Nursing I
Reform of Nursing
Education
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
 The
history of nursing education is
inextricably shaped by:
– Class
– Gender
 Many
of its historic and
contemporary challenges are a result
of this reality
 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
 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
 Social/medical
context:
1. Medical views about the education
of women
– Women’s response to this view
2.Oxford movement
– Movement to reform the Church of
England begun at Oxford University in
1833
– Retrieved many Catholic traditions
 Brotherhoods/sisterhoods
 Monasticism
3. Medical education
reform
– King’s College
Hospital reform led
by Robert Bentley
Todd
– Students lived in
residence
– Religious instruction
– More contact with
teachers
4. Middle class women’s involvement
in charitable work
 Only
option open to respectable
women
 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
 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
 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
 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
 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
 Nightingale
well aware of St. John’s
House nursing reforms
 St. John’s nurses accompanied her to
the Crimea
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
 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
 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
1851)
twice at Kaiserwerth (1850,
 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
 Resigned
1854 & entered into
negotiations with King’s College
Hospital for similar position
 Instead,
appointed to take a group of
nurses to the Crimea
 Became
a celebrity
 Establishment
of Nightingale Fund to
establish systematic nurse training in
Britain
 Originally
college
conceived as a type of
 Changed
hospitals
 First
to the advantage of
training school established at
St. Thomas in 1860
 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
 Lady
probationers paid for their
training
 Wore different uniforms
 Shorter training period
 Different duties
 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
 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
 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
 First
Canadian school at Mack’s
Hospital, St. Catherine ON, 1874
 In 25 years, 24 more schools
 By 1909, 70 Canadian nursing
schools
 Students
from
in these programs drawn
– Lower middle class/agricultural
– Working class
 Few
middle class students
– Respectable middle class women did not
work
 Nursing
educators focussed on
character & behaviour rather than
knowledge
 Nurses were to be womanly
– Modest
– Honest
– Trustworthy
– obedient
 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
 Heavy
moral overlay
 Student’s
lives were heavily
controlled
 Reinforced by 2 aspects of hospital
training
– Residence
– uniforms
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
 Uniforms
 Derived
from attire of domestic
servants
 Reinforced hierarchical distinctions
– Class (in Britain)
– Progress in program
 Discipline
 Conformity
 Esprit
de corps
 Loyalty to institution
 Gender
also a subtext of the uniform
– Didn’t become apparent until men
entered nursing
 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
 Class
differences have always been a
tension in nursing
– Signified by education
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
 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
 Nursing
education was
– Task oriented
– Behaviour oriented
 Control
of education was a contest
between
– Hospitals
– Physicians
– Elite nursing leaders
 Elite
leaders wanted nursing
education out of the hospital
 Would
then be free from
– Service obligations
– Interference from physicians
 Preferred
location was the university
 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
 Teachers
College, Columbia
University offered 1st program for
nurses
– 1898
– Graduate studies
 Undergraduate programs
in early 20th century
established
 Two
important Canadian
developments
 Red
Cross Funding
– Used to establish post-diploma studies
in public health after First World War
– 5 universities
 1st
baccalaureate program at UBC
– Established 1919
– Sandwich program
 Diploma
programs gradually moved
from hospitals to community colleges
 Diploma
education remained the
norm for much of the 20th century