International Perspectives in the History of Nursing

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International Perspectives in the History of Nursing

Roundtable Debate
Tuesday 14th September 2010

2:45pm – 4:00pm

Windsor Building Auditorium

Was there a Nightingale System of training, and, if so, what influence did it have on the development of nursing in the late nineteenth century?’

Chair: Anne Marie Rafferty CBE, RN, D.Phil (Oxon)

Carol Helmstadter, Toronto, Canada: ‘Nightingale Training in Context’

Barbra Mann-Wall, The University of Pennsylvania, Philadelphia, USA: ‘Nuns, Nightingale and Nursing’
Judith Godden, The University of Sydney, Australia: ‘The Power of the Ideal: How the Nightingale System shaped modern nursing’

Lynn McDonald ‘The Nightingale system of training and its influence worldwide’

Sponsored by Royal College of Nursing

Concurrent Session 1

Session 1a: Community Nursing
Dr Margaret McAllister, Ed D, RN is Associate Professor, School of Health and Sport Sciences, Faculty of Science, Health and Education, University of the Sunshine Coast, Queensland, Australia.

61 7 5456 5032

Dr Wendy Madsen, PhD, RN is Senior Lecturer in the Faculty of Science, Engineering and Health at Central Queensland University, Bundaberg.

Dr Judith Godden, PhD, is Honorary Associate in the Department of History, University of Sydney.

Dr Jennene Greenhill, PhD, RN is Director of Research, Senior Lecturer and Coordinator of the Masters in Clinical Education program with the Flinders University Rural Clinical School in South Australia.
Aim: This study took place in 2007-8 in order to provide a national perspective on the teaching of history of nursing within Australia. It aimed to produce information about existing content and processes of history teaching in undergraduate programmes.

Rationale: While teaching the history of nursing can directly improve students’ awareness of nursing and professional identity, it does not enjoy a prominent place within Australian nursing curricula. Despite the extant body of literature on nursing’s history, for example, Lewenson and Herrmann (2008) and Godden and Forsyth (2003), Australian nursing history projects have not been extended to produce educational outcomes (Nelson, 2002).

Significance: The national picture produced on the challenges of teaching nursing’s history as well as the creative approaches, enabled critical analysis and a baseline for strategic curriculum development.

Methodology: All Schools of Nursing in Universities across Australia were invited to participate in a national survey. Semi structured telephone interviews explored what and how the history of nursing is taught to undergraduate students within Australian nursing programmes.

Findings: A good response rate was achieved, with 22 of the 36 Universities participating. The study found that even though participants valued history of nursing teaching, educators have difficulty finding a place for history in the crowded curriculum, due to an over-emphasis on technical skills. Consequently, opportunities to be pedagogically creative were minimal.

The study also found that history learning in nursing in Australia occurs in a variety of ways and some respondents did move beyond teaching basic facts and dates, towards the so called second-order learning wherein students are learning history, albeit in a brief time, in order to make judgments about the profession’s evolution and to make decisions about the significance of events. However, these various teaching strategies and resources are not evenly available.

Conclusions: The benefits of, and approaches to, history learning need to be more persuasively disseminated across Australia. Similarly, the risk of an over-focus in the curriculum on technical competence and vocational preparedness needs to be communicated. In the context of a health-care world that is changing rapidly the pressure from industry has led to a situation where there is shrinking space for history learning within this crowded curriculum and thus we are at risk of producing short term gains of technical proficiency and losing the long term gains of critical, constructive thinkers.


Judith Young

Independent Scholar

Tel: 416 488 0597


This paper focuses on nurses and midwives hired to provide home care in the decades before nurse training was securely established in Canada. The study builds on my earlier work detailing nineteenth-century caregivers in Toronto and compares and contrasts those findings with information on nurses and midwives in the cities of Montreal, Quebec and Halifax, Nova Scotia. The history of religious nursing orders, particularly in Quebec, is well documented; we know also something of early Canadian hospital nurses but little, however, of nurses and midwives hired to care for people in their homes. My study seeks to document the growth of the private health care market in nineteenth-century Canada.
The major primary sources for this study were public documents such as the census, city directories, almanacs, and contemporary newspapers. Among the secondary sources, the work of Carol Helmstadter, Barbara Mortimer, Anne Summers, and Susan Reverby on British and American nursing was especially valuable. For information on working-class Canadian women I looked mainly to Bettina Bradbury and Jane Errington and for the history of midwives in Canada to Hélène Laforce and J.T.H. Connor.
The findings of this study indicate that until the late nineteenth century when trained nurses appeared on the scene, nurses and midwives hired to provide care in Canadian homes were overwhelmingly working-class and female, most were literate, and many were widows. The same was true of Toronto. During this era, it was not possible to clearly separate nurses from midwives; roles were fluid and, in the course of a career, some women used both titles. I found that the number of private nurses grew as cities grew and prospered; this was most evident in Toronto and Montreal but less so in Halifax, a city that experienced less population growth. Much has been written of the ‘disappearance’ of midwives in Canada. By the late nineteenth-century, this was very true of Toronto but not of Montreal and Halifax where a significant number of midwives continued to practice. It is possible to trace some nurses and midwives through several decades and, in particular, I highlight the surprising story of midwife Catherine Adams (1834-1908) of Halifax.


Mathilde Hackmann, RN, Diplom-Pflegepädagogin (FH), MSc

Hamburger Fern-Hochschule

Alter Teichweg 19 – 23

22081 Hamburg


++49 (0) 40 72699996
Aim of study

The study will illuminate the development of leadership structures in home nursing in the city of Hamburg against the political and social background covering the second half of the 19th and the 20th century. The following questions will be addressed: Who were the leaders? Which qualification and preparation, if any, did they have? What were typical responsibilities? Is there a progress in an independent leadership role of nurses?

Rationale and significance

With the introduction of long-term care insurance by the German federal government in 1994 a new role of nursing manager in home nursing was introduced. It is already known how political decisions influence home nursing in different countries (Buhler-Wilkinson 2004, Moers 1997). However no research has been conducted on the development of leadership roles in German home nursing. An historical analysis into leadership roles might help to understand the situation today and strengthen nursing services for communities in the future.


To answer the research questions a case study approach was used by focussing on the city of Hamburg. Primary sources include documents from government on the federal and state level, two of the leading nursing journals, reports from the governing boards of different home nursing agencies and seven interviews with community nurses from an oral history project. Secondary sources include journal articles and studies on German home nursing conducted during the last decades.


In the second half of the 19th century the protestant church was very active in providing community nursing in Hamburg with lady managers or deaconesses as leaders. Private-duty nursing was mainly offered by individual nurses. In their daily work both groups of nurses were very independent with little changes up to the 1960s. A leadership role of nurses became more necessary with the building of teams of nurses. In Hamburg social workers were introduced to lead teams of community nurses in the 1980s.


The development of the independent role of the nurse manager in home nursing was not a straightforward one. In Hamburg nurses took over the leadership positions only recently.

Session 1b: Technology and the Patient

Paula Thomas Ruffin, MSN, RN, CMT

PhD Student/Pre-Doctoral Fellow in the Center for the Study of Complementary & Alternative Therapies

The University of Virginia School of Nursing

AIM: This paper traces the early roots of massage in the medical literature; the inclusion of massage in nurse training-school curricula; and examines the historical shift from providing massage as a basic nursing comfort measure to a specialization of physiotherapy.

RATIONALE: Early nursing care focused on principles of hygiene and basic comfort measures. Guided by Florence Nightingale, the founder of the first nurse training school at St. Thomas’ Hospital in 1861, massage techniques were thought to have been included as part of nurses’ qualifications and nurse training instruction methods and therefore were duplicated in the United States nurse training curricula. During the 1880s and early 1900s massage was part of nurse training curricula and instruction was delivered by physicians, nurses, or masseurs for many disease conditions. By the 1930s and 40s influential nurse authors/educators began to recommend specialization in physiotherapy for nurses, and as more scientific, and pharmacological solutions for symptoms of disease became increasingly popular, the practice of basic nursing comfort measures that incorporated gentle, soothing touch of the body such as massage declined.

METHODOLOGY: Primary sources: Text-books written by physicians, nurses, massage instructors; medical/ nursing journals; and nursing curriculum guidelines from archival collections of the Center for Historical Nursing Inquiry and the Special Collections Center at the University of Virginia. Secondary sources: Published books/articles.

FINDINGS/CONCLUSIONS: Prior to the increase in scientific care, the use of analgesics, and the specialization of physiotherapy departments the nurse provided basic comfort measures that included massage to soothe fears and relieve discomfort among patients. Nursing care of the 1800s included physician ordered massage as treatment for many diseases. Nurse massage instructors believed massage was one of the most effective means of influencing the functions of the human body and also held a firm belief that the act of massage was fundamental in the education of any nurse. Historical research in the use of massage as a basic comfort measure in health care may help refocus attention on the healing of the mind and body and reinforce the value of compassionate touch and balance in today’s expensive, scientifically and technologically based health care setting that often alienates, frightens, and may even do our patient’s harm. This research supports the position that more curriculum time could be given to not only teach the benefits of massage, but incorporate massage into almost all plans of nursing care.

UK Treatment and Nursing Care of TraumAtic

Brain Injury in the Twentieth Century
Christine Eberhardie

MSc, RN, RNT, FHEA, Cert HSM, Adv Dip in Local History

Honorary Principal Lecturer in Nursing,

Faculty of Health and Social Care Sciences,

Kingston University and St George’s, University of London

+44 208 641 6033
Aim of the Study:

  • To examine the changes in the treatment and nursing care of traumatic brain injury (TBI) in the UK during the 20th century.

Rationale and Significance:

  • Modern treatment and care of TBI has developed exponentially during the late 20th century. In order to understand why a person in their eighties today may have different attitudes and fears of treatment which they may have observed or experienced in the 1930’s, it is essential to discover what the treatment was like in the early 20th century too.


  • To describe the treatment and care of TBI through content analysis of contemporary textbooks and articles.

  • Reference will be made to primary documents where they exist.

  • To compare and contrast the findings with oral history records e.g. Nurses Voices


  • The treatment of TBI in the early 20th century was less physiological than today although the fundamentals of surgery were similar. Ventilation and sedation were not the first line treatment of severe TBI.

  • During and after World War I the treatment and care of TBI was influenced by the work of the American neurosurgeon Harvey Cushing and involved wide excision of damaged brain tissue.

  • Techniques such as hypothermic baths were used up until the Fifties and nurses describe the difficulties caused to the staff and patients of this treatment.

  • The Sixties and Seventies brought more advanced diagnostic investigations including the CT scanner. Intensive care units were introduced with new roles for doctors, nurses and other health care professionals.

  • The Eighties and Nineties brought more physiological approaches to neuroprotection. New clinical nurse specialist roles were developed in neurorehabilitation and neurosurgical units.


  • Medical and nursing texts give a limited idealized account of the treatment and care of patients but nevertheless record changes in the techniques available and recommended.

  • The oral history data gives an insight into what the experience may have been like for the patients and staff.


Deborah Gleason-Morgan, RN, MSN, CPNP

PhD Student, University of Virginia, School of Nursing

Charlottesville, Virginia 22903

(804) 938 8630,

Fax: (804) 755 4929,
Aim of Study: This paper examines how the care of children with diabetes was positively affected by the changes in medical technology in the early twentieth century. The nurses’ use of technology in the care of children with diabetes will be described.
Rationale and Significance: At the turn of the century rapid changes in technology had a significant impact on the care of children with diabetes. In earlier times doctors were the primary users of technology. By the early twentieth century, the transfer of the use of some technology from doctors to nurses began to occur, thus blurring the boundaries of medicine and nursing. Unlike the care delivered in many other medical conditions, nurses caring for children with diabetes had more autonomy in the uses of technology. This occurred because nurses were far too often left to care for patients long after doctors went home, and in many cases had to make emergency decisions without advice from the doctor. Over time as doctors saw that nurses could (and did!) make appropriate decisions, (often using technology as back-up), doctors began to relinquish some of these “tasks” to nurses. This transfer of the use of technology from doctor to nurse has continued into the Twenty First Century. Issues of class, race and gender are discussed.
Methodology: The methods of social history were used in this study. Primary sources included the F.G. Banting, and the Elizabeth Hughes papers of the Thomas Fisher Rare Book Library, University of Toronto; medical, nursing and dietary books from the early twentieth century, as well as medical and nursing journal articles of the era. Secondary sources included The Discovery of Insulin, by Michael Bliss; Bittersweet, by Chris Feudtner; Devices & Desires: Gender, Technology, and American Nursing, by Margarete Sandelowski; and A Social History of American Technology, by Ruth Schwartz Cowan.
Findings and Conclusions: Technological changes which occurred during the early twentieth century are outlined using a case study of a child who experienced, first hand, the impact these changes had on the care of children with diabetes in the 1920’s and 1930’s. Responsibility for the use of technology changed over time. Although initially, the nurse’s job was to observe and monitor patients with their eyes and hands (without the use of technology), this evolved. This evolution of the transfer of technology from doctor to nurse is discussed. Additionally, how nurses cared for children with diabetes, using technology is discussed.

Session 1c: Images of Nurses and Imagining the Nurse


Susanne Kreutzer, PhD,

Department for Humanities/Nursing Science

University of Osnabrück

Albrechtstr. 28, 49076 Osnabrück, Germany

0049 – 30 – 629 08 286 (private)

Aim of study

The paper explores the biographical experiences of nurses who played an important role in the professionalisation of nursing in West-Germany. It focuses on the 1950s to 1970s when there was a significant restructuring of the occupational image. In the early 1950s, the catholic and protestant motherhouse sisterhoods still dominated the vocation. However, this changed essentially in the late 1950s and 1960s when the erstwhile religious calling transformed into a modern day female profession that was brought in line with scientific standards.

Rationale and significance

Of vital importance in the reform process was the School of Nursing at the University of Heidelberg which was funded by the Rockefeller Foundation and started 1953. The school was meant to educate a new elite of nurses and played a decisive role in the transfer of US-American concepts of professional nursing into the West German context. The paper concentrates on the biographies, self-images and experiences of these so-called “Hollywood-Nurses”.

First, the paper outlines the educational concept of the Heidelberg Nursing School. The focus then shifts to the “Hollywood-Nurses” themselves – their personal background, their motivations to enter the new type of Nursing School, their experiences during education and later on in the process of nursing reform.


The considerations are, on one hand, based on interviews with Heidelberg Nursing School alumnae. On the other hand, published and unpublished sources of the Nursing School are taken into account.

The methodology of the paper draws on the experiences of Oral History Studies which reflect the actual context of the narratives, the problem of commemoration and the relationship between individual and collective memory. Comparison with written sources allows to verify the statements of the interviews.

Findings and Conclusions

The “Hollywood-Nurses” came from a well-educated middle-class background. In the precarious economic situation after the Second World War they had to enter the field of nursing. For these women the Heidelberg School was highly attractive because it offered them an education according to their social status.

The group of “Hollywood Nurses” was small in number and met strong resistance in the field of nursing. Nevertheless they were highly influential and established an important network of mutual support. Large numbers of women who since the 1980s became the first West German professors for nursing science had been educated in Heidelberg.


Lisa F. Stern, RN, MSN

Planned Parenthood Los Angeles


Aim of Study

In a 1995 article, Patricia D’Antonio explains historians’ persistent desire to interpret the legacy of Florence Nightingale. A “universal symbol,” D’Antonio argues, Nightingale serves as a supple historical figure, through which ideals of medicine, nursing, femininity, nationalism, and religiosity can be refracted. In addition to scholars’ interest in Nightingale, films, television features, and other creative works have repeatedly re-envisioned the nursing leader since her death a century ago. These works of popular fiction both reflect and influence Nightingale’s and nurses’ position in the public imagination. While previous analyses of Nightingale’s image on film (Kalisch & Kalisch, 1983; Hudson Jones, 1988) have engaged the broad question of how the protagonist is depicted, this paper focuses specifically on how filmmakers capture Nightingale’s achievements as a nurse and how they understand the philosophies underlying her work. Evaluating the extent to which the movies and TV programs conform to the historical record, the paper will shed light on the public understanding of Nightingale as a professional and as a thinker.


Rationale and Significance

Nurses and historians can gain from understanding the evolution of Nightingale’s professional image over time, particularly in crafting strategies to shape public perceptions of nurses and their work. The paper traces a concise historical map of imagined ideals of nursing and interrogates the role of popular works in communicating the history of nursing and medicine.



The analysis is founded on a close reading of films and television programs. Movies and TV programs include The White Angel (Warner Brothers, 1936), The Lady with a Lamp (British Lion Film Corporation, 1951), The Holy Terror (Hallmark Hall of Fame, 1965), an animated Florence Nightingale for children (NEST, 2005) and two TV biopics also entitled Florence Nightingale (1985; 2008). An unproduced 1934 Paramount script will also be considered, the paper also incorporates production documents, correspondence, reviews, and articles. These fictionalized versions of Nightingale’s work are weighed against her own writings and the scholarship of Charles Rosenberg, Julia Hallam, Anne Hudson Jones, and others. Contemporary biographies by Mark Bostridge and Gillian Gill provide additional background. General critiques (Farella, 2001; Gordon, 2006) of images of nursing in film enrich the analysis, as does work by Naomi Rogers, Nancy Tomes, and others on nursing, medicine and film.


Findings and Conclusions

While volumes of material and hours of time have been dedicated to popular


Jean C. Whelan, PhD, RN, Assistant Adjunct Professor of Nursing

University of Pennsylvania

610-896-0622 (home)

610-5732168 (fax)
Purpose of Study: This study demonstrates the use of historical photographic analysis as a means of interpreting historical documents such as photos placing them in their historical social, cultural and economic context.

Rationale and Significance: Archival collections hold an enormous number of photos documenting the nursing history. Yet, few analyses of historical photographs exist. While photos often accompany nursing research text, most do so for illustrative rather than analytical purposes. This study utilizes the historical photograph as a primary document, to which can be applied the same questions asked of other historical sources. Analyzing historic photos enhances and expands our knowledge of historical events providing an additional source from which to contextualize and interpret the past.

This study analyzed the photo collection of the Alumnae Association of the Philadelphia General Hospital (PGH) School of Nursing. Founded in 1885, the PGH School was one of the first schools of nursing in Philadelphia established on the principles of Florence Nightingale and enjoyed a long and excellent reputation as a major teaching centers for nurses from the late 19th to mid-20th century.

The PGH photo collection totals approximately 1500 photos featuring images of life in the school and on the wards and campus of the hospital spanning the years from 1880 to the 1970s. The collection is in excellent condition and offers exceptional visual images of the activities in which nurses engaged, the buildings in which delivery of health care took place and the individuals critical to the maintenance of the school and hospital. The breadth, depth, and scope of this collection make it a historically important collection in the field of health care and nursing history.

Methodology: Primary sources used were a selection of PGH photos taken during the late 19th to the 20th century. Titles and other identifying information accompanying the photos were verified. Photos were categorized using predetermined themes. Photographic analysis applied to each photo generated conclusions. Secondary sources used to contextualize findings included books documenting the history of PGH and articles found in nursing and health related professional journals.

Findings and Conclusion: The PGH photographic collection portrays the vast network of activities that took place within a large hospital; analysis of which demonstrates the use of a unique data source to expand interpretation of historic events. Although photographic analysis possesses limitations it also provides a means to investigate the daily workings of hospitals and the power structures within the hospital hierarchy.

Session 1d: Perceptions of Midwifery
Vanessa L. Nelson, Bachelors of Nursing (BN), Bachelor of Arts in International Relations (BA-IR)

University of Calgary, Alberta, Canada

403 629 6372

Aim of study: First, this paper traces the development of midwifery in the province of Alberta from the 1970s until the present. Second, historical barriers to establishing professional autonomy are examined and evaluated within a Canadian and international context. Lastly, this paper considers the implications of the government’s recently proposed “new service delivery models” on the future of midwifery practice in Alberta.

Rationale and significance: Since April 1, 2009 midwifery has been a publicly funded service in the provincial health care system. The Alberta government’s decision to publicly fund was long awaited and has been regarded, by the midwifery community and their consumer advocates, as one of the final achievements toward formal inclusion in the provincial health care system. However, after a decade without funding many midwives have left the province, which has compromised the midwives ability, as a larger profession, to realize autonomy. Furthermore, this recent inclusion in the health care system presents a familiar challenge, co-optation, with a new face, the “new public management.” The proposed development of “new service delivery models” undermines mid-wife led models of care and, similarly, threatens the professional autonomy that midwives have been struggling for since the 1970s.

Methodology: A gender approach is employed to understand ‘obstructions’ to the delivery of midwifery services. The identification of midwifery as a women’s policy, within the larger women’s health movement, aids in explaining the barriers to its adoption. Primary sources include correspondence letters from professional bodies, transcripts of parliamentary debates, local newspapers, as well as position papers from professional and government bodies. Secondary sources from variety of disciplines on the subject of midwifery are used, such as those from history, nursing, medicine, sociology, and law.
Findings: Barriers to midwifery’s development in Alberta include: the social and economic environment, the ideology of the dominant party, the strength of oppositional stakeholders, and the controversial nature of the policy.
Conclusions: Midwifery has made relative gains toward professional autonomy since the 1970s. In the first decade of the 21st century, midwifery in Alberta is exercising more professional autonomy than it has historically been afforded. However, many of the barriers identified in this study still exist and, consequently, could limit further realization of professional autonomy. Finally, the recent inclusion of midwifery into the public health system, paradoxically, undermines midwifery practice by suggesting the integration of non-midwife led models of care.



Frances J Badger

RGN, RM, BSc, MSc.

PhD student, History of Medicine Unit, University of Birmingham, UK

0121 458 4576

07753 149111

Aim of the study

The overall study aim is to explore and analyse the history of nineteenth century midwifery in the English midlands. One of the most significant primary sources identified to date are the registers of a midwife who practised in Coventry, in the county of Warwick, over a period of 28 years, from 1847 until her death in 1875.

Rationale & significance

The registers are unique, and a highly significant source which has not been previously analysed by academic historians. The registers appear to be one of the most extensive and complete records of female domiciliary midwifery practice in England in the second half of the nineteenth century. Survival of such registers from this period are rare and it has been asserted that female midwifery in the nineteenth century was in the hands of occasional practitioners who were unskilled, dangerous and lacked sufficient experience to become competent. The Coventry midwife’s registers are significant because of their survival, and because they indicate a much greater intensity of midwifery practice than previously reported, demonstrating that the midwife was a trusted professional, a ‘somebody’ in her local community and well regarded by poor women, elite subscribers and medical men alike.


The registers had previously been transcribed for use by family historians and the file was arranged with clients’ names in alphabetical order. With the aid of a macro, the file entries were returned to chronological order and checked against the original registers for accuracy. Three main analyses have been conducted: 1) A caseload profile. 2) Identification of repeat custom by local women. 3) Analysis of the links between the midwife, poor women, the lying-in charities and their subscribers and medical men.


The registers contain 5,029 entries over 28 years, and possibly represent all the deliveries she attended. The midwife was regularly delivering over 200 women a year, with a peak of 286 deliveries, over five a week, in 1857, and there is evidence of repeat custom from local woman. The last entry is dated just six weeks before she died, aged 69.


This rich data source demands that the nature and scope of female midwifery practice in the English provinces in second half of the nineteenth century is reconsidered to take account of midwives’ professional profiles, as revealed in the registers of the Coventry midwife.


Tania McIntosh, MA, PhD, RM.

Lecturer in Midwifery

University of Nottingham

0115 8231924
Aim of Study

To explore the role of the midwife in England in the 1930s through the detailed study of the working life of one individual, focusing on concepts of professional identity and changing patterns of work.

Rationale and significance

This paper focuses on a seminal period in maternity provision, when the practice of unqualified midwives was phased out, and a salaried local authority employed midwifery workforce was created following the 1936 Midwives Act. The golden period of midwifery in England is generally taken as being the twenty years following the formation of the NHS when historians have perceived midwives to have autonomy and job satisfaction as well as providing a seamless neighbourhood based service (Allison, Delivered at Home, London,1992). However, this paper demonstrates that midwives were providing care along very similar lines, and with the same ethos, in the 1930s. This was the decade in which the role of the midwives was externally formalised, and this paper demonstrates the effect of this process on the work and mindset of an individual midwife.


This paper is based on an oral interview conducted by the author with retired midwife Alice Pearson. This is analysed in conjunction with her case records which give details of all her deliveries. Her records contained information about factors such as length of labour, and the proportion of that time spent with the woman by the midwife, allowing for descriptive analysis of her work load and care.

This is further informed by contemporary sources which focused on concern about rates of maternal mortality and preventative strategies, including formalised antenatal care. The effect of these national debates at the level of individual practice are explored.


Alice Pearson articulated and demonstrated a sense of professional identity through her work, as well as a sense of vocation. Her pattern of care exemplified partnership with women and other professionals, and put her caring role -rather than quasi-medical surveillance -at the centre of her work.


The 1930s was a seminal period in the development of maternity care in England. This paper highlights the central role of the midwife not only in providing care during this period of flux, but in creating a template of the profession for future generations, through the articulation of a caring and partnership ethos.

Session 1e: Nursing Skills and Nursing Labour
David Justham


Lecturer, School of Nursing, Midwifery and Physiotherapy

The University of Nottingham

01522 573897 (direct line)
Aim: An exploration of the clinical work of nurses in the period between 1930 and 1945 before the commercial availability of penicillin in hospitals in England and Wales

Rationale and significance: Medical texts in the 1930s commonly refer to the need for good nursing care in the management of patients with life-threatening acquired infection. However, good nursing care is not defined. Nursing manuals published in the same period describe the procedures nurses should follow for particular tasks. The extent to which this was done can only be recalled from the nurses themselves. The 1930s was a time of great change in healthcare. The nineteenth century sanitarian, Florence Nightingale, had developed her ideas about nursing in response to miasma. The theory of miasma taught that disease was spontaneously generated out of filth and foul air. Developments in the understanding of specific disease being attributed to specific causative factors, in particular the understanding of the microbial causes of diseases, from the late nineteenth century onwards, had led to the demise of miasma as a theory of disease causation. The history of hospital nurses’ work in the period 1930 to 1945 may offer provide insights for present and future nurses working with patients with acquired new or antibiotic resistant infections.

Methodology: The study is primarily based on oral histories collected in 2008. Thirteen histories were digitally recorded in the respondents’ homes. Oral history provides the historian access to the world of those disenfranchised (typically women and their work) from traditional history (Thompson 2000). Former nurses were recruited via advertisements in the local press and via the mailing list of a voluntary hospital’s Nurses’ League.

Findings: The discipline and ward routines evident in the accounts of this sample of hospital nurses illustrate the management of a ward environment and the provision of nursing care explained through miasma as a cause for disease. The persistence of the notion of miasma may have helped with patient and visitor management. Evidence is found for a mutual working relationship between nurses and doctors rather than a master and servant one. Evidence is found of nurses not being wholly compliant with the expectations of senior nurses for their work.

Conclusions: This study provides valuable insight into the clinical work of nurses caring for patients with acquired infection before the availability of antibiotics using oral histories as primary source material.


Dr Jane Brooks


School of Nursing, Midwifery and Social Work

University of Manchester

0161 306 7636
Aim of study: to explore the work of front line nurses on older adult wards and the training that they received for this work
Rationale: as a clinical nurse I spent much of my professional life working with older people both in the community and in hospital. I was aware that many considered this work tedious and overly arduous. As a nurse historian I therefore decided to research the history of caring for the elderly, but from those on the front line; ordinary ward nurses.
Significance: as nursing history has developed as a discipline, research is moving away from professional and educational issues to practice. People over the age of 60 have long composed the largest hospital population; however they have historically been cared for in the poorest accommodation, were the most poorly staffed and had only very limited access to equipment. It is hoped that this research will provide valuable insights the work of these nurses.
Methodology: the paper is based on an oral history project of 20 nurses who had worked in elderly care; as students and qualified nurses between 1955 and 1980. All the interviews were recorded and transcribed verbatim.
Findings: the participants were split between those who considered the work too arduous and soul-destroying and those who found the work valuable. All the participants described the work as amongst the hardest that nurses do; with the lowest staffing levels, the poorest equipment and often without managerial support. Nevertheless, the participants also describe the enjoyment of Christmas and ward outings and the pleasure of seeing patients with their relatives. Key themes which emerged in the interviews and to be discussed in the paper include: personal care, mealtimes and leisure, professional relations and training. Within these themes the difficulties faced by nurses will be explored; lack of equipment and staff and the status of elderly care.

Conclusions: nursing older people remained physically hard work even into the last quarter of the 20th century. The nurses continued to work in routines, most especially in the areas of hygiene and mealtimes. These routines did often mean that patients were adequately fed and remained dry. However, not all units for older people were able to provide even such fundamental care for the patients and whilst brutality was uncommon, neglect was often a bi-product of poor staffing, low morale and limited leadership.

Dr Richard Hatchett

RN, BA (Hons), Msc, PhD, MBA, RNT

Faculty of Health and Social Care, London South Bank University

0207 815 8023
Abstract Title

The Use of Foreign Labour Within the British Nursing Workforce in the Immediate Post World War 11 Period.

Aim of study

To explore and understand British ministerial workforce policy in regard to nurse recruitment and foreign labour in the immediate post World War II period.

Rationale and significance

This paper offers an understanding of how three ministries viewed nurse recruitment and worked together to meet a severe shortage of nursing staff at the inception of the National Health Service (NHS). It demonstrates the limitations of a reactive workforce policy and one not linked to statistical planning. It illustrates how wider social issues, such as the decline of Empire and economic downturn in parts of the world, were used to the benefit of Britain but how potential workforce solutions run close to attitudes to foreign workers. Such issues remain significant today.


Historiography utilising primary ministerial sources from the National Archives, The Royal of College of Nursing Archives and the Modern Records Centre. Secondary sources primarily focus upon evaluation of the race issues linked to British workforce policy in nursing and other work areas.


The paper argues that the government workforce policy and planning for British nursing in the immediate post World War II period was reactive and essentially ineffective. Its primary aim was to increase recruitment diversification to staff the new NHS by targeting a number of specific groups, including the young, part-time nurses and men. Created interest was large, but the ultimate numbers recruited remained small. Little statistical analysis occurred throughout this period with regard to either local need or the effects on the occupation of targeting specific groups.

The use of nurses from the colonies and foreign labour, such as European volunteer workers (EVWs), presented additional target groups within a largely reactive policy. A variety of factors, some fortuitous, others deliberately manipulated by the ministries, facilitated an active recruitment campaign within these new groups. The paper offers a progressively racist attitude, both in government departments and in nursing and is framed against nurse recruitment.


Ministerial workforce policy within nursing in this time period (and indeed beyond) was reactive, focused on diversification and was poorly linked to any strong statistical analysis. Nursing was generally welcoming to overseas recruits but this can be framed against an increasing racial tension. Britain lessened its support of nursing standards in the colonies in favour of British workforce needs.

Session 1f: Wartime Nursing


Jessica Howell, Ph.D.

Centre for the Humanities and Health and Florence Nightingale School of Nursing and Midwifery

King’s College, London

020 7848 3230
Mode of Presentation: Paper submitted under consideration for the theme “Military history, power and conflict” as part of a panel entitled “Nurses on the Front Line: Representation and Autonomy”.
Aim of study: This paper seeks to elucidate the ways in which literature portrays the emotional resilience of wartime nurses. By analyzing passages drawn from Mary Seacole’s Wonderful Adventures of Mary Seacole in Many Lands (1857) and Louisa M. Alcott’s Hospital Sketches (1863), I will demonstrate that these wartime nurses wrote of their experiences in the Crimean and American Civil wars, respectively, with humor and a sense of adventure. Though not without compassion for the pain and suffering of those around them, Seacole and Alcott resist nervous prostration or “nursing shell shock” as a way to maintain their own autonomy and health.

Rationale and significance: Familiar are nineteenth-century stories of female nervous prostration. In addition, popular novels such as The English Patient (1992) depict nurses who have sustained emotional trauma from caring for the dying and wounded. However, I argue that there was another narrative stance adopted by certain nineteenth-century women authors, who also served as wartime nurses: that of emotional resilience and strength. In fact, both Mary Seacole and Louisa Alcott depict key moments when they choose to remain strong in the face of the horrors of war, discrimination, prejudice or seemingly insurmountable barriers. This strength manifests through humor, indignation, or sometimes even anger.

Methodology: Though Alcott and Seacole’s works have both been analyzed in terms of their sentimental and maternal overtones (see Glenn Hendler and Nicole Fluhr, respectively), their texts have not been approached in terms of what they teach us about nurses’ health and emotional strength. My paper will build upon a tradition of reading both authors transgressing normative roles. I will closely examine certain passages from both Seacole and Alcott’s primary texts, placing them in contrast with nineteenth-century discourses of nervous prostration. In addition, I will provide brief historical and biographical contexts for each author. The presentation will be in the format of a read paper, supplemented with visuals (excerpted texts and relevant images).

Findings and conclusions: In contrast to Hana in The English Patient, Seacole and Alcott’s emotional stances may partly stem from their own political beliefs and faith in the causes that they support, as well as from their own determination to stay independent and autonomous women.

Elizabeth Scannell-Desch, PhD, RN, OCNS

Professor of Nursing

Mount Saint Mary College, Newburgh, New York, USA, 12550

(845) 702-0800

Mary Ellen Doherty, PhD, RN, CNM

Professor of Nursing

Western Connecticut State University, Danbury, CT, USA

(978) 807-5320
Aim of the Study: To describe the lived experience of U.S. military nurses who served in Iraq or Afghanistan during the war years 2003-2009, and life after returning from war.

Rationale and Significance: The study of nurses’ experience in war is timely, relevant, and significant given the realities of armed conflict in our world today. When war breaks out nurses are called to serve. Matejeski (1979) includes war as a significant factor that has influenced nursing and society for decades, and suggests that nurses’ experiences in war be investigated. Following the terrorist attacks in the U.S. on September 11, 2001, several coalition countries, including the U.S., deployed forces to Afghanistan to engage the Taliban and Al Qaeda. In 2003 the U.S. began assigning military nurses and other medical personnel to hospitals in Bagram and Kandahar, Afghanistan. The first contingent of military nurses supporting the U.S. invasion of Iraq was sent to Kuwait in February 2003. To date, no published studies have explored U.S. military nurses experience in the Iraq and Afghanistan wars.

Methodology: Colaizzi’s (1978) phenomenological method guided discovery. This method includes elements of both descriptive and interpretive phenomenology. The sample consisted of 37 military nurses who served in the Army, Navy, or Air Force in the Iraq or Afghanistan wars. Contact information for all nurses who met these criteria was not centrally available, so a purposive ‘snowball sampling’ (Polit & Hungler, 2000) and calls for voluntary participation were used. Four data-generating questions guided the interview process. Most interviews were face-to-face and conducted in naturalistic settings chosen by the participants. Several interviews were conducted telephonically due to geographical constraints. Data analysis followed Colaizzi’s method of analysis.

Findings: Seven themes emerged from the data, including: ‘Deploying to war’; ‘Remembrance of war: Most chaotic scene’; ‘Nurses in harm’s way: More than I bargained for’; ‘Kinship and bonding: My military family’; ‘My war stress: I’m a different person now’; ‘Professional growth: Expanding my skills’; and ‘Listen to me: Advice to deploying nurses.’ Analysis continued until data saturation was achieved.

Conclusions: War takes its toll on everyone involved, including caregivers. Nurses returning from war can provide valuable insights to those who follow. This study gives these nurses a voice in describing their experience, including their stresses, daily milieu, feelings, and a tapestry of the entire deployment.

Plenary Session

The Karen Buhler-Wilkerson Plenary on Community and Public Health Nursing

Rima D. Apple, Ph.D.

Professor Emerita

University of Wisconsin-Madison, United States

phone: (US) 608-251-3094

Aim of study: To analyze the social, political, professional, personal, and local factors that inhibited and promoted a county’s acceptance of community nursing in order to disclose salient issues that shape the public health activities.
Rationale and significance: In 1935, Wisconsin, a state in the mid-west United States, introduced an innovative program to encourage the state’s rural counties to establish community nursing offices. Wisconsin offered to fund a 2-year position of County Demonstration Nurse in each willing county, a role similar to today's Nurse-Family Partnership. The state expected that after two years the beneficial results of this office would be so obvious that the county would continue the program with its own resources. Many of Wisconsin’s counties accepted the offer but not all elected to extend the position with county funds. This study enables us to tease out the crucial issues that affected different counties' decisions about local public health concerns.
Methodology: Records held by the Wisconsin Historical Society form the bulk of the source material for this study. They include: official reports of the nurses and the state Department of health, County Health Board reports, and, most especially, the personal reports of the nurses fighting to solidify their positions. These are supplemented with local newspaper reports, the minutes of the County Boards of Supervisors, and correspondence between state officials and county officials. Histories of public health in Wisconsin and rural public health in other areas of the United States provide a background for the analysis.
Findings and conclusion: This study highlights the distinctive and unique factors, ranging from patriotism to personality, that affected the employment of public health nurses. Through a close reading of the words and activities of the nurses involved and the State Department of Health, and the reactions of county officials and other community members, this paper unpacks the complicated and contradictory administrative structures, professional tensions, and local rivalries that determined a county’s employment of public health nurses during a period of economic stress and shortage of professional personnel, Most significantly, it documents the critical role of nurses in the establishment and maintenance of public health offices.

Jan Maw: RCN Public Health Nurse Advisor

Royal College of Nursing

The paper will explore what impact historical developments have had upon the current clinical practice of occupational health nursing and their role as public health practitioners.

This paper will consider how the early roots of industrialisation impacted upon the social as well as the industrial revolution, and how the past has shaped current thinking about the role of public health practice in workplace health and wellbeing initiatives.

Early industrial health initiatives will be presented, for example, the work of Agricola who in the 16th century wrote of high rates of mortality and morbidity in mine workers and their recommendations to wear face veils, and the work of Paracelsus whose study of metals led to the recommendations that inhalation of metal fumes should be avoided.

Also explored, will be the work of the early 19th century pioneers of industrial and public health nursing such as Molly Young, who worked in the Lanarkshire Mills, and Phillipa Flowerday, who worked at Coleman Mustards Factory. Links will be made between the practice of those early pioneers and the current vision for contemporary workplace health and wellbeing strategies.

The paper will conclude by presenting parallels between the recommended education of industrial nurses in the early 20th century to current curriculum, and will highlight how policy of the past is still relevant to the direction of travel for the 21st century vision for improved health and wellbeing in the workplace.


Sandra B. Lewenson, EdD, RN, FAAN

Lienhard School of Nursing, Pace University

Pleasantville, New York
Aim of the Study:

This study examines the history of public health nursing by exploring the shift in roles as the names changed throughout the late 19th century until today. It also explores the changes in educational requirements to meet the expectations of this nursing role.

Rationale and Significance:

In the late 19th century Florence Nightingale spoke of “health nursing,” and a little later American nursing leader Lillian Wald coined the term “public health nurse.” What the nurse who works in the community in the United States is called has changed over time and has included terms such as district nurse, visiting nurse, public health nurse, tuberculosis nurse, community health nurse, and home health nurse. The change in terms often related to the setting, the location, the clinical focus, or the level of education. Nursing educators, not always clear on what constitutes a public health nursing experience, debate what is the “right” clinical experience for students in courses designated public health/ community health nursing. As the public health nursing role evolved, so did the nomenclature, leading some to question, “what is a public health nurse?”


A historical review of the published public health nursing literature beginning in the late 19th throughout the 20th century was completed. Primary data included early public health nursing textbooks and published and archival materials from the National Organization of Public Health Nursing. Secondary sources including public health/home care nursing histories provided contextual background.


The changing name reflects a variety of social, political, and economic factors that influence the implementation, education, and focus of the role of the public health nurse. Whether public health nurses cared for the sick poor or for those who could pay, whether they worked involuntary visiting nurses’ organizations or in municipal health departments, whether they were educated in postgraduate programs or in baccalaureate degree programs, these nurses provided both curative and preventive services in the community.


The ability to continue to work in public health, regardless of the term applied to their work, shows the resiliency of public health nurses. Gaining clarity in the evolving role and identity of the public health nurse offers greater opportunity to educate leaders in public health nursing. Considering the many iterations of this role over time helps public health nurses continue to work towards improving the health status of individuals, families, populations, and communities throughout the world.

Concurrent Session 2

Session 2a: Issues in Mental Health Nursing
Geertje Boschma, RN, PhD

Associate Professor

School of Nursing, University of British Columbia

T201 - 2211 Wesbrook Mall, Vancouver BC V6T 2B5 Canada

604 822 7467 (phone), 604 7466 (fax)
Purpose: As controversy over large mental hospitals grew in the latter half of the 20th century a deinstitutionalization movement reshaped the context mental health care. A new discourse of community mental health and rehabilitation replaced former discourses of institutional work and custodial care, constructing new identities of client, consumer, survivor, and peer support worker. This study analyzes oral histories of men and women living with mental illness in one western Canadian community, who actively engaged with this complex process of change and negotiated new cultural identities. With a particular focus on the role and identity of the peer support worker, I examine how this emerging group negotiated a new professional identity, while navigating the complex relationships between gender, work, and mental illness.

Rationale & Significance: Peer support workers had a substantial role in the construction of new rehabilitative practices, peer support, and community mental health services in the post-war era. But we only have scant knowledge of their work in this transformative process. Their stories provide a unique lens through which to explore larger social and cultural tensions between work and mental illness. Examining the multifaceted connections between gender, work, and identity, this micro-narrative analysis of a new area of caring work provides insight into the history of community mental health care in the particular context of western Canada.

Methodology: Using oral history methodology, the paper analyses interviews with consumers and peer support workers. The concepts of gender and place form central categories of analysis, highlighting how new community connections and work identities were formed against the backdrop of a rising and empowering consumer movement.

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