1 suicidejocelyn s. barrioseh1020patti smith

1. 1
Suicide
Jocelyn S. Barrios
EH1020
Patti Smith
Columbia Southern University
Patti Smith
The Introduction should be first in this assignment.
2
Literature Review
Suicide has been a significant problem for people for a long
time. The section of the
literature review covers the past discussion surrounding suicide.
Suicide has been a big problem
since the past period. Different researchers have discussed cases
of suicide at different periods.
The literature review section will cover the history of suicide,
the terminology of suicide, pros and

2. cons related to suicide, and finally, summarize the literature
review.
Suicide refers to death which results in many deaths across the
globe. People just to
terminate their lives intentionally. Suicide is a common problem
that has claimed the lives of many
people in the past years.
The number of suicides cases have been increasing for the past
years. Suicides have
increased in both males and females and all genders
(Hedegaard, Curtin & Warner, 2020). The
study reveals that the numbers of death constantly increased
from 1999 to 2018. Despite the United
States government's efforts to stop the cases of suicides through
different programs, the number of
deaths resulting from suicide had kept increasing over the years.
When comparing the suicide rates
between 2018 and 1999, Hedegaard, Curtin & Warner (2020)
indicated that suicide cases were
higher in 2018 compared to 1999 in the united states. The study
clearly shows that suicide
continues to cause death among people and has continuously
resulted in more death than in

3. previous years.
The causes of many suicide cases among youths are depression.
Furr, Westefeld,
McConnel &Jenkin, (2001) conducted a study on suicide and
depression among college students.
The study reveals that suicide cases among college students
were mainly a result of depression.
Most of the students opt to perform suicide when they are under
depression. The college students
Patti Smith
After the Brief History, you should have a Pro section. The Pro
section presents the information from your source material that
agrees with your argument/thesis statement.
Patti Smith
Is this the Brief History section?
Patti Smith
Patti Smith
Patti Smith
3
who are mostly just past teenage age sometimes go through
intense depression due to the issues
resulting from the family or school. The students end up being

4. too much depressed. When the
depression is not well handled, the students engage in suicide;
hence, they lose their lives.
The suicide case results from economic hardship. Kim (2020)
conducted a study to
determine the factors associated with Suicide in Korea. The
study revealed that there was a large
number of suicide cases among low-income people. Low-income
people were more likely to
engage in suicide activities than those with good income. The
low income makes people find it
hard for people to meet their basic needs. The people struggle to
meet basic needs such as food,
clothing and housing. As a result of this, they become more
hopeless and discouraged in life. The
hopeless and discouraged life makes most people think of ways
to terminate their lives. This
hopelessness and fear of failure in life contribute to a large
number of deaths. The availability of
the source of income, such as well-paying job, helps reduce the
cases of Suicide (Noh, 2009).
The suicide cases from the adolescent and young people mostly
result from the
relationship issues. Price, et al., (2016) the study on how

5. romantic concerns among young people
are associated with mental illness finds out that most of the
suicides by the adolescent comes from
the romance. Adolescents sometimes do not make decisions well
when they are in a relationship,
and issues emerge in those relationships. As a result of poor
decision making when issues such as
break-up occur, they opt to commit suicide.
Prisoners carry out suicide's activities. The prisoners find the
decision to commit suicide an
advantageous move. The choice to continue suffering in prisons
and terminating their lives through
suicides. Since prisons have a lot of suffering, most of the
prisoners opt to commit suicide to avoid
going through the suffering, they have to pass through during
their jail term (Fazel, Ramesh &
Hawton, 2017).
Patti Smith
After the Pros section, you should have a Cons section. The
Con section presents the information from your source material
that disagrees with your argument/thesis statement.
Patti Smith
An argumentative focus is required...the format is also very
specific and should be followed as illustrated in the example

6. Literature Review included in the Unit 4 module.
Patti Smith
4
Suicide is considered by the people who commit it as the
solution to avoid transferring
suffering. Committing suicide helps avoid the costs that others
will incur as they try to help in the
form of medication. Diseases that make someone suffer, and
there is no possibility of recovering,
and the best option is suicide. Suicides enable one to be able to
cut the suffering short as it
terminates life through death. Criminals avoid the suffering that
comes with corporal punishment
through suicide which has remained the best solution for many
people who go through suffering.
Suicide brings an end to suffering. People opt to commit suicide
to end the suffering which arises
from daily life.
Suicide hurts the family as t leaves the family members
suffering from the loss of the
provider to the family. When the family's key provider commits
suicide, he/she leaves those who

7. depend on him/her to go through suffering. The family goes
through the social problem in terms of
social relationships as they have to look for how they will be
able to fill the gap left by the person
who has committed Suicide (Cerel, et al., 2008).
Suicide is a problem that affects a different number of people. It
affects people of different
ages and both male and female. Depression can result from
depression, relationship problem, life
difficulties, from lack of income, among other factors.
Introduction
The death of loved ones has a great effect on people. One
significance of death it helps in
the reduction of the straining on the available resources. On the
contrary, death takes away
relatives' friends and people who matter most in life. One way
of death is through suicide. An
example of suicide is by self-shooting and taking poison. Death
can also result naturally from
sickness or an accident. The difference between suicide and
natural death is that suicidal death is
5

8. induced by oneself, while no one induces natural death. When
terrorists commit suicide, it allows
enables people to enjoy peace. At the same time, suicide brings
a lot of suffering to close friends
and relatives. Committing suicide is considered the worst
option one can take to end his or her life,
despite what he/she is going through.
6
References
Hedegaard, H., Curtin, S. C., & Warner, M. (2020). Increase in
suicide mortality in the United
States, 1999–2018.
Jeon, H. J. (2011). Depression and Suicide. Journal of the
Korean Medical Association, 54(4),
370-375.
Furr, S. R., Westefeld, J. S., McConnell, G. N., & Jenkins, J. M.
(2001). Suicide and depression
among college students: A decade later. Professional
Psychology: Research and
Practice, 32(1), 97.

9. Noh, Y. H. (2009). Does unemployment increase in suicide
rates? The OECD panel evidence.
Journal of Economic Psychology, 30(4), 575-582.
Price, M., Hides, L., Cockshaw, W., Staneva, A. A., &
Stoyanov, S. R. (2016). Young love:
Romantic concerns and associated mental health issues among
adolescent help-
seekers. Behavioral Sciences, 6(2), 9.
Fazel, S., Ramesh, T., & Hawton, K. (2017). Suicide in prisons:
an international study of
prevalence and contributory factors. The Lancet Psychiatry,
4(12), 946-952.
Cerel, J., Jordan, J. R., & Duberstein, P. R. (2008). The impact
of suicide on the family. Crisis:
The Journal of Crisis Intervention and Suicide Prevention,
29(1), 38.
Patti Smith
Patti Smith
Patti Smith
Patti Smith

10. The Pedagogy
Role Development in Professional Nursing Practice,
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14. Library of Congress Cataloging-in-Publication Data
Names: Masters, Kathleen, editor.
Title: Role development in professional nursing
practice / [edited by]
Kathleen Masters.
Description: Fifth edition. | Burlington,
Massachusetts : Jones & Bartlett
Learning, 2018. | Includes bibliographical references
and index.
Identifiers: LCCN 2018023086 | eISBN
9781284152920
Subjects: | MESH: Nursing--trends | Nursing--
standards | Professional
Practice | Nurse’s Role | Philosophy, Nursing
Classification: LCC RT82 | NLM WY 16.1 |
DDC 610.73--dc23
LC record available at https://lccn.loc.gov/2018023086
6048
Printed in the United States of America
22 21 20 19 18 10 9 8 7
6 5 4 3 2 1
http://lccn.loc.gov/2018023086
Dedication
This book is dedicated to my Heavenly Father and to

15. my loving family:
my husband, Eddie, and my two daughters,
Rebecca and Rachel. Words
cannot express my appreciation for their ongoing
encouragement and
support throughout my career.
1
© James Kang/EyeEm/Getty Images
CONTENTS
Preface
Contributors
UNIT I: FOUNDATIONS OF PROFESSIONAL
NURSING PRACTICE
A History of Health Care and Nursing
Karen Saucier Lundy and Kathleen Masters
Classical Era
Middle Ages
The Renaissance
The Dark Period of Nursing
The Industrial Revolution
And Then There Was Nightingale . . .
Continued Development of Professional Nursing in
the United
Kingdom
The Development of Professional Nursing in Canada
The Development of Professional Nursing in

16. Australia
Early Nursing Education and Organization in the
United States
2
3
4
5
The Evolution of Nursing in the United States:
The First Century of
Professional Nursing
The New Century
International Council of Nurses
Conclusion
References
Frameworks for Professional Nursing Practice
Kathleen Masters
Overview of Selected Nursing Theories
Overview of Selected Nonnursing Theories
Relationship of Theory to Professional Nursing
Practice
Conclusion
References
Philosophy of Nursing
Mary W. Stewart
Philosophy

17. Early Philosophy
Paradigms
Beliefs
Values
Developing a Personal Philosophy of Nursing
Conclusion
References
Competencies for Professional Nursing Practice
Jill Rushing and Kathleen Masters
Overview
Nurse of the Future: Nursing Core Competencies
Critical Thinking, Clinical Judgment, and Clinical
Reasoning in
Nursing Practice
Conclusion
References
Education and Socialization to the Professional
Nursing Role
Kathleen Masters and Melanie Gilmore
8
6
7
Professional Nursing Roles and Values
The Socialization (or Formation) Process
Facilitating the Transition to Professional Practice
Conclusion
References

18. Advancing and Managing Your Professional Nursing
Career
Mary Louise Coyne and Cynthia Chatham
Nursing: A Job or a Career?
Trends That Affect Nursing Career Decisions
Showcasing Your Professional Self
Mentoring
Education and Lifelong Learning
Professional Engagement
Expectations for Your Performance
Taking Care of Self
Conclusion
References
Social Context and the Future of Professional
Nursing
Mary W. Stewart, Katherine E. Nugent, and
Kathleen Masters
Nursing’s Social Contract with Society
Public Image of Nursing
The Gender Gap
Changing Demographics and Cultural Competence
Access to Health Care
Societal Trends
Trends in Nursing
Conclusion
References
UNIT II PROFESSIONAL NURSING PRACTICE
AND THE
MANAGEMENT OF PATIENT CARE
Safety and Quality Improvement in Professional

19. Nursing
Practice
Kathleen Masters
10
9
11
Patient Safety
Quality Improvement in Health Care
Quality Improvement Measurement and Process
The Role of the Nurse in Quality Improvement
Conclusion
References
Evidence-Based Professional Nursing Practice
Kathleen Masters
Evidence-Based Practice: What Is It?
Barriers to Evidence-Based Practice
Promoting Evidence-Based Practice
Searching for Evidence
Evaluating the Evidence
Implementation Models for Evidence-Based
Practice
Conclusion
References
Patient Education and Patient-Centered Care in
Professional
Nursing Practice
Kathleen Masters

20. Dimensions of Patient-Centered Care
Communication as a Strategy to Support Patient-
Centered Care
Patient Education as a Strategy to Support Patient-
Centered Care
Evaluation of Patient-Centered Care
Conclusion
References
Informatics in Professional Nursing Practice
Kathleen Masters and Cathy K. Hughes
Informatics: What Is It?
The Effect of Legislation on Health Informatics
Nursing Informatics Competencies
Basic Computer Competencies
Information Literacy
Information Management
Current and Future Trends
13
12
14
15
Conclusion
References
Leadership and Systems-Based Professional Nursing
Practice

21. Kathleen Masters and Sharon Vincent
Healthcare Delivery System
Nursing Leadership in a Complex Healthcare
System
Nursing Models of Patient Care
Roles of the Professional Nurse
Conclusion
References
Teamwork, Collaboration, and Communication in
Professional
Nursing Practice
Kathleen Masters
Interprofessional Teams and Healthcare Quality
and Safety
Interprofessional Collaborative Practice Domains
Interprofessional Team Performance and
Communication
Conclusion
References
Ethics in Professional Nursing Practice
Janie B. Butts and Karen L. Rich
Ethics
Ethical Theories and Approaches
Professional Ethics and Codes
Ethical Analysis and Decision Making in Nursing
Relationships in Professional Practice
Moral Rights and Autonomy
Social Justice
Death and End-of-Life Care
Conclusion
References

22. Law and Professional Nursing Practice
Kathleen Driscoll and Kathleen Masters
The Sources of Law
Classification and Enforcement of the Law
Nursing Scope and Standards
Malpractice and Negligence
Nursing Licensure
Professional Accountability
Conclusion
References
Appendix A Provisions of Code of
Ethics for Nurses
Appendix B The ICN Code of Ethics
for Nurses
Glossary
Index
© James Kang/EyeEm/Getty Images
PREFACE
Although the process of professional development is
a lifelong journey, it
is a journey that begins in earnest during
the time of initial academic
preparation. The goal of this book is to provide
nursing students with a
road map to help guide them along their journey as

23. professional nurses.
This book is organized into two units. The chapters in
the first unit
focus on the foundational concepts that are
essential to the development
of the individual professional nurse. The chapters in
Unit II address
issues related to professional nursing practice
and the management of
patient care, specifically in the context of quality
and safety. In the Fifth
Edition, the chapter content is conceptualized,
when applicable, around
nursing competencies, professional standards, and
recommendations
from national groups, such as Institute of Medicine
reports. All chapters
have been updated, several chapters have been expanded,
and two new
chapters have been added in this edition. The
chapters included in Unit I
provide the student nurse with a basicfoundation
in such areasas
nursing history, theory, philosophy, socialization
into the nursing role,
professional development, the social context of
nursing, and professional
nursing competencies. The social context of nursing
chapter has been
expanded to incorporate not only societal trends
but also trends in
nursing practice and education that are changing the

24. future landscape of
the profession. The chapters in Unit II are more
directly related to patient
care management and, as stated previously, are
presented in the context
of quality and safety. Chapter topics include
the role of the nurse in
patient safety and quality improvement, evidence-
based nursing practice,
the role of the nurse in patient education and
patient-centered care,
informatics in nursing practice, the role of the
nurse related to teamwork
and collaboration, systems-based practice and leadership,
ethics in
nursing practice, and the law as it relates to
patient care and nursing.
Unit II chapters have undergone revision, with a
refocus of the content on
recommended nursing and healthcare competencies as
well as
recommendations from faculty using the text in
the classroom.
The Fifth Edition incorporates the revised Nurse of
the Future:
Nursing Core Competencies: Registered Nurse
throughout each chapter.
The 10 essential competencies that are intended to
guide nursing
curricula and practice emanate from the central core of
the model that
represents nursing knowledge (Massachusetts Department
of Higher
Education, 2016) and are based on the
American Association of Colleges

25. of Nursing (AACN) Essentials of Baccalaureate
Education for
Professional Nursing Practice, National League for
Nursing Council of
Associate Degree Nursing competencies, Institute of
Medicine
recommendations, Quality and Safety Education for
Nurses (QSEN)
competencies, and American Nurses Association
standards, as well as
other professional organization standards and
recommendations. The 10
competencies included in the model are patient-
centered care,
professionalism, informatics and technology,
evidence-based practice,
leadership, systems-based practice, safety,
communication, teamwork
and collaboration, and quality improvement. Essential
knowledge, skills,
and attitudes (KSAs) reflecting cognitive, psychomotor,
and affective
learning domains are specified for each competency.
The KSAs identified
in the model reflect the expectations for initial
nursing practice following
the completion of a prelicensure professional
nursing education program
(Massachusetts Department of Higher Education,
2016).
This new edition has competency boxes throughout
the chapters that
link examples of the KSAs appropriate to the
chapter content to Nurse of
the Future: Nursing Core Competencies required of

26. entry-level
professional nurses. The competency model is
explained in detail in
Chapter 4 and is available in its entirety online
at
http://www.mass.edu/nahi/documents/NOFRNCompetencies_up
dated_March2016.pdf
The Fifth Edition also includes applicable AACN
essentials
incorporated as key outcomes throughout each chapter
to assist faculty
with the alignment of curricular content with criteria
required by
accreditors. The key outcomes also demonstrate for
students the link
between expectations included in the competency
model, the
expectations embodied in the essentials document, and
the chapter
content. A discussion of the AACN (2008)
Essentials of Baccalaureate
Education for Professional Nursing Practice is also
included in Chapter 4.
This new edition continues to use case studies,
congruent with
Benner, Sutphen, Leonard, and Day’s (2010)
Carnegie Report
recommendations that nursing educators teach for
“situated cognition”
using narrative strategies to lead to “situated action,”
thus increasing the

27. clinical connection in our teaching or that we
teach for “clinical salience.”
In addition, critical thinking questions are included
throughout each
chapter to promote student reflection on the chapter
concepts.
Classroom activities are also provided based on
chapter content.
Additional resources not connected to this text, but
applicable to the
content herein, include a toolkit focused on
the nursing core
competencies available at
http://www.mass.edu/nahi/documents/NursingCoreCompetencies
Toolkit-
March2016.pdf and teaching activities related to nursing
competencies
available on the QSEN website at
http://qsen.org/teaching-strategies/.
Although the topics included in this textbook are
not inclusive of all
that could be discussed in relationship to the
broad theme of role
development in professional nursing practice, it is
my prayer that the
subjects herein make a contribution to the
profession of nursing by
providing the student with a solid foundation and a
desire to grow as a
professional nurse throughout the journey that
we call a professional
nursing career. Let the journey begin.
—Kathleen Masters

28. References
American Association of Colleges of Nursing. (2008).
The essentials of
baccalaureate education for professional nursing
practice. Retrieved
http://www.mass.edu/nahi/documents/NOFRNCompetencies_up
dated_March2016.pdf
http://www.mass.edu/nahi/documents/NursingCoreCompetencies
Toolkit-March2016.pdf
http://qsen.org/teaching-strategies/
from http://www.aacnnursing.org/Education-Resources/AACN-
Essentials
Benner, P., Sutphen, M., Leonard, V., & Day, L.
(2010). Educating nurses:
A call for radical transformation. San Francisco,
CA: Jossey-Bass.
Massachusetts Department of Higher Education.
(2016). Nurse of the
future: Nursing core competencies: Registered nurse.
Retrieved from
http://www.mass.edu/nahi/documents/NOFRNCompetencies_up
dated_March2016.pdf
Editor
Kathleen Masters, DNS, RN
Professor and Dean
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi

29. http://www.aacnnursing.org/Education-Resources/AACN-
Essentials
http://www.mass.edu/nahi/documents/NOFRNCompetencies_up
dated_March2016.pdf
© James Kang/EyeEm/Getty Images
CONTRIBUTORS
Janie B. Butts, PhD, RN
Professor
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi
Cynthia Chatham, DSN, RN
Associate Professor
University of Southern Mississippi
College of Nursing
Long Beach, Mississippi
Mary Louise Coyne, DNSc, RN
Professor
University of Southern Mississippi
College of Nursing
Long Beach, Mississippi
Kathleen Driscoll, JD, MS, RN
University of Cincinnati
College of Nursing
Cincinnati, Ohio
Melanie Gilmore, PhD, RN
Associate Professor (Retired)
University of Southern Mississippi

30. College of Nursing
Hattiesburg, Mississippi
Cathy K. Hughes, DNP, RN
Teaching Assistant Professor
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi
Karen Saucier Lundy, PhD, RN, FAAN
Professor Emeritus
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi
Katherine E. Nugent, PhD, RN
Professor and Dean (Retired)
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi
Karen L. Rich, PhD, RN
Associate Professor
University of Southern Mississippi
College of Nursing
Long Beach, Mississippi
Jill Rushing, MSN, RN
Director of BSN Program
University of Southern Mississippi
College of Nursing
Hattiesburg, Mississippi

31. Mary W. Stewart, PhD, RN
Director of PhD Program
University of Mississippi Medical Center
School of Nursing
Jackson, Mississippi
Sharon Vincent, DNP, RN, CNOR
University of North Carolina
College of Nursing
Charlotte, North Carolina
© James Kang/EyeEm/Getty Images
UNIT I
Foundations of Professional
Nursing Practice
© James Kang/EyeEm/Getty Images
CHAPTER 1
A History of Health Care and
Nursing1
Karen Saucier Lundy and Kathleen Masters
Learning Objectives
After completing this chapter, the student should
be able to:

32. 1. Identify social, political, and economic influences on
the
development of professional nursing practice.
2. Identify important leaders and events that have
significantly
affected the development of professional nursing
practice.
Key Terms and Concepts
Greek era
Roman era
Deaconesses
Florence Nightingale
Reformation
Chadwick Report
Shattuck Report
William Rathbone
Ethel Fenwick
Jeanne Mance
Mary Agnes Snively
Goldmark Report
Brown Report
Isabel Hampton Robb
American Nurses Association (ANA)
Lavinia Lloyd Dock
American Journal of Nursing (AJN)
Margaret Sanger
Lillian Wald
Jane A. Delano
Annie Goodrich
Mary Brewster

33. Henry Street Settlement
Elizabeth Tyler
Jessie Sleet Scales
Dorothea Lynde Dix
Clara Barton
Frontier Nursing Service
Mary Breckinridge
Mary D. Osborne
Frances Payne Bolton
International Council of Nurses (ICN)
Although no specialized nurse role per se
developed in early civilizations,
human cultures recognized the need for nursing
care. The truly sick
person was weakand helpless and could not fulfill
the duties that were
normally expected of a member of the community.
In such cases,
someone had to watch over the patient, nurse
him or her, and provide
care. In most societies, this nurse role was filled by
a family member,
usually female. As in most cultures, the childbearing
woman had special
needs that often resulted in a specialized role
for the caregiver. Every
society since the dawn of time had someone to
nurse and take care of
the mother and infant around the childbearing
events. In whatever form
the nurse took, the role was associated with compassion,
health

34. promotion, and kindness (Bullough & Bullough, 1978).
Classical Era
More than 4,000 years ago, Egyptian physicians
and nurses used an
abundant pharmacologic repertoire to cure the ill and
injured. The Ebers
Papyrus lists more than 700 remedies for ailments ranging
from
snakebites to puerperal fever (Kalisch & Kalisch,
1986). Healing
appeared in the Egyptian culture as the successful
result of a contest
between invisible beings of good and evil (Shryock,
1959). Around 1000
B.C., the Egyptians constructed elaborate drainage
systems, developed
pharmaceutical herbs and preparations, and embalmed
the dead. The
Hebrews formulated an elaborate hygiene code that
dealt with laws
governing both personal and community hygiene, such as
contagion,
disinfection, and sanitation through the preparation of
food and water.
The Jewish contribution to health is greater in
sanitation than in their
concept of disease. Garbage and excreta were
disposed of outside the
city or camp, infectious diseases were quarantined,
spitting was outlawed
as unhygienic, and bodily cleanliness became a
prerequisite for moral
purity. Although many of the Hebrew ideasabout

35. hygiene were Egyptian
in origin, the Hebrews were the first to codify
them and link them with
spiritual godliness (Bullough & Bullough, 1978).
Disease and disability in the Mesopotamian area were
considered a
great curse, a divine punishment for grievous
acts against the gods.
Experiencing illness as punishment for a sin
linked the sick person to
anything even remotely deviant. Not only was the person
suffering from
the illness but also he or she also was branded by
society as having
deserved it. Those who obeyed God’s law lived in
health and happiness,
and those who transgressed the law were punished
with illness and
suffering. The sick person then had to make
atonement for the sins, enlist
a priest or other spiritual healer to lift the
curse, or live with the illness to
its ultimate outcome (Bullough & Bullough, 1978).
Nursing care by a
family member or relative would be needed,
regardless of the outcome of
the sin, curse, disease-atonement-recovery, or death
cycle. This logic
became the basis for explanation of why some people
“get sick and some
don’t” for many centuries and still persists to
some degree in most

36. cultures today.
The Greeks and Health
In Greek mythology, the god of medicine,
Asclepias, cured disease. One
of his daughters, Hygieia, from whom we derive
the word hygiene, was
the goddess of preventive health and protected
humans from disease.
Panacea, Asclepias’ other daughter, was known as
the all-healing
“universal remedy,” and today her name is used to
describe any ultimate
cure-all in medicine. She was known as the “light”
of the day, and her
name was invoked and shrines built to her during
times of epidemics
(Brooke, 1997).
During the Greek era, Hippocrates of Cos
emphasized the rational
treatment of sickness as a natural rather than a
god-inflicted
phenomenon. Hippocrates (460–370 B.C.) is
considered the father of
medicine because of his arrangements of the oral
and written remedies
and diseases, which had long been secrets held by
priests and religious
healers, into a textbook of medicine that was used
for centuries (Bullough
& Bullough, 1978).
In Greek society, health was considered to
result from a balance
between mind and body. Hippocrates wrote a

37. most important book, Air,
Water, and Places, which detailed the relationship
between humans and
the environment. This is considered a milestone in
the eventual
development of the science of epidemiology as
the first such treatise on
the connectedness of the web of life. This topic of
the relationship
between humans and their environment did not recur
until the
development of bacteriology in the late 1800s
(Rosen, 1958).
Perhaps the idea that most damaged the practice and
scientific
theory of medicine and health for centuries was
the doctrine of the four
humors, first spoken of by Empedocles of
Acragas (493–433 B.C.).
Empedocles was a philosopher and a physician,
and as a result, he
synthesized his cosmologic ideaswith his medical
theory. He believed
that the same four elements that made up the
universe were found in
humans and in all animate beings (Bullough &
Bullough, 1978).
Empedocles believed that man [sic] was a microcosm,
a small world
within the macrocosm, or external environment.
The four humors of the
body (blood, bile, phlegm, and black bile)

38. corresponded to the four
elements of the larger world (fire, air, water,
and earth) (Kalisch &
Kalisch, 1986). Depending on the prevailing humor,
a person was
sanguine, choleric, phlegmatic, or melancholic.
Because of this strongly
held and persistent belief in the connection
between the balance of the
four humors and health status, treatment was aimed
at restoring the
appropriate balance of the four humors through
the control of their
corresponding elements. Through manipulating the two
sets of opposite
qualities—hot and cold, wet and dry—balance was the
goal of the
intervention. Fire was hot and dry, air was hot and
wet, water was cold
and wet, and earth was cold and dry. For example, if a
person had a
fever, cold compresses would be prescribed;
for a chill the person would
be warmed. Such doctrine gave rise to faulty and
ineffective treatment of
disease that influenced medical education for many
years (Taylor, 1922).
Plato, in The Republic, details the importance of
recreation, a
balanced mind and body, nutrition, and exercise. A
distinction was made
among gender, class, and health as early as
the Greek era; only males of

39. the aristocracy could afford the luxury of
maintaining a healthful lifestyle
(Rosen, 1958).
In The Iliad, a poem about the attempts to
capture Troy and rescue
Helen from her lover, Paris, 140 different wounds
are described. The
mortality rate averaged 77.6%, the highest as a
result of sword and spear
thrusts and the lowest from superficial arrow
wounds. There was
considerable need for nursing care, and Achilles,
Patroclus, and other
princes often acted as nurses to the injured.
The early stages of Greek
medicine reflected the influences of Egyptian, Babylonian,
and Hebrew
medicine. Therefore, good medical and nursing
techniques were used to
treat these war wounds: The arrow was drawn or
cut out, the wound
washed, soothing herbs applied, and the wound
bandaged. However, in
sickness in which no wound occurred, an evil
spirit was considered the
cause. The Greeks applied rational causes and
cures to external injuries,
whereas internal ailments continued to be linked to
spiritual maladies
(Bullough & Bullough, 1978).
Roman Era
During the rise and the fall of the Roman era
(31 B.C.–A.D. 476), Greek

40. culture continued to be a strong influence. The
Romans easily adopted
Greek culture and expanded the Greeks’
accomplishments, especially in
the fields of engineering, law, and government.
For Romans, the
government had an obligation to protect its citizens
not only from outside
aggression, such as warring neighbors, but also
from inside the
civilization, in the form of health laws.
According to Bullough and
Bullough (1978), Rome was essentially a “Greek
cultural colony” (p. 20).
Galen of Pergamum (A.D. 129–199), often known
as the greatest
Greek physician after Hippocrates, left for Rome
after studying medicine
in Greece and Egypt and gained great fame as a
medical practitioner,
lecturer, and experimenter. In his lifetime, medicine
evolved into a
science; he submitted traditional healing practices to
experimentation and
was possibly the greatest medical researcher before
the 1600s (Bullough
& Bullough, 1978). He was considered the last of
the great physicians of
antiquity (Kalisch & Kalisch, 1986).
…