A study of the development of nursing will throw light on some of the problems of the past, how

they have been solved and how nursing has progressed rapidly despite various hindrances. The

paternal and maternal instinct in a human being is the main source of the nursing impulse, and is

found in the hearts of people of all ages. A mother's care for her sick child always found expression in

such acts to alleviate pain and help the child to get better.

In a society, the noblest forms of humanitarianism are showing mercy, love and kindness to

those in physical or mental distress. When this impulse or motive is re-enforced by religious

philosophies and beliefs, it inspires people to live a life of service and of self-sacrifice for the sake of

others. Along with this spirit, special training and experience has made nursing an ideal and useful

profession.

Care of the sick is not new. People have cared for their sick throughout recorded history, and

we assume, before that. The term to nurse comes from the Middle English words nurice and norice,

which are contractions of nourice, from Old French that was originally derived from Latin Word nutrica

(Klainberg, Holzemer, Leonard, & Arnold, 1998). This term means “a person who nourishes” and

often referred to a wet nurse. (A wet nurse is a woman who breastfeeds infants for those who are

unable to do so.) (Klainberg., et al. 1998)

It is Important to be familiar with the efforts of those who have gone before us, because they

have a special meaning to our future. It has been said that “those who cannot remember the past are

condemned to repeat it” (Santayana, 1953). Much of the early history of and information about

nursing health care is based on information about ancient cultures that has been gathered by

anthropologist and documented by historians (Spector, 2004).

Reasons for Studying Nursing History

1. To learn from the past by applying the lessons learned from history, nurses will continue to be vital

force in the health care system.

2. By studying nursing history, nurses learn how the profession has advanced from beginnings.

3. How the nurse become empowered (autonomous).

 Empowerment and autonomy are necessary for nursing to bring about positive changes in

health care today.

 Personal power comes to individuals who are clear about what they want from life and whose

see their work as essential to the contributions they wish to make.

Evolution of Nursing

 Pre Historic Nursing

 Pre Christian Era

 Early Christian Era (1 AD – 500 AD)

 Medieval Era (500 AD – 1500 AD)

 Modern Era (1500 AD – 1800 AD)

 Modern Nursing

 Nursing Today

Pre Historic Nursing

Myths, songs and other findings of the archaeologists throw some light on prehistoric man's

care for this sick. In the pre-historic era, it was believed that illness was caused by evil spirits within

the body. In order to get rid of the evil spirit, the body had to be ill-treated. This was done by starving,

beating, and administering nauseous medicines, beating of drums, magic rites and ceremonies and

by causing sudden fright. Sometimes holes were made in the affected parts of the body to allow the

evil spirit to escape. Besides this, there were also many other ways of treating illness. Primitive man's
skill in fighting disease has given us many medical and surgical treatments such as massage

fomentations, trephining, bone setting, hot and cold baths, etc. The doctor cum nurse in such cases

was the medicine man or the witch doctor or the priest physician.

Pre Christian Era, Influence of Ancient Cultural Practices on Health Care (The Folk image of the

Nurse)

Life in ancient cultures was nomadic and was built around finding food and maintaining

warmth. Health Practices were varied and based upon ingenuity, prior experiences, and the

environment. People used plants and herbs to heal, and they harbored the notion that evil spirits and

magic affected well-being. Early people viewed illness and death as part of the natural phenomena of

life, and of course there were variations of practices among cultures (Spector, 2004). People

designed to care for the sick –usually men-passed information verbally through the generations.

As people’s lives and environments became more developed, irrigation and waste were the

first issues related to treating disease. Priest, spiritual guides, or “medicine men” were the healthcare

providers for their communities. During these times, the sick become their responsibility (Kalisch &

Kalisch, 1978). Sickness was often attributed to evil spirits or something that had been done to offend

the priest or gods. Health was often the result of trial and error, because science and technology as

we know them today were not available. If a person ate something that made him ill, that person was

told not to eat it again; if an herb made someone feels well or seemed to improve health, and then

that herb would be used for its assumed curative powers.

As early as 3000 B.C., the Egyptian healthcare system was the first to maintain medical

records. The Egyptians were also the first to classify drugs and develop a planned system to maintain

the health of their society. Rules regarding food and safety and cleanliness were first attributed to the

Egyptians and are still maintained today by many of the Muslim and Jewish faiths. Babylonia was

second oldest society to maintain medical records (Donahue, 1996). During this time, the Persians,

Italians, Chinese, and Indians also developed rudimentary and early attempts at the provision of
health care. Greek society put an emphasis on personal health more than community health and

believed that personal health was influenced by the environment. The Romans recognized the

importance of the regulation of medical practice and created punishment for medical negligence.

Nomadic, Solidarity for Mutual Protection, Belief in power

of gods/evil spirits, Black and White Magic, Ingenious

PRIMITIVE SOCIETY technique of health practices, Medical and Surgical

treatments – Massage, fomentation, trephing , bone setting,

mutation, hot and cold baths

By River Nile. Healthiest and most advanced, Priest

physician – belief in evil spirit.

Imhotep – A surgeon, Architect, priest, scibe, magician

EGYPTIAN CIVILIZATION System of community planning (hygiene, sanitation,

embalming, dentistry), records preserve in papyrus

(diseases, drugs, birth control). Woman assisted priest-

physician as priestes/midwives/wet-nurses.

Apollo (son of god) – god of health. Asculapus (son of

Apollo) – God of Healing. Epigone (Asculapus’ wife) – The

Soother. Hygeia (daughter of Apollo) – Goddess of Health.

Temples – became social, intellectual and medical centers.

GREEK CIVILIZATION Hippocrates – 400 BC, Father of Medicine. Brought out

medicine form magic to science. Stressed on equilibrium of

body, mind and environment. Diagnosis, fresh air,

cleanliness, music and work. Hippocratic oath

Aristotle – Differentiated arteries from vein.

Medical advances borrowed from Greece after they

conquered it. Clung to superstitions. Had good Hygiene

and Sanitation. Made drainage systems, drinking water

ROMAN CIVILIZATION
aqueducts, public baths, hospitals (for soldiers and slaves).

Men and Women of good character did nursing.

Two Classes – Patricians and Plebicians

 By the Yellow River. Confucius – Patriarchal role;

Importance of rule of etiquette; Value of family as a unit;

Women inferior to men. Yang and Yin – Active (male) &

Passive (female) force.

2000BC – dissection done, circulation, pulse, elaborate

material medica, importance of hygiene. Rule of Physical

Exam – “Look, Listen, Ask and Feel”. Baths to reduce fever,

CHINESE CIVILIZATION
blood-letting for evil spirits.

1000BC - Sen Lung, (Father of Medicine), used veg and

animal drugs, vaccination, physiotherapy, treated syphilis

and gonorrhea

1200BC – Liver diet for anemia, seaweed for thyroid

disorders. Lay people still believe in evil spirits entering into

care givers – Hence nursing was impossible.

Moses – A divinely motivated servant of God. “Mosaic

code” – Isolation, hygiene rest and sleep, hours of work,

disposal of excreta, disinfection, regulations to check

HEBREW CIVILIZATION animals before slaughtering/eating. Bible – Do not eat meat

past the 3rd day. King gave health power to priest physician.

Priest Physician – took the role health inspector. House of

Hospitality – the fore runners of inns, hotels, hospitals.

1500 BC – Vedic Age. Brahmanism / Hinduism (worship off

eternal spirit Brahma) with sub castes. Ayurveda (Veda of

Longevity) – explains hygiene, disease prevention,

major/minor surgery, children’s disease, inoculation,

material medica, disease of CNS and GUS.

1400BC – Sushruta, ‘Father of Surgery’ in India. Chakara

wrote ‘Internal Medicine’

INDIAN CIVILIZATION 500BC – Siddharta Gautama discarded caste system.

Hygiene, Sanitation, care of women and children, disease

prevention.
 King Aloska , 272 – 236 BC – Public hospitals with male

nurses and some older women, hospitals for animals.

Universities (monasteries) of Taxila & Nalanda

(Bihar)Nurses should have 3 qualities – High Standards,

Skills and Trustworthiness.

1 AD – Superstition and magic replaced by more up-to-date

practice. But medicine remained in the hands of priest

physician, who refused to touch blood and pathological

tissue.

Early Christian Era (1 AD – 500 AD), The Religious Image of the Nurse

New thoughts and new ideas were introduced in the early Christian era. Even though many

religious were fatalistic in their outlook on illness and looked upon it as a punishment or a necessary

evil, Christianity introduced a new aspect on the subject, thus transforming nursing to a higher level

and raising it to a professional standing. This new aspect that of "altruism" was the highest motive

given to mankind. It taught that one's sincere love for God and a desire to be like Him would be the

chief motive for one's selfless and sacrificial service to mankind without any hope of a reward. This

inspired many godly men and women to step forward in the service of the sick, the suffering and the

needy. They opened their homes to the sick and in need. Such homes were called "Diakonia".

During the time of the persecution of the Christians, people turned to the Bishop of the Church

for help. This necessitated the building of homes cum hospitals where the strangers, the orphans, the

aged, the sick and the lepers were cared for. These homes cum hospitals were known

as Xenodochia. One such outstanding hospital was founded at Casearia by St.Basil in 370 A.D.

The Christian church preserved records and from that time till today we have a continuous

record of the history of nursing. Many rich and noble women launched out in groups and

organizations in the service of the sick and the ailing and used their wealth for this cause.

Monasteries came into being and became a heaven for those who needed help and care. Two

notable names of people belonging to this era are worth mentioning. Celsius, a Greek, studied
anatomy and knew how to do surgical operations for cataracts and hernias. Galen practiced

dissection on animals and studied the anatomy and physiology of the heart and circulation, the

respiratory and the nervous system. His writings together with his translations of Hippocrates were

considered to be the chief medical authority by the Arabs.

Nursing in Pre-Christian times, religious beliefs had great bearing on the attitude towards the

sick and the mode of caring for the sick and the suffering. Christianity believed that one should render

services of love to humanity without any reward. It was equal to one's sincere love of God. This

principle was absorbed in nursing and helped to improve the status of a nurse. Some of examples of

such women are as follows:

Phoebe. She was the first deaconesses. She was intelligent and educated and the best nurse who

could care fort the sick in their homes. She can be compared to a modern public health nurse.

Fabiola. She was a young, beautiful and attractive woman. She was the daughter of a great Roman

Noble. She converted her palace into a hospital and it was the first Christian hospital in Rome. She

collected the poor and sick from the streets and cared for them herself, in her place.

Paula. She was a friend of Fabiola. She devoted herself for the services of the sick. She built a

hospital for strangers, pilgrims, and travellers and for the sick. She constructed a monastery in

Bethlehem. They gave good nursing care for the sick.

Marcella. Marcella was a wealthy woman. Since women of high rank had much freedom in Rome,

she was able to lead a group of such women and induce them in works of charity.

Medieval Era (500 AD – 1500 AD), The Servant Image of the Nurse

During the middle Ages, Christianity attempted to bring fort the notion of personal responsibility

for self, as well as for others, and this was reflected in the care of the sick. Religious communities

established care for the sick poor in hospes, places that could offer nurturance and palliative care and

from which the terms hospital and hospice derive (Nutting & Dock, 1935). These Hospes, or hospitals

were usually near a church or monastery. Men were the caregivers during this time, and the women
were permitted to be midwives or wet nurses and were considered witches if they attempted to usurp

the role of the male healthcare provider (Ehrenrich & English, 1973).

Monks and nuns dedicated to the cause of human suffering worked as doctors and nurses.

They were skilled in the use of home remedies. They got scientific knowledge in the care of the sick

from the books in the monasteries. They did the groundwork for the development of universities. In

the later middle ages, many social problems presented themselves with the disintegration of the

protective units like monasteries, guilds and feudalism and resulting in redistribution of population.

Late in the 12th and 13th centuries nursing become differentiated from medicine and surgery.

Medicine went into a period of advancement while nursing declined. At such time many noteworthy

men and women came out to serve the sick. During the medieval period plague and pestilence were

thought to be due to supernatural rather than natural causes. Religious expeditions like the crusades

led to founding of secular as well as military hospitals. Quarantine was instituted to check spreading

of epidemics like plague. Social problems were solved to a great extent. The needs of abandoned

children were met in hospital, leading to the founding of crèches. People had an indifferent attitude

towards sanitation and hygiene.

The Dark Ages was marked by superstition, mysticism, persecution of free thinkers and

religious wares. Use of talisman and incantations for healing the sick become quite common.

The Crusades (AD 1095-1291). War has always had an impact on the healthcare. During the

time of the Crusades, monks often tended to the sick. It was during this rime that the Church

establishes military nursing orders, such as the Knights Hospitalers (the Knights of Saint John of

Jerusalem), made up exclusively of men who provided care for pilgrims and travelers who were in

need of care (Beyond the French Riviera, 2007). Their fame was widespread, and it even influenced

some crusaders to lay down their weapons and join the Knights of St. John in their work to provide for

the poor, the pilgrims, and travellers (Nutting & Dock, 1935).

St. Dominic (1170-1221). From wealthy Spanish family. Preached.

St. Francis of Assisi 1182 -1226.

 St. Elizabeth of Hungary 1207 -1231 St. Catherine Sienna 1347 – 1380. The women who

assisted in the work of clergy in the church were known as deaconesses. They were matured women,

who did teaching, preaching and caring for the sick at the home.

Made up by knight hospitallers, monks and

serving brothers and sisters

Did excellent work and their fame spread. The

traditions continue in St. John Ambulance Corps,

First Aid to the injured, Societies and Nursing

Associations.
Military Nursing Orders
Even today we follow the military form and

organization and discipline followed them; Strict

discipline and unquestioning obedience;

Promotion system; Ceremony – Hospital rounds,

standing at attention; Self-denial for the sake of

the sick.

Strict Rules in monasteries (few people attracted

them), so mendicants (travelling monks) took

religion to the homes.

St Dominic - From wealthy Spanish family.

Preached. Dominican Order.

Mendicant & Secular Nursing Orders(1000-1500 AD) St Francis of Assisi – middle class family in Italy.

Cared for Leprosy patients. Franciscan Order

Poor Clares (II Order of St Francis) – Order or

women under the leadership of Clarissa, a rich

young woman. Cared for the sick (especiall

 leprosy) They improved the community and

sanitary condition.

A third order started by ST Francis as many men

and women came to join his Order

Secular Nursing Orders (Tertiary / Non-Religious They lived in their homes and took no vows.

Order Could leave at any time

Other Secular Orders – Arose, but did not last

long

Modern Era (1500 AD – 1800 AD), the Renaissance (Dark Age in Nursing)

Before the 1500s, the Catholic Church provided nursing care through the Monks and nuns.

Care was provided to the ill and the unfortunate in the monasteries and hospitals. During that time,

religion had a huge influence on how countries ran. The world was changing; new ideas and medical

discoveries were starting to peak. During the 1500-1800s, two great movements, the Renaissance

and the Reformation had a dramatic impact in nursing. With these two movements occurring, it lead

to dark days in nursing and minimal care for the poor and sick. Saint Vincent De Paul and Louise de

Marrillac, came together to create an organization named Daughters of Charity, to assist the poor and

the sick. To better understand what lead to the founding of Daughters of Charity, I will discuss the

important events, new medical discoveries, and women’s roles during the 1500-1800s that lead to the

founding of the Daughters of Charity.

The movement of the Renaissance brought new medical discoveries, which allowed better

understanding of how the body worked and discovered new vaccinations, which helped many lives.

Medical science was advancing in anatomical knowledge and its application in surgery.

Andreas Vesalius, one of the most profound founders of advanced medical science, he had

an impact in better understanding the anatomy of the body. He dissected cadavers of humans and
published the book, De Humani Corporis Fabrica (The Fabric of the Human Body Andreas

Vesalius) in 1543. It included detailed description of the ligaments, muscles organs of nutrition’s,

contents of the thorax, anatomy of the brain, cranial nerves, and the organs of senses.

William Harvey was significant during the Renaissance, in 1628, he proved that the lungs

were not responsible for circulating the blood; instead the heart was the central pump. Before the

smallpox vaccination was invented, it killed thousands of people throughout the world. In

1796, Edward Jenner developed a method of vaccination for smallpox. He heard tales that

dairywomen who developed cowpox did not develop smallpox.

In 1798 there was a young woman who had developed cowpox, Jenner used the fresh lesion

to inoculate an eight-year-old boy. The boy had mild symptoms for a couple days but after that he had

not symptoms. Weeks later, he inoculated the same boy with smallpox and no disease developed.

Due to Jenner scientific research, he was the first person to attempt to control an epidemic disease

by vaccinating his patients. With this vaccination it saved many lives. Even though, new vaccination

and medical discoveries were occurring during the Renaissance, the people in the world were

encountering many disease and plagues. During the sixteen centuries, diseases like typhus, yellow

fever, bubonic plague and syphilis to name a few killed thousands of people. The movement of new

discoveries and learning had not affected the improvement of nursing and caring for the sick. Medical

care was still not sanitary and many infections occurred because of that. The rich received care from

physicians and the poor received care from the monasteries nuns. With the printing machine being

created, books were now being printed and ideas were spreading like wild fire. The Bible was

accessed by many now and not just by the churches.

Many were now questioning ideas, theories and the church. Henry VIII, from England took the

opportunity of the new ideas of challenging the church. With the Reformation, also known as the

Protestant Revolution occurring in England, many wanted to break away from Rome and the Catholic

church. Henry VIII wanted to divorce his wife but the church refused to allow it. He took advantage

of the Protestant Revolution and separated himself from the papal authority in 1517, which caused a
catalyzing disaster toward which the vocation of nursing was headed to. Before Henry VIII separated

himself from the church, the monastic properties represented one fifth of his kingdom. Henry believed

that the monasteries would take the side of the church, so he seized the monasteries and disposed

over six hundreds of them. Many did not know that his greed also pushed him to confiscate the

monasteries because they conveyed a lot of riches. The result of the monastic dissolution was a

domino effect, that burden people in need. With the monasteries gone, the public was in dire need of

help. The “Poor Law” system, which provided relief to the poor, was developed but had not much of

an impact. With the Medical care soon would change for the poor when the Reformation

occurred. Small hospitals were closed in 1538 and the large ones in 1540. All of London hospitals

were closed. The poor were stuck with nothing. For many centuries, beggars, orphans, elderly,

disabled, poor, and the ill benefited from them. With religious wars occurring, increasing death rates

from plagues, diseases, and wars, those in need were forgotten. The Reformation affected the nuns

who practiced as nurses for the hospitals and monasteries. All medicine was withdrawn from the

monasteries. Medical advances did help physicians but had no or little impact in nursing. Many nuns

stopped practicing because of that. So the sick and the impoverished were left again with

nothing. Medical care dramatically changed for the poor when the Reformation occurred. After the

Reformation, England was worsening and poverty was increasing. Families were in dire need of

income. Women of lower class, worked long hours and in poor condition in their homes or in the

fields. Woman of higher class were forbidden to work as a nurse. They had no responsibilities but to

just look pretty. Only nuns became nurses before the Reformation took place. After the reformation,

people lacked hope and had not belief in the Catholic Church. With the poor and ill in need in Europe,

a man and women by the name of Saint Vincent de Paul and Louise de Marrillac came to

existence in the early 1600s. They noted that the sick and poor needed help but wanted to help them

physically and spiritually. He and Louise de Marrillac organized a group of nurses and founded

the Daughters of Charity in 1633. The Daughters of Charity enlisted young peasant girls to be
trained for six months on how to care for patients physically and spiritually. They were the first

organized group that cared for the sick at home.

The movement of the Renaissance and Reformation left a great impact in nursing. The

Renaissance brought new discoveries that created a better understanding of how the body works, it

brought new vaccinations that cured many lives but it also brought new ideas that impacted

nursing. New ideas triggered the beginning of the Reformation that affected the medical care for the

impoverished and sick. With no one to go too, the poor and sick were left with no hope. These two

important movements were the stepping-stones that lead Saint Vincent De Paul and Louise de

Marrillac to organize together the Daughters of Charity. This organization enlisted many

impoverished women to help with the care of the sick in their home and in hospitals. The Daughters

of Charity were the light in the darkness of the Reformation and also brought hope for the people in

need and sick.

Modern Nursing

From the late 1700s through 1853, the manner in which the sick were cared, remain

essentially unchanged. In Europe the dawn of nursing was underway.

The Deaconess Institute of Kaiserswerth, Germany was established in 1836 by Pastor Theodor

Fliedner, to train the Deaconesses to care for the sick and the provision of social services. Graduates

of the Kaiserswerth program spread their influence throughout the world.

Florence Nightingale. Everyone who had studied about Miss Florence Nightingale knows of

her devotion to the services to the poor and the sick and is also aware of what she did for humanity

and to raise the status of nursing profession. Florence Nightingale was born in a wealthy English

family, on 12th May 1820. As she grew off, she became interested in people and in politics. She had

great desire to become a nurse though her parents were not keen on her becoming one. She was

dissatisfied with the dealt routine lifestyle of the upper class women of their days. She had an active

mind and an interest in her surroundings beyond household and socials events. She had received a
classical education equal to that of men of her day. This education provided her with an

understanding of the circumstances of the world in which she lived. She became aware of the

inadequate care being provided in hospitals, when she accompanied her mother on visits to the ill.

What Nightingale saw in the hospitals intrigued her and made her want to become more involved.

In 1846, in spite of the concerns of parents and friends Nightingale became to visit and care for

the sick in her community. In addition, she visited hospitals in England and throughout Europe. Out of

her experiences she recognized that nurses required knowledge, training and discipline, if they were

to be effective. Nightingale learned about the school at Kaisersworth and in 1850, she was admitted

to the training program. The three years of training she received were rigorous but helped her clarify

what was lacking in the current training of English nurses. After her training, in 1853 she was

appointed as Superintendent of the Institution for the Care of the Sick Gentlewomen in London. She

had an opportunity to give her best service to the wounded soldiers in the Crimean War in 1854.

Florence Nightingale and her nurses attended thousands of wounded and dying soldiers.

Every night Florence Nightingale walked about with a lamp in her hand to help the suffering

soldiers. At this time she helped them to write letters to their families and last messages for those

who were dying. She was rightly known as 'The Lady with the Lamp'. Nightingale and a small band of

untrained nurses went to the British hospitals at Scutari in Turkey. She found the patients were laid

on the floor in bloody uniforms. Equipments and facilities were not present adequately. With great

compassion, she set about the task of organizing and cleaning the hospital and provided care to the

wounded soldiers.

Through her efforts and the help of others, Nightingale introduced numerous improvements in the

military hospital. Her efforts were largely responsible for traumatic reductions (42 % to 2%) in the

wartime death rate of British Soldiers. She also founded the first training school for nurses (St.

Thomas Hospital, London, 1860). Throughout the publication of countless articles and papers, she

shared her ideas about nursing and nursing education. Miss Nightingale was the first to
mention Holism (treating the whole patient) in nursing and the first who stated that a unique body of

knowledge is required to practice professional nursing.

After the war, she worked to bring about better health conditions in the British army.

Nightingale almost single-handedly tried to change health care in England. Nightingale was the

founder of modern nursing education. She established the Army Medical School at the Fort Pitt.

Despite her ill health she worked for the development of nursing services without taking sufficient

rest. Florence founded a training school for nurses in 1860 at St. Thomas Hospital London. The

funds, which were raised by the British people for her service in the Crimean War, were used for this

training school. She was very much interested in improving the conditions of the army in India also.

She planned a complete public health program, which was practiced in all hospitals and in the fields

of nursing. She died peacefully in her sleep at the age of 90 (13 th May 1910 ). In recognition of her

meritorious help to mankind she was offered the Order of Merit in 1907.She was the first lady

recipient for such an honour.

The Florence Nightingale Pledge:

The modified Hippocratic Oath arranged by Mrs. Lystra E. Gretter and her committee for the Farrand

Training School for Nurses, Detroit is called the Florence Nightingale Pledge as a token of esteem for

the Founder of Modern Nursing. The pledge is taken by all the nurses who have completed the

training program before entering to their practice.

The Nurses Pledge:

I solemnly pledge myself before God and in the presence of this assembly

to pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous and will

not take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my

profession and will hold the confidence in all personal matters

 committed to my keeping and all family affairs coming to my

knowledge in the practice of my calling.

With loyalty, I will endeavor to aid the physician in his work and devote

myself to the welfare of those committed to my care.

The renaissance or revival of learning in Europe. This was an age of discovery, invention,

development, expansion and reorganization in all spheres of human life. It is said that in this period in

Europe "The dignity of man began to be emphasized and the search for scientific truth was at least

advocated." Curiosity about the natural world paved the way for rebirth of science. There was great

advancement in the science of health, science of chemistry, anatomy and great improvement in

surgery. Many eminent people's discoveries and inventions led science to make great strides of

progress in its various fields. Some of them were:

Antony Van Leuwenhoek - Improvement on microscope.

William Harvey - Circulation of blood

Daniel Tuke - Treatment of enzyme people

Oliver Wendell Homes - Anatomy

Edward Jenner - Vaccination against small pox

Louis Pasteur - Science of Bacteriology

Edwin Chadwick - Sanitation, hygiene, sanitary laws. Organised Public Health

Department and modern nursing.

Galsiele Fallopian - Studies and description of the minute

organs of the body, including the Fallopian tubes, which bears his name.

William Rathhone - Introduced visiting nursing.

Florence Nightingale - School of Nursing in 1860.

This age also emphasized on provision of pure water supply, proper disposal of refuse and

adhering to sanitary laws. Boards of Health were set up for supervisory purposes.
Nursing Today

Change is often a result of challenges in the community and the world. The 19th Century was

also a time for innovation and reform. Throughout history those who we consider healthcare leaders

have changed or influenced the well-being of a community or society. Those transformations may

have been influenced by need or have resulted from changes on or outside of a system. The

identification of a leader creates or deals with changes based upon the needs of a society.

Over the decades, nurses have evolved into highly specialized, well-respected members of the

medical and health care teams. Many would even say that they are the true backbone of the

healthcare industry.

More Intense, Formal Training. Nursing education is much more formal and comprehensive

than it once was. There are a few educational pathways to becoming a nurse, including earning an

associate degree, a bachelor's degree, or a master's degree – all of which provide an intense science

and practical skills-based education.

The education process nurses have to go through now is drastically different than it was 100 years

ago when nurse training was more focused on etiquette and how to address doctors, and looking the

part. In addition, nowadays nurses have to pass a national exam, which is a fairly recent requirement

for becoming a licensed RN. With a stronger education foundation, nurses have gradually taken on

more patient responsibility, especially advanced practice nurses. Depending on the situation and

what the state allows, nurses can sometimes administer medication, make diagnoses, and work

autonomously. Many nurses who work under a doctor's supervision still have a great deal of input in

helping the team choose the best treatment options.

The Impact of Technology. Like most professions, technology has reshaped the way nurses

do their jobs today. In many ways technology has helped nurses become more accurate, efficient,

and also helps alleviate some of the physical demands. For example, patient records are almost

completely digital today, not only allowing for less paperwork, but helping prevent human error on

charts. With patient histories available in a digital file, it is easier for nurses to understand and assess
a patient. Other technological advances include better monitoring devices, implantable devices for

administering medication, mobile apps to look up any medical information on the go, and special beds

and chairs so nurses don't have to do as much heavy lifting.

More Specializations. After becoming an RN, there are still plenty of advancement

opportunities in the field thanks to all of the specialties that have arisen. Today's nurses can earn

certifications or pursue advanced nurse training/degrees to grow in their roles and increase their

salaries. Fairly new nursing specialties in areas like forensic nursing and bioinformatics simply didn't

exist a few decades ago. And others have become more in demand with advancement in the medical

field and changing demographics, such as radiology nursing, cardiac nursing, and geriatric nursing.

For those who go on to become nurse practitioners, depending on the state, they could very well be

providing primary care services.

More Positions and Possibilities. Not only are there more types of nurses than ever before,

but there are many different places that nurses can work beyond hospitals. Nurses are needed in

medical offices, nursing homes, assisted living facilities, schools, correctional facilities, and to perform

home health care services. Travel nursing is also growing in popularity, where nurses work as

independent contractors in high-demand areas for a scheduled amount of time. In other words, there

is more flexibility today for finding a nursing job that works with your schedule, and lifestyle

preferences.

As older nurses look toward retirement, there could be some situations in which there is a

generational gap between them and the new nurses entering the profession. For instance, those who

have not kept up with technology, or taken continuing education courses to keep their skills fresh,

could find themselves frustrated with the new ways of doing tasks pertaining to the medical field.

However, for the most part, today's nurses, including those who have experienced some of these

changes firsthand, are better off than in years past.

 As nurses become a more integral part of health care services, literally on the front lines of

saving patients' lives, improving health, and working with families, the profession has truly been

elevated. It is more respected and revered than ever before, and salary potential has grown to reflect

all of the hard work that nurses do. Looking back on how far the nursing community has come, it's

safe to say that the profession is more fulfilling and rewarding than it's ever been, and one can only

imagine what the next 10, 20, or 50 years will bring.

 The history of nursing in the Philippines stems from the caregiving provided by women, priests,

and herb doctors during precolonial Philippines. This trend continued during the Spanish colonial era,

although women did not have much opportunity to be formally educated in schools because only a

limited number of Filipino women received primary education in charitable institutions established by

Spaniards. During the Philippine revolution, Filipino women also became the providers of care for

wounded revolutionaries. During the American period in the Philippines, Filipino women were given

the chance to become educated as nurses, guided by their American nurse and missionary mentors,

until nursing became a full-pledged profession in the Philippines, a professional career not only for

modern-day women in the country but also for men in the Philippines (as male nurses).

The advance of nursing in the Philippines as a career was pioneered by a culture of care which was

intrinsic in the Filipino people. This was also the case even before Spanish colonization in

communities. The way the health system was delivered also evolved .

Mysticism and Superstitions were the early beliefs of health and illness in the Philippines. The

cause of a disease was primarily believed to be due to either another person, whom which was an

enemy, or a witch or evil spirits. In the early times, Filipinos were very cautious not to disturb other

people or the evil spirits for the good of their health. These evil spirits could be driven away by

persons with power to banish demons. Belief in special gods of healing, with the priest -physician

(called “word doctors”) as intermediary. If they used leaves or roots, they were called herb doctors

(“herbolarios”) Filipinos who became sick were usually cared for by the female family members or

friends in the home.

 Early Care of the Sick.

The early Filipinos subscribed to superstitious belief and practices in relation to health and

sickness. Herb men were called “herbicheros” meaning one who practiced witchcraft. Persons

suffering from diseases without any identified cause were believed bewitched

by “mangkukulam” or “manggagaway”. Difficult childbirth and some diseases (called “pamao”) were

attributed to “nunos”. Midwives assisted in childbirth. During labor, the “mabuting hilot” (good midwife)

was called in. If the birth became difficult, witches were supposed to be the cause. To disperse their

influence, gunpowder were exploded from a bamboo cane close to the head of the sufferer.

Health Care During the Spanish Regime.

The context of nursing has manifested through simple nutrition, wound care, and taking care of

an ill member of the family. Certain practices when taking care of a sick individuals entails

interventions from babaylan (priest physicians) or albularyo (herb doctor). In 1578, male nurses were

acknowledged as Spanish Friars’ assistants for caring sick individuals in the hospital. These male

nurses were referred as practicante or enfermero.

The religious orders exerted their efforts to care for the sick by building hospitals in different parts of

the Philippines. The earliest hospitals were:

Hospital Real de Manila (1577) – it was established mainly to care for the Spanish king’s soldiers, but

also admitted Spanish civilians; founded by Gov. Francisco de Sande.

San Lazaro Hospital (1578) – founded by Brother Juan Clemente and was administered for many

years by the Hospitalliers of San Juan de Dios; built exclusively for patients with leprosy.

Hospital de Indios (1586) – established by the Franciscan Order; service was in general supported by

alms and contributions from charitable persons.

Hospital de Aguas Santas (1590) – established in Laguna; near a medicinal spring, founded by

Brother J. Bautista of the Franciscan Order.

San Juan de Dios Hospital (1596) – founded by the Brotherhood of Misericordia and administered by

the Hospitaliers of San Juan de Dios; support was delivered from alms and rents; rendered general

health service to the public.

Nursing During the Philippine Revolution.

In the late 1890’s, the war between Philippines and Spain emerges which resulted to

significant amount of casualties. With this, many women have assumed the role of nurses in order to

assist the wounded soldiers. The emergence of Filipina nurses brought about the development of

Philippines Red Cross.

Josephine Bracken — wife of Jose Rizal, installed a field hospital in an estate house in Tejeros. She

provided nursing care to the wounded night and day.

Rosa Sevilla de Alvero — converted their house into quarters for the Filipino soldiers; during the

Philippine-American War that broke out in 1899

Dona Hilaria de Aguinaldo — wife of Emilio Aguinaldo who organized that Filipino Red Cross under

the inspiration of Mabini.

Dona Maria Agoncillo de Aguinaldo — second wife of Emilio Aguinaldo; provided nursing care to

Filipino soldiers during the revolution, President of the Filipino Red Cross branch in Batangas.

Melchora Aquino a.k.a. “Tandang Sora” — nursed the wounded Filipino soldiers and gave them

shelter and food.

Capitan Salome — a revolutionary leader in Nueva Ecija; provided nursing care to the wounded when

not in combat.

Agueda Kahabagan — revolutionary leader in Laguna, also provided nursing services to her troops

Trinidad Tecson (“Ina ng Biak-na-Bato”) — stayed in the hospital at Biak na Bato to care for wounded

soldiers
Hospitals and Nursing Schools.

Americans began training the first Filipino nursing students in 1907. Nursing students in the

Philippines studied many of the same subjects as nursing students in the U.S. However, it was

believed that the curriculum in the Philippines “was never a mirror-image reproduction of the

American nursing curriculum” and involved more than a simple transfer of knowledge from American

nurses to Filipino nurses. The first Filipino nursing students also studied subjects that were more

relevant to their patients, such as “the nursing of tropical diseases” and “industrial and living

conditions in the islands,” as described by Lavinia L. Dock’s 1912 book A History of Nursing: From

the Earliest Times to the Present Day with Special Reference to the Work of the Past Thirty Years.

Hospital School of Nursing’s Formal Training (1901 – 1911).

Formal training in hospital school of nursing transpires. This began when American missionary

doctors and nurses realized that they manpower is insufficient. Thus it resulted to a decision of

training Filipino nurses that would be catering to the hospitals that Americans established in the 20th

century. The first hospital in the Philippines which trained Filipino nurses in 1906 was Iloilo Mission

Hospital, established by the Baptist Missionaries. When this health institution was built, there were no

strict requirements for the applicants as long as they are all willing to work. This has been the

beginning of development of more nursing schools in the country. In this period, Pensionado Act of

1903 (or Act 854) was mandated, allowing Filipino nursing student to study in United States. Among

of the first wave of nurses who went to United States

Iloilo Mission Hospital School of Nursing (Iloilo City, 1906). Was run by the Baptist Foreign

Mission Society of America. Miss Rose Nicolet, a graduate of New England Hospital for Women and

Children in Boston, Massachusetts was the first superintendent for nurses. It moved from its present

location to Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of the
school in 1942. In April 1944 graduate nurses took the first Nurses Board Examination at the Iloilo

Mission Hospital.

Saint Paul’s Hospital School of Nursing (Manila, 1907). The hospital was established by

the Archbishop of Manila, Jeremiah Harty under the supervision of the Sisters of St. Paul de Chartres

located in Intramuros. It provided general hospital services. It opened its training school for nurses in

1908, with Mother Melanie as superintendent and Miss Chambers as Principal.

Philippine General Hospital School of Nursing (Manila, 1907). Philippine General Hospital

School of Nursing. PGH began in 1901 as a small dispensary for Civil officers and Employees in the

City of Manila and later grew as a Civil Hospital. In 1906, Mary Coleman Masters, an educator

advocated for the idea of training Filipino girls for the profession of nursing with the approval of

Government officials, she first opened a dormitory for Girls enrolled at the Philippine Normal Hall and

the University of the Philippines. In 1907, with the support of Governor General Forbes and the

Director of Health and among others, she opened classes in nursing under the Auspices of the

Bureau of Education. Admission was based on an entrance examination. The applicant must have

completed elementary education to the seventh grade. Julia Nichols and Charlotte Clayton taught the

students nursing subjects. American physician also served as lecturers. In 1910, the Act No. 1976

modified the organization of the school placing it under the supervision of the Department of Health.

The Civil Hospital was abolished and the Philippine General Hospital was established.

St. Luke’s Hospital School of Nursing (Quezon City, 1907). St. Luke’s Hospital School of

Nursing (Class 1914). The hospital is an Episcopalian Institution. It began as a small dispensary in

1903. In 1907, the school opened with three girls admitted. These three girls had their first year in

combined classes with the PGH School of Nursing and St. Paul’s Hospital School of Nursing. Miss

Helen Hicks was the first principal. Mrs. Vitaliana Beltran was the first Filipino superintendent of

nurses and Dr. Jose Fores was the first medical director of the hospital.

Mary Johnston Hospital and School of Nursing (Manila, 1907). Mary Johnston Hospital

and School of Nursing. It started as a small dispensary on Calle Cervantes (now Avenida). It was
called the Bethany Dispensary and funded by the Methodist Mission for the relief of suffering among

women and children. In 1907, Sister Rebecca Parrish together with registered nurses Rose Dudley

and Gertude Dreisbach, organized the Mary Johnston School of Nursing. The nurses’ training course

began with three Filipino young girls fresh from elementary as their first students.

Philippine Christian Mission Institute Schools of Nursing. The United Christian Missionary

Society of Indianapolis, Indiana- a Protestant organization of the Disciples of Christ operated three

schools of nursing.

Sallie Long Read Memorial Hospital School of Nursing (Laoag Ilocos Norte, 1903)

The Start of Nursing Practice (1911- 1921)

Promulgation of Act No. 2493 which amends Medical Law (Act No. 310) allowing the regulation of

nursing practice transpired during this period. However, in 1919, the First True Nursing Law was

enacted through Act 2808. During this period the Board Examiners for Nursing was also created. The

first nursing board examination was given on 1920. The first executive officer of the Board Examiners

for Nurses is a physicians.

Mary Chiles Hospital School of Nursing (Manila, 1911). Mary Chiles Hospital School of

Nursing. The hospital was established by Dr. WN Lemon in a small house on Azcarraga, Sampaloc,

Manila. In 1913, Miss Mary Chiles of Montana donated a large sum of money with which the preset

building at Gastambide was bought. The Tuason Annex was donated by Miss Esperanza Tuason, a

Filipino Philanthropist.

Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912)

San Juan de Dios Hospital School of Nursing (Manila, 1913). In 1913, through the initiative

of Dr. Benito Valdez, the board of inspectors and the executive board of the hospital passed a

resolution to open school of nursing. The school has been run by the Daughters of Charity since then.

Sister Taciana Tinanes was the first Directress of the School

 Emmanuel Hospital School of Nursing (Capiz, 1913). Capiz Emmanuel Hospital (CEH). In

1913, the American Baptist Foreign Mission Society sent Dr. PH Lerrigo to Capiz for the purpose of

opening a hospital. Miss Rose Nicolet assisted him. The school offered a 3-year training course for an

annual fee of Php 100.00. Miss Clara Pedroso was the first principal

Southern Islands Hospital School of Nursing (Cebu, 1918). The hospital was established in 1911

under the Bureau of Health. The school opened in 1918 with Anastacia Giron-Tupas as the organizer.

Miss Visitacion Perez was the first principal

A Much Established Professional Organization: 1921 – 1931

During this period, the precursor to the accredited professional organization in the Philippines

was created. The Filipino Nurses Association was established on October 15, and the organization

initiated the publication of Filipino Nurse Journal. Later, this journal was changed to The Philippine

Journal of Nursing. Amendment of certain sections of the Act 2008 was conducted in 1922 under Act

3025 passed by the 5th Legislature. This policy is entitled An Act Regulating the Practice of Nursing

Profession in the Philippine Islands, which necessitates all nurses who are practicing the profession

to register yearly. In 1929, the organization also became a member of the International Council of

Nurses.

Through the 1930s, Philippine schools of nursing continued to adopt those aspects of

American professional nursing they deemed relevant and appropriate, such as higher admission

standards and the specialization of public health nursing.

Public Health Nursing Development: 1931 – 1941

In 1933, the nursing institution have increased their requirement. During this period, they have

implemented that to enter nursing education an applicant must be able to complete secondary

education. The first collegiate nursing graduates of the Philippines graduated from University of the

Philippines School of Public Health Nursing in 1938.

Other Schools of Nursing

1. Zamboanga General Hospital School of Nursing (1921)

2. Chinese General Hospital School of Nursing (1921)

3. Baguio General Hospital School of Nursing (1923)

4. Manila Sanitarium Hospital and School of Nursing (1930)

5. St. Paul School of Nursing in Iloilo City (1946)

6. North General Hospital and School of Nursing (1946)

7. Siliman University School of Nursing (1947)

Nursing during World War II

With the occurrence of the largest and most violent armed conflict in the history of

mankind, there was a re-emergence of nursing needs as well as new programs to entice women into

training. In the US, the government empowered the women to contribute. In fact, more women

worked outside of the home and as well as growth opportunities involving nurses multiplied.

While in the Philippines, World War II made public health nurses in Manila assigned to devastated

areas to attend the sick and the wounded. A year after, thirty one nurses who were taken prisoners of

war by the Japanese army and confined at the Bilibid Prison in Manila were released to the Director

of the Bureau of Health. And just like in the US, a lot of public health nurses joined the guerillas or

went to hide in the mountains during this time.

In 1946, post war records of Bureau of Health showed that there were 308 public health nurses and

38 supervisors compared to the pre-war 556 public health nurses and 38 supervisors. It was in the

same year when the creation of the Nursing Office in the Department of Health was recommended by

Mrs. Genera De Guzman, technical assistant in nursing of the DOH and the President of the Filipino

Nurses Association.
The Degree of Bachelor of Science in Nursing: 1941 – 1951

A nursing curriculum which was based on the thesis presented by Julita V. Sotejo, graduate of

the Philippine General Hospital School of Nursing, tackles on the development of a nursing education

within a University-based College of Nursing. This dissertation was the beginning of nursing

curriculum that have made the Nursing Institution of the country as a baccalaureate course. During

this period, College of Nursing was also created.

When the Japanese occupied the Philippines in 1942, training and practice at the hospital schools of

nursing in Manila was “violently disrupted.” However, U.S. colonial patterns in Philippine nursing

education soon returned after the U.S. reclaimed the country in 1945 and even after the Philippines

gained independence from the U.S. July 4, 1946.

The First Colleges of Nursing in the Philippines

University of Santo Tomas-College of Nursing (1946). In its first year of existence, its

enrollees were consisted of students from different school of nursing whose studied were interrupted

by the war. In 1947, the Bureau of Private Schools permitted UST to grant the title Graduate Nurse to

the 21 students who were of advanced standing from 1948 up to the present. The college has offered

excellent education leading to a baccalaureate degree. Sor Taciana Trinanes was its first directress.

Presently, Associate Professor Glenda A. Vargas, RN, MAN serves as its Dean.

Manila Central University-College of Nursing (1947). The MCU Hospital first offered BSN

and Doctor of Medicine degrees in 1947 and served as the clinical field for practice. Miss Consuelo

Gimeno was its first principal. Presently, Professor Lina A. Salarda, RN, MAN, EdD serves as its

Dean.

University of the Philippines Manila-College of Nursing (1948). The idea of opening the

college began in a conference between Miss Julita Sotejo and UP President. In April 1948, the

University Council approved the curriculum, and the Board of Regents recognized the profession as

having an equal standing as Medicine, Engineering etc. Miss Julita Sotejo was its first dean.
Presently, Professor Josefina A. Tuason, RN, MAN, DrPh is once more reappointed as the Dean of

UP Manila College of Nursing

Proliferation of Nurses as a Workforce: 1951 – 1971

The Philippine Nursing Law was approved under the Republic Act No. 877 on June 19 1953.

Then further amendment was created in 1966 which limits that practice of among nurses 21 years old

and above. The increasing number of nurses in the Philippines have also brought about the

celebration of Nurses’ Week which was proclaimed by President Carlos P. Garcia under the

Proclamation No. 539. The continuous of nurses had also resulted to the first round of migration,

particularly in United States. In fact, between 1966 and 1985 about 25,000 Filipino nurses have

migrated to United States.

Nursing Profession Development: 1971 – 2001

Regulation of the practice of health care providers, the Presidential Decree No. 223, was

mandated which brought about the establishment of the agency, Professional Regulation

Commission. During this period, the Philippine Nursing Act of 1991 was also amended under

Republic Act No. 7164 which expanded nursing practice to other roles such as management,

teaching, decision making, and leadership. The qualification of nurses or faculty’s in the academe

was also updated to Master’s Degree in Nursing or equivalent. Another important event in Philippine

Nursing history is the creation of Nursing Certification Council in 1999 under the Board of Nursing

through Resolution No. 14 which supervise the new programs’ implementation conducted by

Specialty Certification Boards. This improvement also prompted the start of Advanced Practice

Nursing (APN) in the Philippines.

Further Changes in Nursing Law: 2001- to Present

Nursing graduates take their oath in Manila.

During this period, the Philippine Nursing Act of 2002 was enacted under the Republic Act No. 9173

which entails changes on existing policies under Republic Act No. 7164. These changes underscore

on the requirements for faculty and Dean of the Colleges of Nursing, as well as the conduct for

Nursing Licensure Exam.

In a glance

College of Nursing

1. UST College of Nursing – 1st College of Nursing in the Phils: 1877

2. MCU College of Nursing – June 1947 (1st College who offered BSN – 4 year program)

3. UP College of Nursing – June 1948

4. FEU Institute of Nursing – June 1955

5. UE College of Nursing – Oct 1958

1909

 3 female graduated as “qualified medical-surgical nurses”

1919

 The 1st Nurses Law (Act#2808) was enacted regulating the practice of the nursing

profession in the Philippines Islands. It also provided the holding of exam for the practice of

nursing on the 2nd Monday of June and December of each year.

1920

 1st board examination for nurses was conducted by the Board of Examiners, 93 candidates

took the exam, 68 passed with the highest rating of 93.5%-Anna Dahlgren

 Theoretical exam was held at the UP Amphitheater of the College of Medicine and Surgery.

Practical exam at the PGH Library.

1921

Philippine Nurses Association Building

 Filipino Nurses Association was established (now PNA) as the National Organization Of

Filipino Nurses

 PNA: 1st President – Rosario Delgado

 Founder – Anastacia Giron-Tupas

1953

 Republic Act 877, known as the “Nursing Practice Law” was approved.

Though it was not always considered as a profession, Nursing has already been existing for

centuries. Its significance of today will definitely not be proven real if not because of its remarkable

history. And now, the value of Nursing has stood the test of time and is becoming more visible in the

eyes of many not only because of its past, but also due to its considerable contribution in the society.
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