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REVIEW: OVERVIEW OF THE PROFESSIONAL NURSING PRACTICE

The following illustrates varied levels of proficiency according to Patricia Benner (Novice to Expert
Nursing Model)
a. Novice: a beginning nursing student or any nurse who has not had enough real life experience
b. advanced beginner: the advanced beginner can marginally demonstrate acceptable performance
when it comes to carrying out skills essential to the profession
c. Competent: competence is reflected by the nurse who has had the same or who has been in the
same job for 2-3 years
d. Proficient: the proficient nurse is able to perceive situations as a whole or holistically and manages
nursing care rather than performing tasks. A proficient nurse is one who has been in the same job for
3-5 years
e. Expert: the expert nurse no longer relies on rules and guidelines to connect understanding of a
situation to an appropriate action. The expert nurse has an intuitive and analytical grasp of the
situation and is able to find the best fit solution to a problem.
HISTORY OF NURSING
Period of Intuitive Instinct, natural Nursing
Intuitive nursing was practiced since prehistoric times among primitive tribes and lasted through the
early Christian era. Nursing was untaught and instinctive. It was performed out of compassion for
others, out of wish of to help others.
Beliefs and Practices of Prehistoric Man
He was a nomad wanderer, traveller. His philosophy of life was the best for the most and he was
ruled by the law of self preservation maintenance, survival.
Nursing was a function that belonged to women. She took good care of the children, the sick and the
aged.
Traditional female roles of wife, mother, daughter, and sister have always included the care and
nurturing of other family members. From the beginning of time, women have cared for infants and
children; thus, nursing could be said to have its roots in the home.
He believed the illness was caused by the invasion of the victims body of evil spirits through the use of
black magic or voodoo.
He believed that medicine men called shaman or witch doctor had the power to heal by using white
magic. Among others the shaman used hypnosis, charms, dances, incantations ritual recitation of
charms or spells to produce magical effect, purgatives cleansing/purifying, massage, fire, water and
herbs as a means of driving illness from the victim. He also practiced trephining opening the skull to
release evil spirit.
As civilization grew, temples became the centers of medical care because of the belief that illness was
caused by sin and Gods displeasure.
Nursing in the Near East
Mans mode of living changed from a nomadic style to an agrarian society to an urban community life
Man developed a means of communication and the beginnings of a body of scientific knowledge
Nursing remained the duty of slaves, wives, sisters or mothers
The care of the sick was still closely related to religion, superstition and magic. Astrology and
numerology were also used in medical practice
The place saw the three great religious ideologies: Judaism, Christianity and Islam
Contributions of Ancient Civilizations to Medicine and Nursing
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1. Babylonia
Code of Hammurabi provided laws that covered every facet of Babylonian life including medical
practice. The medical regulations established fees, discourages experimentation, recommended
specific doctors for each disease, and gave each patient the right to choose between the use of
charms, medications or surgical procedure to cure his disease. There was no mention of nurses or
nursing.
2. Egypt
The Egyptians introduced the art of embalming which enhanced their knowledge of human
anatomy
They developed the ability to make keen observation and left a record of 250 recognized diseases
There was no mention nurses, hospitals, or hospital personnel. Slaves and patients families nursed
the sick.
3. Israel
Moses is recognized as the Father of Sanitation. He wrote the five books of the Old Testament
which emphasizes the practice of hospitality to strangers and acts of charity help (Genesis, Old
Testament)
Promulgated laws of control on the spread of communicable disease and the ritual of circumcision
of the male child (Leviticus)
Referred to nurses as midwives, wet nurses or childs nurses whose acts where compassionate and
tender outpouring of maternal instincts.
4. Rome
The first organized visiting of the sick began with the establishment of the order of the Deaconesses.
They endeavoured to practice the corporal works of mercy:
o Feed the hungry
o Give water to the thirsty
o Clothed the naked
o Visit the imprisoned
o Shelter the homeless
o Care of the sick
o Bury the dead

Rome (Personalities and Organizations)

o Phoebe was the first deaconesses and visiting nurse
o Marcella was considered the first educator. She taught the care of the sick to her followers
o Paula one of the most learned woman of this period. She built shelters for pilgrims a person
who journeys to a sacred place as an act of religious devotion and hospital for the sick
o Fabiola wealthy matron of the Roman Empire, gave up her early pleasures and lavished her
immense wealth on the poor and sick. Through her efforts the first general public hospital was
built in Rome NOSOCOMIUM- a place for the sick. She gave her fortune to the needy
o Parabolani provided an opportunity for the male nurses in the early church period. They took
care of the sick and buried the dead.

5. GREECE
The Greek God Asklepios was the chief healer
Hygeia, daughter of Asklepios, was goddess of health and was revered holy by some as the
embodiment of the nurse
Nursing was the task of untrained slaves
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The Greeks introduced the caduceus, the insignia of the medical profession today
Hippocrates came to be known as the Father of Medicine

6. CHINA
Used massage, hydrotherapy, and exercise as preventive health measures
They also used many herbs, minerals and acupuncture to heal the sick
7. AFRICA
The nurturing functions of the nurse included roles as midwifes, herbalist, wet nurse, and carer for
children and the elderly
8. INDIA
Early hospital were staffed by male nurses who were required to meet four qualifications:
o Knowledge of the manner in which drugs should be prepared for administration
o Cleverness
o Devotedness to the patient, and
o Purity of mind and body
Indian women served as midwives and nursed ill family members
Period of Apprenticeship Nursing

This period extends from the founding of religious nursing orders in the Crusades which began in the
11th century and ended in 1836, when Pastor Fliedner and his wife established the Kaiserweth Institute
for the training of Deaconesses a woman elected to serve as an assistant in a church (a training school
for nurses) in Germany
It is called the period of on-the-job training. Nursing care was performed without any formal education
and by people who were directed by more experienced nurse. Religious orders of the Christian Church
were responsible for the development of this kind of nursing.

The Crusades
The Crusades were holy wars waged in an attempt to recapture the Holy Land Israel from the Turks
who denied pilgrims permission to visit the Holy Sepulcher a place for sacred relics. Military religious
orders established hospitals that were staffed with men.
Military Religious Orders:
Knights of St John of Jerusalem (Italian) devoted to religious life and nursing
Teutonic Knights (Germany) established tent hospitals for the wounded
Knights of St. Lazarus (Germany) was primarily for the nursing care of lepers in Jerusalem after
Christians had conquered the city. Dedicated themselves to the care of people with leprosy, syphilis
and chronic skin conditions.
The Alexian Brothers were members of a monastic order founded in 1348. They established the
Alexian Brothers Hospital School of Nursing, the largest school of nursing under a religious order. It
operated exclusively for men. In the United States, the school closed in 1969.
The Rise of Secular Orders
During this period, there were also the rise of Religious Nursing Orders for Women. Only by entering a convent
could she follow a career obtain an education, and perform acts of charity that her faith taught would help her
gain grace in heaven. Queens, princesses and other ladies of royalty founded many religious orders.
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Secular Orders:
1. Orders of St. Francis of Assisi (1200-present)
First Order founded by St. Francis himself
Second Order (Poor Clares) founded by St. Clare of Assisi
Third Order (Tertiary Order) composed of members who devoted their time to performance of
acts of mercy in their communities, most provided nursing care in homes and hospitals
2. The Beguines composed of lay nurses who devoted their lives to the service of suffering humanity. It
was founded in 1170 by a priest, Lambert Le Begue.
3. Other Secular Orders : Oblates, Benedictines, Ursulines, Augustinians
Important Personages during this period:
St. Clare founder of the Second Order of St. Francis, took vows of poverty, obedience service and
chastity; gave nursing care to the sick and the afflicted.
St. Elizabeth of Hungary known as the Patroness of Nurses she was the daughter of Hungarian king.
She used all her wealth to make the lives of the poor happy and useful. She built hospitals for the sick
and the needy.
St. Catherine of Siena the first Lady with a Lamp. She was the 25th child of a humble Italian parents.
She pledged her life to service at the age of seven and was referred to as little saint. She was a hospital
nurse, prophetess, researcher and a reformer of society and the church.
The Bubonic Plague (1347-1350)
Ended the middle ages
Was very deadly
Germs carried by rats
Killed of the entire world population
The Dark Period of Nursing Down Fall of Nursing
This extends from the 17th century to the 19th century from the period of reformation until the US Civil
War
The religious upheaval disruption, disturbance led by Martin Luther destroyed the unity of the
Christian faith
Protestantism wept away everything connected with Roman Catholicism in schools, orphanages and
hospitals
There were no provisions for the sick, no one cared for the sick
Nursing became the work of the least desirable women
o Women who took bribes from patients
o Stole the patients food
o Used alcohol as tranquilizer
o They worked 7 days a week, slept in cubbyhole near the hospital ward or patient and ate scraps
of food when they could find them
o These women were personified in a Charles Dickens novel Martin Chuzzlewit as Sairey Gamp
and Betsy Preg. She cared for the sick by neglecting them, stealing from them, and
physically abusing them.
o Hospitals become gloomy and look like cemetery
18th to 19th century, social reforms changed the roles of nurses, based on the beliefs of Florence
Nightingale. Undertook nurses training at the age 31 despite opposition of family. Organize nursing
care for the military hospital in Turkey during the Crimean War. After the war, she returned to England,
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where she established a training school for nurses and wrote books about health care and nursing
education
Florence Nightingale elevated the status of nursing to a respected occupation, improved the quality of
nursing care, and founded modern nursing education. Nurses were viewed as noble, compassionate,
moral, religious, dedicated and self-sacrificing.
Societal Attitudes Before the mid-1800s, nursing was without organization, education, or societal status;
the prevailing attitude was that a womans place was in the home and that no respectable woman should
have a career.
Reforms during the Dark Period
Several Leaders sought to bring reforms
John Howard a prison reformer, he helped improved the living conditions in prisons and gave
prisoners renewed hope.
Mother Mary Aikenhand established the Irish Sister of Charity to bring back into nursing the
dedication of the early Christian era
Pastor Theodor Fliedner and Frederika Munster Fliedner established the institute for the Training of
Deaconesses at Kaiserwerth, Germany, the first organized training school for nurses. Requirements for
entering the school were:
o A character reference from a clergyman
o A certificate of health from a physician, and
o Permission from their nearest relative
Nursing in America
Pre-Civil War Nursing
Madame Jeanne Mance was the first laywoman who worked as a nurse in North America. She
founded the hotel Dieu of Montreal, a log cabin hospital
Elizabeth Seton, an American, founded the Sisters of Charity at Emmitsberg, Maryland in 1809
American Reforms in Nursing
The Nurse Society of Philadelphia organized a school of nursing under the direction of Dr. Joseph
Warrington in 1839. Nurse were trained on the job and attended some preparatory courses
Womens Hospital in Philadelphia established a 6 month course in nursing to increase the nurses
knowledge while they worked.
Nursing During the Civil War
The American Medical Association during the Civil War created the Committee on Training of Nurses. It was
designated to study and make recommendations with regards to the training of nurses. Doctors realized the
need for qualified nurses
Important personages at the time
Dorothea Lynde Dix she was appointed as Superintendent of Female Nurses for the US government
Clara Barton (1812-1912) was a school teacher who volunteered as a nurse during the American Civil
War. She founded the American Red Cross
Period of Educated Nursing Birth of formal education
This period began on June 15, 1860 when the Florence Nightingale School of Nursing opened at St. Thomas
Hospital in London. The development of Nursing during this period was strongly influenced by:
Trends resulting from wars
An arousal of social consciousness
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The emancipation liberation of women

Increased educational opportunities for women

Facts about Florence Nightingale

Recognized as the Mother of Modern Nursing she was also known as the Lady with Lamp
Born on May 12, 1820 in Florence, Italy
Raised in England in an atmosphere of culture and affluence; learned languages, literature,
mathematics and social graces
Her education was rounded out by a continental tour
Compiled notes of her visits to hospitals and her observations of the sanitary facilities, social problems
of the places she visited.
Advocated for care of those afflicted with the diseases caused by lack of hygienic practices
At age 31, she overcame her familys resistance to her ambitions. She entered the Deaconess School
Worked as superintendent for Gentlewoman During illness
Disapproved the restrictions on admission of patients and considered the unchristian and incompatible
with health care
Upgraded the practice of nursing and made nursing an honourable profession for gentlewomen
Led the nurses that took care of the wounded during the Crimean War
Put down her ideas in two published books: Notes on Nursing and Notes on Hospitals
Other Important Personages during this Period:
Linda Richards (1841-1912) first graduate nurse in the US; graduated on September 1, 1873. She is
known for introducing nurses notes and doctors orders. She also initiated the practice of wearing
uniforms.
Dr. William Halsted designed the first rubber gloves
Caroline Hampton Robb the first to wear rubber gloves while working as an operating room nurse
Establishment of nursing organizations :
o American Nurses Association
o National League for Nursing Education
Isabel Hampton Robb the first principal of the John Hopkins Hospital School of Nursing
Clare Louise Maas engaged in medical research on yellow fever during the Spanish-American War
Development of private duty nursing, settlement house nursing, school nursing, government service of
nurses, and prenatal and maternal health nursing
Age of Specialization began in the first decade of the 20th century
Preparation of a standard curriculum based on educational objectives for schools of nursing (19131937)
Edith Cavell known as Mata Hari, served the wounded soldiers during World War I
Mary Mahoney (1845-1926) was the first African American professional nurse. She constantly
worked for the acceptance of African Americans in nursing and for the promotion of equal
opportunities.
Lilian Wald is considered the founder of public health nursing. Wald and Mary Brewster were the
first to offer trained nursing services to the poor in the New York slums.
Lavinia L. Dock (1858-1956) was a feminist. Prolific writer, political activist, suffragette, and a friend of
Wald. She participated in protest movements for womens rights that resulted in the 1920 passage of
the 19th amendment to the US constitution which granted women the Right to vote.
Margaret Higgins Sanger (1879-1966) a public health nurse in New York, has had a lasting impact on
womens health care. Imprisoned for opening the first birth control information clinic in America, she is
considered the founder of Planned Parenthood.
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Mary Breckinridge (1881-1965) a notable pioneer nurse, established the Frontier Nursing Service
(FNS). In 1981, she worked with the American Committee for Devastated France, distributing food,
clothing, and supplies to rural villages and taking care of sick children.

Period of Contemporary Nursing

This covers the period after World War II to present. Scientific and technological developments as well
as social changes marked this period:
Establishment of the World Health Organization April 7, 1948 by the UN to assist in fighting disease by
providing health information and improving nutrition, living standards and environment condition of all
people.
Use of atomic energy for medical diagnosis and treatment
Utilization of computers for collecting data, teaching, establishing diagnosis, maintaining inventory,
making payrolls, record keeping and billing
Use of sophisticated equipment for diagnosis and therapy
The advent of space medicine also brought about the development of aerospace nursing
Health was perceived as a fundamental mental right. Laws were legislated to provide such right
Nursing involvement in community health
Technological advances, such as the development of disposable supplies and equipment, have relieved
the nurse from numerous tedious tasks
Development of expanded role of the nurse; the nurse is constantly assuming responsibilities in patient
care which were formerly the sole prerogative of the physician
History of Nursing in the Philippines
Early Beliefs and Practices (Diseases and their causes and treatment were shrouded with mysticism and
superstitions.)
Beliefs about causation of disease:
o Another person (an enemy or a witch)
o Evil Spirits
People believed that evil spirits could be driven away by persons with powers to expel demons
People believed 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 (herbiolarios)
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.
Healthcare During the Spanish Regimen
The religious orders exerted their efforts to care for the sick by building hospitals in the different parts of the
Philippines
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.
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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 Philippines Revolution

Prominent persons involved in nursing work:
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 Schools of Nursing
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.
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
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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 Pedrosa 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)
First Colleges of Nursing in the Philippines
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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
Nursing Leaders in the Philippines
Anastacia Giron-Tupas First Filipino nurse to hold the position of Chief Nurse Superintendent;
founder of the PNA
Cesaria Tan First Filipino to receive a masters degree abroad
Socorro Sirilan pioneered in Hospital Social Service in San Lazaro Hospital where she was the Chief
Nurse
Rosa Militar pioneered in School health nursing education
Sor Ricarda Mendoza pioneer in nursing education
Socorro Diaz first editor of the PNA magazine called The Message
Conchita Ruiz first full-time editor of the PNA magazine called The Filipino Nurse
Loreto Tupaz dean of Philippine Nursing; regarded as the Florence Nightingale of Iloilo

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