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.