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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

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Nursing 340 – Public Health Nursing 

1. Introduction to Public Health Nursing