou nothing there© Jones against’” & (“Ancient Bartlett Egyptian Learning, LLC NOT FOR SALEHealing,” OR 2012). DISTRIBUTION u NOT FOR SALE OR DISTRIBUTION

28 chapter 2 u Reflections

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC There is NOTevidence FOR of bubonic SALE and OR other DISTRIBUTION pandemics causing great casualties. WritingsNOT FORdiscuss SALE OR DISTRIBUTION what might be considered specialty care and were used as guides by those who had limited access to scrolls or papryrus. Hippocratic medicine and the understanding of the four humors were not adopted by all; most used folk remedies along with a reliance on the gods of healing © Jonesfor relief & Bartlett (Kirby, 2000). Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Historical Happenings © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Another civilization that perfected understanding of the human body in the context of NOT FOR SALE OR DISTRIBUTIONscientific understanding of the era was theNOT Romans. FOR SALE OR DISTRIBUTION Pliny the Elder was a philosopher, scientist, naturalist, and author who wrote the following about 2,000 years ago:

“Unwashed© Jones wool & supplies Bartlett very many Learning, remedies . . . LLCit is applied . . . with honey to old© sores. Jones & Bartlett Learning, LLC WoundsNOT it healsFOR if dippedSALE in ORwine DISTRIBUTIONor vinegar . . . yolks of eggs . . . are taken for dysenteryNOT FOR SALE OR DISTRIBUTION with the ash of their shells, poppy juice, and wine. It is recommended to bathe the eyes with a decoction of the liver and to apply the marrow to those that are painful or swollen” (Trueman, 2012a, para. 7).

Two other Roman peers of Pliny, Marcus Varro © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC and Columella, discovered as Florence Nightingale NOT FORdid SALE1,800 years OR laterDISTRIBUTION that the health of the house NOT FOR SALE OR DISTRIBUTION was important to the health of the family: ”When building a house or farm especial care should be taken to place it at the foot of a wooded hill where © Jones & Bartlett Learning,it is exposed LLC to health-giving winds. Care ©should Jones be & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONtaken where there are swamps in the neighbourNOT FOR- SALE OR DISTRIBUTION hood, because certain tiny creatures which cannot be seen by the eyes breed there. These float through the air and enter the body by the mouth and nose and cause serious disease” (Trueman, 2012, para. 17). ©”There Jones should & beBartlett no marshes Learning, near buildings, LLC for © Jones & Bartlett Learning, LLC marshesNOT give FOR off SALEpoisonous OR vapours DISTRIBUTION during the hot NOT FOR SALE OR DISTRIBUTION period of the summer. At this time, they give birth to animals with mischief-making stings which fly at us ◆◆ Pliny the Elder in thick swarms” (Trueman, 2012, para. 17). u © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Ancient Civilizations and Their Contributions to Nursing 29

◆◆ Statue of Asklepios ◆◆ A Visit to Aesculapius © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Historical Happenings © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR ASALE Greek Cure:OR DISTRIBUTION Hysteria has long been associated with menses,NOT FOR and what SALE was ORtradition DISTRIBUTION- ally described as hysteria might have been what we call premenstrual syndrome. The Hysteria cure is described by Kirby (2000), as follows: Virgins who do not take a husband at the appropriate time of marriage experience © Jones & Bartlett Learning,visions . . . at LLC the time of their first period© theJones blood collects& Bartlett in the womb Learning, in preparation LLC to NOT FOR SALE OR DISTRIBUTIONflow out; but when the mouth of the NOTwomb is FORnot opened SALE up, then OR [the DISTRIBUTION blood] rushes up to the heart and into the lungs. When these are filled with blood, the heart becomes slug- gish and then because of the sluggishness [the body is] numb and then because of the numbness, insanity takes hold of the woman . . . the girl goes crazy because of the violent inflammation, and because the blood starts to decay. In some cases the visions . . . order her© Jonesto jump up & andBartlett throw herself Learning, into wells LLCand drown, as if this was good for© herJones and & Bartlett Learning, LLC servedNOT someFOR useful SALE purpose . . . When OR DISTRIBUTION this person returns to her right mind, womenNOT give FOR SALE OR DISTRIBUTION various offerings to Artemis [a goddess]. They are deceived, the fact is that the disorder is cured when nothing impedes the downward flow of the blood [a normal period]. My prescription is that when virgins experience this trouble, they should cohabit with a man as quickly as possible. If they become pregnant, they will be cured. (p. 335) u © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Islamic Medicine Religion and medicine were closely linked in the Muslim world. © Jones & Bartlett Learning,There wereLLC spiritual rituals connected© to Joneshealing: (1)& Bartlettprayer is an Learning, obli- LLC NOT FOR SALE OR DISTRIBUTIONgation that affords peace and with orNOT without FOR fasting SALE promotes OR DISTRIBUTION the health of mind and body; (2) purification included not only spiritual cleansing but also specific and frequent bathing behaviors of rinsing and/or washing the body and hair along with application of perfume, © Jones & Bartlett Learning, LLC to ensure a clean physique© Jones for the & soul;Bartlett and (3) Learning, hygiene and LLC cleanli- ◆◆ Rod of Asclepius ness extended beyond the spirit and the body to include the home and NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION streets near that home—an uncontaminated body and environment promoted health. Public health was important: Muslim physicians provided care that was closely tied to religious traditions; they believed in a delicate balance between mind and body. Their medical theory included ideas from other cultures, such © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC as Hippocrates’s philosophy of the four humors and the use of Chinese therapeutic contact NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION interventions. The Islamic world of the 7th through 10th centuries reports “the first medical scholars to understand the pathology of contagion, and as a result they created hospitals with separate wards so those with contagious disease could be kept away from others” (Douglas, 2000, pp. 419 & 421). Hospitals in the 10th century offered music, poetry reading, garden © Jonestherapy, & Bartlett hands-on Learning, creative activities, LLC and audible running water© Jones (fountains & Bartlettor waterfalls) Learning, as LLC NOT FORholistic SALE forms ORof healing. DISTRIBUTION Jewelry was not only an adornment,NOT but FORoften timesSALE it wasOR worn DISTRIBUTION

Ancient Civilizations and Their Contributions to Nursing 31

Eastern Medicine: The Chinese utilized certain types of teas for medicinal purposes. China was an important destination along the existing trade paths of the past: Travelers © Jones &who Bartlett traversed Learning, Chinese land LLC routes or moored at Chinese© docks Jones brought & Bartlett several diseases, Learning, LLC NOT FOR includingSALE OR smallpox, DISTRIBUTION dysentery, plague, scarlet fever, cholera,NOT diphtheria, FOR SALE syphilis, OR febrile DISTRIBUTION respiratory disease, and tuberculosis; each of which was not indigenous to that region. Smallpox was a disease that Qian Yi (1032–1113 A.D.) identified and suggested might be treated by variolation (inoculation with a small amount of pox virus); despite this © Jones & Bartlett Learning,intervention, LLC smallpox was still very problematic© Jones in &the Bartlett region. With Learning, refinement, LLC the viral NOT FOR SALE OR DISTRIBUTIONcomponents from an infected person wereNOT placed FOR on SALE a plug ofOR cotton DISTRIBUTION and inserted into the nostril, where it was absorbed into the mucous membranes. Over time this method was adopted by other cultures as it was deemed effective. While the Chinese lacked the proper instrumentation for surgical procedures, specialists emerged to provide healing through© Jones acupuncture, & Bartlett massage, Learning, pressure pointLLC therapy, and symptomatic© Jones relief with & Bartlett Learning, LLC herbsNOT and teas.FOR They SALE used OR techniques DISTRIBUTION similar to those of the alchemists NOTto treat FOR some SALE OR DISTRIBUTION diseases. Li Xuan (14th century A.D.) explained sweet urine and diabetes: This disease is due to the weakness of the renal and urinogenital system. The urine is always sweet. Many physicians do not recognize this symptom . . . the cereal foods of © Jones & Bartlettthe farmers Learning, are the precursors LLC of sweetness . . . the methods© ofJones making &cakes Bartlett and sweet Learning,- LLC meats . . . mean that all very soon turn to sweetness . . . since the renal and urinogenital NOT FOR SALEsystem OR at theDISTRIBUTION reins is weak it cannot distill the nutrient essentials.NOT FOR Therefore SALE the sweetOR -DISTRIBUTION ness comes forth, and the later [urine] does not acquire its normal color. [Another physician] wrote that a diabetic had to give up three things: wine, sex, and eating cereals and slated foodstuffs . . . Chang Kao identified the significance of skin care and the threat to diabetics of the slightest cut or abrasion. (Xu, 2000, pp. 421–422) u © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

to “ward off disease and [influence] of the evil eye.” These practices were particularly prevalent during the mid-14th century when the [world was] devastated by the rampant spread of . . . Black© Jones Death (Douglas,& Bartlett 2000, Learning, p. 421). There LLC is also evidence of advanced© Jonesmedical knowl & Bartlett- Learning, LLC edge: IbnNOT Sina FOR describes SALE “the OR structure DISTRIBUTION of the eye and how the heart valvesNOT let blood FOR enter SALE OR DISTRIBUTION the heart as it contracts were the observations of a physician who performed many surgical procedures” (Douglas, 2000, pp. 421 & 423). Furthermore there is evidence of: (1) inhaled anesthesia on a “sponge” soaked in a narcotic agent and placed over the mouth or nose of © Jonesthe & patient;Bartlett (2) Learning,distilled alcohol LLC to cleanse surgical sites before© Jones and after & a Bartlett procedure; Learning, and (3) LLC NOT FORsutures SALE made OR from DISTRIBUTION animal gut (peritoneal or intestinal lining)NOT or FOR silk. ItSALE appears OR there DISTRIBUTION was

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC basic understandingNOT FOR of SALEparalysis OR secondary DISTRIBUTION to severance of a connection betweenNOT the FOR brain SALE OR DISTRIBUTION and other parts of the body (Douglas, 2000).

Christianity and the Meridian of Time © JonesDuring & Bartlett the meridian Learning, of time LLC many believed that ‘“an anointed© Jones one” performed& Bartlett healings Learning, LLC NOT FORbased SALEon faith, ORhope, DISTRIBUTION and belief, similar to the beliefs of EgyptiansNOT in their FOR Pharaoh SALE god OR and DISTRIBUTION his priests. There is much that is not understood or known about the connection of mind, body, spirit, and health outcomes, then or even today. John describes the healing of a blind man in ancient Galilee: © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION”And his disciples asked him saying, Master,NOT who FORdid sin, SALE this man OR or his DISTRIBUTION parents, that he was born blind? Jesus answered, Neither hath this man sinned, nor his parents; . . . When he had thus spoken, he spat on the ground, and made clay of the spittle, and he anointed the eyes of the blind man with the clay, And said unto him, Go, wash in the Pool of Siloam, . . . He went his way therefore, and washed, and came seeing. . . . He [the man] answered and said, A man that is called© Jesus Jones made clay,& Bartlett and anointed Learning, mine eyes, LLCand said unto to me, Go to the pool© Jones of Siloam, & Bartlett Learning, LLC and wash;NOT and FOR I went SALE and washed, OR DISTRIBUTION and I received sight. . . . Then again calledNOT they the FOR man SALE OR DISTRIBUTION that was blind, and said unto him, Give God the praise; we know that this man is a sinner. He answered and said, Whether he be a sinner or no, I know not. One thing I know, that, whereas I was blind, now I see. . . . And he said, I believe.” (St. John, Chapter 9, Holy Bible; King James © Jones &Version, Bartlett 1979) Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Medieval Europe During the medieval era there were many hazards for the typical peasant/farmer family. Keeping the living quarters warm was a challenge: Fires were built in open hearths and had © Jones & Bartlett toLearning, burn continually; LLC clothing was loose and ©young Jones children & Bartlett were about Learning, the house, LLCso burns NOT FOR SALE ORwere DISTRIBUTION very common and even embers could easilyNOT start FOR a fire. SALE Most ORclothing DISTRIBUTION was made of wool and not easily cleaned; clothing was washed in streams as water was a precious commodity carried in cauldrons from the village water supply. Hot water was obtained by heating water over a fire, which required more firewood in addition to that used for cooking and heating. Most people© Jones did not bathe& Bartlett regularly, Learning, and there were LLC no dedicated facilities for human© Jones waste. & Bartlett Learning, LLC OuthousesNOT were FORbuilt overSALE a cesspit OR DISTRIBUTIONand chamber pots would be emptied in theseNOT cesspits FOR SALE OR DISTRIBUTION periodically if the family had resources. Otherwise, excrement might be deposited almost anywhere, including in close proximity to living quarters. Illness was considered to be from God and many individuals relied on herbal medicine, © Jonescharms, & Bartlett religious Learning,symbols, and LLCfaith pilgrimages for the benefit© Jones of healing. & BartlettMonasteries Learning, and LLC NOT FORnunneries SALE were OR common; DISTRIBUTION monks and nuns adopted formalizedNOT lifestyles FOR based SALE upon OR religious DISTRIBUTION

Christianity and the Meridian of Time 33

Medieval Medicine: Dwale consisted of potent sleeping herbs mixed with vinegar to help extract the active ingredients from herbs; it was able to render a patient uncon- © Jones &scious. Bartlett Herbal Learning, medicine was LLC prevalent and many women© became Jones healers & Bartlett as they learned Learning, LLC NOT FORof SALE plants andOR how DISTRIBUTION to use them for healing purposes. DistilledNOT alcohol FOR or SALE vinegar ORwas usedDISTRIBUTION to steep the active ingredients from the herbs. To make a drink called dwale to make someone sleep while others carve [perform sur- gery] on him: Take three spoonfuls of the gall of a barrow swine [castrated boar] and for a © Jones & Bartlett Learning,woman LLC of gilt [immature sow], three spoonfuls© Jones of hemlock & Bartlett juice, three Learning, spoonfuls of LLC wild NOT FOR SALE OR DISTRIBUTIONnept [briony], three spoonfuls of lettuceNOT [sap], FOR three SALEspoonfuls OR of poppy, DISTRIBUTION three spoonfuls of henbane, and three of vinegar, and mix them all together, boil them a little, and mix . . . [place] three spoonfuls [of the mixture] into half a gallon of good wine. (Hackett, 2000, p. 467) u

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION belief and heritage, while often providing solace for others, especially those afflicted with poverty and disease (Hackett, 2000). Hippocratic principles and strategies such as urine samples were utilized to assess overall health and the four humors or temperaments: black bile (melan chole or melancholy), yellow bile (chole or gall bladder/liver), phlegm (phlegma © Jonesor & pulmonary), Bartlett Learning, and blood (haima LLC or heme) were believed© to Jones influence & theBartlett overall Learning,health of LLC NOT FORan SALEindividual. OR One DISTRIBUTION will observe that some of these terms NOThave been FOR retained SALE in ORthe healthDISTRIBUTION- care terminology of today; for example, an overabundance of black bile was said to lead to

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC moroseness,NOT and FOR “melancholy,” SALE ORthe termDISTRIBUTION for black bile, also describes depressionNOT (Hackett, FOR SALE OR DISTRIBUTION 2000). As the medieval period drew to a close, changes over the next few centuries set the stage for the English Puritan emigration and the colonizing of the United States.

© Jones• &Ideas Bartlett for Learning, Further LLC Exploration© Jones & Bartlett Learning, LLC NOT FORAny nurse SALE can OR reflect DISTRIBUTION upon the comments in this chapterNOT and FOR the ones SALE that followOR DISTRIBUTION to conclude that early nurse leaders and even ancient groups of people greatly influence our practice today. Explore an interest you might have related to your personal passion in nursing and the history of that specialty practice, procedure, or diagnosis. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR• DISTRIBUTIONDiscussion Questions:NOT ApplicationFOR SALE OR DISTRIBUTION to Current Practice 1. Introduce yourself briefly and discuss your own personal nursing history. List 3–4 things© Jonesthat have & influenced Bartlett Learning,your practice. LLC Who or what might have influenced© Jones your& Bartlett Learning, LLC choiceNOT to become FOR SALE a registered OR nurse? DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 2. Choose a group of people (in this chapter or another group not discussed) and describe their contributions to nursing and health care. Discuss how practice today was influenced by their beliefs, ideas, or willingness to look beyond accepted knowledge of the © Jones &time. Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR3. ChooseSALE aOR topic DISTRIBUTION or individual and describe the history asNOT well asFOR implications SALE thenOR DISTRIBUTIONand now for nursing. For example: Lister, Pasteur, antibiotics, embalming, x-ray, birth control, Elizabeth Blackwell & Marie Zakrzewska, stethoscopes, anesthesia, midwives, smallpox, the © Jones & Bartlett Learning,plague, TheodorLLC Fliedner, Pennsylvania© Jones hospital, & Bartlettimportance Learning, of alcohol, LLC medical NOT FOR SALE OR DISTRIBUTIONknights, pesthouses, Virchow, Koch, folkNOT medicine FOR or SALE . . . the ORlist is DISTRIBUTION endless. 4. Define caring: what it is and what it is not. Include ideas from nurse theorists. • MeSH Search Terms Nightingale,© Jones other & ancient Bartlett groups Learning, of people LLC or individuals mentioned in© this Jones chapter & Bartlett Learning, LLC may not haveNOT designated FOR SALE MeSH OR terms. DISTRIBUTION You can still do a Boolean search by usingNOT a FORphrase SALE OR DISTRIBUTION like “ancient egyption medicine” or “Florence Nightingale” or “Virginia Henderson” or “caring theory.”

Christianity and the Meridian of Time 35

For a full suite of assignments and additional learning activities, please use the access code located in the front of your book. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION • References American Nurse Association (ANA). (2010). Florence Nightingale Pledge. Retrieved from © Jones & Bartlett Learning,http://nursingworld.org/FunctionalMenuCategories/AboutANA/WhereWeComeFrom LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION/FlorenceNightingalePledge.aspx NOT FOR SALE OR DISTRIBUTION Allnurses.com. (2012). What is the difference between LPNs and RNs? Retrieved from http:// allnurses.com/lpn-rn-nursing/what-difference-between-579289.html Ancient Egyptian Healing. (2012). Wikipedia, The Free Encyclopedia. Retrieved from http:// en.wikipedia.org/wiki/Ancient_Egyptian_medicine© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Ashley,NOT J. A. (1976). FOR Hospitals,SALE OR paternalism, DISTRIBUTION and the role of the nurse. New York,NOT NY: FOR Teachers SALE OR DISTRIBUTION College Press. Bleiberg, E. I. (2000). World eras volume 5: Ancient Egypt 261–332 B.C.E. Farmington Hills, MI: Gale Group. © JonesDeWitt, & Bartlett K. (1900). Learning, Specialties LLC in nursing. American Journal© of Jones Nursing, & 1(1), Bartlett 14–16. Learning, LLC NOT FORDock, SALE L. L. OR(1900). DISTRIBUTION What we expect from the law. AmericanNOT Journal FOR of Nursing, SALE 1 (1),OR 8–11. DISTRIBUTION Dock L. L., & Stewart, I. M. (1925). A short history of nursing (2nd ed.). New York, NY: GP Putnam’s Sons. Donohue, M. P. (1996) Nursing, the finest art: An illustrated history. St. Louis, MO: Mosby. Douglas, S. L. (2000). World eras volume 2: Rise and spread of Islam 622–1500. Farmington © Jones & Bartlett Learning,Hills, MI: LLC Gale Group. © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONFitzpatrick, M. L. (2007). Historical research:NOT The FOR method. SALE In OR P. L. DISTRIBUTION Munhall (Ed.),Nursing research: A qualitative perspective. (4th ed., pp. 375–386). Sudbury, MA: Jones and Bartlett. Hackett, J. (2000). World eras volume 4: Medieval Europe 814–1350. Farmington Hills, MI: Gale© Group.Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Haddon,NOT C. (1871). FOR Nursing SALE asOR a profession DISTRIBUTION for ladies. St. Paul’s Monthly Magazine,NOT FOR Anthony SALE OR DISTRIBUTION Trollope. Vol. VIII. April 1871 to September 1871. Retrieved from http://books.google.com /books?id=aLYVAQAAIAAJ&pg=PA595&lpg=PA595&dq=Charlotte+Haddon+Nursing +a+profession+for+ladies&source=bl&ots=m6PV62Tp40&sig=GMSSPNps8GaVzXS © Jones & BartlettjCtdKDprycpw&hl=en&sa=X&ei=wbv4T-ajGYjo2AXh0OnHBg&ved=0CD0Q6AEw Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC AA#v=onepage&q=Charlotte%20Haddon%20Nursing%20a%20profession%20for%20NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ladies&f=false Henderson, V. (1960). Basic principles of nursing care. Washington, D.C.: American Nurses Publishing. © JonesIndian & BoardBartlett of Alternative Learning, Medicines. LLC (2010). What is alternative© Jones medicines? & Bartlett Retrieved Learning,from LLC NOT FORhttp://www.altmedworld.net/alternative.htm SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Kirby, J. T. (2000). World eras volume 6: Classical Greek civilization 800–323 B.C.E. Farm- ington Hills, MI: Gale Group. Koloroutis, Mary. (2004). Relationship-based care: A model for transforming practice. Min- neapolis, MN: Creative Health Care Management. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Kalisch, P. A., & Kalisch, B. J. (2004). American nursing: A history (4th ed.). Philadelphia, PA: NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Lippincott, Williams, and Wilkins. Kuhse, H. (1997). Caring: Nurses, women and ethics. Malden, MA: Blackwell. “Miss Linda Richards.” (1900). American Journal of Nursing, 1(1), 12–13. Moore, E. J. (1900). Visiting nursing. American Journal of Nursing, 1(1), 17–21. National Center© Jones for Complementary & Bartlett Learning, and Alternative LLC Medicine [NCCAM]. (n.d.).© Home Jones Page. & Bartlett Learning, LLC RetrievedNOT from FOR http://nccam.nih.gov/ SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Nightingale, F. (1860). Notes on nursing: What it is and what it is not. London, England: Har- rison and Sons. Online Etymology Dictionary. (2012). Nurse. Retrieved from http://www.etymonline.com © Jones &/index.php?term=nurse Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORRolfe, SALEG. (1998). OR Expanding DISTRIBUTION nursing knowledge. Woburn, MA:NOT Butterworth-Heinemann. FOR SALE OR DISTRIBUTION Robinson, V. (1946). White caps: The story of nursing. Philadelphia, PA: J.B. Lippincott Co. Schmidt, N. A., & Brown, J. M. (2012). Evidence-based practice for nurses: Appraisal and application of research. Sudbury, MA: Jones & Bartlett Learning. © Jones & Bartlett TheLearning, Nightingale LLC Pledge.(n.d.). Retrieved from© http://www.countryjoe.com/nightingale/pledge Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION.htm NOT FOR SALE OR DISTRIBUTION Trueman, C. (2012a). Medicine in ancient Rome. Retrieved from http://www.historylearning site.co.uk/medicine_in_ancient_rome.htm Trueman, C. (2012b). Ancient Egyptian medicine. Retrieved from http://www.historylearning site.co.uk/ancient_egyptian_medicine.htm© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Watson, J.NOT (1985). FOR Nursing: SALE Human OR science DISTRIBUTION and human caring. Boston, MA: LittleNOT Brown. FOR SALE OR DISTRIBUTION Xu, G. (2000). World eras volume 7: Imperial China 617–1644. Farmington Hills, MI: Gale Group.