Basic Clinical Nursing Skills

The Emergence of Modern Nursing

To some extent, the three early images of the nurse were held simultaneously for hundreds of years. Then, in the 19th century, one woman changed the course of nursing: Florence Nightingale. Although born to wealth and a family well placed in Victorian English Society, Florence Nightingale had a firm belief in Christian ideals that made h1er disdainful of a life of luxury. She believed her true calling was to minister to the sick. As an intelligent and welleducated woman, she recognized that optimum care of the sick required education. She persevered against family and social opposition and initiated personal study and research into sanitation and health. She studied with Pastor Fleidner of 33, was to reorganize the care for the sick at a hospital established for “Gentlewomen in Distressed Circumstances.”

Nightingale’s success in her first post led Britain’s secretary of war to recruit her for a far more arduous reorganization. Britain was then engaged in a major war in the Crimea; reports were coming back that more men died of wounds in the hospitals than on the battlefield. Funds were raised and nurses recruited for Florence Nightingale’s Crimean campaign. When she arrived at the front, Nightingale found that conditions in the military hospitals were abominable. The absence of sewers and laundry facilities, the lack of supplies, the poor food, and the disorganized medical services contributed to a death rate of more than 50% among the wounded. Nightingale insisted on retaining control of all of her supplies, funds, and personnel. Her efforts and those of her staff reduced the death rate among the wounded to less than 3%. She eventually completely reformed the military’s approach to the health care of the British soldier.

In 1860, she created a school of nursing, which was the model for most nursing education in England. The school was organized around three components: 1) a trained matron with undisputed authority over all members of the staff, 2) a planned course of theoretical and practical training, and 3) a home attached to the hospital in which carefully selected students were placed in the care of “sisters” responsible for their moral and spiritual training. (The English term “sisters” used for secular nurses reflects nursing’s religious history.) Nightingale established educational standards for the students – she concerned herself not just with health care needs but with human needs.

Her school prepared nurses for hospital care (where they were called “ward sisters”) and for supervisory and teaching positions. Nightingale also set up a program for preparing “district” nurses, the public health/visiting nurses of England. She wrote that these district nurses needed additional education because they would be working more independently than the hospital staff members.

Nightingale’s strong statements about the role of nurses and their need for lifelong education are still quoted widely today. Perhaps she, more than anyone else, can be credited with establishing nursing as a profession.

In the early ages, much of the practice of medicine was integrated with religious practices. Before the development of modern nursing, women of nomadic tribes performed nursing duties, such as helping the very young, the old, and the sick, care-dwelling mothers practiced the nursing of their time.

As human needs expanded, nursing development broadened; its interest and functions through the social climates created by religious ideologies, economic development, industrial revolutions, wars, crusades, and education. In this way modern nursing was born.

The intellectual revolution of the 18th and 19th centuries led to a scientific revolution. The dynamic change in economic and political situations also influenced every corner of human development including nursing. It was during the time of Florence Nightingale (1820-1910) that modern nursing developed. She greatly modified the tradition of nursing that existed before her era. She also contributed to the definition of nursing “to put the patient in best possible way for nature to act." Since her time modern nursing development has rapidly occurred in many parts of the world. 

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