1.1 Evolution of Nursing and Nursing Practice

Early Beginnings

The early beginnings of nursing can be traced back to ancient civilizations, where the care of the sick and injured was often a communal and familial responsibility. In these early societies, the role of a nurse was often fulfilled by family members, mainly women, who provided care within the home. Certain ancient cultures, such as Chinese and various American Indian, particularly valued individuals with specific knowledge of herbal remedies and healing practices. These individuals, often referred to as herbalists, played a role akin to what we now associate with nursing (Figure 1.2). Their knowledge of medicinal plants and holistic healing methods contributed to the well-being of their communities (D’Antonio et al., 2010).

Figure 1.2 Medicine women have been central figures in many cultures, including (a) indigenous women in Chile, (b) a Zulu shaman in Basutoland, and (c) the proprietor of a traditional Chinese medicine shop in Malaysia. (credit: (a) “Mapuche medicine woman treating a patient, South Chile” by Wellcome Images/Wikimedia Commons, CC BY 4.0; (b) “A Zulu medicine woman or shaman practicing in Basutoland, So” by Wellcome Images/Wikimedia Commons, CC BY 4.0; (c) “Medical Hall” by Oxlaey.com/Flickr, CC BY 2.0)

Throughout history, religious institutions have also played a significant role in caring for the sick. During the Middle Ages, when plagues and other illnesses were widespread, nursing duties in Western societies fell largely to religious orders. Monks and nuns provided care in monasteries and convents, demonstrating a commitment to service and compassion for the sick. The care provided during this period, however, was not formalized or regulated, and its quality varied widely (D’Antonio et al., 2010; Smith, 2023).

During the Renaissance period that began in Europe in the fourteenth century, a shift occurred in the perception of health care. The emergence of the scientific method and a greater understanding of anatomy and physiology began to influence medical practices. Despite these advancements, nursing remained an informal and often undervalued occupation for centuries. Yet these early beginnings of nursing, rooted in familial care and influenced by religious practices, set the stage for the professionalization and transformation of nursing into the vital and respected discipline it is today (D’Antonio et al., 2010).

Birth of Modern Nursing

The birth of modern nursing is credited to Florence Nightingale, a British nurse who played a transformative role in shaping the profession during the nineteenth century. Nightingale’s impact was particularly significant during the Crimean War (1853–1856), as she led a team of nurses to address the deplorable conditions in military hospitals. Nightingale’s emphasis on sanitation, hygiene, and compassionate care revolutionized hospital practices, fundamentally altering the landscape of health care and nursing. By implementing rigorous cleanliness measures, ensuring proper ventilation, and conducting statistical analysis of patient outcomes, she significantly reduced the spread of infectious diseases (Karimi & Masoudi Alavi, 2015; Smith, 2023).

The world’s first nursing school at St. Thomas’ Hospital was established in 1860 (Figure 1.3) which marked the formalization and professionalization of nursing education. The formal education of nurses, along with the establishment of professional standards and ethics, marked the transition from the informal caregiving of earlier centuries to the emergence of a dedicated and skilled nursing profession (D’Antonio et al., 2010).

Figure 1.3 This statue, outside St. Thomas’ Hospital, honors Mary Seacole, a Jamaican-born nurse who helped care for British soldiers during the Crimean War. (credit: “Mary Seacole statue, St. Thomas’ Hospital, front view,” by OwenBlacker/Wikimedia Commons, Public Domain)

Development of Nursing in the Nineteenth to Twenty-First Centuries

The development of nursing over the past 200 years represents a dynamic evolution marked by significant milestones, professionalization, and adaptation to the changing landscapes of health care. In the early twentieth century, an expansion of nursing practice took place, with nurses playing crucial roles in World Wars I and II and contributing to the establishment of nursing organizations like the American Nurses Association (ANA) in 1911 (D’Antonio et al., 2010).

In the mid-twentieth century, there were further advancements, including the development of specialized nursing fields and the creation of advanced practice roles. Witnessed in the latter part of the twentieth century were increasing diversity in the nursing workforce and a growing emphasis on evidence-based practice—trends that have continued through today. The profession has also adapted to technological innovations, such as electronic health record (EHR)s and telehealth, and embraced interdisciplinary collaboration (D’Antonio et al., 2010).

Throughout these centuries, nurses have faced challenges such as workforce shortages and increased demands on healthcare systems, leading to ongoing efforts to address these issues. The nursing profession has also experienced a shift toward greater autonomy and leadership roles for nurses, including the recognition of nurse practitioners as primary care providers (D’Antonio et al., 2010).

In recent decades, there has been a renewed focus on nursing education, research, and the global impact of nursing practice. Nurses have played pivotal roles in responding to public health crises, including the HIV epidemic, Ebola outbreaks, and the ongoing challenges posed by infectious diseases. In the twenty-first century, there is increased recognition of the importance of nursing in healthcare delivery (D’Antonio et al., 2010; Wakefield et al., 2021). Nurses contribute not only to direct patient care but also to health policy, research, and the development of innovative healthcare solutions. The COVID-19 pandemic further highlighted the indispensable role of nurses in providing frontline care and adapting to rapidly changing healthcare needs (Figure 1.4). Today’s nurses continue to be at the forefront of health care, contributing to improved patient outcomes and shaping the future of the profession.

Figure 1.4 Nurses, like these providers in a California hospital, helped lead the response to the COVID-19 pandemic in the United States. (credit: “USNS Mercy Medical Support at Skilled Nursing Facility Orange County,” by Navy Medicine/Flickr, Public Domain)

Continued Nursing Shortage

One prevailing trend in contemporary nursing is the continued shortage of nurses, a challenge that has persisted for several years, impacting the ability of healthcare systems to meet the growing demand for patient care. Several factors contribute to this shortage, including the expanding scope of healthcare services, an aging population with increased healthcare needs, and a similarly aging workforce that has seen many veteran nurses choosing to retire. Additionally, the limited number of qualified nursing instructors and available clinical sites impedes the possible growth of new nurses. The shortage is further exacerbated by factors such as inadequate nurse staffing ratios, high levels of burnout, and the demanding nature of the profession (Morris, 2023).

Efforts to address the nursing shortage include initiatives to attract individuals to the nursing profession, enhance educational opportunities, and create supportive work environments to retain experienced nurses. The ongoing shortage underscores the importance of strategic planning and collaborative efforts across healthcare stakeholders to ensure the sustainability and resilience of the nursing workforce in meeting the evolving healthcare needs of society.

Higher Education Requirements

A notable trend in contemporary nursing is the increasing emphasis on higher education requirements for entry into the profession. While the traditional path of obtaining an associate degree in nursing (ADN) or a diploma in nursing remains common, there is a growing recognition of the benefits associated with a bachelor of science in nursing (BSN) as the minimum educational standard (Wakefield et al., 2021). This trend is influenced by a desire to elevate the overall quality of patient care, align nursing education with the complexities of modern health care, and enhance critical-thinking and leadership skills among nursing professionals. Many healthcare institutions and employers are now encouraging or requiring nurses to pursue BSN degrees, and some are advocating for a future in which the BSN becomes the standard entry-level qualification. This shift reflects a broader movement in health care toward fostering a highly educated and skilled nursing workforce capable of meeting the diverse and evolving needs of patients and the healthcare system.

Increase in Online Nursing Programs

Another notable trend in contemporary nursing education is the substantial increase in online nursing programs, reflecting the broader shift toward digital learning platforms. This trend has been accelerated by advancements in technology, the recognition of the need for flexible education options, and the impact of the COVID-19 pandemic. Online nursing programs offer accessibility and convenience, allowing aspiring nurses and working professionals to pursue their education without geographical constraints. These programs often integrate virtual simulations, interactive modules, and remote clinical experiences to provide a comprehensive and engaging learning experience. The surge in online nursing education is reshaping the traditional landscape of nursing programs, making education more accessible to a diverse student body and contributing to the ongoing evolution of nursing as a dynamic and technologically advanced profession.

Rise of Technology in Health Care

A significant contemporary trend in nursing is the accelerated adoption of telehealth, the use of digital communication technologies to deliver healthcare services and information remotely. The COVID-19 pandemic has expedited the integration of telehealth platforms, allowing nurses to provide patient care remotely through virtual consultations. This shift not only ensures continuity of care during unprecedented times but also aligns with the broader trend of incorporating technology into various aspects of health care.

Nurses are increasingly utilizing electronic health and medical records to streamline documentation, enhance communication among healthcare providers, and facilitate data-driven decision-making. An electronic health record (EHR) is a digital version of a patient’s medical history, maintained and shared by multiple providers. In contrast, only a single provider maintains and uses an electronic medical record (EMR). While both EHRs and EMRs serve as digital repositories for a patient’s medical information, they differ in terms of scope, accessibility, and functionality. The intent is for EMRs to feed into the EHR, providing a holistic approach to healthcare data, fostering coordination and collaboration among multiple entities involved in a patient’s care. The rise of wearable health technology and mobile health applications further empowers individuals to actively engage in their care, while nurses leverage these tools to monitor health metrics remotely.

The integration of telehealth and other forms of technology not only enhances healthcare accessibility but also transforms nursing practice, requiring nurses to adapt to evolving modes of patient interaction and data management. As technology continues to advance, nurses are at the forefront of harnessing its potential to optimize patient outcomes, promote preventive care, and contribute to the ongoing transformation of the healthcare landscape.

Essential Need for Nurses’ Self-Care

Another essential trend in contemporary nursing is the increasing recognition of the critical need for nurses’ self-care, intentional actions and practices that individuals engage in to promote their physical, mental, and emotional well-being. The demanding and often emotionally taxing nature of nursing, particularly exacerbated by the challenges posed by the COVID-19 pandemic, has underscored the importance of prioritizing nurses’ well-being. Healthcare institutions are placing a greater emphasis on creating supportive work environments, offering resources for mental health and resilience training, and implementing initiatives that address burnout. Nurses are encouraged to engage in self-care practices to mitigate stress, promote mental and physical health, and sustain their overall well-being. Acknowledging the essential role of nurses in the healthcare system, this trend reflects a broader understanding that fostering a culture of self-care is not only beneficial for individual nurses but is integral to sustaining a resilient and effective nursing workforce capable of delivering high-quality patient care (Morris, 2023).

Soft Skills of Nursing

The soft skills in nursing are the interpersonal abilities and personal attributes that enhance a nurse’s ability to interact effectively with patients, families, and colleagues. Communication, empathy, cultural competence, collaboration and teamwork, adaptability, resilience, and problem-solving are examples of fundamental soft skills (Deering & Bal, 2023).

• Communication skills are paramount, encompassing the ability to listen attentively, convey information clearly, and show empathy.
• Empathy enables nurses to connect with patients on an emotional level, fostering trust and understanding.
• Cultural competence allows nurses to respect and navigate diverse backgrounds and beliefs, ensuring culturally sensitive care.
• Collaboration and teamwork are vital, as nurses often work within interdisciplinary teams, requiring effective communication and cooperation.
• Adaptability, resilience, and problem-solving skills are essential in the ever-evolving healthcare environment, enabling nurses to navigate challenges and overcome obstacles to providing person-centered care.

Ultimately, the cultivation of these soft skills enhances the holistic and compassionate nature of nursing practice, contributing to positive patient outcomes and a supportive healthcare environment.

Hard Skills of Nursing

The hard skills in nursing encompass the technical and clinical competencies that are crucial for providing safe and effective patient care. These skills are typically acquired through formal education, training, and hands-on clinical experience. Clinical assessment and critical thinking are foundational hard skills, allowing nurses to analyze patient data, make accurate diagnoses, and develop appropriate care plans. Proficiency in administering medications, performing various medical procedures, and utilizing medical equipment are essential hard skills that ensure the delivery of precise and evidence-based care. Technical skills related to charting and documentation are crucial for maintaining accurate and comprehensive patient records. Advanced life support and emergency response skills are imperative for handling critical situations.

Throughout their career, nurses are expected to continuously update their hard skills to align with advancements in medical technology and evidence-based practices, ensuring they remain competent and capable in their clinical roles. In combination with soft skills, hard skills form a comprehensive skill set that equips nurses to deliver high-quality and proficient care across diverse healthcare settings.