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If there is one thing that this dreadful year has taught us, it is the importance of medical staff. Nurses have been especially busy and helpful during the pandemic, taking on an incredibly complex and daunting public health role. It can be easy to take their place in society for granted, but just how did nursing evolve into this diverse profession so embedded in our culture?
We have put together a quick guide to nursing history. Honestly, each of these developments could merit an entire book of material; such is their significance. This guide should outline some of the most pivotal people and moments in caregivers’ long and storied development.
According to the International Journal of Caring Sciences, modern nursing has ancient origins. In the Greece of antiquity, nursing was the duty of ‘deaconesses’. Although deaconess work was largely carried out within the family unit, there is some evidence that a minority of women sought training in order to serve as nurses for larger groups of people.
In the Homeric poems, Helen of Sparta travels to Egypt to undertake an apprenticeship in herbal healing. It is likely that particularly knowledgeable deaconesses spread their knowledge around the Hellenic world, fostering an early medical tradition amongst women.
In Greek myth, Apollo’s daughter Hygeia was the goddess of health; she was believed to see personal cleanliness as a virtue, which is where the modern term ‘hygiene’ originates. Femininity and healing practice were closely linked in ancient Greece, which may be why nursing has been associated with female practitioners.
In around 100 BC, an Indian text was written that recommended the employment of a nurse during medical care. The Charaka Samhita is considered to be one of the foundational texts of medical practice.
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PHOEBE AND RUFAIDAH BINT SA’AD
Phoebe and Rufaidah Bint Sa’ad are very important in nursing history within the Christian and Muslim worlds, respectively.
Not much is known about Phoebe other than what is revealed about her life in the New Testament. She is listed as a traveling deaconess sent to aid in Rome by St Paul. Many nursing historians have taken this to mean that Phoebe was an early example of a professional nurse and the first known Christian nursing sister.
Rufaidah Bint Sa’ad is important to nursing history in the Muslim world. In the early 7th Century, during the life of Muhammed, Sa’ad set up field hospitals in order to care for wounded warriors. She is said to have learned healing techniques from her father, who was a herbalist. Her practice was endorsed by Muhammed, making her story an interesting parallel to that of Phoebe and St Paul.
From these origins, the connection between religion and nursing practice became established. Nurses around the world still operate under the banners of the crescent and the cross, especially those who help out in times of natural tragedy and war.
THE SISTERS AND DAUGHTERS OF CHARITY
We often associate nursing with nuns. This tradition began in 1633 with the foundation of the Daughters of Charity in Chantilles-Les-Dombes in France. St Vincent initiated the order of the Daughters of Charity, which was a relatively revolutionary religious group by 17th Century standards. Instead of staying within the confines of a religious community, sisters and daughters of charity were instructed in how to offer medical help and sent out into the community, where they essentially offered a community nursing service.
The Sisters and Daughters of Charity’s structural design was passed down through the generations and had a huge influence on the development of nursing systems. To this day, a senior nurse is often known as a Sister.
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Possibly the most famous nurse to ever practice and the originator of many nursing principles, Florence Nightingale, was born on May 12th, 1820, in Italy. She was to become absolutely pivotal to the development of nursing. Nightingale had ambition and therefore refused to marry at a young age in order to pursue her passion – helping the sick and poor. She enrolled in a Lutheran nursing institute in Germany in 1844, where she learned the practices common at the time.
When she moved to London to practice nursing in the 1850s, she realized that contemporary nursing practice was absolutely unfit for purpose during a bad cholera outbreak. She began drafting ideas for nursing that took into account an understanding of society and its impact on hygiene. Nightingale quickly rose up the ranks and developed a reputation for innovation.
Around this time, British soldiers were suffering in appalling conditions during the Crimean war. There were few nurses and doctors on the front line, and field hospitals were dirty and rife with disease. Nightingale was instructed to put together a corps of nurses together to change the way nursing was practiced in Crimea. Nightingale was appalled by what she found there. She encountered a field hospital that was built on a stinking cesspool, with wounded soldiers often dying of typhoid unrelated to their wounds. She completely revised hospital practice and reduced deaths by two thirds – earning her the nickname ‘the angel of Crimea’.
NOTES ON NURSING
Nightingale’s magnum opus, Notes On Nursing, was a guidebook for nursing practice that still holds up amazingly well today. Published in 1859, it was a no-nonsense volume that details Nightingale’s nursing ethos that she developed during her career. It contains tips on ventilation, warmth, nutrition, and observation that are still taken to heart by nurses today.
Operating at around the same time as Florence Nightingale was another pioneer of nursing practice and theory – Mary Seacole. She was the daughter of a Jamaican healer and carried the Caribbean doctrines’ tradition over into her work in nursing during the Crimean war.
Battling racial prejudice, Seacole traveled to Crimea using her own funds and built an effective and clean hospital (known as the hotel) from scratch using scrap materials. She saved countless lives and helped to stop the spread of disease. The hotel also sold amenities and food to soldiers and was credited with greatly improving morale.
THE FOUNDING OF THE ICN
The international council of nurses now represents around 20 million nurses worldwide and aids in international information sharing and collaboration efforts. It was founded in 1899 and was the first truly international organization for health workers.
The international council of nurses was born during the first widespread fight for women’s rights. Professions that were largely practiced by women were looked down upon by patriarchal society, and the foundation of the ICN was, in part, an attempt to break free of this system. Proposed by Ethel Gordon Fenwick in London, it was seen as a way of increasing the representation of nurses through collaboration on healthcare education. Since then, it has become an international advocate for the nursing profession.
THE BACHELOR’S DEGREE IN NURSING
Higher education for nurses was first proposed at the 1893 World’s Fair in Chicago. However, it was not until 1909 that the University of Minnesota offered the world’s first bachelor’s degree in nursing. It represented a great step in the upskilling of nurses that still continues on to this day. With the increase in nursing skills progressing through history, the nurse is taking an ever more central role in the delivery of health regimes.
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Nursing in the United States posed some extreme challenges. Although the East and North of the country quickly developed infrastructure, the south, West, and Central areas were long considered to be wild frontiers. They often lacked integrated healthcare provisions, and people were at the mercy of any illness that they suffered from.
The Frontier Nursing Service was founded in 1925 by Mary Breckinridge in order to address this problem. The service aimed to train and equip qualified nurses and midwives that could travel across rural Kentucky, offering healthcare to those for whom it was previously inaccessible. Rural community nursing is still considered incredibly important in areas with less hospital coverage. Groups in Russia, the USA, and Scotland still operate frontier type nursing services and have saved many lives.
THE WORLD WARS AND SPANISH FLU
The first and second world wars were years of great suffering and great innovation. Industrialized warfare maimed and killed soldiers and civilians alike, and the role of the nurse was never so important as during those dreadful wars. Nurses were often on the front lines, dying alongside soldiers and saving lives. New emergency wound treatment techniques were developed and spread like wildfire. Nurses were formally integrated into military systems and served as active members of militaries on all sides.
The conditions of the first world war also aided the spread of the deadly ‘Spanish flu’. This Influenza infected up to one-third of the world’s population and killed around 50 million people. Nursing had to evolve quickly to deal with the pandemic, with many doctors being away serving in the war. Nurses took on an important public health role, advising the public on how to avoid infection. They performed heroic acts of care at great personal risk. A public health nurse in Alabama is credited with looking after 139 Spanish flu patients alone, with only one fatality. Spanish flu spread quickly amongst soldiers who lived in poor conditions. It was the leading cause of death for military nurses during the first world war.
THE BEVERIDGE REPORT AND PUBLIC HEALTH
After world war two, the embattled and unequal societies of the world needed a new paradigm. Millions of people had died for their state. While there was great optimism now that the war was over, many remembered the terrible depression that occurred after world war one and the massive public health crisis that followed and could not be properly contained – such as the Spanish Flu.
In the UK, a report was commissioned in order to tackle the ‘five giant evils’ of want, squalor, disease, idleness, and ignorance. The Beveridge report, published in 1942, recommended wholesale changes to housing, benefits, and, most importantly, public health. It recommended setting up a National Health Service that was available for all citizens to combat disease and inequality. This had a huge impact on public health nursing around the world. The idea that public health nursing was a vital component of any post-war state’s duty to its people has stuck ever since. From that moment on, nursing was an arm of public wellbeing that also shouldered the responsibility of spreading disease and health awareness to the people.
THE NURSING DOCTORATE
In 1979, Yale University offered the first doctorate in nursing practice (or DNP) in the United States. It represented a big step in the advancement of nurse training and created openings for very deep career paths in the field.
So, why get a DNP? In 2004, the American Association of Colleges of Nursing recommended that all advanced practice nurses should study for a doctorate in nursing. This was a huge benchmark and laid the foundation for the modern expectation that we have of advanced nurses being extremely medically knowledgeable, taking some of the roles traditionally assigned to doctors.
Today, the significance of nursing in our society has become even more clear. As the world struggles to overcome the novel Coronavirus, we are relying upon nurses to care for the sick, deliver public health guidance, and administer vaccines. Nurses have, unfortunately, been on the front lines, and many of them have been victims of the virus. However, it is clear that without the thousands of years of nursing development and the slow ramping up of technical knowledge and skill amongst nurses, the world would have been a great deal worse off when battling the virus.
Taking the role of nurses for granted is no longer an option anywhere in the world. Undoubtedly we will face similar challenges in the future, and we need to develop and support nursing so that we may get through them.
Nursing education is vitally important, as is the funding that will allow young people to train and become life-saving, society-upholding protective figures.