HISTORICAL EVOLUTION OF NURSING CARE

INTERNATIONAL, LATIN AMERICA AND IN PERU

 ORIGIN AND HISTORICAL EVOLUTION OF COMMUNITY NURSING
The
Saint Vincent de A severe Elizabeth Fry founded
her own first school
—.—K--------------------------., Paul founded the smallpox outbreak occurred. Dr.
nursing school, which of public
Hernan Cortez founded religious Bartolache published a became the first Protestant health nursing is
the order of the Sisters of book about the cure for organization
born
Hospital of the Cure and Charity, the precursor the same. to
train and
Immaculate Conception of of home
certified nurses. Nightingale's
Our Lady, which was a very visiting.
thinking evolves
important center for curative
16th First half of the towards
century 17th century
1840 1862
14th
century 17th 18th century 19th 1842
centu (1777) century
ry
Saint Catherine A decree was issued, Public health
of Siena during In France, Saint Francis de Sales whereby foreign evolved William
the time of the and Jeanne Chanta founded an doctors had to significantly and in Rathbone undertook the task of
black plague in association appear before the 1920 training nurses
to work in the community and in
Italy spent her time of visiting friends protomedicato in order to there were
home visiting
visiting the to help poor practice medicine significant and education.
people in their homes. in the country. advances health and social assistance
,
establishing
the foundations of its current
concept
.
 In Mexico the beginning

Public Health Nursing and three years later

the first Public Health course
was organized, where students

Dr. José ma., were instructed in personal hygiene, The The creation of
Luis Mora, advisor to In the legal aspect National School a corps of
of article 28 communicable
of diseases, vaccines, health of Childcare is created,
Dr. legislation, etc.
The
the general health which will visiting nurses
Valentín Visiting Nurse service
instruction, later teach,
Gómez Farías, was organized in Cuba,
visiting nurses among other things, from the
conceived courses national
are created, but their creating the School of
the orientation of the real effectiveness begins Nursing health school is
right much later. for visiting nurses and considered
for Tuberculosis
L
to health, childcare professionals.
1883 which did 1909
Patients. necessary.
not include 1904
1923 1930
social aspects.
1906 1927
XX

USA. The
visiting nurse In Chite,
There were constant The the first course in Sanitary
movement began corporate disputes first Nursing School was Nursing
between nurses and was started, creating
where founded in Ecuador.
the Charity Nursing
practitioners School
the first nurses , which led to the whose graduates could enter
were sent to creation of legal advanced courses in
homes. reports to define the Public Health.
functions of
 The figure of the visiting

The Corps of
health nurse was The WHO, published in its report It is
created, whose The emergence Nursing and characterized
Home Public
functions included of Community Health, above all by
Assistance Practitioners recommended
education and home technical health workers until the
is established, structural changes in
visits. A whose main nursing practice
the creation of health technological
year later, the mission would be " and training, as well as
centres a focus on basic community development
first 50 positions medical-surgical
and problems of
were announced to auxiliary assistance.
the effective implementation .
healthcare
carry out their of primary resources
work in health care in Spain. and by a clearly
1932
anti-tuberculosis 1935 1950
dispensaries. 1974
hospital-centric
healthcare
September 26th
1933 1942 1952 system
1930 19
.

The royal order

indicates that The regulations of By Decree, the
the intern The the Central School of Sanitary
This is the first step
study plans existing
function will Red Cross regulations indicate Instructors are approved, until then were towards a
also be that of a that the functions of whose unified, replacing new way of conceiving
medical assistant the professionals would develop their the names the nursing
psychiatric visiting nurse will be work of nurse, practitioner and profession
corresponding to the mainly in the midwife with the new common
to visit patients in Spain
municipal Provincial title
health services, at home and to Health Headquarters of
especially understand the patient's moral technical health assistant.
 AT INTERNATIONAL LEVEL

Throughout the 20th century there were periods of shortages within

nursing. Many refused to participate in a work structure that offered
few rewards, long hours, hard physical work and very low wages.

This situation was compounded by other significant events that led to

the gradual development of a new organizational model for hospital
care.

The demonstrated success of resuscitation rooms at the front during

World War II led to the creation of special units for patient care.
Post-anesthesia and recovery rooms were established to prevent
postoperative complications.

In this way, it was possible to establish a progression from the intensive

care unit to the intermediate care unit, to the self-care unit, to the long-term
care unit and to the home care unit.

This development of specific types of units required the need for some
type of specialized nursing and altered the nurse-patient ratio in some
areas, which contributed to further accentuating the lack of professionals.
The quality of nursing care and patient satisfaction declined as fewer and fewer
registered nurses provided direct care to patients.

The work was coordinated, but nursing care was fragmented.

It had serious consequences due to the continuous advances in diagnostic and

therapeutic procedures and the development of increasingly sophisticated
technology. The 1950s and 1960s were a time of revolution in health care.
In the seventies, the distance between the professional nurse and the
patient was shortened.

At New York Hospital, the overall goal is to provide quality, ongoing nursing
care to promote healing, prevent complications, promote health, and prevent
relapses and new illnesses.

Nursing care is provided exclusively by professional nurses in a context that

encourages the transfer of the patient from the general hospital to the home.
The nurse is the primary factor in patient care and coordinates the combined
efforts of the patient, the family, and her own to resolve problems that may
hinder full recovery.

Medicine is considered a secondary treatment

Acute care hospitals were started.

Nurses were frustrated in their efforts by inadequate staffing, an emphasis on

efficiency, and a lack of consideration for patient tendencies.
 AT LATIN AMERICAN LEVEL

In the 1970s, the combined goal of nursing care by professional nurses and
comprehensive patient care began to become a reality with the emergence of
primary nursing.

The primary nurse is responsible 24 hours a day, seven days a week

Primary nursing care assumes responsibility for the full range of functions
including education, consultation, comprehensive and continuing care, care
planning and assessment, documentation of progress, discharge planning
and referral to secondary services and facilities.
American “training schools” did not foster the development of critical
thinking or problem solving.

Restless minds were not given rigid discipline and unquestioning

obedience.

In nursing schools, they reduced individualism, creativity, critical thinking,

and confidence.

They served to place students and graduate nurses in a submissive role,

and remained so for many years.
Nursing was not conducive to research, nor were there nurses
trained to undertake it. The need for nursing research was already
recognized by early leaders, who committed themselves to the
scientific method of collecting and interpreting data to generate new
knowledge aimed at improving nursing care.
A series of events eventually led to a firm commitment to incorporate nursing
research into the overall structure of the profession. The Association of
Collegiate Schools of Nursing (ACSN) sponsored a special forum on nursing
research in 1941. The ANA House of Delegates approved a research
program in 1950.

The launch of the journal Nursing Research in 1952 was a

reflection of the promotion and communication of nursing
research.
In 1955, the American Nurses' Foundation was established as a
member corporation of the ANA. This foundation provides research
grants to graduate nurses for scientific and educational projects;
conducts studies, reviews and research; provides scholarships to public
and private non-profit educational institutions; and publishes scientific,
educational and literary works.
Between 1940 and 1956, the Department of Health, Education and Welfare
awarded small grants to a number of individuals for various research
projects.

In 1956, an external nursing research fellowship program was formed in the

Division of Nursing Resources of the United States Public Health Service.

In the 1970s, nursing research was integrated into all collegiate training
programs.
The value of nursing research will become increasingly important as nursing
continues to advance toward professional status and excellence in performance.

The research will result in the establishment of the quality of care. The most
efficient and effective forms of nursing can be identified through research.

Nursing is beginning to be recognized as a legitimate science, although

continued momentum is still needed to achieve this goal. The combined efforts
of nursing students and nursing practitioners are essential to identify the
knowledge base of nursing and to formulate a theory or theories that underpin
professional practice.
 Advances in training

The development of university nursing programs began with diploma

studies. The lack of nurses trained for teaching and administrative positions
was evident.
Dr. Louise Fitzpatrick (1983) describes the following four phases:

a) Origins: 1939-1952. This phase is related to the difficulty of tracking the

development of nursing training programs. However, several important
events were taking place. Diploma programs of various types were on
the rise.
Transition stage: 1953-1964. It was during these eleven years that the
bachelor's degree was recognized as the advanced level of nursing training.
Guidelines for organization, administration, curriculum and examination were
formulated and a Subcommittee on Nursing Graduation Education (of the
NLN) was established. In the 80s a new trend is being produced again as the
position favourable to double preparation is gaining importance.

Regionalization. Regional planning for graduate education began in the

1950s with the creation of two organizations: the Southern Regional
Educational Board (SREB) and the Western Interstate Commission on Higher
Education (WICHE). Both were dedicated to improving nursing through
stronger baccalaureate programs to prepare faculty.
Maturation of the degree: 1964-1975. The nursing degree
matured and became an important credential for nurses holding
managerial positions in those years. Interest in research and an
expansion in the number of diploma programs within clinical
specialties. The Nurses Education Act of 1964 provided a large
financial allocation for construction, faculty development, student
scholarships, and loans.
There was fear that nurses were erudite and posed a threat to medical
hierarchies.

The first Doctor of Nursing Science degree in psychiatric nursing was

initiated at Boston University in 1960. Pedagogy was the most popular
discipline.
 The era of specialization

The concept of nursing specialties was literally unknown before the

influence of Florence Nightingale and the emergence of modern nursing.

Each nurse was expected to care for the patient without regard to the type
of illness that warranted care.

The sick were not separated by illness until the first decades of the 20th
century.
The first nursing specialties emerged in the late 19th and early 20th
centuries: the nurse-midwife and the nurse-anesthetist.

The company nurse. This specialty arose as a response to the risks and
abnormal health conditions in shops, factories and other fields of industrial
work.

The 1960s witnessed another period of remarkable growth in nursing

specialization, which has continued to the present day.
In 1954 Hildegard E. Peplau developed the first graduate-level
program for the preparation of clinical specialists at Rutgers University;
the program's specialty area was psychiatric nursing.

During this period, the “practical nurse” was also introduced as a result
of a specific demonstration funded by the Commonwealth Foundation
at the University of Colorado in 1965.
 Nurses were taught to make judgments about serious or chronic illnesses
in children and to practice as pediatric emergency room practitioners.

ROYAL PROTOMEDICATE COURT

Royal Protomedicato Tribunal: technical body responsible for supervising the

practice of health professions (doctors, surgeons and pharmacists) and for
carrying out a teaching function and attending to the training of these
professionals.
Created in Spain in the 15th century, in the 16th century it spread to the
colonies, founding the protomedicatos of Mexico and Peru, and later that of
the Río de la Plata.
Suppressed in the early 19th century.
 AT THE BEGINNING OF THE 20TH CENTURY:

The birth of the International Red Cross was another key point for the
reform of nursing. J. Henri Dunant
International Council of Nurses ICN: Founded in
1899, it is the oldest nursing organization in the
health field. It is an association of nurses from

yjr«
around the world with the aim of contributing to
the development of nursing, health promotion and
nursing care.
Methods to Treat the Disease

❖ Healing systems vary among common peoples:

❖ Religious rituals
❖ Herbal medicine treatments and surgical methods
❖ Great importance to prevention: Ingestion of medicinal herbs, sweating
baths, purification to maintain a healthy body, use of fetishes and
amulets for protection.
EUROPEAN INFLUENCE

• Arrival in America of Christopher Columbus (supported by the Crown of

Castile) in 1492, beginning of Spanish colonization, development of
trade and gain of wealth.
• Harsh travel conditions for explorers = emergence of numerous
diseases.
• Spanish diseases: typhus and smallpox (decline in American
population).
• American diseases: exploratory syphilis, conquistadors and conquered
exposed to new diseases (not immunized, did not know treatments)
Spanish influence also had positive effects: Transmission of new
remedies and approaches to assistance and care of the sick, Imposition of
Castilian approaches to the concept of health, illness and criteria for its
cure, Medicine: Chair of Medicine in Salamanca before 1492.

In 1503: Isabel la Católica governor Ovando, creation of hospitals to treat

the sick (Christians and Indians)
1509: Hispaniola Hospital of San Nicolás de Bari, of San Buenaventura
and of Concepción de la Vega, Universities: University of San Marcos de
Lima (1551, Dominicans, oldest), Royal and Pontifical University of
Mexico (1551) Conquistadors also benefited from pre-Columbian cultures:
pharmacological knowledge
Religious Orders
Construction of churches, hospitals, schools, universities responsible
for evangelization, education and protection of public health.
Nursing was clearly a religious function (devout service + salvation of
souls). Religious orders dedicated to nursing care: Augustinian Nuns,
Ursuline Nuns, Sisters of Charity.
MEDICINE IN THE COLONIAL ERA
Universities of Lima and Mexico: cultivation of different areas Medicine: first
schools of Medicine (University of Mexico, 1578; University of Lima, 1600)
Creation of churches, buildings, bridges, HOSPITALS (charity houses with
built-in nursing):
• 1524: First hospital on the continent, in Tenochtitlán by Hernán Cortés:
Hospital of the Immaculate Conception (later Hospital of Jesus of Nazareth)
• 1528: Santa Fe Hospital (present-day New Mexico)
• 1524 – 1802: creation of some 30 hospitals, with religious personnel
male and female
NURSING IN THE COLONIAL ERA
Nursing in colonial times was not considered a medical profession, nurses
were considered hospital servants or doctors.
They did not receive formal training in assistance tasks
Functions:
• Preparation of medicines:
• Poultice: a mixture of moist herbs that is pressed against a painful or
inflamed part
• Boluses: large dose of pill-like medicine
• Bandaging and wound care
• Burning incense to fumigate and purify the hospital
• During wars: preparing food, cleaning and making beds, bandages.
Main utensils of colonial nurses:
• Bandages
• Splints
• Tourniquets
• Sutures.

Smallpox inoculations: a vaccine-like method, beginning of preventive

medicine and immunology.
Later replaced by vaccines (modified method, Edward Jenner, 1789, less
dangerous)
 AT THE PERUVIAN LEVEL

ANCIENT AGE
Primitive man, faced with his wounds, imitates the behavior he has observed
in animals, and so immobilizes an injured limb, licks his wounds, and worries
about external injuries.

The first human civilizations and cultures based their medical practice on
two apparently opposing pillars: a primitive and pragmatic empiricism
(mainly applied to the use of herbs or remedies obtained from nature) and a
magical-religious medicine, which turned to the gods to try to understand the
inexplicable.
THE PRE-INCA PERIOD (S VIII BC–S II AD)

It was Paracas, its cloaks and ceramics reveal its advances in medicine
and surgery, using the healing power of plants, the art of embalming and
cranial trepanations.
Knowledge of anatomy, physiology and hygiene were his
pillars.
 INCA PERIOD (11th - 16th century)

The Tahuantinsuyu or Inca Empire is

considered the first culture in South
America. He had a social policy on
nutrition and agriculture that was very
advanced for its time.

They used phytotherapy (retama, molle,

matico, coca, etc.).
 INCA PERIOD (11th - 16th century)

The Incas went so far as to perform

amputations, bandages, They used herbs
as
anesthetics, analgesics. Health and life
care was based on a spirit of service that
Nursing and Medicine represent today.
 THE COLONIAL ERA

The health of the indigenous people was

weakened by slavery and inadequate nutrition.
Syphilis, a disease that killed many residents.
 THE COLONIAL ERA - DARK STAGE OR PERIOD OF NURSING (1550
- 1860)

Urgent need - Recruiting women from all backgrounds. Jail sentences were
negotiated in exchange for performing tasks to care for the sick.
For nursing: Surviving the worst humiliations and conditions ever faced.

In 1541, hospitals were created by a royal ordinance of Isabella the Catholic,

Charles V and Philip II.
Doctors trained them to administer certain medications and types of care for
various ailments.
The first hospital was created in 1537, called “San Andrés” to care for
poor Spaniards; then in 1549, it cared for the mentally ill.

In 1651 the “San Bartolomé” Hospital was created for slaves and is now
known as the Military Hospital.

In 1669 the “Santo Toribio de Mogrovejo” Hospital for incurable patients

was established; now the National Institute of Neurological Diseases.
Later, the “Santa Ana” Hospital was created, later called the Lima Maternity
Hospital and currently the Maternal Perinatal Institute.
Care for the sick was precarious and very deficient, resulting in patients
being hospitalized for weeks or months.

On May 12, 1551, the Royal Pontifical National University of San Marcos,
today UNMSM, was created; operating in the Rosario de Santo Domingo
convent

The first nursing school established in the country, in 1907, operated at the
Bellavista Health House, Callao. It was administered by the Society of
Medical Institutes, and had an English nurse as director.
 Anonymous CompanyBELLAVISTA HEALTH

1907 HOUSE

Create 1* Nursing School

Canons of the Nightingale School

 FOLLOWING
YEARS
Mixed School of Nursing

Archbishop Loayza is brief

I School of Nursing at Hospital 3 4 of the Child

MINSA, Public Charity of Lima, the Health of the

Armed Forces, and Social Security
 STildSOH 9LL

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 1955
Pontifical Document

September 10,
1958 SANTA ROSA DE LIMA
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 DL No. 2231517

1978
July 1978

Ethics and Ontology Monitoring

1st year: 9,308 members registered.

 1983 CEVIT

UPCH
Archbishop
Loayza Hospital
School
UNAC

School School
Children's Daniel Hospital
• SEADo5 V TITLES out OTOAGAN LAS UNIVERSIDA Hospital
- BACHELOR'S DEGREE TEACHER
- DOCTOR
The government, concerned about providing graduates of human
resources training centers in health with experience that would
increase their knowledge of the national reality in what has been
called "deep Peru", welcomed, in 1978, the proposal to create a
mandatory social service for university graduates, as part of their
professional training, through a Pilot Civil Program for Graduates of
Health Sciences (SECIGRA).
On February 15, 2002, Nursing Labor Law No. 27669 was enacted,
establishing the role and scope of nursing expertise, responsibilities and
functions, as well as rights and obligations, career levels and work
modalities. On December 10, 1983, in anticipation of the new general
education law, Law 23330 was enacted, which created the Rural and
Marginal Urban Health Service (SERUMS), replacing SECIGRA SALUD.
 E20N1F6: Official Gazette El Peruano Law No. 30459 known as the LAW OF THE OFFICE OF
the
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1392949-1
LAW No. 30459 The Executive Branch adapts the Regulations of Law 27669. Nurse Labor Law,
approved by Supreme Decree 004-2002-SA. as established in this Law. Within a period of
THE PRESIDENT OF THE CONGRESS OF THE REPUBLIC no more than thirty (30) business days counted from the start of the validity of the rule.

WHEREAS: THEREFORE:
The Law having been reconsidered by the Congress of the Republic, accepting the
THE CONGRESS OF THE REPUBLIC; observations made by the President of the Republic, in accordance with the provisions of
He has given the following Law: article 108 of the Political Constitution of Peru, I order that it be published and complied
with.
LAW THAT INCORPORATES THE In Lima, on the twenty-fifth day of the month of May, two thousand and sixteen.
SECTION K) TO ARTICLE 9 Luis Iberico Nunez
President of the Congress of the Republic
OF LAW 27669, NURSE
WORK LAW NATALIE CONDORI JAHUIRA
First Vice President of the Congress of the Republic
Unique article. Incorporation of paragraph k) to article 9 of Law 27669. Nurse Labor Law
Subsection k) is added to article 9 of Law 27669. Nurse Labor Law, with the following
text:

'Article 9.- Rights

The Nurse has the right to: (...)
k) Carry out their professional work in accordance with their functions and competencies,
established in the current legal framework, through private activities and/or offices called
"nursing professional offices", which must comply with the standards established by the
National Health Authority.
FINAL SUPPLEMENTARY PROVISION

UNIQUE. Regulation

a 1392947-1