The History of Nursing
The History of Nursing
Discuss the changes that have occurred in nursing over the last two centuries
Nursing through the years has improved dramatically due to factors such as the way women were perceived and social reforming. With the advancement of medical knowledge the nursing profession has grown from strength to strength with society understanding the need to train, educate and establish sanitary standards. All of which we can be grateful to many pioneers throughout the years such as Florence Nightingale and Ethel Bedford-Fenwick.
In earlier centuries nursing care was usually provided by volunteers who were untrained or those who possessed little training. During the reign of Henry VIII, nurses were seen to be the ‘dregs’ of society and nursing was considered an unsuitable occupation for ‘proper’ women, this was undoubtedly due to the fact that hospitals in those days were dirty pest houses were patients usually died and the people who were ill were seen to have brought it about upon themselves. Although prior to this, nuns and monks nursed the sick in monasteries until their king abolished all of the caring institutions.
(Encarta Encyclopedia, accessed 09 October 2004)
Modern nursing improved throughout the nineteenth century, one major development being brought about by pioneer Florence Nightingale who during the Victorian era changed the way that society viewed nurses and gave them the respect and high stature that was deserved.
Nightingales impacts began when she volunteered her services during the Crimean War addressing the needs of wounded soldiers. It was during her time her that she revealed the appalling hygiene conditions in which the soldiers were living and she noticed that death rates were not down to injuries and infections but due to bad sanitary practice.
Being a keen statistician and researcher she analysed and documented the data that she discovered producing the ‘polar-area diagram’, this is a statistical model which helps compare data, this showed that nursing care decreased the mortality of soldiers, and with the help of her contact John Delane, the editor of The Times, she published her findings.
Nightingale proposed reformation and was encountered by military officers and doctors objecting, although after she withdrew her services it was recognised that the abominable conditions that she had improved whilst there by cleaning the kitchens, wards and patients, suddenly returned and subsequently she was begged to return and help.
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(Anglin, L.T. 2000)
It was found that due to the sanitary reforming during the Crimean War, mortality rates dropped from 40% down to 2% with thanks going to Nightingale. On her return to Britain she decided to campaign to improve the quality of nursing and in 1856 Nightingale had a long interview with Queen Victoria and Prince Albert, consequently leading to her giving evidence at the 1857 Sanitary Commission.
To get her opinions on reform heard, Nightingale went on to publish two books with the support from her wealthy friends, from this she raised £59,000 and used the money to improve nursing by opening The Nightingale School and Home For Nurses based at St Thomas’s Hospital. The opening of this school marked the beginning of professional education within nursing. Part of the training here included the introduction of the following: the code of practice, supervision, examined practice, regime uniforms. Nightingale was very selective of her nursing students only taking on very few, from this a group of professionally trained nurses were formed.
( accessed on 09 October 2004)
Nightingales contributions to the evolution of nursing as a profession was therefore invaluable, as before she went about reforming, nurses were usually untrained people who saw it to be chore. Through her hard work the stature of nursing was raised to a profession with high standards of education, responsibilities and excellent sanitary practice.
Nursing was on the rise when another pioneer came about, Ethel Bedford-Fenwick concentrated on the politics side, not surprising for someone married to a politician, though this proved to be advantageous to her as her husband Dr Fenwick, helped to campaign in order to safeguard the title of ‘nurse’ and request that a register be introduced. This idea was to increase the standard of nursing so that the character of women was improved; she also wanted to introduce an entry test and 3 years training.
(http://www.nurses.info/personalities_ethel_fenwick.htm accessed 28 September 2004)
Many People were opposed to the Fenwick’s new propositions such as Florence Nightingale, all in disagreement about making nursing professional through training. In a passage of (Baly, M.E. 1995, p. 146) it states that in a letter to Mrs Bedford-Fenwick, Nightingale wrote:
“Nursing has to do with living spirits and bodies. It cannot be tested by public examination, though it may be tested by current supervision”
Ethel Bedford-Fenwick in 1983 acquired the Nursing Record (later became British Nursing Journal) and as editor, used it as the source of her campaign for registration.
The first steps towards the organisation of nursing was when Burdett, the spokesman of the hospitals association, noticed benefits of introducing a register but his ideas differed from those of Mrs Bedford-Fenwick’s, and during a meeting at Burdett’s house, it is believed that Mrs Bedford-Fenwick invited ‘ladies who wished to form a nursing section’ to her home and there the BNA (British Nursing Association) was created.
The BNA insisted that 3 years of training was required whereas Burdett and Nightingale thought that 1 years training was sufficient, although Nightingale thought that those who were to teach other should obtain 2 years of training. Together the BNA formed a pressure group for state registration.
At the end of World War I, with the position that women were now in, it was seen that nurses needed their own professional organisation and in 1916 The College of Nursing (Later the RCN) was registered as a limited company and a council was selected. The idea was to promote the register, education, and training. In 1919 ‘The Nurses’ Registration Act’ was passed and nursing became a regulated profession and each country established a GNC (General Nurses Council). They had the duty of setting up the register, Ethel Bedford-Fenwick being the first name on the world’s first nursing register.
Even after the register was introduced Mrs Bedford-Fenwick did not stop there, even at the age of seventy she continued to devote time to organisations such as Royal British Nurses’ Association. Later in 1926 a new organisation called British College of Nurses was formed after a large anonymous donation was received, Dr Fenwick being the treasurer and Mrs Fenwick as president. This was to be the rival of the College of Nursing.
(Baly, M.E. 1995)
Ethel Bedford-Fenwick’s contributions to the profession were that if she hadn’t of campaigned for registration anybody could have classed themselves as a nurse and not had the relevant training. These days with technology as it is, we need to rely on the fact that people know what they are doing so we feel we are in safe hands.
The first forty years of the century saw a huge social change especially around the times of the First and Second World War. The gains of this were that women sought careers and nursing was an obvious choice.
Throughout the nineteenth century there were some attempts at providing free healthcare although it did not happen until the 5th July 1948, this marking the start of the National Health Service (NHS). They aimed to provide free healthcare for people although initially a small charge was required. The impact this had on the nursing profession was that of mass employment which brought about further training for nurses and more specific job roles. This ultimately was brought about by the Briggs Report.
( accessed 30 September 2004)
In 1970 the Briggs Committee was formed, with thanks to pressure from the RCN, in order to look into the quality of nursing and its training. In 1972 it produced a report recommending a number of changes to be made and that all training bodies should become one, although the midwives and health visitors did not agree to this until 1979. They also suggested an entry age of seventeen.
In 1983, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) was set up, the aim of this was to maintain a register for all UK nurses, midwifes and health visitors, they also dealt with misconduct complaints and up until 2002 were surviving, this was when the Nursing and Midwifery Council (NMC) took over.
( accessed 01 October 2004)
The next reform attempt was that by the UKCC who introduced the ideas of Project 2000. The idea being to ‘determine the education and training required in preparation for nurses, midwives and health visitors in relation to healthcare needs of the 1990s and beyond’.
The main recommendations of the Project 2000 report was to introduce a three year training programme consisting of two years in common foundation and one year in branch leading to a Diploma in Higher Education, this was one of the various changes, as it was felt in order for nursing to be regarded as a serious profession a more academic approach was needed, although it was later amended due to findings that hands on experience is much better.
(Baly, M.E. 1995)
In conclusion, nursing is now seen to be defined as the functions and duties which are carried out by persons who have received formal education and training within the science of nursing which is a long way off what it was in the past.
Nursing improves by the day as more information is learnt and medical knowledge advances. In the future nurses will get more and more duties to perform and at present they are heading towards becoming nursing practitioners; assessing, diagnosing, and administering drugs.
This then should help decrease waiting lists that are currently a major problem for the NHS and the roles that nurses will take mean that patients will be prioritised.
With the explosion of medical and technical knowledge in the healthcare field since World War II, nurses have also begun to specialise in particular areas of nursing care such as neonatal and mental health.
The main thing is that nowadays nurses are now seen with high status and are respected for their duties which was long overdue and the public can be assured that they are in safe hands with thanks to the influences of pioneers such as Florence Nightingale and Ethel Bedford-Fenwick who if they hadn’t pushed for the education, training, sanitation, and registration who knows what the population figure would have been now or who would be treating us!
One last point to consider though, I wonder what Florence Nightingale or Ethel Bedford-Fenwick would suggest the length of training to be now as it presently stands at 3 years and that was sufficient back then but with technology and the progression of medicine, should we not campaign for training and education to be extended due to there being much more to learn now?
Victoria Louise Jackson
Student ID: MCL00037578