In the Middle Ages, the Christian church was concerned with health issues. Temples welcomed the sick and infirm within their walls, and deacons cared for them. They were assisted by women who were called deaconesses. In the eleventh century, in the European states, for example, in the Netherlands and Germany, women’s associations were formed to care for the sick. The associations themselves survived almost until the twentieth century, and the volunteers were called beguines. In 1617 in France, the priest Vincent Paul and his associate, Louise de Marillac, created a community of daughters and Sisters of Mercy.
At first, they held seminars for caregivers and nurses, and in 1641, they founded a special school to train them. Communities of Sisters of Charity were established in many countries of Europe. By the middle of the nineteenth century, approximately 16,000 women had joined their ranks (Rosenthal, 2021). The Daughters of Charity were the largest religious women’s organization in the world. Florence Nightingale, an Englishwoman, established a community of professional nurses during the Crimean War (1853-1856). Sisters of Charity and nuns were sent to field hospitals in Crimea and Turkey to care for the wounded.
In 1882, a community of Sisters of Mercy was created within the Red Cross system. In 1912, the medal for nurses was established. By the beginning of World War I, in 1914, there were 20,000 nurses working in military hospitals. By 1918 their number had risen to 30,000, and, during World War II (1939-1945), nurses showed particular courage. Women worked not only in military hospitals but also on the battlefields, pulling soldiers from under exploding shells and providing them with emergency medical care. In the USA, some 500,000 self-employed and female nurses worked as nurses throughout the war, 90,000 of whom died (Nightingale & Maureen Shawn Kennedy, 2020). In 2020, the nursing profession has become one of the most important in the world because of the COVID-19 pandemic. It could be said that today, nurses are on the front lines in the fight against the dangerous virus. They hardly ever see their family members as they stay in and out of hospitals 24 hours a day, trying to keep numerous patients alive.
Modern nursing care must be based on a scientific approach and evidence-based practice, presenting the nurse as a professional who makes independent decisions and plans and provides evidence-based care as reflected in patient care documentation. Evidence-based medicine has been defined as the integration of best, evidence-based evidence, professional qualifications, and the importance of patient participation in clinical decision-making. Evidence-based practice includes the following components of the theoretical model:
- The patient’s clinical condition;
- The environment and circumstances of the disease;
- Patient preferences and actions;
- Evidence-based data and health care system resources (Nightingale & Maureen Shawn Kennedy, 2020).
These four components are brought together by a fifth overarching element: professional excellence. The patient’s status, environment, and circumstances (comorbidities, social, geographic, or logistical factors, and environment) may influence the patient’s response to nursing manipulation. In the scenario presented above, the favorable home environment allows Mrs. Maria to perform pararethral cleansing before catheterization with sterile water rather than an antiseptic solution (Nightingale & Maureen Shawn Kennedy, 2020). Patient preferences and actions play a leading role in decision-making in clinical circumstances. Patients’ preferences are determined by their values and experiences, their risk aversion, financial capacity, family relationships, and level of knowledge. Preferences may not influence a patient’s actions and will not necessarily be consistent with the recommendations of the treating physicians. For example, Mr. James, the patient in this scenario, chose to forego additional adjuvant therapy for malignancy, even though it may have slightly increased his chances of survival.
The scientifically sound data include “methodologically sound and clinically relevant studies on the effectiveness and safety of nursing manipulation, the accuracy and appropriateness of nursing assessment measures, and the effectiveness of prognostic markers” (Nightingale & Maureen Shawn Kennedy, 2020). For example, the evidence bases for treating the periurethral area or umbilical cord with distilled water instead of antiseptic solution can be found in data from randomized controlled trials (RCTs) by Cheung et al. and the Cochrane Systematic Review (Nightingale & Maureen Shawn Kennedy, 2020). One of the main features of the evidence-based system of views is the fact that not all data derived from the search for answers to specific questions can be equally trusted in direct decision-making.
The evolutionary path of the profession was reflected in the way the work with patients was carried out and the principles on which the latter were based. The number of people belonging to a single specialist decreased over time, which influenced the increased popularity of the individualized approach (Polit & Beck, 2022). With the opportunity to spend more time with patients, nurses began to be able to pay attention to the psychological and spiritual components that influence the effectiveness of the treatment process.
There are now many opportunities to become a nurse in the U.S., taking advantage of several programs. The most common are associate degrees and bachelor’s degrees. In terms of competencies, the difference is that the first program includes the most basic and basic nursing procedures, including informing patients, interacting with doctors, and working with necessary medical equipment (Polit & Beck, 2022). A baccalaureate nurse must be competent in working with more complex procedures, as well as the ability to supervise nursing assistants. Moreover, this degree can be a launching pad for becoming a teacher or medical manager.
The difference between the two programs can easily be seen when analyzing a specific patient situation. For example, if a patient with signs of acute respiratory illness becomes a hospital client, the care would be the ADN’s job, whose job would be to guide the entire treatment process, interact with doctors, follow up on procedures, and address individual needs. However, if unpredictable complications are discovered in the course of treatment, the competence of this medicine will not be sufficient. It will require the involvement of a BDN who has more academic and practical knowledge to handle unusual situations, adjust the treatment plan, and accompany more complex procedures, including connection to a ventilator.
The latter can be accomplished at a greater level at the undergraduate nursing level. This type of education allows the specialist to apply a great deal of academic experience, from which the right conclusions can be drawn about the appropriate treatment strategy (Rosenthal, 2021). At the same time, research data show that the mortality rate in cases of ADN degree nurses under evidence-based medicine is significantly higher.
An important innovation here today is the building of effective communication by nurses with interdisciplinary teams, such as the psychological community and social workers. This collaboration allows hospitals to maximize multifactoriality in treatment by taking into account the hospital client’s environment, psychological state, values and attitudes. This type of work makes the individualized approach more effective and increases the degree of trust between all involved in the treatment process.
References
Nightingale, F., & Maureen Shawn Kennedy. (2020). Notes on nursing: What it is and what it is not. Wolters Kluwer.
Polit, D., & Beck, C. (2022). Essentials of nursing research: Appraising evidence for nursing practice. (10th ed.). Wolters Kluwer Medical.
Rosenthal, J. (2021). Lehne’s pharmacology for nursing care. (11th ed.). Saunders.