Social, Philosophical, and Other Historical Forces Influencing the Development of Nursing

Innate human nature leads people to

• Accept the beliefs and practices of others
• Believe what those around them believe
• Act in ways that are congruent with those beliefs
• Moral beliefs of groups of people produce rules of action, or ethics.
  • Charles Sanders Peirce (1839–1914)
    • Four methods of fixing belief
      • • Tenacity
        • Authority
        • a priori
        • Reasoning

Nursing Ethics

• Nursing ethics
  • Goal: empowered decision making
• Critical social theory
  • We can only understand each aspect of a social phenomenon in relation to the history and structure in which it is found
  • Nursing history influences the present course of nursing
• The history of the nursing profession is linked to status of women

The Influence of Social Need

• Moral
  • Relates to what is considered right and wrong
• Moral reasoning
  • Includes an examination of behaviors and attitudes in light of moral implications
  • May be motivated by
    • • Empathy (Golden Rule)
      • Religious duty
• The nursing profession exists to meet social needs, and is a product of moral reasoning
• Nursing: A Social Policy Statement (ANA, 1980)
  • The nursing profession’s first description of its social responsibility
  • May be used as a framework for understanding the profession’s relationship with society
• The nursing profession was created by society for the purpose of meeting specific health needs.

Spiritual/Religious Influences

• Spirituality and religious doctrine
  • Influenced beliefs about the value of individuals, life, death, and health
  • Made judgments about the origin and essence of healing
  • Defined who would hold positions as legitimate healers

Gender Influences

• Women have been healers in every culture.
• Nursing is generally a profession of women.
• Even now, only 9% of nurses are men.
• Women’s status in society is central to determining the extent of freedom and respect granted to nurses.

Philosophical Influences

• Philosophers
  • Ask questions about the nature of truth and reality
  • Propose theories about morality and the characteristics of the good life
  • Propose theories of action, interaction, cause, and effect that impact the scientific method
  • Influence every aspect of society

Religious Influences and the Role of Women in Ancient Times

• Cosmology
  • The overarching belief system of a culture, including beliefs about the gods
  • The nature of the gods worshiped in any culture directly affects prevailing healing beliefs
  • Whenever the reigning deity in ancient times had a feminine, bisexual, or androgynous nature, women were leaders in the healing arts
• Asclepius
  • Greek god of medicine and healing
  • Followers established temples of healing
  • Health care was delivered by a servant nurse
  • Hippocrates may have studied at an asclepieion
• The Mosaic health code
  • Codified health practices as part of the Hebrew religion: including principles related to food, rest, sleep, cleanliness, hygiene, and childbearing
  • Hebrew high priest served as priest-physician
• Hippocrates
  • Wrote the first Western medical text: Corpus Hippocraticum
  • Was the first to develop a plan of assessment, diagnosis, treatment, and prognosis
  • The Hippocratic Oath is attributed to him

Philosophy in Ancient Times

• Socrates
  • Asserted that one must seek knowledge and develop the inner self in order to experience a good life 
  • Developed the Socratic method of teaching
  • Consists of a dialectic in which two people present opposing opinions.
• Plato
  • Responsible for the Dialogues
  • First recorded full body of philosophical work
  • Described dialogues between Socrates and other people
• Aristotle
  • A student of Plato
  • Believed that virtuous behavior consisted of attaining the golden mean.
  • Proposed that the aim of the good life is eudaimonia
  • Elements of Aristotle’s philosophies can be found in modern nursing.

Religious Influences and the Role of Women in the Early Christian Era

• Christian era
  • The most profound religious influence on healing beliefs and practices in Western civilization
  • Nurses were frequently women of high social status and often became independent practitioners
    • Deaconesses

Philosophy in the Early Christian Era

• St. Paul
  • Agreed with earlier, non-Christian moral philosophers that there is a natural law of conscience inherent in each person
• St. Augustine
  • Devoted himself to integrating Christian doctrine with Plato’s philosophy
  • Emphasized examination of the passions of the soul, including love and faith, as well as the urges, impulses, and vices that occur in every person.

Philosophy in the Middle Ages

• St. Augustine
  • Writings continued to be highly regarded
• St. Thomas Aquinas
  • Synthesized Greek rationalism and Christian doctrine
• Plato and Aristotle
  • Works were retranslated

Religious Influences in the Middle Ages

• Early Middle Ages
  • Religious orders offered the only route through which respectable women and men could serve as nurses
  • People sought healing through religious intervention; empirical treatment was attributed to the devil
  • Mortifying the flesh: people neglected physical needs to honor the spirit.
  • Terrible conditions during the Crusades caused Military nursing orders to be formed in response 
  • The Church credentialed physicians, nurses, and midwives

Women in the Middle Ages

• The status of women declined as a result of Church doctrine
  • St. Thomas Aquinas and St. Jerome
  • Women were officially allowed to practice healing arts only in religious and Church-sanctioned secular nursing orders
    • The Church worked to eliminate female lay healers
    • Women were excluded from universities
    • Women were prohibited from the new profession of medicine
  • Some women secretly continued to work as healers inside and outside of the home

Women Healers and Social Turmoil

• Folk healers
  • Used cures handed down through oral tradition and improved through observation, trial, and evaluation
  • Suspected of witchcraft and paganism
• Witch hunts
  • Lasted from the 14th to the 17th century
  • Carried out by the Church, state, and emerging medical profession
  • Women, particularly women healers, represented a political, religious, and sexual threat to Church and state.
• Kramer and Sprenger
  • Malleus Maleficarum
  • Defined witchcraft as treason against God and described it as female rebellion
  • After the witch hunts, women were prohibited from the healing professions by law in every country in Europe.

The Renaissance and the
Reformation

• 14th through the early 16th centuries
  • The Reformation
    • Martin Luther sparked a movement that resulted in the establishment of Protestantism.
    • Laws and customs in Protestant countries discouraged the humane care of the poor and vulnerable.
    • Religious nursing orders were driven out of hospitals and no qualified group was available to replace them.
    • “Dark Period of Nursing” (1550-1850)
      • Convalescent patients, prostitutes, prisoners, and drunkards provided hospital nursing care.
  • The Renaissance
    • An intellectual rebirth that ushered in a new scientific era 
    • Advances in mathematics and the sciences were made.
    • Philosophical humanism emerged.
    • Humanism established humans, rather than God, as a focus of interest.
    • Renaissance philosophers believed genuine knowledge was accessible through careful observation of empiric phenomena and subjective reasoning.
    • Some have argued that the Renaissance benefited men, but not women.

The Modern Era

• Late 16th through the late 18th centuries
  • Advances in science, politics, and philosophy
  • Philosophers who influence nursing include:
    • Emmanuel Kant
    • John Stuart Mill
    • René Descartes
      • Cartesian philosophy
• Florence Nightingale (1820–1910)
  • Founder of modern nursing
  • Nurse, statistician, sanitarian, social reformer, and scholar
• Lavinia Lloyd Dock (1858 –1956)
  • Champion of women’s rights

Contemporary Era

• Mid-1900s
  • The number of men in nursing professions increased.
  • Nurses entered professional, social, and political spheres.
  • Nursing gained acceptance as a legitimate health care force.
  • Nursing roles expanded.
  • Nursing education evolved.
• Late 20th and early 21st centuries
  • Hospitals streamlined services.
  • Many health care services moved from the hospital to the home as hospital stays shortened.
  • Advances in technology are introduced.
  • Nurses, as Institute of Medicine members, participated in recommendations that continue to shape nursing practice.
    • To Err is Human
    • Crossing the Quality Chasm
    • Future of Nursing: Leading Change, Advancing Health