Chapter 1: Introduction to Nursing — History, Philosophy, and Scope of Practice

Nursing is one of the oldest and most essential professions in human history. From ancient healers to modern advanced practice nurses, the discipline has evolved dramatically while retaining its core commitment: the holistic care of human beings across the lifespan.

A Brief History of Nursing

The modern nursing profession is most closely associated with Florence Nightingale (1820–1910), whose work during the Crimean War demonstrated that systematic sanitation and patient care dramatically reduced mortality. Her 1859 text Notes on Nursing laid the philosophical groundwork for the profession.

In the United States, Lillian Wald (1867–1940) pioneered public health nursing by establishing the Henry Street Settlement in New York City, bringing nursing care directly into impoverished communities. The late 19th and early 20th centuries saw the formalization of nursing education, licensure, and professional organizations such as the American Nurses Association (ANA).

Nursing Philosophy and Models

Nursing theory provides the conceptual framework guiding practice:

Model	Theorist	Core Concept
Self-Care Deficit Theory	Dorothea Orem	Patients need nursing when they cannot meet their own self-care needs
14 Basic Needs	Virginia Henderson	Nurses assist patients with 14 fundamental activities
Adaptation Model	Sister Callista Roy	Patients adapt to stimuli; nurses promote adaptation
Transcultural Nursing	Madeleine Leininger	Care must be culturally congruent

Scope and Standards of Practice

The ANA defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.”

Registered Nurses (RNs) practice within a defined scope that includes assessment, diagnosis (nursing diagnoses), planning, implementation, and evaluation. Advanced Practice Registered Nurses (APRNs) — including nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse-midwives — have an expanded scope that may include prescribing medications and diagnosing medical conditions.

Professional nursing is guided by:

• Code of Ethics (ANA, 9 provisions)
• Nurse Practice Acts (state-level licensure law)
• Evidence-Based Practice (EBP) standards

Key Checklist

• Identify at least two historical figures who shaped modern nursing and their key contributions
• Compare Orem’s Self-Care Deficit Theory with Henderson’s 14 Basic Needs model
• Describe the difference between the RN scope of practice and the APRN scope of practice