Sometimes the significance of today will not be truly apparent unless seen against the backdrop of yesterday. Changes and trends in nursing now, can be understood and interpreted not only by nursing’s contemporary context but also by its past.
The history of modern nursing is integrally bound up with the history of the Christian church. Josephine Dolan who wrote the classic nursing text, “Nursing in Society” claimed, “Even after nineteen hundred years it is difficult to fully comprehend the impact of the birth of Jesus Christ and His teaching on society and the care of the sick”. There is ample evidence for this. In the early Christian church, caring for the sick was seen as a ministry to Christ. During the middle ages nursing was an important part of community life in religious orders. In Benedictine monasteries one of the rules stated, “The care of the sick is to be placed above and before every other duty, as if indeed Christ were being directly served by waiting upon them”. Additionally these monasteries provided an opportunity for women to pursue a career in which they could use their intellectual and spiritual gifts and develop nursing skills. In this era, nursing attracted many women who were well educated and wealthy, including some of royal birth.
The spread of plagues; trends to more crowded urban living; as well as the wars and feuding of the times, created an ever urgent need of care which led to a further expansion of nursing. As well as the services provided by traditional religious orders, some orders were established for lay persons who wanted an opportunity to share in this charitable work. Eventually some hospitals were built outside of the monasteries, and so bringing those nursing services under lay management. The women were sometimes called ‘sisters’ and the male nurses ‘brothers’,even though not members of a religious group.
Throughout the 19th century, the number of hospitals and community nursing associations continued to grow rapidly. Due to a resurgence of religious nursing orders, particularly the Anglican Sisterhoods, a conflict was created. The physicians and surgeons of the day were critical of the nurses who they claimed were more interested in the spiritual needs of patients than the physical. They required nurses who would be answerable first to them and who could accurately observe their patients and monitor the treatments they ordered (naturally enough!). They also favoured an authority structure modelled on the middle class Victorian family. That kind of hierarchical model was perpetuated in nursing beyond the middle of this century. It was perhaps given new impetus by the world wars and the fact that many ex. army nurses held leadership roles in nursing.
Thus even before the dawn of what we might term modern “scientific medicine”, nurses were favouring a holistic approach to care for the sick – caring for the needs of the soul or spirit as well as the body. They rejected a strictly mechanised approach to health care and still do. The famous 19th century nurse, Florence Nightingale not only saw nursing as autonomous of the medical profession, but took the view that the needs of the spirit are as critical to health as the individual organs which make up the body. Nightingale’s services to soldiers in the Crimea, brought her world wide recognition, and the system of nursing she developed was to revolutionise nursing.
BETWEEN THEN AND NOW
In the 21st century, younger nurses and nursing students have a difficult time imagining what nursing was like at the turn of 20th. During this century there have been enormous changes in our society, health services and even the concept of a nurse. An investigation of the nursing history archives highlights this.
Here is an extract taken directly from a book on nurses and nursing published in the 1890’s. Ambulance Work And Nursing —A Handbook On First Aid To The Injured With A Section On Nursing. Published in Chicago by W. T. Keener & Co.
“The qualifications required to be a successful nurse are necessarily of a high order, and this applies not only to the trained nurse, but to her embryo sister who wishes to adopt nursing as a calling. In the first place she must be not only be physically, but constitutionally strong. She must be not only well formed, but must have certain powers of resistance. A girl, for example, who is subject to sick headaches, or who readily “knocks up,” will never make a good nurse. The best type of nursing girl is one who is tall and strong, and who has a certain suppleness of movement. One who is accustomed to play lawn-tennis, who can ride, and skate, and row, makes the best material.
If she can dance, especially if she is an enthusiastic dancer, it is a great advantage, for graceful carriage is a thing to be cultivated, and nothing is more distasteful in a sick-room than a suspicion of clumsiness. If in addition to being well formed she is favoured with good looks, it is all in her favour, for doctors readily recognise the influence of an attractive person in the management of refractory patients.
Respecting her moral attributes, it may be said that a girl who has been brought up in a country parsonage, and has had little experience of the world, is hardly fitted for hospital work. In the wards she will be brought in constant contact with people of various modes of thought, and if she is unable to adapt herself to her surroundings, her novitiate will of necessity be a very uncomfortable one.
Nursing should not be undertaken from sentimental motives, or, from any notion of becoming one of the “Guardian Angels” of the novelist. Such an idea will assuredly end in disappointment, for it will be found that the really sick have but a poor appreciation of sentiment, that the routine duties of the sick-room are monotonous and tiresome, and leave but scant time for indulging one’s imagination or poetic feelings.
It is hardly necessary to say that a nurse should be honest and truthful, for the vast majority of English nurses possess these qualifications in the very highest degree. The only danger to the patient is entirely of another character, for it sometimes happens that the invalid during his long period of convalescence, becomes so enamoured of his kindly attendant that he finds it impossible to dispense with her services, and marries her!
The age at which a nurse should begin her training is a matter concerning which there is some difference of opinion. One authority thinks that the best age is between twenty-five and thirty. This is an entire mistake, for a person who attempts to enter a business or profession at the age of thirty rarely does much at it. Twenty-one is a good age to begin, and forty is a good age at which to retire. A woman is much older than a man at the age of forty, and by that time a woman should have made some permanent provision in life for herself. Few doctors will employ old nurses, and few patients care to have them”.
In the early decades of this century, nurses worked very long shifts of 12 hours or more and had only one day off per week. Not only were they very restricted in their social activities generally, but were rarely able to attend church services or groups. It was in this era that Nurses Christian Fellowship was born – the first organisation of its kind in the world. Consequently NCF became almost a substitute for church; providing Christian teaching, encouragement, and Fellowship. [Photos of the first ANCM Group at the Melbourne Hosp] Since then of course, extensive changes in nursing and nurse education have brought a significant change of role and focus for NCF. It is no longer a substitute ‘church’ but a specialist organisation, which works alongside the church.
Nursing’s links with Christianity are not so obvious today. There are many other philosophies and religions which are influencing nursing theory and practice. Yet it remains a fact that the Christian world view has positively shaped the practice of nursing in our history as a profession, and can still be recognised in nursing codes of ethics and practice. In nursing today, we can still see some strong links to nursing’s past. Among many new trends and changes emerging in nursing theory and practice today, two have generated a good deal of interest for several years. One is a renewed focus on holistic care, and the other, which arises from it, is an interest in spirituality and spiritual care in nursing.
‘Holism’ has become the buzz word of the nineties, and nurses are frequently exhorted to care for the whole person. A new wave of terminology has evolved around this concept, and now in nursing theory you will sometimes find a person described as a biopsychosocial unit! But despite new ways of describing this philosophy, it this simply reflects a long held goal of nursing, “to help a person attain or maintain wholeness in every dimension of their being”. Nursing is revisiting an old concept and is now giving more time and attention to the more intangible aspects of a person’s need. For although the term holistic was not introduced into the nursing literature until 1980s, but it would have been hard to find a nurse in any era who saw only the physical aspect of care as that which defines nursing. In 1971, a nursing theorist by the name of Joyce Travelbee declared, “A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of suffering, whether physical, mental or spiritual is the proper concern of the nurse”.1 (Travelbee, 1971: 159).
It is good news for nursing that despite all the concentration on technology and scientific method, nursing is not losing its focus on person centred integrated care. It is also good news for society as a whole – especially those of us who will be needing nursing care at some stage or another. Further than that, it has been good news to Nurses Christian Fellowship, both here and elsewhere, because it has given us unprecedented opportunities to provide teaching in spiritual care both for Christian nurses through our own workshops and for ongoing education programs conducted by Area Health services, nursing homes and hospitals. In NSW, NCF has been able to present papers at secular nursing conferences on a local, state and national level and contribute a chapter on documenting spiritual care for a nursing book.
A goal of Nurses Christian Fellowship worldwide has always been a quality nursing care that includes a spiritual dimension and is based on a Christian philosophy. So these are exciting times for Christians in nursing, since we have added opportunities to contribute something to nursing’s body of knowledge and at the same time bring a Christian influence.
CARING FOR CARERS
The movement which began in response to the special needs of nurses in the early part of the century has endured to the eve of the next. What has enabled the continuance of this para-church movement maintained and supported by nurses for nurses for 85 years? An examination of the historical records would suggest that a combination of factors may have contributed. In addition to a sound foundation and intensive period of consolidation following its inception, the organisation has maintained a relevant ministry and demonstrated the ability to meet changing conditions and needs.
NCF has always endeavoured to care for nurses. Today we aim to provide specialised support and education to enable them to integrate their Christian faith with nursing practice. We also strive to contribute Christian values and principles to the ongoing development of the nursing profession both directly and indirectly.
Have you considered becoming a member of your national NCF? By linking up with other Christian nurses you will be strengthening the Christian voice in the nursing profession and at the same time gaining access to the resources of an organisation which specialises in integrating Christian faith with nursing theory and practice.
(c) Margaret Hutchison, October 1998.