Nursing INursing I

Reform of Nursing Reform of Nursing EducationEducation

Pre-Nightingale NursingPre-Nightingale Nursing

Emergence of modern nursing tied to Emergence of modern nursing tied to emergence of the modern hospitalemergence of the modern hospital

Prior to early 19Prior to early 19thth century: century:– Hospitals charitable institutions for the Hospitals charitable institutions for the

poor, not providers of health carepoor, not providers of health care– Attendants to those who were sick were Attendants to those who were sick were

other paupers other paupers

The history of nursing education is The history of nursing education is inextricably shaped by:inextricably shaped by:– ClassClass– GenderGender

Many of its historic and Many of its historic and contemporary challenges are a result contemporary challenges are a result of this realityof this reality

Most attendants were elderly former Most attendants were elderly former patients who stayed onpatients who stayed on

Transition to 24/7staffing with fully Transition to 24/7staffing with fully trained nurses took over 100 yearstrained nurses took over 100 years

Reform of nursing began prior to Reform of nursing began prior to NightingaleNightingale

Initial early 19Initial early 19thth century reforms century reforms instituted by physicians working with instituted by physicians working with religious groups (Helmstadter)religious groups (Helmstadter)

Most famous example is the Sisters Most famous example is the Sisters of St. John’s the Evangelist, or St. of St. John’s the Evangelist, or St. John’s HouseJohn’s House

Social/medical context:Social/medical context:

1. Medical views about the education 1. Medical views about the education of womenof women– Women’s response to this viewWomen’s response to this view

2.Oxford movement2.Oxford movement– Movement to reform the Church of Movement to reform the Church of

England begun at Oxford University in England begun at Oxford University in 1833 1833

– Retrieved many Catholic traditionsRetrieved many Catholic traditionsBrotherhoods/sisterhoodsBrotherhoods/sisterhoodsMonasticismMonasticism

3. Medical education 3. Medical education reformreform– King’s College King’s College

Hospital reform led Hospital reform led by Robert Bentley by Robert Bentley ToddTodd

– Students lived in Students lived in residenceresidence

– Religious instructionReligious instruction– More contact with More contact with

teachersteachers

4. Middle class women’s involvement 4. Middle class women’s involvement in charitable workin charitable work

Only option open to respectable Only option open to respectable womenwomen

St. John’s House founded in 1847 by St. John’s House founded in 1847 by Todd & othersTodd & others– Inspired by Kaiserwerth (as was Inspired by Kaiserwerth (as was

Nightingale)Nightingale)

Women lived at St. John’s HouseWomen lived at St. John’s House Sent to hospital for trainingSent to hospital for training

ObjectivesObjectives– Provide working class women with Provide working class women with

training to enable them to elevate their training to enable them to elevate their social positionsocial position

– Provide upper class women with an Provide upper class women with an opportunity to work, without pay, to opportunity to work, without pay, to train these nursestrain these nurses

All probationers had 1 year of All probationers had 1 year of training in technical nursingtraining in technical nursing– Classes from nursing sistersClasses from nursing sisters– Lectures from physiciansLectures from physicians

Sisters (never working class) had 2 Sisters (never working class) had 2 years of intensive training in nursing years of intensive training in nursing & hospital management& hospital management

St. John’s House sent trained nurses St. John’s House sent trained nurses out to work in hospitals & the out to work in hospitals & the communitycommunity

Took over nursing service of King’s Took over nursing service of King’s College Hospital in 1856College Hospital in 1856

Hospital nursing a parallel system for Hospital nursing a parallel system for much of 19much of 19thth century century– Trained nurses during dayTrained nurses during day– Untrained attendants at night “night Untrained attendants at night “night

watchers”watchers”– Eventually night watchers taken over by Eventually night watchers taken over by

student nursesstudent nurses– Mid-20Mid-20thth century before all shifts century before all shifts

comprised of trained nursescomprised of trained nurses

Nightingale well aware of St. John’s Nightingale well aware of St. John’s House nursing reformsHouse nursing reforms

St. John’s nurses accompanied her to St. John’s nurses accompanied her to the Crimeathe Crimea

The Nightingale ReformsThe Nightingale Reforms

Impact of Florence Nightingale Impact of Florence Nightingale (1820-1910)(1820-1910)

Generally portrayed as founder of Generally portrayed as founder of modern nursingmodern nursing

Re-fashioned it as a respectable Re-fashioned it as a respectable occupation for young middle class occupation for young middle class womenwomen

Born to a well-to-do familyBorn to a well-to-do family

Educated by her fatherEducated by her father

Rejected traditional role of Rejected traditional role of wife/motherwife/mother

Drawn to model of nursing she had Drawn to model of nursing she had seen in Europeseen in Europe

Attempted to study with a family Attempted to study with a family friend, Dr. Richard Fowler, at Salisbury friend, Dr. Richard Fowler, at Salisbury HospitalHospital

“… “… it was if I had wanted to be a it was if I had wanted to be a kitchen maid.”kitchen maid.”

Studied twice at Kaiserwerth (1850, Studied twice at Kaiserwerth (1850, 1851)1851)

Studied in France with Sisters of Studied in France with Sisters of Charity (1852, 1853)Charity (1852, 1853)

Left family home in 1853 to take Left family home in 1853 to take position as superintendent of a position as superintendent of a voluntary hospital for womenvoluntary hospital for women

Given allowance by her fatherGiven allowance by her father

Resigned 1854 & entered into Resigned 1854 & entered into negotiations with King’s College negotiations with King’s College Hospital for similar positionHospital for similar position

Instead, appointed to take a group of Instead, appointed to take a group of nurses to the Crimeanurses to the Crimea

Became a celebrityBecame a celebrity

Establishment of Nightingale Fund to Establishment of Nightingale Fund to establish systematic nurse training in establish systematic nurse training in BritainBritain

Originally conceived as a type of Originally conceived as a type of collegecollege

Changed to the advantage of Changed to the advantage of hospitalshospitals

First training school established at St. First training school established at St. Thomas in 1860Thomas in 1860

From the onset, both gender & class From the onset, both gender & class shaped nursing educationshaped nursing education

Class differences in trainingClass differences in training Admitted 2 types of womenAdmitted 2 types of women

– Respectable working class womenRespectable working class women– Highly educated womenHighly educated women

Lady probationers paid for their Lady probationers paid for their trainingtraining

Wore different uniformsWore different uniforms Shorter training periodShorter training period Different dutiesDifferent duties

Class differences in opportunities Class differences in opportunities after graduationafter graduation

Ladies quickly promoted to positions Ladies quickly promoted to positions of authorityof authority

Commended higher salaries once it Commended higher salaries once it become acceptable for them to be become acceptable for them to be paidpaid

Working class students posed Working class students posed problems for the training schoolsproblems for the training schools– Lacked appropriate social gracesLacked appropriate social graces

Elite nursing leaders confused manners with Elite nursing leaders confused manners with educationeducation

– Much of the training for working class Much of the training for working class probationers an exercise in instilling probationers an exercise in instilling appropriate behaviourappropriate behaviour

Nightingale schools proliferated in Nightingale schools proliferated in Britain, UK, CanadaBritain, UK, Canada

Tradition of the lady probationer did Tradition of the lady probationer did not cross the Atlanticnot cross the Atlantic

First US schools opened 1873First US schools opened 1873 By 1923, 6,830 hospitals in US; 25% By 1923, 6,830 hospitals in US; 25%

had training schools attachedhad training schools attached

First Canadian school at Mack’s First Canadian school at Mack’s Hospital, St. Catherine ON, 1874Hospital, St. Catherine ON, 1874

In 25 years, 24 more schoolsIn 25 years, 24 more schools By 1909, 70 Canadian nursing By 1909, 70 Canadian nursing

schoolsschools

Students in these programs drawn Students in these programs drawn fromfrom– Lower middle class/agriculturalLower middle class/agricultural– Working classWorking class

Few middle class studentsFew middle class students– Respectable middle class women did not Respectable middle class women did not

workwork

Nursing educators focussed on Nursing educators focussed on character & behaviour rather than character & behaviour rather than knowledgeknowledge

Nurses were to be womanlyNurses were to be womanly– ModestModest– HonestHonest– TrustworthyTrustworthy– obedientobedient

Male physician was head of the Male physician was head of the hospital “household”hospital “household”– Nurse was motherNurse was mother– Patient was childPatient was child– Everyone deferred to the physicianEveryone deferred to the physician

Routine & drilling in conduct the Routine & drilling in conduct the hallmark of nursing educationhallmark of nursing education

Heavy moral overlayHeavy moral overlay

Student’s lives were heavily Student’s lives were heavily controlledcontrolled

Reinforced by 2 aspects of hospital Reinforced by 2 aspects of hospital trainingtraining– ResidenceResidence– uniformsuniforms

ResidenceResidence

Constructed to resemble middle class Constructed to resemble middle class homehome

Imposed middle class valuesImposed middle class values Facilitated confinement & Facilitated confinement &

supervision of studentssupervision of students For some, the first time they had a For some, the first time they had a

room of their ownroom of their own

UniformsUniforms

Derived from attire of domestic Derived from attire of domestic servantsservants

Reinforced hierarchical distinctionsReinforced hierarchical distinctions– Class (in Britain)Class (in Britain)– Progress in programProgress in program

Discipline Discipline

ConformityConformity Esprit de corpsEsprit de corps Loyalty to institutionLoyalty to institution

Gender also a subtext of the uniformGender also a subtext of the uniform– Didn’t become apparent until men Didn’t become apparent until men

entered nursingentered nursing

Typical nursing student often the Typical nursing student often the despair of nursing’s elite leadersdespair of nursing’s elite leaders

Erasing lower-class behaviours an Erasing lower-class behaviours an exercise in separating trained nurses exercise in separating trained nurses from female attendantsfrom female attendants– Sairey GampSairey Gamp

Class differences have always been a Class differences have always been a tension in nursingtension in nursing– Signified by educationSignified by education

Contested Sites: Where Should Contested Sites: Where Should Nurses be Educated?Nurses be Educated?

Hospital training schools were a clear Hospital training schools were a clear advantage for the modern hospitaladvantage for the modern hospital

Less clear that they were an Less clear that they were an advantage for nursesadvantage for nurses

Apprenticeship modelApprenticeship model– This in itself was not unusualThis in itself was not unusual– The problem was whose needs came The problem was whose needs came

firstfirstThe learner? OrThe learner? OrThe hospitalThe hospital

Student’s education was fitted Student’s education was fitted around service dutiesaround service duties

Nursing education wasNursing education was– Task orientedTask oriented– Behaviour orientedBehaviour oriented

Control of education was a contest Control of education was a contest betweenbetween– HospitalsHospitals– PhysiciansPhysicians– Elite nursing leadersElite nursing leaders

Elite leaders wanted nursing Elite leaders wanted nursing education out of the hospitaleducation out of the hospital

Would then be free fromWould then be free from– Service obligationsService obligations– Interference from physiciansInterference from physicians

Preferred location was the universityPreferred location was the university

The downside?The downside?– Many women could not afford universityMany women could not afford university

Service for education, room, & board was Service for education, room, & board was their only optiontheir only option

– Many women were not eligible to apply Many women were not eligible to apply for universityfor university

– Many universities would not admit Many universities would not admit womenwomen

Teachers College, Columbia Teachers College, Columbia University offered 1University offered 1stst program for program for nursesnurses– 18981898– Graduate studiesGraduate studies

Undergraduate programs established Undergraduate programs established in early 20in early 20thth century century

Two important Canadian Two important Canadian developmentsdevelopments

Red Cross FundingRed Cross Funding– Used to establish post-diploma studies Used to establish post-diploma studies

in public health after First World Warin public health after First World War– 5 universities5 universities

11stst baccalaureate program at UBC baccalaureate program at UBC– Established 1919Established 1919– Sandwich programSandwich program

Diploma programs gradually moved Diploma programs gradually moved from hospitals to community collegesfrom hospitals to community colleges

Diploma education remained the Diploma education remained the norm for much of the 20norm for much of the 20thth century century