Evolution of Nursing

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Evolution of Nursing

When nursing started, it was mostly concerned with gender and a willingness to the job and not formal medical apprenticeship. Nurses were viewed as inexpensive or free labor with limited tasks up until the 19th century. Florence Nightingale is often credited as the founder of modern nursing. She changed social norms associated with nursing and advocated for the education of nurses. In the Civil War, volunteer nurses who cared for wounded soldiers changed the public understanding of nursing. By the late 19th century, hospitals began nursing training programs which helped improve quality, safety and humanized care. By late 20th century, hospital-based skill gathering model reduced in favor of college and university training programs. Nursing has since changed from a practice-based profession to a specialized discipline that incorporates high scientific methods within the past few decades. Presently, clinical nursing has evolved to include sophisticated processes and evidence-based skills such as complex monitoring or catheterization. With the advancement of technology, clinical nurses have adapted to using new resources, materials and techniques to improve patient care delivery. Patient care has evolved from a demoralizing participation for patients as many care givers were not concerned for a client’s dignity to a state where patient care has become the first priority for healthcare professionals with nurses being on the frontline.
            Both associate and baccalaureate nursing degree holders practice professionally as registered nurses though they may tend to differ in their practice competencies based on differences in their nursing education. An ADN, Associate Degree in Nursing, typically takes 3 years and is technical in nature and involves the clinical skills needed to advance the health of a patient. ADN nurses are often accountable for their task-oriented practice. These nurses must be capable of planning, evaluating and exercising efficient patient care from patient admission to patient discharge, since they are registered professionals. On the other hand, BSN, Bachelor of Science in Nursing, typically takes 4 years and involves a broader array of nursing aspects such as supervision, critical thinking, patient care, medication management, community health and other nursing roles. It is mandatory for baccalaureate nurses to demonstrate problem solving and informed decision-making skills by incorporating intellectual, emotional, social and physical competencies to improve patient health outcomes(Matthias & Kim-Godwin, 2016). A BSN nurse needs to have a good understanding of the social, economic and cultural influences that affect patients and impact healthcare delivery.
A 50-year-old patient recovering from a serious car accident and has somewhat raised blood pressure nearing the day of discharge. On admission, medication for blood pressure was ordered in case it was required. However, through physiotherapy, exercise and a good diet, the patient was able to keep away from the high blood pressure medication. A few days to discharge, the patient has somewhat elevated levels of blood pressure. An ADN nurse after checking the vital signs, treatment for the wounds, pain medication and confirming that the patient is adhering to the physiotherapy and diet programs, would administer the high blood pressure medication after noticing the spike in blood pressure as it is what he or she is trained to do. A BSN nurse on the other hand would critically look at other factors that could result in the slightly raised blood pressure levels. If the patient was a family man whose main source of income was his employment as a driver, a BSN nurse would consider the stress the patient would experience with the thoughts of re-integrating back to a working life and the problems of finding another income source not to mention the trauma experienced with such a road accident, especially when nearing the discharge period. This would be confirmed by the patient on asking. With counseling and trauma management programs such as Cognitive Behavioral Therapy, a BSN nurse would avoid the easy method of giving the extra blood pressure medication and instead prescribe a counseling program that treats the problem and not the symptoms.
            The process of collecting, analyzing and implementing research studies in a bid to improve patient outcomes, the practice environment and clinical practice is defined as evidence-based practice(Chrisman et al., 2014). Using the most modern healthcare research helps reduce complications related to chronic diseases and prevents extra illnesses. Evidence-based practice also helps reduce care costs by eliminating unnecessary expenses associated with treating patients with chronic diseases and also lowers expenses for relatively healthier patients. Through, EBP, nurses are able to utilize informatics, adapt to situations and practice in interdisciplinary teams. A greater sense of pride and confidence is also achieved. A BSN curriculum emphasizes on critical thinking and encourages nurses to take into consideration a patient’s religious, cultural, socioeconomic and clinical backgrounds and relevant research studies. BSN programs contain more courses linked to nursing research which enables RNs to know about emerging scientific models or data that may have more impact on the nursing practice. This may be beneficial to matching new medical tools and protocols to a patient’s profile thereby increasing their patients’ health outcomes by understanding the effectiveness or risks of treatments or diagnostic tests through informed decision-making.
Healthcare delivery today involves various interfaces and patient referrals among numerous practitioners with different occupational and educational levels of training. Critical information must therefore be effectively and accurately communicated throughout the healthcare delivery chain. Nurses continually evaluate patients through their constant care and report and communicate significant medical information to other disciplines in case need arises. Nurses as collaborators, managers and coordinators of client care do this to ensure that all the disciplinary elements involved in a patient’s plan of care contribute their services and that the care is streamlined to advance the patient towards the best health objective and outcome (Renton et al., 2019). Good interdisciplinary communication inspires collaboration and helps prevent mistakes. Efficient clinical practice should evaluate possible hindrances to effective communication and encourage outlets and programs that strengthen team collaboration. By doing so, health care providers stand to greatly improve their clinical and patient outcomes.




Chrisman, J., Jordan, R., Davis, C., & Williams, W. (2014). Exploring evidence-based practice research. Nursing Made Incredibly Easy!12(4), 8-12. https://doi.org/10.1097/01.nme.0000450295.93626.e7

Matthias, A., & Kim-Godwin, Y. (2016). RN-BSN Students’ Perceptions of the Differences in Practice of the ADN- and BSN-Prepared RN. Nurse Educator41(4), 208-211. https://doi.org/10.1097/nne.0000000000000244

Renton, S., McGuinness, C., & Strachan, E. (2019). Clinical Nursing Practices: Guidelines for Evidence-Based Practice (6th ed.). Elsevier.