Development of nursing education in india: Pre-indpendence

Introduction:
Nursing originated independently, existed many centuries without contact with modern medicine.  The member of the family at home met the nursing needs of the sick.  Evolution of medicine, surgery and public health into complicated technical area requiring many procedures by persons specially trained and having understanding of scientific principles, which brought two professions closer and together.
1.  Nursing in Pre-historic Times
There are no historical evidence available on ancient history on nursing care of sick in primitive times discovered through myths, songs and archeologistTo get rid of 'evil spirit' unpleasant conditioning like beating, starving, magic rites, nauseous medicines, loud noises sudden fright are used methods.  Primitive man had the skill of massaging, fermentation bone setting, amputation, hot and cold bath, heat to control hemorrhages.
Role of Nurse in Primitive Period
Women were protecting and caring for their children, aged, sick members of the family.  Nursing evolved to response to the desire to keep healthy as well as provide comfort to sick.  This was reflecting in caring, comforting, nourishing and cleansing aspect of the patient.  These love and hope were expressed in empirical practice of nursing.
2. Nursing - Vedic Period (3000 B.C - 1400 B.C)
Indian medicines are found in the sacred books of "Vedas".  The 'Ayur-veda' is thought to have been given by Brahma.  1400 BC Sushruta, known as 'Father of Surgery' in India wrote a book on surgery years later 'Charaka' wrote a book on internal medicine.  By these writings we can learn that those days surgery had advanced to a high level, also had 4 wings of treatment 'Chatushpada Chikitsa'.
  1. Physician - Bhishak
  2. Nurse - Upacharika (Attendent - Anuraktha)
  3. Therapeutic drugs - Dravya
  4. Patient - Adhyaya
Characters of Upacharika (Nurse)
  • Shuchi - Pure or clean in physical appearance and mental hygiene.
  • Daksha - Competency
  • Anuraktha - Willing to care
  • Buddhiman - Co-ordinator with the patient and doctor / intelligent.
3. Nursing Post Vedic Period (600 BC - 600 AD)
Medical education introduced in ancient Universities of 'Nalanda' and 'Thakshashila'. King Ashoka (272-236 BC) constructed hospitals for the people and animals.  Prevention of the disease was given first importance and hygienic practices were adopted.   Cleanliness of the body was religious duty. Doctors and midwives were to be trust worthy and skillful.  They should wear clean cloths and cut their nails short.  Lying rooms were kept well ventilated.  Religious ceremonies and prayer precede co-operations.  The nurses were usually 'men' or 'old women'.  Women are restricted activities at home and cared for sick members in the family during 1 AD period superstition and black magic replaced more in daily practices.  Medicines are remained in the hands of priest - physicians, who refused to touch the blood and pathological tissues. Dissection was for bidden.  Other religious restriction and superstitious practices probably declined the development of nursing.
4. Nursing in Mogul Period (1000 AD)
'Unani' system of medicine developed during the Arab civilization.  It was practiced in Indo-Pakistan subcontinent. The basic framework are consists of blood, phlegm, yellow bile and back bile.  Temperament, strengthening of body and nature are the real physician.
Not believed in eradication of disease greatly depend on defense mechanism of the body and self-care and positive health habits.  Therefore, it becomes part of Indian medicine practice.
5. British period (16th Century onwords)
After the Mogul period the nursing in India hindered due to various reasons like low state of women, system of "pardha" among Muslims, caste system among Hindus, illiteracy, poverty, political unrest, language difference and nursing looked upon as servants work. During the 16th century, nursing development in India taken three dimensions.
  1. Military Nursing
  2. Civilian Nursing
  3. Missionaries Nursing
1. Military Nursing:
Military nursing born during 1st world war but developed very slowly. British officers informed need of nurses to take care British officials and soldiers in India.
On 1888 Feb. 21st - 10 fully qualified certified nurses from Florence Nightingales, arrived to Bombay to lead nursing in India.  This pave the way to develop one of the best nursing in the world.  1894 regular system of training for men for hospital work (orderliness) started.  Medical officers given lecturing to them.  Some men were voluntary did the course and applied for the nursing certificate.  After two months of practical posting to ward, on the account of supervised sister's report, first time hospital 'orderlines' issued certificate and had official status.  This system laid the possible foundation to existing system of training and higher education.
1927 - Description of Indian Military Nursing services formed with 12 matrons, 18 sisters, 25 staff nurses.  They are responsible for supervision, instruction and training of nursing services for entire Indian hospital corps.
2nd world war expanded nursing services to India and overseas under the direction of chief principal matron.   3 year training carried out in selected military hospital preliminary training schools.  After completion sent to military hospital for training.  After successful training certificate issued as "Registered Nurse" and they are members of Indian Military Nursing Services Auxiliary Nursing Services
Shortage of trained nurses in India after the 2nd world war, the Govt., initiated short course of intensive training in 1942 which led to the Auxiliary Nursing Services. Basic training for 6th month is selected civil hospital after passing examination at military hospitals in India sent to overseas to serve in the capacity of 'Assistant Nurses' 3000 women given auxiliary training.
2. Civilian Nursing in India
1664 - East India company built Government General Hospital at Madras for civilian.  1871 - this hospital undertook training of nurses.  On 1854 midwives training school granted certificates of  'Diploma in Midwifery' for passed student and 'sick nursing' for failed students.  First time 6 nurses came out as Diploma in Midwifery Nurses.
3. Missionary Nursing:
Missionary nursing started training for Indian people as nurses.  Various other countries supported.  This brought fully qualified Indian nurses. Those days there were several obstacles for nursing development.
  1. Girls were not allowed to do work.
  2. Degrading and unworthy attitude of people.
  3. Hindus were hold back due to deep seated caste system.
  4. Muslims held under 'paradha' system.
So Christian girls encouraged and trained first.
Frequent disappointment, degradation difficulties nursing training came into existence and look its own shape.  In the beginning there is not uniformity in nursing education.  There is no particular standards were given.  After the course of lecturing 18 months to two years, written examination conducted.  If failed training extended to 3 years.
From 1888-93 five years various experts like doctors, surgeons, nursing superintendent, pharmacists - draw up a curriculum for training.  1907-10 North India united Board of Examiner formed to maintain nursing administration and standards.  1928 - Hindi Text book for nurses developed.  1939 - helped to develop post graduation school for nurses.
Community Health Nursing :
William Rathbone formed Visiting Nurse's Association at England.  She emphasized on charity free care etc.  Florence Lees improved the Visiting Nurses by giving specialized training for their work.  It is influenced in India, because of terrible condition, under which children were born recognised as cause for high mortality rate.   Because untrained 'Dais' are attending women at the time of child birth.
Dais were unwilling to trained and patients will to accept the old customary methods.  In 1926 - Midwives Registration Act formed for the purpose of better training of midwives.  Slowly Community Nursing Training needs felt by the Government. In 1946 - Community Health Nursing was integrated in Basic Nursing Programme at Delhi, Vellore and Madras.
Trained Nurses Association of Indian (TNAI)
In 1908 - TNAI formed to uphold the dignity and honor of the nursing profession.  Florence Mac Haughton was the first president of TNAI.  In 1910 TNAI published journals.  In 1912 - TNAI affiliated to international Nursing Council as a 8th Association in the world. In 1917 June 16th under the Registration Act No:XXI of 1860 - TNAI got registered. In 1922 - SNA formed.
Bibliography
  1. Wilkinson, A. (1965).  'History of Nursing in India and Pakistan'. New Delhi, TNAI.
  2. Annamma, K.V. (189). 'A New Text book for Nurses in India'. Madras, B. I. Publications.
  3. Honda, U. and Gulani, K. K. (1995). 'Community Health Nursing', New Delhi, Ignon Publications.
  4. Sandaranarayanan, B. and Sindhu, B. (2003), 'Learning and Teaching Nursing', Calicut, Brainfill.
  5. Neeraja K. P. (2003), 'Text Book of Nursing Education', New Delhi: Jaypee Brothers.
  6. TNAI (2000). 'History and trends in Nursing in India', New Delhi.
  7. Hurndr, R. and Letiman, B. (183).  'Nursing Education in India', New Delhi.
  8. TNAI (1995). 'Indian Nursing Year Book', 1993-95, New Delhi - TNAI.
  9. TNAI (2002), 'Indian Nursing Year Book', 2000, New Delhi - TNAI.

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