In an industry that combines technology and human touch while administering round the clock care for millions of individuals and families, the nursing profession has faced theoretical overhauls that concretely defined her role in the society. Nursing theories were developed to arrive at different perspectives that formalized the nature of nursing through the development of nursing knowledge. Key themes emerging from literature explains that nursing is person-oriented and is concerned about helping people towards holistic living (Rumbold, 1999:7). Olson and Walsh however claimed that in the history and evolution of the nursing practice, the advantages of nursing was monetary in origin as money poured in from patients who paid for their care while endowments and charitable giving for other expenses (2004:11).
Walsh also questioned nursing leaders’ claims that caring was a simple tradition carried down to the new generation of nurses by asserting that the historic basis of nursing is not simply based on the feminine principles of passivity and nurturance (Rafferty and Elkan, 1997:152). For Walsh, rank and file nurses were ordered to care which for him questions the underlying premise that simply equates nursing with caring (Rafferty and Elkan, 1997:151). Looking back through the history of the nursing practice is probably the best way to identify the historical views that formed the basic core of the nursing practice. Whether historical views are acceptable or not to the modern practice, they will still form part of the formal establishment of care as the core of the nursing practice.
In the mid 19th century, untrained servants provided a form of nursing care that were later followed by Jewish women, influenced by Florence Nightingale’s work, championed the cause of improving nursing (Lewenson, 2006:8). Influenced by social, political and economic forces, the dilemma of American nursing according to Susan Reverby is accentuated by the problems in the past where nursing has been “ordered to care” in a society that does not value caring (Masters, 2005: 186). Since no proper context was given to enable nurses to grasp their universal scope of work, the notion of caring was equated with motherly nurture. The attention of nursing simply reflected the reality of health care where scientific medicine was also in its infancy and medical treatment had little positive effect on whether sick people recovered (Walsh, 2004:11). Rank and file nurses were ordered to care as Olson countered with less charitable goals beneath the veneer of the practice where monetary gain was the main objective of medical institutions. Walsh claimed that although religion has a lot to do with the nursing practice in 1897, the practice was unscientific and unsaintly that prevented nurses from understanding the structural characteristics of the profession (2004:40). Even the earliest nursing uniforms of the period reflected functionality and feminine virtue and were more or less associated with the religious orders and military nursing groups that profoundly exhibit how nurses were treated as second class workers (Ellis and Harley, 2004: 185). Social nursing activities however linked nursing with social welfare and the public in 1893-1944 established a visiting nurse service that provided nursing care to the European immigrants who crowded the ethnic ghettoes of New York (Lewenson, 2006:8).
Nursing education spent more time on practice with lesser theories in its two-year course, in an attempt to increase the number of practicing students helping in the institutions which were mostly run and managed by nuns (Walsh, 2004:60). During the period, a good nurse is seen as someone who can endure hard work with physical strength and endurance for which an absence f such characteristic is criticized as “lacking in self-reliance” (Masters, 2005: 186). A dramatic change in the profession was soon observed by 1900 as time allotted for nursing practice became proportionate with nursing theory and study which also worked to increase the two-year course into three years. Nurses soon responded to the needs of patients with a variety of acute illnesses but the scope of work was limited to social work and health education programs (Lewenson, 2006:9). However nurses during the period made independent judgments about giving medicines as part f their neighborhood visits which nurses considered as part of their routine work (American Ass. for the History of Nursing, 2006: 61). Few nurses during the period however claimed that the administered medications were prescribed by physicians because household botanical remedies and herbal therapies were commonly used on the destitute and marginalized sectors of the society. During the rubric of social feminism however, nurses composed the educated sector of middle and upper class women who participated in the movement to improve working conditions for the poverty-stricken immigrants in industrialized cities (Lewenson, 2006:10).
By 1915, aims to professionalize nursing education was underway but it would probably too early to claim how the concept of care was formally adapted during the period. In 1923, the common description of a good nurse is one who can effectively and capably handle patients creating a conflicting scenario between nurse supervisors and superintendent during the period (Rafferty and Elkan, 1997: 153). Eager to promote nursing as a respectable profession, nurse leaders like Isabel Hampton worked to visualize clear commitment to the standards and principles of nursing practice paved the groundwork for a 1929 investigation of the profession from a variety of official and professional groups (Baer, 2001:108). The assumption that nurses were ordered to care was also brought to the limelight that questioned the underlying values of care that equates this concept with the nursing practice (American Ass. for the History of Nursing, 2006: 62). Values of compassion and comfort was soon questioned over training in science as a tool for the nursing profession as the medical profession sought to submit the practice into a subordinate role for physicians as presented by Dr. Charles Reed in his 1924 speech to the graduate nurses of the Illinois State. The core of the nursing practice soon uniformly enhanced the principle of care which became consistent with the professionalization of the nursing practice (Walsh, 2004: 79). The formal development therefore of a body of nursing knowledge was the key to emphasis that identified the nurse to the caring role (Lewenson, 2006: 9).
Infusing the history of the nursing profession serves to enlighten contemporary arguments who rallied that the concept of caring or its assumption was the foundation of nursing in the early 19th century. History can not entirely claim pride over the work of nurses during the period whose practice simply reflected the realities of the period where medicine was still in its infancy. Similarly, the prevailing perceptions of the period cannot simply push the concept of care where monetary reward pervades the atmosphere of most medical institutions where nurses receive training and work. A charitable veneer has better chances of existence in the community-based practice for nurses that was rampant within the ghettoes where nurses could exercise compassion as a personal choice for their patients. The dramatic changes of the 1900’s welcomed support for the slow process of change that soon enabled nurses to obtain a grasp over the principles of practice in their profession. Now and then, conflicting ideas would change the atmosphere but nevertheless exalted a framework that equated caring as the core of the practice made possible by professionalization as explained by Walsh (2004:79). In effect, these catapults into view how education spelled out the trade with techniques and skills that allowed nurses to form concepts based on theories and argue the cause against other professions which strived to downgrade the nursing practice. A look into the accurate history of nursing will seemingly enhance the value of education and professionalization in the contemporary era that sought to verify the conflicting tensions that magnanimously entertain a romantic view albeit inaccurate.
Works Cited
American Association for the History of Nursing. (2006). Nursing History Review ,14.
Baer, Ellen Davidson. (2001). Enduring Issues in American Nursing. Springer Publishing.
Ellis, Janice Rider and Hartley, Love, Celia. (2004). Nursing in today’s World: Challenges, Issues and Trends. Lippincott Williams and Wilkins.
Lewenson, Sandra B. (2006). Nursing History Review: Official Journal of the American Association for the History of Nursing. Springer Publishing.
Masters, Kathleen. (2005). Role Development in Professional Nursing Practice. Jones and Bartlett Publishers.
Rafferty, Anne Marie and Elkan, Ruth. (1997). Nursing History and the Politics of Welfare. Routledge.
Rumbold, Graham.(1999).Ethics in Nursing Practice. Orlando: Elsevier Health Sciences.
Olson, Tom and Walsh, Eileen. (2004). Handling the Sick: The Women of St. Luke’s and the Nature of Nursing, 1892-1937. Columbus: Ohio State University.
