The knowledge of the foundation and history of nursing evolved today's modern nursing, which was based on practice and error before Florence Nightingale. The sick then were taken care of by religious groups, women and those with little or no knowledge of disease process.

Nursing has come a long way in overcoming some barriers though some still exists like socioeconomic status, educational requirements for entry into practice, pandemic disease.
Nightingale noticed the high death mortality when she came in and linked it to uncleanliness through her studies of people and the environment. She began the practice of good hand washing in nursing.

The training of nurses then was hospital based where classes were held on the wards after patient care. Student duties then included housekeeping, meal preparations and assisting physicians. ‘To the doctor, the first duty [of the nurse] is that of obedience. You have no responsibility beyond that of faithfully carrying out the directions received' (Weeks-Shaw, 1902, p.4).

The trend in nursing changed tremendously from the 19th century. Certification and or experience is needed in certain areas of nursing before one can practice in that area like ICU.

Another trend is the use of technology in nursing which has provided advancement in patients care. All the rooms in the hospitals now have hand sanitizers on the wall outside the room or inside the patient's room, thereby reducing the risk of transmission of infection unlike in the early 19th century.

Another trend is the advancement in the training and recruitment of highly qualified nurses who use their nursing judgment and rationale behind care given. Today most hospitals are hiring RN-BSN nurse over associate degree and LVN.

References
S. Abram: Brilliance and Bureaucracy: Nursing and changes in the Rockefeller foundation.

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