Fundamentals Nursing

The Development of Modern Nursing

The intellectual revolution of the 18th and 19th centuries led to a scientific revolution. With the discovery and exploration of new continents, an economic revolution evolved, after which nations became more interdependent through trade. The Industrial Revolution displaced workers from cottage craftsmen to factory laborers. With these changes came stressors to health. New illnesses, transmitted in the holds of ships by seamen and stowaway rodents, jumped national boundaries and continents. The closeness of factory work, the long hours, and the unhealthy working conditions led to the rapid transmission of communicable disease such as cholera and plague. Lack of prenatal care, inadequate nutrition, and poor delivery techniques resulted in a high rate of material and infant mortality. Many orphaned children died in workhouses of neglect or cruelty.

During this time, a “proper” woman’s role in life was to maintain a gracious and elegant home for her family. The common women worked as servants in private homes or were dependent on their husbands’ wages. The provision if care for the sick in hospitals or private homes fell to the uncommon women – often prisoners or prostitutes who had little or no training in nursing. Because of this nursing had little acceptance and no prestige. The only acceptable nursing role was within a religious order where services were provided as part of Christian charity.

The creation of the institute of Protestant Deaconesses at Kaiserswerth, Germany, changed the Order of Deaconesses ignited recognition of the need for the services of women in the care of the sick, the poor, children, and female prisoners. The training school for nurses at Kaiserswerth included care of the sick in hospitals, instruction in visiting nursing, instruction in religious doctrine and ethics, and pharmacy. The deaconess movement eventually spread to four continents, including North America, North Africa, Asia, and Australia.

Florence Nightingale, the most famous Kaiserswerth pupil, was born to a wealthy and intellectual family. Her education included the mastery of several ancient and modern languages, literature, philosophy, history, science, mathematics, religion, art and music. It was expected that she would follow the usual path of a wealthy and intelligent woman of the day: marry, bear children, and maintain an elegant home. Nightingale believed she was “called by God to help others … [and] to improve the well-being of mankind” (Schuyler 1992, p.4). She was determined to become a nurse, in spite of opposition from her family and the restrictive societal code for affluent young English women. As a well-traveled young woman of the day, she visited Kaiserswerth in 1847, where she received three months’ training in nursing. In 1853, she studied in Paris with the Sisters of Charity, after which she returned to England to assume the position of superintendent of a charity hospital for ill governesses.

During the Crimean War, the inadequacy of care for the soldiers led to public outcry. Florence Nightingale was asked by Sir Sidney Herbert of the British War Department to recruit a contingent of female nurses to provide care to the sick and injured in the Crimea. Nightingale and her nurses transformed the military hospital by setting up diet kitchens, a laundry, recreation centers, and reading rooms, and organizing classes for orderlies. Mary Grant Seacole, a Jamaican born and trained nurse also went to the Crimean to assist Nightingale’s nurses in their care of the injured.

When she returned to England, Nightingale was given an honorarium of ₤4500 by a grateful English public. She later used this to develop the Nightingale Training School for Nurses, which opened in 1860. The school served as a model for other training schools. Its graduates traveled to other countries to manage hospitals and institute nurse training programs. The efforts of Florence Nightingale and her nurses changed the status of nursing to a respectable occupation for women.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.6-7)
Fundamentals Nursing

The Role of Religion in the Development of Nursing

Many of the world’s religions encourage benevolence, but it was the Christians value of “love thy neighbor as thyself” that had a significant impact on the development if Western nursing. The principle of caring was established with Christ’s parable of the Good Samaritan providing care for a tired and injured stranger. Converts to Christianity during the third and fourth centuries included several wealthy matrons of the Roman Empire, including Marcella, Fabiola, and Paula, who used their wealth to provide houses of care and healing (the forerunner of hospitals) for the poor, the sick, and the homeless.

Women were not the sole providers of nursing services in the third century in Rome there was an organization of men called the Parabolani Brotherhood. This group of men provided care to the sick and dying during the great plague in Alexandria. During the Crusades, several knighthood orders – such as the Knights of Saint John of Jerusalem (also known as the Knights of Lazarus  – formed, composed of brothers in arms who provided nursing care to their sick and injured comrades. These orders where responsible for building great hospitals, the organization and management of which set a standard for the administration of hospitals throughout Europe at that time. As the Christian church grew, more hospitals were built, as were specialized institutions providing care for orphans, widows, the elderly, the poor, and the sick. During the Middle Ages (AD 500-1500), male and female religious, military, and secular orders with the primary purpose of caring for the sick were formed. Conspicuous among them were the aforementioned Knights of Saint John (Knights Hospitalers); the Alexian Brotherhood (organized in 1431); and the Augustinian sisters, which was the first purely nursing order.

In the late 16th century, Camillus DeLellis, later sainted for his work of Christian charity, founded a nursing order to provide are for the poor, the sick, the dying, and those in prisons, In 1633, the Sisters of Charity were founded by Saint Vincent de Paul in France. It was the first of many such orders organized under various Roman Catholic church auspices and largely devoted to caring for the sick. The Order of the Sisters of Charity sent nursing sisters to provide care in the New World, establishing hospitals in Canada, the United States, and Australia.

The deaconess groups, composed of women who provided care, had their origins in the Roman Empire of the third and fourth centuries but were suppressed during the Middle Ages by the Western churches. However, these groups of nursing providers resurfaced occasionally throughout the centuries, most notably in 1836, when Theodor Fliedner reinstituted the Order of the Deaconesses and opened a small hospital and training school in Kaiserswerth, Germany. Florence Nightingale received her “training” in nursing at the Kaiserswerth School.

Kozier, Barbara Fundamentals of Nursing 5th edition (Addison –  Wesley Publishing Company, Inc. p.50)