Nursing History, Image, and History of a Caring Profession PDF

Nursing History, Image, and History of a “Caring” Profession SHANI SERRAO (SHE/HER), RN, BSN, MSC, BHSC CLINICAL INSTRUCTOR U N I V E R S I T Y O F S A S K AT C H E W A N COLLEGE OF NURSING S E P T 6 TH/ 9 T H 2 0 2 4 Learning Objectives:  Describe the historical development of nursing ...

Nursing History, Image, and History of a “Caring” Profession SHANI SERRAO (SHE/HER), RN, BSN, MSC, BHSC CLINICAL INSTRUCTOR U N I V E R S I T Y O F S A S K AT C H E W A N COLLEGE OF NURSING S E P T 6 TH/ 9 T H 2 0 2 4 Learning Objectives:  Describe the historical development of nursing  Explain the importance of the history of nursing in understanding current nursing practice concerns  Analyze the image of nurses WHAT/ SO WHAT/ NOW WHAT Learning Objectives:  Can assist us in understanding and explaining and therefore intervening in present day problems  Provides a base for an informed and critical understanding of our society  Helps us anticipate how the future can look  Mandated by the Canadian Association of Schools of Nursing (CASN) WHAT/ SO WHAT/ NOW WHAT What is a Registered Nurse? “RNs are self-regulated health-care professionals who work autonomously and in collaboration with others to enable individuals, families, groups, communities and populations to achieve their optimal levels of health. At all stages of life, in situations of health, illness, injury and disability, RNs deliver direct health-care services, coordinate care and support clients in managing their own health. RNs contribute to the health-care system through their leadership across a wide range of settings in practice, education, administration, research and policy.” (CNA, 2015, p. 5) 4 Prehistoric Compassion https://youtu.be/t7J_oybRfuc?si=brlAaNHRHLX8PrlE&t=372 Nursing History – Global Who wrote the history that we know?  Christianity and the Middle Ages (500s – 1500s)  More structured nursing care  Involvement of the Church  Nuns  The Crusades Renaissance (1300s – 1600s) and the Enlightenment (1600s to 1700s)  18th Century  Major impact on health and illness  Significant advancement in science  Development of germ theory (Klebs, Pasteur, Lister, and Koch)  These developments greatly influenced nursing Industrial Revolution (1760 to 1840)  Hazardous workplaces  Child labour  Crowding into cities = increase disease  Little public health policy or law Professional Nursing  Florence Nightingale (1820 – 1910)  Founder of “professional nursing”  Went against customs of her time  educated, travelled to Germany and studied to become a nurse at the Institute of Protestant Deaconesses Crimean War (1853 - 1856)  Asked to go by British Secretary of State for War  Dramatically decreased mortality and morbidity rates with simple nursing care  Secured medical supplies, sanitary reforms, improved hygiene  Technology amplified her efforts and recognition (telegraph)  British national heroine  Florence Nightingale (1820 – 1910) Nightingale Model (of nursing education):  Established formal nurse education programs in Britain  First Nightingale school of nursing was established in 1860  Became model of nursing education globally  Hospital apprenticeship program  First nurse statistician  1860: published “Notes on Nursing”  Health vs illness  Stressed good environmental conditions  Florence Nightingale (1820 – 1910) Nightingale Model (of nursing education):  Role division by class/status  Previous to nursing schools, care was given by varied attendants regardless of sex, gender, skill  Recast nursing as “respectable” profession What is a nurse as per Nightingale:  good woman, “highest class of character”  purity, honesty, truthfulness, trustworthiness, cheerfulness, and quietness  submission to physicians (male) Mary Seacole (1805 – 1881)  Seen as a “rival” to Nightingale  Biracial (born and raised in Jamaica)  Learned traditional herbal remedies from her mother Crimean war:  Travelled to London and was rejected by Nightingale’s organization  Went to Turkey, set up “British Hotel” to care for officers  Highly skilled  Seacole fund established  Published travel memoir “Wonderful Adventures of Mrs. Seacole in Many Lands” Mary Seacole “Did these ladies shrink from accepting my aid because my blood flowed beneath a somewhat duskier skin than theirs?” (Seacole, 1857). History of Nursing in Canada Nursing History – Canada  Nursing Tradition in New France  First nurses were male attendants and Jesuit priests.  Most came to “minister” to the sick, motivated by desire to convert the Indigenous population Catholic Nursing Tradition in New France (1600s)  Catholic nursing sisters built a vast network of nurse-run hospitals since 1637  Catholic hospitals founded as charitable institutions  Care of ill but also of evangelization  First hospital in Canada/North America:  Hôtel-Dieu de Québec in 1639 in Quebec City Marie Rollet Hébert  First laywoman to provide care in new France  Indigenous peoples’ knowledge of herbs and remedies also benefited European settlers. Opening of the West: Health and Nursing Care Expansion Expansion across Canada:  Marguerite d’Youville formed Sisters of Charity, known as “the Grey Nuns”/visiting nuns (1700s – 1800s)  Grey Nuns spread out from Montreal towards the West often arriving to care for the new settlers.  Established missions in Manitoba, Saskatchewan and Northwest Territories  By 1947, nursing sisters operated at least 146 hospitals across Canada.  Nursing History – Canada Nursing in Canada also has a much longer history than is typically acknowledged  Long before European settlement in Canada, Indigenous healers and midwives occupied important caregiving roles in their communities  extensive knowledge of medicinal plants and knew how to harvest, prepare and administer them to treat ailments  Colonization led to forced assimilation, which included efforts to suppress the healing knowledge and practices of Indigenous people https://canadian-nurse.com/en/articles/issues/2017/july-august- 2017/reconsidering-nursings-history-during-canada-150 Nursing History – Canada  New colony of Canada devastated by epidemics of infectious diseases  Indigenous healers used knowledge to care for the population, including many white settlers  Limited knowledge re: disease processes; virtually non- existent technology  Good nursing care only effective defence against disease Colonial HealthCare in Canada: “Indian Hospitals” Between 1890s and 1945:  Indigenous health care and initiatives were run by the Department of Indian Affairs  hospitals were church and government run  western style medical services provided to Indigenous peoples  Separate from non-Indigenous – underfunded/overcrowded/understaffed  Indigenous peoples had some of the highest mortality and morbidity rates in the country  Tuberculosis Colonial HealthCare in Canada: “Indian Hospitals” 1960s:  secular federal system replaced church run facilities - 22 Indian hospitals Indian Health Services had 4 goals: 1. provide complete health service for Indigenous peoples to raise the standard of health 2. sought to assimilate Indigenous peoples into mainstream, non-Indigenous societies 3. aimed to “correct” the traditional medical and health practices of Indigenous peoples 4. public health—particularly reducing the threat of tuberculosis (10X higher in Indigenous communities) Indian Hospitals were designed to assimilate Indigenous people into Eurocentric society by replacing traditional health practices with biomedicine  Colonial HealthCare in Canada: “Indian Hospitals” Highly unethical research on children in residential schools between 1942 and 1952  withheld essential nutrients/treatment 1970s:  federally funded medical insurance  the government reduced funds to Indian hospitals  remote and rural nursing care were the only source of health to a lot of communities Decolonizing Nursing: The Canadian Indigenous Nurses Association 1970s:  Indigenous nurses came together to form Registered Nurses of Canadian Indian Ancestry (RNCIA) now called the Canadian Indigenous Nurses Association (CINA)  Firstgroup of Indigenous professionals to organize as an association Founded by:  Jean Goodwill, Jocelyn Bruyere, and Ann Callahan who believed in Indigenous control over Indigenous health services Decolonizing Nursing: Jean Cuthand Goodwill (1928 – 1997)  Little Pine First Nation, SK  Raised by mother’s sister – midwife and medicine woman  RN from Holy Family Hospital, PA  One of the first Indigenous nurses to attend a mainstream nursing school in the 1950s  Worked for IHS – fueled her political activism and leadership Nursing consultant for Health and Welfare Canada (1978) Special advisor to the Minister of National Health and Welfare in 1981 President of RNCIA from 1982 to 1989 (Potter et al, 2021, P 38) Helped develop an access for Indigenous students to enter nursing at the UofS Nursing Education in Canada Nursing Education Late 1800s:  Nightingale’s apprenticeship model shaped the development of nursing education Nightingale Model of Nursing Education: Hospital Schools/Apprenticeship Model  No independent funding in Canada for nurses  Nursing students had to provide nursing care in return for living/education expenses  Lack of independent funding limited nursing control over nursing education  Financial benefit to the hospital  Poor living conditions for students  Education of questionable quality First Canadian Nursing Schools 1874:  Theophilus Mack, MD, established a nursing school in St Catherines General and Marine Hospital (ON)  improve sanitation and postsurgical mortality rates  hired two nurses who had trained in the Nightingale apprenticeship model School’s motto: “I see and I am silent” First School for Nurses (est. 1881)  Toronto General Hospital Mary Agnes Snively (1847 – 1933)  Superintendent in 1884  1896 - introduced 3 year course with 84 hours of practice nursing and 119 hours of instruction by medical staff  Established proper living conditions for students, a curriculum, established criteria for clinical and educational time  Winnipeg General Hospital initiated 1st “Training School for 1887 Nurses” in Western Canada Schools opened in: Montreal, Fredericton, Saint John, Halifax, and Charlottetown had opened schools. Vancouver General Hospital - 1891 1890 Alberta - Medicine Hat in 1894. 212 nurse training schools in the 886 hospitals across Canada 1930 Impact of Nursing Organizations  Schools and nurses began to organize.  Women’s rights movement contributed to their impact Victorian Order of Nurses (VON) in 1898  Lady Ishbel Aberdeen started this after listening to women who had given birth in remote locations Setting of a professional standard of education 33  Impact of Nursing Organizations International Council of Nurses (ICN) in 1899  Founded by British nurse and suffragist Ethel Gordon Manson  sought to address the professional welfare of nurses, the interests of women, and the improvement of people’s health  Could not enter without a national nursing organization 1909: Canada entered ICN Canadian National Association of Trained Nurses (CNATN) which later became the Canadian Nurses’ Association (1924) 34 Establishing University Programs  World War I  Influenza epidemic of 1918  Community health practices promoted  healthof mothers and children was seen as particularly critical Establishing University Programs  First Canadian nonintegrated undergraduate nursing degree program:  University of British Columbia 1919  First institution to approve an integrated degree in nursing:  University of Toronto 1942  U of S – established 1938 – grad 1943  The Weir Report (Survey of Nursing Education in Canada) 1874 – 1930s:  Hospitals used apprenticeship style training  Nursing students were the primary means of staffing hospitals, exploited, ? Quality of nursing education  The Weir report recommended against hospital education  1960s, 95% of Canadian nurses still followed the apprenticeship model 1960s – Present Education reform:  based on accreditation 1910 – first provincial legislation for nurses in Canada Admission criteria and curricula were set for nursing schools, as were rules governing the registration and discipline of practicing nurses 1965: Royal Commission on Health Services called for the separation of nursing education and hospital services 38 1960s – Present Education reform: Baccalaureate as Entry-to-Practice Requirement (BETP):  1975 – Alberta Task Force on Nursing Education  1982 - CNA approved a resolution for baccalaureate entry to practice by the year 2000.  2000 – 2010: every province and territory except Quebec implemented BETP 39  Racism in Nursing Education  For many years, nursing was defined as a profession for young, unmarried, middle class, white women  Women of color were largely barred from entering nurse training schools until the 1930s and 1940s  Many women of color sought education in the US  Marginalization led to advocacy and activism for some  Important to acknowledge the systemic racism that has impacted nursing education and health care delivery Recognizing history of Black nurses a first step to addressing racism and discrimination in nursing - Dal News - Dalhousie University  Racism in Nursing Education Charlotte Edith Anderson Monture (1890 – 1996)  First Indigenous registered nurse in Canada  Indian Act restricted “Status Indians” from pursuing higher education  Denied admission in Ontario, went to US and graduated in 1914  WWI veteran  Returned to Six Nations Reserve in 1919  First Indigenous woman to gain the right to vote (1917) Nursing Education Today  Collaborative programming  Professional development  Accelerated programs, Master’s, PhDs CASN:  Monitors standards of nursing education alongside provincial regulators  National Nursing Education Framework Applying to practice:  National Council Licensure Examination (NCLEX) 42 Canadian Nurses  Canadian missionary nursing – on a global scale  Movement of Canadian nurses into post world war II organizations (WHO)  Ongoing interest in international work and organizations continues  Remote or Northern nursing – a distinguishing feature Decolonizing Nursing: Bringing birth home - Restoring Indigenous Midwifery  Indigenous midwives were once a cornerstone of every Indigenous community  were silenced and ordered to stop their work 2008 – National Aboriginal Council of Midwives (NCIM) Part of the Truth and Reconciliation Commission (TRC) 94 calls to action Call to action 19: Establish measurable goals to address health outcome gaps and publish annual progress reports. Focus areas include infant mortality, mental health, addictions, chronic diseases and the availability of appropriate health services. Call to action 22: Recognize the value of Indigenous healing practices and use them in the treatment of Indigenous patients in collaboration with Indigenous healers and Elders. Call to action 23: Increase the number of Indigenous health-care providers. Call to action 24: Require all medical students to take a course on Indigenous health issues. Nursing Image Throughout History Gordon, S., & Nelson, S. (2005). An End to Angels. The American Journal of Nursing, 105(5), 62–69. https://doi.org/10.1097/00000446-200505000- 00031 Pre Florence Nightingale: “The Drunken Nurse vs The Saint” Any view of nursing is strongly based in gender identity Mid 19th century – more women were working outside the home Until Nightingale, nurses were primarily religious (saint) or servants (portrayed as unrespectable) Florence Nightingale: “The Lady with the Lamp” Nightingale continued the virtuous “angelic” image; “good women” Also fought for women to work outside the home 1860s onwards: Uphill battle for nursing reform Correlated with women’s emancipation movement Nurse reformers perpetuated the virtue script to establish nursing as a profession but also sentimentalized the view of a nurse at the same time  New Faces of Nursing End of 20th century/beginning of 21st century:  profession little valued and understood by society  misconceptions and stereotypes  angels of mercy, the doctor’s handmaiden and sexy nurse/sex object  male nurse was viewed as effeminate or homosexual  Related to gender roles  prejudices held by members of the nursing profession Teresa-Morales, C., Rodríguez-Pérez, M., Araujo-Hernández, M., & Feria-Ramírez, C. (2022). Current Stereotypes Associated with Nursing and Nursing Professionals: An Integrative Review. International journal of environmental research and public health, 19(13), 7640. https://doi.org/10.3390/ijerph19137640 New Faces of Nursing  “Kind caring angel” image trivializes the knowledge a nurse acquires through experience and education  Perpetuated by mass media  Impact of COVID – 19 “RNs are self-regulated health-care professionals who work autonomously and in collaboration with others to enable individuals, families, groups, communities and populations to achieve their optimal levels of health. At all stages of life, in situations of health, illness, injury and disability, RNs deliver direct health-care services, coordinate care and support clients in managing their own health. RNs contribute to the health-care system through their leadership across a wide range of settings in practice, education, administration, research and policy.” (CNA, 2015) Some Key Concepts  Nursing has always existed in some form due to the health care needs of society and is not removed from the society it is part of (socially, economically, culturally).  Indigenous people had a long history of health care and assisted settlers with health care.  In Canada, nursing started out entwined with religion. Colonial attitudes resulted in inequitable health care towards Indigenous peoples in Canada.  The Nightingale model of nursing influenced nursing schools in Canada in the late 1800s and was primarily apprenticeship based, which led to exploitation of nursing students and inconsistent quality of education.  The development of nursing education in Canada (and the world) was closely entwined with women’s rights movements. Nurses had to advocate for nurse control over nursing standards and education. This was also closely linked to the ability to organize and be part of organizations, such as the ICN.  Baccalaureate as an entry-to-practice requirement for nursing has been fully implemented in English-speaking Canada.  Only viewing nurses as “angels” trivializes the profession of nursing. Learning Objectives: WHAT/ SO WHAT/ NOW WHAT  References Association of Ontario Midwives. (2024). https://www.ontariomidwives.ca/decolonizing-health-care-engaging-trc-calls-action Canadian Nurses Association. (2015). FRAMEWORK FOR THE PRACTICE OF REGISTERED NURSES IN CANADA. https://hl-prod- ca-oc-download.s3-ca-central-1.amazonaws.com/CNA/2f975e7e-4a40-45ca-863c- 5ebf0a138d5e/UploadedImages/Framework_for_the_Pracice_of_Registered_Nurses_in_Canada__1_.pdf Gordon, S., & Nelson, S. (2005). An End to Angels. The American Journal of Nursing, 105(5), 62–69. https://doi.org/10.1097/00000446-200505000-00031 Nelson, S. (2011). The image of nurses: The historical origins of invisibility in nursing. Florianopolis, 20(2), 219-20. https://www.scielo.br/j/tce/a/SV3mrX5KbK5hqhZPS5xRPyp/?lang=en National Council of Indigenous Midwives. (2020). https://indigenousmidwifery.ca/history-strategic-plan/ Wytenbroek, L., & Grypma, S. (2024). 3: The Development of Nursing in Canada [Review of 3: The Development of Nursing in Canada]. In POTTER AND PERRY’S CANADIAN FUNDAMENTALS OF NURSING (pp. 34–45). Elsevier Inc. Wytenbroek, L., & Vandenberg, H. (2017). Reconsidering nursing’s history during Canada 150. https://canadian- nurse.com/en/articles/issues/2017/july-august-2017/reconsidering-nursings-history-during-canada-150