essay on history of nursing

History of Nursing in the Last 100 Years Essay

Nursing profession has evolved significantly in the last 100 years, from the time when nurses had to be submissive to matrons and take orders from them without digressing, to the current situation where nurses handle complex and diverse roles in healthcare. However, significant changes started to be witnessed following the advent of scientific revolution. Importantly, the Spanish war in the 19 th century played a significant role in aiding the development of nursing profession, with nurses required to take care of military personnel (Judd, Sitzman, & Davis, 2010). Over the years, nurses have been highly recognized for their efforts in care giving activities, creating awareness in the community about various health problems and offering emotional support to patients and their relatives. Generally, modern nursing is said to have developed in early 19 th century in Britain and Germany. The practice spread all over the world by the 1900, having grown very fast in the later years of 19 th century to become a professional career practice. This was facilitated by the tendency of hospitals to develop schools of nursing that had a lot of attraction to ambitious women from various backgrounds. The Nightingale era schools stopped operating from the 19 th century and the hospitals took over the work of controlling nursing schools. Here, clinical experience became more recognized than book academic performance only.

Currently, humanitarianism has enhanced nursing practice in RN oriented hospitals, schools, colleges, and universities; this has brought access nearer to people who are willing to practice nursing as a career. Modern nursing is generally the same practice that has existed over the years, though there are great advancements that allow nurses to carry out their jobs more effectively and efficiently. However, current nursing care is challenged with increased patients’ needs and requirements that have to be taken care of, thus expanding the scope of responsibilities for nurses. Indeed, modern nursing practice goes beyond the conventional care, thus it includes a wide array of duties, such as ensuring that patients take medication as prescribed by physician, following up patient’s healing progress, clerical work and statistics analysis, and supervising dietary procedures of all patients.

In contemporary health care system, nursing is always accompanied by many issues that are very important for good health maintenance. For instance, it is crucial for nurses to make sure that patient keeps a healthy diet. Nurses assist doctors in operatingrooms, during ward rounds, and in other practices that doctors may need assistance in. Nowadays, nurses have skills and knowledge in various spheres including management, family, community, psychological, surgical, women health, emergency, clinical and advanced practice. The major duties of a nurse include:

• Documentation of patient’s symptoms and medical history;
• Management of treatments and medications as directed by doctors;
• Keeping a good observation to the patient and record any changes;
• Assisting health practitioners;
• Developing care plans for patients;
• Monitoring and operating medical equipment;
• Enhancing health awareness of all the members of community;
• Clerical works in diagnostic tests and analysis of results.

Currently, the United State has 3.1 million Licensed Registered Nurses (RN’s). Out of these, there are 2.6 million RNs employed in nursing, and 62.2% of the registered nurses are working in hospitals (American Nurses Association, 2011). In addition, nurses in United States are estimated to have a mean hourly wage of $33.13 and a mean yearly wage of $68.910 (Bureau of Labour Statistics, 2014). All in all, nursing profession is currently leading in terms of workforce, and it is among the best paying jobs in the US (Peterson’s, 2009).

The introduction of advanced technology has also led to many changes in the nursing (Huston, 2013). Technology has made nursing easier to administer, thought it has become more difficult to generate results due to intensive research work and data analysis required. This calls for nurses to remain at the cutting edge of technological progress (Glynn-Jones, 2013). The explosion of knowledge in recent years has sparked interest in many young people who would like to take advantage of potential opportunities. Colleges also offer updated training services to aspiring nurses. Most of employers are seeking competent nurses who are ready to move at the same pace with technological advancements, especially when it comes to specialization. Indeed, the emergence of terminal illnesses in recent years such as diabetes and cancer has put nurses on their toes to ensure they have enough knowledge and skills in order to provide the best and quality care to their patients. It is, therefore, evident that nursing practice has changed a lot in the past century, with the changes being more advanced, efficient and effective than they used to be 100 years ago.

American Nurses Association. (2011). Registered Nurses in the US: Nursing by the numbers. Web.

Bureau of Labour Statistics. (2014). Occupational Employment and Wages, May 2013 . Web.

Glynn-Jones, C. (2013). The role of nursing has changed considerably . Web.

Huston, C., (2013). The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead. The Online Journal of Issues in Nursing, 18(2), 1.

Judd, D., Sitzman, K., & Davis, M. (2010). A History of American Nursing: Trends and Eras . MA, USA: Jones & Bartlett Learning.

Peterson’s. (2009). Nursing Programs – 2010: Advance Your Nursing Career. NJ, USA: Peterson’s.

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Foundation and History of Nursing

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Published: Mar 16, 2024

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Foundation of nursing, history of nursing, modern nursing.

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American Nursing: An Introduction to the Past

Professional nursing holds a unique place in the American health care system. As members of the largest health care profession, the nation’s 3.1 million nurses work in diverse settings and fields and are frontline providers of health care services. While most nurses work in acute-care settings such as hospitals, nurses’ expertise and skills extend well beyond hospital walls. Working independently and with other health care professionals, nurses promote the health of individuals, families, and communities. Millions of Americans turn to nurses for delivery of primary health care services, health care education. and health advice and counseling. Nurses are critical links in maintaining a cutting-edge health care system.Nursing continues to be an indispensable service to the American public.  

Florence Nightingale

Nursing and Hospital Care in the United States

The Beginnings of Nurse Education

The outbreak of the Civil War created an immediate need for capable nurses to care for the enormous number of sick and wounded. About 20,000 women and men served as nurses in both the North and the South. The commendable service rendered by Civil War nurses provided a rationale for future experiments in setting up training programs for nursing. One such program was initiated in Pennsylvania where the Women’s Hospital of Philadelphia offered a six months nurse training course, which graduated its first class in 1869. Similar courses, such as that offered by the New England Hospital for Women and Children were begun in other locales.

Professional Nurse Education Begins  

The success of these first three so-called “Nightingale schools” led to a proliferation of similar nursing schools, or as they were most commonly called, nurse training programs. By 1900, somewhere between 400 to 800 schools of nursing were in operation in the country. These programs followed a fairly typical pattern. The school was either affiliated with or owned by a hospital that provided the students with the clinical experience considered necessary for the education of a nurse. Students received two to three years of training. While in the program students carried out the majority of patient care activities offered in the hospital, receiving only a modicum of classroom education in the form of lectures on patient care and related subjects. At the end of the educational program, students received a diploma and were eligible to seek work as a trained nurse .

The Profession of Nursing Organizes

These changes improved and reformed many aspects of the nurse training system, but problems remained. Reflecting the social and legal status of African Americans at the time, American professional nursing maintained strict racial segregation until the mid-twentieth century. African American individuals wanting to become nurses had to train in a separate educational system and faced a divided employment field in which white and black nurses did not participate equally. Nursing also remained a predominantly female profession. While a few schools admitted men, most schools refused them admission.  

Challenges for Nursing

Employment conditions for nurses also presented challenges. In the early part of the twentieth century, hospitals employed only a few graduate nurses, mainly in supervisory positions. They relied instead on student nurses for the majority of the bedside care provided to patients. Most nurses, once they graduated from their educational program, entered the field of private duty nursing. Private duty nurses were employed by individual patients primarily in their homes. As institutions became the more normative site for delivery of sick care, private duty nurses moved with their patients into the hospital, delivering care to hospitalized individuals who could afford to pay for their own nurse. But for nurses, private duty often did not provide regular and dependable employment; nurses were hired on an ad hoc basis by patients and were oftentimes without a regular source of income. The cost of private duty was also quite high, limiting the number of patients employing private duty nurses. It was not until the mid-twentieth century that hospitals hired nurses as regular staff on a permanent basis, providing full professional nursing services to all hospitalized patients.

Nursing Diversifies  

Despite the many difficulties within the profession, nursing continued to grow as an occupational field and became recognized as an essential health care service by the early twentieth century. Nurses fanned out into diverse fields delivering services to many people outside of hospitals. For example, Lillian Wald founded the Henry Street Settlement House in 1893, which provided nursing and other social services to impoverished populations on the Lower East Side of New York City. Replication of Wald’s work in other parts of the country led to the growth of the field of public health nursing, opening up new employment opportunities for nurses and expanding the type of services provided  by nurses.

The special skills possessed by nurses were easily transferred to different fields of health care. For example, nurses were educated to administer anesthesia during surgery, leading to the specialty field of nurse anesthetists. By the early twentieth century it was quite common to find nurse anesthetists delivering anesthesia in many of the nation’s hospitals. By the 1920s, in some parts of the country, nurse-midwives delivered babies, in many cases to the most impoverished populations.

Mid-twentieth Century Nursing

The community college movement achieved only partial success. Community college programs did graduate many new nurses and often at a lower cost than traditional diploma programs. But, as the needs of late-twentieth-century patients became increasingly more complex, research studies indicated that being treated by nurses prepared at the baccalaureate level improved patient outcomes.  

The Modern Practice of Nursing

  Nursing education also thrived in the latter half of the twentieth century. Significant federal financial support for educating nurses, which became available beginning in the 1960s, permitted the revamping and modernizing of many nursing educational programs. Significantly, increased funding for nursing research permitted nursing to develop a sounder scientific basis for its practice. Nurse researchers today carry out cutting-edge studies that shed light on the ways and means of solving many health care problems and improving nursing services.

Historically, the nursing profession has consistently demonstrated its ability to adapt to changing and varied health care needs. It remains an exceedingly popular and highly respected profession that attracts large numbers of new recruits to its ranks. There is little doubt that nursing will continue to maintain its status as an extremely important profession, serving the health needs of the nation.

Jean C. Whelan (1949-2017) was Adjunct Assistant Professor of Nursing, University of Pennsylvania School of Nursing.

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The History of Nursing

It could be said that nursing is as old as mankind since people have always needed nursing care when ill or wounded. The word nurse is derived from the Anglo-French nurice and the Latin nutrica , both of which mean nourish. This is exactly what nurses have always done.

The common belief is that nursing has always been a feminine occupation with males entering the field in recent years, but this is not the case. During the Middle Ages, nurses were mostly untrained women who helped deliver babies or were wet nurses. Nuns had more training and cared for the sick. However, by the 13th through the 16th centuries, religious orders felt as if it was their duty to care for the physical needs of people as well as their spiritual needs and formed brotherhoods to carry out this mission. In 1259, the Alexian Brothers started the ministry of caring for the sick and hungry, and they are still in existence today in many countries, including the United States. The Hospitaller Brothers of St. John of God was formed in Spain in 1550. From 1550 through 1614, Saint Camillus de Lellis cared for the sick and dying at St. James’ Hospital in Rome. It was not until 1633 when Saint Vincent de Paul founded the Daughter of Charity that women began to play a larger role in organized nursing. In 1645, Jeanne Mance, a nurse from France, established the Hotel-Dieu de Montreal in Canada, the first hospital in North America.

By the 18th century, the United States was beginning to realize the need for organized nursing services. In 1751, Benjamin Franklin and Dr. Thomas Bond opened Pennsylvania Hospital, the nation’s first hospital. It served the poor and homeless in Philadelphia. When the American Revolutionary War broke out in 1775, Congress recruited nurses to care for the sick and wounded. They requested one nurse for every 10 patients.

Throughout the years, wars have increased the need for nurses and have had a great influence on the evolution of nursing.  Florence Nightingale , who is widely regarded as the mother of modern nursing, made her greatest impact when she served in the Crimean War from 1853 to 1856. Her sanitation efforts dropped the mortality rate dramatically. She went on to establish the Florence Nightingale School for Nurses in London. Between 1861 and 1865, over 2000 nurses served in the Civil War, some on the front lines. Many of these nurses wrote of their war experiences.

As the United States continued to see the need for nursing education, the first training school was opened 1872 at the New England Hospital for Women and Children in Boston. Its first graduate was Linda Richards , the first American trained nurse. After that, more and more hospitals opened nursing schools. Unfortunately, in many of the schools, the training consisted of very little book learning, and many times the students were exploited as free labor. Contrary to the autonomous Nightingale schools, nursing was under the control of medicine.

By the 1970s, the three-year, hospital-based diploma schools were starting to be replaced by two-year associate degree programs at technical schools or by four-year Bachelor of Science degree programs at universities. These schools provide the academic curricula and are affiliated with hospitals for clinical training. As the need for higher education in nursing is growing, universities also are offering master’s and doctorate programs.

The following nursing timeline shows how world events and famous nurses influenced nursing history and paved the way for modern nursing practice.

• 1751 – The first hospital was founded in Philadelphia, Pennsylvania.
• 1775 to 1783 – Nurses were recruited to care for the wounded under the command of George Washington.
• 1783 – James Derham used his earnings from nursing to buy his freedom from slavery.
• 1841 – Dorothea Dix advocated for the mentally ill and established mental institutions.
• 1853 to 1856 – Florence Nightingale served in the Crimean War and set up a holistic system of nursing.

• 1860 – The Florence Nightingale School of Nursing was opened in London.
• 1861 – Nurses began to wear uniforms.
• 1861 to 1865 – During the Civil War, over 2,000 nurses cared for injured and ill soldiers.
• 1865 – Sojourner Truth cared for injured African-American soldiers in Washington, D.C. Her sanitation practices reduced infections, and she taught other nurses her principles.
• 1873 – Linda Richards, the first American trained nurse, graduated from the New England Hospital for Women and Children School of Nursing.
• 1879 – Mary Eliza Mahoney , the first African-American trained nurse, graduated from the New England Hospital School of Nursing.
• 1881 – Clara Barton established the American Red Cross.
• 1893 – Lillian Wald founded the Visiting Nurse Service of New York.

• 1901 – New Zealand began requiring registration for nurses.
• 1902 – Ellen Dougherty from New Zealand became the first registered nurse in the world.
• 1902 – Lina Rogers Struthers was hired as the first public school nurse.
• 1908 – Congress established the United States Naval Nursing Corps.
• 1908 – The National Association of Colored Graduate Nurses was established. It merged with the American Nurses Association in 1951.
• 1914 to 1918 – Nurses from the U.S. Navy Nursing Corps and the American Red Cross served in World War I.
• 1917 – Margaret Sanger established the National Birth Control League that later became Planned Parenthood.
• 1925 – The Frontier Nursing Service was started by Mary Breckinridge.
• 1939 to 1945 – Over 59,000 American nurses served in World War II.
• 1950 – The first intensive care units were established and created the specialty of critical care nursing.
• 1956 – Columbia University School of Nursing offered the first master’s program for nurses.
• 1959 to 1975 – Over 5,000 nurses served during the war.
• 1965 – The University of Colorado established the first nurse practitioner program.
• 1967 – Dame Cicely Saunders started the first hospice in London and provided the foundation for care of the terminally ill.
• 1972 – Eddie Bernice Johnson was the first registered nurse elected to the U.S. House of Representatives.
• 1979 – Case Western Reserve University started the first doctoral program for nurses.
• 1990 – Nursing uniforms become more casual. Nurses in hospital settings began to wear “scrubs”.

• 2010 – The Institute for the Future of Nursing released recommendations for improved health care.

Nursing in the past laid the framework for the common purpose of health and well-being of individuals and communities. Nursing theories and processes have changed over the years, but the goal of nursing today remains the same.

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The Evolution of Nursing Research

Jacqueline m. stolley.

Trinity College of Nursing, Moline, Illinois

THE RESEARCH CULTURE in nursing has evolved in the last 150 years, beginning with Nightingale’s work in the mid-1850s and culminating in the creation of the National Institute of Nursing Research (NINR) at the National Institues of Health (NIH). This article highlights nursing’s efforts to facilitate the growth of the research culture by developing theory, establishing the importance of a research-based practice, advancing education, and providing avenues for dissemination of research. Similarities with the chiropractic profession are discussed, along with a commentary by Cheryl Hawk, D.C, Ph.D.

EVOLUTION OF NURSING RESEARCH

The development of a research culture in nursing in many ways parallels that of chiropractic, and by reviewing key aspects of the evolution of the science of nursing, there are lessons to be learned, and mistakes to be avoided. Nursing research has changed dramatically in the past 150 years, beginning with Florence Nightingale in the 19th century. Clearly, nursing research has not always had the influence and significance it holds today. In fact, for a number of years after Nightingale’s work, little is found in the literature concerning nursing research. This is perhaps due to the past perception of nursing as an apprenticeship in a task-oriented caring profession ( 1 ). Although research was conducted with respect to nursing education and administration in the first half of the 20th century, it was not until the 1950s that nursing research began the advancement that has been seen in the past three decades. This is due to many factors: an increase in the number of nurses with advanced academic preparation, the establishment of vehicles for dissemination of nursing research, federal funding and support for nursing research, and the upgrading of research skills in faculty and students. This article provides a brief review of the development of research in nursing, and along with it, the theory that has guided that process.

NURSING THEORY DEVELOPMENT

As with other practice professions, nursing requires a knowledge foundation that is based on theory and derived from systematic research. The first nursing theorist, Florence Nightingale, created detailed reports of both medical and nursing matters as chief nurse for the British in the Crimean War in the mid-1850s. Nightingale noted that “… apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion” (p. 6) ( 2 ). As a result, Nightingale’s conceptualization of nursing included the need to have an understanding of the laws of nature, the prevention of disease, and the use of personal power. She viewed persons as both physical and spiritual beings, emphasizing the importance of the environment and the need to care for the patient, not the disease. With her emphasis on the environment, changes in nutrition, hydration, and sanitation resulted, and mortality rates dropped drastically during the Crimean War ( 3 ). In subsequent years, Nightingale developed “laws of nursing” that formed the basis for nursing science and guided nursing education in the United States from 1850 to the 1950s ( 4 ).

In the 1960s, nursing theory was used to guide teaching rather than research or practice. This was a natural outgrowth of nursing’s earlier focus on education and professional identity. Additionally, the National League for Nursing (the professional accrediting body) stipulated a conceptual framework for curriculum. Paradigmatic concepts integral to nursing were identified as person, environment, health , and nursing ( 5 – 7 ), and scientific energies were spent developing curriculum that corresponded to existing theories ( 7 ). At this point in time, nurse educators began to urge students to “care for the whole person” and textbooks underscored the importance of “holism” in nursing, with subtitles such as “The Biopsychosocial Approach.” Nurse authors acknowledged multiple causality in human illness, but all too often research, curricula, and textbooks reflected linear cause-and-effect models rather than multivariate approaches.

The 1950s and 1960s saw the development of theories explaining the art and science of nursing. Hildegard Peplau published Interpersonal Relations in Nursing ( 8 ) in 1952, based on her work as a psychiatric nurse. Other theories. included Levine’s Conservation Principles of Nursing ( 9 ) in, 1967; Roger’s Introduction to the Theoretical Basis of Nursing ( 10 ) in 1970, and The Science of Unitary Man ( 11 ) in 1980, followed by The Science of Unitary Human Beings, a Paradigm for Nursing ( 12 ) in 1983. Imogene King published A Theory for Nursing: Systems, Concepts, Process ( 13 ) in 1981, and Sister Calista Roy published her adaptation model ( 14 ) in 1980. These “grand” theories were complex and key concepts were hard to measure empirically. Thus it was difficult to test these early nursing theories through research. With the emphasis on clinical nursing research, the recent trend has been to develop and test midrange theories that describe patient problems and nursing practice.

NURSING RESEARCH DEVELOPMENT

In 1859, Nightingale used the battlefield hospitals of the Crimean War as her research laboratory, using an epidemiological process to describe the morbidity and mortality of sick and injured soldiers. Her pioneering epidemiological research and statistical methodology (documenting the relationship between the environment and health status of soldiers) was the hallmark of scientific investigation in nursing ( 4 , 15 ).

An historical review from 1900 to 1949 reveals that nursing research in the United States (see Table 1 ) was in its infancy, focusing on nursing education, nurses, nursing students, and ways to organize nurses’ work. As noted earlier, at this time, nursing theory was discussed solely as a means of developing and organizing educational curriculum. Early educators were unable to develop educational programs that both represented a nursing perspective and helped students focus on nursing concepts and problems rather than medical concepts and problems. In the first half of this century, groups were formed to answer such questions as: what is nursing, what do nurses do, and how unique is nursing from other health science disciplines? Professional debates raged as to whether nursing was merely a “poor stepsister” of medicine or whether it was part of the biological, natural, or physical sciences ( 4 ). Research during this period was essentially nonexistent in terms of nursing practice.

Nursing: Historical Developments in Nursing Theory and Research

It was not until the 1980s that nursing devoted a sizeable portion of its research effort to patients and patient behavior, an emphasis that emerged logically as nurses began to recognize the interplay between behavior and rehabilitation or recovery from illness. Historically, nurses searched for single causative agents when promoting health or preventing illness, even as they acknowledged the contributions of multiple other factors. Predominant modes of inquiry relied on early in the development of a culture of nursing research were empirical (logical positivist). Nurse researchers modeled themselves after colleagues in the basic and biomedical sciences, perhaps in an effort to seek scientific validation. Only during the 1980s and 1990s did nurses increasingly use qualitative research methods, such as phenomenology and ethnography, to explain complex human phenomena. Therefore, nurse researchers are just beginning to respond to the need to view human problems in less reductionistic terms when the research questions call for a holistic combination of quantitative and qualitative research methodologies ( 16 ). Over the past two decades, many nurses have pursued further education, consultation, or research to enhance their understanding and ability to respond constructively to patient behavior. For example, by the mid-1980s, there was a sizable increase in nursing studies of individuals and families experiencing developmental, environmental, or illness-generated crisis situations involving both acute and long-term stress responses ( 17 – 20 ).

During the 1990s, nursing practice underwent a clinical revolution in response to societal, medical, scientific, and technologic advances. Changes in nursing practice began to result from nursing research (e.g., research-based practice guidelines) as the efforts of individuals both in and outside of nursing (e.g., National Academy of Science, National Institute for Nursing Research, and major foundations) coalesced to stimulate and support clinical nursing research. Concurrently, there was a new surge of interest among nurses themselves in redefining the problems of their practice and delineating the gaps in knowledge underpinning their practice base. As noted earlier, the current decade has been marked by interest in multiple modes of inquiry (qualitative and quantitative) for a practice discipline which must address complex human phenomena. In the past, the type of research questions most often addressed through nursing research were of a descriptive or exploratory nature. However, nurse researchers are now going beyond “what is” and “how” questions and are addressing more explanatory or predictive-level questions using methodologically rigorous experimental and quasi-experimental designs as they redefine clinical problems and systematically address gaps in their knowledge base. After becoming established in the research arena, nursing researchers have expanded to incorporate and collaborate on interdisciplinary studies, health care systems and health services research, and taxonomies such as Nursing Intervention Classification (NIC) ( 21 ) and Nursing Outcomes Classification (NOC) ( 22 ). The taxonomies represent efforts to define what nurses do and outcomes sensitive to nursing interventions.

The culture of nursing research has now advanced to the point where consideration can be given not just to the conduct of research, but also to its application in practice. The conduct of research is not the end, but rather a means through which practice is improved by utilizing research findings. Research utilization is the process of conveying and applying research-based knowledge to impact or change existing practices in the health care system ( 23 ). The primary components of research utilization involve summarizing knowledge generated through research; imparting the research knowledge to nurses, other health professionals, policymakers, and consumers of health care; and accomplishing desired outcomes for patients, their families, and health care providers and agencies. Models for research utilization were developed in the 1970s, beginning with the Western Interstate Commission for Higher Education in Nursing (WCHEN) Regional Program for Nursing Development ( 24 ). Other models include the Conduct and Utilization of Research in Nursing (CURN) project ( 25 ), the Stetler/Marram model ( 26 ), the retrieval and application of research in nursing (RARIN) model ( 27 ) and the Iowa model of research in practice ( 28 ). The primary goal of research utilization programs is to make research findings an integral part of nursing practice, assuring research-based care delivery models. Research utilization is an excellent model for application of research findings to practice by advanced practice nurses.

An important trend is the use of research findings to serve as the basis for treatment decision making called evidence-based practice ( 29 ). Using this process, a question involving treatment is developed, and determination of the adequacy of current research is made. If the research base is adequate, it is synthesized, protocols are developed and applied, and evaluation is completed. Through these efforts, the nursing profession, in partnership with other professions, bridges the gap between research and practice to improve patient care.

EDUCATIONAL ADVANCEMENT

Early nursing education took place in hospital training programs (nursing diploma), modeled on Florence Nightingale’s work in the United Kingdom ( 30 ). In 1915, nursing’s educational accrediting body, the National League for Nursing (NLN) called for university-level education. Baccalaureate programs in nursing emerged in 1923 at Yale University and Western Reserve University, but the majority of nursing education took place in hospital-based diploma programs. In 1971, the first community college programs for nursing education opened, providing graduates with an associate degree in nursing. Today, entry into nursing practice takes place primarily in associate degree programs, with baccalaureate programs second. Gradually, diploma programs have decreased in number, and few exist today. Associate degree programs may introduce nursing students to research, but baccalaureate programs included nursing research in the upper division curriculum. From 1900 to the 1960s, most nursing leaders obtained their graduate-level preparation in schools of education ( 30 ). For many years, the Master’s degree was considered the terminal degree in nursing.

The number of nurses whose career was devoted to research was miniscule in the 1960s. Indeed, even by the 1970s only about 400 nurses in the United States held a doctoral degree ( 31 ). In 1955, the Nursing Research Grants and Fellowship Program of the Division of Nursing, United States Public Health Service (USPHS) was established. This program awarded grants for nursing research projects, nursing research fellowships, and nurse-scientist graduate training ( 32 ). Early funding was for nurses to obtain their doctorates in fields outside of nursing, because there were no nursing doctoral programs available. As a result, nurse-physiologists, nurse-anthropologists, and so forth emerged in the field. They were educated to conduct research, but often stayed in the field of their doctorate and did not apply their research efforts to nursing care problems.The emphasis during this period continued to be on establishing nursing’s rightful place in the academic setting of the university. As nursing became integrated into university life during the 1970s, nursing faculty became aware of their responsibility to develop new knowledge, and in many university-based schools of nursing, faculty members began to prepare both themselves and their students to become investigators ( 33 ).

Currently, three types of doctoral degrees in nursing are available. A Nursing Doctorate (ND), first established at Case Western Reserve University in 1979, was designed to be equivalent to the Doctor of Medicine degree, providing students preparation for the practice of generalized nursing and future leadership, but not for advanced practice. Professional doctorates, Doctor of Nursing Science (DNS, DNSc, DSN), emphasized advanced clinical, administrative, or policy-related practice and leadership. The Doctor of Nursing Science degree focuses on applied rather than basic research, and on applying and testing new knowledge in practice. Although the Doctor of Philosophy (PhD) was first available to nurses at Teachers College at Columbia University in the 1920s, interest in doctoral education was rekindled in the 1970s. The number of doctoral programs in nursing has increased from zero in the 1950s to over 65 institutions, three-fourths of which are academic doctorates (PhD) that prepare graduates for a lifetime of scholarship and research ( 34 ). More recently, nurses in academic settings have been encouraged to obtain postdoctoral research training with support available through both individual (F32) and institutional (T32) traineeships through the National Institutes of Health (NIH).

RESEARCH FUNDING AND SUPPORT

Several factors stimulated the growth of nursing research in the 1980s and 1990s. Perhaps the most important factor was the creation in 1986 of the National Center for Nursing Research (NCNR) in the United States Public Health Service (USPHS). The development of this Center resulted from intense political action by the American Nurses’ Association (ANA) ( 23 ). The primary aim of the NCNR was “the conduct, support, and dissemination of information regarding basic and clinical nursing research, training and other programs in patient care research” (p. 2) ( 35 ). Prior to the establishment of the NCNR, most of the federal funds supporting research were designated for medical studies that concentrated on the diagnosis and cure of disease. Thus, creation of the NCNR was a major achievement for nurse researchers. In 1993, the NCNR became the National Institute of Nursing Research (NINR), strengthening nursing’s position by giving the Center institute status within the NIH. This advance served to put nursing into the mainstream of research activities and on more equal status with scientists and other health professions. With the establishment of the Center and then the Institute, federal funding for nursing research has grown. In 1986, the NCNR had a budget of $16.2 million. In 1996, the budget for the NINR was about $55 million ( 1 ), more than a threefold increase over a decade. The NINR elected to foster five research priorities for 1995 through 1999: community-based nursing models, effectiveness of nursing interventions in HIV/AIDS, cognitive impairment, living with chronic illness, and biobehavioral factors related to immunocompetence ( 22 ).

The NINR’s strategic plan for the next millenium includes funding nursing research on chronic illnesses (e.g., improving adherence to chemotherapy, pain relief), quality and cost effectiveness of care, health promotion and disease prevention, management of symptoms (e.g., gender differences in response to therapeutics, managing the pain cycle), health disparities (e.g., cultural sensitivity), adaptation to new technologies (e.g., transplants), and palliative care at the end of life. Special allocations and Requests for Applications (RFA) have facilitated research in these target areas, although investigator-initiated research topics are funded if they are significant to nursing or patient care. The projected budget for NINR for the year 2000 is over $70 million, which is approximately distributed as follows: 73% for extramural research project grants; 8% for pre- and postdoctoral training; 3.5% for career development; 3.5% for Core Centers in specialized areas of research inquiry; 3% for the intramural program. Planning research for the next 5 years and into the next century is a welcome challenge for the NINR and the scientific community ( 36 ).

RESEARCH DISSEMINATION

Significant milestones in the development of nursing science began in the mid-1950s (see Table 1 ). From 1950 to 1959, there was growing emphasis on the need to identify a body of knowledge for the developing profession of nursing in order to justify its presence in post-World War II universities ( 37 ). Not only was the first journal of Nursing Research established in 1952; several textbooks related to nursing research were also published. Another critical step in the evolution of the culture of nursing science was the establishment of the American Nurses Foundation by the American Nurses Association specifically to promote nursing research. During the 1950s, regional research conferences were instituted for the first time, and federal support of nursing research began ( 4 , 33 , 37 ). All these elements were essential to the development of a science of nursing.

Several new nursing research journals, including Applied Nursing Research (ANR), were instituted in the late 1980s. ANR publishes research reports of special significance to nurse clinicians ( 1 ). Increasingly, clinical specialty (i.e., Heart and Lung, Journal of Gerontological Nursing ) journals are publishing data-based articles as well.

Another important event in the development and dissemination of nursing theory and research was the creation of the Annual Review of Nursing Research in 1983. This publication includes critical analyses of research pertinent to nursing and health, including nursing practice, nursing care delivery, nursing education, and the nursing profession. Chapters systematically assess knowledge development in nursing, encourage the use of research findings in practice, and provide direction for future research ( 22 ). More recently, scholars have joined to create the Encyclopedia of Nursing Research ( 38 ), a publication that provides a comprehensive overview of research studies, the history of nursing research, and the evolution of theory development in nursing.

The next century challenges nursing research with critical imperatives for improving health care. Changes in our nation’s population and their needs and expectations will impact the direction of nursing research. Consumers are becoming more involved in managing their own health care, and practitioners are continually adjusting to new technologies as well as innovative health care systems. The broad spectrum of nursing research encompasses both clinical and basic investigations with the patient as the central focus. Nursing must concentrate on making certain that our valuable scientific findings are incorporated into practice and focus on developing the next generation of nurse researchers ( 36 ).

The research culture in chiropractic is similar to where nursing research was in its early years. To move chiropractic research forward will require many of the same changes that occurred in nursing, such as educational advancement, collaboration in academic settings, federal acknowledgement and support, and development of more avenues for research dissemination to practitioners. Just as nursing had to overcome significant barriers such as attitudes and low educational and professional status, so, too, will the chiropractic profession have to strive to develop a research tradition in order to integrate research as part of its practice culture.

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History of Nursing

The history of nursing encompasses the story of the largest section of the health care workforce, in war and peace, home and hospital. It includes the nursing care of adults, mothers and babies, children, and people with a learning disability or mental health problem. Use this guide as a starting point to find information resources related to the history of nursing including books, journals, archives and exhibitions.

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The RCN Library and Archive Service holds an unrivalled range of English language nursing journals from around the world. The earliest issues date back to 1888 with titles covering a wide variety of nursing fields.

If you are a member of the RCN you have access to a digitised collection of 22 nursing journals from the Royal College of Nursing Collection covering dates from 1891 to 1986. It contains information about nursing, hospitals, wards, staff, illness and diseases, medicine and treatments, hospital equipment and events.

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Once Upon a Time Exhibition

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Women’s History Series: Dr. Sumiko Fujiki, College of Nursing

In the early 1900’s , Jusaburo and Shigeyo Nishimura Fujiki immigrated from Japan to Devil’s Slide, Utah, and in 1926 , they gave birth to a girl, Sumiko, who would later make significant strides in the health sciences at the University of Utah.

Sumiko Fujiki studied nursing at the University of Utah and graduated in 1949 . Soon after graduating, she began teaching at the Thomas D. Dee Memorial Hospital School of Nursing in Ogden. As one of the first to receive a federal grant from the National Institute of Mental Health, she then studied for her Master’s degree in Psychiatric Nursing at Washington University in St. Louis, Missouri. For a brief amount of time, she also taught at this university.

In 1957 , Fujiki returned to her home state because the University of Utah recruited her to create and direct a brand new Master’s program in Psychiatric Nursing. This program was federally funded and was the first graduate program at the university. Fujiki’s main assignment within the first year of the Psychiatric Nursing program was to work with other faculty to create a curriculum that would become the outline for the general graduate program at the College of Nursing . Four students enrolled in the program the first year. Fujiki was the director of this program until the mid 1970’s. She also was tasked with recruiting students into the program for Fall of 1958.

In 1976 , Sumiko Fujiki became Dr. Fujiki when she earned her PhD in Education from the University of Utah. She died in 2001 . She was widely respected in the field throughout the country and is remembered as a pioneer in psychosocial nursing education in the state of Utah. -Explore the College of Nursing digital collection -Visit our History of the College of Nursing digital exhibit Images courtesy of Historical Collections, Spencer S. Eccles Health Sciences Library, University of Utah.

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