Chapter 1 - History of Healthcare & Nursing

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Medicine

Established as a profession long before nursing. Early medicine - in Greek & Roman eras - myth, magic & religion heavily influenced explanations & cures. Early attempts to understand & control disease.

What is Medicaid? (Also started 1965)

Medicaid is health insurance available to certain people and families who have limited income and resources. It covers an estimated 58 million people. Medicaid is overseen by the federal government, but each state establishes its own eligibility standards, and determines the scope of services. States also set the rate of payment for services, and administer their own Medicaid programs. Like Medicare, Medicaid is overseen by the Centers for Medicare and Medicaid Services of the Department of HHS. Koba, 2018

What is Medicare? (Started in 1965)

Medicare is health insurance managed by the U.S. government for people age 65 or older and for some people under the age of 65 with certain disabilities. Medicare program also funds residency training programs for the vast majority of physicians in the United States (but not nursing) Medicare is managed by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services. Medicare provides assistance for some 45 million people, according to the latest statistics

Nursing

We need to know where we came from in order to understand where we are as a profession, and where we need to go.

Patricia Benner

u1982 Book - Novice to Expert u2010 Carnegie Report - Educating Nurses: A Call for Radical Transformation (Benner et al.) uShortage of nurses & nursing faculty uNeed for more BS nurses, less AD nurses uIncrease salaries for nursing faculty uPrepare nurses for varied employment - not primarily hospitals

Nursing in the 21st Century

u1999 - Institute of Medicine (IOM) Report: To Err is Human u2000 - Nurse Practitioner Authority Expanded u2005 - Doctorate of Nursing Practice (DNP) u2010 - The Future of Nursing: Leading Change, Advancing Health (Focus on Education), IOM report uTechnological advances uAging population uRise of consumerism, self-care responsibility uIssues of cost, quality, access uIncreasing cultural diversity uHigh tech vs high touch nursing uDemand for evidence-based practice

WWII (1939-1945)

uCadet Nurse Corp added 124,000 new RNs to the profession

Florence Nightingale

uChallenged prejudices against women uElevated the status of all nurses uEst. first training school for nurses in 1860 (encouraged belief - body of nursing knowledge different than medical knowledge) uWrote books -health care and nursing education. uCrimean War - dramatically reduced mortality from 42.7% to 2.2% in 6 months, use of graphs uEstablished standards -hospitals, nursing education; instrumental - est. public health nursing uAdvocated the principles of cleanliness and nutrition in promoting health

Industrial Revolution 1790-early 1800s

uCrowded living conditions in cities uPoor sanitation uNo birth control; high birth parity uChild labor & exploitation uFew public health laws, no safety regulations for industry uLife expectancy of those born in 1900: males 46; females 48

1980-1990s

uDRGs and managed care instituted to improve quality of care and reduce costs (1982) uDiagnosis Related Group (DRG) A diagnosis-related group (DRG) is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge uAttempt to obtain third-party reimbursement for APRNs in primary and acute care uTechnological advances improved ability to keep patients alive created new ethical challenges uCulturally sensitive care needed due to increased immigration

The Civil War (1861-1865)

uDorothea Dix (1802 - 1887), an advocate for the mentally ill, was appointed Superintendent of Women Nurses of the Union Army 1861 uClara Barton (1821 - 1912) - "Angel of the Battlefield" and founder of the American Red Cross uHarriet Tubman (1820 - 1913), born into slavery, escaped to Philadelphia. During the war she nursed soldiers using herbs and other home remedies

1960-1970s

uEra of specialty care and clinical specialization uEmergence of NPs in primary care - Loretta Ford u1970- Clinical nurse specialist uDoctor of Nursing Science (DNSc) was originated by 1970 u1971 Idaho became first state to recognize diagnosis and treatment as part of the legal scope of practice for NPs u1971 - Florence Wald and her associates found Hospice, Inc.

Advancements of 20th Century

uEradication of smallpox and vaccines for various diseases (polio, diptheria, tetanus, measles, mumps, rubella, chickenpox, flu, Hepatitis A & B). uThe development & mass production of antibiotics 1940's uAdvances in blood typing, banking, and transfusion. uAdvances in cancer treatment. uDevelopment of immunosuppressive drugs & tissue typing. uAdvancements in heart surgery. uDevelopment of medical insulin for diabetics (1922). uDevelopment and use of X-Rays (discovered 1895). uDevelopment of vitamin supplements. uPlacebo controlled, randomized, blinded clinical trials

Bubonic Plague in 1300's

uExtremely high death rate uKilled an estimated 50 million people across three continents in the 1300s uStill reported today - but treatable with antibiotics

Schools of Nursing

uFirst 3 US training schools for nurses opened in 1870's uBellevue Training School - in NYC (closed 1969) uNew England Hospital - Women & Children (1862) uCT Training School - New Haven CT (until 1926) uLinda Richards - 1st trained nurse, graduated 1873 from New England Hospital for Women and Children uSeparate schools emerged for African-Americans - necessity to care for segregated population uMale students not allowed until 1886

Florence Nightingale (1820 - 1910) and the Origin of Professional Nursing

uFlorence Nightingale was born into a wealthy British family. It was assumed that Florence would follow the traditional path dictated for women of the upper class during the Victorian era, which included marriage and the rearing of a family.

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uFor the first two centuries after European exploration of North America, all nursing was home nursing. uEven when the nation's first hospital began in Philadelphia in 1751, it was thought of primarily as an asylum or poorhouse. uAnother century or more would pass before the public viewed hospitals as reputable and safe.

Lillian Wald (1867 - 1940)

uFounder of Public Health Nursing and coined the term public health nurse uEstablished Henry Street Settlement House , a neighborhood nursing service for the sick poor in the Lower East side of NYC, in 1893 with colleague Mary Brewster uSet standards for PHN, nursing education, school nursing uVisiting Nurse Service of NY - separated from the Settlement House in 1944

Mary Breckinridge (1881 - 1965)

uFrom influential Kentucky family uEducated in US and Europe uFounded Frontier Nursing Service established in Kentucky 1925 uIntroduced midwives and established one of the first midwifery schools in the US

Margaret Sanger (1869-1966

uHer mother had many children and died young uWitnessed poor women as a nurse on Lower East Side NY - horrified by conditions, lack of control over body and little available contraception for the poor. uHad to leave the country several times due to controversy of her work uStarted first birth control clinic in 1916 uStarted what is now Planned Parenthood

Nightingale Pledge

uI solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practise my profession faithfully. I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. I shall be loyal to my work and devoted towards the welfare of those committed to my care u*With loyalty will I aid the physician in his work, and as a missioner of health, I will dedicate myself to devoted service for human welfare

Licensure for Nurses

uIn 1901 New York, New Jersey, Illinois, and Virginia were the first states that organized state nurses' associations with the goal of enacting a nurse practice act for their states. uBy 1921, 48 states, as well as the District of Columbia and the territory of Hawaii, had enacted laws that regulated the practice of professional nursing

Predictions for the future of nursing

uIncreasing number of patients & shortage of nurses = Challenge for the nurse to provide high quality, safe care uEmployment of registered nurses is projected to grow 15 percent from 2016 to 2026, much faster than the average for all occupations uHigher education will be in demand uIncreased need for bilingual nurses

LPN - Licensed Practical Nurse

uInstitute of Research and Sciencein Nursing Education Report: Resulted in the establishment of practical nursing under Title III of the Health Amendment Act of 1955. This led to a growth in practical nursing schools in the U.S.

Nursing in Antiquity

uNo formal education uOral traditions passed from generation to generation uObservations of others caring for sick uEarly hospitals were begun by members of religious communities—nuns and monks. Most care given at home. uChanges in religion in Europe decreased education for women & changed public opinion of "nurses" - "dark period" 1500-1860

What are some themes?

uNursing's history provides a framework for understanding how nursing is practiced today and societal trends that shape the profession uDiscipline of nursing evolved from a myriad of roots uGradual growth from to professionalism uWhat role did women's rights play? uWartime created increased need for nurses and elevated their status. uMovement from Trained Assistants with Religious Ties to Highly Educated Individuals

Patient Protection and Affordable Care Act - PPACA

uOn March 23, 2010, President Obama signed comprehensive health reform, the Affordable Care Act (ACA), into law. The following summary explains key health coverage provisions of the law including: •Medicaid expansion to 138% of the federal poverty level •The creation of health insurance exchanges ... •New regulations ... prevent health insurers from denying coverage to people for any reason, ... health status, and from charging higher premiums based on health status and gender; •The requirement that most individuals have health insurance beginning in 2014; and •The penalties to employers that do not offer affordable coverage to their employees, with exceptions for small employers.

1922 Sigma Theta Tau International - Now SIGMA

uOnly Honor Society for Nursing uStarted by nursing students uhttps://www.sigmanursing.org/why-sigma/about-sigma

Civil War 1861-1865

uPaid Nurses in the Civil War were male, for example Walt Whitman (poet) uFemale Nurses were initially volunteers uCatholic Orders also responded to the call u"...left a heritage far beyond a country's gratitude for bodies salvaged and spirits renewed. Observing the difference they had made, both the public and the medical community finally came to recognize nursing as a legitimate profession"

1945 - 1960

uPost war surge in growth of new facilities uAcute shortage of nurses - difficult working conditions uDiscovery of Sulfa drugs, cardiac drugs uADN program initiated uANA first accepted African American nurses as members uClinical nursing research began and Journal of Nursing Research published

Nursing Education 2

uPractical and vocational nursing education (LPN/LVN) uRegistered nursing education uDiploma in nursing uAssociate degree in nursing (AD) uBaccalaureate in nursing (BS in nursing or BSN) uGraduate education in nursing MSN/DNP/PhD uContinuing education (mandatory vs. non-mandatory states) uIn-service education

Nursing Organizations American Nurses Association (ANA)

uPurpose: To improve the quality of nursing care. uEstablished 1911. uEstablishes standards for nursing practice. uEstablishes a professional code of ethics. uDevelops educational standards uOversees a credentialing system. uInfluences legislation affecting health care. For RNs only. Publications: American Journal of Nursing; American Nurse

Illnesses and Epidemics 17th-18th Century

uScarlet Fever uSmallpox uTuberculosis uSyphilis uTyphoid Fever uTyphus Fever uMeasles uMumps uRubella uChicken Pox uPertussis (Whooping Cough)

Nursing Education Changes

uThe Goldmark Report: Published in 1923, this report concluded that for nursing to be on an equal footing with other disciplines, nursing education should occur in the university setting, not hospital based diploma programs.

1929 - 1945

uThe Great Depression (1929) uHospitals staffed with nursing students; most graduate nurses worked in private duty uHospitals were forced to close their schools of nursing so they lost their "free help" uMany families could no longer afford private duty, therefore unemployed nurses went to work for minimum wage caring for increased number of patients needing charity care 1935 - Social Security Act, enhanced the practice of public health nursing (care for crippled and blind

1917 - 1929

uWWI [1914-1918], Influenza epidemic, early depression era uStrong demand for nursing services uPublic health nursing flourished providing education in home nursing and hygiene u1920 - Congress passed a bill providing nurses with military rank u1920 - Women's Right to Vote uIncreased use of hospitals and an acceptance of the scientific basis of medicine

Origins of Professional Nursing in the United States

uWithin a decade of Nightingale's return from the Crimea, the United States experienced the outbreak of civil war. When the war began, there was no provision for military nurses in either the Union or the Confederacy. At the time, there were no nursing schools, no "trained" nurses, and no nursing credentials...female volunteers uCivil war nurses laid the foundation for nursing in the US

Nursing Education

•Nursing courses demand more: •Content building •Understanding vs. memorizing •Application of information •Practicum component •Clinical preceptors