Medicine
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For chemical substances, see Medication. For other uses, see Medicine (disambiguation).
The ancient Greek symbol today associated with medicine the world over: the rod of Asclepius with its encoiled serpent. The World Health Organization, the Royal Society of Medicine, the American Medical and Osteopathic Associations, the British and the Australian Medical Associations are some of the bodies that incorporate it in their insignia
Medicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness.
Contemporary medicine applies health science, biomedical research, and medical technology to diagnose and treat injury and disease, typically through medication, surgery, or some other form of therapy. The word medicine is derived from the Latin ars medicina, meaning the art of healing.[1][2]
Though medical technology and clinical expertise are pivotal to contemporary medicine, successful face-to-face relief of actual suffering continues to require the application of ordinary human feeling and compassion, known in English as bedside manner.[3]
History
Main article: History of medicine
The ancient Sumerian god Ningishzida, the patron of medicine, accompanied by two gryphons.
Prehistoric medicine incorporated plants (herbalism), animal parts and minerals. In many cases these materials were used ritually as magical substances by priests, shamans, or medicine men. Well-known spiritual systems include animism (the notion of inanimate objects having spirits), spiritualism (an appeal to gods or communion with ancestor spirits); shamanism (the vesting of an individual with mystic powers); and divination (magically obtaining the truth). The field of medical anthropology studies the various prehistoric medical systems and their interaction with society.
Early records on medicine have been discovered from early Ayurvedic medicine in the Indian subcontinent, ancient Egyptian medicine, traditional Chinese medicine and ancient Greek medicine. Early Greek doctor Hippocrates, who is also called the Father of Medicine,[4][5] and Galen laid a foundation for later developments in a rational approach to medicine. After the fall of Rome and the onset of the Dark Ages in Western Europe, the Greek tradition of medicine went into decline. After 750, the Muslim Arab world had Galen and Aristotle's works translated into Arabic, and Islamic physicians engaged in some significant medical research. Notable Islamic medical pioneers include polymath Avicenna, who, along with Hippocrates, has also been called the Father of Medicine,[6][7] Abulcasis, the father of surgery, Avenzoar, the father of experimental surgery, Ibn al-Nafis, the father of circulatory physiology, and Averroes.[8] Rhazes, who is called the father of pediatrics, was one of first to question the Greek theory of humorism, which nevertheless remained influential in both medieval Western and medieval Islamic medicine [9] During the Crusades, one Muslim observer famously expressed a dim view of contemporary Western medicine. [10] However, overall mortality and mordibity levels in the medieval Middle East and medieval Europe did not significantly differ one from the other, which indicates that there was no major medical "breakthrough" to modern medicine in either region in this period. The fourteenth and fifteenth Black Death was just as devastating to the Middle East as to Europe, and it has even been argued that Western Europe was generally more effective in recovering from the pandemic than the Midddle East. [11] As the medieval ages ended, important early figures in medicine emerged in Europe, including Gabriele Falloppio and William Harvey.
An ancient Greek patient gets medical treatment: this aryballos (circa 480-470 BCE, now in Paris's Louvre Museum, probably contained healing oil
The major shift in medical thinking was the gradual rejection, especially during the Black Death in the 14th and 15th centuries, of what may be called the 'traditional authority' approach to science and medicine. This was the notion that because some prominent person in the past said something must be so, then that was the way it was, and anything one observed to the contrary was an anomaly (which was paralleled by a similar shift in European society in general - see Copernicus's rejection of Ptolemy's theories on astronomy). Physicians like Ibn al-Nafis and Vesalius led the way in improving upon or indeed rejecting the theories of great authorities from the past (such as Hippocrates, and Galen), many of whose theories were in time discredited.
Modern scientific biomedical research (where results are testable and reproducible) began to replace early Western traditions based on herbalism, the Greek "four humours" and other such pre-modern notions. The modern era really began with Robert Koch's discoveries around 1880 of the transmission of disease by bacteria, and then the discovery of antibiotics around 1900. The post-18th century modernity period brought more groundbreaking researchers from Europe. From Germany and Austrian doctors such as Rudolf Virchow, Wilhelm Conrad Röntgen, Karl Landsteiner, and Otto Loewi) made contributions. In the United Kingdom Alexander Fleming, Joseph Lister, Francis Crick, and Florence Nightingale are considered important. From New Zealand and Australia came Maurice Wilkins, Howard Florey, and Frank Macfarlane Burnet). In the United States William Williams Keen, Harvey Cushing, William Coley, James D. Watson, Italy (Salvador Luria), Switzerland (Alexandre Yersin), Japan (Kitasato Shibasaburo), and France (Jean-Martin Charcot, Claude Bernard, Paul Broca and others did significant work. Russian (Nikolai Korotkov also did significant work, as did Sir William Osler and Harvey Cushing.
The Persian philosopher Avicenna, sometimes called the Father of Medicine. His Canon of Medicine, written during the Islamic Golden Age, probed the nature of contagious disease, identified anaesthetics and medicinal drugs, introduced quarantine and experimental medicine, and even the idea of clinical trials
As science and technology developed, medicine became more reliant upon medications. Pharmacology developed from herbalism and many drugs are still derived from plants (atropine, ephedrine, warfarin, aspirin, digoxin, vinca alkaloids, taxol, hyoscine, etc). The first of these was arsphenamine / Salvarsan discovered by Paul Ehrlich in 1908 after he observed that bacteria took up toxic dyes that human cells did not. Vaccines were discovered by Edward Jenner and Louis Pasteur. The first major class of antibiotics was the sulfa drugs, derived by French chemists originally from azo dyes. This has become increasingly sophisticated; modern biotechnology allows drugs targeted towards specific physiological processes to be developed, sometimes designed for compatibility with the body to reduce side-effects. Genomics and knowledge of human genetics is having some influence on medicine, as the causative genes of most monogenic genetic disorders have now been identified, and the development of techniques in molecular biology and genetics are influencing medical technology, practice and decision-making.
Evidence-based medicine is a contemporary movement to establish the most effective algorithms of practice (ways of doing things) through the use of systematic reviews and meta-analysis. The movement is facilitated by the modern global information science, which allows all evidence to be collected and analyzed according to standard protocols which are then disseminated to healthcare providers. One problem with this 'best practice' approach is that it could be seen to stifle novel approaches to treatment. The Cochrane Collaboration leads this movement. A 2001 review of 160 Cochrane systematic reviews revealed that, according to two readers, 21.3% of the reviews concluded insufficient evidence, 20% concluded evidence of no effect, and 22.5% concluded positive effect.[12]
[edit] Clinical practice
Girl having her head bandaged, as depicted by the portraitist Henriette Browne (1829-1901)
In clinical practice doctors personally assess patients in order to diagnose, treat, and prevent disease using clinical judgment. The doctor-patient relationship typically begins an interaction with an examination of the patient's medical history and medical record, followed a medical interview[13] and a physical examination. Basic diagnostic medical devices (e.g. stethoscope, tongue depressor) are typically used. After examination for signs and interviewing for symptoms, the doctor may order medical tests (e.g. blood tests), take a biopsy, or prescribe pharmaceutical drugs or other therapies. Differential diagnosis methods help to rule out conditions based on the information provided. During the encounter, properly informing the patient of all relevant facts is an important part of the relationship and the development of trust. The medical encounter is then documented in the medical record, which is a legal document in many jurisdictions.[14] Followups may be shorter but follow the same general procedure.
The components of the medical interview[13] and encounter are:
* Chief complaint (cc): the reason for the current medical visit. These are the 'symptoms.' They are in the patient's own words and are recorded along with the duration of each one. Also called 'presenting complaint.'
* History of present illness / complaint (HPI): the chronological order of events of symptoms and further clarification of each symptom.
* Current activity: occupation, hobbies, what the patient actually does.
* Medications (Rx): what drugs the patient takes including prescribed, over-the-counter, and home remedies, as well as alternative and herbal medicines/herbal remedies. Allergies are also recorded.
* Past medical history (PMH/PMHx): concurrent medical problems, past hospitalizations and operations, injuries, past infectious diseases and/or vaccinations, history of known allergies.
* Social history (SH): birthplace, residences, marital history, social and economic status, habits (including diet, medications, tobacco, alcohol).
* Family history (FH): listing of diseases in the family that may impact the patient. A family tree is sometimes used.
* Review of systems (ROS) or systems inquiry: a set of additional questions to ask which may be missed on HPI: a general enquiry (have you noticed any weight loss, change in sleep quality, fevers, lumps and bumps? etc), followed by questions on the body's main organ systems (heart, lungs, digestive tract, urinary tract, etc).
The physical examination is the examination of the patient looking for signs of disease ('Symptoms' are what the patient volunteers, 'Signs' are what the healthcare provider detects by examination). The healthcare provider uses the senses of sight, hearing, touch, and sometimes smell (taste has been made redundant by the availability of modern lab tests). Four chief methods are used: inspection, palpation (feel), percussion (tap to determine resonance characteristics), and auscultation (listen); smelling may be useful (e.g. infection, uremia, diabetic ketoacidosis). The clinical examination involves study of:
* Vital signs including height, weight, body temperature, blood pressure, pulse, respiration rate, hemoglobin oxygen saturation
* General appearance of the patient and specific indicators of disease (nutritional status, presence of jaundice, pallor or clubbing)
* Skin
* Head, eye, ear, nose, and throat (HEENT)
* Cardiovascular (heart and blood vessels)
* Respiratory (large airways and lungs)
* Abdomen and rectum
* Genitalia (and pregnancy if the patient is or could be pregnant)
* Musculoskeletal (including spine and extremities)
* Neurological (consciousness, awareness, brain, vision, cranial nerves, spinal cord and peripheral nerves)
* Psychiatric (orientation, mental state, evidence of abnormal perception or thought)
Laboratory and imaging studies results may be obtained, if necessary.
The medical decision-making (MDM) process involves analysis and synthesis of all the above data to come up with a list of possible diagnoses (the differential diagnoses), along with an idea of what needs to be done to obtain a definitive diagnosis that would explain the patient's problem.
The treatment plan may include ordering additional laboratory tests and studies, starting therapy, referral to a specialist, or watchful observation. Follow-up may be advised.
This process is used by primary care providers as well as specialists. It may take only a few minutes if the problem is simple and straightforward. On the other hand, it may take weeks in a patient who has been hospitalized with bizarre symptoms or multi-system problems, with involvement by several specialists.
On subsequent visits, the process may be repeated in an abbreviated manner to obtain any new history, symptoms, physical findings, and lab or imaging results or specialist consultations.
[edit] Institutions
Contemporary medicine is in general conducted within health care systems. Legal, credentialing and financing frameworks are established by individual governments, augmented on occasion by international organizations. The characteristics of any given health care system have significant impact on the way medical care is provided.
Advanced industrial countries (with the exception of the United States) [15][16] and many developing countries provide medical services though a system of universal health care which aims to guarantee care for all through a single-payer health care system, or compulsory private or co-operative health insurance. This is intended to ensure that the entire population has access to medical care on the basis of need rather than ability to pay. Delivery may be via private medical practices or by state-owned hospitals and clinics, or by charities; most commonly by a combination of all three.
Most tribal societies, but also some communist countries (e.g. China) and the United States,[15][16] provide no guarantee of health care for the population as a whole. In such societies, health care is available to those that can afford to pay for it or have self insured it (either directly or as part of an employment contract) or who may be covered by care financed by the government or tribe directly.
Modern drug ampoules
Transparency of information is another factor defining a delivery system. Access to information on conditions, treatments, quality and pricing greatly affects the choice by patients / consumers and therefore the incentives of medical professionals. While the US health care system has come under fire for lack of openness,[17] new legislation may encourage greater openness. There is a perceived tension between the need for transparency on the one hand and such issues as patient confidentiality and the possible exploitation of information for commercial gain on the other.
[edit] Delivery
See also: clinic, hospital, and hospice
Provision of medical care is classified into primary, secondary and tertiary care categories.
Primary care medical services are provided by physicians, physician assistants, or other health professionals who have first contact with a patient seeking medical treatment or care. These occur in physician offices, clinics, nursing homes, schools, home visits and other places close to patients. About 90% of medical visits can be treated by the primary care provider. These include treatment of acute and chronic illnesses, preventive care and health education for all ages and both sexes.
Secondary care medical services are provided by medical specialists in their offices or clinics or at local community hospitals for a patient referred by a primary care provider who first diagnosed or treated the patient. Referrals are made for those patients who required the expertise or procedures performed by specialists. These include both ambulatory care and inpatient services, emergency rooms, intensive care medicine, surgery services, physical therapy, labor and delivery, endoscopy units, diagnostic laboratory and medical imaging services, hospice centers, etc. Some primary care providers may also take care of hospitalized patients and deliver babies in a secondary care setting.
Tertiary care medical services are provided by specialist hospitals or regional centers equipped with diagnostic and treatment facilities not generally available at local hospitals. These include trauma centers, burn treatment centers, advanced neonatology unit services, organ transplants, high-risk pregnancy, radiation oncology, etc.
Modern medical care also depends on information - still delivered in many health care settings on paper records, but increasingly nowadays by electronic means.
[edit] Branches
Working together as an interdisciplinary team, many highly-trained health professionals besides medical practitioners are involved in the delivery of modern health care. Examples include: nurses, emergency medical technicians and paramedics, laboratory scientists, (pharmacy, pharmacists), (physiotherapy,physiotherapists), respiratory therapists, speech therapists, occupational therapists, radiographers, dietitians and bioengineers.
The scope and sciences underpinning human medicine overlap many other fields. Dentistry, while a separate discipline from medicine, is considered a medical field.
A patient admitted to hospital is usually under the care of a specific team based on their main presenting problem, e.g. the Cardiology team, who then may interact with other specialties, e.g. surgical, radiology, to help diagnose or treat the main problem or any subsequent complications / developments.
Physicians have many specializations and subspecializations into certain branches of medicine, which are listed below. There are variations from country to country regarding which specialties certain subspecialties are in.
The main branches of medicine used in Wikipedia are:
* Basic sciences of medicine; this is what every physician is educated in, and some return to in biomedical research.
* Medical specialties
* interdisciplinary fields, where different medical specialties are mixed to function in certain occasions.
[edit] Basic sciences
* Anatomy is the study of the physical structure of organisms. In contrast to macroscopic or gross anatomy, cytology and histology are concerned with microscopic structures.
* Biochemistry is the study of the chemistry taking place in living organisms, especially the structure and function of their chemical components.
* Biostatistics is the application of statistics to biological fields in the broadest sense. A knowledge of biostatistics is essential in the planning, evaluation, and interpretation of medical research. It is also fundamental to epidemiology and evidence-based medicine.
* Cytology is the microscopic study of individual cells.
* Embryology is the study of the early development of organisms.
* Epidemiology is the study of the demographics of disease processes, and includes, but is not limited to, the study of epidemics.
* Genetics is the study of genes, and their role in biological inheritance.
* Histology is the study of the structures of biological tissues by light microscopy, electron microscopy and immunohistochemistry.
* Immunology is the study of the immune system, which includes the innate and adaptive immune system in humans, for example.
* Medical physics is the study of the applications of physics principles in medicine.
* Microbiology is the study of microorganisms, including protozoa, bacteria, fungi, and viruses.
* Neuroscience includes those disciplines of science that are related to the study of the nervous system. A main focus of neuroscience is the biology and physiology of the human brain and spinal cord.
* Nutrition science (theoretical focus) and dietetics (practical focus) is the study of the relationship of food and drink to health and disease, especially in determining an optimal diet. Medical nutrition therapy is done by dietitians and is prescribed for diabetes, cardiovascular diseases, weight and eating disorders, allergies, malnutrition, and neoplastic diseases.
* Pathology as a science is the study of disease—the causes, course, progression and resolution thereof.
* Pharmacology is the study of drugs and their actions.
* Physiology is the study of the normal functioning of the body and the underlying regulatory mechanisms.
* Toxicology is the study of hazardous effects of drugs and poisons.
[edit] Specialties
Main article: Medical specialty
In the broadest meaning of "medicine", there are many different specialties. However, within medical circles, there are two broad categories: "Medicine" and "Surgery." "Medicine" refers to the practice of non-operative medicine, and most subspecialties in this area require preliminary training in "Internal Medicine". "Surgery" refers to the practice of operative medicine, and most subspecialties in this area require preliminary training in "General Surgery." There are some specialties of medicine that do not fit into either of these categories, such as radiology, pathology, or anesthesia, and those are also discussed further below.
[edit] Surgery
Main article: Surgery
Surgical specialties employ operative treatment. In addition, surgeons must decide when an operation is necessary, and also treat many non-surgical issues, particularly in the surgical intensive care unit (SICU), where a variety of critical issues arise. Surgery has many subspecialties, e.g. general surgery,Transplant surgery, trauma surgery, cardiovascular surgery, neurosurgery, maxillofacial surgery, orthopedic surgery, otolaryngology, plastic surgery, oncologic surgery, vascular surgery, and pediatric surgery. In some centers, anesthesiology is part of the division of surgery (for logistical and planning purposes), although it is not a surgical discipline.
Surgical training in the U.S. requires a minimum of five years of residency after medical school. Sub-specialties of surgery often require seven or more years. In addition, fellowships can last an additional one to three years. Because post-residency fellowships can be competitive, many trainees devote two additional years to research. Thus in some cases surgical training will not finish until more than a decade after medical school. Furthermore, surgical training can be very difficult and time consuming.
[edit] 'Medicine' as a specialty
Main article: Internal Medicine
Internal medicine is the medical specialty concerned with the diagnosis, management and nonsurgical treatment of unusual or serious diseases, either of one particular organ system or of the body as a whole. According to some sources, an emphasis on internal structures is implied.[18] In North America, specialists in internal medicine are commonly called "internists". Elsewhere, especially in Commonwealth nations, such specialists are often called physicians.[19] These terms, internist or physician (in the narrow sense, common outside North America), generally exclude practitioners of gynecology and obstetrics, pathology, psychiatry, and especially surgery and its subspecialities.
Because their patients are often seriously ill or require complex investigations, internists do much of their work in hospitals. Formerly, many internists were not subspecialized; such general physicians would see any complex nonsurgical problem; this style of practice has become much less common. In modern urban practice, most internists are subspecialists: that is, they generally limit their medical practice to problems of one organ system or to one particular area of medical knowledge. For example, gastroenterologists and nephrologists specialize respectively in diseases of the gut and the kidneys.[20]
In Commonwealth and some other countries, specialist pediatricians and geriatricians are also described as specialist physicians (or internists) who have subspecialized by age of patient rather than by organ system. Elsewhere, especially in North America, general pediatrics is often a form of Primary care.
There are many subspecialities (or subdisciplines) of internal medicine:
* Cardiology
* Critical care medicine
* Dermatology
* Endocrinology
* Gastroenterology
* Geriatrics
* Hematology
* Hepatology
* Infectious diseases
* Nephrology
* Neurology
* Oncology
* Pediatrics
* Pulmonology
* Rheumatology
* Sleep medicine
Training in internal medicine (as opposed to surgical training), varies considerably across the world: see the articles on Medical education and Physician for more details. In North America, it requires at least three years of residency training after medical school, which can then be followed by a one to three year fellowship in the subspecialties listed above. In general, resident work hours in medicine are less than those in surgery, averaging about 60 hours per week in the USA.
[edit] Diagnostic specialties
* Clinical laboratory sciences are the clinical diagnostic services which apply laboratory techniques to diagnosis and management of patients. In the United States these services are supervised by a pathologist. The personnel that work in these medical laboratory departments are technically trained staff who do not hold medical degrees, but who usually hold an undergraduate medical technology degree, who actually perform the tests, assays, and procedures needed for providing the specific services. Subspecialties include Transfusion medicine, Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology and Clinical immunology.
* Pathology as a medical specialty is the branch of medicine that deals with the study of diseases and the morphologic, physiologic changes produced by them. As a diagnostic specialty, pathology can be considered the basis of modern scientific medical knowledge and plays a large role in evidence-based medicine. Many modern molecular tests such as flow cytometry, polymerase chain reaction (PCR), immunohistochemistry, cytogenetics, gene rearrangements studies and fluorescent in situ hybridization (FISH) fall within the territory of pathology.
* Radiology is concerned with imaging of the human body, e.g. by x-rays, x-ray computed tomography, ultrasonography, and nuclear magnetic resonance tomography.
* Clinical neurophysiology is concerned with testing the physiology or function of the central and peripheral aspects of the nervous system. These kinds of tests can be divided into recordings of: (1) spontaneous or continuously running electrical activity, or (2) stimulus evoked responses. Subspecialties include Electroencephalography, Electromyography, Evoked potential, Nerve conduction study and Polysomnography. Sometimes these tests are performed by techs without a medical degree, but the interpretation of these tests is done by a medical professional.
[edit] Other
Following are some selected fields of medical specialties that don't directly fit into any of the above mentioned groups.
* Ophthalmology exclusively concerned with the eye and ocular adnexa, combining conservative and surgical therapy.
* Dermatology is concerned with the skin and its diseases. In the UK, dermatology is a subspecialty of general medicine.
* Emergency medicine is concerned with the diagnosis and treatment of acute or life-threatening conditions, including trauma, surgical, medical, pediatric, and psychiatric emergencies.
* Obstetrics and gynecology (often abbreviated as OB/GYN (American English) or Obs & Gynae (British English)) are concerned respectively with childbirth and the female reproductive and associated organs. Reproductive medicine and fertility medicine are generally practiced by gynecological specialists.
* Palliative care is a relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
* Pediatrics (AE) or paediatrics (BE) is devoted to the care of infants, children, and adolescents. Like internal medicine, there are many pediatric subspecialties for specific age ranges, organ systems, disease classes, and sites of care delivery.
* Physical medicine and rehabilitation (or physiatry) is concerned with functional improvement after injury, illness, or congenital disorders.
* Psychiatry is the branch of medicine concerned with the bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
[edit] Interdisciplinary fields
Interdisciplinary sub-specialties of medicine are:
* General practice, family practice, family medicine or primary care is, in many countries, the first port-of-call for patients with non-emergency medical problems.
* Many other health science fields, e.g. dietetics
* Bioethics is a field of study which concerns the relationship between biology, science, medicine and ethics, philosophy and theology.
* Biomedical Engineering is a field dealing with the application of engineering principles to medical practice.
* Clinical pharmacology is concerned with how systems of therapeutics interact with patients.
* Conservation medicine studies the relationship between human and animal health, and environmental conditions. Also known as ecological medicine, environmental medicine, or medical geology.
* Dentistry deals with evaluation, diagnosis, prevention, and treatment of diseases, disorders and conditions of the soft and hard tissues of the jaw (mandible), the oral cavity, maxillofacial area and the adjacent and associated structures
* Disaster medicine deals with medical aspects of emergency preparedness, disaster mitigation and management.
* Diving medicine (or hyperbaric medicine) is the prevention and treatment of diving-related problems.
* Evolutionary medicine is a perspective on medicine derived through applying evolutionary theory.
* Forensic medicine deals with medical questions in legal context, such as determination of the time and cause of death.
* Gender-based medicine studies the biological and physiological differences between the human sexes and how that affects differences in disease.
* Hospital medicine is the general medical care of hospitalized patients. Physicians whose primary professional focus is hospital medicine are called hospitalists in the USA.
* Medical humanities includes the humanities (literature, philosophy, ethics, history and religion), social science (anthropology, cultural studies, psychology, sociology), and the arts (literature, theater, film, and visual arts) and their application to medical education and practice.
* Medical informatics, medical computer science, medical information and eHealth are relatively recent fields that deal with the application of computers and information technology to medicine.
* Nosology is the classification of diseases for various purposes.
* Nosokinetics is the science/subject of measuring and modelling the process of care in health and social care systems.
* Pain management (also called pain medicine) is the medical discipline concerned with the relief of pain.
* Preventive medicine is the branch of medicine concerned with preventing disease.
o Community health or public health is an aspect of health services concerned with threats to the overall health of a community based on population health analysis.
o Occupational medicine's principal role is the provision of health advice to organizations and individuals to ensure that the highest standards of health and safety at work can be achieved and maintained.
o Aerospace medicine deals with medical problems related to flying and space travel.
* Osteopathic medicine, a branch of the U.S. medical profession.
* Pharmacogenomics is a form of individualized medicine.
* Sports medicine deals with the treatment and preventive care of athletes, amateur and professional. The team includes specialty physicians and surgeons, athletic trainers, physical therapists, coaches, other personnel, and, of course, the athlete.
* Therapeutics is the field, more commonly referenced in earlier periods of history, of the various remedies that can be used to treat disease and promote health [3].
* Travel medicine or emporiatrics deals with health problems of international travelers or travelers across highly different environments.
* Urgent care focuses on delivery of unscheduled, walk-in care outside of the hospital emergency department for injuries and illnesses that are not severe enough to require care in an emergency department. In some jurisdictions this function is combined with the emergency room.
* Veterinary medicine; veterinarians apply similar techniques as physicians to the care of animals.
* Wilderness medicine; its about practice of medicine in the wild ,where conventional medical facilities may not be available.
[edit] Education
Main articles: Medical education and Medical school
Painted by Toulouse-Lautrec in the year of his own death: an examination in the Paris faculty of medicine, 1901
Medical education and training varies around the world. It typically involves entry level education at a university medical school, followed by a period of supervised practice or internship, and/or residency. This can be followed by postgraduate vocational training. A variety of teaching methods have been employed in medical education, still itself a focus of active research.
Many regulatory authorities require continuing medical education, since knowledge, techniques and medical technology continue to evolve at a rapid rate.
[edit] Legal controls
In most countries, it is a legal requirement for a medical doctor to be licensed or registered. In general, this entails a medical degree from a university and accreditation by a medical board or an equivalent national organization, which may ask the applicant to pass exams. This restricts the considerable legal authority of the medical profession to physicians that are trained and qualified by national standards. It is also intended as an assurance to patients and as a safeguard against charlatans that practice inadequate medicine for personal gain. While the laws generally require medical doctors to be trained in "evidence based", Western, or Hippocratic Medicine, they are not intended to discourage different paradigms of health.
Doctors who are negligent or intentionally harmful in their care of patients can face charges of medical malpractice and be subject to civil, criminal, or professional sanctions.
[edit] Statute of limitations
There is only a limited time during which a medical malpractice lawsuit can be filed. In the USA and Canada, these statute of limitations laws vary between 1 and 4 years (see Medical malpractice for more information).
[edit] Controversy
The Catholic social theorist Ivan Illich subjected contemporary western medicine to detailed attack in his Medical Nemesis, first published in 1975. He argued that the medicalization in recent decades of so many of life's vicissitudes — birth and death, for example — frequently caused more harm than good and rendered many people in effect lifelong patients. He marshalled a body of statistics to show what he considered the shocking extent of post-operative side-effects and drug-induced illness in advanced industrial society. He was the first to introduce to a wider public the notion of iatrogenesis.[21] Others have since voiced similar views, but none so trenchantly, perhaps, as Illich. [22]
Through the course of the twentieth century, healthcare providers focused increasingly on the technology that was enabling them to make dramatic improvements in patients' health. The ensuing development of a more mechanistic, detached practice, with the perception of an attendant loss of patient-focused care, known as the medical model of health, led to criticisms that medicine was neglecting a holistic model.[citation needed] The inability of modern medicine to properly address some common complaints continues to prompt many people to seek support from alternative medicine. Although most alternative approaches lack scientific validation, some, notably acupuncture for some conditions and certain herbs, are backed by evidence.[23]
Medical errors and overmedication are also the focus of complaints and negative coverage. Practitioners of human factors engineering believe that there is much that medicine may usefully gain by emulating concepts in aviation safety, where it is recognized that it is dangerous to place too much responsibility on one "superhuman" individual and expect him or her not to make errors. Reporting systems and checking mechanisms are becoming more common in identifying sources of error and improving practice. Clinical versus statistical, algorithmic diagnostic methods were famously examined in psychiatric practice in a 1954 book by Paul E. Meehl, which controversially found statistical methods superior.[24] A 2000 meta-analysis comparing these methods in both psychology and medicine found that statistical or "mechanical" diagnostic methods were generally, although not always, superior.[24]
Disparities in quality of care given are often an additional cause of controversy.[25] For example, elderly mentally ill patients received poorer care during hospitalization in a 2008 study.[26] Rural poor African-American men were used in a study of syphilis that denied them basic medical care
Sunday, July 5, 2009
Hospital
Hospital
A hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays.
Today, hospitals are usually funded by the state, by health organizations, (for profit or non-profit), health insurances or charities, including by direct charitable donations. In history, however, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers
Etymology
During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which is also the root for the English words hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, eventually removed from the word to leave a circumflex on modern French hôtel. The word is also related to the Sanskrit word 'Ispital' and the German 'Spital'.
Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word is normally used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both usages are found.
[edit] Types
Some patients in a hospital come just for diagnosis and/or therapy and then leave ('outpatients'); while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals are usually distinguished from other types of medical facilities by their ability to admit and care for inpatients.
[edit] General
The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency department to deal with immediate threats to health and the capacity to dispatch emergency medical services. A general hospital is typically the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have many different hospitals of varying sizes and facilities.
[edit] Specialized
A teaching hospital in Canada
Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.
A hospital may be a single building or a campus. (Many hospitals with pre-20th-century origins began as one building and evolved into campuses.) Some hospitals are affiliated with universities for medical research and the training of medical personnel. Worldwide, most hospitals are run on a non-profit basis by governments or charities. Within the United States, most hospitals are not-for-profit.
[edit] Teaching
A teaching hospital (or university hospital) combines assistance to patients with teaching to medical students and is often linked to a medical school.
[edit] Clinics
A medical facility smaller than a hospital is generally called a clinic, and is often run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.
Departments
Hospitals may have any of the following departments or units:
* Behavioral health services
* Burn unit
* Cancer center
* Cardiology
* Coronary care unit
* Dentistry
o Oral and maxillofacial surgery
* Dermatology
* Dispensary
* Emergency department
o Trauma center
* Gastroenterology
* Intensive care unit
* Internal medicine
o Endocrinology
o Epidemiology
o Immunology
* Laboratory services
* Neurology
* Nursing unit
* Obstetrics and gynecology (OB/GYN)
o Neonatal intensive care unit
* Orthopedic services
* Outpatient department
* Pathology
* Pediatrics
* Pharmacy
* Plastic surgery
* Psychiatric ward
* Rehabilitation services
* Physical therapy
* Post anesthesia care unit
* Radiology
* Respiratory therapy
* Surgery
* Urgent care
* Urology
Non-medical departments include:
* Medical records department
* Release of information department
History
[edit] Early examples
A physician visiting the sick in a hospital. German engraving from 1682.
In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healer-god Asclepius might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.[1]
The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of dedicated hospitals to the world. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty written in the 6th century A.D., King Pandukabhaya (4th century BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.[2][3] Mihintale Hospital is perhaps the oldest in the world.[4] Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura and Medirigiriya.[5]
Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least 18 hospitals ca. 230 BC, with physicians and nursing staff, the expense being borne by the royal treasury.[6] Stanley Finger (2001) in his book Origins of Neuroscience: A History of Explorations Into Brain Function cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted."[7] However Dominik Wujastyk of the University College London disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.[8]
The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".[9]
[edit] Roman Empire
The Romans created valetudinaria for the care of sick slaves, gladiators and soldiers around 100 BC, and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.[10]
The adoption of Christianity as the state religion of the empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the Church to provide for the poor, sick, widows and strangers. It ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.[11]
[edit] Medieval Islam
Main article: Bimaristan
Further information: Islamic medicine
This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (June 2009)
The earliest recorded hospital in the medieval Islamic world was that of al-Walid ibn 'Abdul Malik (ruled 705-715 CE) which he built in 86 AH (706-707 CE). It somewhat resembled the Persian bimaristan and Byzantine nosocomia, but was more general as it extended its services to lepers, invalid and destitute people. All treatment and care was free of charge and there was more than one physician employed in this hospital.[12][verification needed]
In the medieval Islamic world, the word "bimaristan" was used to indicate an establishment where the ill were welcomed and cared for by qualified staff. In this way Muslim physicians distinguished between a hospital and a hospice, assylum, lazaret or leper-house, all of which were more concerned with isolating the sick and the mad (insane) from society than offering them a cure. Some thus consider the medieval Bimaristan hospitals as "the first hospitals" in the modern sense of the word.[13]
The first free public hospital was opened in Baghdad during the Caliphate of Haroon-ar-Rashid. The first hospital in Egypt was opened in 872 AD and thereafter public hospitals sprang up all over the empire from Spain and the Maghrib to Persia. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice - an early parallel to modern medical schools. [14][15]
Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan[citation needed]. In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a psychiatric hospital and medical madrasa in Edirne, and a number of other early hospitals were also built in Turkey. The clerics working in these facilities employed scientific methodology far beyond that of their contemporaries in their treatment of patients.[16]
[edit] Medieval Europe
Hospicio Cabañas was the largest hospital in colonial America. In Guadalajara, Mexico
The church at Les Invalides in France showing the often close connection between historical hospitals and churches.
Cancer Hospital at the University of Florida.
Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.
[edit] Colonial America
The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502-1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[17] Abandoned in the mid-18th century, the hospital now lies in ruins near the Cathedral in Santo Domingo.
Conquistador Hernán Cortés founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in 1524 to care for the poor.[17]
The first hospital in North America north of Mexico was the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project of the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.
[edit] Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.
Guy's Hospital was founded in London in 1724 from a bequest by wealthy merchant Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.[18]
When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the 19th century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.[citation needed]
By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In Continental Europe the new hospitals were generally built and run from public funds. The National Health Service, the principle provider of healthcare in the United Kingdom, was founded in 1948.
In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the USA.
[edit] Criticism
While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly provide important help to patients with serious or rare health problems, hospitals are also criticised for a number of faults, some of which are endemic to the system, others which develop from what some consider wrong approaches to health care.
One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses are rarely intimately familiar with the patient. The high working pressures often put on the staff exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals is often voiced as a contributing factor to the feelings of faceless treatment many people complain about.[19]
Another criticism is that hospitals are in themselves a dangerous place for patients, who are often suffering from weakened immune systems - either due to their body having to undergo substantial surgery or because of the illness which placed them in the hospital itself. Most of these criticisms stem from the pre-Listerian era. However, even in modern hospitals, hospital acquired infections can be an important cause of hospital related morbidity, and sometimes mortality.
[edit] Funding
In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals are also still supported by the historical type of charitable or religious associations).
In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents (although as hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-emergency treatment in countries with such systems, and those who can afford it often take out private health care to get treatment faster).[20] On the other hand, many countries, including for example the USA, have in the 20th Century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today.[21] Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after the Hurricane Katrina in the USA), they incur direct financial losses,[21] ensuring that there is a clear disincentive to admit such patients.
While for-profit-based systems have produced some of the best hospitals in the world, a proportion of the populace may have little or no access to health care services of adequate quality.[citation needed]
As quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this. Independent external assessment of quality is one of the most powerful ways of assessing the quality of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international health care accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.
[edit] Buildings
The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian architecture of many modern hospitals.
[edit] Architecture
Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.
However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."[22]
Some newer hospital designs now try to reestablish design that takes the patient's psychological needs into account, such as providing for more air, better views, and more pleasant color schemes. These ideas hearken back to the late 18th century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.[22]
Another major change which is still ongoing in many parts of the world is the change from a ward-based system (where patients are treated and accommodated in communal rooms, separated at best by movable partitions) to a room-based environment, where patients are accommodated in private rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital, which causes some hospitals to charge for the privilege of private rooms.[23]
A hospital is an institution for health care providing patient treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays.
Today, hospitals are usually funded by the state, by health organizations, (for profit or non-profit), health insurances or charities, including by direct charitable donations. In history, however, hospitals were often founded and funded by religious orders or charitable individuals and leaders. Similarly, modern-day hospitals are largely staffed by professional physicians, surgeons, and nurses, whereas in history, this work was usually done by the founding religious orders or by volunteers
Etymology
During the Middle Ages the hospital could serve other functions, such as almshouse for the poor, hostel for pilgrims, or hospital school. The name comes from Latin hospes (host), which is also the root for the English words hotel, hostel, and hospitality. The modern word hotel derives from the French word hostel, which featured a silent s, eventually removed from the word to leave a circumflex on modern French hôtel. The word is also related to the Sanskrit word 'Ispital' and the German 'Spital'.
Grammar of the word differs slightly depending on the dialect. In the U.S., hospital usually requires an article; in Britain and elsewhere, the word is normally used without an article when it is the object of a preposition and when referring to a patient ("in/to the hospital" vs. "in/to hospital"); in Canada, both usages are found.
[edit] Types
Some patients in a hospital come just for diagnosis and/or therapy and then leave ('outpatients'); while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals are usually distinguished from other types of medical facilities by their ability to admit and care for inpatients.
[edit] General
The best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency department to deal with immediate threats to health and the capacity to dispatch emergency medical services. A general hospital is typically the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have many different hospitals of varying sizes and facilities.
[edit] Specialized
A teaching hospital in Canada
Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.
A hospital may be a single building or a campus. (Many hospitals with pre-20th-century origins began as one building and evolved into campuses.) Some hospitals are affiliated with universities for medical research and the training of medical personnel. Worldwide, most hospitals are run on a non-profit basis by governments or charities. Within the United States, most hospitals are not-for-profit.
[edit] Teaching
A teaching hospital (or university hospital) combines assistance to patients with teaching to medical students and is often linked to a medical school.
[edit] Clinics
A medical facility smaller than a hospital is generally called a clinic, and is often run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.
Departments
Hospitals may have any of the following departments or units:
* Behavioral health services
* Burn unit
* Cancer center
* Cardiology
* Coronary care unit
* Dentistry
o Oral and maxillofacial surgery
* Dermatology
* Dispensary
* Emergency department
o Trauma center
* Gastroenterology
* Intensive care unit
* Internal medicine
o Endocrinology
o Epidemiology
o Immunology
* Laboratory services
* Neurology
* Nursing unit
* Obstetrics and gynecology (OB/GYN)
o Neonatal intensive care unit
* Orthopedic services
* Outpatient department
* Pathology
* Pediatrics
* Pharmacy
* Plastic surgery
* Psychiatric ward
* Rehabilitation services
* Physical therapy
* Post anesthesia care unit
* Radiology
* Respiratory therapy
* Surgery
* Urgent care
* Urology
Non-medical departments include:
* Medical records department
* Release of information department
History
[edit] Early examples
A physician visiting the sick in a hospital. German engraving from 1682.
In ancient cultures, religion and medicine were linked. The earliest known institutions aiming to provide cure were Egyptian temples. Greek temples dedicated to the healer-god Asclepius might admit the sick, who would wait for guidance from the god in a dream. The Romans adopted his worship. Under his Roman name Æsculapius, he was provided with a temple (291 BC) on an island in the Tiber in Rome, where similar rites were performed.[1]
The Sinhalese (Sri Lankans) are perhaps responsible for introducing the concept of dedicated hospitals to the world. According to the Mahavamsa, the ancient chronicle of Sinhalese royalty written in the 6th century A.D., King Pandukabhaya (4th century BC) had lying-in-homes and hospitals (Sivikasotthi-Sala) built in various parts of the country. This is the earliest documentary evidence we have of institutions specifically dedicated to the care of the sick anywhere in the world.[2][3] Mihintale Hospital is perhaps the oldest in the world.[4] Ruins of ancient hospitals in Sri Lanka are still in existence in Mihintale, Anuradhapura and Medirigiriya.[5]
Institutions created specifically to care for the ill also appeared early in India. King Ashoka is said to have founded at least 18 hospitals ca. 230 BC, with physicians and nursing staff, the expense being borne by the royal treasury.[6] Stanley Finger (2001) in his book Origins of Neuroscience: A History of Explorations Into Brain Function cites an Ashokan edict translated as: "Everywhere King Piyadasi (Asoka) erected two kinds of hospitals, hospitals for people and hospitals for animals. Where there were no healing herbs for people and animals, he ordered that they be bought and planted."[7] However Dominik Wujastyk of the University College London disputes this, arguing that the edict indicates that Ashoka built rest houses (for travellers) instead of hospitals, and that this was misinterpreted due to the reference to medical herbs.[8]
The first teaching hospital where students were authorized to methodically practice on patients under the supervision of physicians as part of their education, was the Academy of Gundishapur in the Persian Empire. One expert has argued that "to a very large extent, the credit for the whole hospital system must be given to Persia".[9]
[edit] Roman Empire
The Romans created valetudinaria for the care of sick slaves, gladiators and soldiers around 100 BC, and many were identified by later archeology. While their existence is considered proven, there is some doubt as to whether they were as widespread as was once thought, as many were identified only according to the layout of building remains, and not by means of surviving records or finds of medical tools.[10]
The adoption of Christianity as the state religion of the empire drove an expansion of the provision of care. The First Council of Nicaea in 325 A.D. urged the Church to provide for the poor, sick, widows and strangers. It ordered the construction of a hospital in every cathedral town. Among the earliest were those built by the physician Saint Sampson in Constantinople and by Basil, bishop of Caesarea. The latter was attached to a monastery and provided lodgings for poor and travelers, as well as treating the sick and infirm. There was a separate section for lepers.[11]
[edit] Medieval Islam
Main article: Bimaristan
Further information: Islamic medicine
This article needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be challenged and removed. (June 2009)
The earliest recorded hospital in the medieval Islamic world was that of al-Walid ibn 'Abdul Malik (ruled 705-715 CE) which he built in 86 AH (706-707 CE). It somewhat resembled the Persian bimaristan and Byzantine nosocomia, but was more general as it extended its services to lepers, invalid and destitute people. All treatment and care was free of charge and there was more than one physician employed in this hospital.[12][verification needed]
In the medieval Islamic world, the word "bimaristan" was used to indicate an establishment where the ill were welcomed and cared for by qualified staff. In this way Muslim physicians distinguished between a hospital and a hospice, assylum, lazaret or leper-house, all of which were more concerned with isolating the sick and the mad (insane) from society than offering them a cure. Some thus consider the medieval Bimaristan hospitals as "the first hospitals" in the modern sense of the word.[13]
The first free public hospital was opened in Baghdad during the Caliphate of Haroon-ar-Rashid. The first hospital in Egypt was opened in 872 AD and thereafter public hospitals sprang up all over the empire from Spain and the Maghrib to Persia. As the system developed, physicians and surgeons were appointed who gave lectures to medical students and issued diplomas to those who were considered qualified to practice - an early parallel to modern medical schools. [14][15]
Between the eighth and twelfth centuries CE Muslim hospitals developed a high standard of care. Hospitals in Baghdad in the ninth and tenth centuries employed up to twenty-five staff physicians and had separate wards for different conditions. Al-Qairawan hospital and mosque, in Tunisia, were built under the Aghlabid rule in 830 CE and was simple but adequately equipped with halls organized into waiting rooms, a mosque, and a special bath. The hospital employed female nurses, including nurses from Sudan[citation needed]. In addition to regular physicians who attended the sick, there were Fuqaha al-Badan, a kind of religious physio-therapists, group of religious scholars whose medical services included bloodletting, bone setting, and cauterisation. During Ottoman rule, when hospitals reached a particular distinction, Sultan Bayazid II built a psychiatric hospital and medical madrasa in Edirne, and a number of other early hospitals were also built in Turkey. The clerics working in these facilities employed scientific methodology far beyond that of their contemporaries in their treatment of patients.[16]
[edit] Medieval Europe
Hospicio Cabañas was the largest hospital in colonial America. In Guadalajara, Mexico
The church at Les Invalides in France showing the often close connection between historical hospitals and churches.
Cancer Hospital at the University of Florida.
Medieval hospitals in Europe followed a similar pattern to the Byzantine. They were religious communities, with care provided by monks and nuns. (An old French term for hospital is hôtel-Dieu, "hostel of God.") Some were attached to monasteries; others were independent and had their own endowments, usually of property, which provided income for their support. Some hospitals were multi-functional while others were founded for specific purposes such as leper hospitals, or as refuges for the poor or for pilgrims: not all cared for the sick. The first Spanish hospital, founded by the Catholic Visigoth bishop Masona in 580 at Mérida, was a xenodochium designed as an inn for travellers (mostly pilgrims to the shrine of Eulalia of Mérida) as well as a hospital for citizens and local farmers. The hospital's endowment consisted of farms to feed its patients and guests.
[edit] Colonial America
The first hospital founded in the Americas was the Hospital San Nicolás de Bari [Calle Hostos] in Santo Domingo, Distrito Nacional Dominican Republic. Fray Nicolas de Ovando, Spanish governor and colonial administrator from 1502-1509, authorized its construction on December 29, 1503. This hospital apparently incorporated a church. The first phase of its construction was completed in 1519, and it was rebuilt in 1552.[17] Abandoned in the mid-18th century, the hospital now lies in ruins near the Cathedral in Santo Domingo.
Conquistador Hernán Cortés founded the two earliest hospitals in North America: the Immaculate Conception Hospital and the Saint Lazarus Hospital. The oldest was the Immaculate Conception, now the Hospital de Jesús Nazareno in Mexico City, founded in 1524 to care for the poor.[17]
The first hospital in North America north of Mexico was the Hôtel-Dieu de Québec. It was established in New France in 1639 by three Augustinians from l'Hôtel-Dieu de Dieppe in France. The project of the niece of Cardinal de Richelieu was granted a royal charter by King Louis XIII and staffed by colonial physician Robert Giffard de Moncel.
[edit] Modern era
In Europe the medieval concept of Christian care evolved during the sixteenth and seventeenth centuries into a secular one, but it was in the eighteenth century that the modern hospital began to appear, serving only medical needs and staffed with physicians and surgeons. The Charité (founded in Berlin in 1710) is an early example.
Guy's Hospital was founded in London in 1724 from a bequest by wealthy merchant Thomas Guy. Other hospitals sprang up in London and other British cities over the century, many paid for by private subscriptions. In the British American colonies the Pennsylvania General Hospital was chartered in Philadelphia in 1751, after £2,000 from private subscription was matched by funds from the Assembly.[18]
When the Vienna General Hospital opened in 1784 (instantly becoming the world's largest hospital), physicians acquired a new facility that gradually developed into the most important research center. During the 19th century, the Second Viennese Medical School emerged with the contributions of physicians such as Carl Freiherr von Rokitansky, Josef Škoda, Ferdinand Ritter von Hebra and Ignaz Philipp Semmelweis. Basic medical science expanded and specialization advanced. Furthermore, the first dermatology, eye, as well as ear, nose and throat clinics in the world were founded in Vienna, being considered as the birth of specialized medicine.[citation needed]
By the mid-nineteenth century most of Europe and the United States had established a variety of public and private hospital systems. In Continental Europe the new hospitals were generally built and run from public funds. The National Health Service, the principle provider of healthcare in the United Kingdom, was founded in 1948.
In the United States the traditional hospital is a non-profit hospital, usually sponsored by a religious denomination. One of the earliest of these "almshouses" in what would become the United States was started by William Penn in Philadelphia in 1713. These hospitals are tax-exempt due to their charitable purpose, but provide only a minimum of charitable medical care. They are supplemented by large public hospitals in major cities and research hospitals often affiliated with a medical school. The largest public hospital system in America is the New York City Health and Hospitals Corporation, which includes Bellevue Hospital, the oldest U.S. hospital, affiliated with New York University Medical School. In the late twentieth century, chains of for-profit hospitals arose in the USA.
[edit] Criticism
While hospitals, by concentrating equipment, skilled staff and other resources in one place, clearly provide important help to patients with serious or rare health problems, hospitals are also criticised for a number of faults, some of which are endemic to the system, others which develop from what some consider wrong approaches to health care.
One criticism often voiced is the 'industrialised' nature of care, with constantly shifting treatment staff, which dehumanises the patient and prevents more effective care as doctors and nurses are rarely intimately familiar with the patient. The high working pressures often put on the staff exacerbate such rushed and impersonal treatment. The architecture and setup of modern hospitals is often voiced as a contributing factor to the feelings of faceless treatment many people complain about.[19]
Another criticism is that hospitals are in themselves a dangerous place for patients, who are often suffering from weakened immune systems - either due to their body having to undergo substantial surgery or because of the illness which placed them in the hospital itself. Most of these criticisms stem from the pre-Listerian era. However, even in modern hospitals, hospital acquired infections can be an important cause of hospital related morbidity, and sometimes mortality.
[edit] Funding
In the modern era, hospitals are, broadly, either funded by the government of the country in which they are situated, or survive financially by competing in the private sector (a number of hospitals are also still supported by the historical type of charitable or religious associations).
In the United Kingdom for example, a relatively comprehensive, "free at the point of delivery" health care system exists, funded by the state. Hospital care is thus relatively easily available to all legal residents (although as hospitals prioritize their limited resources, there is a tendency for 'waiting lists' for non-emergency treatment in countries with such systems, and those who can afford it often take out private health care to get treatment faster).[20] On the other hand, many countries, including for example the USA, have in the 20th Century followed a largely private-based, for-profit-approach to providing hospital care, with few state-money supported 'charity' hospitals remaining today.[21] Where for-profit hospitals in such countries admit uninsured patients in emergency situations (such as during and after the Hurricane Katrina in the USA), they incur direct financial losses,[21] ensuring that there is a clear disincentive to admit such patients.
While for-profit-based systems have produced some of the best hospitals in the world, a proportion of the populace may have little or no access to health care services of adequate quality.[citation needed]
As quality of health care has increasingly become an issue around the world, hospitals have increasingly had to pay serious attention to this. Independent external assessment of quality is one of the most powerful ways of assessing the quality of health care, and hospital accreditation is one means by which this is achieved. In many parts of the world such accreditation is sourced from other countries, a phenomenon known as international health care accreditation, by groups such as Accreditation Canada from Canada, the Joint Commission from the USA, the Trent Accreditation Scheme from Great Britain, and Haute Authorité de santé (HAS) from France.
[edit] Buildings
The National Health Service Norfolk and Norwich University Hospital in the UK, showing the utilitarian architecture of many modern hospitals.
[edit] Architecture
Modern hospital buildings are designed to minimize the effort of medical personnel and the possibility of contamination while maximizing the efficiency of the whole system. Travel time for personnel within the hospital and the transportation of patients between units is facilitated and minimized. The building also should be built to accommodate heavy departments such as radiology and operating rooms while space for special wiring, plumbing, and waste disposal must be allowed for in the design.
However, the reality is that many hospitals, even those considered 'modern', are the product of continual and often badly managed growth over decades or even centuries, with utilitarian new sections added on as needs and finances dictate. As a result, Dutch architectural historian Cor Wagenaar has called many hospitals:
"... built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for ... They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety."[22]
Some newer hospital designs now try to reestablish design that takes the patient's psychological needs into account, such as providing for more air, better views, and more pleasant color schemes. These ideas hearken back to the late 18th century, when the concept of providing fresh air and access to the 'healing powers of nature' were first employed by hospital architects in improving their buildings.[22]
Another major change which is still ongoing in many parts of the world is the change from a ward-based system (where patients are treated and accommodated in communal rooms, separated at best by movable partitions) to a room-based environment, where patients are accommodated in private rooms. The ward-based system has been described as very efficient, especially for the medical staff, but is considered to be more stressful for patients and detrimental to their privacy. A major constraint on providing all patients with their own rooms is however found in the higher cost of building and operating such a hospital, which causes some hospitals to charge for the privilege of private rooms.[23]
MICHEL JACKSON
Michael Jackson
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other persons named Michael Jackson, see Michael Jackson (disambiguation).
Semi-protected
Michael Jackson
Michael Jackson in 1984
Michael Jackson in 1984
Background information
Birth name Michael Joseph Jackson
Born August 29, 1958(1958-08-29)
Gary, Indiana, United States
Died June 25, 2009 (aged 50)
Westwood, Los Angeles, California, United States
Genre(s) Pop, R&B, rock, soul
Occupation(s) Singer-songwriter, record producer, musical arranger, dancer, choreographer, actor, author, businessman, financier, inventor
Instrument(s) Vocals, multiple instruments, percussion
Voice type(s) Falsetto[1]
Years active 1964–2009
Label(s) Motown, Epic
Associated acts The Jackson 5/The Jacksons
Website MichaelJackson.com
Michael Joseph Jackson (August 29, 1958 – June 25, 2009) was an American recording artist, entertainer and businessman. The seventh child of the Jackson family, he made his debut as an entertainer in 1968 as a member of The Jackson 5. He then began a solo career in 1971 while still a member of the group, and that successful career led to him being dubbed the "King of Pop"[2] in subsequent years. Jackson's 1982 album Thriller remains the world's best-selling album of all time,[3] and four of his other solo studio albums are among the world's best-selling records: Off the Wall (1979), Bad (1987), Dangerous (1991) and HIStory: Past, Present and Future, Book I (1995).
In the early 1980s, he became a dominant figure in American popular music and culture. He was the first African American entertainer to amass a strong crossover following on MTV, with videos such as "Beat It", "Billie Jean" and "Thriller"—widely credited with transforming the music video from a promotional tool into an art form—bringing fame to the relatively new channel. Videos such as "Black or White" and "Scream" made Jackson an enduring staple on MTV well into the 1990s. Beyond his success on television, Jackson popularized a number of physically complicated dance techniques, such as the robot and the moonwalk, with his elaborate stage performances. His distinctive musical sound and vocal style influenced many hip hop, pop music and contemporary R&B artists across several generations.
Jackson donated and raised millions of dollars for beneficial causes through his Heal the World Foundation, charity singles, and support of 39 charities. Other aspects of his personal life, including his often changing appearances and eccentric behavior, generated significant controversy that damaged his public image. Though he was accused of child sexual abuse in 1993, the criminal investigation was closed due to lack of evidence and Jackson was not charged. The singer had experienced health concerns since the early 1990s along with conflicting reports regarding the state of his finances since the late 1990s. Jackson married twice and fathered three children, actions which caused further controversy. In 2005, Jackson was tried and acquitted of different sexual abuse allegations and several other charges.
One of the few artists to have been inducted into the Rock and Roll Hall of Fame twice, his other achievements include multiple Guinness World Records—including one for "Most Successful Entertainer of All Time"—thirteen Grammy Awards, thirteen number one singles in his solo career, and the sale of 750 million records worldwide.[4] At the time of his death, Jackson was preparing for This Is It, a series of 50 concerts that would have been held at The O2 arena in London, beginning July 13, 2009.[5]
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For other persons named Michael Jackson, see Michael Jackson (disambiguation).
Semi-protected
Michael Jackson
Michael Jackson in 1984
Michael Jackson in 1984
Background information
Birth name Michael Joseph Jackson
Born August 29, 1958(1958-08-29)
Gary, Indiana, United States
Died June 25, 2009 (aged 50)
Westwood, Los Angeles, California, United States
Genre(s) Pop, R&B, rock, soul
Occupation(s) Singer-songwriter, record producer, musical arranger, dancer, choreographer, actor, author, businessman, financier, inventor
Instrument(s) Vocals, multiple instruments, percussion
Voice type(s) Falsetto[1]
Years active 1964–2009
Label(s) Motown, Epic
Associated acts The Jackson 5/The Jacksons
Website MichaelJackson.com
Michael Joseph Jackson (August 29, 1958 – June 25, 2009) was an American recording artist, entertainer and businessman. The seventh child of the Jackson family, he made his debut as an entertainer in 1968 as a member of The Jackson 5. He then began a solo career in 1971 while still a member of the group, and that successful career led to him being dubbed the "King of Pop"[2] in subsequent years. Jackson's 1982 album Thriller remains the world's best-selling album of all time,[3] and four of his other solo studio albums are among the world's best-selling records: Off the Wall (1979), Bad (1987), Dangerous (1991) and HIStory: Past, Present and Future, Book I (1995).
In the early 1980s, he became a dominant figure in American popular music and culture. He was the first African American entertainer to amass a strong crossover following on MTV, with videos such as "Beat It", "Billie Jean" and "Thriller"—widely credited with transforming the music video from a promotional tool into an art form—bringing fame to the relatively new channel. Videos such as "Black or White" and "Scream" made Jackson an enduring staple on MTV well into the 1990s. Beyond his success on television, Jackson popularized a number of physically complicated dance techniques, such as the robot and the moonwalk, with his elaborate stage performances. His distinctive musical sound and vocal style influenced many hip hop, pop music and contemporary R&B artists across several generations.
Jackson donated and raised millions of dollars for beneficial causes through his Heal the World Foundation, charity singles, and support of 39 charities. Other aspects of his personal life, including his often changing appearances and eccentric behavior, generated significant controversy that damaged his public image. Though he was accused of child sexual abuse in 1993, the criminal investigation was closed due to lack of evidence and Jackson was not charged. The singer had experienced health concerns since the early 1990s along with conflicting reports regarding the state of his finances since the late 1990s. Jackson married twice and fathered three children, actions which caused further controversy. In 2005, Jackson was tried and acquitted of different sexual abuse allegations and several other charges.
One of the few artists to have been inducted into the Rock and Roll Hall of Fame twice, his other achievements include multiple Guinness World Records—including one for "Most Successful Entertainer of All Time"—thirteen Grammy Awards, thirteen number one singles in his solo career, and the sale of 750 million records worldwide.[4] At the time of his death, Jackson was preparing for This Is It, a series of 50 concerts that would have been held at The O2 arena in London, beginning July 13, 2009.[5]
sejarah keperawatan
BAB I
PENDAHULUAN
LATAR BELAKANG
Sejarah perkembangankeperawatan didunia dapat diawali pertama, sejak manusia itu di ciptakan. Diman dasarnya manusia diciptakan memiliki naluri untuk merawat diri sendiri sebagaimana yang dicerminkan pada seorang ibu. Naluri yang sederhana adalah memelihara kesehatan dalam hal ini adalah menyusui anaknya sehingga harapan pada awal perkembangan keperawatan, perawat harus memiliki naluri keibuan kemudian bergeser kezaman purba diman zaman ini orang masih percaya pada suatu tantangan adanya kekuatan mistis yang dapat mempengaruhi kehidupan manusia, kepercayaan ini di kenal dengan nama anisme, diman seseorang yang sakit dapat disebabkan karma kekuatan alam atau pengaruh kekuatan gaib sehingga timbul keyakinan bahwa jiwa yang jahat akan dapat menimbulkan kesakitan dan jiwa yang sehat dapat menimbulkan keasehatan atau kesejahteraan. Pada saat itu peran perawat sebagai ibu yang merawat keluarga yang sakit dengan memberian perawat fisik serta mengobati penyakit dengan menghilangkan pengaruh jahat. Kemudian dilanjutkan dengan kepercayaan dewa-dewa dimana pada masa itu penyakit dianggap disebabkan karena kemarahan dewa sehingga kuil kuil didirikan sebagai tempat pemujaan dan orang yang meminta kesembuhan di kuil tersebut dengan bantuan priest physician.setelah itu perkembangn keperawatan terus berubah dengan berubahnya zaman
BAB II
PEMBAHASAN
1.SEJARAH PERKEMBANGAN KEPERAWATAN ZAMAN KUNO
Keperawatan lahir sejak naluriah keperawatan lahir bersamaan dengan penciptaan manusia perkembangan keperawatan dipengaruhi dengan semakin maju peradaban manusia maka semakin berkembang keperawatan
Perkembangan dipengaruhi oleh :Perawatan dan pengobatan zaman purba Orang-orang pada zaman dahulu hidup dalam keadaan primitive.Namun demikian mereka sudah mampu sedikit pengetahuan dan kecakapan dalam merawat atau mengobati. Pekerjaan "merawat" dikerjakan berdasarkan naluri (instink) à naluri binatang à "mother instinct" (naluri keibuan) yang merupakan suatu naluri dalam yang bersendi pada pemeliharaan jenis (melindungi anak, merawat orang lemah)
Perawatan Dan Pengobatan Secara Praktis Telah Dilakukan Oleh Orang-Orang Primitive, Misalnya :
a. Merawat dan mengobati luka-luka
b.Menurunkan panas dengan memberikan air minum yang banyak atauperawatannya dengan menggunakan air (kompres)
c. Membuka absoes dengan menggunakan batu-batu tajam
d. Menhentikan pendarahan dengan menggunakan batu-batu panas
e. Pemakaian tumbuh-tumbuhan sebagai pengobatan penyakit
Pengaruh kepercayaan terhadap perawatan dan pengobatan Manusia zaman purba menganut kepercayaan/agama "animisme" menghubungkan terjadinya penyakit dnegan kepercayaan animisme ini, sehingga mereka beranggapan bahwa orang menderita sakit disebabkan karena kemasukan arwah-arwah (roh-roh) itu. Orang-orang yang menaruh perhatian terhadap tanda-tanda penyakit orang "ahli" dalam mengambil tindakan pengobatan terhadap orang sakit. Orang ahli tersebut kemudiajn disebut ahli obat-obatan = dukun dalam pengobatannya dukun antara lain memperhatikan aturan-aturan sebagai berikut :
A. Ajaran alam
Suatu kepercayaan yang menganjurkan bahwa alam sendiri memberikan petunjuk-petunjuk tentang obat yang akan dipakai misalnya Luka yang berdarah di beri balutan atau kain yang berwarna merah/daun merah. Apabila sakit kuning di beri obat minum dari akar-akaran atau kulit tumbuhan berwarna kuning.
B. Ajaran transmigrasi
Suatu ajaran yang mempercayai akan adanya kekeuatanm daya pemindahan. Misal : Pada waktu seorang wanita akan melahirkan, diberi air rendaman daun dan membuka lebar-lebar semua pintu
Perawatan Pada Beberapa Bangsa Dan Negara
A. Mesir
Bangsa mesir pada zaman purba telah menyembah banyak dewa. Dewa yang terkenal antara lain Isis. Mereka beranggapan bahwa dewa ini menaruh minat terhadap orang sakit dan memberikan pertolongan pada waktu si sakit sedang tidur.Didirikanlah kuil yang merupakan rumah sakit pertama di mesirKetabiban
Ilmu ketabiban terutama ilmu bedah telah dikenal oleh bangsa mesir zaman purba (± 4800 SM). Dalam menjalankan tugasnya sebagai tabib ia menggunakan bidai (spalk), alat-alat pembalut, ia mempunyai pengetahuan tentang anatomi, Hygienr umum serta tentang obat-obatan. Didalam buku-buku tertulis dalam kitab Papyrus didalamnya memuat kurang lebih 700 macam resep obat-obatan dari Mesir
B. Babylon dan syiria
Ilmu pengetahuan tentang anatomi dan obat-obat ramuan telah diketahui oleh bangsa Babylon sejak beberapa abad SM. Pada salah satu tulisan yang menyatakan bahwa pada 680 SM orang telah mengetahui cara menahan darah yang keluar dari hidung dan merawat jerawant pada muka.Bangsa Babylon menyembah dewa oleh karena itu perawatan atau pengobatan berdasarkan kepercayaan tersebut.
C. Yahudi kuno
Ilmu pengetahuan bangsa Yahudi banyak di peroleh dari bangsa Mesir. Misalnya : cara-cara memberi pengobatan orang yang terkenal adalah Musa. Ia juga dikenal sebagai seorang ahli hygiene. Dibawah pimpinannya bangsa Yahgudi memajukan minatnya yang besar terhadap kebersihan umum dan kebersihan diri.
Undang-undang kesehatan bangsa Yahudi menjadi dasar bagi hygiene modern dimana cara-cara dan peraturannya sesuai dengan bakteriologi zaman sekarang, misalnya :
1. Pemeriksaan dan peminilah bahan makanan yang akan di makan
2. Mengadakan cara pembuangan kotoran manusia
3. Pelarangan makan daging babi karena dapat menimbulkan suatu penyakit
4. Memberitahukan kepada yang berwajib bila ada penyakit yang berbahaya, sehingga dapat diambil tindakan
D. India
Bangsa India (Hindu) di zaman purba telah memeluk agama Brahmana, disamping memuja dan meminta pertolongan kepada dewa (dikuil) untuk menyembuhkan orang sakit. Di India telah terdapat RS khususnya di Utara saat pemerintahan Rasa Asoka, ± 8 RS dimana sebagian kemudian dijadikan sekolah-sekolah pengobatan dan perawatan
E. Tiongkok
Bangsa Tiongkok telah mengenal penyakit kelamin diantaranya gonorhoea dan syphilis. Pencacaran juga telah dilakukan sejak 1000 SM ilmu urut dan psikoterapi.
Orang-orang yang terkenal dalam ketabiban :
1) Seng Lung
Dikenal sebagai "Bapak Pengobatan, yang ahli penyakit dalam dan telah menggunakan obat-obat dari tumbuh-tumbuhan dan mineral (garam-garaman). Semboyannya yang terkenal adalah Lihat, Dengar, Tanya, Rasa.
2) Chang Chung Ching ± 200 Sm telah mengerjakan lavement dengan menggunakan bambo.
F. Yunani
Bangsa Yunani zaman purba memuja dan memuliakan banyak dewa (polytheisme) dewa yang terkenal adalah dewa yang dianggap sebagai dewa pengobatan putri dan dewa yang bernama hygiene sebagai Dewi kesehatan, maka timbullah perkataan higyene. Untuk pemujaan terhadap para dewa didirikan kuil (1134 SM) yang juga berfungsi sebagai pengobatan orang sakit dan perawatan dikerjakan oleh para budak-budak.
Orang-orang ternama dalam ketabiban antara lain
1. Hippocrates (hidup ± 400 SM) à bapak pengobatan dengan jasa :
- Dasar cara pengobatan sampai sekarang ini
- Penyakit bukan karena setan, melainkan rusaknya undang-undang alam
- Mengembangkan tehnik pemeriksaan badan
- Mengajarkan tentang makanan si sakit
- Menganjurkan supaya penderita sakit jiwa dirawat secara perikemanusiaan
- Mengajarkan tentang semangat pekerjaan, menghargai teman sejawat, , bertanggung
jawab terhadap si sakit yang menjadi sumpah hypocrates
2. Plato
ahli filsafat Yunani, otak sebagai pusat kesadaran
3. Aristoteles
Ahli filsafat, ahli jiwa dan ilmu haya
G. Roma
Rumah sakit Roma zaman purba di sebut valentrumdinari Roma yang terdapat di swiss ditemukan alat-alat perawatan ex. Peralatan untuk huknah pot-pot tempat selep. Juga ditemukan instrument untuk keperluan pembedahan ex : pisau, pincet, klem arteri, speculum. Tokoh terkenal Julius Caesar (101-44 SM). Seorang wali Negara yang pertama-tama mengakui guru-guru hygiene dan menganjurkan tentang kesehatan dan kebersihan
H. Irlandia
Pengetahuan tentang pengobatan telah diketahui lama SM. Tentang Rumah sakit, Seorang putri raja bernama Macha (abad ke 3) mendirikan rumah sakit untuk orang-orang miskin yang sakit. Nama RS tersebut Broin Beargh àtau rumah kesusahan
I. Amerika
Rumah sakit sederhana telah didirikan dikota besar oleh bangsa Asteken di Amerika Utara, sedang RS yang baik dan merupakan RS pertama didirikan pada tahun 1521 oleh cortez dari Mexico yaitu RS san Jesu Nazareno
2. PERKEMBANGAN PERAWATAN ZAMAN PERMULAAN MASEHI
Nabi Isa lahir "Agama Baru" agama masehi (Nasrasni/Kristen) perkembangan perawatan bercorak keagamaan ajaran kasih sayang terhadap sesama manusia (perhatian dan perawatan terhadap orang kesusahan – keadaan sakit)
Permulaan diakones
Diakones pembantu pendeta dalam gereja, memberi nasehat, mengobati orang sakit serta mengunjungi tempat tawanan. Diakones menjadi satu lembaga wanita yang pertama dari organisasi agama Kristen yang bekerja dan mengembangkan pekerjaan perawatan perawat penunjang rumah yang pertama.
Philantrop
Philantrop laki-laki dan wanita yang menjauhkan diri dari keramaian dunia dan berkumpul dalam satu tempat-monastic (laki-laki = monk; wanita = non)
3 wanita yang berjasa Morcella, Febicla, Paula Permulaan rumah sakit.
Agama Kristen berkembang di Roma, zaman pemerintahan constantyn yang agung (tahun 325). Mendirikan bangunan/tempat khusus untuk menampung orang terlantar orang sakit yang memerlukan pertolongan dan perawatan xenodocheian = rumah tahu (xeno = tamu) dalam bahasan latin tamu; hospes "Hospital"/rumah sakit
Monastic hospital
Adalah gabungan antara hospital/xenodochoion dnegan monastery. Disini orang yang sakit dirawat oleh non (wanita) dimana monastic hospital yang terkenal didirikan pada tahun 559, mempunyai kurang lebih 200 non. Bentuk dari monastic hospital :
- Bangsal untuk merawat orang sakit
- Bangunan untuk orang yang perlu pertolonga, orang cacat, miskin, yatim piatu
- Bangunan tempat tabib dan tempat monk-monk dan non
- Pekerjaan perawatan dikerjakan oleh non-non
B. Penyebaran agama
Pada permulaan masehi terjadi penyebaran agama kristen di Eropa. Hal ini berdampak positif terhadap perkembangan keperawatan. Kemajuan ini terlihat pada zaman pemerintahan Lord Constandne yaitu dengan :
• XENODHOECIN atau HOSPES (penampungan orang yang membutuhkan pertolongan terutama orang yang menderita sakit)
• Mendirikan Rumah Sakit terkenal di Roma Yaitu MONASTIC HOSPITAL
• Pada pertengahan abad VI Masehi di Asia Barat Daya-Timur Tengah terjadi
penyebaran agama Islam. Nabi Muhammad SAW menyebarkan agama Islam abd VII
Masehi yang mencakup Afrika, Asia Tenggara, Asia Barat dan sebagian Eropa yaitu
Spanyol dan Turki.
• Pada waktu itu berkembang ilmu pengetahuan : Ilmu pasti, ilmu kimia, ilmu hygiene dan obat-obatan
Kegiatan pelayanan keperawatan berkualitas telah di mulai sejak seorang perawat muslim pertama yaitu Rufaidah pada zaman Nabi Muhammad SAW, yang selalu berusaha memberikan pelayanan terbaiknya bagi yang membutuhkan tanpa membedakan kliennya kaya atau miskin
Berikut ini akan lebih dijelaskan tentang sejarah perkembangan keperawatan dimasa Islam dan di Arab Saudi khususnya :
1. Masa Penyebaran Islam/the Islamic period (570-632)
Perkembangan keperawatan masa ini, sejalan dengan perang kaum muslimin/Jihad (holy wars), memberikan gambaran keperawatan di masa ini. System kedokteran mengenai pengobatan lebih dilakukan dnegan ke rumah pasien dengan diberikannya resep oleh dokter. Dalam periode ini dikenal seorang perawat yang bersama Nabi Muhammad SAW yaitu Rufaidah binti Sa'ad / Rufaidah Al-Asamiya
2. Masa setelah nabi/post-prophetic era (632-1000M)
Sejarah tentang keperawatan setelah wafatnya Nabi Muhammad SAW jarang sekali. Dokumen yang ada lebih didominasi oleh kedokteran dimasa itu. Dr. Al-Razi yang digambarkan sebagai seorang pendidik, dan menjadi pedoman yang juga menyediakan pelayanan keperawatan. Dia menulis dua karangan tentang "The reason why some persons and the common people leave a physician even if he is clever" dan "A clever physician does not have power to heal all diseases, for that is not within the realm of possibility". Dimasa ini ada perawat diberi nama "Al Asiyah"
3. Masa Late to Middle Ages (1000-1500 M)
Dimasa ini Negara-negara Arab membangun RS dengan baik dan mengenalkan perawatan orang sakit. Ada gambaran unik di RS yang tersebar dalam peradaban Islam dan banyak dianut5 RS modern saat ini hingga sekarang, yaitu pemisahan antara ruang pasien laki-laki dan wanita, serta perawat wanita merawat pasien wanita dan perawat laki-laki, hanya merawat pasien laki-laki
C. Perang
• Adanya perang berdampak positif bagi keperawatan oleh karena banyaknya korban perang maka kebutuhan tenaga perawat sangat tinggi.
• Perang salib Banyaknya sukarelawan dijadikan perawat yang terdiri orde-orde agama, para wanita yang mengikuti suami ke medan perang. Pengaruh perang salib terhadap keperawtan adalah mulai dikenal konsep P3K. keberadaan perawat mulai dibutuhkan dalam ketentraman dan timbul peluang kerja bagi perawat dibidang sosial.
1. Hotel Dieu Di Lion
Perawat diambil dari mantan wanita jalanan atau wanita yang telah bertaubat
2. Hotel Dieu di Paris
Perawat diambil dari orde-orde agama sesudah revolusi perancis orde agama dihapuskan dan pekerjaan perawat digantikan oleh orang-orang bebas yang tidak terikat pada agama. Pelopor perawat yang terkenal di rumah sakit ini adalah GENEVIEVE BOUZUET
2. ST. Thomas Hospital
Didirikan pada tahun 1123 M, dirumah sakit inilah FLORENCE NIGHTINGALE memulai karirnya memperbaharui keperawatan.Pada awal abad XIX reformasi sosial masyarakat merubah peran perawat dan wanita secara umum. Perawat mulai dipercaya banyak orang. Contohnya adalah FLORENCE Nightingale yang menjadi pelopor keperawatan dunia.
Florencen Nightingale Lahir tahun 1820 dari keluarga kaya raya dan terhormat meniti karirnya dirumah skait ST. Thomas Hospital ditentang keras oleh keluarganya. Ia diterima mengikuti kursus pendidikan perawat pada usia 31 tahun. Ditunjuk oleh pemerintahan inggris untuk menata asuhan keperawatan rumah sakit militer di turki memberi peluang baginya untuk meraih prestasi (Taylor. C, 1989) Sesudah perang krim Florence nightingale kembali ke Inggris mempelopori berdirinya sekolah-sekolah perawat modern tahun 1840 Kontribusi Florence Nightingale
a. Menetapkan standar manajemen rumah sakit
b. Menegaskan bahwa nutrisi merupakan bagian penting dari asuhan keperawtan
c. Meyakinkan bahwa akupasional merupakan suatu terapi bagi orang sakit
d. Mengidentifikasi kebutuhan personal pasien dan peran perawat untuk
memenuhinya
e. Mengemdbangkan standar okupasi bagi pasien wanita
f. Mengembangkan pendidikan keperawatan
g. Menetapkan 2 komponen keperawatan yaitu kesehatan dan penyakit
h. Meyakinkan bahwa keperawatan berdiri sendiri dan berbeda dnegan rofesi
kedokteran.
i. Menekankan kebutuhan pendidikan lanjut bagi perawat
Tahun 1962-sekarang
Keperawatan mulai berkembang dengan pesat Tahun 1962 mulai banyak berdiri akademi keperawatan (AKPER) tahun 1985 program studi ilmu keperawatan (PSIK) diselenggarakan oleh fakultas kedokteran universitas Indonesia lulusan I tahun 1988
Dampak : Meningkatkan pelayanan keperawatan, pendekatan proses keperawatan dan meningkatkan peran dan fungsi perawat.
3.SEJARAH PERKEMBANGAN KEPERAWATAN DI INDONESIA
Perawatan sudah dilaksanakan sejak adanya manusia dan yang jadi sasarannya adalah manusia dari sejak lahir sampai dengan datangnya kematian. Di Indonesia pekerjaan perawat dikerjakan berdasarkan naluri perasaan keibuan untuk merawat anak-anaknya (Mother Instinct). Sejarah perkembangan keperawatan di Indonesia telah banyak di pengaruhi oleh penjajah diantaranya Jepang,Belanda,dan Inggris.Dalam perkembangan di Indonesia di bagi menjadi beberapa bagian diantaranya:
Zaman Kuno
Seperti juga di Negara-negara lainnya keperawatan diserahkan kepada perempuan yang merawat keluarganya
Penyakit dianggap perbuatan setan yaitu dukun
Cara pengobatan dengan menggunakan daun-daunan
Zaman penjajahan Belanda
Tahun 1596 Cornelis De Houtman adalah orang Belanda pertama yang datang ke Indonesia pada zaman penjajahan.
Zaman VOC, (1602 – 1799)
Orang-orang Belanda datang ke Indonesia pertama kali dengan maksud untuk berdagang. Dalam usaha perdagangannya itu di bentuklah VOC. Sehubungan dengan adanya staf dan tentara maka dua usaha kesehatan. Untuk itu didirikanlah rumah sakit yang pertama yang bernama " Binnen Hospital " didirikan pada tahun 1641 bertempat di Batavia ( sekarang Jakarta) Tenaga perawatannya diambil dari penduduk pribumi ( Bumi Putera ) yang diberi nama Zieken oppaser ( penjaga orang sakit) Rumah sakit ini dibawah pengawasan dokter militer. Pada tahun 1724-1744) di luar kota didirikan rumah sakit yang kedua yang diberi nama : Buiten Hospital mengantikan Binnen Hospital yang di tutup pada tahun1808. Karena VOC dibubarkan 1799 maka oleh pemerintahan Belanda menyerahkan kepada pemerintah Indonesia yang kemuudian membentuk Organisasi Negara " Hindia Belanda". Pada tahun zaman penjajahan belanda I ( 1799-1811 ) tidak ada usaha kesehatan yang boleh dikatakan menonjol pada umumnya merupakan usaha lanjutan dari apa yang telah ada. Pengaruh kententaraan pada keperawatan mulai ada usaha-usaha dibidang kesehatan yang antara lain
MGD ( Militaire Gezondsheids Dienst ) - dinas kesehatan tentara
BGD (Burgerlije Gezon Dienst ) – dinas kesehatan rakyat,
Pada waktu pemerintahan Daendels yang terkenal dengan pembuatan jalan Merak Banyuwangi, perlu lebih meningkatkan kesehatan tentaranya. Dibuatlah beberapa Rumah sakit Garnizoen, yaitu di Semarang dan Surabaya. Pelayanannya hanya memperhatikan dinas kesehatan tentara saja.
Zaman Penjajahan Inggris Tahun 1811-1816
Gubernur Jenderal Raffles sangat memperhatikan kesehatan rakyat. Usaha-usaha di bidang kesehatan tersebut dinyatakan dalam kata-katanya "kesehatan adalah milik manusia". Usaha-usahanya:
a. Mengadakan vaksinasi umum
b. Memperbaiki perawatan orang sakit gila (jiwa)
c. Memperbaiki perawatan dari orang-orang tahanan.
Zaman Penjajahan Belanda II (1816-1942)
Setelah pemerintahan diserahkan kembali pada Belanda, maka usaha-usaha kesehatan nampak maju. Prof. Dr. Reinwardt menyusun undang-undang kesehatan, diantaranya tentang praktek dokter, kebidanan, pengobatan dan lain-lain untuk wilayah sekitar Batavia pada 1819 oleh Residen V Pabst didirikan rumah sakit untuk umum di Jakarta, diantara rumah sakit Stadsverban di Glodok. Rumah sakit ini mempunyai perlengkapan yang sederhana. Pada tahun 1919 rumah sakit Stadsverban menjadi CBZ (Central Burgerlijke Ziekeninrichting) yangkemudian dipindahkan di Salemba.
Dr. W. de bosch yang sangat menaruh perhatian terhadap kesehatan mendirikan sekolah dokter jawa (1852), yang kemudian berkembang menjadi STOVIA (1898) dan akhirnya GHS (1927). Ia juga mengadakan persiapan pendidikan kebidanan pada tahun 1852. Tahun 1875 pendidikan kebidanan ini ditutup kembali.Rumah-rumah sakit partikelir(swasta) diadakan oleh Zending.
Muhammadiyah,bala keselamatan. Salah satu yang terkenal adalah rumah sakit di Gang Paal yang sekarang menjadi Rumah Sakit Cikini, didirikan pada tahun 1879. rumah skit yang lain ialah: RS St Carolus di Jakarta, RS St Borromeus di Bandung dan RS Elizabeth di Semarang. Pendidikan perawatan telah ada yang dimulai di RS cikini pada tahun 1900. Pendidikan juru rawat dimulai pada tahun 1906 di RS Glodok pad tahun 1912.
Zaman Penjajahan Jepang (1942-1945)
Pada zaman penjajahan jepang keperawatan di Indonesia boleh dikatakan mundur. Pimpinan rumah sakit yang tadinya adalah orang-orang belanda di ambil alih orang-orang jepang dan sebagian oleh bangsa Indonesia. Obat-obatan sangat kurang,oleh karenanya wabah penyakit dimana-mana. Bahan-bahan balutan sangat kurang,sampai dipergunakannya daun pisang dan pelapah pisang.
Zaman Kemerdekaan (1945-1961)
Keadaan rumah sakit dan perawatan mengalami kekurangan-kekurangan terutama obat-obatan. Semwnjak tahun 1949 pemerintahan mulai membangun dan menyusun kenbali perbaikan-perbaikan di lapangankesehatan.
Tahun 1962- sekarang
Perawatan mulai berkenbang dengan pesat,dengan didirikannya pendidikan akademi keperawatan (AKPER) dan pada tahun 1962 dan Program Studi Ilmu keperawatan (PSIK) Fakultas Kedokteran Universitas Indonsia di Jakarta (1985),yang membawa dampak positif terhadap pelayanan perawatan. Pendekatan perawatan menggunakan proses perawatan yang berdasarkan pada kebutuhan manusia seutuhnya.
Perawatan Penyakit jiwa di Indonesia.
Perawatan penyakit jiwa di Indonesia tidak sama. Ada yang dirawat dengan lemah lembut,ada juga yang secara kasar. Ini tergantung dari kemajuan rakyat di tiap daerah. Perawatan tidak dikerjaan di rumah sakit tetapi di luar rumah sakit,disebabkan belum ada keinsyafan dan pengertain rakyat tentang penyakit jiwa. Baru pada tahun 1800 para penderita penyakit jiwa dikumpulkan di bangsal-bangsal tetapi perawatannya bersifat penjagaan saja.
Rumah-rumah sakit jiwa baru didirikan pada tahun 1875 di Cilendek,Bogor yang merupakan rumah sakit jiwa yang pertama di Indonesia dengan kapasitas 400. Rumah sakit jiwa yang kedua ialah rumah sakit jiwa di Lawang didirikan pada tahun 1894 yang sekarang terdiri dari sumber porong,Pasuruan,Sumpyuh,sehingga merupakan rumah sakit jiwa yang terbesar di Asia Tenggara dengan kapasitas 3300. Rumah sakit jiwa ke 3 ialah yang berada di magelang,didirikan pada tahun 1923 dengan kapasitas 1400.Yang lainnya didirikan di Grogol Jakarta.Padang,Palembang,Banjarmasing,Menado,yang masing-masing dngan kapasitas 1.k.60 Perawatan dikerjakan oleh juru rawat-juru rawat dan penjaga orang sakit dibawah pengawasan perawat jiwa bangsa Indonesia.
Pendidikan perawat jiwa baru dibuka pada bulan September 1940 di Cilendek,Bogor. Pendidikan ini berupa "Kursus".Pada mulanya yang diterima hanya orang-orang Belanda dan Indo Belanda;pada tahun 1951 dibuka kursus untuk perawat-perawat bangsa Indonesia.Yang mengikuti banyak yang berasal dari luar Jawa,misalnya : Sumatra,Kalimantan da sebagainya.
Saat ini perawatan penyakit jiwa dikerjakan secara modern dan tidak lagi ditempatkan dalam kamar tertutup,akan tetapi dibangsal-bangsal bebas.Mereka mendapat kebebasan,dihibur dan dapat bergaul dengan sopan sehingga akhirnya insyaf dan sadar.
Pengobatan dengan jalan diberi shock atau dikagetkan.Pada Zaman pertengahan dengan cara ditakut-takuti atau dijatuhkan kedalam sumur.Juga dipergunakan Hydro-therapie dengan menggunakan air panas atau air dingin. Pengobatan semacam ini hingga sekarang masih dilakukan.
Pada zaman modern sekarang pengobatan dilakukan dengan menggunakan obat-obat tidur,dihibur dengan musik,olahraga,berdansa dan lain-lain.Shock therapie masih dilakukan terutama dengan aliran listrik (ECT).Therapie kerja masih tetap dilaksanakan
Perkembangan keperawatan di Indonesia dipengaruhi oleh kondisi social dan ekonomi yaitu penjajahan pemerintahan colonial Belanda, Inggris dan Jepang serta situasi pemerintahan Indonesia setelah Indonesia merdeka Dibedakan atas :
1. Masa sebelum kemerdekaan
Masa penjajahan belanda I Pada masa ini perawat berasal dari penduduk pribumi yang disebut VELPLEGEK dengan sebutan zieken oppaser sebagai penjaga rumah sakit. usaha pemerintahan Belanda dibidang kesehatan adalah :
• Mendirikan rumah sakit I Binnen Hospital di Jakarta pada tahun 1799
• Mendirikan rumah sakit II Butten Hospital
• Membentuk dinas kesehatan tentara (military gezond herds dients)
• Membentu Dinas Kesehatan Rakyat (Burgerlijke gezandherds dienst)
Zaman Penjajahan Inggris
Gubernur jendral Rafles sangat memperhatikan rakyat semboyan :Kesehatan adalah milik manusia. Usaha-usahanya dibidang kesehatan :
• Pencacaran secara umum
• Membenahi cara perawatan pasien dengan gangguan jiwa
• Memperhatikan kesehatan pada para tawanan
Zaman Penjajahan Jepang
Menyebabkan perkembangan keperawatan mengalami kemunduran yang juga merupakan zaman kegelapan dunia keperawatan di Indonesia. Kemunduran-kemunduran ini terlihat pada
• pekerjaan perawat dikerjakan oleh orang-orang yang tidak terdidik,
• Pimpinan RS diambil alih oleh orang-orang jepang,
• Obat-obatan sangat kurang
• Wabah penyakit terjadi dimana-mana.
BAB III
PENUTUP
KESIMPULAN
Keperawatan lahir sejak naluriah keperawatan lahir bersamaan dengan penciptaan manusia perkembangan keperawatan dipengaruhi dengan semakin maju peradaban manusia maka semakin berkembang keperawatan. dan pengobatan zaman purba Orang-orang pada zaman dahulu hidup dalam keadaan primitive.Namun demikian mereka sudah mampu sedikit pengetahuan dan kecakapan dalam merawat atau mengobati. Pekerjaan "merawat" dikerjakan berdasarkan naluri (instink) à naluri binatang à "mother instinct" (naluri keibuan) yang merupakan suatu naluri dalam yang bersendi pada pemeliharaan jenis (melindungi anak, merawat orang lemah). keibuan kemudian bergeser kezaman purba diman zaman ini orang masih percaya pada suatu tantangan adanya kekuatan mistis yang dapat mempengaruhi kehidupan manusia, kepercayaan ini di kenal dengan nama anisme, diman seseorang yang sakit dapat disebabkan karna kekuatan alam atau pengaruh kekuatan gaib sehingga timbul keyakinan bahwa jiwa yang jahat akan dapat menimbulkan kesakitan dan jiwa yang sehat dapat menimbulkan keasehatan atau kesejahteraan.
SARAN
Untuk menjadi perawat yang profesional kita harus tahu tentang sejarah perkembangan keperawatan, karena dengan mengetahui sejarah perkembangankeperawatan kita dapat mengetahui sampai dimana perkembangan keperawatan pada masa dahulu dan dimana letak kekurangan dan kelebihan keperawatan pada masa dahulu sehingga kita bisa memperbaiki kekurangan tersebut hingga menjadi lebih baik .
DAFTAR PUSTAKA
Hidayat,A. Aziz alimul.2004.Pengantar Konsep Dasar Keperawatan.
Jakarta:Salemba Medika
www.google.Sejarah perkembangan keperawatan pendidikan dan pelayana keperawatan pada zaman kuno.com
PENDAHULUAN
LATAR BELAKANG
Sejarah perkembangankeperawatan didunia dapat diawali pertama, sejak manusia itu di ciptakan. Diman dasarnya manusia diciptakan memiliki naluri untuk merawat diri sendiri sebagaimana yang dicerminkan pada seorang ibu. Naluri yang sederhana adalah memelihara kesehatan dalam hal ini adalah menyusui anaknya sehingga harapan pada awal perkembangan keperawatan, perawat harus memiliki naluri keibuan kemudian bergeser kezaman purba diman zaman ini orang masih percaya pada suatu tantangan adanya kekuatan mistis yang dapat mempengaruhi kehidupan manusia, kepercayaan ini di kenal dengan nama anisme, diman seseorang yang sakit dapat disebabkan karma kekuatan alam atau pengaruh kekuatan gaib sehingga timbul keyakinan bahwa jiwa yang jahat akan dapat menimbulkan kesakitan dan jiwa yang sehat dapat menimbulkan keasehatan atau kesejahteraan. Pada saat itu peran perawat sebagai ibu yang merawat keluarga yang sakit dengan memberian perawat fisik serta mengobati penyakit dengan menghilangkan pengaruh jahat. Kemudian dilanjutkan dengan kepercayaan dewa-dewa dimana pada masa itu penyakit dianggap disebabkan karena kemarahan dewa sehingga kuil kuil didirikan sebagai tempat pemujaan dan orang yang meminta kesembuhan di kuil tersebut dengan bantuan priest physician.setelah itu perkembangn keperawatan terus berubah dengan berubahnya zaman
BAB II
PEMBAHASAN
1.SEJARAH PERKEMBANGAN KEPERAWATAN ZAMAN KUNO
Keperawatan lahir sejak naluriah keperawatan lahir bersamaan dengan penciptaan manusia perkembangan keperawatan dipengaruhi dengan semakin maju peradaban manusia maka semakin berkembang keperawatan
Perkembangan dipengaruhi oleh :Perawatan dan pengobatan zaman purba Orang-orang pada zaman dahulu hidup dalam keadaan primitive.Namun demikian mereka sudah mampu sedikit pengetahuan dan kecakapan dalam merawat atau mengobati. Pekerjaan "merawat" dikerjakan berdasarkan naluri (instink) à naluri binatang à "mother instinct" (naluri keibuan) yang merupakan suatu naluri dalam yang bersendi pada pemeliharaan jenis (melindungi anak, merawat orang lemah)
Perawatan Dan Pengobatan Secara Praktis Telah Dilakukan Oleh Orang-Orang Primitive, Misalnya :
a. Merawat dan mengobati luka-luka
b.Menurunkan panas dengan memberikan air minum yang banyak atauperawatannya dengan menggunakan air (kompres)
c. Membuka absoes dengan menggunakan batu-batu tajam
d. Menhentikan pendarahan dengan menggunakan batu-batu panas
e. Pemakaian tumbuh-tumbuhan sebagai pengobatan penyakit
Pengaruh kepercayaan terhadap perawatan dan pengobatan Manusia zaman purba menganut kepercayaan/agama "animisme" menghubungkan terjadinya penyakit dnegan kepercayaan animisme ini, sehingga mereka beranggapan bahwa orang menderita sakit disebabkan karena kemasukan arwah-arwah (roh-roh) itu. Orang-orang yang menaruh perhatian terhadap tanda-tanda penyakit orang "ahli" dalam mengambil tindakan pengobatan terhadap orang sakit. Orang ahli tersebut kemudiajn disebut ahli obat-obatan = dukun dalam pengobatannya dukun antara lain memperhatikan aturan-aturan sebagai berikut :
A. Ajaran alam
Suatu kepercayaan yang menganjurkan bahwa alam sendiri memberikan petunjuk-petunjuk tentang obat yang akan dipakai misalnya Luka yang berdarah di beri balutan atau kain yang berwarna merah/daun merah. Apabila sakit kuning di beri obat minum dari akar-akaran atau kulit tumbuhan berwarna kuning.
B. Ajaran transmigrasi
Suatu ajaran yang mempercayai akan adanya kekeuatanm daya pemindahan. Misal : Pada waktu seorang wanita akan melahirkan, diberi air rendaman daun dan membuka lebar-lebar semua pintu
Perawatan Pada Beberapa Bangsa Dan Negara
A. Mesir
Bangsa mesir pada zaman purba telah menyembah banyak dewa. Dewa yang terkenal antara lain Isis. Mereka beranggapan bahwa dewa ini menaruh minat terhadap orang sakit dan memberikan pertolongan pada waktu si sakit sedang tidur.Didirikanlah kuil yang merupakan rumah sakit pertama di mesirKetabiban
Ilmu ketabiban terutama ilmu bedah telah dikenal oleh bangsa mesir zaman purba (± 4800 SM). Dalam menjalankan tugasnya sebagai tabib ia menggunakan bidai (spalk), alat-alat pembalut, ia mempunyai pengetahuan tentang anatomi, Hygienr umum serta tentang obat-obatan. Didalam buku-buku tertulis dalam kitab Papyrus didalamnya memuat kurang lebih 700 macam resep obat-obatan dari Mesir
B. Babylon dan syiria
Ilmu pengetahuan tentang anatomi dan obat-obat ramuan telah diketahui oleh bangsa Babylon sejak beberapa abad SM. Pada salah satu tulisan yang menyatakan bahwa pada 680 SM orang telah mengetahui cara menahan darah yang keluar dari hidung dan merawat jerawant pada muka.Bangsa Babylon menyembah dewa oleh karena itu perawatan atau pengobatan berdasarkan kepercayaan tersebut.
C. Yahudi kuno
Ilmu pengetahuan bangsa Yahudi banyak di peroleh dari bangsa Mesir. Misalnya : cara-cara memberi pengobatan orang yang terkenal adalah Musa. Ia juga dikenal sebagai seorang ahli hygiene. Dibawah pimpinannya bangsa Yahgudi memajukan minatnya yang besar terhadap kebersihan umum dan kebersihan diri.
Undang-undang kesehatan bangsa Yahudi menjadi dasar bagi hygiene modern dimana cara-cara dan peraturannya sesuai dengan bakteriologi zaman sekarang, misalnya :
1. Pemeriksaan dan peminilah bahan makanan yang akan di makan
2. Mengadakan cara pembuangan kotoran manusia
3. Pelarangan makan daging babi karena dapat menimbulkan suatu penyakit
4. Memberitahukan kepada yang berwajib bila ada penyakit yang berbahaya, sehingga dapat diambil tindakan
D. India
Bangsa India (Hindu) di zaman purba telah memeluk agama Brahmana, disamping memuja dan meminta pertolongan kepada dewa (dikuil) untuk menyembuhkan orang sakit. Di India telah terdapat RS khususnya di Utara saat pemerintahan Rasa Asoka, ± 8 RS dimana sebagian kemudian dijadikan sekolah-sekolah pengobatan dan perawatan
E. Tiongkok
Bangsa Tiongkok telah mengenal penyakit kelamin diantaranya gonorhoea dan syphilis. Pencacaran juga telah dilakukan sejak 1000 SM ilmu urut dan psikoterapi.
Orang-orang yang terkenal dalam ketabiban :
1) Seng Lung
Dikenal sebagai "Bapak Pengobatan, yang ahli penyakit dalam dan telah menggunakan obat-obat dari tumbuh-tumbuhan dan mineral (garam-garaman). Semboyannya yang terkenal adalah Lihat, Dengar, Tanya, Rasa.
2) Chang Chung Ching ± 200 Sm telah mengerjakan lavement dengan menggunakan bambo.
F. Yunani
Bangsa Yunani zaman purba memuja dan memuliakan banyak dewa (polytheisme) dewa yang terkenal adalah dewa yang dianggap sebagai dewa pengobatan putri dan dewa yang bernama hygiene sebagai Dewi kesehatan, maka timbullah perkataan higyene. Untuk pemujaan terhadap para dewa didirikan kuil (1134 SM) yang juga berfungsi sebagai pengobatan orang sakit dan perawatan dikerjakan oleh para budak-budak.
Orang-orang ternama dalam ketabiban antara lain
1. Hippocrates (hidup ± 400 SM) à bapak pengobatan dengan jasa :
- Dasar cara pengobatan sampai sekarang ini
- Penyakit bukan karena setan, melainkan rusaknya undang-undang alam
- Mengembangkan tehnik pemeriksaan badan
- Mengajarkan tentang makanan si sakit
- Menganjurkan supaya penderita sakit jiwa dirawat secara perikemanusiaan
- Mengajarkan tentang semangat pekerjaan, menghargai teman sejawat, , bertanggung
jawab terhadap si sakit yang menjadi sumpah hypocrates
2. Plato
ahli filsafat Yunani, otak sebagai pusat kesadaran
3. Aristoteles
Ahli filsafat, ahli jiwa dan ilmu haya
G. Roma
Rumah sakit Roma zaman purba di sebut valentrumdinari Roma yang terdapat di swiss ditemukan alat-alat perawatan ex. Peralatan untuk huknah pot-pot tempat selep. Juga ditemukan instrument untuk keperluan pembedahan ex : pisau, pincet, klem arteri, speculum. Tokoh terkenal Julius Caesar (101-44 SM). Seorang wali Negara yang pertama-tama mengakui guru-guru hygiene dan menganjurkan tentang kesehatan dan kebersihan
H. Irlandia
Pengetahuan tentang pengobatan telah diketahui lama SM. Tentang Rumah sakit, Seorang putri raja bernama Macha (abad ke 3) mendirikan rumah sakit untuk orang-orang miskin yang sakit. Nama RS tersebut Broin Beargh àtau rumah kesusahan
I. Amerika
Rumah sakit sederhana telah didirikan dikota besar oleh bangsa Asteken di Amerika Utara, sedang RS yang baik dan merupakan RS pertama didirikan pada tahun 1521 oleh cortez dari Mexico yaitu RS san Jesu Nazareno
2. PERKEMBANGAN PERAWATAN ZAMAN PERMULAAN MASEHI
Nabi Isa lahir "Agama Baru" agama masehi (Nasrasni/Kristen) perkembangan perawatan bercorak keagamaan ajaran kasih sayang terhadap sesama manusia (perhatian dan perawatan terhadap orang kesusahan – keadaan sakit)
Permulaan diakones
Diakones pembantu pendeta dalam gereja, memberi nasehat, mengobati orang sakit serta mengunjungi tempat tawanan. Diakones menjadi satu lembaga wanita yang pertama dari organisasi agama Kristen yang bekerja dan mengembangkan pekerjaan perawatan perawat penunjang rumah yang pertama.
Philantrop
Philantrop laki-laki dan wanita yang menjauhkan diri dari keramaian dunia dan berkumpul dalam satu tempat-monastic (laki-laki = monk; wanita = non)
3 wanita yang berjasa Morcella, Febicla, Paula Permulaan rumah sakit.
Agama Kristen berkembang di Roma, zaman pemerintahan constantyn yang agung (tahun 325). Mendirikan bangunan/tempat khusus untuk menampung orang terlantar orang sakit yang memerlukan pertolongan dan perawatan xenodocheian = rumah tahu (xeno = tamu) dalam bahasan latin tamu; hospes "Hospital"/rumah sakit
Monastic hospital
Adalah gabungan antara hospital/xenodochoion dnegan monastery. Disini orang yang sakit dirawat oleh non (wanita) dimana monastic hospital yang terkenal didirikan pada tahun 559, mempunyai kurang lebih 200 non. Bentuk dari monastic hospital :
- Bangsal untuk merawat orang sakit
- Bangunan untuk orang yang perlu pertolonga, orang cacat, miskin, yatim piatu
- Bangunan tempat tabib dan tempat monk-monk dan non
- Pekerjaan perawatan dikerjakan oleh non-non
B. Penyebaran agama
Pada permulaan masehi terjadi penyebaran agama kristen di Eropa. Hal ini berdampak positif terhadap perkembangan keperawatan. Kemajuan ini terlihat pada zaman pemerintahan Lord Constandne yaitu dengan :
• XENODHOECIN atau HOSPES (penampungan orang yang membutuhkan pertolongan terutama orang yang menderita sakit)
• Mendirikan Rumah Sakit terkenal di Roma Yaitu MONASTIC HOSPITAL
• Pada pertengahan abad VI Masehi di Asia Barat Daya-Timur Tengah terjadi
penyebaran agama Islam. Nabi Muhammad SAW menyebarkan agama Islam abd VII
Masehi yang mencakup Afrika, Asia Tenggara, Asia Barat dan sebagian Eropa yaitu
Spanyol dan Turki.
• Pada waktu itu berkembang ilmu pengetahuan : Ilmu pasti, ilmu kimia, ilmu hygiene dan obat-obatan
Kegiatan pelayanan keperawatan berkualitas telah di mulai sejak seorang perawat muslim pertama yaitu Rufaidah pada zaman Nabi Muhammad SAW, yang selalu berusaha memberikan pelayanan terbaiknya bagi yang membutuhkan tanpa membedakan kliennya kaya atau miskin
Berikut ini akan lebih dijelaskan tentang sejarah perkembangan keperawatan dimasa Islam dan di Arab Saudi khususnya :
1. Masa Penyebaran Islam/the Islamic period (570-632)
Perkembangan keperawatan masa ini, sejalan dengan perang kaum muslimin/Jihad (holy wars), memberikan gambaran keperawatan di masa ini. System kedokteran mengenai pengobatan lebih dilakukan dnegan ke rumah pasien dengan diberikannya resep oleh dokter. Dalam periode ini dikenal seorang perawat yang bersama Nabi Muhammad SAW yaitu Rufaidah binti Sa'ad / Rufaidah Al-Asamiya
2. Masa setelah nabi/post-prophetic era (632-1000M)
Sejarah tentang keperawatan setelah wafatnya Nabi Muhammad SAW jarang sekali. Dokumen yang ada lebih didominasi oleh kedokteran dimasa itu. Dr. Al-Razi yang digambarkan sebagai seorang pendidik, dan menjadi pedoman yang juga menyediakan pelayanan keperawatan. Dia menulis dua karangan tentang "The reason why some persons and the common people leave a physician even if he is clever" dan "A clever physician does not have power to heal all diseases, for that is not within the realm of possibility". Dimasa ini ada perawat diberi nama "Al Asiyah"
3. Masa Late to Middle Ages (1000-1500 M)
Dimasa ini Negara-negara Arab membangun RS dengan baik dan mengenalkan perawatan orang sakit. Ada gambaran unik di RS yang tersebar dalam peradaban Islam dan banyak dianut5 RS modern saat ini hingga sekarang, yaitu pemisahan antara ruang pasien laki-laki dan wanita, serta perawat wanita merawat pasien wanita dan perawat laki-laki, hanya merawat pasien laki-laki
C. Perang
• Adanya perang berdampak positif bagi keperawatan oleh karena banyaknya korban perang maka kebutuhan tenaga perawat sangat tinggi.
• Perang salib Banyaknya sukarelawan dijadikan perawat yang terdiri orde-orde agama, para wanita yang mengikuti suami ke medan perang. Pengaruh perang salib terhadap keperawtan adalah mulai dikenal konsep P3K. keberadaan perawat mulai dibutuhkan dalam ketentraman dan timbul peluang kerja bagi perawat dibidang sosial.
1. Hotel Dieu Di Lion
Perawat diambil dari mantan wanita jalanan atau wanita yang telah bertaubat
2. Hotel Dieu di Paris
Perawat diambil dari orde-orde agama sesudah revolusi perancis orde agama dihapuskan dan pekerjaan perawat digantikan oleh orang-orang bebas yang tidak terikat pada agama. Pelopor perawat yang terkenal di rumah sakit ini adalah GENEVIEVE BOUZUET
2. ST. Thomas Hospital
Didirikan pada tahun 1123 M, dirumah sakit inilah FLORENCE NIGHTINGALE memulai karirnya memperbaharui keperawatan.Pada awal abad XIX reformasi sosial masyarakat merubah peran perawat dan wanita secara umum. Perawat mulai dipercaya banyak orang. Contohnya adalah FLORENCE Nightingale yang menjadi pelopor keperawatan dunia.
Florencen Nightingale Lahir tahun 1820 dari keluarga kaya raya dan terhormat meniti karirnya dirumah skait ST. Thomas Hospital ditentang keras oleh keluarganya. Ia diterima mengikuti kursus pendidikan perawat pada usia 31 tahun. Ditunjuk oleh pemerintahan inggris untuk menata asuhan keperawatan rumah sakit militer di turki memberi peluang baginya untuk meraih prestasi (Taylor. C, 1989) Sesudah perang krim Florence nightingale kembali ke Inggris mempelopori berdirinya sekolah-sekolah perawat modern tahun 1840 Kontribusi Florence Nightingale
a. Menetapkan standar manajemen rumah sakit
b. Menegaskan bahwa nutrisi merupakan bagian penting dari asuhan keperawtan
c. Meyakinkan bahwa akupasional merupakan suatu terapi bagi orang sakit
d. Mengidentifikasi kebutuhan personal pasien dan peran perawat untuk
memenuhinya
e. Mengemdbangkan standar okupasi bagi pasien wanita
f. Mengembangkan pendidikan keperawatan
g. Menetapkan 2 komponen keperawatan yaitu kesehatan dan penyakit
h. Meyakinkan bahwa keperawatan berdiri sendiri dan berbeda dnegan rofesi
kedokteran.
i. Menekankan kebutuhan pendidikan lanjut bagi perawat
Tahun 1962-sekarang
Keperawatan mulai berkembang dengan pesat Tahun 1962 mulai banyak berdiri akademi keperawatan (AKPER) tahun 1985 program studi ilmu keperawatan (PSIK) diselenggarakan oleh fakultas kedokteran universitas Indonesia lulusan I tahun 1988
Dampak : Meningkatkan pelayanan keperawatan, pendekatan proses keperawatan dan meningkatkan peran dan fungsi perawat.
3.SEJARAH PERKEMBANGAN KEPERAWATAN DI INDONESIA
Perawatan sudah dilaksanakan sejak adanya manusia dan yang jadi sasarannya adalah manusia dari sejak lahir sampai dengan datangnya kematian. Di Indonesia pekerjaan perawat dikerjakan berdasarkan naluri perasaan keibuan untuk merawat anak-anaknya (Mother Instinct). Sejarah perkembangan keperawatan di Indonesia telah banyak di pengaruhi oleh penjajah diantaranya Jepang,Belanda,dan Inggris.Dalam perkembangan di Indonesia di bagi menjadi beberapa bagian diantaranya:
Zaman Kuno
Seperti juga di Negara-negara lainnya keperawatan diserahkan kepada perempuan yang merawat keluarganya
Penyakit dianggap perbuatan setan yaitu dukun
Cara pengobatan dengan menggunakan daun-daunan
Zaman penjajahan Belanda
Tahun 1596 Cornelis De Houtman adalah orang Belanda pertama yang datang ke Indonesia pada zaman penjajahan.
Zaman VOC, (1602 – 1799)
Orang-orang Belanda datang ke Indonesia pertama kali dengan maksud untuk berdagang. Dalam usaha perdagangannya itu di bentuklah VOC. Sehubungan dengan adanya staf dan tentara maka dua usaha kesehatan. Untuk itu didirikanlah rumah sakit yang pertama yang bernama " Binnen Hospital " didirikan pada tahun 1641 bertempat di Batavia ( sekarang Jakarta) Tenaga perawatannya diambil dari penduduk pribumi ( Bumi Putera ) yang diberi nama Zieken oppaser ( penjaga orang sakit) Rumah sakit ini dibawah pengawasan dokter militer. Pada tahun 1724-1744) di luar kota didirikan rumah sakit yang kedua yang diberi nama : Buiten Hospital mengantikan Binnen Hospital yang di tutup pada tahun1808. Karena VOC dibubarkan 1799 maka oleh pemerintahan Belanda menyerahkan kepada pemerintah Indonesia yang kemuudian membentuk Organisasi Negara " Hindia Belanda". Pada tahun zaman penjajahan belanda I ( 1799-1811 ) tidak ada usaha kesehatan yang boleh dikatakan menonjol pada umumnya merupakan usaha lanjutan dari apa yang telah ada. Pengaruh kententaraan pada keperawatan mulai ada usaha-usaha dibidang kesehatan yang antara lain
MGD ( Militaire Gezondsheids Dienst ) - dinas kesehatan tentara
BGD (Burgerlije Gezon Dienst ) – dinas kesehatan rakyat,
Pada waktu pemerintahan Daendels yang terkenal dengan pembuatan jalan Merak Banyuwangi, perlu lebih meningkatkan kesehatan tentaranya. Dibuatlah beberapa Rumah sakit Garnizoen, yaitu di Semarang dan Surabaya. Pelayanannya hanya memperhatikan dinas kesehatan tentara saja.
Zaman Penjajahan Inggris Tahun 1811-1816
Gubernur Jenderal Raffles sangat memperhatikan kesehatan rakyat. Usaha-usaha di bidang kesehatan tersebut dinyatakan dalam kata-katanya "kesehatan adalah milik manusia". Usaha-usahanya:
a. Mengadakan vaksinasi umum
b. Memperbaiki perawatan orang sakit gila (jiwa)
c. Memperbaiki perawatan dari orang-orang tahanan.
Zaman Penjajahan Belanda II (1816-1942)
Setelah pemerintahan diserahkan kembali pada Belanda, maka usaha-usaha kesehatan nampak maju. Prof. Dr. Reinwardt menyusun undang-undang kesehatan, diantaranya tentang praktek dokter, kebidanan, pengobatan dan lain-lain untuk wilayah sekitar Batavia pada 1819 oleh Residen V Pabst didirikan rumah sakit untuk umum di Jakarta, diantara rumah sakit Stadsverban di Glodok. Rumah sakit ini mempunyai perlengkapan yang sederhana. Pada tahun 1919 rumah sakit Stadsverban menjadi CBZ (Central Burgerlijke Ziekeninrichting) yangkemudian dipindahkan di Salemba.
Dr. W. de bosch yang sangat menaruh perhatian terhadap kesehatan mendirikan sekolah dokter jawa (1852), yang kemudian berkembang menjadi STOVIA (1898) dan akhirnya GHS (1927). Ia juga mengadakan persiapan pendidikan kebidanan pada tahun 1852. Tahun 1875 pendidikan kebidanan ini ditutup kembali.Rumah-rumah sakit partikelir(swasta) diadakan oleh Zending.
Muhammadiyah,bala keselamatan. Salah satu yang terkenal adalah rumah sakit di Gang Paal yang sekarang menjadi Rumah Sakit Cikini, didirikan pada tahun 1879. rumah skit yang lain ialah: RS St Carolus di Jakarta, RS St Borromeus di Bandung dan RS Elizabeth di Semarang. Pendidikan perawatan telah ada yang dimulai di RS cikini pada tahun 1900. Pendidikan juru rawat dimulai pada tahun 1906 di RS Glodok pad tahun 1912.
Zaman Penjajahan Jepang (1942-1945)
Pada zaman penjajahan jepang keperawatan di Indonesia boleh dikatakan mundur. Pimpinan rumah sakit yang tadinya adalah orang-orang belanda di ambil alih orang-orang jepang dan sebagian oleh bangsa Indonesia. Obat-obatan sangat kurang,oleh karenanya wabah penyakit dimana-mana. Bahan-bahan balutan sangat kurang,sampai dipergunakannya daun pisang dan pelapah pisang.
Zaman Kemerdekaan (1945-1961)
Keadaan rumah sakit dan perawatan mengalami kekurangan-kekurangan terutama obat-obatan. Semwnjak tahun 1949 pemerintahan mulai membangun dan menyusun kenbali perbaikan-perbaikan di lapangankesehatan.
Tahun 1962- sekarang
Perawatan mulai berkenbang dengan pesat,dengan didirikannya pendidikan akademi keperawatan (AKPER) dan pada tahun 1962 dan Program Studi Ilmu keperawatan (PSIK) Fakultas Kedokteran Universitas Indonsia di Jakarta (1985),yang membawa dampak positif terhadap pelayanan perawatan. Pendekatan perawatan menggunakan proses perawatan yang berdasarkan pada kebutuhan manusia seutuhnya.
Perawatan Penyakit jiwa di Indonesia.
Perawatan penyakit jiwa di Indonesia tidak sama. Ada yang dirawat dengan lemah lembut,ada juga yang secara kasar. Ini tergantung dari kemajuan rakyat di tiap daerah. Perawatan tidak dikerjaan di rumah sakit tetapi di luar rumah sakit,disebabkan belum ada keinsyafan dan pengertain rakyat tentang penyakit jiwa. Baru pada tahun 1800 para penderita penyakit jiwa dikumpulkan di bangsal-bangsal tetapi perawatannya bersifat penjagaan saja.
Rumah-rumah sakit jiwa baru didirikan pada tahun 1875 di Cilendek,Bogor yang merupakan rumah sakit jiwa yang pertama di Indonesia dengan kapasitas 400. Rumah sakit jiwa yang kedua ialah rumah sakit jiwa di Lawang didirikan pada tahun 1894 yang sekarang terdiri dari sumber porong,Pasuruan,Sumpyuh,sehingga merupakan rumah sakit jiwa yang terbesar di Asia Tenggara dengan kapasitas 3300. Rumah sakit jiwa ke 3 ialah yang berada di magelang,didirikan pada tahun 1923 dengan kapasitas 1400.Yang lainnya didirikan di Grogol Jakarta.Padang,Palembang,Banjarmasing,Menado,yang masing-masing dngan kapasitas 1.k.60 Perawatan dikerjakan oleh juru rawat-juru rawat dan penjaga orang sakit dibawah pengawasan perawat jiwa bangsa Indonesia.
Pendidikan perawat jiwa baru dibuka pada bulan September 1940 di Cilendek,Bogor. Pendidikan ini berupa "Kursus".Pada mulanya yang diterima hanya orang-orang Belanda dan Indo Belanda;pada tahun 1951 dibuka kursus untuk perawat-perawat bangsa Indonesia.Yang mengikuti banyak yang berasal dari luar Jawa,misalnya : Sumatra,Kalimantan da sebagainya.
Saat ini perawatan penyakit jiwa dikerjakan secara modern dan tidak lagi ditempatkan dalam kamar tertutup,akan tetapi dibangsal-bangsal bebas.Mereka mendapat kebebasan,dihibur dan dapat bergaul dengan sopan sehingga akhirnya insyaf dan sadar.
Pengobatan dengan jalan diberi shock atau dikagetkan.Pada Zaman pertengahan dengan cara ditakut-takuti atau dijatuhkan kedalam sumur.Juga dipergunakan Hydro-therapie dengan menggunakan air panas atau air dingin. Pengobatan semacam ini hingga sekarang masih dilakukan.
Pada zaman modern sekarang pengobatan dilakukan dengan menggunakan obat-obat tidur,dihibur dengan musik,olahraga,berdansa dan lain-lain.Shock therapie masih dilakukan terutama dengan aliran listrik (ECT).Therapie kerja masih tetap dilaksanakan
Perkembangan keperawatan di Indonesia dipengaruhi oleh kondisi social dan ekonomi yaitu penjajahan pemerintahan colonial Belanda, Inggris dan Jepang serta situasi pemerintahan Indonesia setelah Indonesia merdeka Dibedakan atas :
1. Masa sebelum kemerdekaan
Masa penjajahan belanda I Pada masa ini perawat berasal dari penduduk pribumi yang disebut VELPLEGEK dengan sebutan zieken oppaser sebagai penjaga rumah sakit. usaha pemerintahan Belanda dibidang kesehatan adalah :
• Mendirikan rumah sakit I Binnen Hospital di Jakarta pada tahun 1799
• Mendirikan rumah sakit II Butten Hospital
• Membentuk dinas kesehatan tentara (military gezond herds dients)
• Membentu Dinas Kesehatan Rakyat (Burgerlijke gezandherds dienst)
Zaman Penjajahan Inggris
Gubernur jendral Rafles sangat memperhatikan rakyat semboyan :Kesehatan adalah milik manusia. Usaha-usahanya dibidang kesehatan :
• Pencacaran secara umum
• Membenahi cara perawatan pasien dengan gangguan jiwa
• Memperhatikan kesehatan pada para tawanan
Zaman Penjajahan Jepang
Menyebabkan perkembangan keperawatan mengalami kemunduran yang juga merupakan zaman kegelapan dunia keperawatan di Indonesia. Kemunduran-kemunduran ini terlihat pada
• pekerjaan perawat dikerjakan oleh orang-orang yang tidak terdidik,
• Pimpinan RS diambil alih oleh orang-orang jepang,
• Obat-obatan sangat kurang
• Wabah penyakit terjadi dimana-mana.
BAB III
PENUTUP
KESIMPULAN
Keperawatan lahir sejak naluriah keperawatan lahir bersamaan dengan penciptaan manusia perkembangan keperawatan dipengaruhi dengan semakin maju peradaban manusia maka semakin berkembang keperawatan. dan pengobatan zaman purba Orang-orang pada zaman dahulu hidup dalam keadaan primitive.Namun demikian mereka sudah mampu sedikit pengetahuan dan kecakapan dalam merawat atau mengobati. Pekerjaan "merawat" dikerjakan berdasarkan naluri (instink) à naluri binatang à "mother instinct" (naluri keibuan) yang merupakan suatu naluri dalam yang bersendi pada pemeliharaan jenis (melindungi anak, merawat orang lemah). keibuan kemudian bergeser kezaman purba diman zaman ini orang masih percaya pada suatu tantangan adanya kekuatan mistis yang dapat mempengaruhi kehidupan manusia, kepercayaan ini di kenal dengan nama anisme, diman seseorang yang sakit dapat disebabkan karna kekuatan alam atau pengaruh kekuatan gaib sehingga timbul keyakinan bahwa jiwa yang jahat akan dapat menimbulkan kesakitan dan jiwa yang sehat dapat menimbulkan keasehatan atau kesejahteraan.
SARAN
Untuk menjadi perawat yang profesional kita harus tahu tentang sejarah perkembangan keperawatan, karena dengan mengetahui sejarah perkembangankeperawatan kita dapat mengetahui sampai dimana perkembangan keperawatan pada masa dahulu dan dimana letak kekurangan dan kelebihan keperawatan pada masa dahulu sehingga kita bisa memperbaiki kekurangan tersebut hingga menjadi lebih baik .
DAFTAR PUSTAKA
Hidayat,A. Aziz alimul.2004.Pengantar Konsep Dasar Keperawatan.
Jakarta:Salemba Medika
www.google.Sejarah perkembangan keperawatan pendidikan dan pelayana keperawatan pada zaman kuno.com
Saturday, July 4, 2009
Baltic Sea
Baltic Sea
Jump to: navigation, search
For other uses, see Baltic (disambiguation).
Coordinates: [show location on an interactive map] 59°30′N 23°00′E / 59.5°N 23°E / 59.5; 23
Map of the Baltic Sea.
Baltic Sea
The Baltic Sea is a brackish inland sea located in Northern Europe, from 53°N to 66°N latitude and from 20°E to 26°E longitude. It is bounded by the Scandinavian Peninsula, the mainland of Europe, and the Danish islands. It drains into the Kattegat by way of the Øresund, the Great Belt and the Little Belt. The Kattegat continues through Skagerrak into the North Sea and the Atlantic Ocean. The Baltic Sea is artificially linked to the White Sea by the White Sea Canal and to the North Sea by the Kiel Canal. The Baltic is bordered on its northern edge by the Gulf of Bothnia, its northeastern edge by the Gulf of Finland, and on its eastern edge by the Gulf of Riga.
Jump to: navigation, search
For other uses, see Baltic (disambiguation).
Coordinates: [show location on an interactive map] 59°30′N 23°00′E / 59.5°N 23°E / 59.5; 23
Map of the Baltic Sea.
Baltic Sea
The Baltic Sea is a brackish inland sea located in Northern Europe, from 53°N to 66°N latitude and from 20°E to 26°E longitude. It is bounded by the Scandinavian Peninsula, the mainland of Europe, and the Danish islands. It drains into the Kattegat by way of the Øresund, the Great Belt and the Little Belt. The Kattegat continues through Skagerrak into the North Sea and the Atlantic Ocean. The Baltic Sea is artificially linked to the White Sea by the White Sea Canal and to the North Sea by the Kiel Canal. The Baltic is bordered on its northern edge by the Gulf of Bothnia, its northeastern edge by the Gulf of Finland, and on its eastern edge by the Gulf of Riga.
Popular culture
Popular culture
This section requires expansion.
The Caribbean is the setting for countless literary efforts often related to piracy and swashbuckling. One memorable work of pulp fiction has in its title a geographic feature unique in its way to the islands: Fear Cay, the eleventh Doc Savage adventure by Lester Dent. Many James Bond adventures were set there. It is also well known as the location of the Pirates of the Caribbean films, featuring Port Royal. Less swashbuckling, but not lacking in man-against-the-sea exploits, is Peter Matthiessen's Far Tortuga (1975), which chronicles the adventures of a turtling crew in the late 1960's. The book's prose, informed by the Caribbean's boundless, sun-bleached expanses, is sparse, and challengingly so: Only one metaphor is used, and all dialogue unfolds unencumbered by attribution, as Matthiessen paints a picture of humanity literally and figuratively adrift.
This section requires expansion.
The Caribbean is the setting for countless literary efforts often related to piracy and swashbuckling. One memorable work of pulp fiction has in its title a geographic feature unique in its way to the islands: Fear Cay, the eleventh Doc Savage adventure by Lester Dent. Many James Bond adventures were set there. It is also well known as the location of the Pirates of the Caribbean films, featuring Port Royal. Less swashbuckling, but not lacking in man-against-the-sea exploits, is Peter Matthiessen's Far Tortuga (1975), which chronicles the adventures of a turtling crew in the late 1960's. The book's prose, informed by the Caribbean's boundless, sun-bleached expanses, is sparse, and challengingly so: Only one metaphor is used, and all dialogue unfolds unencumbered by attribution, as Matthiessen paints a picture of humanity literally and figuratively adrift.
Economy and human activity
Economy and human activity
A Caribbean beach in Isla Margarita, Venezuela.
The Caribbean region has seen a significant increase in human activity since the colonization period. The sea is one of the largest oil production areas in the world, producing approximately 170 million tons per year.[11] The area also generates a large fishing industry for the surrounding countries, accounting for half a million metric tons of fish a year.[12]
Human activity in the area also accounts for a significant amount of pollution, Pan American Health Organization estimating in 1993 that only about 10% of the sewage from the Central American and Caribbean Island countries is properly treated before being released into the Sea.[11]
The Caribbean region supports a large tourist industry. The Caribbean Tourism Organization calculates that about 12 million people a year visit the area, including (in 1991–1992) about 8 million Cruise Ship tourists.
A Caribbean beach in Isla Margarita, Venezuela.
The Caribbean region has seen a significant increase in human activity since the colonization period. The sea is one of the largest oil production areas in the world, producing approximately 170 million tons per year.[11] The area also generates a large fishing industry for the surrounding countries, accounting for half a million metric tons of fish a year.[12]
Human activity in the area also accounts for a significant amount of pollution, Pan American Health Organization estimating in 1993 that only about 10% of the sewage from the Central American and Caribbean Island countries is properly treated before being released into the Sea.[11]
The Caribbean region supports a large tourist industry. The Caribbean Tourism Organization calculates that about 12 million people a year visit the area, including (in 1991–1992) about 8 million Cruise Ship tourists.
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