Chapter 3 History of Community and Public Health Nursing

© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEChapter OR Fo DISTRIBUTIONcus NOT FOR SALE OR DISTRIBUTION Classical Era Early Nursing Education and Organization in the The Greeks and Health United States Roman Era The Evolution of Nursing in the United States: The First Middle Ages © Jones & Bartlett Learning, LLCCentury of Professional Nursing© Jones & Bartlett Learning, LLC Black Death NOT FOR SALE OR DISTRIBUTIONThe Emergence of CommunityNOT and FORPublic HealthSALE OR DISTRIBUTION The “Witch Craze” of the Early Middle Ages Nursing The Renaissance Lillian Wald, Public Health Nursing, and Community Activism The Emergence of Home Visiting Dorothea Lynde Dix The© JonesReformation & Bartlett Learning, LLC Clara Barton© Jones & Bartlett Learning, LLC TheNOT Advancement FOR SALE of Science OR andDISTRIBUTION Health of the Public Birth of NOTthe Midwife FOR in SALEthe United OR States DISTRIBUTION The Dark Period of Nursing The Nursing Profession Responds to the Great Depression Early Organized Health Care in the Americas: A Brave and World War II New World Early Education and Standardization of Practice of Public The Chadwick Report and the Shattuck Report Health Nursing © Jones & BartlettThe Industrial Learning, Revolution LLC © JonesChallenges & Bartlett of the Learning, 1930s LLC Progressive Initiatives After the War Years NOT FOR SALEJohn SnowOR andDISTRIBUTION the Science of Epidemiology NOT FOR SALE OR DISTRIBUTION Social and Political Influence of the 1960s and 1970s And Then There Was Nightingale . . . Public Health Nursing Services in the 1980s and 1990s The Crimean Experience: “I Can Stand Out the War with Science and Health Care, 1945–1960: Decades Any Man” of Change Florence Nightingale and Sanitation © Jones & Bartlett Learning, LLCYears of Revolution, Protest, ©and Jones the New & Order, Bartlett Learning, LLC Returning Home a Heroine: The Political Reformer NOT FOR SALE OR DISTRIBUTION1961–2000 NOT FOR SALE OR DISTRIBUTION Nightingale and Military Reforms The Nightingale School at St. Thomas: The Birth of Managed Care and Healthcare Reform: First Decades of Professional Nursing the 21st Century Taking Health Care to the Community: Nightingale The Patient Protection and Affordable Care Act (ACA) © andJones Wellness & Bartlett Learning, LLC of 2010 © Jones & Bartlett Learning, LLC NOTNightingale’s FOR SALE Legacy OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Questions to Consider After reading this chapter, you will know the answers to 9. Who is Lillian Wald, and why is she considered a © Jones & Bartlettthe following Learning, questions: LLC © Jones &prominent Bartlett figureLearning, in the developmentLLC of commu- NOT FOR SALE 1. ORWhen DISTRIBUTION did humans first begin thinking about NOTthe FOR SALEnity health OR nursing DISTRIBUTION in the United States? 10. What led to early standardization of public health causes of illness? 2. What were the contributions of the Greeks and Egyp- nursing practice in the United States? tians to our health practices today? 11. What are the major legislative events, discoveries, and inventions that have improved the health status 3. What are the© origins Jones of public & Bartlett health? Learning, LLC © Jones & Bartlett Learning, LLC 4. Who did the first home visits? of populations and communities? 5. What were majorNOT health FOR concerns SALE of theOR Middle DISTRIBUTION Ages? 12. What is the Patient ProtectionNOT FOR and AffordableSALE OR Care DISTRIBUTION 6. What were Florence Nightingale’s contributions to Act of 2010 (ACA, or “Obamacare”) and why is this nursing as a profession? healthcare reform legislation considered one of the 7. What was the Chadwick Report, and why is it signifi- most significant federal mandates for public and community health in the history of the United States? © Jonescant to & community Bartlett healthLearning, nursing? LLC © Jones & Bartlett Learning, LLC NOT8. WhatFOR role SALE did William OR Rathbone DISTRIBUTION play in the evolution NOT FOR SALE OR DISTRIBUTION of community health nursing?

9781449687151_CH03_PASS02.indd 68 22/10/14 7:15 PM © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR CHAPTERSALE OR DISTRIBUTION 3 NOT FOR SALE OR DISTRIBUTION History of Community and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Public HealthNOT Nursing FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

Karen Saucier Lundy and © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC KayeNOT W. Bender FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

KeY terMs © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC American Journal of NursingNOT (AJN) FOR SALE Goldmark OR DISTRIBUTION Report Louis PasteurNOT FOR SALE OR DISTRIBUTION American Nurses Association (ANA) Annie Goodrich Patient Protection and Aff ordable Clara Barton Greek era Care Act of 2010 Black Death (bubonic plague) health visiting William Rathbone Frances Payne Bolton Henry Street Settlement Reformation Mary© Breckenridge Jones & Bartlett Learning, Edward LLC Jenner © Jones Isabel & Hampton Bartlett Robb Learning, LLC MaryNOT Brewster FOR SALE OR DISTRIBUTION Kaiserwerth Institute NOT FOR Roman SALE era OR DISTRIBUTION Cadet Nurse Corps Edwin Klebs Margaret Sanger case management Robert Koch Jessie Sleet Scales deaconesses Joseph Lister Saint Vincent de Paul Jane A. Delano managed care Elizabeth Tyler © Jones & Dorothea Bartlett Lynde Learning, Dix LLC Nightingale School© Jonesof Nursing & Bartlett Lillian Learning, Wald LLC NOT FOR LaviniaSALE Lloyd OR DockDISTRIBUTION at St. Thomas NOT FOR SALE OR DISTRIBUTION Frontier Nursing Service Nursing’s Agenda for Health Care Reform

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALERefle ORctions DISTRIBUTION NOT FOR SALE OR DISTRIBUTION hat do you know about the history of health care and the role of nursing in health prevention and promotion? WHow do you define healing and healers as related to human history? How do you think Florence Nightingale would react if she were alive today regarding nursing, healing, and health care? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION or as long as humanity has existed, so have the nursing century in Europe as common practice. (Kalisch & Fof the sick and community attempts to prevent illness. Kalisch, 1986) Health practices of early humans most likely evolved as a As early as 3000 to 1400 b.c., the Minoans created way for groups to survive. Many of these early causal links ways to flush water and construct drainage systems. Circa between© Jones humans & Bartlettand their environmentLearning, wereLLC attributed © Jones & Bartlett Learning, LLC 1000 b.c., the Egyptians constructed elaborate drainage to NOTsuperstition FOR andSALE religion. OR EvidenceDISTRIBUTION from our earliest NOT FOR SALE OR DISTRIBUTION systems, developed pharmaceutical herbs and prepara- human ancestors suggests that techniques such as mind– tions, and embalmed the dead. The Hebrews formulated body connections (e.g., voodoo, alchemy, and/or spells), an elaborate hygiene code that dealt with laws governing isolation, migratory patterns, and/or societal estrange- both personal and community hygiene, such as conta- ment of those community members who were defined by © Jones & Bartlett Learning, LLC © Jonesgion, & disinfection, Bartlett Learning, and sanitation LLC through the prepara- the group as sick were used to manage disease and protect NOT FOR SALE OR DISTRIBUTION NOT FORtion of SALE food and OR water. DISTRIBUTION Hebrews, although few in number, the health of the community (Hanlon & Pickett, 1984). exercised great influence in the development of religious and health doctrine. According to Bullough and Bullough Classical Era (1978), most of their genus was religious, giving birth to both Christianity and Islam. The Jewish contribution to More than 4,000 years© ago,Jones Egyptian & Bartlett physicians Learning, and nurses LLC © Jones & Bartlett Learning, LLC public health is greater in sanitation than in their concept used an abundant pharmacologicalNOT FOR SALE repertoire OR toDISTRIBUTION cure the NOT FOR SALE OR DISTRIBUTION of disease. Garbage and excreta were disposed of outside ill and injured. The Ebers Papyrus lists more than 700 rem- the city or camp, infectious diseases were quarantined, edies for ailments from snake bites to puerperal fever. The spitting was outlawed as unhygienic, and bodily clean- Kahun Papyrus (circa 1850 b.c.) identified suppositories liness became a prerequisite for moral purity. Although (e.g., crocodile feces) that could be used for contraception © Jones & Bartlett Learning, LLC many of the© JonesHebrew ideas& Bartlett about hygiene Learning, were Egyptian LLC (Kalisch & Kalisch, 1986). NOT FOR SALE OR DISTRIBUTION in origin, NOTMoses FORand the SALE Hebrews OR were DISTRIBUTION the first to codify Healing appeared in the Egyptian culture as the suc- them and link them with spiritual godliness. Their notion cessful result of a contest between invisible beings of good of disease was rooted in the “disease as God’s punishment and evil (Shryock, 1959). The physician was not a shaman; for sin” idea. instead, there was specialization and separation of func- The civilization that grew up between the Tigris and © Jones & Bartletttion, with Learning,physicians, priests, LLC and sorcerers all practic©- Jones & Bartlett Learning, LLC Euphrates Rivers is known geographically as Mesopotamia NOT FOR SALEing separately OR DISTRIBUTION and independently. Some patients wouldNOT FOR SALE OR DISTRIBUTION (modem Iraq) and includes the Sumerians. Disease and consult the physician, some visited the shaman, and oth- disability in the Mesopotamian area, at least in the earlier ers sought healing from magical formulas. Many tried all period, was considered a great curse, a divine punishment three approaches. The Egyptians, quite notably, did not for grievous acts against the gods. Having such a curse of accept illness and death as inevitable but rather believed © Jones & Bartlett Learning, LLCillness resulting from sin did© not Jones exactly & put Bartlett the sick perLearning,- LLC that life could be indefinitely prolonged. NOT FOR SALE OR DISTRIBUTIONson in a valued status in theNOT society. FOR Experiencing SALE OR illness DISTRIBUTION Because Egyptians blended medicine and magic, the as punishment for a sin linked the sick person to anything concoctions believed to be the most effective were often even remotely deviant: Such things as murder, perjury, bizarre and repulsive by today’s standards. For example, adultery, or drunkenness could be the identified sins. Not lizard’s blood, swine’s ears and teeth, putrid meat and fat, only was the person suffering from the illness, but he or tortoise© Jones brains, & the Bartlett milk of aLearning, lactating woman, LLC the urine © Jones & Bartlett Learning, LLC she was also branded by society as having deserved it. The ofNOT a chaste FOR woman, SALE and excretaOR DISTRIBUTION of donkeys and lions were NOT FOR SALE OR DISTRIBUTION illness made the sin apparent to all; the sick person was frequently used ingredients. At least some explanation for isolated and disgraced. Those who obeyed divine law lived these odd ingredients can be found in the following: in health and happiness. Those who transgressed the law These pharmacological mixtures were intended to were punished, with illness and suffering thought to be © Jones & Bartlettsicken andLearning, drive out theLLC intruding demon, which was© Jonesconsequences. & Bartlett The Learning, sick person LLCthen had to make atone- NOT FOR SALEthought OR toDISTRIBUTION cause the disease. Drugs containing fecalNOT FORment forSALE the sins, OR enlist DISTRIBUTION a priest or other spiritual healer matter were in fact used until the end of the eighteenth to lift the spell or curse, or live with the illness to its

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORultimate SALE outcome. OR DISTRIBUTION In simple terms, the person had to getNOT considered FOR SALE a milestone OR DISTRIBUTION in the eventual development of right with the gods or live with the consequences (Bullough the science of epidemiology as the fi rst such treatise on & Bullough, 1978). Nursing care by a family member or the connectedness of the web of life. Th is topic of the re- relative would be needed in any case, regardless of the lationship between humans and their environment did not outcome of the sin/curse/disease–atonement/recovery or reoccur until the development of bacteriology in the late © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC death cycle. Th is logic became the basis for explanation of nineteenth century (Fromkin, 1998; Rosen, 1958). why some people get sickNOT and FOR some don’tSALE for manyOR DISTRIBUTION centu- Perhaps the idea that mostNOT damaged FOR the SALEpractice OR and DISTRIBUTION ries, and it still persists to some degree in most cultures scientifi c theory of medicine and health for centuries was today (Achterberg, 1990). the doctrine of the four humors, fi rst spoken of by Em- pedocles of Acragas (493–433 b.c. ). Empedocles was a I have© Jonesan almostalmos & complete Bartlett disregard Learning, of precedent LLC philosopher and© Jones a physician, & Bartlett and as a Learning,result, he synthe- LLC andNOT a faith FOR in the SALE possibility OR of DISTRIBUTIONsomething better. It sized his cosmologicalNOT FOR ideas SALE into his OR medical DISTRIBUTION theory. He irritates me to be told how things always have been believed that the same four elements (or “roots of things”) done . . . I defy the tyranny of precedent. I cannot made up the universe and were found in humans and in all “aﬀ ord the luxury of a closed mind. I go for anything animate beings (Bullough & Bullough, 1978). Empedocles new that might improve the past. believed that each human was a microcosm, a small world © Jones & Bartlett Learning, LLC © Joneswithin the& Bartlettmacrocosm, Learning, or external environment.LLC Th e four NOT FOR SALEYou must OR never DISTRIBUTION so much as think whether you like NOThumors FOR of SALE the body OR (blood, DISTRIBUTION bile, phlegm, and black bile) it or not, whether it is bearable or not; you must corresponded to the four elements of the larger world (fi re, never think of anything except the need, and how air, water, and earth) (Kalisch & Kalisch, 1986). Depend- to meet it. ing on the prevailing humor, a person was sanguine, cho- —Clara© Jones Barton, & Civil Bartlett War nurse Learning, and leric,LLC phlegmatic, or melancholic.© Jones & Bartlett Learning, LLC founderNOT FOR of the AmericanSALE OR Red CrossDISTRIBUTION Because of this strongly heldNOT and FOR persistent SALE belief OR in DISTRIBUTION ” the connection between the balance of the four humors and health status, treatment was aimed at restoring the the Greeks and health appropriate balance of the four humors through the control of their corresponding elements. By manipulating In Greek© Jones mythology, & Bartlett the god of medicine,Learning, Asclepius, LLC cured the two sets of© oppositeJones qualities—hot& Bartlett Learning,and cold, wet LLC and disease.NOT One FOR of his SALE daughters, OR Hygeia, DISTRIBUTION from whose name dry—balanceNOT was the FOR goal SALE of the intervention.OR DISTRIBUTION Fire was we derive the word “hygiene,” was the goddess of preven- hot and dry, air was hot and wet, water was cold and wet, tive health and protected humans from disease. Panacea, and earth was cold and dry. For example, if a person had a Asclepius’s other daughter, was known as the all-healing fever, cold compresses would be prescribed for a chill and © Jones &“universal Bartlett remedy”; Learning, today her LLC name is used to describe any© Jonesthe person & Bartlett would be warmed.Learning, Such LLC doctrine gave rise to NOT FORultimate SALE “cure-all” OR DISTRIBUTION in medicine. Panacea was known as the NOTfaulty FOR and SALE ineff ective OR treatment DISTRIBUTION of disease that infl uenced “light” of the day, and her name was invoked and shrines medical education for many years (Taylor, 1922). built to her during times of epidemics (Brooke, 1997). Plato, in Th e Republic, detailed the importance of recre- During the Greek era, Hippocrates emphasized the ation, a balanced mind and body, nutrition, and exercise. rational treatment of sickness as a natural, rather than A distinction was made among gender, class, and health as god-infl icted, phenomenon.© Jones Hippocrates & Bartlett of Cos Learning,(460–370 early LLC as the Greek era; that is, only© Jonesmales of the& Bartlett aristocracy Learning, LLC b.c. ) is considered the NOTfather FORof medicine SALE because OR DISTRIBUTION of his could aff ord the luxury of maintainingNOT FOR a healthful SALE lifestyle OR DISTRIBUTION arrangements of the oral and written remedies and dis- (Rosen, 1958). eases, which had long been secrets held by priests and In Th e I l adi , Homer’s poem about the attempts to cap- religious healers, into a textbook of medicine that was used ture Troy and rescue Helen from her lover Paris, 140 dif- for centuries© Jones (Bullough & Bartlett & Bullough, Learning, 1978). Hippocrates’s LLC ferent wounds© areJones described. & Bartlett Th e mortality Learning, rate averaged LLC contributionNOT FOR to the SALE science ofOR public DISTRIBUTION health was his recog- 77.6%, with NOTthe highest FOR mortality SALE ORresulting DISTRIBUTION from sword nition that making accurate observations of and drawing and spear thrusts and the lowest mortality resulting from general conclusions from actual phenomena formed the superfi cial arrow wounds. Th ere was considerable need basis of sound medical reasoning (Shryock, 1959). for nursing care, and Achilles, Patroclus, and other princes In Greek society, health was considered to result from a oft en acted as nurses to the injured. Th e early stages of © Jones &balance Bartlett between Learning, mind and body. LLC Hippocrates wrote a most© JonesGreek medicine& Bartlett refl Learning,ected the infl LLC uences of Egyptian, NOT FORimportant SALE OR book, DISTRIBUTION Air , Water and Places, which detailed theNOT Babylonian, FOR SALE and ORHebrew DISTRIBUTION medicine. Therefore, good relationship between humans and the environment. It is medical and nursing techniques were used to treat these

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEwar wounds: OR DISTRIBUTION Th e arrow was drawn or cut out, the woundNOT FORconvalescent SALE camps OR DISTRIBUTIONalong the battle sites (Rosen, 1958). washed, soothing herbs applied, and the wound bandaged. Many of these early military hospitals have been exca- However, in sickness in which no wound occurred, an evil vated by archaeologists along the banks of the Rhine and spirit was considered the cause. For example, the cause of Danube Rivers. Th ey had wards, recreation areas, baths, the plague was unknown, so the question became how and pharmacies, and even rooms for offi cers who needed a © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC why aff ected soldiers had angered the gods. According to “rest cure” (Bullough & Bullough, 1978). Coexisting were Th e I l adi , the true healerNOT ofFOR the plagueSALE was OR the DISTRIBUTION prophet the Greek dispensary formsNOT of temples FOR (SALE iatreia ), OR which DISTRIBUTION who prayed for Apollo to stop shooting the “plague started out as a type of physician waiting room. Th ese arrows.” Th e Greeks applied rational causes and cures to eventually developed into a primitive type of hospital— external injuries, while internal ailments continued to be that is, places for surgical patients to stay until they could linked© Jones to spiritual & Bartlett maladies (BulloughLearning, & Bullough, LLC 1978). be taken home© Jones by their & families. Bartlett Although Learning, nurses LLCduring NOT FOR SALE OR DISTRIBUTION the RomanNOT era were FOR usually SALE family OR members, DISTRIBUTION servants, or roman era slaves, nursing had strengthened its position in medical care and emerged during the Roman era as a separate and During the rise and the fall of the Roman era (31 b.c. – a.d. distinct specialty (Minkowski, 1992). 476), Greek culture continued to be a strong infl uence. Th e During this era, the Romans developed massive aque- © Jones & BartlettRomans easily Learning, adopted GreekLLC culture and expanded the© Jonesducts, & bath Bartlett houses, Learning, and sewer systems. LLC Even though these NOT FOR SALEGreeks’ OR accomplishments, DISTRIBUTION especially in the fi elds of engi-NOT FORengineering SALE feats OR were DISTRIBUTION remarkable at the time, poorer and neering, law, and government. Th e development of policy, less fortunate residents oft en did not benefi t from the same law, and protection of the public’s health was an important level of public health amenities, such as sewer systems precursor to our modern public health systems (Fromkin, and latrines (Bullough & Bullough, 1978). However, the 1998; Rosen, 1958).© For Jones Romans, & the Bartlett government Learning, had an LLCRomans did provide many ©of theirJones citizens & Bartlett with what Learning, we LLC obligation to protectNOT its citizens, FOR SALE not only OR from DISTRIBUTION outside would consider public healthNOT services. FOR SALE OR DISTRIBUTION aggression such as warring neighbors, but also from inside the civilization in the form of health laws. According to Bullough and Bullough (1978), Rome was essentially a note this! “Greek cultural colony” (p. 20). id you know that engineers during the Roman era devel- ©During Jones the & 3rd Bartlett century b.c. Learning,, Rome began LLC to dominate Doped an© aqueduct Jones system & Bartlett capable ofLearning, providing 40 gallonsLLC theNOT Mediterranean, FOR SALE Egypt, OR the DISTRIBUTION Tigris–Euphrates Valley, of water perNOT person FOR per SALE day to Rome’s OR DISTRIBUTION 1 million residents, the Hebrews, and the Greeks (Boorstin, 1985). Greek sci- comparable to our consumption rates today? ence and Roman engineering then spread throughout the ancient world, providing a synthesized Greco-Roman © Jones & Bartlettfoundation Learning, for eventual LLCpublic health policies (Bullough© Jones & Bartlett Learning, LLC NOT FOR SALE& Bullough, OR DISTRIBUTION1978). NOT FOR SALE OR DISTRIBUTION Galen of Pergamum ( a.d. 129–199), oft en known as the greatest Greek physician aft er Hippocrates, left for Rome aft er studying medicine in Greece and Egypt and gained great fame as a medical practitioner, lecturer, and experi- menter. In his lifetime,© medicineJones & evolved Bartlett into aLearning, science; he LLC © Jones & Bartlett Learning, LLC submitted traditionalNOT healing FOR practices SALE to experimentation OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and was possibly the greatest medical researcher before the 17th century (Bullough & Bullough, 1978). Galen was con- Middle ages sidered the last of the great physicians of antiquity (Kalisch & ©Kalisch, Jones 1986). & Bartlett Learning, LLC Th e Middle© JonesAges, or &the Bartlett medieval Learning,era, served as LLCa transi- NOTTh e FORGreek SALEphysicians OR and DISTRIBUTION healers certainly made the tion betweenNOT ancient FOR and SALE modern OR civilizations. DISTRIBUTION Th e medi- most contributions to medicine, but the Romans surpassed cal knowledge of the Greeks and Romans was preserved the Greeks in promoting the evolution of nursing. Roman and expanded in the Islamic world, which underwent armies developed the notion of a mobile war nursing unit a “Golden Age” at this time but disappeared in Europe as their battles took them too far from home to be cared aft er the decline of the Roman Empire (476–1453 a.d. ). © Jones & Bartlettfor by their Learning, wives and family. LLC Th is portable hospital ©was Jones While & 9th-Bartlett and 10th-century Learning, MuslimLLC physicians such NOT FOR SALEa series OR of tents DISTRIBUTION arranged in corridors; as battles wore on,NOT FORas Al-Razi, SALE or OR Rhazes DISTRIBUTION (841–926 a.d. ), and Ibn-Sina, these tents gave way to buildings that became permanent known as Avicenna (980–1037 a.d. ), were developing the

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORfoundations SALE OR of modernDISTRIBUTION pharmacology in Persia, in EuropeNOT and FOR other SALE pilgrims OR as wellDISTRIBUTION as the occasional person who medicine was experiencing a reversal. Once again, myth, needed extra care (Kalisch & Kalisch, 1986). Early Eu- magic, and religion were explanations and cures for illness ropean hospitals were more like hospices or homes for and health problems. For Europeans, the medieval world the aged, sick pilgrims, or orphans. Nurses in these early was the result of fusion among three streams of thought, hospitals were religious deaconesses who chose to care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC actions, and ways of life—Greco-Roman, Germanic, and for others in a life of servitude and spiritual sacrifi ce Christian—into one (Donahue,NOT FOR 1985). SALE OR DISTRIBUTION(Minkowski, 1992). NOT FOR SALE OR DISTRIBUTION Black Death Cultural ConneCtion During the Middle Ages, a series of horrible epidemics, uring the Early Middle Ages, Europeans seldom washed including the Black Death (bubonic plague) , ravaged the or© changed Jones their & clothesBartlett more Learning, than once or twiceLLC a year. © Jones & Bartlett Learning, LLC D civilized world (Diamond, 1997; Fromkin, 1998). In the This NOTlack of personalFOR SALE sanitation OR set upDISTRIBUTION ideal conditions for the NOT FOR SALE OR DISTRIBUTION 14th century, Europe, Asia, and Africa saw nearly half bubonic plague where one out of three faces disappeared their populations lost to the bubonic plague. According from these human communities. to Bullough and Bullough (1978), an interesting account Source: Kelly, J. (2005). The great mortality: An intimate history of the of the arrival of the bubonic plague in 1347 claims that the © Jones &Black Bartlett Death, the Learning, most devastating LLC plague of all time . New York, NY: © Jones & Bartlett Learning, LLC HarperCollins. disease had started in the Genoese colony of Kaff a in the NOT FOR SALE OR DISTRIBUTION NOTCrimea. FOR Th SALE e story OR passed DISTRIBUTION down through the ages was that the city was being besieged by a Mongol khan. When the Nursing was most infl uenced by Christianity with disease broke out among the khan’s men, he catapulted the the beginning of deaconesses , or female servants, doing bodies of its victims into Kaff a to infect and weaken his the work of God by ministering© Jones to& theBartlett needs of Learning, others. enemies.LLC Th e soldiers and colonists© Jones of Kaff & aBartlett then carried Learning, LLC Deacons in the early ChristianNOT FOR churches SALE were OR apparently DISTRIBUTION the disease back to Genoa. NOT FOR SALE OR DISTRIBUTION available only to care for men; deaconesses cared only for the needs of the women. Th is role of the deaconess in the church was considered a forward step in the development thinK aBout this of nursing, and in the 19th century it would strongly infl u- he Pima Indians of the American Southwest referred to the ence ©the Jones young Florence & Bartlett Nightingale. Learning, LLC Tplague as ©oimmeddam Jones &or Bartlett“wandering Learning,sickness.” Below LLC is During NOT FORthis era, SALE Roman OR military DISTRIBUTION hospitals were an ancient IndianNOT legend FOR that SALE describes OR the DISTRIBUTION horror of their replaced by civilian ones. In early Christianity, the diako- ancestors suff ering fromoimmeddam . nia , a kind of combination outpatient and welfare offi ce, “Where do you come from?” an Indian asks a tall, black- was managed by deacons and deaconesses and served as haired stranger. © Jones &the Bartlett equivalent Learning, of a hospital. LLC Jesus served as the example© Jones “I come & Bartlett from far way,” Learning, the stranger LLCreplies, “from . . . across NOT FORof SALE charity ORand compassionDISTRIBUTION for the poor and marginal ofNOT the FOR Eastern SALE Ocean.” OR DISTRIBUTION society. “What do you bring?” the Indian asks. Communicable diseases were rampant during the “I bring death,” the stranger answers. “My breath causes Middle Ages, primarily because of the walled cities that children to wither and die like young plants in the spring emerged in response to the paranoia and isolation of the snow. I bring destruction. No matter how beautiful a woman, populations. Infection ©was Jones next to &impossible Bartlett to Learning, control. LLConce she has looked at me, she© becomes Jones as &ugly Bartlett as death. Learning, LLC Physicians had little toNOT off er, FOR deferring SALE to the OR church DISTRIBUTION for And to men, I bring not death alone,NOT but FOR the destruction SALE OR of DISTRIBUTION management of disease. Nursing roles were carried out their children and the blighting of their wives. . . . No people primarily by religious orders. Th e oldest hospital (other who look upon me are ever the same.” than military hospitals in the Roman era) in Europe was most© likely Jones the Hôtel-Dieu & Bartlett in Lyons,Learning, France, LLC founded in © Jones & Bartlett Learning, LLC aboutNOT 542 by FOR Childbert SALE I, king OR of DISTRIBUTION France. Th e Hôtel-Dieu Worldwide,NOT more FOR than 60SALE million OR deaths DISTRIBUTION were eventu- in Paris was founded in about 652 by St. Landry, bishop ally attributed to this horrible plague. In some parts of of Paris. Europe, only one-fourth of the population survived, with During the Middle Ages, charitable institutions, hos- some places having too few people to bury the dead. Fami- pitals, and medical schools increased in number, with lies abandoned sick children, and the sick were oft en left © Jones &the Bartlett religious leadersLearning, as caregivers. LLC Th e word “hospital”© Jonesto die alone & Bartlett (Cartwright, Learning, 1972). LLC NOT FORwhich SALE derives OR from DISTRIBUTION the Latin hospitalis , meaning “serviceNOT FOR Nurses SALE and physicians OR DISTRIBUTION were powerless to avert the of guests,” was most likely used for a shelter for travelers disease. Black spots and tumors on the skin appeared,

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEand petechiae OR DISTRIBUTION and hemorrhages gave the skin a dark-NOT FORhealing SALE (Achterberg, OR DISTRIBUTION 1990; Barstow, 1994; Briggs, 1996). ened appearance. Th ere was also acute infl ammation of As women found themselves “ineligible” to practice in the lungs, burning sensations, unquenchable thirst, and their roles as healers, they faced an even greater threat as infl ammation of the entire body. Hardly anyone affl icted they were labeled as witches. survived the third day of the attack. So great was the A revival of the Holy Inquisition, a body formed in © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC fear of contagion that ships were set to sail with bod- France in 1022 and codifi ed by the Catholic Church in ies of infected personsNOT without FOR a SALE crew, drift OR ing DISTRIBUTION through the 1486 Malleus malefi carumNOT (Hammer FOR SALE of Witches) OR byDISTRIBUTION the North, Black, and Mediterranean seas from port to Pope Innocent VIII, allowed the persecutions to take port with their dead passengers (Cohen, 1989). Bubonic form. By formalizing the legal punishment of witches and plague is caused by the bacillus Pasteurella pestis , which midwives, the Pope codifi ed this “step-by-step, how-to is ©usually Jones transmitted & Bartlett by the Learning, bite of a fl eaLLC carried by an manual” for© dealingJones with & Bartlett the witch Learning,problem. Achterberg LLC animalNOT vector, FOR typicallySALE ORa rat. DISTRIBUTION Aft er the initial fl ea bite, (1990) describesNOT thisFOR signifi SALE cant ORendorsement DISTRIBUTION in this way: the infection spreads through the lymph nodes, and the “We are dealing here with an evil that surpasses rational nodes swell to enormous size; the infl amed nodes are understanding. Here was, indeed, the worst aberration of called bubos, from which the bubonic plague derives its humanity and it trickled down the hierarchy of author- name. Medieval people knew that this disease was in some ity” (p. 86). Th e legal system throughout Europe became © Jones & Bartlettway communicable, Learning, but theyLLC were unsure of the mode© of Jonesincreasingly & Bartlett harsh Learning,with each new LLC conviction, and as the NOT FOR SALEtransmission OR DISTRIBUTION (Diamond, 1997)—hence the avoidanceNOT of FORdistinction SALE between OR sorceryDISTRIBUTION and heresy was further blurred, victims and a reliance on isolation techniques. Th e prac- those accused of witchcraft and heresy were found guilty tice of quarantine in city ports was developed as a preven- of devil worship. With the support of both the church and tive measure and is still used today (Bullough & Bullough, civil authorities, as many as 250,000 women were accused, 1978; Kalisch & Kalisch,© Jones 1986). & Bartlett Learning, LLC“tried,” and tortured into making© Jones confessions & Bartlett and eventu- Learning, LLC NOT FOR SALE OR DISTRIBUTIONally burned at the stake simplyNOT for FOR being SALEwomen ORhealers DISTRIBUTION (Briggs, 1996). Th e accusers linked women’s special healing “powers” to an alliance with Satan, and over three centuries ethiCal ConneCtion they punished and eliminated women as perceived threats he Gallup Poll organization named nursing as the most to their medical supremacy in society. T©“ethical” Jones profession & Bartlett in the United Learning, States in 2013,LLC according Our stereotype© Jones of a& witch Bartlett today Learning,refl ects these LLC ancient toNOT a survey FOR of American SALE adults. OR More DISTRIBUTION than 80% of respondents and deadlyNOT associations FOR SALE of women OR DISTRIBUTION healers and evil categorized nurses as having very high or high ethics. Nurs- magic: the elderly, unattractive woman dressed in black ing has been ranked the number one most ethical profession on a broomstick with a black cat at her side. Women in during the last 10 years, passed only in 2001 by fi re fi ghters in Europe who practiced as healers oft en used empirically © Jones & Bartlettthe wake ofLearning, the 9/11 terrorist LLC attacks. © Jonessound & herbalBartlett and Learning, alternative healthLLC practices (hence The plague had far-reaching social and religious conse- NOT FOR SALE OR DISTRIBUTION NOT FORthe caldron SALE association), OR DISTRIBUTION provided gynecological and quences. The authority of the Catholic Church was weak- obstetric care of women at all hours (hence the broom, ened, due to the inability of priests to halt the disease and protect their parishioners from the Black Death, which was because proper women did not go out at night and were commonly assumed to be God’s vengeance for the sins presumed to “fl y”), and relied on other women for advice of humans. Although dreadful and terrifying, the plague and shared practices of healing (hence the “coven” associa- brought about radical© societalJones changes & Bartlett through theLearning, drop in LLCtion; Achterberg, 1990; Barstow,© Jones 1994). & As Bartlett described Learning, by LLC value of land, due toNOT a reduction FOR in SALEworkers, thusOR raising DISTRIBUTION the Briggs (1996), “To this endNOT they have FOR allegedly SALE fl ORown DISTRIBUTIONby price of labor and ultimately ending Europe’s feudal system night to meetings where orgiastic, blasphemous or can- (Fromkin, 1998). nibalistic rituals symbolized their defection from social and personal virtue” (p. 4). Briggs (1996) estimates that 100,000 trials of witches The© “WitchJones Craze” & Bartlett of the Early Learning, Middle Ages LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION occurred NOTin Europe FOR between SALE the OR years DISTRIBUTION 1450 and 1750, As respected “wise women” through the centuries, during with at least 50% of the accused being executed in bru- the Middle Ages midwives and women healers gradually tal hangings and burnings. Th is “witch craze” reached its transformed into members of a “demonized” avocation. height during the 12th through 14th centuries in France, As formal training in medicine gradually developed in Germany, and other European countries (Achterberg, © Jones & BartlettEurope, leaders Learning, of the churchLLC and offi cials at the time© Jones 1990; & Barstow, Bartlett 1994; Learning, Briggs, 1996).LLC Religion, magic, NOT FOR SALErestricted OR such DISTRIBUTION education to men only, consequently creat-NOT FORhealing, SALE and witchcraft OR DISTRIBUTION were inextricably linked through- ing a legal male monopoly of the practice of medicine and out human history, but during this era dramatic changes

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORin SALE cultural OR values DISTRIBUTION and paranoia about women’s perceivedNOT the FOR agreement SALE among OR theDISTRIBUTION leaders was almost unanimous powers resulted in a mass cultural movement to eliminate on the abolition of the monastic or cloistered career. Th e women as healers (Briggs, 1996; Minkowski, 1992). eff ects on nursing were drastic: Monastic-affi liated institutions, including hospitals and schools, were closed, and orders of nuns, including nurses, were dissolved. Even in the renaissance© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC countries where Catholicism fl ourished, seizures of mon- During the rebirth of NOTEurope, FOR great SALEpolitical, OR social, DISTRIBUTION and asteries by royal leaders occurredNOT frequently. FOR SALE OR DISTRIBUTION economic advances occurred along with a tremendous Religious leaders, such as Martin Luther in Germany, revival of learning. Donahue (1985) contends that the who led the Reformation in 1517, were well aware of the Renaissance has been “viewed as both a blessing and a lack of adequate nursing care as a result of these sweeping curse”© (p. Jones 188). Th & ereBartlett was a renewed Learning, interest LLC in the arts changes. Luther© Jonesadvocated & that Bartlett each town Learning, establish some- LLC and sciences,NOT FOR which SALE helped OR advance DISTRIBUTION medical science thing akin to aNOT “community FOR SALE chest” to OR raise DISTRIBUTION funds for hospi- (Boorstin, 1985; Bullough & Bullough, 1978). Columbus tals and nurse visitors for the poor (Dietz & Lehozky, 1963; and other explorers discovered new worlds, and belief in Fromkin, 1998). For example, in England, where there a sun-centered rather than earth-centered universe was had been at least 450 charitable foundations before the promoted by Copernicus (1473–1543); Sir Isaac Newton’s Reformation, only a few survived the reign of Henry VIII, © Jones &(1642–1727) Bartlett theoryLearning, of gravity LLC changed the world forever.© Joneswho closed & Bartlett most of Learning,the monastic LLChospitals (Donahue, NOT FORGunpowder SALE OR was DISTRIBUTION introduced, and social and religious up-NOT1985). FOR Eventually, SALE OR Henry DISTRIBUTION VIII’s son, Edward VI, who heavals resulted in the American and French revolutions reigned from 1547 to 1553, was convinced and did endow at the end of the 18th century (Weiner, 1993). some hospitals—namely St. Bartholomew’s Hospital and In the arts and sciences, Leonardo da Vinci, known as St. Th omas’s Hospital, which would eventually house one of the greatest geniuses© Jones of all &time, Bartlett made a Learning,number theLLC Nightingale School of Nursing© Jones in the & 19th Bartlett century Learning, LLC of anatomical drawingsNOT based FOR on dissection SALE experiences.OR DISTRIBUTION (Bullough & Bullough, 1978). NOT FOR SALE OR DISTRIBUTION Th ese drawings have become classics in the progression of knowledge about the human anatomy. Many artists of this time left an indelible mark and continue to exert infl u- Got an alternatiVe? ence today, including Michelangelo, Raphael, and Titian hrenreich and English (1973), in their seminal work, Witches, Mid- (Donahue,© Jones 1985; &Minkowski, Bartlett 1992; Learning, Weiner, 1993).LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION Ewives, and Nurses:NOT A FORHistory ofSALE Women ORHealers DISTRIBUTION, note that in the Middle Ages it was the women who were testing new herbs and the emergence of home Visiting innovative ways of healing, leading to the adoption of humane, empirical paradigms of healing. All the while, they contend, their Saint Vincent de Paul In 1633, founded the Sisters of Char- male counterparts clung to their ritualistic and outdated proce- © Jones &ity Bartlettin France, anLearning, order of nuns LLC who traveled from home to © Jonesdures, such& Bartlett as leeching, Learning, use of mercury, LLCand purgation. home visiting the sick. As the services of the sisters grew, NOT FOR SALE OR DISTRIBUTION NOT FORThese SALE authors contendOR DISTRIBUTION that the witch craze, where thou- St. Vincent appointed Mademoiselle Le Gras as supervi- sands of women were tried and put to death, was a ruling- sor of these visitors. Th ese nurses functioned as the fi rst class campaign of terror against the female peasant healers organized visiting nurse service, making home visits and who dared to introduce what is now considered holistic or caring for the sick in their homes. De Paul believed that © Jones & Bartlett Learning, LLCcomplementary healing modalities.© Jones Given that & God Bartlett consid- Learning, LLC for family members to go to the hospital was disruptive ered illness and suff ering as payment for sin, anyone who NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION to family life and that taking nursing services to the home off ered healing interventions, such as boiling up herbs and enabled health to be restored more eff ectively and more potions in big pots, must be anti-God and, therefore, must effi ciently (Weiner, 1993). be working for the “other side” or the Devil. It is hardly sur- prising, according to Ehrenreich and English, that nursing fell the© reformation Jones & Bartlett Learning, LLC into disrepute© by Jones the 18th ¢ury, Bartlett and that Learning, the only women LLC NOT FOR SALE OR DISTRIBUTION who had anyNOT status forFOR being SALE involved OR in healing DISTRIBUTION were those Religious changes during the Renaissance were to infl u- in holy orders. Yet for many poor people, their only remedies ence nursing perhaps more than any other aspect of soci- were these traditional healing “potions.” As medicine grew ety. Particularly important was the rise of Protestantism with scientifi c models of illness management, these tried and as a result of the reform movements of Martin Luther tested remedies were held up as “old wives’ tales.” © Jones &(1483–1546) Bartlett inLearning, Germany and LLC John Calvin (1509–1564)© Jones & Bartlett Learning, LLC Source: Ehrenreich, B., & English, D. (1973). Witches , midwives , and NOT FORin SALE France ORand Geneva,DISTRIBUTION Switzerland. Although the vari-NOTnurses FOR: A history SALE of women OR healersDISTRIBUTION . Old Westbury, NY: Feminist Press. ous sects were numerous in the Protestant movement,

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE the advancement OR DISTRIBUTION of science and NOT FORAchilles, SALE the OR mighty DISTRIBUTION Greek warrior, had been dipped as health of the public an infant by his mother in the River Styx so that he would be invincible to iron weapons. Because his mother had It took the fi rst 50 years of the 18th century for the new held him by his heel, this was the only vulnerable part of his knowledge from the© Enlightenment Jones & Bartlett to be organized Learning, and LLCbody. In the adaptation of Homer’s© Jones Iliad, the& Bartlett Trojan warrior Learning, LLC digested, according NOTto Donahue FOR (1985).SALE In OR Great DISTRIBUTION Britain, Paris (played by Orlando Bloom)NOT shoots FOR Achilles SALE in the OR heel DISTRIBUTION Edward Jenner discovered an eff ective method of vaccina- with a poison arrow and brings about his death. A simple tion against the dreaded smallpox virus in 1798. Psychiatry superfi cial wound to the heel would not have been deadly; developed as a separate branch of medicine, and instru- consequently, history provides us with an early account of ments such as the pulse watch and the stethoscope were biochemical warfare. invented© Jones that &measured Bartlett and Learning, allowed for LLCassessment of Source: Peterson,© Jones W. (Producer & Bartlett & Director). (2004). Learning, Troy. United LLC States: theNOT body. FOR SALE OR DISTRIBUTION Warner Bros.NOT FOR SALE OR DISTRIBUTION One of the greatest scientists of this period was Louis Pasteur (1822–1895). A French chemist, Pasteur fi rst became interested in pathogenic organisms through his note this! studies of the diseases of wine. His discovery, that heating © Jones & Bartlett Learning, LLC © Joneshe & Reformation Bartlett Learning,had a devastating LLC eff ect upon nursing. wine to a temperature of 55° to 60°C killed the microor- NOT FOR SALE OR DISTRIBUTION NOT FORImagine SALE our ORsituation DISTRIBUTION in the United States if a decree went ganisms that spoiled wine, was critical to the wine indus- T out that hospitals would be closed in 2 years. There would be try’s success in France. Th is process of pasteurization led no places available to care for the ill. Such were the conditions Pasteur to investigate many fi elds and save many lives from in England from 1538–1540 during the reign of Henry VIII. No contaminated milk and food. provision was made for the sick and poor, there was no lay Joseph Lister (1827–1912)© Jones was & aBartlett physician Learning,who set out LLC © Jones & Bartlett Learning, LLC organization to replace those who had fl ed, and no one to to decrease the mortalityNOT FORresulting SALE from ORinfection DISTRIBUTION aft er NOT FOR SALE OR DISTRIBUTION develop or teach others to carry on. surgery. He used Pasteur’s research to eventually arrive at a Source: Dietz, D. D., & Lehozky, A. R. (1963). History and modern nursing . chemical antiseptic solution of carbolic acid for use in sur- Philadelphia, PA: F. A. Davis. gery. Widely regarded as the father of modern surgery, he practiced© Jones his antiseptic & Bartlett surgery Learning, with great LLCresults, and the © Jones & Bartlett Learning, LLC Listerian principles of asepsis changed the way physicians NOT FOR SALE OR DISTRIBUTION the darkNOT period FOR of SALE nursing OR DISTRIBUTION and nurses practice to this day (Dietz & Lehozky, 1963). Robert Koch (1843–1910), a physician known for his Th e last half of the period between 1500 and 1860 is widely research in anthrax, is regarded as the father of microbi- regarded as the “dark period of nursing” because nursing ology. By identifying the organism that caused cholera, conditions were at their worst (Donahue, 1985). Educa- © Jones & BartlettVibrio cholerae Learning,, he also demonstrated LLC its transmission ©by Jones tion &for Bartlett girls, which Learning, had been providedLLC by the nuns in NOT FOR SALEwater, food,OR andDISTRIBUTION clothing. NOT FORreligious SALE schools, OR was DISTRIBUTION lost. Because of the elimination Edwin Klebs (1834–1913) proved the germ theory— of hospitals and schools, there was no one to pass on that is, that germs are the causes of infectious diseases. knowledge about caring for the sick. As a result, the hos- Th is discovery of the bacterial origin of diseases may be pitals were managed and staff ed by municipal authorities; considered the greatest achievement of the 19th century. women entering nursing service oft en came from illiterate Although the microscope© Jones had been& Bartlett around for Learning, two cen- LLCclasses, and even then there© were Jones too few & toBartlett serve (Dietz Learning, LLC turies, it remained NOTfor Lister, FOR Pasteur, SALE and OR Koch—and DISTRIBUTION & Lehozky, 1963). Th e lay attendantsNOT FOR who SALE fi lled ORthe nurs-DISTRIBUTION ultimately Klebs—to provide the missing link (Dietz & ing role were illiterate, rough, inconsiderate, and oft en Lehozky, 1963; Fromkin, 1998; Rosen, 1958). immoral and alcoholic. Intelligent women and men could not be persuaded to accept such a degraded and low-status Media © Jones MoMen & Bartlettt Learning, LLC position in© the Jones off ensive & Bartlett municipal Learning, hospitals of LLCLondon. NOT FOR SALE OR DISTRIBUTION Nursing slippedNOT FORback into SALE a role OR of servitudeDISTRIBUTION as menial, Troy (2004) low-status work. According to Donahue (1985), when a his movie starring Brad Pitt as Achilles is based on the woman could no longer make it as a gambler, prostitute, Tepic poem The Iliad by Homer. The movie recounts the or thief, she might become a nurse. Eventually, women legend of the Trojan War, as the fortress city is attacked by a serving jail sentences for crimes such as prostitution and © Jones & BartlettGreek army Learning, led by Menelaus LLC of Sparta and Agamemnon of© Jonesstealing & Bartlett were ordered Learning, to care for LLC the sick in the hospitals NOT FOR SALEMycenae. OR DISTRIBUTION NOT FORinstead SALE of serving OR their DISTRIBUTION sentences in the city jail (Dietz & Lehozky, 1963). Th e nurses of this era took bribes from

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORpatients, SALE became OR DISTRIBUTION inappropriately involved with them, andNOT A sailor,FOR JeanSALE Louis, OR donated DISTRIBUTION the endowment for the hos- survived the best way they could, oft en at the expense of pital’s founding (Bullough & Bullough, 1978). their assigned patients. During the 17th and 18th centuries, colonial hospi- During this era, nursing had virtually no social stand- tals were oft en used to house the poor and downtrodden, ing or organization. Even Catholic sisters of the religious though they bore little resemblance to modern hospitals. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC orders throughout Europe “came to a complete stand- Hospitals called pesthouses were created to care for people still” professionally becauseNOT ofFOR the intolerance SALE OR of DISTRIBUTIONsociety with contagious diseases; theirNOT primary FOR purpose SALE was OR to DISTRIBUTION (Donahue, 1985, p. 231). protect the public at large, rather than to treat and care for the patients. Contagious diseases were rampant during the Media MoMent early years of the American colonies, oft en being spread © Jones & Bartlett Learning, LLC by the large ©number Jones of immigrants& Bartlett who Learning, brought these LLC MartinNOT Chuzzlewit FOR SALE (1843–1844) OR DISTRIBUTION diseases withNOT them FORon their SALE long journeysOR DISTRIBUTION to America. By Charles Dickens Medicine was not as developed as in Europe, and nursing remained in the hands of the uneducated. Average harles Dickens created the immortal character of Sairey life expectancy at birth was only around 35 years by 1720. CGamp, who was a visiting nurse based on an actual hired Plagues were a constant nightmare, with outbreaks of © Jones &attendant Bartlett whom Learning, Dickens had LLC met in a friend’s home: © Jonessmallpox & and Bartlett yellow fever.Learning, In 1751, LLC the fi rst true hospital NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION She was a fat old woman, this Mrs. Gamp, with a husky in the new colonies, Pennsylvania Hospital, was erected voice and a moist eye, which she had a remarkable in Philadelphia on the recommendation of Benjamin power of turning up and showing the white of it. Franklin (Kalisch & Kalisch, 1986). Having very little neck, it cost her some trouble to By today’s standards, hospitals in the 19th century were look over herself, if one© Jonesmay say so, & to Bartlett those to whom Learning, disgraceful,LLC dirty, unventilated, ©and Jones contaminated & Bartlett by infec- Learning, LLC she talked. She woreNOT a very FOR rusty black SALE gown, OR rather DISTRIBUTION tions; to be a patient in a hospitalNOT actually FOR increased SALE one’sOR DISTRIBUTION the worse for snuff , and a shawl and bonnet to cor- risk of dying. As in England, nursing was considered an respond. . . . The face of Mrs. Gamp—the nose in inferior occupation. Aft er the sweeping changes as a result particular—was somewhat red and swollen, and it of the Reformation, educated religious health workers were replaced with lay people who were “down and outers,” in was© Jones diﬃ cult to& enjoy Bartlett her society Learning, without becoming LLC © Jones & Bartlett Learning, LLC conscious of the smell of spirits. Like most persons prison, or had no option left except to work with the sick NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION who have attained to great eminence in their profes- (Kalisch & Kalisch, 1986). sion, she took to hers very kindly; insomuch, that set- The Chadwick Report and the Shattuck Report ting aside her natural predilections as a woman, she went to a lying-in [birth] or a laying-out [death] with Edwin Chadwick became a major fi gure in the develop- © Jones & Bartlettequal zest Learning, and relish. LLC © Jonesment of &the Bartlett fi eld of public Learning, health in LLCGreat Britain by draw- NOT FOR SALE OR DISTRIBUTION NOTing FOR attention SALE to the OR cost DISTRIBUTION of the unsanitary conditions that Sairey Gamp was hired to care for sick family members shortened the lifespan of the laboring class and posed but was instead cruel to her patients, stole from them, and threats to the wealth of Britain. Although the fi rst sanita- ate their rations; she was an alcoholic and has been immor- tion legislation, which established a National Vaccination talized forever as a reminder of the world in which Florence Board, was passed in 1837, Chadwick found in his classic Nightingale came of age© (Donahue, Jones 1985;& Bartlett Minkowski, Learning, 1992). study, LLC Report on an Inquiry into© the Jones Sanitary & Conditions Bartlett of Learning, LLC NOT FOR SALE OR DISTRIBUTIONthe Laboring Population of GreatNOT Britain FOR , that SALE death ratesOR DISTRIBUTION were high in large industrial cities such as Liverpool. A early organized health Care in the more startling fi nding, from what is oft en referred to sim- americas: a Brave new World ply as the Chadwick Report, was that more than half the © Jones & Bartlett Learning, LLC children of labor-class© Jones workers & Bartlett died by Learning, age 5, indicating LLC In theNOT New World,FOR SALEthe fi rst ORhospital DISTRIBUTION in the Americas—the poor living conditionsNOT FOR that SALE aff ected OR the DISTRIBUTIONhealth of the most Hospital de la Purisima Concepcion—was founded some vulnerable. Laborers lived only half as long as members time before 1524 by Hernando Cones, the conqueror of of the upper classes. Mexico. Th e fi rst hospital in the continental United States One consequence of the report was the establishment was erected in Manhattan in 1658 for the care of sick sol- of the fi rst board of health, the General Board of Health © Jones &diers Bartlett and slaves. Learning, In 1717, a hospitalLLC for infectious diseas-© Jonesfor England, & Bartlett in 1848 Learning,(Richardson, LLC 1887). More legisla- NOT FORes SALE was built OR in DISTRIBUTIONBoston; the fi rst hospital established byNOT tion FOR followed SALE that OR initiated DISTRIBUTION social reform in the areas of a private gift was the Charity Hospital in New Orleans. child welfare, elder care, the sick, the mentally ill, factory

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEhealth, ORand education.DISTRIBUTION Soon sewers and fireplugs, basedNOT FORWorkers SALE were OR forced DISTRIBUTION to go to the machines, rather than on an available water supply, appeared as indicators that the other way around. Such relocations meant giving up the public health linkages from the Chadwick Report had not only farming, but also a way of life that had existed an impact. for centuries. The emphasis on profit over people led to In the United States during the 19th century, waves of child labor, frequent layoffs, and long workdays filled with © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC epidemics of yellow fever, smallpox, cholera, typhoid fever, stressful, tedious, unfamiliar work. Labor unions did not and typhus continuedNOT to plague FOR the SALEpopulation OR as inDISTRIBUTION England exist, nor was there any legalNOT protection FOR againstSALE exploita OR DISTRIBUTION- and the rest of the world. As cities continued to grow in the tion of workers, including children (Donahue, 1985). All industrialized young nation, poor workers crowded into of these rapid changes and often threatening conditions larger cities and suffered from illnesses caused by the unsan- were described in the work of Charles Dickens; in his book itary© livingJones conditions & Bartlett (Hanlon Learning, & Pickett, 1984). LLC Similar to Oliver Twist©, forJones example, & Bartlett children worked Learning, as adults LLC with- whatNOT occurred FOR with SALE Chadwick’s OR DISTRIBUTION classic study in England, out question.NOT FOR SALE OR DISTRIBUTION Lemuel Shattuck, a Boston bookseller and publisher who According to Donahue (1985), urban life, trade, and had an interest in public health, organized the American industrialization contributed to these overwhelming Statistical Society in 1839 and issued a census of Boston in health hazards, and the situation was confounded by 1845. Shattuck’s census revealed high infant mortality rates the lack of an adequate means of social control. Reforms © Jones & Bartlettand high overall Learning, population LLC mortality rates. In his Report© Joneswere &desperately Bartlett needed, Learning, and the LLCsocial reform movement NOT FOR SALEof the Massachusetts OR DISTRIBUTION Sanitary Commission in 1850, ShatNOT- FORemerged SALE in response OR DISTRIBUTION to the unhealthy by-products of the tuck not only outlined his findings on the unsanitary con- Industrial Revolution. It was in this world of the 19th cen- ditions, but also made recommendations for public health tury that reformers such as John Stuart Mill (1806–1873) reform that included the keeping of population statistics emerged. Although the Industrial Revolution began in and development of© a monitoringJones & systemBartlett that Learning,would pro- LLCEngland, it quickly spread to© the Jones rest of Europe& Bartlett and to Learning, the LLC vide information to NOTthe public FOR about SALE environmental, OR DISTRIBUTION food, United States (Bullough & NOTBullough, FOR 1978). SALE The OR reform DISTRIBUTION and drug safety as well as infectious disease control (Rosen, movement is critical to understanding the emerging health 1958). He also called for services such as well-child care, concerns that were later addressed by Florence Nightin- school-age children’s health, immunizations, mental health, gale. Mill championed popular education, the emanci- health education for all, and health planning. The Shattuck pation of women, trade unions, and religious toleration. Report© Jones was revolutionary & Bartlett in itsLearning, scope and visionLLC for public Other reform© Jones issues of & the Bartlett era included Learning, the abolition LLC of health,NOT but FOR it was SALE virtually OR ignored DISTRIBUTION during Shattuck’s life- slavery and,NOT most FOR important SALE for OR nursing, DISTRIBUTION more humane time. It would not be until 19 years later, in 1869, that the care of the sick, the poor, and the wounded (Bullough & first state board of health was formed (Kalisch & Kalisch, Bullough, 1978). There was a renewed energy in the reli- 1986; Minkowski, 1992). gious community with the reemergence of new religious © Jones & Bartlett Learning, LLC © Jonesorders & inBartlett the Catholic Learning, church that LLC provided service to the NOT FOR SALEThe I ndustrialOR DISTRIBUTION Revolution NOT FORsick and SALE disenfranchised. OR DISTRIBUTION Epidemics had ravaged Europe for centuries, but they During the mid-18th century in England, capitalism became even more serious with urbanization. Industrial- emerged as an economic system based on profit. This ization had brought people to cities, where they worked emerging system resulted in mass production, as con- in close quarters (as compared with the isolation of the trasted with the previous© Jones system & ofBartlett individual Learning, workers LLCfarm) and contributed to the© socialJones decay & Bartlett of the second Learning, LLC and craftsmen. In theNOT simplest FOR terms, SALE the IndustrialOR DISTRIBUTION Revo- half of the 19th century. SanitationNOT FOR was poor SALE or nonexis OR DISTRIBUTION- lution was the application of machine power to processes tent, sewage disposal from the growing population was formerly done by hand. Machinery was invented during lacking, cities were filthy, public laws were weak or nonex- this era and ultimately standardized quality; individual istent, and congestion of the cities inevitably brought pests craftsmen© Jones were & Bartlettforced to Learning,give up their LLCcrafts and lands in the form© ofJones rats, lice, & andBartlett bedbugs, Learning, which transmitted LLC andNOT become FOR factory SALE laborers OR forDISTRIBUTION the capitalist owners. All many pathogens.NOT FOR Communicable SALE OR diseases DISTRIBUTION continued to types of industries were affected; this newfound efficiency plague the population, especially those who lived in these produced profits for owners of the means of production. unsanitary environments. For example, during the mid- As a result, the era of invention flourished, factories grew, 18th century typhus and typhoid fever claimed twice as and people moved in record numbers to work in the cities. many lives each year as did the Battle of Waterloo (Hanlon © Jones & BartlettUrban areas Learning, grew, tenement LLC housing projects emerged,© Jones & Pickett, & Bartlett 1984). Through Learning, foreign LLC trade and immigration, NOT FOR SALEand overcrowded OR DISTRIBUTION cities became serious threats to wellbeNOT- FORinfectious SALE diseases OR spread DISTRIBUTION to all of Europe and eventually ing (Donahue, 1985). to the growing United States.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR John SALE snow OR andDISTRIBUTION the science of NOTand FOR intellectual SALE abilities OR DISTRIBUTION not common to female children of the Victorian age. She mastered the fundamentals of Greek epidemiology and Latin, and she studied history, art, mathematics, and John Snow, a prominent physician, is credited with being philosophy. To her family’s dismay, she believed that God had called her to be a nurse (Bostridge, 2008). Nightin- the fi rst epidemiologist.© Jones In 1854, & he Bartlett demonstrated Learning, that LLC © Jones & Bartlett Learning, LLC gale was keenly aware of the suff ering that industrializa- cholera rates were linkedNOT with FOR water SALEpump use OR in LondonDISTRIBUTION NOT FOR SALE OR DISTRIBUTION (Cartwright, 1972; Johnson, 2006). Snow investigated the tion created; she became obsessed with the plight of the area around Golden Square in London and arrived at the miserable and suff ering. Conditions of general starvation conclusion that cholera was not carried by bad air, nor had accompanied the Industrial Revolution, along with necessarily by direct contact. He formed the opinion that overfl owing prisons and workhouses, and displaced per- diarrhea,© Jones unwashed & Bartlett hands, and Learning, shared food LLC somehow sons in all sections© Jones of British & Bartlett life. Nightingale Learning, wrote in LLC the playedNOT a large FOR part SALEin spreading OR theDISTRIBUTION disease. spring of 1842,NOT “My FORmind isSALE absorbed OR with DISTRIBUTION the suff erings People around Golden Square in London were not sup- of man; it besets me behind and before. . . . All that the plied with water by pipes, but rather drew their water from poets sing of the glories of this world seem to me untrue. surface wells by means of hand-operated pumps. A severe All the people that I see are eaten up with care or poverty or disease” (Woodham-Smith, 1951, p. 31). © Jones &outbreak Bartlett of cholera Learning, occurred LLC at the end of August 1853,© Jones & Bartlett Learning, LLC resulting in at least 500 deaths in just 10 days in Golden NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Square. By identifying rates of cholera, Snow for the fi rst note this! time linked the sources of the drinking water at the Broad lorence Nightingale never made a public appearance, nev- Street pump to the outbreaks of cholera, thereby proving Fer issued a public statement, and did not have the right that cholera was a waterborne disease. Snow’s epidemio- to vote. logical investigation started© Jones a train & of Bartlettevents that Learning, eventu- LLC © Jones & Bartlett Learning, LLC ally would end the greatNOT epidemics FOR ofSALE cholera, OR dysentery, DISTRIBUTION NOT FOR SALE OR DISTRIBUTION and typhoid (Minkowski, 1992). researCh alert When Snow attended the now-famous community s part of her work, Florence Nightingale collaborated with meeting of Golden Square and gave his evidence, govern- AWilliam Farr, the eminent medical statistician. Nightingale’s ment© offi Jones cials asked& Bartlett him what Learning, measures wereLLC necessary. epidemiological© Jones investigations, & Bartlett supported Learning, by Farr, illustrated LLC His reply was, “Take the handle off the Broad Street pump.” NOT FOR SALE OR DISTRIBUTION that attentionNOT to environmental FOR SALE cleanliness OR DISTRIBUTION was an impor- Th e handle was removed the next day, and no more chol- tant factor in preventing spread of disease (Bostridge, 2008). era cases occurred (Snow, 1855). Although he did not dis- Nightingale channeled her investigations to support hospital cover the true cause of the cholera—the identifi cation of reforms and the need for educated nurses who could provide the organism—he came very close to the truth (Johnson, better management of the hospital environment. Statistical © Jones &2006; Bartlett Rosen, 1958).Learning, LLC © Jonessupport & and Bartlett solicited criticismLearning, allowed LLC Nightingale to argue NOT FOR SALE OR DISTRIBUTION NOTmore FOR forcefully SALE for OR her reforms. DISTRIBUTION and then there Was nightingale . . . Source: Keeling, A. W. (2006). “Carrying ointments and even pills!” Medicines in the work of Henry Street Settlement visiting nurses, Florence Nightingale was named one of the 100 most 1893–1944. Nursing History Review , 14 . infl uential persons of the last millennium byLife magazine (1997), one of only eight© Joneswomen so& identifiBartlett ed. Learning,Of those LLC © Jones & Bartlett Learning, LLC eight women, who includedNOT FORsuch luminaries SALE OR as JoanDISTRIBUTION of For Nightingale, her entire lifeNOT would FOR be haunted SALE by OR this DISTRIBUTION Arc, Helen Keller, and Elizabeth I, Nightingale was identi- confl ict between the opulent life of gaiety that she enjoyed fi ed as a true “angel of mercy,” having reformed military and the plight and misery of the world, which she was unable health care in the Crimean War and used her political to alleviate. She was, in essence, an “alien spirit in the rich savvy© to Jones forever change & Bartlett the way Learning, society views LLCthe health of and aristocratic© socialJones sphere & Bartlettof Victorian Learning, England” (Palmer, LLC the vulnerable,NOT FOR the SALEpoor, and OR the forgotten.DISTRIBUTION She is probably 1977, p. 14). NOTNightingale FOR remained SALE ORunmarried, DISTRIBUTION and at the one of the most written-about women in history (Bullough age of 25, she expressed a desire to be trained as a nurse in & Bullough, 1978). Florence Nightingale has become syn- an English hospital. Her parents emphatically denied her onymous with modern nursing. request, and for the next 7 years, she made repeated attempts Florence Nightingale was the second child born to the to change their minds and allow her to enter nurse training. © Jones &wealthy Bartlett English Learning, family of William LLC and Frances Nightin-© JonesShe wrote, & Bartlett“I crave for Learning, some regular LLCoccupation, for some- NOT FORgale SALE on May OR 12, DISTRIBUTION 1820, in her namesake city, Florence, Italy.NOT thing FOR worth SALE doing OR instead DISTRIBUTION of frittering my time away on As a young child, Florence displayed incredible curiosity useless trifl es” (Woodham-Smith, 1951, p. 162).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEDuring OR this DISTRIBUTION time, Nightingale continued her educationNOT FORmoved SALE to London OR andDISTRIBUTION worked briefly as the superin- through the study of math and science, and she spent 5 tendent of the hospital Establishment for Gentlewomen years collecting data about public health and hospitals (Di- During Illness, finally realizing her dream of working as etz & Lehozky, 1963). While in Egypt, Nightingale studied a nurse (Bostridge, 2008; Cook, 1913). Egyptian, Platonic, and Hermetic philosophy; Christian © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC scripture; and the works of poets, mystics, and mission- The Crimean Experience: “I Can Stand Out the War with aries in her efforts NOTto understand FOR SALE the nature OR ofDISTRIBUTION God and Any Man” NOT FOR SALE OR DISTRIBUTION her “calling” as it fit into the divine plan (Calabria, 1996; Nightingale’s opportunity for greatness came when she Dossey, 2000). was offered the position of female nursing establishment The next spring, Nightingale traveled unaccompanied of the English General Hospitals in Turkey by the British to ©the Jones Kaiserwerth & Bartlett Institute inLearning, Germany and LLC stayed there Secretary of© War,Jones Sir Sidney & Bartlett Herbert. Learning, Soon after theLLC out- forNOT 2 weeks, FOR vowing SALE to return OR DISTRIBUTIONto train as a nurse. In June break of theNOT Crimean FOR War, SALE stories OR of theDISTRIBUTION inadequate care 1851, Nightingale took her future into her own hands and lack of medical resources for the soldiers became and announced to her family that she planned to return widely known throughout England (Woodham-Smith, to Kaiserwerth and study nursing. According to Dietz 1951). The country was appalled at the conditions so viv- and Lehozky (1963, p. 42), her mother had “hysterics” idly portrayed in the London Times. Pressure increased on © Jones & Bartlettand “scene Learning,followed scene.” LLC Her father “retreated into the© JonesSir Herbert & Bartlett to rectify Learning, the situation. LLC He knew of one woman NOT FOR SALEshadows,” OR and DISTRIBUTION her sister, Parthe, expressed that the familyNOT FORwho was SALE capable OR of DISTRIBUTIONbringing order out of the chaos and name was forever disgraced (Cook, 1913). wrote the following now-famous letter to Nightingale on In 1851, at the age of 31, Nightingale was finally permit- October 15, 1854, as a plea for her service: ted to go to Kaiserwerth. She studied there for 3 months There is but one person in England that I know of who with Pastor Fliedner. Her family insisted that she tell no © Jones & Bartlett Learning, LLCwould be capable of organising© Jones and & superintending Bartlett Learning, LLC one outside the family of her whereabouts, and her mother NOT FOR SALE OR DISTRIBUTIONsuch a scheme. . . . TheNOT difficulty FOR SALEof finding OR DISTRIBUTIONwomen forbade her to write any letters from Kaiserwerth. While equal to a task after all, full of horrors, and requir- there, Nightingale learned about the care of the sick and ing besides knowledge and good will, great energy the importance of discipline and commitment of oneself to and great courage, will be great. Your own personal God (Donahue, 1985). She returned to England and cared qualities, your knowledge and your power of admin- for© her Jones then-ailing & Bartlett father, from Learning, whom she LLC finally gained © Jones & Bartlett Learning, LLC istration and among greater things your rank and po- someNOT support FOR for SALE her intent OR to DISTRIBUTION become a nurse—her life- NOT FOR SALE OR DISTRIBUTION sition in Society give you advantages in such a work long dream (Bostridge, 2008). which no other person possesses. (Woodham-Smith, In 1852, Nightingale wrote the essay “Cassandra,” 1951, pp. 87–89) which stands today as a classic feminist treatise against © Jones & Bartlettthe idleness Learning, of Victorian women.LLC Through her voluminous© Jones Nightingale & Bartlett took Learning, the challenge LLC from Sir Herbert and NOT FOR SALEjournal OR writings, DISTRIBUTION Nightingale reveals her inner struggleNOT FORset sail SALEwith 38 self-proclaimedOR DISTRIBUTION nurses with varied training throughout her adulthood with what was expected of a and experiences, of whom 24 were Catholic and Angli- woman and what she could accomplish with her life. The can nuns. Their journey to the Crimea took a month. On life expected of an aristocratic woman in her day was one November 4, 1854, the brave nurses arrived at Istanbul she grew to loathe; throughout her writings, she poured and were taken to Scutari the same day. Faced with 3,000 out her detestation ©of Jonesthe life of & an Bartlett idle woman Learning, (Night- LLCto 4,000 wounded men in a© hospital Jones designed & Bartlett to accom Learning,- LLC ingale, 1979, p. 5). NOTIn “Cassandra,” FOR SALE Nightingale OR DISTRIBUTION put her modate 1,700 patients, the nursesNOT FORwent to SALE work (Kalisch OR DISTRIBUTION thoughts to paper, and many scholars believe that her & Kalisch, 1986). This is the scene that the nurses faced: eventual intent was to extend the essay to a novel. She There were 4 miles of beds 18 inches apart. Most soldiers wrote in “Cassandra,” “Why have women passion, intel- were lying naked with no bed or blanket. There were no lect,© Jonesmoral activity—these & Bartlett Learning,three—in a place LLC in society kitchen or© laundry Jones facilities. & Bartlett The little Learning, light present LLC took whereNOT no FOR one of SALE the three OR can DISTRIBUTIONbe exercised?” (Nightingale, the form ofNOT candles FOR in beer SALE bottles. OR The DISTRIBUTION hospital was liter- 1979, p. 37). Although uncertain about the meaning of ally floating on an open sewage lagoon filled with rats and the name “Cassandra,” many scholars believe that it came other vermin (Donahue, 1985). from the Greek goddess Cassandra, who was cursed by The barracks “hospital” was more of a death trap than Apollo and doomed to see and speak the truth but never a place for healing before Nightingale’s arrival. In a letter © Jones & Bartlettto be believed. Learning, Nightingale LLC saw the conventional life© of Jonesto Sir & Herbert, Bartlett Nightingale, Learning, demonstrating LLC her sense of NOT FOR SALEwomen OR as a DISTRIBUTIONwaste of time and abilities. After receivingNOT a FORhumor, SALE wrote, ORwith DISTRIBUTION tongue in cheek, that “the vermin generous yearly endowment from her father, Nightingale might, if they had but unity of purpose, carry off the four

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORmiles SALE of beds OR on DISTRIBUTION their backs and march them into the WarNOT made FOR her SALE famous ORsolitary DISTRIBUTION rounds with a lamp or lantern Offi ce” (Stanmore, 1906, pp. 393–394). to check on the soldiers. Nightingale had a lifelong pat- By taking the newly arrived medical equipment and tern of sleeping few hours, spending many nights writing, setting up kitchens, laundries, recreation rooms, read- developing elaborate plans, and evaluating implemented ing rooms, and a canteen, Nightingale and her team of changes. She seldom believed in the “hopeless” soldier; © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC nurses proceeded to clean the barracks of lice and fi lth. instead, she saw only one that needed extra attention. Nightingale was in herNOT element: FOR She SALE set out OR not onlyDISTRIBUTION to Nightingale was convinced thatNOT most FOR of theSALE maladies OR DISTRIBUTION provide humane health care for the soldiers, but also to that the soldiers suff ered and died from were prevent- essentially overhaul the administrative structure of the mil- able (Williams, 1961). itary health services (Williams, 1961). Nightingale and Before Nightingale’s arrival and her radical and well- her nurses© Jones faced overwhelming& Bartlett Learning, odds and deplorable LLC con- documented ©interventions Jones & basedBartlett on sound Learning, public health LLC ditions.NOT No FORaccommodations SALE OR had DISTRIBUTION been made for their principles, mortalityNOT FOR rates SALEfor the Crimea OR DISTRIBUTION War were esti- quarters, so they ended up in one of the hospital towers, mated to range from 42% to 73%. Nightingale is credited 39 women crowded into six small rooms. In addition to with reducing that rate to 2% within 6 months of her having no furniture, one of the rooms even contained a arrival at Scutari. She did so by conducting careful, sci- long-neglected, forgotten corpse swarming with vermin! entifi c epidemiological research (Dietz & Lehozky, 1963). © Jones &Ever Bartlett the disciplinarian, Learning, Nightingale LLC insisted on strict adher-© JonesUpon arriving & Bartlett at Scutari, Learning, Nightingale’s LLC fi rst act was to NOT FORence SALE to a standard OR DISTRIBUTION nurse uniform: gray tweed dresses, grayNOT order FOR 200 SALE scrubbing OR brushes. DISTRIBUTION Th e death rate fell dramati- worsted jackets, plain white caps, short woolen cloaks, and cally once Nightingale discovered that the hospital was brown scarves embroidered in red with the words “Scutari built literally over an open sewage lagoon. A dead horse Hospital” (Bullough & Bullough, 1978). was even retrieved from the sewer system under Scutari © Jones & Bartlett Learning, (Andrews,LLC 2003). © Jones & Bartlett Learning, LLC Florence Nightingale and Sanitation NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Although Nightingale never accepted the germ theory, she demanded clean dressings; clean bedding; well- Bad sanitary, bad architectural, and bad administra- cooked, edible, and appealing food; proper sanitation; and tive arraignments often make it impossible to nursenurse.. fresh air. Aft er the other nurses were asleep, Nightingale © Jones & Bartlett Learning, LLC © Jones & Bartlett —Florence Learning, Nightingale LLC NOT FOR SALE OR DISTRIBUTION “ NOT FOR SALE OR DISTRIBUTION”

GloBal ConneCtion made up my mind that if the army wanted nurses, they would around the Caribbean and Central America. After her husband’s © Jones & “ BartlettIbe glad of me,Learning, and with all LLCthe ardor of my nature, which ever© Jonesdeath, she & returned Bartlett to Kingston Learning, to help run LLC the family boarding- NOT FOR carriedSALE me OR where DISTRIBUTION inclination prompted, I decided that I wouldNOT house. FOR During SALE two epidemicsOR DISTRIBUTION of cholera and one epidemic of go to the Crimea; and go I did, as all the world knows.” yellow fever, she sharpened her skills as a nurse, even performing —Mary Seacole a postmortem autopsy of a baby who had died of cholera. Seacole eventually traveled with her brother to other South Mary Seacole, contemporary© Jones of Florence & Bartlett Nightingale, Learning, was American LLC countries, establishing hotels© Jones and providing & Bartlett care for Learning, LLC the sick. When she learned of the Crimean War, she traveled named in 2004 the greatestNOT black FOR Briton SALE of all time. OR Although DISTRIBUTION NOT FOR SALE OR DISTRIBUTION few have heard of Seacole, she was an important fi gure in the to England, at her own expense, and off ered her services to establishment of nursing as a profession. The Royal College the British Army. She was refused because of the color of her of Nursing President Sylvia Denton said of this honor: “Mary skin. The putdown did not deter Seacole, who funded her own Seacole stood up against the discrimination and prejudices she 3,000-mile trip to Crimea, where she off ered her services to encountered.© Jones Against & Bartlett all odds, Mary Learning, had an unshakeable LLC belief Florence Nightingale.© Jones Nightingale & Bartlett refused herLearning, off er as a nurse, LLC in theNOT power FOR of nursing SALE to make OR a DISTRIBUTIONdiff erence.” so Seacole setNOT up a FOR“hotel forSALE invalids”—called OR DISTRIBUTION the British Seacole was born in the early 1880s as Mary Grant, in Kingston, Hotel—in nearby Baklava. Jamaica, to a Scottish father and a free black Jamaican mother. At her hotel, Seacole banned drunkenness and gambling, Her mother taught her about Creole medicine and she grew up dispensed medicines, fed soldiers meals, and tended to the © Jones &well Bartlett educated. Learning, In 1838, she married LLC Edward Seacole, who died© Joneswounded & on Bartlett the battlefi Learning, eld under fi re,LLC making home visits to campsites in the area. Seacole’s hotel was a fi nancial disaster, NOT FOR shortlySALE afterward. OR DISTRIBUTION During their short marriage, they traveledNOT FOR SALE OR DISTRIBUTION Continued

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEbecause OR she DISTRIBUTION did not require payment for services and did notNOT FOR Selected SALE References OR DISTRIBUTION on the Life of Mary Seacole have the support of the British government. She used all of Crawford, P. (1992). The other lady with the lamp: Nursing her savings to secure medicine and other needed supplies for legacy of Mary Seacole. Nursing Times, 88 (11), 56–58. the sick. When the Crimean War ended in 1856, Seacole was in Gustafson, M. (1996). Mary Seacole, the Florence Nightingale of severe debt and struggled© Jones in her lifetime& Bartlett residence Learning, in England. LLCJamaica. Christian Nurse International,© Jones 12 (4),& 9.Bartlett Learning, LLC Her writings providedNOT some FOR fi nancial SALE support. OR DISTRIBUTIONKing, A. (1974). Mary Seacole, NOTpart I: AFOR matter SALE of life. Essence,OR DISTRIBUTION Through the years, historians have come to recognize Sea- 4 (11), 32. cole’s heroic and strong commitment to the development King, A. (1974). Mary Seacole, part II: The Crimea. Essence, 4 (12), of war nursing. It is possible that Nightingale and Seacole 68, 94. never met. Historical evidence is inconclusive regarding the Messmer, P. R., & Parchment, Y. (1998). Mary Grant Seacole: The exact© Jones nature of & their Bartlett personal Learning,contact at Scutari. LLC Nightingale’s © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION fi rst nurseNOT practitioner. FOR ClinicalSALE Excellence OR DISTRIBUTION for Nurse Practitio- refusal to accept Seacole’s off er to join her nurses at Sebastopol ners, 2 (1), 47–51. refl ected the discrimination and prejudice of the day. Seacole Payne, D. (1999). Face to face: Florence Nightingale and Mary received the Crimean Medal, the French Legion of Honor, and Seacole battle it out face to face. Nursing Times, 95(19), a Turkish Medal. She died in 1881 and is buried in London. 26 –27. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEAccording OR DISTRIBUTION to Palmer (1982), Nightingale possessed theNOT FORIt was SALE her success OR DISTRIBUTION at Scutari that enabled Nightingale qualities of a good researcher: insatiable curiosity, com- to begin a long career of infl uence on the public’s health mand of her subject, familiarity with methods of inquiry, a through social activism and reform, health policy, and the good background of statistics, and the ability to discrimi- reformation of career nursing. Using her well-publicized nate and abstract. She© used Jones these &skills Bartlett to maintain Learning, detailed LLCsuccessful “experiment” and© supportive Jones evidence& Bartlett from Learning, the LLC and copious notes andNOT to codify FOR observations. SALE OR Nightingale DISTRIBUTION Crimean War, Nightingale effNOT ectively FOR argued SALE the ORcase DISTRIBUTIONfor relied on statistics and attention to detail to back up her the reform and creation of military health that would serve conclusions about sanitation, management of care, and dis- as the model for people in uniform to the present ease causation. Her now-famous “cox combs” are a hallmark (D’Antonio, 2002). Nightingale’s ideas about proper hos- of military health services management, through which pital architecture and administration infl uenced a genera- she© diagrammed Jones & Bartlettdeaths in Learning,the Army from LLC wounds and tion of medical© Jones doctors & Bartlett and the entire Learning, world, inLLC both fromNOT other FOR diseases SALE and ORcompared DISTRIBUTION them with deaths that military andNOT civilian FOR service. SALE Her OR work DISTRIBUTION in Notes on Hospi- occurred in similar populations in England (Palmer, 1977). tals, published in 1859, provided the template for the orga- Nightingale was fi rst and foremost an administrator: nization of military health care in the Union Army when She believed in a hierarchical administrative structure with the U.S. Civil War erupted in 1861. Her vision for health © Jones & Bartlettultimate control Learning, lodged in LLC one person to whom all subordi-© Jonescare of& soldiersBartlett and Learning, the responsibility LLC of the governments NOT FOR SALEnates and OR offi DISTRIBUTION ces reported. Within a matter of weeks ofNOT her FORwho send SALE them OR to war DISTRIBUTION continues today; her infl uence can arrival in the Crimea, Nightingale was the acknowledged be seen throughout the last century and into the 21st cen- administrator and organizer of a mammoth humanitar- tury, as health care for the women and men who serve ian eff ort. From her Crimean experience on, Nightingale their countries is a vital part of the wellbeing of not only involved herself primarily in organizational activities and the soldiers but also society in general (D’Antonio, 2002). health planning administration.© Jones & Palmer Bartlett (1982) Learning, contends LLCSee Box 3-1 . © Jones & Bartlett Learning, LLC that Nightingale “perceivedNOT FOR the Crimean SALE ORventure, DISTRIBUTION which NOT FOR SALE OR DISTRIBUTION was set up as an experiment, as a golden opportunity to demonstrate the effi cacy of female nursing” (p. 4). Although Many soldiers wrote about their experiences of the Nightingale faced initial resistance from the unconvinced Angel of Mercy, Florence Nightingale. One soldier and© oppositionalJones & Bartlettmedical offi Learning, cers and surgeons, LLC she boldly wrote perhaps© Jones one of& theBartlett most revealing Learning, tributes LLC to this ‘Lady with the Lamp’: defiNOT ed convention FOR SALE and remained OR DISTRIBUTION steadfastly focused on her “NOT FOR SALE OR DISTRIBUTION mission to create a sanitary and highly structured environ- What a comfort it was to see her pass even. She ment for her “children”—the British soldiers who dedi- would speak to one and nod and smile to as many cated their lives to the defense of Great Britain. Proving her more, but she could not do it all, you know. We lay resilience and insistence on absolute authority regarding there by hundreds, but we could kiss her shadow as © Jones & Bartlettnursing and Learning, the hospital LLC environment, Nightingale was© Jones it fell,& Bartlettand lay our Learning, heads on the LLC pillow again content. NOT FOR SALEknown ORto send DISTRIBUTION nurses home to England from the CrimeaNOT FOR SALE OR DISTRIBUTION —Tyrell, 1856, p. 310 for suspicious alcohol use and character weakness. ”

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEBox 3-1 ORSinging DISTRIBUTION to Promote a Healthy Body and Soul: “TNOThe Nightingale’s FOR SALE Song toOR the DISTRIBUTION Sick Soldier”

lorence Nightingale set an example to all with her com- patients. They would reach their hands out to me and smile. Fmitment and compassion to the weary and the sick. She The nurses often remarked that many of these patients had had a special fondness for animals and birds and regularly not smiled in weeks. I was able to use singing as a way to touch showed compassion for© them Jones in correspondence. & Bartlett In Learning, one such theLLC souls of the sick and bring comfort© Jones to those who& Bartlett were sad. Learning, LLC letter to her cousin, sheNOT said, “There FOR is nothingSALE that OR makes DISTRIBUTION my After realizing how the singing touchedNOT my FOR patients, SALE I thought OR DISTRIBUTION heart thrill like the voice of birds, much more than the human about how I could integrate singing, my other profession, into voice. It is the angels calling us with their songs.” After her my nursing practice as a way to focus on the needs of the soul extraordinary acclaim resulting from her heroic actions dur- and the body. I believe that a nurse can communicate the joy ing ©the Jones Crimean War,& Bartlett numerous articles,Learning, songs, andLLC poems of that is inside us© to Jones the patient & through Bartlett the useLearning, of music as anLLC praiseNOT were FOR written SALE that linked OR Nightingale’s DISTRIBUTION compassion to act of compassion.NOT FOR SALE OR DISTRIBUTION the beautiful song of a nightingale. One such broadside that In this poem, Nightingale’s legacy as a model, compassion- circulated after the war was published anonymously by Punch ate caregiver is conveyed through singing and the song of a magazine entitled “The Nightingale’s Song to the Sick Soldier.” nightingale. A song that was to keep a weary soldier alive and A broadside was a song or poem that was written to reflect hopeful. It is this song that should be kept in the hearts of each © Jones & theBartlett feelings andLearning, sentiment ofLLC the community. © Jonesnurse. It should& Bartlett radiate outwardlyLearning, to “infect” LLC all those around NOT FOR SALEThe title OR of DISTRIBUTIONthis poem is used as a metaphor for Nightin-NOTand FOR emit aSALE joyful spirit OR that DISTRIBUTION is highly contagious. gale’s contribution to the war as a beautiful song. Last sum- Shandi Shiver, Senior BSN Nursing Student mer while preparing to enter nursing school, I volunteered Professional singer at a hospital where my job was to help conduct recreational The University of Southern Mississippi activities for the patients on the hospice ward. My favorite part © Jones & Bartlett Learning, LLCSchool of Nursing © Jones & Bartlett Learning, LLC of the day was when INOT got the FOR chance SALE to sing hymnsOR DISTRIBUTION to the NOT FOR SALE OR DISTRIBUTION

An African nurse from Jamaica, Mary Grant Seacole, and the soldiers (Woodham-Smith, 1951). Both had suf- offered her services to Nightingale after hearing of the fered from negative stereotypes: The soldier was often need ©for Jones nurses in & Scutari. Bartlett Although Learning, Nightingale LLC rejected portrayed as ©a drunken Jones oaf & withBartlett little ambition Learning, or honor; LLC SeacoleNOT as a FORpart of SALE her nursing OR staff,DISTRIBUTION Seacole persisted in the nurse wasNOT perceived FOR asSALE a tipsy, OR self-serving, DISTRIBUTION illiter- her passion to provide care to the British military (Payne, ate, promiscuous loser. After the Crimean War and the 1999). Using her own money, she set up a type of inn that efforts of Nightingale and her nurses, both returned with provided food and lodging for soldiers and their families honor and dignity, never more to be downtrodden and © Jones &near Bartlett Scutari (Hine,Learning, 1989). AlthoughLLC Seacole is less well© Jonesdisrespected. & Bartlett Learning, LLC NOT FORknown SALE than OR Nightingale, DISTRIBUTION her contributions to nursing inNOT FORAfter SALEher return OR from DISTRIBUTION the Crimea, Florence Nightingale wartime were significant in the history of minority nurs- never made a public appearance, never attended a public ing. Seacole is often referred to as “the other lady with function, and never issued a public statement (Bullough the lamp” and “the Florence Nightingale of Jamaica.” The & Bullough, 1978). Even so, she single-handedly raised School of Nursing in Kingston, Jamaica, is today named nursing from, as she put it, “the sink it was” into a in her honor (Crawford,© 1992).Jones & Bartlett Learning,respected LLC and noble profession© (Palmer, Jones 1977). & Bartlett As an avid Learning, LLC Scores of books andNOT articles FOR have SALE been written OR DISTRIBUTION about scholar and student of the GreekNOT writer FOR Plato, SALE Nightingale OR DISTRIBUTION Nightingale—she is an almost mythic figure in history. She believed that she had a moral obligation to work primar- truly was a beloved legend throughout Great Britain by the ily for the good of the community. Because she believed time she left the Crimea in July 1856, 4 months after the war that education formed character, she insisted that nurs- ended.© LongfellowJones & immortalized Bartlett Learning, this “Lady with LLC the Lamp” ing must go ©beyond Jones care & for Bartlett the sick; Learning,the mission of LLC the in hisNOT poem FORof “Santa SALE Filomena” OR (Longfellow,DISTRIBUTION 1857). trained nurseNOT must FORinclude SALE social reformOR DISTRIBUTION to promote the good. This dual mission of nursing—caregiver and politi- Returning Home a Heroine: The Political cal reformer—has shaped the profession as we know it Reformer today, especially in the field of community health nursing. LeVasseur (1998) contends that Nightingale’s insis- © Jones &When Bartlett Nightingale Learning, returned LLC to London, she found that© Jonestence on & nursing’s Bartlett involvement Learning, of aLLC larger political ideal NOT FORher SALE efforts OR to DISTRIBUTIONprovide comfort and health to the BritishNOT in FORthe historical SALE foundation OR DISTRIBUTION of the field distinguishes us soldier succeeded in making heroes of both Nightingale from other scientific disciplines, such as medicine.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEHow OR did DISTRIBUTION Nightingale accomplish this transformaNOT- FORmother, SALE was an OR instant DISTRIBUTION success. An expanded library edi- tion? You will learn throughout this text how nurses effect tion was written for nurses and used as the textbook for change through others. Florence Nightingale is the stan- the students at St. Thomas. The book has since been trans- dard by which we measure our effectiveness. She effected lated into multiple languages, although it is believed that change through her wide command of acquaintances: Nightingale refused all royalties earned from the publica- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Queen Victoria was a significant admirer of her intellect tion of the book (Cook, 1913). and ability to effectNOT change, FOR and SALEshe used OR her DISTRIBUTIONposition as The nursing students NOTchosen FOR for the SALE new trainingOR DISTRIBUTION national heroine to get the attention of elected officials in school were handpicked; they had to be of good moral Parliament. She was tireless and had an amazing capacity character, sober, and honest. Nightingale believed that for work. She used people (Bostridge, 2008). Everyone the strong emphasis on morals was critical to gaining who© couldJones be &of Bartlettservice to Learning,her was enlisted LLC to help her respect for© the Jones new “Nightingale & Bartlett nurse,”Learning, with no LLC pos- meetNOT her FORgoals. HerSALE brother-in-law, OR DISTRIBUTION Sidney Herbert, was a sible ties toNOT the FORdisgraceful SALE association OR DISTRIBUTION of past nurses. member of Parliament and often delivered her “messages” Nursing students were monitored throughout their in the form of legislation. When Nightingale wanted the 1-year program both on and off the hospital grounds; public incited, she turned to the press, writing letters to the their activities were carefully watched for character weak- London Times and having others of influence write articles. nesses, and discipline was severe and swift for violators. © Jones & BartlettShe was not Learning, above threats LLC to “go public” by certain dates© Jones Accounts & Bartlett from Nightingale’s Learning, journals LLC and notes revealed NOT FOR SALEif an elected OR DISTRIBUTIONofficial refused to establish a commissionNOT or FORinstant SALE dismissal OR of DISTRIBUTIONnursing students for such behaviors appoint a committee. And when those commissions were as “flirtation, using the eyes unpleasantly and being in the formed, Nightingale was ready with her list of selected company of unsavory persons.” Nightingale contended people for appointment (Palmer, 1982). that “the future of nursing depends on how these young © Jones & Bartlett Learning, LLCwomen behave themselves”© (Smith,Jones 1934, & Bartlett p. 234). Learning,She LLC Nightingale and Military Reforms NOT FOR SALE OR DISTRIBUTIONknew that experiment at St.NOT Thomas FOR to SALE educate OR nurses DISTRIBUTION The first real test of Nightingale’s military reforms came and raise nursing to a moral and professional calling in the United States during the “War Between the States”— represented a drastic departure from the past images the Civil War. Nightingale was asked by the Union to of nurses and would take extraordinary women of high advise on the organization of hospitals and care of the moral character and intelligence. Nightingale knew every sick© andJones wounded. & Bartlett She sent Learning, recommendations LLC back to nursing student© Jones (called & aBartlett probationer), Learning, personally, LLC often theNOT United FOR States SALE based ORon her DISTRIBUTION experiences and analysis having theNOT students FOR at herSALE house OR for DISTRIBUTIONweekend visits. She in the Crimean War, and her advisement and influence devised a system of daily journal keeping for the proba- gained wide publicity. Following her recommendations, tioners; Nightingale herself read the journals monthly to the Union Army set up a sanitary commission and pro- evaluate their character and work habits. Every nursing © Jones & Bartlettvided for regularLearning, inspection LLC of camps. Nightingale also© Jonesstudent & Bartlettadmitted toLearning, St. Thomas LLChad to submit an accept- NOT FOR SALEexpressed OR a desireDISTRIBUTION to help with the Confederate militaryNOT FORable “letter SALE of goodOR DISTRIBUTION character,” and Nightingale herself but, unfortunately, had no channel of communication with placed graduate nurses in approved nursing positions them (Bullough & Bullough, 1978). (Nightingale, 1915). One of the most important features of the Nightingale The Nightingale School of Nursing at St. Thomas: School was its relative autonomy. Both the school and the The Birth of Professional© Jones Nursing & Bartlett Learning, LLChospital nursing service were© Jonesorganized & under Bartlett the head Learning, LLC The British publicNOT honored FOR Nightingale SALE OR by DISTRIBUTIONendowing matron. This was especiallyNOT significant FOR SALEbecause ORit meant DISTRIBUTION 50,000 pounds in her name upon her return to England that nursing service began independently of the medical from the Crimea. The money had been raised from the staff in selecting, retaining, and disciplining students and soldiers under her care and donations from the public. nurses (Bullough & Bullough, 1978; Nightingale, 1915). This© Jones Nightingale & Bartlett Fund eventually Learning, was used LLC to create the Nightingale© Jones was opposed & Bartlett to the Learning,use of a standardized LLC Nightingale School of Nursing at St. Thomas NOT FOR SALE OR DISTRIBUTION, which was to governmentNOT examination FOR SALE and theOR movement DISTRIBUTION for licen- be the beginning of professional nursing (Donahue, 1985). sure of trained nurses. She believed that schools of nursing Nightingale, at the age of 40, decided that St. Thomas’s would lose control of educational standards with the advent Hospital was the place for her training school for nurses. of national licensure, most notably those standards related While the negotiations for the school went forward, she to moral character. Nightingale led a staunch opposition © Jones & Bartlettspent her timeLearning, writing Notes LLC on Nursing: What It Is and© Jones to the & movement Bartlett by Learning, the British Nurses LLC Association (BNA) NOT FOR SALEWhat It OR Is Not DISTRIBUTION, which was published in 1859 (Bostridge,NOT FORfor licensure SALE of OR trained DISTRIBUTION nurses, which the BNA believed 2008). The small book of 77 pages, written for the British critical to protecting the public’s safety by ensuring the

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORqualifi SALE cation OR of DISTRIBUTIONnurses by licensure exam. Nightingale wasNOT work FOR in the SALE districts. OR Rathbone DISTRIBUTION then contacted Nightingale convinced that qualifying a nurse by examination tested for assistance. Her recommendation was to train more only the acquisition of technical skills, not the equally nurses, and she advised Rathbone to approach the Royal important evaluation of character. She believed nursing Liverpool Infi rmary with a proposal for opening another involved “divergencies too great for a single standard to be training school for nurses (Rathbone, 1890). Th e infi rmary © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC applied” (Nutting & Dock, 1907; Woodham-Smith, 1951). agreed to Rathbone’s proposal, and district nursing soon NOT FOR SALE OR DISTRIBUTIONspread throughout England as NOTsuccessful FOR “health SALE nursing” OR DISTRIBUTION I look to the day when there are no nurses to the sick in the community for the sick poor through voluntary but only nurses to the well. agencies (Rosen, 1958). Ever the visionary, Nightingale (1893) contended that —Florence Nightingale, 1893 © Jones & Bartlett Learning, LLC “Hospitals are© butJones an intermediate & Bartlett stage Learning, of civilization. LLC “NOT FOR SALE OR” DISTRIBUTION Th e ultimateNOT aim is FOR to nurse SALE the sickOR poorDISTRIBUTION in their own homes” (Attewell, 1996). She also wrote in regard to visit- Taking Health Care to the Community: Nightingale ing families at home (1894), “We must not talk to them or and Wellness at them but with them” (Attewell, 1996). A service similar Early eff orts to distinguish hospital from community to that begun by Rathbone, health visiting, began in Man- © Jones &health Bartlett nursing Learning, include Nightingale’s LLC views on “health© Joneschester, &England, Bartlett in 1862 Learning, by the Manchester LLC and Salford NOT FORnursing,” SALE whichOR DISTRIBUTION she distinguished from “sick nursing.” NOTSanitary FOR Association.SALE OR Th DISTRIBUTION e purpose of placing “health visi- She wrote two influential papers: “Sick-Nursing and tors” in the home was to provide health information and Health-Nursing,” which was read in the United States at instruction to families. Eventually, health visitors evolved the Chicago Exposition in 1893, and “Health Teaching to provide preventive health education and district nurses in Towns and Villages”© inJones 1894 (Monteiro, & Bartlett 1985). Learning, Both toLLC care for the sick at home (Bullough© Jones & Bullough, & Bartlett 1978; Learning, LLC papers praised the successNOT of FOR prevention-based SALE OR nursingDISTRIBUTION Howse, 2007). NOT FOR SALE OR DISTRIBUTION practice. Winslow (1946) acknowledged Nightingale’s infl uence in the United States by being one of the fi rst in the Nightingale’s Legacy fi eld of public health to recognize the importance of taking When Nightingale returned to London aft er the Crimean responsibility for one’s own health. As she wrote in 1891, War, she remained haunted by her experiences related to “there© are Jones more people & Bartlett to pick usLearning, up and help LLC us stand on the soldiers dying© Jones of preventable & Bartlett diseases. Learning, She was trou-LLC our ownNOT two FOR feet” (Attewell,SALE OR 1996). DISTRIBUTION According to Palmer bled by nightmaresNOT andFOR had SALE diffi culty OR sleeping DISTRIBUTION in the years (1982), Nightingale was a leader in the wellness move- that followed. She wrote in her journal: “Oh my poor men; ment long before the concept was identifi ed. Nightingale I am a bad mother to come home and leave you in your saw the nurse as the key fi gure in establishing a healthy Crimean graves. . . . I can never forget. . . . I stand at the © Jones &society, Bartlett and she Learning, envisioned LLCa logical extension of nursing© Jonesaltar of &the Bartlett murdered Learning, men and while LLC I live, I fi ght their NOT FORin SALE acute hospital OR DISTRIBUTION settings to the broadest sense of commu-NOTcause” FOR (Woodham-Smith, SALE OR DISTRIBUTION 1983, pp. 178, 193). Nightingale nity used in nursing today. Writing in Notes on Nursing , became a prolifi c writer and a staunch defender of the she visualized the nurse as “the nation’s fi rst bulwark in causes of the British soldier, sanitation in England and health maintenance, the promotion of wellness, and the India, and trained nursing. prevention of disease” (Palmer, 1982, p. 6). As a woman, Nightingale was not able to hold an offi - William Rathbone, ©a wealthy Jones ship & Bartlettowner and Learning, philan- cial LLC government post or to vote.© Historians Jones & have Bartlett had var- Learning, LLC thropist, is credited withNOT the establishment FOR SALE of theOR fi rstDISTRIBUTION visit- ied opinions about the exact natureNOT ofFOR the disability SALE ORthat DISTRIBUTION ing nurse service, which eventually evolved into district kept her homebound for the remainder of her life. Recent nursing in the community. He was so impressed with the scholars have speculated that she experienced post-trau- private-duty nursing care that his sick wife had received matic stress disorder from her experiences in the Crimea; at home© Jones that he set& outBartlett to develop Learning, a “district LLCnursing ser- there is also considerable© Jones & evidence Bartlett that Learning, she suff ered LLCfrom vice”NOT in Liverpool, FOR SALEEngland. OR At his DISTRIBUTION own expense, in 1859, the painful diseaseNOT brucellosisFOR SALE (Barker, OR 1989; DISTRIBUTION Nightingale, he developed a corps of nurses who were trained to care 1915; Young, 1995). Nevertheless, Nightingale exerted for the sick poor in their homes (Bullough & Bullough, incredible infl uence through friends and acquaintances, 1978; Howse, 2007; Minkowski, 1992). He divided the directing from her sickroom sanitation and poor law community into 16 districts; each was assigned a nurse reform. Her mission to “cleanse” spread from the military © Jones &and Bartlett a social workerLearning, who providedLLC nursing and health © Jonesto the British & Bartlett Empire; Learning, her fi ght for LLC improved sanitation NOT FOReducation. SALE OR Rathbone’s DISTRIBUTION experiment in district nursing wasNOT both FOR at home SALE and ORin India DISTRIBUTION consumed her energies for the so successful that he was unable to fi nd enough nurses to remainder of her life (Vicinus & Nergaard, 1990).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE According OR DISTRIBUTION to Monteiro (1985), two recurrent themesNOT FORsick, they SALE were alsoOR sent DISTRIBUTION to the workhouse. Trained nursing are found throughout Nightingale’s writings about disease care in these venues was all but nonexistent. Th rough leg- prevention and wellness outside the hospital. Th e m o s t islative pressure and a well-designed public campaign persistent theme is that nurses must be trained diﬀ erently describing the horrors of the workhouse infi rmary, reform and instructed specifi cally in district and instructive nurs- of the workhouse system was accomplished by 1867. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ing. Nightingale consistently wrote that the “health nurse” Although it was not as complete as Nightingale had must be trained in theNOT nature FOR of poverty SALE and OR its DISTRIBUTION infl uence wanted, nevertheless nursesNOT were inFOR place SALE and being OR paid DISTRIBUTION on health, something she referred to as the “pauperization” a salary (Nightingale, 1915; Seymer, 1954). of the poor. She also believed that above all, health nurses must be good teachers about hygiene and helping families ethiCal ConneCtion learn© Jonesto better & care Bartlett for themselves Learning, (Nightingale, LLC 1893). here are© fiJones ve essential & Bartlett points in securingLearning, the health LLC of She insisted that untrained, “good intended women” NOT FOR SALE OR DISTRIBUTION Thouses:NOT FOR SALE OR DISTRIBUTION could not substitute for nursing care in the home. Instead, Pure air Nightingale pushed for an extensive orientation and addi- Pure water tional training, including prior hospital experience, before Eﬃ cient drainage someone was hired as a district nurse. She outlined the © Jones & Bartlett Learning, LLC © Jones Cleanliness & Bartlett Learning, LLC qualifi cations in her paper “On Trained Nursing for the Sick Light NOT FOR SALEPoor,” inOR which DISTRIBUTION she called for 1 month’s “trial” in districtNOT FOR SALE OR DISTRIBUTION Sources: Nightingale, F. (1860). Notes on nursing : What it is and what it nursing, 1 year’s training in hospital nursing, and 3 to is not. London: Harrison; Cook, 1913, p. 133. 6 months training in district nursing (Monteiro, 1985). According to Nightingale, “Th ere is no such thing as ama- teur nursing.” © Jones & Bartlett Learning, LLC To set these poor sick people© Jones going again, & Bartlett with a Learning, LLC Th e second themeNOT that FORemerged SALE from ORher writingsDISTRIBUTION was sound and clean house, asNOT well asFOR with aSALE sound bodyOR DISTRIBUTION the focus on the role of the nurse. Nightingale clearly dis- and mind, is about as great a benefi t as can be given tinguished the role of the health nurse in promoting what we them—worth acres of gifts and relief. This is depau- today call self-care. In the past, philanthropic visitors under “perizing them.” the aegis of Christian charity would visit the homes of the —Florence Nightingale poor© Jonesand off er& them Bartlett relief (Monteiro,Learning, 1985). LLC Nightingale © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION believed that such activities did little to teach the poor My view you know” is that the ultimate destination to care for themselves and further “pauperized” them— of all nursing is the nursing of the sick in their own keeping them dependent and vulnerable, unhealthy, prone homes. . . . I look to the abolition of all hospitals and to disease, and reliant on others to keep them healthy. Th e workhouse infi rmaries. But no use to talk about the nurse had to help the families at home manage a healthy “year 2000.0. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEenvironment OR DISTRIBUTION for themselves, and Nightingale saw a trainedNOT FOR SALE OR DISTRIBUTION —Florence Nightingale, letter to nurse as being the only person who could pull off such a Henry Bonham Carter, 1867 feat. She stated, “Never think that you have done anything ” eff ectual in nursing in London, till you nurse not only the sick poor in workhouses, but those at home.” Although Nightingale© Jones is best & known Bartlett for her Learning, reform of LLC By 1901, Nightingale lived© inJones a world & without Bartlett sight Learning, or LLC hospitals and militaryNOT health FOR care, SALE she was aOR great DISTRIBUTION believer sound, leaving her unable toNOT write. FOR Over theSALE next 5OR years, DISTRIBUTION in the future of health care, which she anticipated should she lost her ability to communicate and most days existed be preventive in nature and would more than likely take in a state of unconsciousness. In November 1907, Nightin- place in the home and community. Her accomplishments gale was honored with the Order of Merit by King Edward in© the Jones fi eld of& “sanitaryBartlett nursing” Learning, extended LLC beyond the VII, the fi ©rst Jonestime the &award Bartlett was ever Learning, given to a woman. LLC In wallsNOT of theFOR hospital SALE to ORinclude DISTRIBUTION workhouse reform and May 1910,NOT the Nightingale FOR SALE Training OR SchoolDISTRIBUTION of Nursing at community sanitation reform. In 1864, Nightingale and St. Th omas celebrated its Jubilee. By that time, there were Rathbone once again worked together to lead the reform now more than 1,000 training schools for nurses in the of the Liverpool Workhouse Infi rmary, where more than United States alone (Cook, 1913). 1,200 sick paupers were crowded into unsanitary and Nightingale died in her sleep around noon on © Jones & Bartlettunsafe conditions Learning, (Bostridge, LLC 2008). Under the British© JonesAugust & Bartlett13, 1910, Learning,and was buried LLC quietly and without NOT FOR SALEPoor Laws, OR theDISTRIBUTION most desperately poor of the large citiesNOT FORpomp SALEnear the OR family’s DISTRIBUTION home at Embley, her coffi n car- were gathered into large workhouses. When they became ried by six sergeants of the British Army (Bostridge, 2008).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOROnly SALE a small OR cross DISTRIBUTION marks her grave at her request: “FN.NOT and FOR “ladylike” SALE behavior OR DISTRIBUTION became the associated traits of a Born 1820. Died 1910.” (Brown, 1988). Th e family refused “good nurse,” thus setting the “feminization of nursing” as a national funeral and burial at Westminster Abbey out the ideal standard for a good nurse. Th ese historical roots of respect for Nightingale’s last wishes. She had lived for of gender- and race-based caregiving excluded males and 90 years and 3 months. minorities from the nursing profession, a trend that con- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC tinued for many years and still infl uences career choices NOT FOR SALE OR DISTRIBUTIONfor men and women today. ThNOT ese early FOR training SALE schools OR DISTRIBUTION Money would be better spent in maintaining health provided a stable, subservient, white female workforce, in infancy and childhood than in building hospitals as student nurses served as the primary nursing staff for to cure diseasedisease.. these early hospitals. “© Jones & Bartlett —Florence Learning, Nightingale, LLC 1894 A signifi ©cant Jones report, &known Bartlett simply Learning, as the Goldmark LLC NOT FOR SALE OR DISTRIBUTION Report (moreNOT formally, FOR Nursing SALE and OR Nursing DISTRIBUTION Education It is cheaper to” promote health than to maintain in the United States ), was released in 1922; it advocated people in sickness. the establishment of university schools of nursing to train —Florence Nightingale, 1894 nursing leaders. Th e report, initiated by Nutting in 1918, was an exhaustive (500-page) and comprehensive inves- © Jones &“ Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ” tigation into the state of nursing education and training. NOT FOR aSALE daY in OR the DISTRIBUTION liFe NOTAuthor FOR Josephine SALE ORGoldmark, DISTRIBUTION a social worker and pioneer in research into nursing preparation in the United States, Barbara Dossey stated: arbara Dossey is a noted Nightingale scholar and the From our fi eld study of the nurse in public health Bauthor of the book Florence© Jones Nightingale & Bartlett : Mystic , VisionaryLearning, , LLCnursing, in private duty,© and Jones as instructor & Bartlett and Learning, LLC Healer (Philadelphia, PA:NOT Lippincott FOR Williams SALE & Wilkins, OR DISTRIBUTION2000). supervisor in hospitals, it NOTis clear FOR that thereSALE is needOR DISTRIBUTION Was Nightingale a mystic? Mysticism is often defi ned as an of a basic undergraduate training for all nurses alike, individual’s direct, unmediated experience of God. A mystic which should lead to a nursing diploma. (Goldmark, is a person who has such an experience, to a greater or lesser 1923, p. 35) degree.© Jones Nightingale & receivedBartlett her Learning,fi rst call from GodLLC at age 16 © Jones & Bartlett Learning, LLC and received three more direct calls from God in her life. She Th e fi rst university school of nursing was established NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION believed the messages of Christianity, but was tolerant and at the University of Minnesota in 1909. Although the new ecumenical in her attitude toward world religions. She wrote, nurse training school was under the college of medicine “To know God we must study Him in the Pagan and Jewish and off ered only a 3-year diploma, the Minnesota pro- dispensations as in the Christian.” gram nevertheless represented a signifi cant leap forward © Jones & Source Bartlett: Creative Learning, Nursing by Creative LLC Nursing Management, Inc. © Jonesin nursing & Bartletteducation. Learning, LLC NOT FOR ReproducedSALE OR with DISTRIBUTION permission of Creative Nursing Management, Inc. NOT FOR Nursing SALE for the OR Future DISTRIBUTION (the so-called Brown Report), in the format Book via Copyright Clearance Center.. authored by Esther Lucille Brown in 1948 and sponsored by the Russell Sage Foundation, was critical of the quality and structure of nursing schools in the United States. early nursing education and Th e Brown Report ultimately became the catalyst for the organization in ©the Jones united & Bartlett states Learning,implementation LLC of educational© nursing Jones program & Bartlett accredi- Learning, LLC NOT FOR SALE OR DISTRIBUTIONtation through the National LeagueNOT FORfor Nursing SALE (NLN; OR DISTRIBUTION In the United States, the fi rst training schools for nurs- Brown, 1936, 1948). ing were modeled aft er the Nightingale School of Nursing Positive changes also occurred for minority and male at St. Th omas in London. Bellevue Training School for nurses. As a result of the post–World War II nursing short- Nurses© inJones New York & BartlettCity; Connecticut Learning, Training LLC School for age, the associate© Jones degree in& nursing Bartlett (ADN) Learning, was established LLC NursesNOT in New FOR Haven, SALE Connecticut; OR DISTRIBUTION and the Boston Train- by Mildred MontagNOT FOR in 1952 SALE as a 2-year OR programDISTRIBUTION for reg- ing School for Nurses at Massachusetts General Hospital istered nurses (Montag, 1959). In 1950, nursing became in Boston were the earliest programs for trained nurses in the fi rst profession for which the same licensure exam, the the United States (Nutting & Dock, 1907). Based on the State Board Test Pool, was used throughout the nation to Victorian belief in the natural affi nity for women to be sen- license registered nurses (RNs). Th is increased mobility © Jones &sitive, Bartlett possess Learning,high morals, and LLC be caregivers, early nursing© Jonesfor the registered& Bartlett nurse Learning, resulted in a LLC signifi cant advantage NOT FORtraining SALE required OR DISTRIBUTION that applicants be female. Sensitivity,NOT for FOR the relatively SALE newOR profession DISTRIBUTION of nursing (State Board high moral character, purity of character, subservience, Test Pool Examination, 1952).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEthinK OR aBout DISTRIBUTION this NOT FORnursing SALE was well OR on DISTRIBUTIONits way to public recognition of practice and educational standards, as state aft er state passed ome nurses believe that the legacy of Florence Nightingale similar legislation over the next several years. is holding nursing back and represents the negative and S Margaret Sanger worked as a nurse on the Lower East backward elements of nursing. This view cites as evidence Side of New York City in 1912 with immigrant fami- Nightingale’s support© for Jones the subordination & Bartlett of nurses Learning, to phy- LLC © Jones & Bartlett Learning, LLC lies. She was astonished to fi nd widespread ignorance sicians, opposition to registration of nurses, and failure to see NOT FOR SALE OR DISTRIBUTIONamong these families aboutNOT conception, FOR SALEpregnancy, OR and DISTRIBUTION mental health nurses as part of the profession. Wheeler has childbirth. Aft er a horrifying experience with the death gone so far as to say, “The nursing profession needs to ex- of a woman from a failed self-induced abortion, Sanger orcise the myth of Nightingale, not necessarily because she devoted her life to teaching women about birth control. was a bad person, but because the impact of her legacy has © Jones & Bartlett Learning, LLC A staunch ©activist Jones in the & early Bartlett family Learning,planning movement, LLC held the profession back too long.” After reading this chapter, Sanger is credited with founding Planned Parenthood of whatNOT do FORyou think? SALE Is Nightingale OR DISTRIBUTION relevant in the 21st century NOT FOR SALE OR DISTRIBUTION America (Sanger, 1928). to the nursing profession? Why or why not? Source: Wheeler, W. (1999). Is Florence Nightingale holding us back? Nursing 99 , 29 (10), 82–23. thinK aBout this © Jones & Bartlett Learning, LLC © Joneshere & Bartlett have been manyLearning, theories aboutLLC the cause of Night- NOT FOR SALE OR DISTRIBUTION NOT FOR Tingale’s SALE chronic OR illness, DISTRIBUTION which led to her being an invalid Preventable disease should be looked upon as a for most of her adult life. Many people have interpreted her social crime. condition as hypochondriacal, something of a melodrama of —Florence Nightingale, 1894 the Victorian times. Nightingale was rich and could take to her “ © Jones & Bartlett Learning, LLCbed. Rumors have fl oated around© Jones among & nursing Bartlett students Learning, LLC ” for years that she suff ered from tertiary syphilis. She became NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ill during the Crimean War in May 1855 and was diagnosed the evolution of nursing in the united with a severe case of Crimean fever. Today Crimean fever is states: the First Century of professional recognized as Mediterranean fever and is categorized as bru- cellosis. Nightingale also developed ankylosing spondylitis, nursing© Jones & Bartlett Learning, LLC or infl ammation© Jones of the & spine. Bartlett Learning, LLC Early NOT nurse FOR leaders SALE of the OR century DISTRIBUTION included Isabel Hamp- For theNOT next 34FOR years, SALE Nightingale OR managed DISTRIBUTION to continue ton Robb , who in 1896 founded the Nurses’ Associated her writing and advocacy, often predicting her imminent Alumnae. In 1911, this organization offi cially became death. Some have claimed that she suff ered from bipolar dis- known as the American Nurses Association (ANA) . Lavinia order, causing her to experience long periods of depression Lloyd Dock was a militant suff ragist who linked women’s and remarkable bursts of productivity. Read about the various © Jones & Bartlett Learning, LLC © Jonestheories & Bartlett of her chronic Learning, disabling LLCcondition and refl ect on NOT FOR SALEroles as OR nurses DISTRIBUTION to the emerging women’s movementNOT in FOR SALE OR DISTRIBUTION the United States. By contrast, Isabel Hampton Robb— your own conclusions about her mysterious illness. like Nightingale herself—opposed the women’s suff ragist Sources: Dossey, B. (2000). Florence Nightingale : Mystic , visionary , healer (Philadelphia, PA: Lippincott Williams & Wilkins); Nightingale suff ered movement, instead focusing on the need for women to bipolar disorder. (2004). Australian Nursing Journal , 12 , 2. own property in Great Britain. Her well-reasoned position was that property© ownershipJones & was Bartlett the link Learning,to women’s LLC © Jones & Bartlett Learning, LLC voting power. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Mary Adelaide Nutting, Lavinia Lloyd Dock, Sophia As the modern nursing movement is emphatically Palmer, and Mary E. Davis were instrumental in develop- an outcome of the original and general woman’s ing the fi rst nursing journal, American Journal of Nursing movement . . . it would be a great pity for them (AJN)© Jones , in October & Bartlett 1900. Th Learning,rough the ANA LLC and theAJN , [nurses]© to Jones allow one & of Bartlett the most remarkableLearning, move- LLC nurses then had a professional organization and a nation- “ments of the day to go on under their eyes without NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION al journal with which to communicate with one another comprehending it. . . . Unless we possess the ballot (Kalisch & Kalisch, 1986). we shall not know when we may get up in the morn- State licensure of trained nurses began in 1903 with the ing to fi nd all that we had gained has been taken enactment of North Carolina’s licensure law for nursing. from us. © Jones & BartlettShortly thereaft Learning, er, New LLC Jersey, New York, and Virginia© Jones & Bartlett Learning, —Lavinia LLC Lloyd Dock, 1907 NOT FOR SALEpassed ORsimilar DISTRIBUTION licensure law for nursing. ProfessionalNOT FOR SALE” OR DISTRIBUTION

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African American Nurses in History Goldstein, R. L. (1960). Negro nurses in hospitals. American ead more about the contributions of African American Journal of Nursing , 60 (2), 215–217. Rnurses . . . © Jones & Bartlett Learning,Mabel LLC Staupers, who led battle to© endJones prejudice, & Bartlett dies at 99. Learning, LLC Alexander, Z., & Dewjee,NOT A. (1981). FOR Mary SALE Seacole. ORHistory DISTRIBUTION Today , (1990). American Journal of NursingNOT , 9 (2), FOR 121. SALE OR DISTRIBUTION 31 , 45. Mosley, M. O. P. (1995). Beginning at the beginning: A history Bell, P. L. (1993). “Making do” with the midwife: Arkansas’s Mamie of the professionalization of black nurses in America, 1908– O. Hale in the 1940s. Nursing History Review , 1 , 155–169. 1951. Journal of Cultural Diversity , 2 (4), 101–109. Brewman, M. P. (1952). The Negro nurse. Nation , 175 (8), 160. Mosley, M. O. P. (1995). Despite all odds: A three-part history of Buhler-Wilkerson, © Jones K.& (1992). Bartlett Caring Learning,in its “proper place”: LLC Race and the professionalization© Jones of & black Bartlett nurses through Learning, two profes- LLC benevolenceNOT FOR in Charleston,SALE OR SC, 1813–1930.DISTRIBUTION Nursing Research , sional nursingNOT organizations, FOR SALE 1908–1955. OR Journal DISTRIBUTION of National 41 (1), 14–20. Black Nurses Association , 7 (2), 10–20. Campinha-Bacote, J. (1988). The Black nurses’ struggle toward Mosley, M. O. P. (1995). Mabel K. Staupers: A pioneer in profes- equality: An historical account of the National Association sional nursing. N & HC Perspectives on Community , 16 (1), 12–17. © Jones & Bartlettof Colored Learning,Graduate Nurses. LLC Journal of National Black Nurses© Jones Mosley, M.& BartlettO. P. (1996). Learning,A new beginning: LLC The story of the NOT FOR SALEAssociation OR , 2DISTRIBUTION (2), 15–25. NOT FORNational SALE Association OR ofDISTRIBUTION Colored Graduate Nurses, 1908– Carnegie, M. E. (1992). Black nurses in the United States: 1879– 1951. Journal of National Black Nurses Association , 8 (1), 20–32. 1992. Journal of National Black Nurses Association , 6(1), 13–18. Smith, S. L. (1994). White nurses, black midwives, and public health Chayer, M. E. (1954). Mary Eliza Mahoney. American Journal of in Mississippi, 1920–1950. Nursing History Review, 2 , 29–49. Nursing , 54(4), 429–431. Staupers, M. K. (1937). The Negro nurse in America. Opportunity , Davis A. T. (1999). Early black© Jones American & leaders Bartlett in nursing Learning, : Archi- LLC15 (11), 339–341. © Jones & Bartlett Learning, LLC tects for integration andNOT equality FOR . (National SALE League OR for DISTRIBUTIONNursing Staupers, M. K. (1961). No time for prejudiceNOT: A story FOR of the SALE integration OR of DISTRIBUTION Series.) Sudbury, MA: Jones and Bartlett. Negroes in nursing in the United States. New York, NY: MacMillan. Doona, M. E. (1986). Glimpses of Mary Eliza Mahoney (7 May Tucker-Allen, S. (1997). The founding of the Association of Black 1845–4 January 1929). Journal of Nursing History , 1 (2), 20–34. Nursing Faculty: My memories of the fi rst fi ve years.ABNF Elmore,© Jones J. A. (1976). & Black Bartlett nurses: Their Learning, service and LLCtheir struggle. Journal , 8 (4),© 73–80. Jones & Bartlett Learning, LLC Washington, B. T. (1910). Looking through the years: 1910. Training AmericanNOT FOR Journal SALE of Nursing OR , 76 (3),DISTRIBUTION 435–437. NOT FOR SALE OR DISTRIBUTION George, V. D., Bradford, D. M., & Battle, A. (2000). Yesterday, colored nurses at Tuskegee. American Journal of Nursing, 11 , today, and tomorrow: Transitioning through time with the 167–171. (Reprinted by permission in Creative Nursing: A Jour- Cleveland Council of Black Nurses. Nursing & Health Care nal of Values, Issues , Experience & Collaboration, 3 (1), 16, 1997.) Perspectives , 21 (5), 219–227. Wilkins, R. (1943). Black women in white. Negro Digest , 1(6), 61–63. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION By 1917, the emerging nursing profession was driven by publicity campaign to recruit young women to enter nurse two signifi cant events that dramatically increased the need training. Th e Army School of Nursing, headed by Annie for additional trained nurses in the United States: World Goodrich as dean, and the Vassar Training Camp for War I and the infl uenza epidemic. Nightingale’s work and Nurses prepared nurses for the war and for home nurs- the devastation of the Civil© Jones War had & fi Bartlettrmly established Learning, the ing LLC and hygiene nursing through© Jonesthe Red Cross& Bartlett (Dock & Learning, LLC need for nursing care inNOT war. Mary FOR Adelaide SALE Nutting, OR DISTRIBUTION who Stewart, 1931). Th e CommitteeNOT on Nursing FOR estimatedSALE OR that DISTRIBUTION became a professor of nursing and health at Columbia there were at most 200,000 active “nurses” in the United University, chaired the newly established Committee on States at the beginning of World War I, both trained and Nursing in response to the call for more nurses as the untrained, which was inadequate to support the military United© StatesJones entered & Bartlett the war in Learning, Europe. U.S. LLC nurses real- eff ort abroad© (KalischJones && BartlettKalisch, 1986). Learning, At home, LLC the ized earlyNOT on FOR that WorldSALE War OR I was DISTRIBUTION unlike previous wars: infl uenza epidemicNOT FOR of 1917–1919 SALE ledOR to DISTRIBUTION increased public It was a global confl ict that involved coalitions of nations awareness of the need for public health nursing and public against nations, involving vast amounts of supplies and education about hygiene and disease prevention. demanding the organization of all the nation’s resources Th e successful campaign to attract nursing students for military purposes (Kalisch & Kalisch, 1986). Along focused heavily on patriotism, which ushered in the new © Jones &with Bartlett Lillian Wald Learning, and Jane A.LLC Delano , director of nursing© Jonesera for nursing& Bartlett as a profession. Learning, By LLC1918, nursing school NOT FORin SALE the American OR DISTRIBUTION Red Cross, Nutting initiated a nationalNOT enrollments FOR SALE were ORup by DISTRIBUTION 25%. In 1920, Congress passed

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEa bill that OR provided DISTRIBUTION nurses with military rank (DockNOT & FORneed for SALE trained OR nurses DISTRIBUTION evolved as in England, and schools Stewart, 1931). Following close behind, the passage of the throughout the United States developed along the Night- 19th Amendment to the U.S. Constitution granted women ingale model. Visiting nurses were first sent to philan- the right to vote. According to Stewart (1921): thropic organizations in New York City (1877), Boston (1886), Buffalo (1885), and Philadelphia (1886) to care for Probably the greatest© Jones contribution & Bartlett of the war Learning, experience LLC © Jones & Bartlett Learning, LLC the sick at home. By the end of the century, most large cit- to nursing lies in the fact that the whole system of nurs- NOT FOR SALE OR DISTRIBUTIONies had some form of visitingNOT nursing FOR program, SALE and OR some DISTRIBUTION ing education was shaken for a little while out of its well- headway was being made even in smaller towns (Heinrich, worn ruts and brought out of its comparative seclusion 1983). Industrial or occupational health nursing was first into the light of public discussion and criticism. When started in Vermont in 1895 by a marble company inter- so many lives hung on the supply of nurses, people were ested in the health and welfare of its workers and their ©aroused Jones to a& new Bartlett sense of theirLearning, dependence LLC on the prod- © Jones & Bartlett Learning, LLC families. Tuberculosis (TB) was a leading cause of death in NOTucts of FOR nursing SALE schools, OR and DISTRIBUTION many of them learned for NOT FOR SALE OR DISTRIBUTION the 19th century; nurses visited patients bedridden from the first time of the hopelessly limited resources which TB and instructed persons in all settings about prevention nursing educators have had to work with in the train- of the disease (Abel, 1997). ing of these indispensable public servants. Whatever © Jones & Bartlettthe future Learning, may bring, LLCit is unlikely that nursing schools© JonesLillian & Wald, Bartlett Public Learning, Health Nursing, LLC and NOT FOR SALEwill ORwillingly DISTRIBUTION sink back again into their old isolationNOT or FORCommunity SALE Activism OR DISTRIBUTION that they will accept unquestionably the financial status Lillian Wald, a wealthy young woman with a great social which the older system imposed on them. (p. 6) conscience, graduated from the New York Hospital School While nursing as a profession was emerging in the of Nursing in 1891 and is credited with creating the title United States, it remained© Jones a “white, & Bartlett female only” Learning, career LLC“public health nurse.” After© aJones year working & Bartlett in a mental Learning, LLC choice during theseNOT early years. FOR Men SALE and minoritiesOR DISTRIBUTION were institution, Wald entered NOTmedical FOR school SALE at Woman’s OR DISTRIBUTION excluded from the field, and those who wanted to enter Medical College in New York. While in medical school, nursing school found themselves essentially “locked out.” she was asked to visit immigrant mothers on New York’s Eventually, quotas were established in select nursing pro- Lower East Side and instruct them on health matters (see grams to permit African Americans’ and other minori- Box 3-2). Wald was appalled by the conditions there. Dur- ties’© admission.Jones & Even Bartlett when Learning,these nurses graduated,LLC they ing one now© Jonesfamous home & Bartlett visit, a small Learning, child asked LLC Wald hadNOT very FORfew employment SALE OR opportunities DISTRIBUTION owing to segre- to visit herNOT sick mother. FOR SALE OR DISTRIBUTION gationist policies of hospitals and other health agencies. Males faced the same challenges, and eventually schools of nursing were developed specifically for male nurse train- © Jones & Bartletting. Early rolesLearning, for male LLCnurses were limited to psychiat©- Jones & Bartlett Learning, LLC NOT FOR SALEric facilities, OR DISTRIBUTIONwhere their strength and larger stature wereNOT FOR SALE OR DISTRIBUTION considered advantages in dealing with these populations. These early discriminatory policies reflected the era but were also patterned after Nightingale’s belief that nursing was best suited for women and their nurturing instinct. Nightin- gale did not write specifically© Jones about & Bartlettthe inclusion Learning, of minori- LLC © Jones & Bartlett Learning, LLC ties in the nursing profession.NOT FOR However, SALE as indicatedOR DISTRIBUTION by her NOT FOR SALE OR DISTRIBUTION attitude toward Mary Seacole (as discussed earlier in this chapter), she seemed to have a preference for white female nurses as the face of the emerging profession of nursing. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION The Emergence of Community and And the rest, as they say, is history. According to Wald: Public Health Nursing “Nursing is love in action and there is no finer manifesta- tion of it than the care of the poor and disabled in their own The pattern for health visiting and district nursing practice homes” (Wald, 1915, p. 14). What Wald found changed © Jones & Bartlettoutside the Learning, hospital was LLC similar in the United States© to Jonesher life& Bartlettforever and Learning, secured a place LLC for her in American NOT FOR SALEthat in EnglandOR DISTRIBUTION (Roberts, 1954). U.S. cities were besiegedNOT FORnursing SALE history. OR Wald DISTRIBUTION said, “all the maladjustments of our by overcrowding and epidemics after the Civil War. The social and economic relations seemed epitomized in this

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rom the schoolroom where I had been giving a lesson in In fact, it was very plain that they were sensitive to their con- Fbed-making, a little girl led me one drizzling March morning. dition, and when, at the end of my ministrations, they kissed She had told me of her sick mother, and gathering from her my hands (those who have undergone similar experiences will, incoherent account that© a childJones had been & Bartlett born, I caught Learning, up the I LLCam sure, understand), it would have© Jones been some & solaceBartlett if by Learning, LLC paraphernalia of the bed-makingNOT FOR lesson SALE and carried OR it withDISTRIBUTION me. any conviction of the moral unworthinessNOT FOR of the family SALE I could OR DISTRIBUTION The child led me over broken roadways . . . between tall, have defended myself as a part of a society which permitted reeking houses whose laden fire-escapes, useless for their such conditions to exist. Indeed, my subsequent acquaintance appointed purpose, bulged with household goods of every with them revealed the fact that miserable as their state was, description.© Jones The &rain Bartlett added to the Learning, dismal appearance LLC of the they were not without© Jones ideals & for Bartlett the family life, Learning, and for society, LLC streetsNOT and FOR to the discomfortSALE OR of the DISTRIBUTION crowds which thronged of which they wereNOT so FORunloved SALE and unlovely OR aDISTRIBUTION part. them, intensifying the odors which assailed me from every That morning’s experience was a baptism of the fire. side. Through Hester and Division Streets we went to the end Deserted were the laboratory and the academic work of of Ludlow; past odorous fish-stands, for the streets were a the college. I never returned to them. On my way from the market-place, unregulated, unsupervised, unclean, past evil- sick-room to my comfortable student quarters my mind was © Jones & smelling,Bartlett uncovered Learning, garbage LLC cans . . . © Jonesintent on & my Bartlett own responsibility. Learning, To my inexperience LLC it seemed NOT FOR SALEAll the OR maladjustments DISTRIBUTION of our social and economic relationsNOT certain FOR that SALE conditions OR such DISTRIBUTION as these were allowed because seemed epitomized in this brief journey and what was found at people did not know, and for me there was a challenge to the end of it. The family to which the child led me was neither know and to tell. When early morning found me still awake, my criminal nor vicious. Although the husband was a cripple, one naive conviction remained that, if people knew things—and of those who stand on© street Jones corners & exhibitingBartlett deformities Learning, “things”LLC meant everything implied© inJones the condition & Bartlett of this Learning, LLC to enlist compassion, andNOT masking FOR the SALE begging OR of alms DISTRIBUTION by a family—such horrors would ceaseNOT to exist, FOR and I rejoicedSALE that OR DISTRIBUTION pretense of selling, although the family of seven shared their I had a training in the care of the sick that in itself would give two rooms with boarders—who were literally boarders, since a me an organic relationship to the neighborhood in which this piece of timber was placed over the floor for them to sleep on— awakening had come. and although the sick woman lay on a wretched, unclean bed, Source: Wald, L. D. (1915). The House on Henry Street. New York, NY: soiled© withJones a hemorrhage & Bartlett two days Learning, old, they were LLCnot degraded Henry Holt and ©Company. Jones & Bartlett Learning, LLC humanNOT beings, FOR judged SALE by any OR measure DISTRIBUTION of moral values. NOT FOR SALE OR DISTRIBUTION

brief journey” (p. 6). Wald was profoundly affected by 1985). She began her work with 10 nurses in 1893, which © Jones &her Bartlett observations; Learning, she and herLLC colleague, Mary Brewster,© Jonesgrew to & 250 Bartlett nurses servingLearning, 1,300 LLCpatients each day by Henry Street Settlement NOT FORquickly SALE established OR DISTRIBUTION the in thisNOT 1916. FOR During SALE this ORsame DISTRIBUTION period, the budget for the service same neighborhood in 1893. She quit medical school and grew from nothing to more than $600,000 per year, all devoted the remainder of her life to “visions of a better from private donations. world” for the public’s health. Wald hired African American nurse Elizabeth Tyler in This effort later evolved into the Visiting Nurse Service 1906, which evidenced her commitment to cultural diversity. of New York City, which© laid Jones the foundation & Bartlett for the Learning, estab- Although LLC unable to visit white patients,© Jones Tyler & made Bartlett her own Learning, LLC lishment of public healthNOT nursing FOR in the SALE United OR States. DISTRIBUTION The way by “finding” African AmericanNOT families FOR whoSALE needed OR her DISTRIBUTION health needs of the population were met through address- service. In 3 months, Tyler had so many African American ing social, economic, and environmental determinants of families in her caseload that Wald hired a second African health, in a pattern after Nightingale. The nurses helped American nurse, Edith Carter. Carter remained at Henry educate© Jonesfamilies about& Bartlett disease Learning,transmission LLCand stressed Street for 28 years© Jones until her & retirement Bartlett (Carnegie, Learning, 1991). LLC the importanceNOT FOR of SALEgood hygiene. OR DISTRIBUTION They provided preven- During herNOT tenure FOR at Henry SALE Street, OR Wald DISTRIBUTION demonstrated tive, acute, and long-term care. As such, the Henry Street her commitment to racial and cultural diversity by em- Settlement went far beyond the care of the sick and the ploying 25 African American nurses over the years, and prevention of illness: It aimed at rectifying those causes she paid them salaries equal to white nurses, and pro- that led to the poverty and misery. vided identical benefits and recognition to minority nurses © Jones & BartlettWald was aLearning, tireless social LLC activist for legislative reforms © Jones(Carnegie, & Bartlett1991). This Learning, practice was LLCexceptional during the NOT FORthat SALE would OR provide DISTRIBUTION a more just distribution for the mar-NOTearly FOR part SALEof the 20th OR century, DISTRIBUTION a time when African Ameri- ginal and disadvantaged in the United States (Donahue, can nurses were often denied admission to white schools

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEof nursing OR and DISTRIBUTION membership in professional organizationsNOT FOR Wald’s SALE other OR signifi DISTRIBUTION cant accomplishments include the and were denied opportunities for employment in most establishment of the Children’s Bureau, set up in 1912 as settings. Because hospitals of this era oft en set quotas for part of the U.S. Department of Labor. She was also an African American patients, those nurses who managed enthusiastic supporter of and participant in women’s suf- to graduate from nursing schools found themselves with frage, lobbied for inspections of the workplace, and sup- © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC few patients who needed or could aff ord their services. ported her employee, Margaret Sanger, in her eff orts to African American nursesNOT struggled FOR SALE for the rightOR toDISTRIBUTION take the give women the right to birthNOT control. FOR She wasSALE active OR in the DISTRIBUTION registration examination available to white nurses. American and International Red Cross and helped form Wald submitted a proposal to the city of New York aft er the Women’s Trade Union League to protect women from learning of a child’s dismissal from a New York City school sweatshop conditions. for© a skinJones condition. & Bartlett Her proposal Learning, was for one LLC of the Henry Wald fi© rst Jones coined &the Bartlett phrase “public Learning, health nursing”LLC StreetNOT Settlement FOR SALE nurses ORto serve DISTRIBUTION for free for 1 month in and transformedNOT FOR the fi SALEeld of community OR DISTRIBUTION health nursing a New York school. Th e results of her experiment were from the narrow role of home visiting to the population so convincing that salaries were approved for 12 school focus of today’s community health nurse (Robinson, nurses. From this beginning, school nursing was born in 1946). According to Dock and Stewart (1931), the title of the United States and became one of many community “public health nurse” was purposeful: Th e role designation © Jones & Bartlettspecialties creditedLearning, to Wald LLC (Dietz & Lehozky, 1963). © Joneswas designed& Bartlett to link Learning, the public’s LLC health to governmental NOT FOR SALEIn 1909, OR WaldDISTRIBUTION proposed a program to the MetropolitanNOT FORresponsibility, SALE notOR private DISTRIBUTION funding. As state departments Life Insurance Company to provide nursing visits to its of health and local governments began to employ more industrial policyholders. Statistics kept by the company and more public health nurses, their role increasingly documented the lowered mortality rates of policyholders focused on prevention of illness in the entire community. attributed to the nurses’© Jones public &health Bartlett practice Learning, and clini- LLCA distinction was made between© Jones the visiting & Bartlett nurse, whoLearning, LLC cal expertise. Th e programNOT FOR demonstrated SALE OR savings DISTRIBUTION for the was employed by the voluntaryNOT agencies FOR primarily SALE OR to pro- DISTRIBUTION company and was so successful that it lasted until 1953 vide home care to the sick, and the public health nurse, (Hamilton, 1988). who concentrated on preventive measures (Brainard, 1922). Early public health nurses came closer than hos- researCh alert pital-based nurses to the autonomy and professionalism © Jones & Bartlett Learning, LLC that Nightingale© Jones advocated. & Bartlett Th eir Learning,work was conducted LLC hree exceptional African American nurses—Jessie Sleet, NOT FOR SALE OR DISTRIBUTION in the unconfiNOT nedFOR setting SALE of the OR home DISTRIBUTION and community, Elizabeth Tyler, and Edith Carter—are considered pioneers T they were independent, and they enjoyed recognition as in community health nursing. This research article details how specialists in preventive health (Buhler-Wilkerson, 1985). these three African American community health nurses made Public health nurses from the beginning were much more signifi cant contributions to the development of New York holistic in their practice than their hospital counterparts. © Jones & BartlettCity’s community Learning, health nursing LLC by providing much-needed© Jones & Bartlett Learning, LLC Th ey were involved with the health of industrial workers, NOT FOR SALEhealth ORcare toDISTRIBUTION unserved members of the African AmericanNOT FOR SALE OR DISTRIBUTION immigrants, and their families, and were concerned about community (1900–1937). They provided strong leadership in exploitation of women and children. Th ese nurses also diverse roles such as supervisors, administrators, and educators played a part in prison reform and care of the mentally ill in patients’ homes, babies’ health stations, settlement houses, (Heinrich, 1983). and clinics. Their work occurred during a period of rapid indus- © Jones & Bartlett Learning, LLC Considered the fi rst African© Jones American & Bartlett public health Learning, LLC trialization, immigration, and great population growth in the NOT FOR SALE OR DISTRIBUTIONnurse, Jessie Sleet Scales wasNOT hired FOR in 1902 SALE by the OR Char- DISTRIBUTION midst of teeming slums, diseases, and death. In community ity Organization Society, a philanthropic organization, health nursing history, it was a period of establishment, activ- to visit African American families infected by TB. Scales ism, expansion, and development. For these African Ameri- provided district nursing care to New York City’s African can nurse pioneers, it was a time of signifi cant challenges American families and is credited with paving the way for and© Jones growth. They & Bartlett faced educational, Learning, professional, LLC and racial © Jones & Bartlett Learning, LLC African American nurses in the practice of community barriersNOT andFOR increased SALE mortality OR DISTRIBUTION among people of their own NOT FOR SALE OR DISTRIBUTION health (Mosley, 1996). race. This research chronicles their brave and skilled eff orts to transcend these barriers and improve the health of African Dorothea Lynde Dix American citizens during the early part of the 20th century. Dorothea Lynde Dix, a Boston schoolteacher, became aware © Jones & Bartlett Source: Mosley, Learning, M. O. (1996). SatisfiLLC ed to carry the bag: Three black© Jonesof the & horrendous Bartlett conditions Learning, in prisons LLC and mental institu- community health nurses’ contributions to health care reform, NOT FOR SALE1900–1937. OR Nursing DISTRIBUTION History Review , 4 , 65–82. NOT FORtions when SALE asked OR to DISTRIBUTIONconduct a Sunday school class in the House of Correction at Cambridge, Massachusetts. She was

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORappalled SALE at OR what DISTRIBUTION she saw and went about studying if theNOT FORClara BartonSALE, through OR DISTRIBUTION her work in the Civil War, had conditions were isolated or widespread; she took 2 years come to believe that such an organization was desperately off to visit every jail and almshouse from Cape Cod to the needed in the United States. However, it was not until Berkshire Mountains (Tiffany, 1890, p. 76). Her report 1882 that Barton was able to convince Congress to ratify was devastating. Boston was scandalized by the reality the Treaty of Geneva, thus becoming the founder of the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC that the most progressive state in the union was now asso- American Red Cross (Kalisch & Kalisch, 1986). Barton also ciated with such horribleNOT conditions. FOR SALE The shocked OR DISTRIBUTION legis- played a leadership role in the NOTSpanish–American FOR SALE War OR in DISTRIBUTION lature voted to allocate funds to build hospitals. For the Cuba, where she led a group of nurses to provide care for rest of her life, Dorothea Dix stood out as a tireless zealot both U.S. and Cuban soldiers and Cuban civilians. At the for the humane treatment of the insane and imprisoned. age of 76, Barton went to President McKinley and offered She had© Jonesexceptional & Bartlettsavvy in dealing Learning, with legislators: LLC She the help of the© Red Jones Cross &in Cuba.Bartlett McKinley Learning, agreed to LLC al- acquaintedNOT herself FOR with SALE the legislators OR DISTRIBUTION and their records and low Barton toNOT go with FOR Red SALECross nurses, OR DISTRIBUTION but only to care displayed the “spirit of a crusader.” For her contributions, for the Cuban citizens. Once in Cuba, the U.S. military she is considered one of the pioneers of the reform move- saw what Barton and her nurses were able to accomplish ment in the United States, and her efforts are felt worldwide with the Cuban military, and American soldiers pressured to the present day (Dietz & Lehozky, 1963). military officials to allow Barton’s help. Along with battling © Jones & BartlettDix was also Learning, known for herLLC work in the Civil War, hav-© Jonesyellow fever, & Bartlett Barton was Learning, able to provide LLC care to both Cuban NOT FORing SALE been appointed OR DISTRIBUTION superintendent of the female nurses ofNOT and FOR U.S. militarySALE personnelOR DISTRIBUTION and eventually expanded that the Army by the secretary of war in 1861. Her tireless efforts care to Cuban citizens in Santiago. One of Barton’s most led to the recruitment of more than 2,000 women to serve famous patients was young Colonel Teddy Roosevelt, who in the Army during the Civil War. Officials had consulted later became the president of the United States. Florence Nightingale concerning© Jones conditions& Bartlett in Learning,military LLCBarton became an instant ©heroine Jones both & in Bartlett Cuba and Learning, LLC hospitals and were determinedNOT FOR not to SALE make the OR same DISTRIBUTION mis- in the United States for her bravery,NOT FOR tenaciousness, SALE ORand DISTRIBUTION takes. Dix enjoyed far more sweeping powers than Night- organized services for the military and civilians torn apart ingale, in that she had the authority to organize hospitals, by war. On August 13, 1898, the Spanish–American War to appoint nurses, and to manage supplies for the wounded came to an end. The grateful people of Santiago, Cuba, (Brockett & Vaughan, 1867). Among her most well-known built a statue to honor Clara Barton in the town square, nurses© during Jones the & Civil Bartlett War were Learning, the poet Walt LLC Whitman where it stands© toJones this day. & Tales Bartlett of the work Learning, of Barton LLC and and theNOT author FOR Louisa SALE May AlcottOR DISTRIBUTION (Donahue, 1985). her Red CrossNOT nurses FOR were spreadSALE through OR DISTRIBUTION the newspapers of the United States and in the schools of nursing. A congressional committee investigating the work of Barton’s Red Cross staff applauded the work of these nurses and © Jones & Bartlett Learning, LLC © Jonesrecommended & Bartlett that the Learning, U.S. Medical LLC Department create a NOT FOR SALE OR DISTRIBUTION NOTpermanent FOR SALE reserve OR corps DISTRIBUTION of trained nurses. These reserve nurses became the Army Nurse Corps in 1901. Barton also led the disaster recovery of the deadliest UNN04 natural disaster in U.S. history, which surpassed even the recent Hurricane Katrina in its devastating death toll. On © Jones & Bartlett Learning,September LLC 8, 1900, before hurricanes© Jones were &even Bartlett named, aLearning, LLC FPONOT FOR SALE OR DISTRIBUTIONvast storm with wind speeds exceedingNOT FOR 140 miles SALE per hourOR DISTRIBUTION blew into Galveston Bay. In 24 hours, wind and water had killed an estimated 6,000 people and destroyed an estimated 6,000 buildings. There was no federal help or resources, and © Jones & Bartlett Learning, LLC the grieving survivors© Jones were & faced Bartlett with a federalLearning, government LLC NOT FOR SALE OR DISTRIBUTION that “didn’t do”NOT relief FOR for disasters. SALE The OR only DISTRIBUTION resources came from outside private donors, churches, and philanthropic Clara Barton organizations—and Clara Barton and her Red Cross nurses. The idea for the International Red Cross was the brainchild One-sixth of the city’s population was dead, and the sand- of a Swiss banker, J. Henri Dunant, who proposed the for- bar of Galveston had no place to bury them. Clara Barton © Jones &mation Bartlett of a neutral Learning, international LLC relief society that could© Jonesarrived &on Bartlettthe scene quickly,Learning, and she LLC organized efforts to NOT FORbe SALE activated OR in DISTRIBUTIONtime of war. The International Red CrossNOT comfort FOR the SALE survivors OR and DISTRIBUTION provide healthcare services and was ratified by the Geneva Convention on August 22, 1864. community-based relief (Baker, 2006).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEClara OR Barton DISTRIBUTION will always be remembered both as theNOT FORbelow SALEthe national OR average. DISTRIBUTION These nurses, as at the Henry founder of the American Red Cross and the driving force Street Settlement, provided health care for everyone in the behind the creation of the Army Nurse Corps. district for a small annual fee. A delivery was assessed an additional small fee. Nurse midwives provided primary Birth of the Midwife in the United States care, prenatal care, and postnatal care, with an emphasis © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC Women have always assisted other women in the birth on prevention (Wertz & Wertz, 1977). of babies. These “layNOT midwives” FOR SALEwere considered OR DISTRIBUTION by com- The “Roaring Twenties”NOT ushered FOR American SALE women—OR DISTRIBUTION munities to possess special skills and somewhat of a “call- newly armed with the right to vote—into the new freedom ing.” With the advent of professional nursing in England, of the “flapper era”—shrinking dress hemlines, shortened registered nurses became associated with safer and more hairstyles, and the increased use of cosmetics. Hospitals predictable© Jones childbirth & Bartlett practices. Learning, In England LLC and in other were used© by Jones greater numbers& Bartlett of people, Learning, and the LLC scien- countriesNOT FOR where SALE Nightingale-system OR DISTRIBUTION nurses were preva- tific basisNOT of medicine FOR SALEbecame ORwell DISTRIBUTIONestablished as most lent, most registered nurses were also trained as midwives surgical procedures were done in hospitals. Penicillin was with a 6-month specialized training period. In the United discovered in 1928, creating a revolution in the preven- States, the training of registered nurses in the practice of tion of infectious disease deaths (Donahue, 1985; Kalisch midwifery was prevented primarily by physicians. U.S. & Kalisch, 1986). The previously mentioned Goldmark © Jones & Bartlettphysicians Learning,saw midwives LLC as a threat and an intrusion into© JonesReport & Bartlettrecommended Learning, the establishment LLC of college- and NOT FOR SALEmedical OR practice. DISTRIBUTION Such resistance indirectly led to the proNOT- FORuniversity-based SALE OR nursing DISTRIBUTION programs. liferation of “granny wives” who were ignorant of modern Mary D. Osborne, who functioned as supervisor of practices, were untrained, and were associated with high public health nursing for the state of Mississippi from 1921 maternal morbidity (Donahue, 1985). to 1946, had a vision for a collaboration with community The first organized© Jones midwifery & Bartlett service inLearning, the United LLCnurses and granny midwives,© Joneswho delivered & Bartlett 80% of Learning,the LLC States was the FrontierNOT Nursing FOR Service SALE founded OR DISTRIBUTION in 1925 African American babies inNOT Mississippi. FOR SALEThe infant OR andDISTRIBUTION by Mary Breckenridge. Breckenridge graduated from St. maternal mortality rates were exceptionally high among Luke’s Hospital Training School in New York in 1910 African American families, and these granny midwives, and received her midwifery certificate from the British who were also African American, were untrained and had Hospital for Mothers and Babies in London in 1925. She little education. had© extensiveJones &experience Bartlett in Learning, the delivery LLC of babies and Osborne© tookJones a creative & Bartlett approach Learning, to improving LLC mater- midwiferyNOT FOR systems SALE in NewOR ZealandDISTRIBUTION and Australia. In nal and infantNOT health FOR among SALE African OR DISTRIBUTION American women. rural Appalachia, babies had been delivered for decades She developed a collaborative network of public health by granny midwives, who relied mainly on tradition, nurses and granny midwives in which the nurses imple- myths, and superstition as the bases of their practice. mented training programs for the midwives, and the mid- © Jones & BartlettFor example, Learning, they might LLC use ashes for medication and© Jones wives & in Bartlett turn assisted Learning, the nurses LLC in providing a higher NOT FOR SALEplace a ORsharp DISTRIBUTION axe, blade up, under the bed of a laboringNOT FORstandard SALE of safe OR maternal DISTRIBUTION and infant health care. The pub- woman to “cut” the pain. The people of Appalachia were lic health nurses used Osborne’s book, Manual for Mid- isolated because of the terrain of the hollows and moun- wives, which contained guidelines for care and was used tains, and roads were limited to most families. They also in the state until the 1970s. They taught good hygiene, in- had one of the highest birth rates in the United States. fection prevention, and compliance with state regulations. Breckenridge believed© Jones that if a &midwifery Bartlett service Learning, could LLCOsborne’s innovative program© Jones is credited & Bartlettwith reducing Learning, LLC work under these conditions,NOT FOR it SALEcould work OR anywhereDISTRIBUTION the maternal and infant mortalityNOT ratesFOR in SALEMississippi OR and DISTRIBUTION (Donahue, 1985). in other states where her program structure was adopted Breckenridge had to use English midwives for many (Sabin, 1998). years and only began training her own midwives in 1939, when she started the Frontier Graduate School of Nurse The Nursing Profession Responds to the Great © Jones & Bartlett Learning, LLC Depression© and Jones World & War Bartlett II Learning, LLC MidwiferyNOT FOR in Hyden, SALE Kentucky, OR DISTRIBUTION with the advent of World NOT FOR SALE OR DISTRIBUTION War II. The nurse midwives accessed many of their families With the stock market crash of 1929 came the Great on horseback. In 1935, a small 12-bed hospital was built Depression, which resulted in widespread unemployment at Hyden and provided delivery services. The nurse mid- of private-duty nurses and the closing of nursing schools, wives under the direction of Breckenridge were success- while simultaneously creating an increasing need for char- © Jones & Bartlettful in lowering Learning, the highest LLC maternal mortality rate in the© Jonesity health & Bartlett services Learning,for the population. LLC Nursing students, NOT FOR SALEUnited ORStates DISTRIBUTION (in Leslie County, Kentucky) to substantiallyNOT FORwho had SALE previously OR DISTRIBUTIONbeen the primary source of staff for

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORhospitals, SALE becameOR DISTRIBUTION scarcer. Unemployed graduate nurses NOT FORanimals, SALE even ORusing DISTRIBUTION open ditches for toilets but they were hired to replace them for minimal wages, a trend never complained. One nurse was always on duty in that was to influence the profession for years to come each tentful of 20 men. She had medical orderlies to (MacEachern, 1932). help her. The touch of femininity, the knowledge that Other nurses found themselves accompanying troops a woman was around, gave the wounded man courage © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC to Europe as the United States entered World War II. and confidence and a feeling of security. (Pyle, 1944) Military nurses were aNOT critical FOR presence SALE at theOR invasion DISTRIBUTION NOT FOR SALE OR DISTRIBUTION of Normandy in 1938, as well as in North Africa, Italy, During the midst of the Depression, many nurses France, and the Philippines, where Navy nurses provided found that the expansion and advances in aviation care aboard hospital ships. More than 100,000 nurses opened up a new field for nurses. In an effort to increase volunteered© Jones and were& Bartlett certified Learning, for military serviceLLC in the the public’s confidence© Jones in& theBartlett safety ofLearning, transcontinental LLC ArmyNOT and Navy FOR Nurse SALE Corps. OR DISTRIBUTION air travel, nursesNOT were FOR hired SALE in the promisingOR DISTRIBUTION new role of The resulting severe shortage of nurses on the home “nurse-stewardess” (Kalisch & Kalisch, 1986). Congress front resulted in the development of the Cadet Nurse created an additional relief program, the Civil Works Corps. Frances Payne Bolton, a Congresswoman from Administration (CWA), in 1933 that provided jobs to Ohio, is credited with the founding of the Cadet Nurse the unemployed, including placing nurses in schools, © Jones &Corps Bartlett through Learning, the Bolton ActLLC of 1945. By the end of the© Jonespublic hospitals& Bartlett and clinics,Learning, public LLC health departments, NOT FORwar, SALE more ORthan 180,000DISTRIBUTION nursing students had been trainedNOT and FOR public SALE health OR education DISTRIBUTION community surveys and through this Act, while advanced practice graduate nurses campaigns. in psychiatry and public health nursing had received grad- The Social Security Act of 1935 was also passed by uate education to increase the numbers of nurse educators Congress to provide old-age benefits, rehabilitation ser- (Donahue, 1985; Kalisch© &Jones Kalisch, & 1986). Bartlett Learning, vices,LLC unemployment compensation© Jones administration, & Bartlett aid to Learning, LLC Ernie Pyle, a famousNOT correspondent FOR SALE in World OR WarDISTRIBUTION II, dependent and/or disabled childrenNOT and FOR adults, SALE and mon OR- DISTRIBUTION offered Americans a “front-seat view” of the war through ies to state and local health services. The Social Security his detailed journalistic accounts of daily life on the front. Act included Title VI, which authorized the use of federal Pyle was the first journalist who put his own life in danger funds for the training of public health personnel. This led by reporting from the battlefront; he spent a great deal of to the placement of public health nurses in state health time ©with Jones soldiers & duringBartlett active Learning, combat and LLC was killed departments ©and Jones the expansion & Bartlett of public Learning, health nursing LLC duringNOT a sniper FOR attack SALE in Ie Shima,OR DISTRIBUTION Japan, in 1942. Chaplin as a viable careerNOT path. FOR SALE OR DISTRIBUTION Nathan Baxter Saucier was assigned to retrieve his body, While nurses were forging new paths for themselves conduct his service, and assist the soldiers with build- in various fields, Hollywood began featuring nurses in ing his coffin. The funeral service lasted only about 10 films during the 1930s. The only feature-length films to © Jones &minutes. Bartlett Pyle Learning,was buried with LLC his helmet on, at Saucier’s© Jonesever focus & entirelyBartlett on theLearning, nursing profession LLC were released NOT FORrequest. SALE The OR Navy,DISTRIBUTION Marine Corps, and Army were all rep-NOTduring FOR this SALE decade. OR War DISTRIBUTION Nurse (1930), Night Nurse (1931), resented at the service. Pyle was a highly regarded and Once to Every Woman (1934), The White Parade (1934, humanistic voice for those serving America during World Academy Award nominee for Best Picture), Four Girls in War II. Here is an example of his accounts of life for nurses White (1939), The White Angel (1936), and Doctor and in a field hospital in Europe: Nurse (1937) all used nurses as major characters. Dur- © Jones & Bartlett Learning,ing LLC the bleak years of the economic© Jones depression, & Bartlett young Learning, LLC The officers and NOTnurses liveFOR two SALE in a tent OR on DISTRIBUTION two sides women found these nurse heroinesNOT whoFOR promoted SALE ORide- DISTRIBUTION of a company street—nurses on one side, officers on alism, self-sacrifice, and the profession of nursing over the other. . . . The nurses wear khaki overalls because personal desires particularly appealing. No longer were of the mud and dust. Pink female panties fly from a nurses depicted as subservient handmaidens who worked line© amongJones the & brown Bartlett warlike Learning, tents. On the LLC flagpole is as nurses only© Jonesas a temporary & Bartlett pastime Learning, before marriage LLC a NOTRed Cross FOR flag SALE made ORfrom DISTRIBUTIONa bed sheet and a French (Kalisch & Kalisch,NOT FOR1986). SALE OR DISTRIBUTION soldier’s red sash. The American nurses—and there were lots of them—turned out just as you would ex- Early Education and Standardization of Practice of Public pect: wonderfully. Army doctors and patients too were Health Nursing unanimous in their praise of them. . . . Doctors told After the turn of the century in the United States, infec- © Jones & Bartlettme that in Learning,the first rush LLCof casualties they were calmer© Jonestious diseases & Bartlett such as Learning,smallpox, TB, LLC malaria, cholera, and NOT FOR SALEthan the OR men. DISTRIBUTION For the first ten days they had to live likeNOT typhoid FOR were SALE practice OR prioritiesDISTRIBUTION for public health nurses.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEThe public OR DISTRIBUTIONhealth nurse often initially detected an infecNOT- FORChildren’s SALE Bureau OR of DISTRIBUTION the U.S. Department of Labor for tious disease, then referred those patients to physicians state supervisory nurses, regional supervisory nurses, and for treatment, provided follow-up care to patients when local county nurses. The goal of this special project was indicated, and tried through education and demonstra- to place at least one public health nurse in each county in tions to family and caregivers to prevent the spread of every state. The efforts to reach this goal were remarkable, © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC disease. Progress for early education efforts was largely but qualified public health nurses continued to be few in gained through experience.NOT FOR A 3-month SALE orientationOR DISTRIBUTION and number (Association of StateNOT and TerritorialFOR SALE Directors OR DISTRIBUTIONof observation process was established in the early 1920s for Nursing [ASTDN], 1993). nurses new to the concepts and policies of public health The U.S. Public Health Service (USPHS), under the nursing. The philosophy was simple: Public health nurs- nursing consultation of Pearl Melver, provided leadership ing© was Jones about & prevention Bartlett ofLearning, disease, the LLC promotion of in the development© Jones of & public Bartlett health Learning, nursing services LLC to health,NOT care FOR of the SALE sick, andOR rehabilitationDISTRIBUTION to productive the states.NOT This FOReffort SALE was encouraged OR DISTRIBUTION by the National life (Erickson, 1996). Organization of Public Health Nursing and the Nursing By 1927, the Rockefeller Foundation provided private Section of the American Public Health Association. Joint funding for a training station for health workers in con- efforts of the federal public health nurses and those who junction with several local county health departments. were becoming organized in the states became the impetus © Jones & BartlettNurses, physicians, Learning, and sanitariansLLC from many states and© Jonesfor the & Bartlettgrowth of theLearning, specialty ofLLC public health nursing NOT FOR SALEforeign OR countries DISTRIBUTION received public health orientation andNOT FOR(ASTDN, SALE 1993). OR DISTRIBUTION training through this initiative before it was discontin- Another provision of the Social Security Act of 1935 ued in 1932. In 1929, the Rockefeller Foundation pro- was the establishment of Crippled Children’s Services. vided grants through the Rosenwald Fund designated Through this initiative, public health nurses were trained for programs to improve© Jones the health & Bartlett and lower Learning, the death LLCin rehabilitation nursing, primarily© Jones in orthopedics. & Bartlett These Learning, LLC rates of the AfricanNOT American FOR population SALE OR in theDISTRIBUTION South. nurses visited crippled childrenNOT in FORtheir homes, SALE held OR con DISTRIBUTION- These funds, used to establish permanent public health ferences with parents, and assisted in field clinics (Roberts, nursing positions for African American nurses, targeted 1985a). children in areas where nursing and sanitation would Syphilis had also been recognized as a major source make a profound impact on health and health practices of morbidity and mortality for many years. In 1938, the (Forbes,© Jones 1946). & Bartlett Learning, LLC USPHS and© stateJones boards & Bartlettof health cooperated Learning, in aLLC major NOT FOR SALE OR DISTRIBUTION project toNOT attempt FOR to conquer SALE theOR disease DISTRIBUTION through case Challenges of the 1930s finding, treatment, follow-up contact, and education. Pub- In 1933, President Roosevelt initiated the New Deal to lic health nursing was in the vanguard of this effort. Edu- relieve the economic hardship of the country. The Social cational conferences were planned so that all public health © Jones & BartlettSecurity Act Learning, in 1935 (Public LLC Law No. 99-271) provided© Jones nurses & wouldBartlett have Learning, an opportunity LLC to attend. Prenatal NOT FOR SALEfunding OR to increase DISTRIBUTION public health programs, particularlyNOT FORscreening SALE of patients OR DISTRIBUTION for syphilis was being introduced as to extend services and improve health care for mothers a standard nursing intervention at this time. These efforts and children in rural areas suffering from economic stress. were particularly successful in the South (Erickson, 1940; State boards of health secured funds in 1934 through the Box 3-3).

1920s Frost established epidemiology as science basic to 1930s Association of State and Territorial Directors of community health Nursing formed ©1920s Jones National & Bartlett Organization Learning, for Public Health LLC Nursing 1930 Crippled© Jones Children’s & BartlettPrograms established Learning, LLC NOT FORformed SALE OR DISTRIBUTION 1930 NationalNOT Institutes FOR SALE of Health OR established DISTRIBUTION 1920s Public Health Nursing Section of American Public 1935 Social Security Act passed Health Association formed 1938 American Public Health Association set standards 1921 First federal monies allocated for health and social for school health welfare Source: From Public Health Milestones in the 1920s and 1930s. APHA, © Jones & Bartlett1923 Health Learning, Organization LLC of League of Nations founded© Jones2006. &Reprinted Bartlett with permissionLearning, from theLLC American Public Health NOT FOR SALE1925 ORFrontier DISTRIBUTION Nursing founded NOT FORAssociation. SALE OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEThe country OR DISTRIBUTION was gradually recovering from the GreatNOT graduates FOR SALE employed OR to DISTRIBUTION support public health nursing. Depression, and economic progress was accelerating. Farm These individuals quickly became a valuable resource and production had broadened through diversification. New support to public health nursing, performing both clerical industries expanded the economy. The southern states, and clinical support activities (ASTDN, 1935–1993). along with some of the eastern states, began to recognize In December 1947, senior cadet nurses had a 6-month © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC the importance of nursing service in industrial hygiene general training in public health and polio care through programs. The U.S. DivisionNOT FORof Industrial SALE HygieneOR DISTRIBUTION asked the training center of the stateNOT boards FOR of health. SALE The OR pur- DISTRIBUTION for a public health nurse to plan and help institute nurs- pose of the Cadet Nurse Corps Program, funded through ing services. The prevention of disease, improvement of the USPHS, was to encourage young women to study hazardous work conditions, promotion of health practices nursing and to augment the supply of nurses in all health including© Jones nutrition, & andBartlett first aid Learning, were the interventions LLC to services. © Jones & Bartlett Learning, LLC be providedNOT FOR through SALE industrial OR nursing.DISTRIBUTION As these nurses Nurses wereNOT returning FOR toSALE work followingOR DISTRIBUTION the close of were employed, short-term educational and direct expe- World War II, although the overall demand for nurses con- rience opportunities in areas with industrial nurses were tinued to exceed the supply. Newly constructed hospitals, planned so that the nurses could receive the best prepa- industry, and public health agencies were all clamoring ration possible for the role (Morton, Roberts, & Bender, and vying for the short supply of nurses. While more active © Jones &1993; Bartlett Roberts, Learning, 1985a, 1985b; LLC Smith, 1934). © Jonesprofessional & Bartlett nurses and Learning, more students LLC in schools existed NOT FOR SALE OR DISTRIBUTION NOTby FORthe early SALE 1950s ORthan DISTRIBUTION at any previous time, the increase Progressive Initiatives After the War Years in numbers and caliber of nurses had not kept pace with By 1942, state boards of health and education began to the need for service (ASTDN, 1935–1993). enter operative agreements to strengthen public health Throughout the 1950s, the nursing home industry nursing service to the ©school-age Jones population.& Bartlett The Learning, role of beganLLC to emerge, with licensure© Jonesrequirements & Bartlett for stan -Learning, LLC the public health nurseNOT in the FORschool SALE was generalized, OR DISTRIBUTION but dards of operation developed toNOT ensure FOR quality SALE of services OR DISTRIBUTION much emphasis was placed on health promotion, immu- and care. Communities were accommodating an increase nizations, nutrition, and correction of physical defects. in the number of elderly persons living with chronic and Landmark legislation was passed by the U.S. Congress in degenerative diseases. Public health nurses provided train- March 1943, establishing the Emergency Maternity and ing courses for nurses’ aides employed in nursing homes. Infant© Care Jones (EMIC) & Bartlett program forLearning, the care of LLC the depen- Country public© Joneshealth nurses & Bartlett regularly Learning, visited the nurs LLC- dentsNOT of enlisted FOR menSALE of theOR U.S. DISTRIBUTION armed services. The ing homes withinNOT their FOR communities, SALE OR providing DISTRIBUTION TB skin program was designed to provide for maternity care and testing, administering flu vaccines, and providing techni- acute illness care of the infants and was administered cal assistance in nursing care. Nutritionists and physical through the U.S. Children’s Bureau. In less than a month, therapists provided additional expertise to improve care © Jones &the Bartlett program wasLearning, initiated LLCin almost all states. Training© Jonesprocesses & andBartlett support Learning, public health LLC nurses in the areas NOT FORfor SALE public OR health DISTRIBUTION nurses was once again funded by theNOT of FORrehabilitation SALE and OR nutrition DISTRIBUTION (Hanlon & Pickett, 1974a, federal government, and the role of the public health nurse 1974b; Morton et al., 1993). expanded to include mothers and babies in a more formal A national trend began in the 1960s to release psy- way (ASTDN, 1935–1993). chiatric patients from institutional care as improved psy- The USPHS Division of Public Health Nursing con- chotropic drugs and treatment modalities were available. ducted research during© theJones mid-1940s & Bartlett to study Learning, public Inadequate LLC staffing at the state© mentalJones health & Bartlettinstitutions Learning,as LLC health nursing. The NOTmost significant FOR SALE recommendations OR DISTRIBUTION a result of the nursing shortageNOT was a complicatingFOR SALE factor. OR DISTRIBUTION included the designation of public health nursing in states The National Institute of Mental Health funded projects as a major division of nursing, the recognition of public to study the impact that public health nurses might have health nursing as a service delivery system to all public on mental health care. A mental health nurse consultant health© divisions Jones and & Bartlettprograms, andLearning, the importance LLC of edu- was employed© byJones many states& Bartlett to spearhead Learning, the research LLC cationalNOT and FOR practice SALE issues relatedOR DISTRIBUTION to professional nursing. efforts of theseNOT projects. FOR SALEThe projects’ OR DISTRIBUTIONpublic health nurs- The studies cited a low educational level for public health ing activity was defined as “aftercare” and was designed to nurses and strongly recommended upgrading educational determine the effectiveness of integrating follow-up ser- qualifications. The studies critiqued the established ex- vices to mental health patients and their families into gen- penditure of nursing time and activities, determining that eral public health nursing service. Public health nursing © Jones &many Bartlett duties carried Learning, out by LLCpublic health nurses could be© Jonesservices & included Bartlett case Learning, finding and LLC referral, hospital dis- NOT FORdelegated SALE ORto clerical DISTRIBUTION staff and health aides. Health aidesNOT charge FOR planning, SALE home OR DISTRIBUTIONand family assessments before and were introduced to the public health team with high school after discharge to the home, and medication monitoring

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1940s Public health programs focused on health needs of 1950s Policy emphases on health and federal funds the war period for states, environmental health issues, housing, 1946 Centers for Disease Control and Prevention estab- behavior, medical care, and children’s health lished by Congress© Jones & Bartlett Learning, LLC1950 Tuberculosis outpatient© treatment Jones becomes& Bartlett Learning, LLC 1946 Mahoney introducedNOT FOR use ofSALE penicillin OR for DISTRIBUTIONtreatment acceptable NOT FOR SALE OR DISTRIBUTION of syphilis 1950 Introduction of the Salk vaccine 1948 National Heart, Lung, and Blood Institute 1950 White House Conference on Children and Youth established Source: From Public Health Milestones in the 1940s and 1950s. APHA, 1948© Jones World & Health Bartlett Organization Learning, established LLC 2006. Reprinted© Jones with permission & Bartlett from the AmericanLearning, Public HealthLLC Association. NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION

(Amendt & White, 1965; Cottrell, 1948). Mental health regarding children’s health status, received federal grants services remained an integral part of public health ser- under the Vaccination Assistance Act. In 1965, pub- vice delivery throughout this decade, with new activities lic health nurses administered an increased number of © Jones & Bartlettenhancing Learning,the communities’ LLC focus (Box 3-4). © Jonesimmunizations. & Bartlett The Learning, oral polio vaccine, LLC known as the Sabin NOT FOR SALEGreat OR emphasis DISTRIBUTION was placed on child health, growth, andNOT FORvaccine, SALE became OR available DISTRIBUTION in a sugar cube administration development in the early 1960s. Communicable disease, form. A measles vaccine became available in 1966 and intestinal parasites, and physical defects that had been so rubella in 1969. Following mass initial immunization prevalent in the school-age population were greatly dimin- campaigns for both measles and rubella, the new vaccines ished. Evaluations of© this Jones population & Bartlett found the Learning, new con- LLCwere incorporated into routine© Jones immunization & Bartlett schedules Learning, LLC cerns to be dental andNOT oral defects, FOR vision SALE and OR hearing DISTRIBUTION defects, for children (ASTDN, 1935–1993).NOT FOR SALE OR DISTRIBUTION mental and emotional disturbances, accidents, and serious By the mid-1960s, federal funding for maternal/child nutritional deficiencies. Continuing education was provided health services required the incorporation of contraceptive to enhance public health nurses’ skills in observation, assess- information and general reproductive health into public ment, and nursing interventions in the care of children. Pub- health services. The objective was to reduce maternal and lic© health Jones nurses & began Bartlett to be trained Learning, to assess LLC developmental infant mortality© Jones and to & generally Bartlett improve Learning, the health LLC and progressNOT ofFOR children. SALE Child OR health DISTRIBUTION services provided by public wellbeing ofNOT mothers FOR and SALE children. OR Some DISTRIBUTION states had already health nurses included screening for physical defects, admin- identified the health problems associated with multiple istration of immunizations, follow up to correct physical unplanned and unwanted pregnancies and had been early defects, referral for mental health evaluations, consultation leaders in efforts to repeal federal and state laws restricting © Jones & Bartlettwith teachers, Learning, and health LLCpromotion in nutrition, accident© Jones birth & control Bartlett services. Learning, By 1944, these LLC efforts had resulted in NOT FOR SALEprevention, OR and DISTRIBUTION mental health (Roberts, 1985a). NOT FORintegrated SALE family OR planning DISTRIBUTION counseling and issuing of select An evaluation of the school health programs in the supplies with maternity and postpartum services into many mid-1960s identified the need for additional nursing per- of the county health departments. Contraceptive supplies sonnel to provide more direct preventive health services. at that time included condoms and diaphragms. However, Specialized federal funding through Title V grants was because of the wide divergence of public opinion, the provided through the© Jonesstate departments & Bartlett of education Learning, to LLCdevelopment of the program© wasJones slow and& Bartlett unpublicized Learning, LLC promote public healthNOT initiatives. FOR SALEMany schools OR DISTRIBUTION recruited (ASTDN, 1935–1993: MortonNOT et al., FOR 1993). SALE OR DISTRIBUTION their nursing staff from the public health nursing workforce. Those public health nurses who went to schools took Social and Political Influence of the 1960s and 1970s a broad view of child health and served as emissaries to By 1965, county health departments routinely provided school© Jones administrators & Bartlett and local Learning, boards’ members. LLC County contraceptive© Jones counseling & Bartlettand supplies. Learning, Oral contraceptives LLC publicNOT health FOR nurses SALE continued OR DISTRIBUTION to serve as consultants to were also NOTavailable FOR by thisSALE time OR and DISTRIBUTION gave women more the schools in the areas of immunizations and communi- convenient and accepted choices. Public health nurses cable disease and as a referral source for Crippled Chil- promoted family planning and were key in identifying dren’s Services (Roberts, 1985a). women at highest risk and need for such services. Family Immunizations administered by public health nurses planning nursing visits increased across the country. Even- © Jones & Bartlettwere proving Learning, effective, LLC yet surveys showed that many© Jones tually, & theBartlett federal Learning,government appropriatedLLC monies for NOT FOR SALEpreschool OR and DISTRIBUTION school-age children were not completelyNOT FORadditional SALE education OR DISTRIBUTION of public health nurses to function immunized. Boards of health, continuing their vigilance as family planning nurse practitioners (NPs).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALELandmark OR legislationDISTRIBUTION in 1965 amended the SocialNOT FORAfter SALEfederal ORcosts DISTRIBUTIONstudies were implemented by the Security Act of 1935 by establishing Medicare, a health public health nurses in home health care, it was demon- insurance plan for people 65 years of age and older and strated that additional auxiliary staff, including health for those with long-term disabilities. The insurance plan aides and clerks, would allow public health nurses more included reimbursement for intermittent skilled nursing time for nursing activities. Action was taken to create © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC services provided to homebound persons. The purpose of additional clerical and aide positions to support the nurs- home health services wasNOT twofold. FOR Healthcare SALE OR costs DISTRIBUTION were ing staff. NOT FOR SALE OR DISTRIBUTION beginning to skyrocket; home care would reduce costly More liberal social values emerged, and the 1960s hospitalization stays with the added benefit of patients became known for having spawned a sexual revolution. being in familiar home settings, enhancing quality of life. These effects were recognized by the early 1970s. Com- The ©goal Jones of the &program Bartlett was Learning,to rehabilitate LLC patients to munities were© faced Jones with & tremendous Bartlett Learning,increases in sexu LLC- their NOTmaximum FOR potential SALE and OR to teachDISTRIBUTION families to care for ally transmittedNOT diseases FOR and SALE teen pregnancy OR DISTRIBUTION rates. Social the physical and emotional needs of patients. programs in response to these increases were initiated in Public health nurses had been providing home nursing the 1960s and were formalized in public and community services on a limited basis since the inception of public health efforts in all states. The establishment of Medic- health nursing, but this would be the first reimbursement aid through the amendment to the Social Security Act, © Jones &established Bartlett for Learning, direct nursing LLC services. In addition, the© JonesTitle XIX, & enhancedBartlett theLearning, delivery of LLChealthcare services to NOT FORreimbursable SALE OR home DISTRIBUTION health nursing services to be providedNOT a widerFOR range SALE of recipients. OR DISTRIBUTION The quantity and variance of would require public health nurses to learn new assess- activities in public health nursing continued to increase. ment and rehabilitative technical skills. Federal regulations All the while, the traditional programs of health pro- established for certification were monumental, however. tection and disease control moved forward, many with Continuing education for© theJones nurses & and Bartlett nurses’ aides Learning, who anLLC accelerated pace. Collaboration© Jones with other& Bartlett agencies, Learning, LLC were directly providingNOT care FORwas just SALE one of OR the regulaDISTRIBUTION- institutions, and groups continuedNOT atFOR a high SALE level in OR an DISTRIBUTION tions that in itself would be an immense task once service effort to coordinate resources to achieve the best pos- delivery was fully implemented (Buhler-Wilkerson, 1993; sible public health service delivery. Medicaid programs Erickson, 1996; Institute of Medicine [IOM], 1988). enhanced the expansion of Crippled Children’s Services Federal grants through the USPHS were made avail- as a payment mechanism for many previously uncovered able to© support Jones the & implementation Bartlett Learning, of home health. LLC Nurse services. Additional© Jones screening & Bartlett and specialty Learning, treatment LLC consultants,NOT FOR supervising SALE nurses, OR andDISTRIBUTION staff nurses attended clinics for neurology,NOT FOR heart, SALE and orthopedics OR DISTRIBUTION were estab- university-supported educational offerings in rehabilita- lished throughout the United States. Other initiatives also tion care and techniques. Educational workshops were centered the delivery of child health services. Particularly designed to upgrade nursing skills and techniques in re- in states with high infant mortality rates, state boards © Jones &habilitative Bartlett care Learning, and on the LLC conditions of participation© Jonesof health & enteredBartlett cooperative Learning, agreements LLC in the 1970s NOT FORof SALE home health OR DISTRIBUTION services. Additional workshop topics in-NOTto FORestablish SALE public OR health DISTRIBUTION nursing positions in newborn cluded documentation of skilled care and nursing care intensive care units. The goal was to improve the com- plans, medication administration and side effects, and the munication, referral, and follow-up mechanisms for these disease processes of many chronic health conditions. high-risk infants after discharge from the hospital. Title XIX of the Social Security Act (Medicaid) estab- © Jones & Bartlett Learning,lished LLC Early and Periodic Screening,© Jones Diagnosis, & Bartlett and Treat -Learning, LLC NOT FOR SALE OR DISTRIBUTIONment (EPSDT) in 1969 to improveNOT the FORaccess toSALE preventive OR DISTRIBUTION and primary health care for low-income children. State boards of health used this opportunity to strengthen the delivery of well-child services. These physical screenings © Jones & Bartlett Learning, LLC were made available© Jones primarily & Bartlett by public Learning, health nurses LLC and NOT FOR SALE OR DISTRIBUTION were reimbursableNOT nursingFOR SALE services, OR another DISTRIBUTION recognition of the value of public health nursing service. The Denver Developmental Screening Test (DDST) was incorporated into the physical assessment, giving public health nurses a new tool to help find potential developmental delays and © Jones & Bartlett Learning, LLC © Jonesprovide & early Bartlett intervention Learning, in the newborn LLC to 6-year age NOT FOR SALE OR DISTRIBUTION NOTgroups. FOR Workshops SALE OR and DISTRIBUTION in-service programs were conducted to teach the DDST standardized procedures.

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1960s Public health policy issues focused on inequal- 1970 Occupational Safety and Health Administration ity, integration, poverty, “the pill,” housing envi- established ronmental health, consumer protection, human 1973 HMO Act passed rights, and© Jones peace & Bartlett Learning, LLC1976 National immunization© Jones program & for Bartlett “swine flu” Learning, LLC 1960 TuberculosisNOT sanatoriums FOR SALE phased OR out DISTRIBUTIONand main- 1978 Association of CommunityNOT FOR Health SALE Nursing OREdu- DISTRIBUTION stream treatment begun cators formed 1961 First White House Conference on Aging 1979 Last outbreak of poliomyelitis in the United 1961–1962 Sabin vaccine introduced States 1962© Jones National & Bartlett Institute Learning, of Child Health LLC established 1979 ©First Jones Healthy &People Bartlett report Learning, LLC 1964NOT FORSurgeon SALE General’s OR ReportDISTRIBUTION on Smoking and Health Source: FromNOT Public Health FOR Milestones SALE in OR the 1960s DISTRIBUTION and 1970s. APHA, published 2006. Reprinted with permission from the American Public Health 1965 Medicaid and Medicare programs enacted Association. 1970 Roe v. Wade © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEMedical OR DISTRIBUTIONtechnology continued to advance rapidly,NOT FORand rising SALE unemployment OR DISTRIBUTION rates. National leadership was including advances in genetic diagnostics and treatment. reducing funding for many of the social programs begun Routine screening for sickle-cell anemia was introduced and in the 1960s; the philosophy was that less governmen- was integrated with EPSDT services. Other genetic techno- tal spending would enhance the national economy. The logical advances determined© Jones that a& contributing Bartlett Learning,factor to the LLCincreased number of homeless© Jonespersons became& Bartlett a national Learning, LLC high incidence of mentalNOT retardation FOR SALE resulted OR from DISTRIBUTION genetic concern. Continuing concernsNOT included FOR SALEillicit drug OR use, DISTRIBUTION disorders such as hypothyroidism and phenylketonuria rising teen pregnancy rates, and alterations in family unit (PKU). Medication and dietary treatments were developed structures. Inadequate healthcare resources were also a for these genetic disorders that would improve the quality continuing concern requiring cost containment, manage- of life and life expectancy. Nursing interventions included ment of resources, and careful evaluation and incorpo- a home© Jones assessment, & Bartlett treatment Learning, modalities LLCordered by the ration of advancing© Jones technology. & Bartlett During Learning, this era, LLC public attendingNOT FOR physician, SALE provision OR DISTRIBUTIONof dietary supplements, and health nursingNOT servicesFOR SALE became OR varied DISTRIBUTION throughout the teaching basic child health care and special health care country. In some states, basic services included both tradi- based on the genetic diagnosis derived from the screening tional preventive health services and family health services (ASTDN, 1935–1993; Hanlon & Pickett, 1974b). Please refer directed at high-risk mothers and babies and a reduction © Jones & Bartlettto Box 3-5 Learning,for milestones LLC of the 1960s and 1970s. © Jonesof unplanned & Bartlett pregnancies Learning, (ASTDN, LLC 1935–1993). NOT FOR SALEA dramatic OR DISTRIBUTION increase in home health nursing visitsNOT FORFortunately, SALE OR public DISTRIBUTION health nursing continued to grow began at the close of the 1970s as a result of Medicare’s and was a strong workforce in the country by the 1980s. implementation of diagnosis-related groups (DRGs), Infant death rates declined significantly. Public health which were designed to lower costs through reduced nurses participated in many research studies on public institutionalization. Medicaid also reimbursed for home health problems such as congenital syphilis and TB pre- health services to eligible© Jones individuals & Bartlett not on Medicare Learning, and LLCventive studies. Federal funding© Jones requirements & Bartlett changed Learning, LLC for some children withNOT special FOR healthcare SALE OR needs. DISTRIBUTION Private from categorical grants to blockNOT grants. FOR Categorical SALE OR fund DISTRIBUTION- medical insurance plans and the Veteran’s Administration ing of the 1960s and 1970s had required that resources were beginning to reimburse for home health services as be restricted to the program that funded the resource; a well. Additional nursing positions were essential to meet nursing position funded by family planning, for example, the© demand Jones and & toBartlett balance theLearning, quantity relationship LLC with was limited© to Jones family planning & Bartlett activities. Learning, Block funding LLC al- qualityNOT nursing FOR SALE care. As OR more DISTRIBUTION acutely ill patients were lowed agenciesNOT more FOR discretion SALE onOR the DISTRIBUTION use of these funds; cared for in the home and more advanced technological therefore, services could be offered more efficiently to the care was introduced into home health care, this specialty public. Integrated public health nursing delivery systems increased (ASTDN, 1935–1993). were born. The integration of services allowed public health nurses to return to the more patient-oriented or © Jones & BartlettPublic Health Learning, Nursing Services LLC in the 1980s and 1990s © Jonesfamily-oriented & Bartlett care Learning, that had been LLC the traditional phi- NOT FOR SALEAs the OR1980s DISTRIBUTION began, the United States was experiencingNOT FORlosophy SALE of public OR health DISTRIBUTION nursing (ASTDN, 1993; Buhler- an economic recession with skyrocketing interest rates Wilkerson, 1993).

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEGenetics OR screening DISTRIBUTION programs expanded as a result ofNOT with FOR medical SALE providers OR DISTRIBUTION in an effort to improve the overall advanced technology in the early 1980s. The first initiative status of this high-risk population. Documentation of the was newborn screening for sickle-cell anemia. The goal care process was essential for continuity of care from the was early detection of disease because early intervention initial assessment and plan of care through implementa- could prevent common infections or premature deaths. tion of services and ongoing evaluation. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC State legislatures mandated hospitals to collect newborn Case management emerged during this decade as a new screening specimens NOTbefore FORinfant SALEdischarge OR from DISTRIBUTION the term, but the concept and theNOT related FOR activities SALE of ORcase DISTRIBUTION hospital. Screening included at least three genetic dis- management were the principles and foundations upon orders: sickle-cell anemia, PKU, and hypothyroidism. which public health nursing practice had been built. Case Public health nurses were given the responsibility for management is a program for intensive individual super- following© Jones up with & the Bartlett newborns Learning, with a questionable LLC or vision, follow© up, Jones and referrals & Bartlett to appropriate Learning, levels of care.LLC positiveNOT screen. FOR Questionable SALE OR screens DISTRIBUTION for PKU and hy- Public healthNOT nurses FOR had beenSALE providing OR DISTRIBUTION a form of case pothyroidism require prompt attention because early management through the years to many patients, such as treatment with diet and/or medication will prevent irre- those receiving TB treatment, those receiving home health versible mental retardation and growth delay. The avail- services, and children with special healthcare needs. ability of public health nurses provided an effective means School health nurses also became stronger in this era. © Jones &for Bartlett timely follow Learning, up of screenings LLC and for the implemen-© JonesSchool nurses& Bartlett strengthened Learning, the educational LLC process of stu- NOT FORtation SALE of medical OR DISTRIBUTION and nursing care plans when indicatedNOT dents FOR by assistingSALE ORthem DISTRIBUTION in improving or adapting to their (ASTDN, 1993). health status. School nurses were available during school A crucial indicator of any state’s quality of life is infant hours to serve as counselors and to provide case finding mortality. Public health nursing became a viable resource and referral to physicians, health departments, and other during the 1980s for delivering© Jones services & Bartlett (either personal Learning, or agenciesLLC as appropriate to meet© theJones needs & of Bartlett school-age Learning, LLC preventive) aimed at reducingNOT FOR infant SALEmortality. OR The DISTRIBUTION major children. Activities included generalNOT healthFOR screening SALE OR and DISTRIBUTION cause of infant mortality was prematurity. Contributing referral, hearing and vision screening, identification of factors included poor nutrition, smoking, teen pregnancy, suspected abuse and neglect, substance abuse counseling, and inadequate prenatal care. Socioeconomic factors such and appropriate decision making and support. In addition, as inadequate housing, drug abuse, and lack of education school nurses provided classroom presentations on health were ©also Jones contributing & Bartlett factors. Learning,Maternal risk LLCscoring and issues and provided© Jones emergency & Bartlett care for Learning, injuries and LLC ill- documentationNOT FOR to ensureSALE referrals OR DISTRIBUTION to appropriate levels of nesses at school.NOT FOR SALE OR DISTRIBUTION care were standards of care. Tracking systems were intensi- Communicable disease had renewed public health fied to ensure adequate levels of care. interest in the nation throughout the 1980s. TB case rates Family planning services during the 1980s were also were increasing. Measles cases were being reported among © Jones &identified Bartlett as aLearning, priority to reduce LLC infant mortality. Risk fac-© Jonescollege-age & Bartlett students. New Learning, communicable LLC disease concerns NOT FORtors SALE included OR age DISTRIBUTION and/or inadequate income to purchaseNOT emerged FOR SALEin the 1980s, OR DISTRIBUTIONincluding increased incidence of contraceptive supplies. Public health nurses continued to hepatitis B, human immunodeficiency virus (HIV) infec- promote family planning services, provide health promotion, and acquired immune deficiency syndrome (AIDS). tion and education in their communities, and intensify Case conferences with private medical consultants were tracking systems of teens and others at risk. The Special established on a district level for initiation and ongoing Supplemental Food Program© Jones for &Women, Bartlett Infants, Learning, and review LLC of treatment plans carried© Jones out by & public Bartlett health Learning, LLC Children (WIC) continuedNOT toFOR address SALE infant OR mortality. DISTRIBUTION nurses. Drug resistance and failureNOT to take FOR medication SALE wereOR DISTRIBUTION WIC certification and nutrition education were integrated identified as major hindrances to individual cure and sub- into maternal and child health nursing services’ standards sequent eradication of TB. In 1986, public health nurses of care. initiated directly observed therapy (DOT) for TB cases. Congressional© Jones & authorization Bartlett Learning, gave states theLLC option to Rather than© self-administration, Jones & Bartlett patients Learning, would presLLC- expandNOT their FOR Medicaid SALE programs OR DISTRIBUTION in 1987. The services’ ent to the healthNOT department FOR SALE or the OR public DISTRIBUTION health nurse expansion included case management of high-risk moth- would visit the home for administration of medications. ers and infants to ensure comprehensive care as a reim- Later in the decade, public health officials recognized that bursable service. Nutritionists, social workers, and public the increase in TB cases was, in part, associated with the health nurses formed teams to establish care plans and as- emerging HIV and AIDS cases. HIV screening became a © Jones &sume Bartlett case manager Learning, roles based LLC on the patient’s risk factors.© Jonesstandard & of Bartlett nursing care Learning, for all active LLC TB cases. NOT FORPublic SALE health OR nursing DISTRIBUTION activities included nursing assess-NOT FORMany SALEstates took OR an DISTRIBUTION early stance to address measles ments, home visits, health education, and communication among the college-age population in the mid-1980s as

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEa result OR of the DISTRIBUTION increased incidence of disease reportedNOT FORprevention SALE in others.OR DISTRIBUTION Public health nurses were instru- throughout the nation. The college-age population was at mental in establishing and integrating new initiatives in greatest risk for disease because they had been immunized public health to combat old public health problems and with less-than-effective immunizations in the late 1960s to address new public health concerns. The value of pub- or had not received the immunization. Collaboration with lic health nursing activities continued to be recognized © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC state college boards resulted in requirement of measles as reimbursement for selected activities and NP services and rubella immunityNOT for college FOR admission.SALE OR Public DISTRIBUTION health were expanded. NOT FOR SALE OR DISTRIBUTION nurses reviewed immunization records, provided screen- The federal government’s staggering budget deficits ing tests when indicated, and administered immunizations were the major national focus as the 1990s began. Health- to assist in the control of measles. care costs were escalating, and governmental measures ©The Jones first &cases Bartlett of AIDS Learning, were diagnosed LLC in the early attempting© to Jones control &increasing Bartlett costs Learning, were not provingLLC 1980s.NOT Research FOR SALE soon unraveled OR DISTRIBUTION part of the mystery of effective. NOTThe gloomy FOR SALE financial OR picture DISTRIBUTION was exacerbated the disease. Risk factors for transmission of disease were by Desert Storm, the U.S. military troops’ assignment by identified, and a screening test for HIV, the virus that leads President George H. W. Bush to protect Saudi Arabia and to AIDS, became available. Screening provided a means to retaliate for Iraq’s invasion of Kuwait. to detect HIV infection earlier and to provide appropri- Current and emerging healthcare issues of the 1990s © Jones & Bartlettate counseling Learning, and education LLC to alter risk behaviors and© Joneslay close & Bartlett to the heart Learning, of public LLChealth. The percentage NOT FOR SALEreduce ORtransmission. DISTRIBUTION Education of the public and high-NOT FORof the SALEpopulation OR older DISTRIBUTION than 65 continued to rise. Life risk individuals was the only effective weapon that public expectancy in the United States had risen from 47 years health had to address this disease. Public health nurses in 1900 to 75 years in 1990. Infant mortality, although attended educational workshops to gain knowledge and significantly declining through the years, required con- skills for testing and© counseling Jones & patients Bartlett who Learning, requested LLCtinued vigilance. The increased© Jones incidence & Bartlettof syphilis Learning, and LLC testing. Health educationNOT materials FOR SALE were developed OR DISTRIBUTION to sup- other sexually transmitted diseasesNOT FORwas of SALEchief concern OR DISTRIBUTIONto port counseling and educational strategies. In addition, public health. The number of persons infected with HIV public health nurses implemented standards of care by and/or diagnosed with AIDS was increasing at alarming integrating assessment of risk factors for patients receiving rates. Substance abuse continued to be a major problem, other public health services and by disseminating infor- with studies identifying it as a contributing factor in 50% mation© Jones through & publicBartlett presentations Learning, in schools LLC and com- of all traffic© Jones accidents, & Bartlettin the transmission Learning, of HIV LLC infec- munityNOT organizations. FOR SALE OR DISTRIBUTION tion, and inNOT infant FOR morbidity SALE and OR mortality. DISTRIBUTION Progress continued for public health nurses during this Yet federal funding reductions were inevitable for pub- era, yet dilemmas remain. A national nursing shortage lic health as a result of the sluggish national economy as was recognized, with all states feeling the effects. Public the United States entered the 1990s. Without significant © Jones & Bartletthealth felt theLearning, effects of theLLC nursing shortage greatly, ©with Jones infusions & Bartlett of money Learning, for additional LLC staff, medications, vac- NOT FOR SALEthe vacancy OR ratesDISTRIBUTION reaching 20% at times. A commission NOTon FORcines, andSALE health OR promotion/disease DISTRIBUTION prevention activities, nursing was organized by the Secretary of the U.S. Depart- states faced increases in preventable diseases and deaths ment of Health and Human Services (HHS) to examine and and a reversal of the recent favorable trends in lowering make recommendations regarding the nursing shortage. infant mortality and teen pregnancy. Difficult economic The commission’s report, completed in 1989, cited the real- times resulted in the careful reviews of resources and the ity of the shortage and© Jonesthe impact & onBartlett healthcare Learning, delivery. LLCutilization of those resources.© JonesFocus was & againBartlett directed Learning, LLC The shortage was determinedNOT FOR to be SALE the result OR of theDISTRIBUTION increas- toward enhancing nursing NOTeducation FOR and SALE staff developOR DISTRIBUTION- ing demand for nurses, and the report urged agencies to be ment, strengthening relationships with schools of nursing, attentive to using measures aimed at reducing the barriers and developing a quality assurance process for the integra- to effective recruitment and retention (HHS, 1988). tion of public health nursing services. Because of the large ©One Jones of the & commission’s Bartlett Learning, recommendations LLC was that number of© nurses Jones employed, & Bartlett public Learning, health nurses LLC were nursingNOT shouldFOR SALEhave greater OR representationDISTRIBUTION in the policy afforded NOTgreater FORaccess SALEto approved OR continuingDISTRIBUTION education and decision-making activities of healthcare institutions. opportunities specific to their area of practice. Select con- Acting on this recommendation, both public health nurses tinuing education offerings, including TB updates, HIV and their administrations developed mechanisms whereby testing and counseling courses, and community assess- public health nurses moved into broader policy-making ment, became required orientation for newly employed © Jones & Bartlettroles. At the Learning, close of the LLC decade, public health nursing© Jones public & health Bartlett nurses Learning, (Gebbie, 1996). LLC NOT FOR SALEcontinued OR as DISTRIBUTION a strong force in the delivery of health careNOT FORThe SALE nation OR experienced DISTRIBUTION a significant increase in the in many states and in health promotion and disease incidence of syphilis. Case rates were climbing and were

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1980s Public policy centered around AIDS, Medicare, Med- 1990 Healthy People 2000 report published icaid, tobacco control, international health, minority 1991 Healthy Communities 2000: Model Standards published health, national healthcare reform, and national 1993 AZT sanctioned as able to reduce perinatal HIV health objectives© Jones & Bartlett Learning, 1996LLC War and Public Health published© Jones & Bartlett Learning, LLC 1982 Warning labelsNOT on aspirin FOR for Reye’sSALE syndrome OR DISTRIBUTION 1997 Plans underway for modernNOT microbiological/bio FOR SALE- OR DISTRIBUTION prevention medical laboratory capabilities 1986 First anti-tobacco initiative by public health community 2000 Healthy People 2010 published 1988 The Future of Public Health published by the Institute Source: From Public Health Milestones in the 1980s and 1990s. APHA, © Jonesof Medicine & Bartlett Learning, LLC 2000. Reprinted© with Jones permission & fromBartlett the American Learning, Public Health LLC Association. 1989NOT Year FOR 2000 HealthSALE Objectives OR DISTRIBUTION published NOT FOR SALE OR DISTRIBUTION

higher than they had been since the late 1940s. Much of the health nurses with current knowledge on their assessment increased incidence was associated with drug abuse—the of simultaneous administration of several vaccines when © Jones &exchange Bartlett of sex Learning, for drugs. CongenitalLLC syphilis was again© Jonesindicated & Bartlettand on contraindications Learning, LLC for immunization NOT FORan SALE issue of OR public DISTRIBUTION health concern for infant morbidity andNOT administration FOR SALE (HHS, OR 1992).DISTRIBUTION mortality. Public health nursing protocols included standards of care for infected maternity patients and follow up Science and Health Care, 1945–1960: for their newborn infants. Public health nurses increased Decades of Change their assessment for signs© Jones and symptoms & Bartlett of disease Learning, and LLC © Jones & Bartlett Learning, LLC for risk status of patientsNOT in FORtheir care,SALE assisted OR diseaseDISTRIBUTION Dramatic technological and scientificNOT FOR changes SALE charac OR- DISTRIBUTION intervention specialists with follow up of patients with terized the decades following World War II, including positive laboratory results, and assisted with accessing the discovery of sulfa drugs, new cardiac drugs, surger- medical treatment. ies, and treatment for ventricular fibrillation. The Hill– The incidence of another communicable disease, hepa- Burton Act, passed in 1946, provided funds to increase titis B,© was Jones also increasing. & Bartlett With Learning, the advent of LLC the hepati- the construction© Jones of new hospitals.& Bartlett A significant Learning, change LLC in tis B NOTvaccination, FOR public SALE health OR nursesDISTRIBUTION implemented new the healthcareNOT system FOR was theSALE expansion OR DISTRIBUTION of private health protocols to screen maternity patients for hepatitis B and insurance coverage and the dramatic increase in the birth to provide follow up and immunization administration rate, coined the “baby boom” generation. Clinical research, to the infants of infected mothers. Standing orders were both in medicine and in nursing, became an expectation © Jones &written Bartlett to effectively Learning, carry LLCout the immunization and fol-© Jonesof health & providers,Bartlett andLearning, more nurses LLC sought advanced NOT FORlow SALE up of theseOR infants.DISTRIBUTION This was a major new public healthNOT degrees. FOR TheSALE Journal OR of DISTRIBUTION Nursing Research was first pub- initiative. See Box 3-6 for a summary of activities during lished, heralding the arrival of nursing scholarship in the the 1980s and 1990s. United States. Federal monies increased for public health to address Owing to increased numbers of hospital beds, addi- preventive intervention strategies for persons infected with tional financial resources for health care, and the post– HIV during the 1990s.© States Jones initiated & Bartlett programs Learning,to make World LLC War II economic resurgence,© Jones an acute & Bartlettshortage of Learning, LLC select drugs available toNOT patients. FOR These SALE programs OR requiredDISTRIBUTION nurses occurred, and the existingNOT staff FOR faced SALE increasingly OR DISTRIBUTION private physicians to submit medication orders for the stressful working conditions. Nurses began showing signs patient. Public health nurses assisted patients with com- of the strain, engaging in debates about strikes and collec- pleting application forms, consulting private physicians tive bargaining demands. regarding© Jones program & guidelines,Bartlett Learning,and adding medication. LLC The composition© Jones of & the Bartlett nursing Learning, profession LLCalso ImmunizationNOT FOR SALEadministration OR DISTRIBUTION had been a priority changed. TheNOT ANA FOR accepted SALE African OR DISTRIBUTIONAmerican nurses health effort for public health nurses since the early part for membership, consequently ending racial discrimina- of the century. A national emphasis reemerged in the tion in the dominant nursing organizations. The National early 1990s to meet a national objective to complete the Association of Colored Graduate Nurses was disbanded immunization of 90% of all children by 2 years of age. in 1951. Males entered nursing schools in record number, © Jones &The Bartlett Centers Learning,for Disease ControlLLC and Prevention (CDC)© Jonesoften as & a resultBartlett of previous Learning, military LLC experience as medics. NOT FORidentified SALE ORbarriers DISTRIBUTION to children receiving their basic immu-NOTPrior FOR to theSALE 1950s OR and DISTRIBUTION 1960s, male nurses had suffered nization series. The national discussion provided public minority status and were discouraged from nursing as a

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEcareer. SeeminglyOR DISTRIBUTION forgotten by modern society, includNOT- FORamong SALE the first OR states DISTRIBUTION to expand the NP role to include ing Florence Nightingale and early U.S. nursing leaders, prescriptive authority. By the new century, NP programs males made up more than one-half of the nursing care were offered at the MSN level in family nursing, gerontol- during medieval times. The Knights Hospitalers, Teutonic ogy, adult, neonatal, mental health, and maternal–child Knights, Franciscans, and many other male nursing orders care; they have since expanded to include the acute care © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC had provided excellent nursing care for their societies. In practitioner as well. Certification of NPs now occurs at the fact, St. Vincent de PaulNOT had FOR first SALEconceived OR of DISTRIBUTIONthe idea of national level through the ANANOT and FOR many specialtySALE ORorgani DISTRIBUTION- social service. Pastor Theodor Fliedner, teacher and men- zations, and NPs are licensed throughout the United States tor of Florence Nightingale at Kaiserwerth in Germany; by state boards of nursing (Hagedorn & Quinn, 2004). The Ben Franklin; and Walt Whitman (during the Civil War) doctorate of nursing practice (DNP) has emerged in the all© either Jones served & Bartlettas nurses orLearning, were strong LLC advocates for past decade© asJones the preferred & Bartlett educational Learning, preparation LLC for maleNOT nurses FOR (Kalisch SALE & Kalisch,OR DISTRIBUTION 1986). all advancedNOT practice FOR nurses. SALE OR DISTRIBUTION

Years of Revolution, Protest, and the Managed Care and Healthcare Reform: © Jones & BartlettNew Order, Learning, 1961–2000 LLC © JonesFirst & DBartlettecades Learning,of the 21st LLC Century NOT FOR SALEDuring OR the social DISTRIBUTION upheaval of the 1960s, nursing was influNOT- FOREscalating SALE healthcare OR DISTRIBUTION costs resulting from the explosion enced by many changes in society, such as the women’s of advanced technology and the increased lifespan of movement, the organized protest against the Vietnam War, Americans led to the demand for healthcare reform in the civil rights movement, President Lyndon Johnson’s the late 1980s. The nursing profession heralded the way in “Great Society” social© Jonesreforms, &and Bartlett increased Learning, consumer LLChealthcare reform when an ©unprecedented Jones & Bartlett collaboration Learning, LLC involvement in healthNOT care. FOR Specialization SALE OR in DISTRIBUTION nursing, of more than 75 nursing associations,NOT FOR led bySALE the ANA OR and DISTRIBUTION such as cardiac intensive care unit (ICU), nurse anes- NLN, published Nursing’s Agenda for Health Care Reform. thetist training, and the clinical specialist role for nurs- This document addressed the challenge of managed care ing emerged as a trend that affected both education and in the context of cost containment and quality assurance practice in the healthcare system. Medicare and Medicaid, of healthcare service for the nursing profession (ANA, enacted© Jones in 1965 & underBartlett Title Learning, XVIII of the LLCSocial Security 1991). Managed© Jones care is& a Bartlettmarket approach Learning, based on LLC man- Act,NOT provided FOR accessSALE to ORhealth DISTRIBUTION care for the elderly, the aged competitionNOT FOR as a major SALE strategy OR to DISTRIBUTION contain healthcare poor, and the disabled. The ANA took a courageous and costs; it remains a major system of care today, with ex- controversial stand in that same year (1965) by approving panded considerations as the ACA continues to influence its first position paper on nursing education, advocating the quality and costs of health care. © Jones & Bartlettfor all nursing Learning, education LLC for professional practice to take© Jones The & Bartlett IOM’s (2008a) Learning, report Assuring LLC the Health of the NOT FOR SALEplace in OR colleges DISTRIBUTION and universities. Nurses returning fromNOT FORPublic SALEin the 21st OR Century DISTRIBUTION builds upon its 1988 report and Vietnam faced emotional challenges through the recog- has major implications for public health policy develop- nition of post-traumatic stress disorder (PTSD), which ment. The report contains several specific recommenda- affected some nurses’ postwar lives. tions for strengthening the relationship between the vital With the increased specialization in medicine, the sectors charged with protecting the public’s health. The demand for primary© care Jones healthcare & Bartlett providers Learning, exceeded LLCreport proposes an ecological© modelJones upon & Bartlett which to baseLearning, LLC the supply. As a responseNOT FORto this SALEneed for OR general DISTRIBUTION prac- health professional educationNOT (including FOR SALEnursing OReduca DISTRIBUTION- titioners, Dr. Henry Silver (MD) and Dr. Loretta Ford tion), clinical activities, and research with a population (RN) collaborated to develop the first NP program in the focus. Multiple determinants of health form the basis for United States at the University of Colorado (Silver, Ford, an ecological model, which operates on the assumption & ©Steady, Jones 1967). & NPsBartlett were initially Learning, prepared LLC in pediatrics that health© isJones affected & onBartlett several levels Learning, by these LLC factors. withNOT advanced FOR SALErole preparation OR DISTRIBUTION in common childhood Given thatNOT nurses FOR make SALE up the ORlargest DISTRIBUTION single workforce illness management and well-child care. Silver and col- within the health system, the report’s recommendations leagues(1967) found that NPs could manage as much as and the potential use of an ecological model as part of a 75% of the pediatric patients in community clinics, leading population-focused practice have significant potential for to the widespread use of NPs and growth of educational creating new paths in nursing practice, education, and © Jones & Bartlettprograms forLearning, NPs. The LLC first state in 1971 to recognize© Jones research. & Bartlett Learning, LLC NOT FOR SALEdiagnosis OR and DISTRIBUTION treatment as part of the legal scope of pracNOT- FORA companionSALE OR study DISTRIBUTION by the IOM (2008b), Who Will tice for NPs was Idaho. Alaska and North Carolina were Keep the Public Healthy?, builds on the ecological model

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORand SALE considers OR factorsDISTRIBUTION likely to aff ect public health in theNOT possible FOR settings SALE and OR needs DISTRIBUTION were seen as positive for many. 21st century, such as globalization, technological and sci- Continuing into the second decade of the new century, entifi c advances, and demographic shift s in the U.S. popu- patients are followed more closely within the system, dur- lation. It defi nes a public health professional as a person ing both illness and wellness. Hospital stays continue to be educated in public health or a related discipline who is shorter, and more healthcare services are being provided © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC employed to improve health through a population focus. in outpatient facilities and through community-based Eight new content areasNOT for public FOR health SALE professionals OR DISTRIBUTION to settings such as home health,NOT occupational FOR SALE health, ORand DISTRIBUTION master are identifi ed in this study: informatics, genomics, school health. War, bioterrorism, an aging population, communication, cultural competence, community-based and emerging epidemics are just some of the challenges participatory research, policy and law, global health, and for today’s nurses. Consensus regarding basic education ethics.© Jones & Bartlett Learning, LLC and the entry© level Jones of registered & Bartlett nurses Learning, has not occurred. LLC Even NOT as theseFOR studies SALE were OR beingDISTRIBUTION conducted, public Relating to theNOT global FOR community SALE asOR well DISTRIBUTION as our own di- health history was being changed. Seasoned public health verse population demands that nurses remain committed professionals, experiencing the erosion of the basic public to cultural sensitivity in care delivery. health infrastructure created by state and local budget Because of professional nurses’ engagement in health- cuts, had predicted that the United States would be chal- care reform—beginning with Nursing’s Agenda for Health © Jones &lenged Bartlett signifi Learning,cantly should LLCany of the dilemmas of the past© JonesCare Reform & Bartlett (ANA, 1991)Learning, and in theLLC years following— NOT FORreturn. SALE None OR of DISTRIBUTION those predictions, however, accuratelyNOT the FOR profession SALE was OR poised DISTRIBUTION to take a leadership role in the portrayed the impact that the events of September 11, passage of the Patient Protection and Aﬀ ordable Care 2001, and the subsequent anthrax threats would have on Act (ACA) of 2010. Th e purpose of the ACA is to provide public health. Almost overnight, public health agencies aff ordable, quality health care to all Americans. Th e ACA and their partners became© Jones immersed & Bartlett in emergency Learning, pre- wasLLC signed into law March 23,© 2010Jones and &upheld Bartlett by the Learning, LLC paredness activities thatNOT have nowFOR become SALE routine. OR DISTRIBUTION Public U.S. Supreme Court, which ruledNOT it constitutional FOR SALE on JuneOR DISTRIBUTION health professionals were challenged to place a high prior- 28, 2012. Th e bill includes unprecedented preventive care ity on such activities as syndromic surveillance, mass- and protections, including insurance companies no longer casualty planning, handling of biological and chemical being able to deny individuals for preexisting conditions agents that would also be considered evidentiary material, or to drop them from coverage when they get sick. and other© Jones similar &work. Bartlett New partners Learning, such as postalLLC work- Th e history© Jones of health & careBartlett and nursing Learning, provides LLC us ers, NOTlaw enforcement, FOR SALE and OR communication DISTRIBUTION experts with ample examplesNOT FOR of the SALE wisdom OR of DISTRIBUTIONour forebears in emerged. Public health nurses were also called upon to the advocacy of nursing in these challenging settings and administer smallpox vaccine, something that had not been the unknown future. Nurses today, by considering the les- done in almost 2 decades. Th e beginning of the 21st cen- sons of the past, become part of a profession that is well © Jones &tury Bartlett dawned with Learning, improved LLChealth status and a new public© Jonesprepared & to Bartlett provide the Learning, full range of LLC quality, cost-eff ective NOT FORhealth SALE threat: OR terrorism. DISTRIBUTION Since September 11, 2001, terror-NOTservices FOR needed SALE in ORthe promotion DISTRIBUTION of health throughout the ism has been a constant threat to the United States and to new century. See Box 3-7 . the global community. aFFordaBle Care aCt (aCa) art ConneCtion © Jones & Bartlett Learning, LLCursing has been at the forefront© Jones of healthcare & Bartlett reform Learning, LLC esearch the web for early artwork where a nurse is featured NOT FOR SALE OR DISTRIBUTION Nfor many decades. The professionNOT FORof nursing SALE was theOR DISTRIBUTION Rfrom the 19th and 20th centuries. Describe how diff erent fi rst of the health professions to support the creation of the these portrayals are from today’s nurse. Medicare program in 1958, in spite of critical opposition from the medical and hospital industries. Th © e JonesU.S. healthcare & Bartlett system Learning,continued to LLCfocus on fed- © Jones & Bartlett Learning, LLC eral coverageNOT FOR and spiralingSALE OR costs DISTRIBUTION during the fi rst decade NOT FOR SALE OR DISTRIBUTION of the 21st century. Th e public and private sectors dem- leVels oF preVention onstrated increased dissatisfaction with healthcare access, Primary: Identify the primary healthcare interventions used quality, accessibility, and aff ordability. Healthcare organi- by Florence Nightingale. zations emerged in a managed care environment, involv- Secondary: What secondary interventions did Lillian Wald use? © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC ing public and private sectors of the healthcare industry. Tertiary: How do tertiary interventions today diff er from NOT FORTh SALE e economic OR DISTRIBUTIONand quality outcome benefi ts of caring forNOT those FOR in theSALE past? OR DISTRIBUTION patients and managing their care over a continuum of

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2001 9/11 terrorist attacks (New York City and 7.0 magnitude earthquake in Haiti; CDC response Washington, DC) and bioterrorist attacks lead to efforts help prevent 7,000 deaths from cholera new initiatives in state and federal public health 2011 Implementation of ACA: providing free preven- policies, organizational© Jones responses,& Bartlett and initiativesLearning, LLC tive care for Medicare ©recipients; Jones Community & Bartlett First Learning, LLC CDC investigatesNOT first FOR anthrax SALE case; ORthe victimDISTRIBUTION was Choice Option offers NOThome- FORand community-based SALE OR DISTRIBUTION a 63-year-old Florida man; patient first in a series of services to disabled individuals through Medicaid domestic terrorism victims of infection by anthrax “Treatment as Prevention” as a means to reduce HIV sent through the mail transmission, after a research study showed that 2003© Jones Severe & acute Bartlett respiratory Learning, syndrome (SARS)LLC coronavi- individuals© Jones who &had Bartlett started antiretroviral Learning, therapy LLC NOT FORrus identified SALE OR DISTRIBUTION immediatelyNOT FOR after SALEdiagnosis OR lowered DISTRIBUTION the risk of HIV 2004 First state laws restricting access to over-the- transmission to their uninfected sexual partners by counter medications used in methamphetamine as much as 96% production in Georgia Community resource programs enhanced to imple- 2005 Hurricane Katrina hits New Orleans and Mississippi © Jones & Bartlett Learning, LLC © Jones & mentBartlett “test and Learning, treat” strategies LLC for individuals and Gulf Coast resulting in unprecedented public heath couples NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION disaster and response at state and federal levels Increased treatment for HIV-positive mothers to Rubella eliminated in the United States prevent mother-to-child transmission 2006 CDC recommends 15th and 16th routine immuniza- 2012 Implementation of ACA: electronic health records, tions for children and adolescents (rotavirus and encouraging integrated health systems by provid- human papillomavirus,© Jones respectively)& Bartlett Learning, LLC ing incentives for healthcare© Jones providers & Bartlettto form Learning, LLC CDC celebratesNOT 60th FOR anniversary. SALE OR DISTRIBUTION Accountable Care OrganizationsNOT FOR (ACOs) SALE OR DISTRIBUTION 2007 CDC issues federal order of isolation, the last such U.S. Supreme Court decision upholds ACA against order being issued in 1963 legal Constitutional challenges, with the exception 2008 Large, multi-state foodborne illness outbreaks are of mandatory State expansion of Medicaid © Jonesdetected & Bartlett and investigated, Learning, revealing LLC gaps in food Greater© Jones investment & Bartlettin health information Learning, technol- LLC NOT FORsafety andSALE the need OR to DISTRIBUTION improve prevention efforts ogy:NOT privacy, FOR accessibility SALE and OR security DISTRIBUTION of patient 2009 CDC identifies the novel H1N1 influenza virus data, and social media educational efforts H1N1 flu pandemic dominates CDC activities 2013-14 Implementation of ACA: Improved and expanded 2010 The Patient Protection and Affordable Care Act of preventive health coverage for Medicaid recipients 2010 (ACA) was signed into law, putting in place com- by providing new funding to state Medicaid pro- © Jones & Bartlettprehensive Learning, U.S. health LLC reform as the most significant© Jones & gramsBartlett and providers Learning, that chose LLC to cover preventive NOT FOR SALE ORfederal DISTRIBUTION mandate since the New Deal in the 1930s NOT FOR SALEservices ORfor patients DISTRIBUTION at little or no cost

Critical Thinking Activities 1. Take a walk© through Jones your & Bartlettneighborhood Learning, and college LLC campus. Identify public health© Jones measures & thatBartlett exist that Learning, LLC can be tracedNOT to the FOR Greek SALE and Roman OR DISTRIBUTIONeras. NOT FOR SALE OR DISTRIBUTION 2. How do you think Lillian Wald would react to present-day public health departments? 3. How does the current interest in alternative and complementary health care relate to the Greeks’ ideas about health? 4. How would you explain healthcare reforms of the 20th and 21st centuries in the United States to those from © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC other comparable societies and countries? NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION References Abel, E. K. (1997, November). Take the cure to the poor: Patients’ Achterberg, J. (1990). Woman as healer: A panoramic survey of the © Jones & Bartlettresponses Learning, to New York City’s LLC tuberculosis program, 1894–1918.© Joneshealing & Bartlett activities of Learning,women from prehistoric LLC times to the present. NOT FOR SALEAmerican OR JournalDISTRIBUTION of Public Health, 87, 11. NOT FORBoston, SALE MA: Shambhala. OR DISTRIBUTION

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORAmendt, SALE J. A.,OR & White,DISTRIBUTION R. P. (1965, July). Continued care servicesNOT Cartwright, FOR SALE F. F. (1972). OR Disease DISTRIBUTION and history. New York, NY: Dorset for mental patients. Nursing Outlook, pp. 57–60. Press. American Nurses Association. (1991). Nursing’s agenda for health Cohen, M. N. (1989). Health and the rise of civilization. New Haven, care reform. Washington, DC: Author. CT: Yale University Press. American Public Health Association (APHA). (2006, November). Cook, E. (1913). The life of Florence Nightingale (Vols. 1 and 2). Public health milestones©. Unpublished Jones & paper. Bartlett Washington, Learning, DC: LLCLondon, UK: Macmillan. © Jones & Bartlett Learning, LLC Author. NOT FOR SALE OR DISTRIBUTIONCottrell, H. (1948). Mental health principlesNOT FOR in the SALEstate and ORlocal DISTRIBUTION Andrews, G. (2003). Nightingale’s geography. Nursing Inquiry, 10(4), health programs: A Commonwealth Fund demonstration (Record 270–274. Group 51, Vol. 36). Mississippi Department of Archives, Division Association of State and Territorial Directors of Nursing (ASTDN). of Public Health Nursing, Historical Files. (1993). Historical summary of the Association of State and Territo- Crawford, P. (1992). “The other lady with the lamp”: Nursing legacy rial© Directors Jones of Nursing & Bartlett (1935–1993) Learning,. Unpublished LLC manuscript. of Mary Seacole.© Jones Nursing Times& Bartlett, 88(11), 56–58. Learning, LLC AssociationNOT of FOR State and SALE Territorial OR Directors DISTRIBUTION of Nursing (ASTDN). D’Antonio, P. (2002).NOT Nurses FOR in SALEwar. Lancet OR, 360 DISTRIBUTION(9350), 7–12. Selected reports from annual meeting and correspondence, Diamond, J. (1997). Guns, germs, and steel: The fates of human societ- 1935–1993. ies. New York, NY: W. W. Norton. Attewell, A. (1996). Florence Nightingale’s health-at-home visitors. Dickens, C. (1844). Martin Chuzzlewit. New York, NY: Macmillan. Health Visitor, 69(10), 406. Dietz, D. D., & Lehozky, A. R. (1963). History and modern nursing. © Jones &Baker, Bartlett K. (2006, Learning, April/May). The LLC future of New Orleans: Can the© JonesPhiladelphia, & Bartlett PA: F. A. Learning, Davis. LLC NOT FOR SALEdisasters OR that befellDISTRIBUTION other cities help save this one? American NOTDock, FOR L. N., SALE & Stewart, OR I. M. DISTRIBUTION (1931). A short history of nursing (3rd Heritage. ed.). New York, NY: G. P. Putnam. Barker, E. R. (1989). Care givers as casualties. Western Journal of Donahue, M. P. (1985). Nursing: The finest art. St. Louis, MO: Mosby. Nursing Research, 11(5), 628–631. Dossey, B. M. (2000). Florence Nightingale: Mystic, visionary, healer. Barstow, A. L. (1994). Witchcraze: A new history of the European Springhouse, PA: Corporation. witch hunt. New York, NY:© Jones HarperCollins.. & Bartlett Learning, Erickson,LLC G. P. (1996, June). To pauperize© Jones or empower: & Bartlett Public health Learning, LLC Boorstin, D. J. (1985). TheNOT discoverers: FOR A SALEhistory of ORman’s DISTRIBUTIONsearch to nursing at the turn of the 20th andNOT 21st FOR century. SALE Public Health OR DISTRIBUTION know his world and himself. New York, NY: Vintage. Nursing, 13(3), 163–169. Bostridge, M. (2008). Florence Nightingale: The making of an icon. Erickson, P. (1940). The role of the public health nurse in the New York, NY: Farrar, Straus and Giroux. syphilis research project in Washington County. Presented at the Brainard, A. M. (1922). The evolution of public health nursing. 1940 annual meeting of the Mississippi Nurses Association, Philadelphia,© Jones PA: & Saunders. Bartlett Learning, LLC Jackson, MS.© Jones & Bartlett Learning, LLC Briggs,NOT R. (1996). FOR Witches SALE and ORneighbors: DISTRIBUTION The social and cultural Forbes, M. D. NOT(1946). FORReport ofSALE a review OR of public DISTRIBUTION health nursing context of European witchcraft. New York, NY: Penguin Books. in the Mississippi Board of Health (Record Group 51, Vol. 36). Brockett, L. P., & Vaughan, M. C. (1867). Woman’s work in the civil Mississippi Department of Archives, Division of Public Health war: A record of heroism, patriotism and patience. Philadelphia, Nursing, Historical Files. PA: Zeigler, McCurdy. Fromkin, D. (1998). The way of the world: From the dawn of civi- © Jones &Brooke, Bartlett E. (1997). Learning, Medicine women: LLC A pictorial history of women© Joneslizations & Bartlettto the eve of Learning, the twenty-first LLC century. New York, NY: NOT FOR SALEhealers. Wheaton,OR DISTRIBUTION IL: Quest Books. NOT FORRandom SALE House. OR DISTRIBUTION Brown, E. L. (1936). Nursing as a profession. New York, NY: Russell Gebbie, K. M. (1996, November 18). Preparing currently employed Sage Foundation. public health nurses for change in the health care system: Meeting Brown, E. L. (1948). Nursing for the future. New York, NY: Russell report and suggested action steps. New York, NY: Columbia Sage Foundation. University School of Nursing Center for Health Policy and Brown, P. (1988). Florence Nightingale© Jones. Herts, & UK:Bartlett Exley Publications. Learning, LLCHealth Sciences Research. (Report© basedJones on meeting & Bartlett in Atlanta, Learning, LLC Buhler-Wilkerson, K. (1985).NOT Public FOR health SALE nursing: OR InDISTRIBUTION sick- GA, July 11, 1996.) NOT FOR SALE OR DISTRIBUTION ness or in health? American Journal of Public Health, 75, Goldmark, J. C. (1923). Nursing and nursing education in the United 1155–1156. States. New York, NY: Macmillan. Buhler-Wilkerson, K. (1993). Bringing care to the people: Lillian Hagedorn, S., & Quinn, A. A. (2004). Theory-based nurse practi- Wald’s legacy of public health nursing. American Journal of tioner practice: Caring in action. Topics in Advanced Practice Public© Jones Health, 83 &(12), Bartlett 1778–1786. Learning, LLC Nursing eJournal© Jones, 4(4). Retrieved & Bartlett from http://www.medscapeLearning, LLC Bullough,NOT V. FORL., & Bullough, SALE B. OR (1978). DISTRIBUTION The care of the sick: The .com/viewarticle/496718_2NOT FOR SALE OR DISTRIBUTION emergence of modern nursing. New York, NY: Prodist. Hamilton, D. (1988). Clinical excellence, but too high a cost: The Calabria, M. D. (1996). Florence Nightingale in Egypt and Greece: Metropolitan Life Insurance Company Visiting Nurse Service Her diary and “visions.” Albany, NY: State University of New (1909–1953). Public Health Nursing, 5, 235–240. York Press. Hanlon, J. J., & Pickett, G. E. (1974a). Community nursing services. © Jones &Carnegie, Bartlett M. E. Learning,(1991). The path LLC we tread: Blacks in nursing 1854–© JonesIn J. J.& Hanlon Bartlett (Ed.), Learning,Public health administration LLC and practice NOT FOR SALE1990 (2nd OR ed.). DISTRIBUTION New York, NY: National League for Nursing Press.NOT FOR(pp. 533–547). SALE St. OR Louis, DISTRIBUTION MO: Mosby.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALEHanlon, ORJ. J., &DISTRIBUTION Pickett, G. E. (1974b). Historical perspectives.NOT FORNutting, SALE M. A., & OR Dock, DISTRIBUTION L. L. (1907). A history of nursing (Vol 1). In J. J. Hanlon (Ed.), Public health administration and practice New York, NY: G. P. Putnam. (pp. 22–44). St. Louis, MO: Mosby. The 100 people who made the millennium. (1997). Life Magazine, Hanlon, J. J., & Pickett, G. E. (1984). Public health administration 20(10a). and practice (8th ed.). St. Louis, MO: Mosby. Palmer, I. S. (1977, March/April). Florence Nightingale: Reformer, Heinrich, J. (1983). Historical© Jones perspectives & Bartlett on public health Learning, nursing. LLCreactionary, researcher. Nursing© JonesResearch, 13–18.& Bartlett Learning, LLC Nursing Outlook, 32NOT(6), 317–320. FOR SALE OR DISTRIBUTIONPalmer, I. S. (1982). Through NOTa glass darkly:FOR FromSALE Nightingale OR DISTRIBUTION to Hine, D. C. (1989). Black women in white: Racial conflict and coop- now. Washington, DC: American Association of Colleges of eration in the nursing profession 1890–1950. Bloomington, IN: Nursing. Indiana University Press. Payne, D. (1999). Face to face: Florence Nightingale and Mary Howse, C. (2007). “The ultimate destination of all nursing”: The Seacole battle it out face to face. Nursing Times, 95(19), 26–27. ©development Jones &of districtBartlett nursing Learning, in England, 1880–1925. LLC Nursing Pyle, E. (1944).© Jones Here is your & war:Bartlett The story Learning, of G. I. Joe. Cleveland, LLC NOTHistory FORReview ,SALE 15, 65–94. OR DISTRIBUTION OH: WorldNOT Publishing. FOR SALE OR DISTRIBUTION Institute of Medicine (IOM). (1988). The future of public health. Rathbone, W. (1890). A history of nursing in the homes of the poor. Washington, DC: National Academies Press. Introduction by Florence Nightingale. London, UK: Macmillan. Institute of Medicine (IOM). (2008a). Assuring the health of the Richardson, B. W. (1887). The health of nations: A review of the works public in the 21st century. Retrieved from http://www.iom.edu/ of Edwin Chadwick (Vol. 2). London, UK: Longmans, Green. © Jones & BartlettActivities/PublicHealth/PubHealth21stCen.aspx Learning, LLC © JonesRoberts, & BartlettE. (1985a). Learning,Highlights: Maternal LLC and child health and NOT FOR SALEInstitute OR of Medicine DISTRIBUTION (IOM). (2008b). Who will keep the publicNOT FORcrippled SALE children’s OR service, DISTRIBUTION 1935–1985. Jackson, MS: Mississippi healthy: Educating public health professionals for the 21st century. Department of Health. Retrieved from http://www.iom.edu/CMS/3793/4723/4307.aspx Roberts, E. (1985b, March). The role of the southern nurse in public Johnson, S. (2006). The ghost map: The story of London’s most terrify- health. Symposium on Southern Science and Medicine at the ing epidemic and how it changed science, cities and the modern Education and Research Center, Jackson, MS. world. New York, NY:© PenguinJones Books. & Bartlett Learning, LLCRoberts, M. (1954). American nursing:© Jones History & and Bartlett interpretation Learning,. LLC Kalisch, P. A., & Kalisch,NOT B. J. (1986). FOR The SALE advance OR of American DISTRIBUTION nurs- New York, NY: Macmillan. NOT FOR SALE OR DISTRIBUTION ing (2nd ed.). Boston, MA: Little, Brown. Robinson, V. (1946). White caps: The story of nursing. Philadelphia, Le Vasseur, J. (1998). Plato, Nightingale, and contemporary nursing. PA: Lippincott. Image: Journal of Nursing Scholarship, 30(3), 281–285. Rosen, G. (1958). A history of public health. New York, NY: M. D. Longfellow, H. W. (1857, November). Santa Filomena. Atlantic Publications. ©Monthly Jones, 1, 22–23. & Bartlett Learning, LLC Sabin, L. (1998).© Jones Struggles & and Bartlett triumphs: Learning, The story of LLCMississippi MacEachern,NOT FOR M. T.SALE (1932). ORWhich DISTRIBUTION shall we choose: Graduate or nurses 1800–1950NOT FOR. Jackson: SALE Mississippi OR DISTRIBUTION Hospital Association student service? Modern Hospital, 38, 97–98, 102–104. Health, Research and Educational Foundation. Minkowski, W. I. (1992). Women healers of the Middle Ages: Sanger, M. (1928). Motherhood in bondage. New York, NY: Selected aspects of their history. American Journal of Public Brentano’s. Health, 82(2), 288–295. Seymer, L. (1954). Selected writings of Florence Nightingale. © Jones & BartlettMontag, M. L.Learning, (1959). Community LLC college education for nursing: ©An Jones New & York,Bartlett NY: Macmillan. Learning, LLC NOT FOR SALEexperiment OR DISTRIBUTION in technical education for nursing. New York, NY:NOT FORShryock, SALE R. H. (1959). OR The DISTRIBUTION history of nursing: An interpretation of the McGraw-Hill. social and medical factors involved. Philadelphia, PA: Saunders. Monteiro, L. A. (1985). Florence Nightingale on public health nurs- Silver, H. K., Ford, L. C., and Steady, S. G. (1967). A program to ing. American Journal of Public Health, 75(2), 181–185. increase health care for children: The pediatric nurse practitioner Morton, M., Roberts, E., & Bender, K. (1993). Celebrating public program. Pediatrics, 39(3). health nursing: Caring© Jonesfor Mississippi’s & Bartlett communities Learning, with cour- LLCSmith, E. (1934). Mississippi special© Jones public health & Bartlett nursing project Learning, LLC age and compassion,NOT 1920–1993 FOR. Jackson, SALE MI: OR Mississippi DISTRIBUTION State made possible by federal fundsNOT. Paper FOR presented SALE at theOR 1934 DISTRIBUTION Department of Health. annual Mississippi Nurses Association meeting, Jackson, MS. Mosley, M. O. P. (1996). Satisfied to carry the bag: Three black Snow, (1855). On the mode of communication of cholera(2nd ed). community health nurses’ contribution to health care reform, London, England: Churchill Publishers. 1900–1937. Nursing History Review, 4, 65–82. Stanmore, A. H. G. (1906). Sidney Herbert of Lea: A memoir. Nightingale,© Jones F. (1893). & Bartlett Sick-nursing Learning, and health-nursing. LLC In Women’s New York,© NY:Jones E. P. Dutton. & Bartlett Learning, LLC NOTmission FOR (pp. 184–205). SALE (Arranged OR DISTRIBUTION and ed. by Baroness Burdett- The State NOTBoard Test FOR Pool SALEExamination. OR (1952). DISTRIBUTION American Journal Coutts.) London, UK: Sampson, Law, Marston. of Nursing, 52, 613. Nightingale, F. (1915). Florence Nightingale to her nurses: A selec- Stewart, I. M. (1921). Developments in nursing education since tion from Miss Nightingale’s addresses to probationers and nurs- 1918. U. S. Bureau of Education Bulletin, 20(6), 3–8. es of the Nightingale school at St. Thomas’s Hospital. London, Taylor, H. O. (1922). Greek biology and medicine. Boston, MA: © Jones & BartlettUK: Macmillan. Learning, LLC © JonesMarshall & Bartlett Jones. Learning, LLC NOT FOR SALENightingale, OR F.DISTRIBUTION (1979). Cassandra. In M. Stark (Ed.), FlorenceNOT FORTiffany, SALE F. (1890). OR The DISTRIBUTION life of Dorothea Lynde Dix. Boston, MA: Nightingale’s Cassandra (original work published in 1928). Old Houghton Mifflin. Westbury, NY: Feminist Press.

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© Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORTyrell, SALE H. (1856). OR PictorialDISTRIBUTION history of the war with Russia 1854–1856.NOT Wertz, FOR R. W., SALE & Wertz, OR D. C. DISTRIBUTION (1977). Lying-In: A history of childbirth London, UK: W. and R. Chambers. in America. New Haven, CT: Yale University Press. Vicinus, M., & Nergaard, B. (1990). Ever yours, Florence Nightingale: Williams, C. B. (1961, May). Stories from Scutari. American Journal Selected letters. Boston, MA: Harvard University Press. of Nursing, 61, 88. U.S. Department of Health and Human Services. (1988, December). Winslow, C. E. A. (1946). Florence Nightingale and public health Final report of the ©Secretary’s Jones Commission & Bartlett on Learning,Nursing. LLCnursing. Public Health Nursing, 38©, Jones330–332. & Bartlett Learning, LLC Washington, DC: Author.NOT FOR SALE OR DISTRIBUTIONWoodham-Smith, C. (1951). FlorenceNOT Nightingale FOR. SALENew York, OR NY: DISTRIBUTION U.S. Department of Health and Human Services, Public Health Ser- McGraw-Hill. vices, Centers for Disease Control and Prevention. (1992, May). Woodham-Smith, C. (1983). Florence Nightingale. New York, NY: Standards for pediatric immunization practice. Atlanta, GA: Author. Atheneum. Wald, L. D. (1915). The house on Henry Street. New York, NY: Young, D. A. (1995). Florence Nightingale’s fever. British Medical Henry© Jones Holt. & Bartlett Learning, LLC Journal, 311©, 1697–1700. Jones & Bartlett Learning, LLC Weiner,NOT D. B. FOR (1993). SALE The citizen OR patientDISTRIBUTION in revolutionary and NOT FOR SALE OR DISTRIBUTION imperial Paris. Baltimore, MD: Johns Hopkins University Press.

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