Nursing I

1. Nursing I Reform of Nursing Education

2. Pre-Nightingale Nursing • Emergence of modern nursing tied to emergence of the modern hospital • Prior to early 19th century: • Hospitals charitable institutions for the poor, not providers of health care • Attendants to those who were sick were other paupers

3. The history of nursing education is inextricably shaped by: • Class • Gender • Many of its historic and contemporary challenges are a result of this reality

4. Most attendants were elderly former patients who stayed on • Transition to 24/7staffing with fully trained nurses took over 100 years • Reform of nursing began prior to Nightingale

5. Initial early 19th century reforms instituted by physicians working with religious groups (Helmstadter) • Most famous example is the Sisters of St. John’s the Evangelist, or St. John’s House

6. Social/medical context: 1. Medical views about the education of women • Women’s response to this view

7. 2.Oxford movement • Movement to reform the Church of England begun at Oxford University in 1833 • Retrieved many Catholic traditions • Brotherhoods/sisterhoods • Monasticism

8. 3. Medical education reform • King’s College Hospital reform led by Robert Bentley Todd • Students lived in residence • Religious instruction • More contact with teachers

9. 4. Middle class women’s involvement in charitable work • Only option open to respectable women

10. St. John’s House founded in 1847 by Todd & others • Inspired by Kaiserwerth (as was Nightingale) • Women lived at St. John’s House • Sent to hospital for training

11. Objectives • Provide working class women with training to enable them to elevate their social position • Provide upper class women with an opportunity to work, without pay, to train these nurses

12. All probationers had 1 year of training in technical nursing • Classes from nursing sisters • Lectures from physicians • Sisters (never working class) had 2 years of intensive training in nursing & hospital management

13. St. John’s House sent trained nurses out to work in hospitals & the community • Took over nursing service of King’s College Hospital in 1856

14. Hospital nursing a parallel system for much of 19th century • Trained nurses during day • Untrained attendants at night “night watchers” • Eventually night watchers taken over by student nurses • Mid-20th century before all shifts comprised of trained nurses

15. Nightingale well aware of St. John’s House nursing reforms • St. John’s nurses accompanied her to the Crimea

16. The Nightingale Reforms • Impact of Florence Nightingale (1820-1910) • Generally portrayed as founder of modern nursing • Re-fashioned it as a respectable occupation for young middle class women

17. Born to a well-to-do family • Educated by her father • Rejected traditional role of wife/mother • Drawn to model of nursing she had seen in Europe

18. Attempted to study with a family friend, Dr. Richard Fowler, at Salisbury Hospital • “… it was if I had wanted to be a kitchen maid.” • Studied twice at Kaiserwerth (1850, 1851)

19. Studied in France with Sisters of Charity (1852, 1853) • Left family home in 1853 to take position as superintendent of a voluntary hospital for women • Given allowance by her father

20. Resigned 1854 & entered into negotiations with King’s College Hospital for similar position • Instead, appointed to take a group of nurses to the Crimea

21. Became a celebrity • Establishment of Nightingale Fund to establish systematic nurse training in Britain • Originally conceived as a type of college

22. Changed to the advantage of hospitals • First training school established at St. Thomas in 1860

23. From the onset, both gender & class shaped nursing education • Class differences in training • Admitted 2 types of women • Respectable working class women • Highly educated women

24. Lady probationers paid for their training • Wore different uniforms • Shorter training period • Different duties

25. Class differences in opportunities after graduation • Ladies quickly promoted to positions of authority • Commended higher salaries once it become acceptable for them to be paid

26. Working class students posed problems for the training schools • Lacked appropriate social graces • Elite nursing leaders confused manners with education • Much of the training for working class probationers an exercise in instilling appropriate behaviour

27. Nightingale schools proliferated in Britain, UK, Canada • Tradition of the lady probationer did not cross the Atlantic • First US schools opened 1873 • By 1923, 6,830 hospitals in US; 25% had training schools attached

28. First Canadian school at Mack’s Hospital, St. Catherine ON, 1874 • In 25 years, 24 more schools • By 1909, 70 Canadian nursing schools

29. Students in these programs drawn from • Lower middle class/agricultural • Working class • Few middle class students • Respectable middle class women did not work

30. Nursing educators focussed on character & behaviour rather than knowledge • Nurses were to be womanly • Modest • Honest • Trustworthy • obedient

31. Male physician was head of the hospital “household” • Nurse was mother • Patient was child • Everyone deferred to the physician • Routine & drilling in conduct the hallmark of nursing education

32. Heavy moral overlay • Student’s lives were heavily controlled • Reinforced by 2 aspects of hospital training • Residence • uniforms

33. Residence • Constructed to resemble middle class home • Imposed middle class values • Facilitated confinement & supervision of students • For some, the first time they had a room of their own

34. Uniforms • Derived from attire of domestic servants • Reinforced hierarchical distinctions • Class (in Britain) • Progress in program • Discipline

35. Conformity • Esprit de corps • Loyalty to institution • Gender also a subtext of the uniform • Didn’t become apparent until men entered nursing

36. Typical nursing student often the despair of nursing’s elite leaders • Erasing lower-class behaviours an exercise in separating trained nurses from female attendants • Sairey Gamp

37. Class differences have always been a tension in nursing • Signified by education

38. Contested Sites: Where Should Nurses be Educated? • Hospital training schools were a clear advantage for the modern hospital • Less clear that they were an advantage for nurses

39. Apprenticeship model • This in itself was not unusual • The problem was whose needs came first • The learner? Or • The hospital • Student’s education was fitted around service duties

40. Nursing education was • Task oriented • Behaviour oriented • Control of education was a contest between • Hospitals • Physicians • Elite nursing leaders

41. Elite leaders wanted nursing education out of the hospital • Would then be free from • Service obligations • Interference from physicians • Preferred location was the university

42. The downside? • Many women could not afford university • Service for education, room, & board was their only option • Many women were not eligible to apply for university • Many universities would not admit women

43. Teachers College, Columbia University offered 1st program for nurses • 1898 • Graduate studies • Undergraduate programs established in early 20th century

44. Two important Canadian developments • Red Cross Funding • Used to establish post-diploma studies in public health after First World War • 5 universities

45. 1st baccalaureate program at UBC • Established 1919 • Sandwich program • Diploma programs gradually moved from hospitals to community colleges

46. Diploma education remained the norm for much of the 20th century