Nursing has faced struggles towards its development and professionalization through time. It has undergone changes in response to the needs and influences of the society. Several factors have influenced the progress of nursing. Kozier et al. (2004) identified recurring themes that have influenced the nursing practice as it grows and develops. These themes are women’s societal roles and status, religious values, societal attitudes, nursing leadership and war. One factor that influenced the development of nursing is women’s role in the society.
As a mother, sister and wife, women are expected to perform caring roles that make them suitable for the nursing profession. Religion plays an essential role in the nursing practice. The Christian value of ‘love thy neighbor as thyself’ and the Good Samaritan parable instilled the need to serve and care for others. In the past, before the mid-1800s, society has a different notion of nursing. At that time, it was not a profession. It was not based on a scientific body of knowledge and it was without an organization.
However, through the passing of time, the image of nursing has improved due to the contributions of nursing leaders such as Florence Nightingale. Nursing leadership constituted the establishment of nursing as a profession. Several nurse leaders have emerged through the years that placed the significance of nursing in the health field. Florence Nightingale, Clara Button, Lilian Wald, Lavinia Dock, Margaret Sanger and Mary Breckinridge are among the notable contributors in the field of nursing as well as in women’s history. The importance of nurses began to emerge because of wars throughout history.
Wounded soldiers needed care and nurturing. During this period, it was Florence Nightingale who showed the importance of nursing by reducing the mortality rate in military hospitals. This is created important changes in the field of nursing. Main Changes in Nursing Crimean War The relevance of history to the nursing practice was argued in Borsay’s article . Although it was declared that history is always relevant, it is a fact that nursing and history belong in two different categories. It was stated that learning from the past may not be beneficial to nursing.
However, Borsay (2009) used the statement of Tosh (1991, pp. 9-20) that although nothing happens in the same way and in one condition twice, one can use history to find solutions for present issues. There is a change in the image of nurses in the society. Before the mid-1800s, women had a different role and status to uphold in the society. In the Victorian era, women were confined in their houses as wives, mothers and sisters. Respectable women were not allowed to have education or careers. Their main purpose is to be a charming companion for their husbands and be responsible mothers to their children.
Women were stereotyped as housekeepers. Hospitals were dominated by nurses who were poorly educated and ill-mannered. Some of them were believed to be notorious criminals. Nursing was handled by unqualified women who did not provide therapeutic caring to patients. An example of this societal image of nurses during that era was described in Charles Dickens’ book Martin Chuzzlewit. Kozier et al. (2004, p. 4) used the description of Donahue (1996) about Sairy Gump, the nurse character in Martin Chuzzlewit, saying that ‘she cured for the sick by neglecting them, stealing from them and physically abusing them’.
Another testimony about the nurse-patient relationship that existed in the 1800s was the historical narratives of a minor actor called Joseph Wilde. He noticed that there was camaraderie between patients in the hospital. He declared that hospital staff, particularly nurses, were cold and impersonal. Wilde described that he saw ‘signs of impatience… but none of pity’ (Howie 1973). This summarized the negative image that nurses had produced in that period of time. This image of evil nurses had been changed through the efforts of outstanding nurses who pioneered leadership in nursing.
By the time of the Crimean War, Florence Nightingale had produced a complete opposite image of nurses. Nurses gained the image similar to that of the angel of mercy. After the efforts of nurse leaders during the time of war, nurses were marked with nobility, compassion, morality, dedication and self-sacrifice. The nursing profession established its importance to the world by reducing the suffering of patients and providing care to wounded and dying soldiers of war. Another significant contribution that can be considered as a great innovation in the nursing field is Nightingale’s use of research.
Although during her period, research had not been fully established in the nursing field, Nightingale pioneered the use of research. McDonald (2007) stated in her article that ‘immediately on return from the war, in August 1856, Nightingale set to work to prevent such massive deaths from ever recurring. She got appointed to a royal commission to investigate the causes of high mortality in Crimean War and to recommend preventive measures. ‘ Among the duties of a nurse as a researcher, one has to disseminate useful information to the public.
Nightingale fulfilled this role as she prepared and published a summary report relating the conditions in the field and hospitals. The gruesome conditions of soldiers at the war zone were revealed to the public. The report included inadequacies in the supplies and the miserable situations the soldiers were enduring. Nightingale’s purpose was to awaken the awareness of the public as well as the authorities who could have prevented such conditions (McDonald 2007). Nightingale also fostered advocacy in the nursing field. As an advocate, she was mindful of the dreadful effects of war to the health and welfare of the public.
‘She circulated a 567-page volume that contains a supposedly confidential report for the war secretary’ (McDonald 2007). In this volume, Nightingale discussed the health and welfare of the soldiers that served as a warning to avoid yet another disastrous event such as the Crimean War. Nightingale recognized that the Crimean War produced one good outcome – the nursing profession. The high incidence of death and illness produced the need for nursing. With the achievements that resulted from the works of nurse leaders such as Florence Nightingale, society has accepted the importance of nursing.
The demand for nurses was also recognized. It was undeniable that more recruits were needed to be able to meet the demands for nursing. Thus, the nursing profession welcomed another development as the first regular nursing school in London: Saint Thomas’s Hospital was founded by Nightingale. One criteria of a profession is having a specialized education and body of knowledge. In this case, the structure of nursing clearly developed and progressed towards the establishment of nursing as a profession. The work of the nurse leaders during the early periods of nursing was marked with service orientation.
Nightingale displayed altruism in the nursing practice. McDonald (2007) quoted in her article an evidence that supported Nightingale’s altruism, ‘To the French and German who apply for help to their hospitals, I reply that I will lay their applications before the central committee, as soon as its in working order, which I will do, through you, if you will permit… ’ It was also stated in the article that Nightingale joined the Ladies’ Committee to be able to provide relief and supplies as well as nurses to those who need caring.
She was concerned with the urgency of the needed action. Lastly, Nightingale had been concerned with public health. Her interest in the community was later developed as an important part of nursing: Community Health Nursing. She started the vision of public healthcare due to the belief that through social science research, social betterment can be achieved. Nightingale led nursing into areas such as public health, hospital administration and sanitary reform. She elaborated in her selected writings the unsanitary ways of the community.
She stated that the inadequate measures for cleanliness and proper waste disposal were considered dangerous habits that were detrimental to one’s health. She gave importance to the contribution of environment in one’s health. She argued that the wastes produced by humans and animals contaminate the water leading to illnesses such as diarrhea. She stressed the importance of proper waste disposal in the community. In her writings, she believed that the mothers should be mainly responsible for the health of their children.
Therefore they should keep the cleanliness in their homes (Internet Modern History Sourcebook 1997). Another Crimean heroine who was identified is Mary Seacole. Although at first, she was rejected to provide her services, she still was able to come up with a way to nurse the sick and dying. She was known to use herbal medicine in providing care. This can be considered as an early use of alternative medicine in nursing. Seacole cared under heat and danger; she was nursing soldiers from both sides in the actual war zone. This showed dedication in the cause of nursing.
This is another change in the course of nursing, nurses are supposed to show dedication in their profession (Anionwu 2006). Mary Seacole was recognized for her efforts to manage cholera and yellow fever epidemics in her home country before the Crimean war. The nursing work of Seacole in the management of communicable diseases marked the importance of nursing in the various areas of health (Mary Seacole Memorial Statue Appeal 2010). American Civil War There is no formal nursing service that existed in America before the civil war.
Nursing care was obtained from female relatives. The only prominent professionals in the healthcare field were physicians who did home visits, recommendations and surgical procedure on kitchen tables. Other tasks such as dressing of wounds and administration of drugs were left to the relatives. Hospital care was only allotted to those who were unable to obtain home care. Before and during the early years of civil war, nursing functions were performed by male enlisted men recovering from an illness or injury and not strong enough for military activities.
The place of women in the nursing field was determined in civilian hospitals as ward matron. Their responsibilities range from dietary therapy to ward cleaning (Freemon 2001). Nightingale contributed a lot of changes in the nursing field. She proved her authority when she was approached by the federal government during the American civil war to provide advice regarding the medical care for soldiers (Grant 2002). During the American civil war, women were eager to be nurses to help alleviate soldiers’ suffering. There was a formation of women’s clubs and societies in every city and state.
The largest formed private health organization was the United States Sanitary Commission. The purpose of this organization was to improve the health and morale of the Union Army. Approximately, 2,000 women from the north and south aided as volunteer nurses in military hospitals. Among the nurse leaders recognized for their contributions were Dorethea Dix and Clara Barton. (Brumgardt 2003). The idea of service to others prevailed even after the Crimean war. Dorothea Dix was appointed as the superintendent of nurses during the American civil war. Through her work, she showed leadership in various roles.
She performed the administrative role of appointing nurses in healthcare settings. It was another development in nursing. Nurses were given the authority, similar to those of their colleagues in the healthcare field. Dix’s activities range from routine visits to hospitals to personally monitoring the situations of patients. She was also a collaborator, another role that can be expected of nurses. She adjusted disputes and difficulties concerning nurses. She showed the same dedication as Nightingale and Seacole by supervising hospitals far and near.
Although Dix made her mark in military nursing, she was also known for her early contributions in alleviating the conditions of mentally ill people. She improved the condition of mentally ill patients by convincing many state legislatures to extend financial support for the transfer of people in inhumane institutions such as prison into state funded special facilities with provision for extended care (American Association of University Women 2010). Clara Barton was another important figure during the civil war. She was a teacher and US patent office clerk before the civil war.
She was called the ‘Angel of Battlefield’ because of her nursing work. As a private citizen, she was faced with the challenge of getting medical supplies and food. She used her resources and advertised medical supplies and food, used her home as a warehouse and garnered the aid of her friends to distribute needed supplies in battlefields. As the situation of these soldiers was responded by the government, Barton shifted her concerns in another way to help. She established an agency that assisted relatives to communicate with missing loved ones and locate missing soldiers (American Association of University Women 2010).
Besides her responsibility to organize the nursing services, one of her main contributions was the establishment of the American Red Cross, which linked with the International Red Cross through the Treaty of Geneva (Kozier 2004). The presence of nurses in military hospitals before the civil war was uncommon. This was said to be the reason why male doctors and female nurses had clashes during the early years of the civil war. One prominent figure that has been part of these conflicts was Mary A. Bickerdyke. She was said to defy military protocols to do her nursing work.
Without consulting other healthcare professionals, she did various activities like thorough cleaning, bathing the patients and so on. Over the course of war, the relationship between male doctors and nurses had been in better terms. Each accepted the need for coordination to improve the health services. Nursing was recognized as a respectable profession in the healthcare field (Freemon 2001). Boer War Australian women played a significant role as nurses in the Boer War. It was Australia’s first involvement in an international war.
Nursing was needed whenever casualties arose. Despite the huge transformation of the nursing profession during that period, British authorities were hesitant in deploying female nurses to the Boer War. The reason behind this reluctance originated from prejudices and outdated images of nursing as a low-status and unprofessional occupation. Australian nurses made their own stand in changing this image by establishing the New South Wales Army Nursing Service Reserve. The organization with its 14 members were sent to war and served the New South Wales Army Medical Corps.
These Australian nurses showed the same dedication that was cultured in the nursing leaders of the Crimean and American civil wars. They faced the same gruesome conditions: crowded makeshift hospitals, seriously ill patients and hectic and tiring schedules each day (Australian Government-Department of Veterans’ Affair 2010). Bassett (1992, p. 19-21) presented statements from women who served in the Boer War: ‘Lately I have taken to cleaning the mouths of worst typhoids. By the time I have finished doing twenty or thirty tremulous pairs
of lips, the same quivering tongues, with the teeth, gums, and palates accompanying them, I am nearly as tremulous as any of them. ‘ Nurse Gertrude Fletcher ‘Imagine being left alone on the veldt in a Boer farm with your patient[s], far from assistance, hearing no news and knowing nothing of what was happening. My hut was built of clay, round with a mushroom-shaped roof of reeds.. There were no drugs other than [those] I had with me and no medical aid available. All treatment was left entirely in my hands… Altogether I had thirty patients [here] and thirteen at one time.
‘ Julia Johnson Countless accounts supported the claims of commitment of Australian nurses in their profession. Wallace (1976) quoted the writings of Captain W. W. Dobbin, a Victorian Bushman, about the commitment that Australian nurses had shown. Dobbin wrote: ‘You have no doubt heard of all the misfortunes, disease and discomfort encountered by the troops unfortunate enough to be sent in Beira, Marndellas, etc. Our nursing sisters were the only sisters who ventured into these districts and they have indeed done more than their share of work. ‘ World War I
There are numerous advancements in the field of medicine before the beginning of World War I (WWI). Advancements in the fields of medicine such as the discovery of germ theory, bacteriology and antisepsis helped healthcare professionals alleviate the cause of disease and illness. Several discoveries about diseases caused by bacteria such as anthrax, tuberculosis and cholera had been established. During this time, blood typing for transfusions was discovered and used to save lives (Holder 2004). Alongside these discoveries, the knowledge of providing nursing care was also developed.
The conditions of soldiers during the world war were considered worse because of the advancements in weaponry. Another factor that aggravated the health conditions of the soldiers was that the WWI used trench warfare. The situation of soldiers living and fighting in the trenches presented worse problems than before. Soldiers had to deal with lice and rats every day. The sanitary condition of these battlefields also caused dysentery among these soldiers. Other concerns mentioned were trench fever and trench foot that lead to incapacity and amputation for soldiers (Holder 2004).
By the World War I, the importance of nurses in the military field had been recognized. The British authorities had formed an elite corps of army nurses, capable military hospitals, hospital ships and so on. This proved their preparation for the causalities in war. Nursing had given enthusiasm to young women; many volunteered in organizations such as Red Cross and Voluntary Aid Detachments (VAD). An American nurse named Alice Fitzgerald was a prominent figure who contributed to nursing work during the war. She was an indispensable asset due to her being multilingual.
During WWI, she gave nursing care to soldiers from various nationalities such as French, German and Americans. Her achievements ranged from emergency volunteer work in Italy to reorganizing the OR nursing service. She believed that an OR could work efficiently if there was a harmonious relationship between the physician and nurses. Her efforts were an early recognition for another branch in nursing: OR nursing. Through WWI, nurses, such as Fitzgerald, recognized the importance of triage in an emergency situation. Nurses were able to learn dependent functions such as helping physicians set fractures and cleaning jagged wounds.
Nurses displayed various responsibilities in the area such as making bandages, dressing and cleaning wounds. In addition to this, nurses learned also to make their own decisions. They were able to function independently when hundreds of new patients were brought all at once and the doctor was unavailable. WWI provided an opportunity for nurses to show resourcefulness and alertness in times of crisis (Watson 2004). Towards the end of the 19th century, nursing had gained the interest of many. Many developments were made to establish it as a profession.
Literary works and books about nursing were published for others to read. The specialized body of knowledge was considered for nursing because it was recognized as something to be learned, not just any natural skill. Although there were resistance from male doctors, trained nurses during WWI tried to be competent in their work. These nurses accepted the challenge to show that they possess the appropriate skills to meet the specific needs of each patient (Watson 2004). This illustrated that nurses had cultured the respect to their own profession, recognizing it as separate from the medical profession.
This helped the nursing profession establish its own identity in the healthcare field. Nursing that was in its infancy during the Crimean and civil wars in the mid-1800s had developed greatly towards its recognition as a profession. The wars had helped nurses improve education requirements and training and uphold values and moral standards for women in the profession. By WWI, nurses were no longer typical home caregivers, they had received sufficient trainings that can render them professionals (Holder 2004). List of References
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