THE EVOLUTION OF NURSING AS A PROFESSION: GLOBALLY & IN INDIA

Nursing is an ancient art and one of the oldest professions that has been around since the beginning of human life. It started with the need to provide care and comfort to those who were suffering from illness or injury. Throughout history, nursing has evolved from being a form of community service to a modern profession that requires specialized knowledge and training.

The roots of nursing can be found in mythology, ancient cultures, and religions. In the Middle Ages, nursing was primarily performed by religious orders, such as nuns and monks. In the 19th century, nursing began to emerge as a modern profession, thanks to the work of Florence Nightingale. She emphasized the importance of hygiene, sanitation, and patient care, which transformed nursing into a respected profession.

Today, nursing is a highly respected profession that requires specialized knowledge and training. Nurses play a critical role in healthcare, providing care and support to patients in hospitals, clinics, and home care settings. The history of nursing profession reflects the evolution of healthcare and the important role that nursing has played in the care of individuals and communities throughout history.

PRE-HISTORIC NURSING

Prehistoric nursing practices were based on myths and superstitions, with the belief that illnesses were caused by evil spirits. Prehistoric communities would use various methods to try to rid the body of these spirits, such as starvation, beating, and administering nauseous substances. They would also use magic rites and ceremonies to try to cure the sick.

Prehistoric communities also had individuals who acted as both doctors and nurses. These individuals were believed to possess special powers that allowed them to communicate with the spirits and to heal the sick.  There practices were based on a combination of superstition, magic, and herbal remedies. While these methods may not have been effective in curing illnesses, they did provide some comfort to the sick and helped to alleviate their suffering.

NURSING IN EARLY CIVILIZATIONS (ANCIENT TIMES)

Nursing has been an essential part of healthcare since ancient times. In the early civilizations, nursing was closely related to religion and spirituality, and healthcare practices were often based on superstition and belief.

·    In ancient Egypt, medicine and nursing were thought to be of divine origin. Temples served as hospitals, and priest physicians served as doctors and nurses. High-ranking women who became priestesses played the role of nurses, and mothers and daughters nursed the sick at home. Sacred books were strictly followed by priest physicians, and the society made progress in medicine, surgery, and nursing.

·         In ancient Greece, medicine was closely connected with religion, and Apollo, the Sun God, was the God of healing. Temples were also places for the treatment of the sick, and priest physicians were in charge of them. Personal cleanliness, exercise, and dietetics were emphasized. Hippocrates separated medicine from religion for the first time.

·    In ancient Rome, there was proper sanitation, drainage, and sewage systems, and Roman noble women cared for the sick. With the advent of Christianity, deacons and deaconesses performed the duties of nurses.

·   In ancient China, there was an advancement in medicine and surgery. The society had good knowledge of internal organs and blood circulation, and they practiced dissections, vaccinations, and physiotherapy. The sick was prayed for in halls of healing, and importance was given to cleanliness and hygiene.

·   In ancient India, the Ayurvedic system stressed hygiene, sickness prevention, sanitation, good ventilation, and the cultivation of medicinal plants. Nurses attended to the patient, and the attendant had to be cool-headed and pleasant in demeanour. The nursing treatments prescribed included baths, enema, emetics, vaginal and urethral infusions, venesection, gargles, massages, and rubbing or pressing limbs, among others. Nursing attendants were expected to have good behaviour, purity, kindness, and skill. King Ashoka built monasteries and hospitals for both men and animals and made provision for the education and training of women for nursing.

Nursing in early civilizations had a spiritual and religious significance, and nursing practices were based on belief and superstition. However, advancements were made in medicine, surgery, and nursing, and nursing played an essential role in the care of the sick and in preserving life. The evolution of nursing practices throughout history reflects the advancements in medical knowledge and technology, and the important role that nurses play in the care of individuals and communities.

EARLY CHRISTIAN ERA (1-500 AD)

During the early Christian era, Religion played a significant role in shaping the attitude towards the sick and their care. The fundamental belief of Christianity was to serve humanity with love and without any reward.

·        Deaconess, derived from the Greek word "diakonia," which means to serve or minister, was a group of mature women who taught and cared for the sick in their homes. Marriage was not prohibited, and they could live at home while performing their duties. They were involved in clerical work in the church, teaching, helping women converts, and visiting the sick. They were the first visiting nurses.

·   Widows were another group of women who assisted deaconesses in home visiting. They were granted freedom from their responsibilities at home to serve the sick and the church.

·    Virgins were younger women who helped in caring for the church vestments and providing alms to the poor. They lived in their own homes, and when necessary, received payment. The order of virgins was created because the church felt that virginity was essential to purity of life.

·      Later, widows and virgins were merged into a group of nuns. They wore the usual dress of women, which was later changed to a more uniform one. They lived in their own houses, and many received allotment from the church. All members were enrolled for church service.

·    Phoebe was the first deaconess who was intelligent and educated. She could care for the sick in their homes and can be compared to a modern public health nurse.

·    Fabiola was the daughter of a great Roman noble. She converted her palace into the first Christian hospital in Rome and collected the poor and sick from the streets to care for them in her palace.

·   Paula, a friend of Fabiola, devoted herself to the service of the sick. She built hospitals for strangers, pilgrims, and travellers, and the sick. She also constructed a monastery in Bethlehem.

·   Marcella, a wealthy woman, led a group of high-ranking women and induced them to work for charity.

Women played a vital role in caring for the sick. They served as deaconesses, widows, and virgins who later merged into a group of nuns. These women dedicated their lives to caring for the sick and the poor and provided a foundation for modern-day nursing.

MEDIEVAL ERA (500 AD – 1500 AD)

The Medieval era, spanning from 500 AD to 1500 AD, is often referred to as the “Middle ages” or "Dark Ages of Medicine". During this time, the Roman Empire broke apart, resulting in a decline of medical knowledge and a return to primitive medicine based on superstition and dogma. Despite this setback, the Middle Ages saw the rise of altruism, which encouraged people to serve others without any expectation of reward. This spirit of selflessness laid the foundation for new developments in nursing care.

One of the most important developments during this time was the emergence of monasticism. Monasteries became centres of learning, medicine, and nursing. Monks and nuns worked as doctors and nurses, using their knowledge of home remedies to care for the sick. They also gained scientific knowledge from books in monasteries, which contributed to the development of universities. Monasteries provided medical and nursing care to travellers, the poor, and the needy, giving women the freedom to develop their skills and ideas. However, criticism of monasteries led to stricter rules and declining interest in the work by the 9th and 10th centuries.

During the Crusades, a religious movement that aimed to rescue the tomb of Jesus Christ in Jerusalem from the Muslims, two military nursing orders were formed: the Order of Knights of St. John of Jerusalem and the Order of Knights of St. Lazarus. These orders provided excellent nursing care to the sick and wounded, and their traditions continue to live on today in organizations like the St. John Ambulance Corps. The Order of St. Lazarus specialized in the care of leprosy patients, which enriched and strengthened nursing care.

The rise of medicant and secular nursing orders further advanced nursing care during the Middle Ages. Medicants were traveling monks who gave up their possessions and lived with the poor, earning their livelihood through manual labor or begging. Inspired by the religious teachings of Jesus Christ, they formed various religious and non-religious orders for providing nursing care. Prominent monks like St. Dominie and St. Francis of Assisi had large numbers of followers who took vows of chastity and obedience, and who provided nursing care to the sick.

Despite the lack of progress in medicine during the Medieval era, nursing care advanced through the emergence of monasticism, military nursing orders, and medicant and secular nursing orders. These developments laid the foundation for future advancements in nursing care and continue to influence nursing practices today.

"DARK AGES IN NURSING (1500 AD – 1850 AD)"

The period between 1500 AD and 1850 AD is often referred to as the "Dark Ages in Nursing". It was a time when nursing was considered to be a lowly and undesirable profession. Nursing was often carried out by women who were poor, uneducated and had no other means of supporting themselves.

During this time, nursing was associated with religious institutions and convents. The nuns who provided nursing care were often untrained and had little knowledge of medical science. Nursing care was based on religious beliefs and superstitions rather than scientific knowledge.

It was not until the 19th century that nursing began to emerge as a profession in its own right. Florence Nightingale was a pioneer in this regard. She is often credited with being the founder of modern nursing. She established the first professional nursing school at St. Thomas' Hospital in London in 1860.

Nightingale was instrumental in promoting nursing as a profession for women. She believed that nursing was a noble and important calling and that women were ideally suited to this role. Nightingale's work during the Crimean War in the 1850s brought nursing to the attention of the public and helped to raise the profile of the profession.

In addition to Nightingale, other notable figures emerged during this time who made significant contributions to the field of nursing. These include Mary Seacole, a Jamaican nurse who provided care to soldiers during the Crimean War, and Dorothea Dix, an American nurse who campaigned for the rights of the mentally ill.

Despite the efforts of Nightingale and others, nursing remained a low-paying and undervalued profession throughout much of the 19th century. Nurses were often subjected to poor working conditions and long hours. It was not until the early 20th century that nursing began to be recognized as a profession in its own right, with its own set of standards and qualifications.

In conclusion, the period between 1500 AD and 1850 AD was a difficult time for nursing. It was a time when nursing was associated with religious institutions and was often carried out by untrained and poorly educated women. However, the work of pioneers like Florence Nightingale helped to transform nursing into the respected and valued profession that it is today.

MODERN ERA OF NURSING

The modern era of nursing began in the mid-19th century and is characterized by the emergence of nursing as a distinct profession with a unique body of knowledge and skills. This era saw the development of modern healthcare systems, advancements in medical knowledge and technology, and the growth of nursing education and research.

One of the most influential figures in the modern era of nursing was Florence Nightingale. During the Crimean War, Nightingale led a team of nurses to care for wounded soldiers. She transformed nursing by introducing principles of sanitation, hygiene, and patient-cantered care. Her efforts reduced the mortality rate among soldiers and set a new standard for nursing care.

In the United States, the modern era of nursing was influenced by the work of Clara Barton, who founded the American Red Cross in 1881. The organization provided nursing care during wartime and disaster relief efforts, and Barton advocated for the professionalization of nursing.

The 20th century brought significant changes to nursing practice, including the development of nursing specialties such as paediatrics, psychiatry, and critical care. Nurses began to play a more active role in patient care decision-making, and nursing education expanded to include advanced degrees and research opportunities.

The establishment of professional organizations, such as the American Nurses Association (ANA) and the International Council of Nurses (ICN), helped to promote nursing as a distinct profession and advocate for the rights of nurses and patients.

Advancements in medical technology, such as antibiotics, diagnostic imaging, and life support systems, also changed the way nurses provide care. Nurses are now able to provide more complex and specialized care and have a greater understanding of the pathophysiology and treatment of disease.

The modern era of nursing has also been marked by a focus on cultural competency and diversity in nursing practice. Nurses are trained to provide care that is sensitive to patients' cultural backgrounds and beliefs, and to advocate for social justice and health equity.

Today, nursing continues to evolve with the changing healthcare landscape. Nurses are at the forefront of healthcare delivery, providing critical care and promoting health and wellness. The profession remains committed to advancing nursing science, education, and practice to improve patient outcomes and meet the healthcare needs of diverse populations.

HISTORY OF NURSING IN INDIA

The history of the professional nursing in India dates back to the 17th century when the East India Company started Military Nursing in St George Military Hospital in Madras in 1664. Since then, nursing has come a long way and has become an integral part of the healthcare system in India. Here is a brief overview of the history of nursing in India:

In 1854, the government sanctioned the first training school for midwives, and in 1861, the first public health nursing school was started. In 1867, St. Stephens Hospital in Delhi became the first hospital to begin training Indian girls as nurses. In 1871, the first school of nursing was established in Govt. General Hospital, Madras with a 6-month diploma midwives’ program.

Between 1890 and 1900, many schools under mission or government were started in various parts of India. In 1897, Dr BC Roy played a significant role in raising the standards of nursing and that of male and female nurses. In 1908, the Trained Nurses Association of India (TNAI) was formed to uphold the dignity and honour of the nursing profession.

In 1918, training schools were started for health visitors and dais at Delhi and Karachi. In 1926, Madras state formed the first registration council to provide basic standards in education and training.

In 1946, the first 4-year basic bachelor’s degree program was established at RAK College of Nursing in Delhi and CMC, Vellore. After independence in 1947, the Community Development Programme and the expansion of hospital services created a large demand for nurses, ANMs, health visitors, midwives, nursing tutors, and nursing administrators. The Indian Nursing Council (INC) was constituted in 1949, and Miss Andrenwala was appointed as Nursing Advisor to the Government of India.

In 1959, the first master’s program in nursing was started at RAK College of Nursing, New Delhi. In 1963, the School of Nursing in Trivandrum instituted the first 2 years post-certificate bachelor’s degree program. In 1985, the Indira Gandhi National Open University (IGNOU) was established.

In 1986, the M. Phil program at RAK College of Nursing, New Delhi, was started. In 1991, the first doctoral program in nursing was established at the Institute of Nursing Sciences, MV Shetty Memorial College, Mangalore. In 1992, the post-basic program was started under IGNOU.

From 2002 onwards, nursing education flourished in an unprecedented manner throughout India. In 2005-06, the INC started the PhD program (INC consortium) with the collaboration of Rajiv Gandhi University with 25 seats.

Today, nursing is a respected profession in India, and nurses play a crucial role in providing quality healthcare services to people. Nursing education has also undergone significant changes, and many specialized courses and programs are now available to aspiring nurses.

CONCLUSION

Nursing has come a long way to evolve as a respected and essential profession in the healthcare industry. Globally, the development of nursing can be traced back to Florence Nightingale, who pioneered the transformation of nursing into a skilled and specialized profession. In India, nursing began with the East India Company's Military Nursing in 1664 and has since grown significantly. With the establishment of nursing schools, the formation of professional associations, and the introduction of degree and doctoral programs, the nursing profession has witnessed remarkable progress in India. The profession's evolution has been marked by the incorporation of technological advances, the development of specialized fields, and the emphasis on evidence-based practice. The continuous growth and expansion of nursing as a profession in India and globally are essential for improving healthcare outcomes and addressing the healthcare needs of individuals and communities. The future of nursing appears bright, with increasing emphasis on professionalism, education, and research.

REFERENCES

 TK Indrani. History of Nursing in India. 1st edition, 2007. Jaypee Brothers Medical Publishers.

Cope, Zachary. Six Disciples of Florence Nightingale. 1st edition, 1961. Pitman Medical Publishing Co. Ltd.

D'Souza, Marietta. A History of Nursing in India. 1st edition, 1999. Jaypee Brothers Medical Publishers.

Jamieson, Elizabeth M, Eleanor B. Trends in Nursing History. Their Social, International and Ethical Relationships. 6th edition, 1966. B Saunders Company Philadelphia, London.

Pavey, Agnes E. The Story of the Growth of Nursing as an Art, a vocation, and a profession. 5th edition, 1959. Faber and Faber Limited, London.

Samer, Margaret C. Trends and Professional Adjustments in Nursing. Reprint 1962. WB Saunders Company, Philadelphia, London.

Seymer, Lucy Ridgely. A General History of Nursing. 4th edition, 1956. Faber and Faber Limited, London.