Nursing in the Philippines has a deep and enigmatic history.

Read the history of nursing

in the Philippines.
Contents [show]

Early Beliefs & Practices

1.Beliefs about causation of disease:

another person (an enemy or a witch)

evil spirits

2.Belief that evil spirits could be driven away by persons with powers to expel 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)

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 mangagaway. 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 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 kings 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. Baustista of the Franciscan Order.

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

and administered by the Hopsitaliers of San Juan de Dios; support was delivered
from alms and rents; rendered general health service to the public.

Nursing During the Philippine Revolution

Josephine Bracken, wife of Jose Rizal- installed a field hospital in an estate

house in Tejeros; 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; 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 (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

Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
It was ran 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 Pauls 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)
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. Lukes Hospital School of Nursing (Quezon City, 1907)
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. Pauls 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)
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)
Mary Chiles Hospital School of Nursing (Manila, 1911)
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 Philantropist.
Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912)
San Juan de Dios Hospital School of Nursing (Manila, 1913)
In 1913, through the initaiative 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)
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 orginizer. Miss Visitacion Perez was the first
principal
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)

The FIRST Colleges of Nursing in the Philippines

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

In a glance
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
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.

The Earliest Hospitals Established were the following:

a. Hospital Real de Manila (1577). It was established mainly to care for the Spanish Kings
soldiers, but also admitted Spanish civilians.Founded by Gov. Francisco de Sande
b. San Lazaro Hospital (1578) built exclusively for patients with leprosy. Founded by Brother Juan
Clemente
The Earliest Hospitals Established
a. Hospital de Indio (1586) Established by the Franciscan Order; Service was in general
supported by alms and contribution from charitable persons.
b. Hospital de Aguas Santas (1590). Established in Laguna, near a medicinal spring, Founded by

Brother J. Bautista of the Franciscan Order.

c. San Juan de Dios Hospital (1596) Founded by the Brotherhood de Misericordia and support was
derived from alms and rents. Rendered general health service to the public.
Nursing During the Philippine Revolution
The prominent persons involved in the nursing works were:
a. Josephine Bracken wife of Jose Rizal. Installed a field hospital in an estate house in Tejeros. Provided
nursing care to thw wounded night and day.
b. b.Rosa Sevilla De Alvero converted their house into quarters for the filipino soldier,during the
Philippine-American war that broke out in 1899.
c. Dona Hilaria de Aguinaldo Wife of Emilio Aguinaldo; Organized the Filipino Red Cross under the
inspiration of Apolinario Mabini.
d. Dona Maria de Aguinaldo- second wife of Emilio Aguinaldo.Provided nursing care for the Filipino
soldier during the revolution. President of the Filipino Red Cross branch in Batangas.
e. Melchora Aquino (Tandang Sora) Nurse the wounded Filipino soldiers and gave them shelter and
food.
f. Captain Salome A revolutionary leader in Nueva Ecija; provided nursing care to the wounded when
not in combat.
g. Agueda Kahabagan Revolutionary leader in Laguna, also provided nursing services to her troop.
h. Trinidad Tecson Ina ng Biac na Bato, stayed in the hospital at Biac na Bato to care for the wounded
soldier.
Hospitals and Nursing Schools
1.Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)

 It was ran by the Baptist Foreign Mission Society of America.

Miss Rose Nicolet, a graduate of New England Hospital for woman and children in Boston,
Massechusettes, was the first superintendent.
Miss Flora Ernst, an American nurse, took charge of the school in 1942.
2. St. Pauls Hospital School of Nursing (Manila, 1907)
The hospital was established by the Archbishop of Manila, The Most Reverend Jeremiah Harty, under
the supervision of the Sisters of St. Paul de Chartres.
It was located in Intramuros and it provided general hospital services.
3. Philippine general Hospital School of Nursing (1907)
In 1907, with the support of the Governor General Forbes and the Director of Health and among others,
she opened classes in nursing under the auspices of the Bureau of Education.
Anastacia Giron-Tupas, was the first Filipino to occupy the position of chief nurse and superintendent
in the Philippines, succeded her.
4.St. Lukes Hospital School of Nursing (Quezon City, 1907)
The Hospital is an Episcopalian Institution. It began as a small dispensary in 1903. In 1907, the school
opened with three Filipino girls admitted.
Mrs. Vitiliana Beltran was the first Filipino superintendent of nurses.
5. Mary Johnston Hospital and School of Nursing (Manila, 1907)
It started as a small dispensary on Calle Cervantes (now Avenida)
It was called Bethany Dispensary and was founded by the Methodist Mission.

 Miss Librada Javelera was the first Filipino director of the school.
6. Philippine Christian mission Institute School of Nursing.
The United Christian Missionary of Indianapolis, operated Three schools of Nursing:
1. Sallie Long Read Memorial Hospital School of Nursing (Laoag, Ilocos Norte,1903)
2. Mary Chiles Hospital school of Nursing (Manila, 1911)
3. Frank Dunn Memorial hospital
7. San Juan de Dios hospital School of Nursing (Manila, 1913)
8. Emmanuel Hospital School of Nursing (Capiz,1913)
9. Southern Island Hospital School of Nursing (Cebu,1918)
The hospital was established under the Bureau of Health with Anastacia Giron-Tupas as the organizer.
The First Colleges of Nursing in the Philippines
University of Santo Tomas .College of Nursing (1946)
Manila Central University College of Nursing (1948)
University of the Philippines College of Nursing (1948). Ms.Julita Sotejo was its first Dean
The Basic Human Needs
Each individual has unique characteristics, but certain needs are common to all people.
A need is something that is desirable,useful or necessary.
Human needs are physiologic and psychologic conditions that an individual must meet to achieve a
state of health or well-being.

Maslows Hierarchy of Basic Human Needs

Physiologic
1. Oxygen
2. Fluids
3. Nutrition
4. Body temperature
5. Elimination
6. Rest and sleep
7. Sex
Safety and Security
Physical safety
Psychological safety
The need for shelter and freedom from harm and danger
Love and belonging
The need to love and be loved
The need to care and to be cared for.
The need for affection: to associate or to belong
The need to establish fruitful and meaningful relationships with people,institution, or organization
Self-Esteem Needs
Self-worth
Self-identity
Self-respect
Body image

Self-Actualization Needs
The need to learn, create and understand or comprehend
The need for harmonious relationships
The need for beauty or aesthetics
The need for spiritual fulfillment
Characteristics of Basic Human Needs
1. Needs are universal.
2. Needs may be met in different ways
3. Needs may be stimulated by external and internal factor
4. Priorities may be deferred
5. Needs are interrelated
Concepts of health and Illness
HEALTH
is the fundamental right of every human being. It is the state of integration of the body and mind
Health and illness are highly individualized perception. Meanings and descriptions of health and illness
vary among people in relation to geography and to culture.
Health - is the state of complete physical, mental, and social well-being, and not merely the absence of
disease or infirmity. (WHO)
Health is the ability to maintain the internal milieu. Illness is the result of failure to maintain the
internal environment.(Claude Bernard)
Health is the ability to maintain homeostasis or dynamic equilibrium. Homeostasis is regulated by the
negative feedback mechanism.(Walter Cannon)
Health is being well and using oness power to the fullest extent. Health is maintained through
prevention of diseases via environmental health factors.(Florence Nightingale)
Health is viewed in terms of the individuals ability to perform 14 components of nursing care unaided.
(Henderson)
Positive Health symbolizes wellness. It is value term defined by the culture or individual. (Rogers)

Health is a state of a process of being becoming an integrated and whole as a person.(Roy)

Health is a state the characterized by soundness or wholeness of developed human structures and of
bodily and mental functioning.(Orem)
Health- is a dynamic state in the life cycle;illness is an interference in the life cycle. (King)
Wellness is the condition in which all parts and subparts of an individual are in harmony with the whole
system. (Neuman)
Health is an elusive, dynamic state influenced by biologic,psychologic, and social factors.Health is
reflected by the organization, interaction, interdependence and integration of the subsystems of the
behavioral system.(Johnson)
Illness and Disease
Illness
is a personal state in which the person feels unhealthy.
Illness is a state in which a persons physical, emotional, intellectual, social, developmental,or spiritual
functioning is diminished or impaired compared with previous experience.
Illness is not synonymous with disease.

Disease
An alteration in body function resulting in reduction of capacities or a shortening of the normal life
span.
Common Causes of Disease
Biologic agent e.g. microorganism
Inherited genetic defects e.g. cleft palate
Developmental defects e.g. imperforate anus
Physical agents e.g. radiation, hot and cold substances, ultraviolet rays

Chemical agents e.g. lead, asbestos, carbon monoxide

Tissue response to irritations/injury e.g. inflammation, fever

Faulty chemical/metabolic process e.g. inadequate insulin in diabetes
Emotional/physical reaction to stress e.g. fear, anxiety
Stages of Illness
Symptoms Experience- experience some symptoms, person believes something is wrong
3 aspects physical, cognitive, emotional
Assumption of Sick Role acceptance of illness, seeks advice
Medical Care Contact
Seeks advice to professionals for validation of real illness,explanation of symptoms, reassurance
or predict of outcome
Dependent Patient Role
The person becomes a client dependent on the health professional for help.
Accepts/rejects health professionals suggestions.
Becomes more passive and accepting.
Recovery/Rehabilitation
Gives up the sick role and returns to former roles and functions.
Risk Factors of a Disease
1. Genetic and Physiological Factors
For example, a person with a family history of diabetes mellitus, is at risk in developing the disease later
in life.
2. Age
Age increases and decreases susceptibility ( risk of heart diseases increases with age for both sexes
3. Environment

 The physical environment in which a person works or lives can increase the likelihood that certain
illnesses will occur.
4. Lifestyle
Lifestyle practices and behaviors can also have positive or negative effects on health.
Classification of Diseases
1. According to Etiologic Factors
a. Hereditary due to defect in the genes of one or other parent which is transmitted to the
i. offspring
b. Congenital due to a defect in the development, hereditary factors, or prenatal infection
c. Metabolic due to disturbances or abnormality in the intricate processes of metabolism.
d. Deficiency results from inadequate intake or absorption of essential dietary factor.
e. Traumatic- due to injury
f. Allergic due to abnormal response of the body to chemical and protein substances or to physical
stimuli.
g. Neoplastic due to abnormal or uncontrolled growth of cell.
h. Idiopathic Cause is unknown; self-originated; of spontaneous origin
i. Degenerative Results from the degenerative changes that occur in the tissue and organs.
j. Iatrogenic result from the treatment of the disease
2. According to Duration or Onset

a. a.Acute Illness An acute illness usually has a short duration and is severe. Signs and symptoms
appears abruptly, intense and often subside after a relatively short period.
b. Chronic Illness chronic illness usually longer than 6 months, and can also affects functioning in any
dimension. The client may fluctuate between maximal functioning and serious relapses and may be life
threatening. Is is characterized by remission and exacerbation.
Remission- periods during which the disease is controlled and symptoms are not obvious.
Exacerbations The disease becomes more active given again at a future time, with recurrence of
pronounced symptoms.
c. Sub-Acute Symptoms are pronounced but more prolonged than the acute disease.
3. Disease may also be Described as:
a. Organic results from changes in the normal structure, from recognizable anatomical changes in an
organ or tissue of the body.
b. Functional no anatomical changes are observed to account from the symptoms present, may result
from abnormal response to stimuli.
c. Occupational Results from factors associated with the occupation engage in by the patient.
d. Venereal usually acquired through sexual relation
e. Familial occurs in several individuals of the same family
f. Epidemic attacks a large number of individuals in the community at the same time. (e.g. SARS)

g. Endemic Presents more or less continuously or recurs in a community. (e.g. malaria, goiter)
h. Pandemic An epidemic which is extremely widespread involving an entire country or continent.

i. Sporadic a disease in which only occasional cases occur. (e.g. dengue, leptospirosis)
Leavell and Clarks Three Levels of Prevention
a. Primary Prevention seeks to prevent a disease or condition at a prepathologic state ; to stop
something from ever happening.
Health Promotion
-health education
-marriage counseling
-genetic screening
-good standard of nutrition adjusted to
developmental phase of life
Specific Protection
-use of specific immunization
-attention to personal hygiene
-use of environmental sanitation
-protection against occupational hazards
-protection from accidents
-use of specific nutrients
-protections from carcinogens

-avoidance to allergens
b. Secondary Prevention also known as Health Maintenance.Seeks to identify specific
illnesses or conditions at an early stage with prompt intervention to prevent or limit disability;
to prevent catastrophic effects that could occur if proper attention and treatment are not
provided
Early Diagnosis and Prompt Treatment
-case finding measures
-individual and mass screening survey
-prevent spread of communicable disease
-prevent complication and sequelae
-shorten period of disability
Disability Limitations
- adequate treatment to arrest disease process and prevent further complication and
sequelae.
-provision of facilities to limit disability and prevent death.
c. Tertiary Prevention occurs after a disease or disability has occurred and the recovery
process has begun; Intent is to halt the disease or injury process and assist the person in
obtaining an optimal health status.To establish a high-level wellness.

To maximize use of remaining capacitiess

Restoration and Rehabilitation
-work therapy in hospital
- use of shelter colony

A Brief History of Nursingby Kathy Quan, R.N., B.S.N., P.H.N.

There have been caregivers throughout human history. Where there is illness, you will find a caregiver
of some sort in the picture. Florence Nightingale elevated the role of caregiver to that of a professional
nurse during the Crimean War in 1854, when she brought standards of care and infection control to
wounded soldiers. She started a school for nursing, but it was not the first school.
The Beginning
In 1836, a secular movement began when the Reverend Theodore and Friedericka Fliedner established
a three-year course for nurses at their school in Kaiserwerth, Germany. Florence Nightingale visited
this school in 1851. Graduates could dispense medications and nurse the ill and convalescing patients
back to health. Sixteen hundred nurses had been trained here and at various Kaiserwerth
motherhouses throughout the world by 1864. Kaiserwerth had a motherhouse as far away as
Milwaukee, Wisconsin.
Modern nursing began early in the nineteenth century in Europe with the Protestant Deaconess
Movement. The deaconesses cared for the sick and infirm and were housed in motherhouses, where
they received room and board but no pay for their work (similar to a monastic system).
Florence Nightingale (18201910)
Ms. Nightingale was from a well-to-do family in Britain and, after receiving an extensive education,
she decided to devote her life to caring for the sick. She volunteered to go to Crimea in 1854 to work
in the Turkish hospital in Scutari. The conditions appalled her. The Barrack hospital was dark, poorly
ventilated and overrun with vermin. Nurse Nightingale taught the few trained nurses and orderlies
there how to clean and disinfect the facility. As a result of her early infection control measures, the
death rate fell from 40 percent to 2 percent within six months.
After the war, Nightingale returned to London and wrote about her adventures and findings. She also
started her own school for nurses. Her book, Notes on Nursing, was published in 1859 and is still
required reading in most nursing programs.

The Beginning of Nursing in America

Nursing in America was still in its infancy at the start of the Civil War in 1861. As the war began, the
only nurses in this country were members of religious orders such as the Catholic Sisters of Mercy and
the Sisters of Charity. They were quickly overwhelmed by the numbers of war casualties and the Army
was ordered by the U.S. government to establish a nursing service. Dorothea Dix, who was sixty years
old and had devoted her life to the reform of insane asylums, was picked to lead the nursing efforts for
the war.
Nurse Dix set some rigid standards for the women who volunteered for the nursing service. She took
in no one under thirty years of age and all applicants had to be plain looking. The uniform was a plain
black or brown dress with no bows or hoops. The women wore no curls or jewelry. For the most part,
the nurses worked in hospitals far from the battlefields. However, a young woman named Clara Barton
took to the battlefields to bring her nursing skills to the wounded. She went on to found the American
Red Cross.
Other famous nurses at the time were Mary Todd Lincoln, who worked as a volunteer nurse in Union
hospitals, and Louisa May Alcott. Ms. Alcott wrote about her experiences as a Civil War nurse in her
book, Hospital Sketches.
Harriet Tubman, a famous runaway slave, also served as a nurse in the Civil War. She was awarded a
government pension in 1892 for the work she had done on the Sea Islands in South Carolina. What
would all these nurses think about the advances in the field of nursing today?

The nursing profession has developed throughout history, seeing a transformation in

practice, types of caregivers, roles, and policy changes, but nursing remains a profession of
caring and service to those in need. Many notable nurses have worked to revolutionize this
career and have allowed nursing to evolve while simultaneously providing better care and
circumstances in many situations.
The earliest nurses never attended nursing school; they were often nuns or other women
who provided care for the sick, poor, or homeless without family support. Women were
frequently called in to work as midwives to help deliver babies, or as wet nurses to
breastfeed. During the Middle Ages, early hospitals were operated by nurses who were often
affiliated with religious organizations. Many of these institutions were places for patients to
die, with nurses providing comfort during the final hours.
In the 18th and 19th centuries, the nursing profession expanded to include care of soldiers
during many prominent wars. In 1853, Florence Nightingale served as a nurse during the
Crimean War, during which she not only cared for the injured, but set standards of
cleanliness in the areas where she worked; her sanitary reforms reduced the overall
incidence of infection where they were implemented. Nightingale moved on to author a book
called Notes on Nursing, which was written as a set of guidelines for other nurses. She
eventually opened one of the first nursing schools, the Florence Nightingale School for
Nurses in London in 1860.

Many nurses worked during the American Civil War; their stories and letters paid tribute to
their circumstances and the large volume of casualties. Later, in 1881, Clara Barton
developed a humanitarian program designed to meet the needs of those affected by
disaster. Barton had served during the Civil War and understood the necessity of volunteer
cooperation to meet the needs for food, clothing, and shelter for those in trouble. The
organization was known as the Red Cross, and Barton served as its leader for over 20 years.
At the end of the 19th century, more nurses began to work toward changing policy in
leadership and education in nursing schools, recognizing their role as more than that of a
bedside caregiver. By implementing change, many nurses went beyond the scope of care to
educate those in leadership about the need for prevention and to reach some groups of
people that may have fallen through the cracks. In 1893, Lillian Wald began promoting the
role of the public health nurse to help those living outside of the hospital setting; and in
1925, Mary Breckinridge started the Frontier Nursing Service to help some of the poor and
destitute living in rural parts of America.
During the 20th century, nursing continued to evolve, with the addition of new programs and
professional organizations designed to specifically address some of the challenges of the
nursing profession. The American Nurses Association began publishing the American Journal
of Nursing, which continuously provides new information about research and trends in
current practice. Nursing programs changed to offer students new courses to become
licensed practical nurses and to require certification and testing to become registered
nurses. Nursing schools began to evolve from traditional hospital-based programs to
university-level curricula. Nurses began to gain further education in the form of advanced
degrees. In 1956, Columbia offered the first program for a masters degree in nursing, and in
1979, Case Western offered the first doctoral program.
Nursing skills developed during the 20th century as nurses filled greater roles with more
critical functions. The rise of intensive care units and specialty areas saw the expansion of
many areas of expertise in nursing. Nurses began to work in more specialized care settings
and studied care of patients in their respective fields. Nursing schools taught skills in areas
such as orthopedics, pediatrics, critical care, trauma and flight nursing, neonatal nursing,
and psychiatric nursing, among many other specialties, all of which became identifiable
concentrations in which to work.
Nurses also moved beyond the role of being the doctors assistant, and the scope of nursing
practice expanded in many specialties. Nurses now perform many procedures and lifesaving
measures that were once restricted only to the practice of medical doctors. Nursing
diagnoses guide the care of patients depending on their needs during hospitalization or
supervision. The role of the nurse practitioner as a type of advanced specialty nursing
brought nurses up to a level in which they could prescribe medication, perform procedures,
and follow the course of clinical patient care. Nurses play an essential role in not just the
physical or emotional care of patients, but in the management of social issues, prevention of
disease, and monitoring of trends. Nursing continues to expand into a distinct element of the
health care team, providing caring and service to those in need worldwide.