This paper traces the history of nursing from its origins in ancient Rome and Constantinople through the influences of religion, the contributions of Florence Nightingale, and the expansion of advanced practice nursing in the twentieth century. It examines how social, economic, and governmental forces — including the introduction of Medicare and Medicaid — shaped the development of nurse practitioner programs, beginning with the landmark 1965 Ford-Silver program. The paper concludes by addressing current challenges in APRN education, including workforce shortages and the growing use of simulation-based and academic-practice partnership training models.
The occupation of nursing has existed throughout nearly all of recorded history in some form or another. In the ancient Roman Empire, records document the nursing practice in which nurses provided care to in-patients at local Roman hospitals. In Constantinople — the Rome of the East — nurses were "known as hypourgoi" (Kourkouta, 1998). These nurses, both male and female, were tasked with roles much like those of today's nurses and provided a wide variety of services to patients.
Kourkouta (1998) states that the main tasks of the hypourgoi (male nurses) and hypourgisses (female nurses) were to give "psychological support of patients, everyday care of patients' bodily needs and elementary comfort, cleaning of patients and providing them with proper food, the administration of medicines according to a doctor's instructions, supervising wards when the physicians were not present, the performance of enemas, cuppings and bloodletting, the main therapeutic means used at that time, [and] the placing of patients on the operating table and the performance of minor operations" (p. 32).
In short, nurses demonstrated very many of the same values and attitudes required of them in the profession today. This should not be surprising, because the doctrine on providing quality care is derived essentially from the same source for the modern world as it was for the ancient Romans — the Hippocratic Oath, which is of ancient Grecian origin.
Religion was a major historical influence on the development of the nursing profession. Christianity in the West and Islam in the Middle East both helped to spread the practice of nursing (Jan, 1996; Kourkouta, 1998). In the modern era, however, nursing shifted into more of a secular practice. In the West, Florence Nightingale served as the model nurse for the modern era. As the nursing practice developed in the West, with increasing focus on institutionalized education, standards, and accreditation being built into the curriculum, nursing took on a more pronounced professional dimension. In particular, advanced practice nurses were called upon to fill the gap left by physicians who were leaving the primary care field for more specialized medicine (O'Brien, 2003).
"Ford and Silver's 1965 NP program origins"
"Workforce demands and simulation-based training"
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