Keywords: nursing, empiricism, evolution, professionalization, commitment, recognizing

Abstract

The article presents a historical journey of nursing since the Middle Ages, just when the role of women in domestic work was recognized, they empirically assumed care of the sick people; The activity of caring for the sick had to go through a long journey, making care more technical and leading to professionalization, a fact that occurred with the appearance of Florence Nightingale, a forerunner of the nursing profession in the 20th century. This activity of caring for the sick was marked by strong social and cultural discrimination. Although, Nightingale established the foundations of professionalization, she was unable to extend its development and therefore lacked recognition in underdeveloped countries, in the case of Nicaragua; it was immersed in empiricism for patient care for many years. In Nicaragua there is not enough information about the daily nursing practices in ancient times, what has been found are accounts of the first young women who exercised the task of caring for the sick.

However, the scope of professionalization in nursing has been of great magnitude, after having gone through a slow process since Florence Nightingale founded the School for Nurses, inaugurated in 1860 St. Thomas in London, to be a so accelerated, complex, and essential for the health care of today’s population, located in different spaces and high social recognition.

This article will allow you to make a memory of the historical journey of the profession.

1. Introduction

The article gathers information on the historical development of nursing, considered the history of the development of the profession, answers questions about the origin, methods, and limitations in the historical development of that knowledge. For this reason, this article internalizes nursing about epistemology, as any profession is considered a social product that adopts in a circumstantial way each epoch of its history; under this premise nursing has developed the content of its function from empiricism to professionalism so efficiently becoming a profession and science, maintaining the originality of its essence which is the art of care.

Ariza (2011) and Fernández (2015) consider that empiricism is all sensory experience as the only source of knowledge that materializes and magnifies experience through trial and error so that it underestimates all scientific manifestations for cognitive development, this statement is confronted with Marxist philosophy that considers empiricism as the inductive scientific method that arises from observation for construction of the theory and then it is tested experimentally leading to the syllogism.

In the historical development nursing was affected by empiricism from its genesis whose dark era of rejection, discrimination, and contempt, had to go through four evolutionary stages to become a scientific profession, in this sense, the philosophical affirmation is accepted that empiricism is transferred from generation to generation as repetitive behavior and exercised before an observed action, this statement is widely reflected in the evolutionary stages of The Nurseto Moreno. (Fajardo. YM., Ibarra., A Silva.S. 2017)

2. Development

2.1. Historical tour of the nursing

The historical journey of nursing is a sociocultural heritage of Nursing that allows the new generation to know their history, and the article refers to each of the stages of this and its contribution over time.

Pastor Quiles, M., and Mateo Corredor, D. (2019) consider that the time of prehistory is temporary from 2,500,000 a.C. to 8000 a.C. Although it has limited documentation regarding human relationships and the definition of roles in it, however, some studies have determined that women would have been mostly dedicated to the care of their offspring and, therefore, most of the productive activities were carried out by men.

The emergence of Christianity or the so-called middle stage covers ancient times such as archaic societies and the classical world (476 to 1492). (Doctors, 2021) At a time when nursing practice developed empirically oriented to a domestic task, it was the ideal time to recognize women as the first caregiver in ancient communities. “The closeness of women to nature because of their reproductive function means that historically they have been assigned the function of caring, to such an extent that culture interprets and assumes it as something inherent”. (Torres, 2006)

In this route arises the vocational stage. It includes the beginning of the Christian world, which extends from the sixteenth, seventeenth, and eighteenth centuries and the transition period, darkest moment in the history of nursing (last part of the eighteenth century to the middle of the nineteenth century), at this time a conflict with religion and vocation is observed. According to Torres(2006):

The vocational qualifier is associated with the birth of the Christian religion. The sick, the one who suffers, is a chosen one of God and the one who cares for him and consecrates himself to Him as well. Theoretical knowledge is almost non-existent and applied procedures are very rudimentary. What is important is an attitude, centered on charity, submission, and religiosity. Caring activities relate to Christian concepts of health and disease, attributed to God’s designs. The figure of the caregiver appears, whom Collièrecalls the “consecrated woman”. Women, possessing the knowledge of care, become objects of persecution and repression because they represent two great threats to the power of the church, first: Being a woman would incite the sin of the flesh, and second, acquiring knowledge through experiences of the body would distance them from God and the church. (p. 3)

Over time the civilizations were combined and transformed all their context, then appears, the so-called technical stage that covers the contemporary world (nineteenth and twentieth centuries). It was characterized by the new conception of the man about the division of the disease-health process, ceases to be seen as a design of God and begins the fight against the disease is; the care of the sick was required, however, it did not have a method to follow, just as there was no scientific theory that explained a method to follow in the process of care (p.4).

Subsequently, the stage of professionalization of nursing is approaching, characterized by a long period of transition called the dark stage of nursing.

The contribution of Florence Nightingale at this stage gave way to the development of nursing as a profession, imprints a unique style of thought known as Ingelian nith patterns, in which the rigidity of discipline and obedience to hierarchy were the center of the construction of thought in nursing. Florence was recognized as the first woman admitted to the British Royal Statistical Society, and an honorary member of the American Statistical Association laid the foundations and established the professionalization of Nursing, in 1860 creates the School of Nursing at the Hospital in St. Thomas of London, extends the need to professionalize nurses. (Ruiza, M., Fernández, T. and Tamaro, E. 2004) however, was not a massive formation in the world. For the poor and developing countries, it seemed impossible to achieve professionalization because of its high cost for training, this allowed empiricism to be an everyday way of providing care to the sick.

Graphic organizer. Historical tour of the nursing

2.2. Nursing empiricism in Nicaragua

Although there is not a wide range of information on nursing in Nicaragua, Soledad Galeano in her writing reflects that the care of the sick remained immersed in the world of empiricism for hundreds of years; describes that an incident of great magnitude highlighted the enormous need to train nursing professionals.

On the morning of March 31, 1931, a warm and clear Managua was violently shaken by an earthquake that covered the characters of tragedy. More than 1,000 dead and 2,000 injured among the ruins of the city, a voracious fire unleashed in the commercial area of the city, were enough to establish a picture of despair a completely unprotected population, a deficient health system and unable to give the truthful, effective and timely first aid response; immediately the attention of the red cross institutions to the situation that attracted neighboring countries to provide much-needed help (Galiano, S. 1950).

This incident opened the doors to a new stage of nursing in Nicaragua, from this moment we see a slow process of professionalization in nursing, limited and exclusive.

2.3. Historical tour of the development of nursing in Nicaragua

In the notes of Soledad Galeano, the signs of an incipient profession are glimpsed, 71 years after Florence founded the first school for professionalization in nursing located in the Hospital in Santo Thomas in London, Nicaragua still did not have schools for nursing training. The earthquake that occurred in 1931 sensitized the hearts of the heads of charity of Panama, to such an extent, that it put at the order of the Ministry of Beneficence and Health of Nicaragua, two scholarships for studies in professional nursing at the Santo Tomás Hospital in Panama, to two Nicaraguan ladies, the course would last a year to accredit them as care professionals, without a doubt this moment marked the beginning of the end of deficient empiricism in the care of the sick. Nicaragua had not achieved the transition from the domestic stage in the development of the profession, with the formation of the first two young ladies it was possible to reach the vocational stage influenced by religion, observed by their good conduct and position in society, being, Adela Prado and Carmen Morales. (p.551) . Upon the return of the afore mentioned ladies (1932) they were chosen by the Nicaraguan Ministry of Health for the opening of the first two health centers in the country, one was located in Chinandega and the other in Rivas, the results were flattering, becoming the cornerstone for the quality of the nursing services offered.

Although the Government of Panama continued to grant this type of scholarship, it is considered such a slow process, since only two nurses were trained per year, however accrediting the first two professional nurses in Nicaragua is the birth and a brilliant awakening to undertake the path of a laudable humanitarian mission, as the foundation Florence, in its eagerness to achieve a profession with a body of knowledge or a scientific method that applied throughout the world. (García Martín - Caro, C., Martínez Martín, M.L. 2007)

Galiano, S. (1950) describes bald moments for nursing training in Nicaragua, narrates the historical significance as follows.

The years had passed and the formation process remained extremely slow for this reason, Luis M. Debayle, health director, considered too slow the nursing training process offered by the Ministry of Health of Panama, only graduated two nurses per year, this did not correspond to the many activities and needs that Nicaragua had. Therefore, he considered the creation of a School of Nursing that would fill the pressing need however, the department of health did not have a budget to develop the work immediately, between 1935 and 1936 a Central Sanitary Unit was created in Managua to which a School of Visitors who received some training for the care of the sick in order to ensure that the graduate nurses who were arriving from Panama received support from these visitors with less training, it is believed that from here arises the guild of nursing assistants, for the aspirants it was not necessary that had some knowledge in nursing, but had to meet some requirements such as: selected ladies of good conduct, in a group of age between 18 and 25 years, single, with primary education; the training was directed to the basic knowledge in theoretical theory and practice, an extremely monitored process, however, in the training process they did not develop hospital practice because their training was in the area of preventive care, homework and epidemiological surveillance, the training period lasted three years later they were certified co as health visitors (Martínez, M and Chamorro, E. 2011).

The difference was not noticeable, the need was still latent, Nicaragua continued to be observed for such a lack; other nearby countries such as Panama, had transcended to a more developed stage in nursing knowledge, the offers of collaboration were not allowed to wait was like this when the Morava mission arrived in Nicaragua in charge of the Moravian missionary Dr. Arthur David Thaler jr. This missionary not only raised funds to build a hospital in Bilvaskarma (Atlantic Region of the country) but also founded the private Ruth C.S. Thaeler School of Nursing, which opened its doors in 1935 whose first student was Miss. Laurita Wilson was recognized as the first graduate nurse in Nicaragua. The study programs followed patterns of the American School and in them, American doctors and nurses participated because it was also a private school. This was not successful, so it descended to the intermediate level of preparation.

Eleven years after that tragedy that claimed hundreds of lives in Managua Nicaragua, and that gave rise to the training of nursing professionals, another particular event again highlighted the lack of professional nursing for the care of patients in hospitals, it was in 1942 when Mrs. Courtney R. Byxby was in Nicaragua, Suffering an accident where she fractured both her legs, during her stay at the Baptist Hospital, she observed the needs of human resources in nursing, moved by so much lack she wrote to the Board of Ladies Bautistas in New York about the need for a private School of Engineering. A year after the incident 1943 sand founded the Baptist School of Nursing approved by the Ministry of Education, who offered the Title of Professional Nurses starting scarcely with Miss. Julia Pérez from Diriamba, Ms. Lidia Espinoza and Ms. Hellen Thomas, from the Atlantic Coast. (Ramirez, 2005)

In 1943, the General Director of Health and the cooperation of the SCISP had not left the project of establishing a National School for the training of nursing professionals who could satisfy in number and preparation the multiple needs of public health services, on October 1, 1944, which opened its doors to the first group of 12 students the National School of Nurses at the General Hospital el Retiro in Managua Nicaragua. After having overcome difficulties and having properly conditioned and equipped the North Wing of the General Hospital, nursing practices began, the first equipped rooms were: women’s medicine, surgery, and men’s medicine, each with nine beds.

From 1937 to 1944 the school of visitors in Nicaragua gave its first fruits, in this period I managed to graduate 13 young ladies as health visitors, it was the right time for a deep analysis in terms of the health problem that maintained a deficiency of professional resources in nursing, along with reflection are given major changes in the health system; Precisely the Inter-American Cooperative Service of Public Health, (SCISP) was part of the substantial modification of the organizational structure of the School of Visitors, this organization contributed to the technical training of a nurse specialized in public health, Miss Mabel Johnson. It was necessary to change the programs by shortening the training period being reduced to six months to accelerate the training of collaborators in nursing. This transformation allowed the growth of the school, so much so, that in a period of 2 years (1944-1946) 19 nurses had been graduated, notoriously, as the school formed new collaborators, the number of health centers in the republic rose rapidly; between 1946 and 1948 26 new visitors graduated (pp.551-554).

On October 10, 1946, the students of the first group who had satisfactorily completed the programs of theory and practice received their diplomas as nurses, having joined the nursing staff of the General Directorate of Health in Managua and different departmental capitals of the country. By 1950 five groups had entered, with a total of 37, students, being secular or worldly 31 and Sisters Josephine or Mojas 6. (p.555)

The time of massive growth was getting closer, the nurses were already making themselves feel, they had experienced the feeling nightingaleanus.

In those eleven years, there were already three accredited institutions training nursing staff however, it was a very limited number that was graduating to offer professional services, but enough to feel relevant as a guild of professionals, so much so that, on August 15, 1949, 2 4 graduate nurses, founded a “National Association of Nurses of Nicaragua.” The Provisional Board of Directors was composed as follows: Ms. Soledad Galiano, Honorary President; Ms. María E. de Valle, Effective President; Ms. Trinidad de Aragón, Vice-President; Ms. Estela González, Treasurer; Ms. Julia de Ruiz, Secretary; Ms. Alicia Morales, Prosecutor; Ms. Irma Sánchez and Amanda Amaya, Members. A Commission consisting of six nurses was appointed to draw up the Statutes and Regulations of the Association.

By 1949 the infirmary in the hospitals remained in the hands of the religious congregation as in the past. The need to protect and increase the working capacity of the labor forces gives rise to the creation of some hospitals of a private nature, although they did not fill a need in the majority social class, they contributed in some way to the development of hospital medical practice. Thus we see that the Moravo hospital in Bilwaskarma and the General Memorial of Puerto Cabezas emerge.

The process does not stop and the schools continue to grow, 1950 began to operate a nursing school in the Adventist Hospital of Puerto Cabezas, later it was considered that the place was not entirely suitable for the growth that required the proper functioning of the School and the administration agreed to the transfer of the hospital to the Trinity, department of Estelí.

In 1951 by presidential order, the School of Nursing “Salvadorita de Somoza” was created, in the city of Bluefields, currently, it is a Regional Technical Health Educational Center, popularly known as “School of Nursing” that works under the direction of the Ministry of Health and methodologically by the UNAN-León, it was a new school that joined the training of nursing professionals, however, there was a lot of limitation because it did not correspond to the population’s demand for assistance. The process continued its pace, however, a socio-political conflict in Nicaragua brought with its delays, a setback in the formation. (International Council of Nurses, 2012)

On October 3, 1964, the General Assembly of the Nurses’ Association decided to celebrate nurse’s Day in Nicaragua on May 12, in commemoration of the birth of Florence Nightingale.

Graphic organizer. The historical journey of nursing in Nicaragua

2.4. The phenomenon of the training of human resources in nursing in Nicaragua

In 1979 after the triumph of the Sandinista revolution, the “Luis Felipe Moncada” Polytechnic Institute of Health was created, depending methodologically and administratively on the Ministry of Health, whose main objective was to train human resources in health; in the area of Nursing the careers of Nursing Assistant were offered with several orientations: General, Obstetricians and Pediatrics, Health Brigades, Dental Assistant, Nurses with a specialty in Anesthesia, and Surgical Technicians.

In 1980 the National School of Nursing that depended on the Ministry of Health was incorporated into the Polytechnic Institute of Health (IPS) “Luis Felipe Moncada” and the process of curricular transformation began, for all schools, participating in the review as part of the respective commission the Association of Nicaraguan Nurses. (International Council of Nurses, 2012)

By national decree in 1986 the academic level of Senior Technical Nurse is reduced to Medium Technical Nurse; with this last level, two promotions graduated from each school. In that same year, the National Association of Sick Women of Nicaragua (NASWN) obtained funding for the Training Project for Obstetric Nurses in Nicaragua, with the Polytechnic Institute (POLISAL) being the training institution, graduating from 52 Obstetric Nurses.

As a result of persistent and belligerent actions of the National Nursing integrated by Service, Teaching and Guild, it was achieved in 1988 the reopening of the academic level of Higher Technical Nursing in all the training centers and the Bachelor’s Degree in the School of Nursing of the Polytechnic University of Nicaragua (UPOLI).

In 1988, faced with the need to continue training nursing professionals with a high level of professional and human development, the UNAN Managua in its Regional Faculty of Justice opens its doors with the offer of the superior technician in nursing, which had strong demand, especially from that person who worked in the health units as auxiliaries of the and nursing, a career that was subsidized by 6% of the budget of the republic, constitutionally allocated to public universities. (Peace, 2017)

In 2003, this same faculty expands its nursing training offer to a higher level; the bachelor’s degree in maternal and child nursing.

In 2005, he offered another specialization, a degree in public health. Socially they were the point of greatest satisfaction, the health services had substantially improved the quality of nursing care, but there was also great satisfaction on the part of the graduates because they had improved human development and improvements in their living and working conditions.

In 2006, UNAN-Managua transferred the obstetrics degree to FAREM Chontales to provide a new opportunity for specialization to nursing personnel, to strengthen the quality of care during pregnancy, childbirth, and puerperium, thus reducing maternal deaths.

From 2017- 2021 Doctorates are offered that include nursing professionals in some of these, an opportunity that has allowed double degree; in the case of the doctorate in Education and Intervention Social, the UNAN Managua, FAREM Chontales in collaboration with the University Pablo de Olavide, has the second cohort in force but also that has been extended to the Multidisciplinary Regional Faculty of Estelí, the CIES also offers doctorates in epidemiology with free access for nursing with a master’s level, relevant for scientific, methodological and technological updating.

In this accelerated and evolutionary process, the state assumes an important role for public health and eminently regulatory function of the individual and collective actions of all nursing professionals, but it has also established shared commitments with society in general in the transformation of care, leaving behind empiricism and locating a nursing professional. Qualified, who enjoys great admiration and social respect for his laudable work, (Torres E., Dandicourt T and Rodríguez, A. 2005).

There are currently more than 10 nursing schools nationwide (POLISAL UNAN Managua, FAREM Chontales, Matagalpa, Carazo, Estelí, Ocotal León, UPOLI, Martin Lutero) in charge of training nursing professionals in different profiles.

It is imperative to recognize the history of nursing in Nicaragua, society must know its origins, the challenge proposed at every moment of its history, as well as its scientific or cultural, political, and social advances, after many years it has gone from empiricism to professionalization in significant numbers, in its hands it has the responsibility of patient care. Undoubtedly, the profession enjoys admiration and social recognition for its laudable work in public and private health care García, (Barquero, W, and Galeano, O. 2014).

Aware of this need to train human resources with a high social commitment, the different institutions of higher education have developed programs with a high scientific value in Nicaragua; UNAN Managua has carried out different professional training programs in Nursing, from the technical level to the Doctorate level; POLISAL has offered master’s degrees in Teaching in Nursing, the Center for Research and Health Studies its master’s programs are accessible for nursing, with the opportunity to apply for a master’s degree in epidemiology, Public Health, Health Administration among others.

To date nursing training is accessible from undergraduate, undergraduate, and postgraduate the phenomenon of curricular transformation has been taking important turns for nursing training, the NUNAN-Managua opens professional nursing in the new curriculum by competence (CIRA. UNAN Managua, 2019)

Graphic Organizer. The phenomenon of the formation of human resources in Nursing

3. Conclusion

Although the primitive empiricism of nursing has been disappearing, today it is translated into the scientific theory of observation proposed by (John Locke, George Berkeley and David Hume, and Francis Bacon classical representatives of empiricism). In the field of Health Sciences, “empiricism in the form of therapy based on personal experience and that of other professionals in the care of patients through the demonstration of knowledge”.

In this context, all the training schools continue to improve the degree programs of the sciences of Nursing, the UNAN Managua from the Regional Multidisciplinary Faculty of Chontales, aware of the current health situation of the country is in a process of curricular transformation to advance in competitiveness.

The Nursing professional increasingly presents a high social commitment that since his years of training has been developing empathy with the most felt problems of society, perceived from the practices of training and professionalization, which in turn have been inserted into the world of work from in public and private health institutions under the premise of solidarity, humanism, social commitment, and competitiveness.

The professional practice of nursing has broken barriers and traditional paradigms locating its role within the indispensable health teams in health care, with technical, scientific, and ethical responsibility, Ariza (2011). A feat of the global economy for nursing staff was the first line of action in the care of patients affected by the covid19 pandemic, a maximum combination of knowledge, social and ethical commitment, were transcendental elements in the face of such a difficult scenario.