An Evolution of Caring: in nursing and NCF

Picture1An Evolution of Caring…

Of all the ideas and concepts that have symbolised nursing since its beginnings there is one central idea that has been constant and enduring.  Many of my High School friends had a burning ambition to become nurses. At the time I did not share that ambition so I was curious to know why they had such a desire to do nursing. It was simple apparently. They said they wanted to care for people…to help people. In those days before career advisors, they may have had a rather hazy or romantic view of what nursing would actually involve (apart from what was conveyed by the Sue Barton Nurse series of books that were often given to us as school prizes), but clearly their concept of a nurse was one who cares.

3Professor Tracey McDonald in her RCNA (45th Patricia Chomley Memorial) Oration in 2011 said, The unifying nursing narrative throughout the 19th century was about ‘care’ and the ‘power and authority to provide nursing care’. Speaking of the early part of the 20th century she said, Many nurses at this time achieved impressive care outcomes and set up systems that ensured patients received safe and effective care. NURSING – OUR MULTIGENERATIONAL WORK IN PROGRESS

If we trace the evolution of nursing throughout the 20th century we see a continuity of this narrative Even though other concerns were emerging, they were strongly related to that central one. In most nursing books, including two recent publications I have read this year, the term “nursing care” is used repeatedly. The two words seem inseparable.

4The tradition of care in association with nursing, extends also to an organization that was formed first and foremost to care for nurses. Nurses Christian Fellowship Australia, originally the Australian Nurses Christian Movement was from the beginning an organization focused on caring for the carers. That remains its motto today. 4a 

This short paper will attempt to show in parallel the evolution of nursing care in Australia and NCF, in its caring role over the past 100 years. A relatively short time in the long history of nursing, but the exact time span of what we know today as Nurses Christian Fellowship Australia.

During that 100 years we see an enormous growth in both the development of the nursing profession and in ANCM and NCFA as it adapted to a series of rapid changes in the profession. The evolution of care in nursing, and revolution in ways of caring over the past 100 years, encompass not only models of nursing, emerging technology, and education. but also social aspects and the changing needs of nurses.

5  1913 – the year that the Nurses Christian Movement began here in Melbourne was just three years after the death of Florence Nightingale. It was the year of the opening of the new Melbourne Hospital on the Lonsdale Street site.(22 July). With four operating theatres, electric lifts, x-ray equipment, an ophthalmic and other specialised departments, the hospital could now provide efficient care for at least 320 in patients and many more outpatients. (On 27 March the following year, through Royal Charter, the hospital became known as The Royal Melbourne Hospital)

6What was it like to be a nurse in Australia in 1913? It was the conditions that created a unique sub culture for nurses in the early part of the 20th century that kindled a vision for a Christian work among nurses. Trainee nurses worked very long hours, usually on split shifts with only one day off a week, so they were virtually cut off from church attendance and other Christian activities. They were also resident in Nurses Homes and subject to strict rules and regulations in relation to off duty time.

7Apart from long hours, poor pay and conditions by our standards today, what things concerned professional nurses in 1913? During that year the Australasian Nurses’ Journal published a rather militant article stating the case for the Australian trained nurse. It was a rather lengthy article but here are a couple of excerpts.

“What is to become of the Australian trained nurse?  Will the public come to her assistance, and offer her fair thing? I am afraid she will have to help herself, and turn some of that strength with which she capably helps others towards her own interest…..”

“The Australian nurse is a quick, capable woman, but it is evident that her intellect is not the brightest where her own interests are concerned….. The Australian nurse is still too British to make any radical change in the nursing scheme. She is so used to the little or no pay of her hospital career that she thinks herself quite rich on £2 2s per week. … It is absurd, in this fair land, Australia, to say that the community cannot pay more than £2 2s per week for the services of a trained nurse.

I was more than astonished to find an article like this written 1n 1913! If things were tough for the trained nurse though, they were even tougher for the trainee nurse. They worked 12 hour shifts, and in most hospitals they were not paid. The Matron at the Melbourne Hospital finally persuaded the hospital to pay trainees, sometime around 1915.

8Surprisingly the instigators of the Nurses Christian Movement were not actually nurses, but they had an understanding of the needs of nurses at that time, and possessed a remarkably clear vision for such a work. They were in fact a group of Christian people both lay and clergy who had been hospital patients themselves and had been greatly impressed by nurses working at The Melbourne Hospital. In 1911, Rev Frank Paton was ill in Melbourne Hospital. While he was there he saw that the spiritual need of the nurses was very great, but that there was no provision made to meet this need. He responded by gathering others to pray with him for nurses at The Melbourne Hospital. The group was led to pray specifically for one particular nurse, believing she was the one through whom God could begin the work they had envisioned. For two years nothing happened. Then the nurse was converted and her life was transformed. She not only brought several of her nursing friends to Christ but also gained permission from the Matron to conduct Bible Study circles for the nurses who wished to attend. Membership grew until nearly half the staff were enrolled. These are the leaders of that group.

Very soon a general committee was formed, and NCM groups were established in other hospitals in Melbourne. Miss R E Gordon, a returned Army sister from WW1, was appointed as “Travelling Secretary” to support the groups and further develop the work of Nurses Christian Movement (NCM), and work expanded quickly.

9 The rapid growth of the ANCM in its early decades can to some extent be attributed to the respect it enjoyed in nursing circles and the quick response to changing conditions and needs of nurses. It can be argued that the long lasting influence of this para-church movement is due to a combination of factors, namely: a solid foundation, a relevant ministry and the continuing ability to meet changing conditions and needs. The evolution of ANCM/NCF was in many ways, as you will see, a response to the evolution of nursing.

 The first decades

10 Although the work expanded quickly at first it was halted for about three years during the First World War. Well over 2000 nurses served with the Australian Army Nursing Service. 11 The Pneumonic Influenza Epidemic was also partly responsible for the pause in the work at that time.

12Then in 1919 Miss Fanny Collett, a missionary nurse, was asked to assume leadership and reorganise the work. It was due to her prayerful and practical efforts that NCMs were established in further Melbourne and country Victoria hospitals, and the movement was introduced to the other Australian states and territories.(pause) 13After the formation of the Western Australian Branch, the Australian Nurses Christian Movement (ANCM) was officially established in 1924, and a Federal Constitution formally adopted in 1928.

14By 1940 one third of Australia’s trained nurses had volunteered for overseas service. Before and throughout the years of World War 2 and in the post war period there was a quick response by ANCM to serve these nurses. The Movement enjoyed a great respect in nursing circles for the practical service given to nurses during those years Each Army Nursing Sister leaving Australia was presented with a specially bound and inscribed New Testament, no doubt the very first nurses Bible. It was reported that “many letters of appreciation for the Bible were received from recipients in different parts of the war zone”. Sixty of the nine hundred nurses who attended Annual Nurses Service at St Andrews Cathedral in Sydney in 1941, were Army or RAAF Nursing Sisters. 15 Staff and members of ANCM also served as hostesses at a club and hostel for Army and Air Force nurses situated in St Andrews place in Sydney. Many contacts and friendships made, were to bear fruit when these nurses returned home after the war to take up senior positions in the hospitals of NSW.

16 In the meantime nursing in Australia was evolving too. From 1913 through to 1920s Nursing Registration Acts were being passed to standardize nursing qualifications.  The Australian Nursing Federation was formed mainly to secure registration with the International Council of Nurses. 17 Australian membership was achieved in 1937.

18In 1946 The National Florence Nightingale Memorial Committee, was created with branches in all States and with representatives of the Red Cross Society, to provide post graduate courses for nurses. It was this body which pioneered the establishment of the College of Nursing, Australia in 1949.

19 During the 1940s and 50s ANCM was flourishing in all States, with groups functioning in most metropolitan hospitals as well as many in country hospitals. Nurses were living in Nurses Homes and there were good attendances at hospital Bible Study Groups. 20 Nurses Rest Rooms maintained by each State Branch, provided a venue for social interaction and spiritual support. One year there were 4,673 visitors to the ANCM Rooms in Sydney. These rooms also provided a venue for inter-hospital meetings, held weekly or fortnightly, and special events such as missionary meetings and prayer days.

21Nurses were cared for by a variety of social events such as picnics, tennis days and group outings. Houseparties and camps were also a feature of the work in all State Branches. During the early years of my time on staff in NSW where we had a Nurses Holiday Home at Katoomba in the Blue Mountains, houseparties and “At Home” weeks were held virtually monthly. 22  There were also leadership conferences and Beach camps for student nurses.

23 118 ANCM members were serving on the mission fields. ANCM cared for them by praying, writing and sending copies of the Cap & Cuffs magazine regularly. New Life magazine reported that around 75% of Australian nurses on the mission field in that era were members of ANCM. Large numbers also served in the Bush Church Aid Society in remote areas of Australia.

24In 1957 the vision of a Scottish nurse and the desire of existing nurses fellowships brought about the formation of NCF International. ANCM became a founding member of NCFI, which today links nurses and national NCFs throughout the world, with 35 member countries, and links with many non-member countries.

25 And in nursing? Up until the mid fifties nurses were still counting drips and taking BPs manually. But the late 50s and 60s saw some major changes in nursing. Disposables were beginning to appear, as was piped oxygen and suction and the first respirators. It was the beginning of the new technology, with the emergence of the respirators, graduate courses in cardio thoracic nursing, and critical care nursing – some hospital based and others through the colleges of nursing in Sydney and Melbourne.

26The establishment of Intensive care wards with their new technology, and the resulting advances in critical care nursing in particular, saw changing relationships between nurses and doctors. There was a new sense of teamwork and mutual respect.

27 The focus of nursing internationally was on theories and models of nursing. There was an emphasis on defining the nurse patient relationship. Models by Joyce Travelbee, Virginia Henderson and Orlando were beginning to appear.

28 In 1961 The Twelfth Quadrennial Conference of the ICN, held in the Exhibition Building in Melbourne, attracted 2300 visitors from 40 countries. It was well organised and seen by contemporaries as the ‘coming of age’ for Australian nurses.  In a couple of days it will once again take place in Melbourne.

 The 1970s

29 In 1970 there was a change of name for ANCM, which became Nurses Christian Fellowship Australia. But many more changes were in store for nursing. The 1970s was an era of even more rapid change in technology, nursing care and nurses roles. The first heart transplants were performed. Dr Winston who performed the first heart transplant was speaker at an NCF grads dinner attended by over 100 nurses at Sydney University. This period saw the advent of TPN and mechanical devices for the delivery of IV fluids and medications.

It was towards the end of that era that I enrolled in a refresher course in a major teaching hospital, and went back to nursing part time alongside my work with NCF. I was thrilled to find myself in such an interesting and challenging clinical setting, even though it was a sharp learning curve. The relationships between medical and nursing staff had begun to change, particularly in critical care areas and the strong long held hierarchical system was disappearing. The appearance of HIV and AIDS posed a challenge for safe practice. There was a demand for evidence based practice. Clinical career paths developed that gave nurses alternatives to administration or education.

Around this time (from late 60s to early 70s) nurses began to move moved out of Nurses Homes, and the work among students gradually declined along with hospital group membership. We began to look for new ways to encourage and prepare students to apply their faith in nursing. 30 NCF in NSW developed a three part Christian Life Course held as weekends away at Hokonui

In light of all this change there were many other new challenges for NCF. Artificial prolongation of life and new definitions of death gave rise to a whole raft of new bioethical issues for health professionals. 31 NCF responded with workshops and seminars on ethical issues for nurses as well as frameworks for ethical decision making. In the 80s NCF contributed to position papers published by the College of Nursing and accepted invitations to contribute a viewpoint on contemporary nursing issues.

One historian commenting on this era said, “The dramatic changes in nursing practice that occurred in this period greatly altered the work of nurses. With the new discoveries in the applied sciences related to health, hospitals emphasised cure rather than care as they had in the pre-war era. Nursing demanded an enhanced knowledge base with the increasing specialistion of medicine and nursing” (Bob Besser, 1999)

32 NCFs program also became more specialized. Graduate nurse education was expanded and a series of professional workshops and seminars was provided. One of the first I can remember was “Cure or Care?” Others dealt with a Christian perspective on topical nursing issues, care for the carer, and medical and nursing ethics.

NCF in NSW introduced the Persons in Crisis course developed by Barbara Simsen, who is with us today. They were on the cutting edge of a new recognition in nursing that we needed to address the needs of the whole person in illness and hospitalization. The workshops were so successful they became a regular feature of the program led by a team of NCF graduate members. 33 Following that were the courses on Spiritual Care in nursing practice – again a response not only to a Christian perspective but also to a growing recognition in nursing of this dimension of need. It was recognized that nurses needed to be prepared to care for spiritual needs as well as the physical, psychosocial ones. Again these workshops became so popular they were held regularly for NCF members and any other nurses interested. Further on in the 80s and 90s I developed a curriculum that could be used in secular as well as Christian settings, and so NCF in NSW participated in ongoing education programs for health areas, and Christian institutions such as Chesalon, Hammonville (now Hammond Care) and other smaller hospitals and nursing homes.

34The work with prospective nurses (later called pre nurses) was also reinvented and expanded. It had begun in Victoria and NSW during the fifties with meetings and weekend camps. Mary Evans, a President of NCF Victoria, reported that there were sometimes 100 girls attending the camps. In NSW that aspect of the work was smaller until in the seventies, when partly in response to the nurse shortages of the time, this aspect of the work was stepped up.

35 These very popular week long camps were held each year for a time, but were now called Nursing Preview. As in Victoria, quite a number of girls became Christians while attending Pre nurses events. (SA and Qld also)

36 As men came to undertake general nursing courses, NCF was keen to include them, and where possible have representatives on State councils and other teams and committees. [Recruitment poster from USA ]

37 Nurse education moved from hospitals to the tertiary sector in the mid-eighties – first to a diploma from Colleges of Advanced Education, and soon to a university degree when these colleges became universities or merged with universities. This change while a great step forward for nursing, brought its own problems in the early years. The new graduates were not always welcomed by established nurses and administrators in medical treatment units. There was a significant drop out rate for newly practicing nurses. They felt stressed by a lack of clinical experience, and there were insufficient new grad program placements. NCF again responded to new needs with a weekend course for new graduate nurses to help them prepare for entry to the graduate workforce. NCF in some States tried to provide mentoring wherever possible, and programs to support them.

For several years NCF in NSW maintained NCF groups for nursing students in colleges and universities, while in Victoria, work with students continued in universities until fairly recently.

38 Throughout the nineties and the first decade of the 21st century the emphasis for NCFA has been in caring for nurses, midwives and nursing students by providing spiritual and professional support through Bible study groups, workshops, ongoing education, conferences, and resource materials.Three years ago NCF in NSW gained accreditation for professional education events with the Royal College of Nursing Australia, and we are planning to extend that to other States

39Additionally NCF Branches currently arrange social and fellowship events such as professional breakfasts, dinners and barbeques, and even the occasional houseparty. New technology has been embraced, with websites and social media to spread the word and encourage Christian nurses to engage with NCF.

41One hundred years of caring in nursing and NCF is concluding, but what will the next 100 years hold? For NCFA, all will depend on whether young nurses of today will take up its mission and carry it further into this second century.

40I pray that the tradition of caring for both nursing and NCF will not only survive but will thrive and flourish to make a real difference in the nursing world of the future. 41

Margaret Hutchison
May 2013

View Power Point Show   An Evolution of Care-c

Presented at the Centenary Conference of NCF Australia by Margaret Hutchison
Melbourne Vic. May 2013