Representations and Practices of Nursing

1. Medicine, Disease and Society in Britain, 1750 - 1950 Representations and Practices of Nursing Lecture 12

2. Lecture Themes and Outline • Situation up to the ‘Reforms’ of the C19 • Reform: Nightingale • Modernisation • Professionalisation- Registration and the creation of state nursing

3. Anne Summers’ definition ‘Attending to the needs of the permanently or temporarily disabled patient; administering food and drink as well as medicaments; keeping the patient comfortable; keeping the patient and his surroundings clean; ensuring the patient is treated as the subject as well as the object of treatment and helped to keep quiet, calm and cheerful; medical observation by eye or instrument, of physical or behavioural reactions to diet and therapy; the patient must be nursed for as long as the illness continues, regardless of Outcome’.

4. Points to consider • Emphasis on care rather than cure • The nurse is seen as necessary to the success of scientific diagnostic medicine as well as domestic health care • Nursing requires not only learned skills but qualities of character – contentious? • From the late C19 onwards nursing becomes increasingly a paid and professional occupation, but retains ideas of service. Continued religious link • Women = traditional carers of children and the sick, associated with selflessness and subordination • Also highly idealised

5. Nursing in the C19th ‘Since the nineteenth century, nursing has sought respectability and modernity by linking its fortunes firmly with mainstream medicine, and by seeking a secular model for the profession to distance it definitively from its religious, unscientific past’. (Anne Summers in Loudon, Western Medicine)

6. Sarah/Sairey Gamp, Dickens’s fictional character, was used by the growing nursing profession of the nineteenth century to blacken the reputation of the working nurse who had provided a service in home and hospital without the benefit of ‘modern’ training.

7. Before reform • Medieval and early modern period – strong links between nursing and Christianity • The reformation in Britain led to a more secular model for nursing • Nursing predominantly the responsibility of the patient’s family (poor or rich) or was carried out by neighbours/community • From C18th, nurses were employed by voluntary hospitals and similar charities – seen as a low status profession

8. Nursing duties at the London Hospital, c. 1740 ‘To enter upon their Business every morning at six in Summer and at seven in Winter, to stop at ten and be in bed by eleven every Night; to clean their wards, pewter and utensils every day by seven in the morning; to attend the patients diligently during their Watch, and provide them with what is directed by the Physician, Surgeon and Apothecary, and see particularly that they take their medicines, and to keep the beds of the Patients neat and decent.’

9. Florence Nightingale, founder of modern secular nursing (1820-1910) • Notes on Nursing (1860) • Health, sanitarian believed in miasma • Set up training school for nurses at St Thomas’ Hospital, London • Character as important as technical skills • Deeply religious but her character was far removed from the sentimental Victorian imagery of the ‘Lady with the Lamp’ and the ‘angel of mercy’.

10. Nightingale Myth ‘It was not until the great Florence Nightingale returned in glory from the Crimean War, in the year 1855, that steps were taken to train nurses systematically for a period of years, after which they could work independently as professional nurses. Money publicly subscribed to Florence Nightingale for her wonderful work in the Crimean War was used by her to found the Nightingale School for Nurses at St Thomas’s Hospital. These Nightingale nurses went to the ends of the earth founding nurse-training schools, after the pattern of their alma mater in London.’ Nursing as a Career and Livelihood, G M Hardy (1955)

11. Circa 1850: Florence Nightingale as a Nightingale with her angels caring for the wounded in an illustration titled ‘Wounded Soldiers and Nightingales’.

12. Nightingale myth

13. Rebecca Strong ‘Very little was expected from us, as progress was slow in regard to organised teaching. Kindness, watchfulness, cleanliness, and guarding against bed sores were well ingrained. A few stray lectures were given … There was a dummy on which to Practice bandaging, and some lessons were given, also a skeleton, and some ancient medical books, one, fortunately, on Anatomy for those who attempted self-education’ (trained at St Thomas’s in 1867)

14. Wider impetus for reform • Impetus for reform came from observing religious organisations on the Continent • Elizabeth Fry (Quaker) established the Institution of Nursing Sisters in 1840 • Charitable and social welfare movements – nursing missions and Visiting Societies, which became the forerunners of District Nursing. • The idea of hygiene, closely related to hospitals during the C19th, was perhaps just as much to do with middle-class interest in cleanliness

15. Typical Nurse’s Experience, c. 1890 ‘The nurse went on duty at 7.00am. Much of the work consisted of washing patients, cleaning wards and medical equipment, food preparation and serving (including carrying round brandies and wines for patients), some tuition, 2 daily prayers. Bed at 9.20 with very short breaks for meals.’ Joan Lane, Social History of Medicine

16. Nurses in laundry c.1910

17. St. Bart’s Hospital London c.1908

18. Campaign for Registration • Began 1880s • 1888 – British Nurses Association formed • 1899 – International Council of Nurses founded • 1914-1918 – War raised nurses’ status • 1919 – Nurses Registration Act • 1941 – National pay scales

19. Late 19th century campaign for women’s suffrage.

20. Aims of Registration • To set up centralised means of control over nursing- a central body or council of nurses • Self-government - so nurses should have a majority and direct representation on the council • A one-portal system of entry- control over the curriculum an duration and standard of training and a single register

21. Opposition to Registration • The Voluntary Hospital sector who controlled pay and conditions - wanted Nightingale’s model of the nurse as a devoted, disciplined, cheap and complaint, work force, and not upper class. • Matrons also opposed, under the current system they had an enhanced managerial role and feared registration would lead to centralisation and they would lose local control over nurses. • From the medical profession - had many supporters, including the husband of Bedford-Fenwick. • From nurses who were anti-registration- including Florence Nightingale.

22. Anne Witz: Professions and Patriarchy ‘The passage of the Nurses Registration Act in 1919 did not represent a victory for pro-registrationist nurses. The nursing profession had not come to power. Instead nurses were henceforth to be tightly constrained within a state-profession relation within which they were the weaker partner, as well as within the employment relation between hospitals and nurses and the inter-professional relation between doctors and nurses.’

23. Conclusion Three themes in the development of modern nursing emerge: • The impact of reformers and pressure groups – linked with charity, religion and universal suffrage • The rise in the importance of the hospital – nurses latched onto the development they saw in medicine • The changing experience of women in society – private/public spheres – reinforced gender division