Class 2: Nursing History Timeline – Flashcards

"CNA believes learning from nursing history is critical to advancing the profession in the interests of the Canadian public" (CNA, 2007).

• Self understanding, group cohesiveness, empowerment, and pride. • Better prepared for the future by understanding the challenges and opportunities of the past. • Critically reflect on the contributions to Canadian society and the health care system. • Challenges conventional wisdom and offers insight. • Illuminates complexity and diversity of this profession.

The Egyptians (3300-1500B.C.): Recognized the importance of preventing illness and maintaining health. Ancient Greece: Hippocrates (The father of scientific medicine and Western medical ethics). Galen (Greek physician-scientist). Romans: Recognized the importance of fresh water and hygiene. Hebrews: Following "The 10 Commandments" promoted health

• recognized the importance of preventing illness and maintaining health through well-balanced diet of fruits vegetables, fish, milk, legumes, seeds, and oil • Egyptians provided framework for development of medicine in ancient Greece

• considered father of scientific medicine and Western medical ethics • developed methods of treating disease and establishing ethical principles upon which practice was based • developed medicine into a science

• Greek physician-scientist, made important contributions to field of physiology before becoming physician to the gladiators • Greek physicians had significant influence on the Romans

• recognized the importance of fresh water and hygiene for public health • 312BC to 226AD developed aqueducts, public baths and constructed public toilets and sewers, which greatly improved health

• recognized importance of nutrition and developed dietary law that protected the public • what foods to eat, how to prepare, how to slaughter meats • nurses cared for sick in the home and community and served as midwives

• nursing became a caring service, undertaken by women • offered respite to ill and fatigued pilgrims travelling to the Holy Land • during 11th and 13th century hospitals built, religious orders formed during crusades, cared for and defended pilgrims • during Protestant Reformation hospitals and other intuitions run by monks and nuns were disbanded or closed • conditions deteriorated as lack of sanitation prevailed and disease spread rapidly • during 17th century, conditions began to improve and there was greater emphasis on nursing • St. Vincent de Paul founded the Sisters of Charity in 1633 to care for the sick, poor, and orphaned

• roots of nursing and health care in North America may be found in the values and ideals of the European settlers in New France (Quebec) • during late 19th and 20th century indigenous women played essential roles within their own and newcomer communities as midwives, nurses, and caregivers • indigenous knowledge care for many white settlers in Western Canada

• 1608 Samuel de Champlain selected Quebec as the site for a colony of settlers to support the growing fur trade • 1617 *Mme Hébert* became the first woman to emigrate to the new world from France, cared for Native people and settlers alike - husband's apothecary and agricultural skills helped prevent starvation and mitigate illness • first nurses to tend to sick were male attendants at a "sick bay"; • First nursing mission established in 1639 at Sillery; Jesuit priests who were missionary immigrants to New France, also served as nurses • *Jeanne Mance* (1641) founded a hospital in the region of Ville-Marie (later Montreal); only person with health care knowledge in new settlement; nurses not physicians provided care

• Marguerite d'Youville (1738) formed the Sisters of Charity of Montreal; later called Grey Nuns • admitted wealthy paying guests to hospital as well as patients who required care • to meet expenses made military garments and tents, started a brewery and a tobacco plant, and operated a freight and cartage business

• during war between British and the French (1756) Grey Nuns cared for both sides at the General Hospital of Montreal

• the Grey Nuns (1844): Montreal to Manitoba • the Grey Nuns (1859): Montreal to Alberta

• considered the founder of modern nursing • promoted improved nursing care using principles of cleanliness and comfort • defined focus and scope of nursing practice (Notes on Nursing: What it is and what it is not). • promoted documentation of nursing activities and observations

• superintendent at Harley Street Hospital • organized nurses to care for soldiers in Crimean war (1854) with dramatic reductions in morbidity and mortality rates • after Crimean War became political advocate for women, health care reform and people's health

• Wrote much to educate nurses and lay women about nursing/caring for the ill. • Established St. Thomas's Hospital in London - 1st organized program of training for nurses - The Nightingale Training School for Nurses.

• Recorded and communicated data • 1st Nurse Researcher • Promoted evidence-based Practice

• 1639 Hotel-Dieu de Quebec, first hopital in America north of Mexico • 1819 France sent the Sisters of St. Joseph of Cluny to West Africa to to engage in medical missions in Senegal • 1844 Grey Nuns traveled from Montreal to western Canada and northern Canada • Catholic religious orders originally based in Europe were instrumental in the development of hospitals and nursing serves in United States, Canada, and Australia

• early hospitals challenged financially because they didn't charge poor patients • First hospital diploma school in Canada (1874): St. Catharines • Training School at the St. Catharines General and Marine Hospital. • Growth of hospital schools of nursing: - The Winnipeg General Hospital 1887: first in Western Canada. - By 1930 there were approximately 330 schools of nursing

• appointed superintendent of The School for Nurses at the Toronto General Hospital in 1884 • teach before a nurse, rectified all deficiencies: new residence, developed a curriculum plan including nursing theory and practice, lengthened education period to three years • 1907 established the Canadian Society of Superintendents of Training Schools of Nursing • driving force behind founding of the Provisional Organization of the Canadian National Association of Trained Nurses (later the CNA) • first Canadian member of the ICN, later served as vice-president

• Goal was to raise the raise the standard of professional nursing and ensure those practicing were qualified and able. But how?? • Formation of the *Victoria Order of Nurses* (1898) Lady Ishbel Aberdeen. • What was happening outside the borders of Canada? • American Society of Superintendents of Training Schools for Nurses of the United States and Canada (later to be National League for Nursing 1912) • Nurses' Associated Alumnae of the United States and Canada • Formation of nursing organizations - Ethel Bedford-Fenwick ICN (1899)

Establishment of Nursing Associations: • The Canadian Society of Superintendent of Training Schools for Nurses (1907) • Provisional Society of the Canadian National Association of Trained Nurses (CNATN): • Mary Agnes Snively founding president • ICN member in 1909 • CNATN became the Canadian Nurses Association (CNA) in 1924 and a federation of provincial associations in 1930

• 1918 WWI and influenza pandemic led to support for public health programs and new patterns of health care delivery • First undergraduate nursing degree program: University of British Columbia in 1919 • several new five-year nonintegrated degree programs began at Canadian universities in the 1920s and 1930s

• program quality an important concern of rapid development of nursing education programs in hospitals • nursing students were exploited in apprenticeships system of nursing education that developed in hospital-based diploma nursing programs • (1932) Dr. George Weir reported results of first national study of nursing education, commissioned jointly by CNA and CMA confirmed deplorable conditions of nursing students

• 1960s following war, nursing leaders called for better prepared faculty in schools and for quality and standards as priorities in nursing education programs • 1960's the move to separate nursing education from the authority of hospitals. • 1964 Royal Commission on Heal Services: basic integrated degree model became program of choice by the 1970s • 1975: Alberta Task Force on Nursing Education recommends baccalaureate preparation by 2000.

• CNA found 105/161 hospital schools of nursing with clinical assignments was not based on the students' educational needs, but on the service needs of patient care units • *Dr. Helen K. Mussallem* found hospital schools of nursing used their students as a workforce, that hours on duty were too long, that nursing instruction in classroom was limited and insufficient, and that teaching personnel were ill-prepared and too few in number • Dr. Helen K. Mussallem: War helped to mature Canadian nursing and created opportunities for independent decision making.

• *WWI* led to new value being placed on promoting and maintaing health, along with influenza epidemic of 1918/1919 led to support for public health programs and new patterns of health care delivery to prevent disease and improve the health and well-being of the Canadian populace • *the Great Depression* unemployment and hardship to nurses, private-duty nurses laid off, Canadian universities faced reduced revenues, staff layoffs, and difficult working conditions • during *WWII* health education became a priority as doctors and nurses were needed to care for military personnel, as well as civilians; nurses were recruited for military service, resulting in nursing shortage; new interest in nursing education led to increased external university funding, more scholarships and bursaries, growth of existing schools, and found of new programs between 1941-1949

The image of nursing is influenced by the assumptions that most nurses: - are women - aid to doctors - majority are not well-educated - are not from the most privileged social class - are not well paid

1) Angel of Mercy (1854-1919) 2) Girl Friday (1920-1929) 3) The Heroine (1930-1945) 4) The Mother (1945-1965) 5) Sex Object (mid 1960s)

- the image of the nurse was portrayed as "noble, moral, religious, virginal, ritualistic, and self-sacrificing" (ex: Florence Nightingale) - nurses wore grey or blue uniforms - nurses were presented by the media as noble and heroic

- the image of the nurse was portrayed as "subservient, cooperative, methodical, dedicated, modest, and loyal" - nurses served as a handmaiden which began from the deprofessionalization of nursing that occurred in the 1920's which caused a decline in education standards - the decline was due to increase of hospitals with nursing students as the staff, poor working conditions, and mistreatment of students

- the image of the nurse was portrayed as "brave, rational, dedicated, decisive, humanistic, and autonomous" - movies displayed the heroism of nurses - recruitment posters for the war displayed nurses as a positive image - many nurses volunteered for military services and were highly regarded by society

- the image of the nurse was portrayed as "maternal, nurturing, sympathetic, passive, expressive, and domestic" - nursing was considered a high status occupation for women at this time

- the image of the nurse was portrayed as "sensual, romantic, hedonistic, frivolous, irresponsible, and promiscuous" and continues in todays society - the image is readily identified in older television programs such as M*A*S*H - nurses were depicted as a sex object with no evidence of intellectuality or professionalism

- the image of the nurse was proposed as an "intelligent, logical, progressive, sophisticated, empathic, and assertive women or man who is committed to attaining higher and higher standards of health care" - this image is timeless and as relevant today as it was in 1982 - nurses could be described by society/media as "the good, the bad and the crazy" - filmmakers are starting to see nurses as "intelligent, strong and passionate characters and are increasingly turning to nursing characters who offer a broader, deeper and authentic representation of modern nurses and nursing"

- the image of nurses is influenced by the media and the self-images of nurses is more negative than that of any other health care providers - images portrayed in earlier studies saw nursing as interesting, with good job security and income but had less independence in the workplace - in the late 1980s, a study was conducted throughout Alberta to describe the nursing profession in which 87% of the responses saw nurses as caring, compassionate, knowledgeable, intelligent, helpful, devoted, dedicated, responsible and hard working" - the internet has been seen as providing a positive image of nursing

- nurses have been known as having a low self-esteem - unless nurses have a concept of the "careerist" image themselves, nursing will not succeed in changing the image

• 1905- Canadian nurse journal • 1908 - Canadian national association of trained nurses • 1909 - International council of nursing accepted Canada's nursing status • 1911 - nurses associated alumni from the States and Canada and formed the American Nurses Association • 1914 - World War 1 • 1915 - emphasis on graduate training. • 1916 -Registered nursing Act • 1916 - standard public uniform was proposed by American nurses association • 1917- 1918 Spanish flu • 1919 - District nurse • 1919 - first undergrad nursing degree was established at the University of British Columbia • 1920 - Women were granted more rights • 1920 - FASHION CRISIS!!! "the bob" • 1920 - Red cros outpost • In the 1920's - movement to technology • Personalities o Mary Agnes Snively o Katie Brighty

*1950s*: Post-war shortage of Nurses *1952*: Sedatives introduced to mental health nursing *1953*: National Student Nursing Association was established *1967*: Dame Cecily Saunders sets up the first hospice center in London, England • Men in Quebec were allowed to register as Nurses alongside females. *1970s*: A time for nursing groups to legitimize and expand the role of the Nurse: • Nurse Practitioners Associations of Ontario (1973) • Manitoba Nurse Practitioner Interest Group (1975) • Saskatchewan Nurse Practitioner Demonstration (1975) *1975*: Aboriginal Nurses Association was founded *1976*: Launch of the Canadian Nurses Association Global Health and Equity Program *1980s*: Certification in nursing specialties: • Occupational Health Nurse (1984) • Neuroscience Nurse (1987) *1980 - 1982*: The initiation of the baccalaureate degree be the minimum educational requirement for nursing practice *1985*: Canadian Code of Ethics *1988*: Nursing research and PhD programs in nursing were supported *1991*: First doctoral program in nursing *1993*: Alberta budget cutbacks *2008 - 2010*: Robert Wood Johnson Foundation and Institute of Medicine looking at expanding the extent of nursing practice in the changing healthcare system *2009*: Recommendations for education for nurses

1) Worlds first Nursing school - Founded about 250 B.C in India; males only 2) In 1300 A.D the Alexian Brothers were layman for an informal group in which aided the lower societal class 3) St. Camillus created the first field ambulance and the Red Cross. St. John of God spent his life taking care of those terminally ill and diseased. 4) Great Britain 1936 - Edward Galvin created the Society of Registered Male Nurses. 5) USA - 1971 - Men nurses formed American Assembly for Men in Nursing 6) Canada - 1956 - smaller scale Male Nurses' Committee formed in Ontario 7) In 1901, men were barred from enlisting as nurses. The navy followed suit in 1908. Men who had trained to be nurses were allowed to enlist with the army, but they were not allowed to perform nursing duties. 8) Over 1200 trained male professionals were told that they were overqualified and were instead assigned to hard labour or patrolling tasks during the war 9) In 1955, Eisenhower allows men to enrol as nurses in the army once again 10) Florence Nightingale declared nursing as a female dominant occupation 11) Nursing was seen as an inferior position for a male internationally 12) Men didn't have the skills to care and nurture for clients in comparison to women 13) The 's 1980's saw the first spike of male nurses entering the profession. 14) The segregation of Men is still apparent in current times 15) Higher admission requirements and tougher programs have seen a rise in the number of male students accepted into nursing schools

• (1860s) newer schools didn't have the financing and required students to provide nursing services to the hospitals in return for their education. • (1874) the first hospital diploma school in Canada opened in 1874 in St. Catharines General and Marine hospital. Requirements included plain English education, good character and Christian motives. • (1887) The Winnipeg General claims to be the first hospital in Western Canada to start a training school for nurses. Previously requirement was only: certificate of good health from a physician and a certificate of good character from a clergyman. Must be over 21 and under the age of 30 had to go through a month's probation in reading, writing, arithmetic and plain sewing • (1896) Mary Agnes Snively introduced a 3yr course at the Toronto General Hospital, which includes 84hrs of practical training and 119hrs of instruction by medical staff. The move to establish Hospital school swept the country. • (1898) At the same time hospital training schools were sweeping the country nurses began to advocate for an improved educational standard. Lady Aberdeen conceived the idea to establish the Victorian Order of Nurses (VON). VON signified a professional standard of education for Canadian nurses. It recognized the need for not only compassion but also knowledge. • (1909) There were 70 schools for nursing: 10 were a two year course, 3 were a two and a half year course, 57 were a 3 year course, 12 schools introduced a preliminary training for probationers, where they were taught basic skills. • (1919) The first Canadian undergrad nursing degree program was established at the University of British Columbia. • (1932) Kathleen Russel at the University of Toronto worked towards the establishment of a school of nursing within the university that would function independently and free from hospital control. Was successful and the school of nursing was awarded funding by both the Ontario government and Rockefeller Foundation. Important: removal of nursing education from hospital control meant that the labor of student nurses wouldn't be exploited. "It also represented an attempt on the part of nurse educators to incorporate science into the art of nursing education." • (1991) The University of Alberta initiated the first Canadian PhD nursing program. • (1998) New Brunswick was the first province to require baccalaureate degree for nurses in Canada. • (2003) People feared that as more nursing programs move to baccalaureate education will contribute to the shortage of nurses, but in reality shortages, cutbacks and downsizing of the nursing workforce were the real causes. • (present) The degree program at universities for RN's train students to think critically while handling tougher workloads, dealing with modern technologies, and advocating for the patients. Unlike degree programs, diploma programs never talked about what would happen after a nurse treats a patient. As illustrated from these chronological orders of events, it can be summarized that nursing education has grown as a profession. It has evolved from a minuscule role requiring low educational standards, to a highly respected and acknowledged status needing a range of skills.