Care has been provided to humans since the dawn of time.
During the Prehistoric period, women were responsible for taking care of the home and preserving the species, while men secured resources, such as by hunting. At that time, magical rituals, intuitive knowledge and domestic care focused on clothing, food and hygiene were practiced.
In the Middle Ages, for charitable reasons, religious women were the caregivers. It was initially a moral obligation and an opportunity for redemption form sin and an imitation of the suffering of Christ, as reflected in the Gospel according to Luke: “And into whatsoever city ye enter, and they receive you, heal the sick that are therein.”
Families in need were cared for by women of high social standing, known as deaconesses. There were also widows, women who cared for the poor and were known as such out of respect for their age, and the virgins, who came before the nuns and were related more to ecclesiastical duties. Marcella, Fabiola and Paula were considered Roman matrons, wealthy women who tended to the poor and the sick and established institutions for providing care, known as Marcella Homes.
The type of care offered at that time consisted of providing shelter and comfort, clothing, food and refuge, while technical care was relegated.
Later in history, during the Early Medieval Period (5th century AD), people believed that diseases were sent by God due to sin. That is when feudal women became relevant caregivers, in charge of caring for the sick in the realm; as well as the monks, making it a duty of the monastic community. Some of the most significant hospitals of the time included the Hotel-Dieu de Lyon (Paris), the Santo Spirito hospital (Roma), St Katharine’s and St Bartholomew’s hospitals (London), and the hospitals in Baghdad and Cairo. The work of these ecclesiastic institutions focused on charity and mercy towards the poor and the sick, for the most disadvantaged social classes.
Later, in the Late Medieval Period (15th century AD), a series of events led to the growth of cities and mass movements of people. Some of them settled in hamlets built up around a castle or a monastery. They were devoted to trade and craftsmanship, and a new social class came about: the bourgeoisie.
There was also a key historical event that took place during this time: the Crusades. Eight military expeditions, which , together with the existing religious fervor and the fear that the Turks would conquer Europe, sought primarily to free the Holy Land from the control of the “infidels”. Organizations arose, such as the military orders tasked with conquering the Holy Land and spreading Christianity and carrying for the sick and wounded. There were also religious orders, such as the Franciscans, established by Saint Francis of Assisi, and secular organizations, working groups that did not take the vows of monastic life. The latter included the Hospital Brothers of Saint Anthony, the Beguines and the Sisters of Hôtel-Dieu in Paris.
The people sent up their prayers and pleas to the saints to cure the sick. They also conducted exorcisms to treat the mentally ill, and they trusted in the curative powers of relics.
Beginning in the 15th century AD, Protestantism, led by Martin Luther, promoted faith as the only way to salvation. As a result of that, care was no longer give out of charity, and all activities involving personal sacrifice lost interest. Convents were closed and congregations were dissolved. During this period, care reached a very low level, as women of very low social stature, with no knowledge, were responsible for giving the care to secure for themselves an occupation, shelter and food at the hospital.
Faced with the rise of Protestantism and the weakening of the Catholic Church, following the Council of Trent, convoked in 1545 by Pope Paul III, reforms were subsequently dictated in the Catholic Church, focused on its doctrine and restructuring, as well as the problem of care for the sick. The guidelines that came from this council led to new involved religious orders, such as the Brothers of St. John of God, the Tertiary Friars, Franciscans and the Daughters of Charity. The end of this dark period for nursing gave rise to a new concept in caregiving.
Of note is the book The Art of Nursing (1833), written by the Order of St. John of God, to teach the nurses of the time. The book explains how to feed the sick, how to administer the prescribed drugs, wash and comfort the sick.
With the arrival of the modern age (18th century), under the influence of the Illustration and reason, medicine took a great step forward, with new techniques and new inventions such as the barometer, thermometer, microscope and blood pressure measuring. Hospitals were progressively secularized and moved from charitable centers to institutions focused on fighting disease. The system was medicalized, with physicians at the center of healthcare and hospital management. The role of nurses at that time became one of a physician’s assistant. Nursing knowledge was based on learning the techniques delegated by the physician.
Civil authorities took charge of acute illnesses and began to finance their treatment, while the Church, through the establishment of private ecclesiastical hospitals, offered care to deprived groups, sufferers of chronic illnesses and the elderly, whose needs were not covered by the civil authorities. The orders of the Cottolengo House of Providence, the Little Sisters of the Poor and the Little Sisters of the Abandoned Elderly are examples.
This moment can be considered the start of modern nursing. All of this is thanks to the revolution brought about by the work of Florence Nightingale and other figures such as the Fliedners, Elizabeth Fry and organizations like the International Red Cross and the International Council of Nurses. They all championed a nursing system based on trained nurses with scientific knowledge and compensation. It was the start of the Stable Reform of Nursing.
Florence Nightingale is the mother of nursing, the forerunner of today’s nursing models and theories, and driving force behind the professionalization of nursing. She began the search for a professional body with knowledge of its own, organized the best teaching for the profession and broke social prejudices with regard to women.
All of these contributions (training a professional body with knowledge of its own, applying the scientific method, postulating models and/or theories that guide our practice, and daily practice, key to the profession and empowering professional care) have brought us to where we are today, an autonomous and responsible profession.
That is why we must not forget where we come from, looking to the future and to where we want to go. What I mean is that we are all involved in training and socializing future nursing professionals, from the classrooms to the institutions where students conduct their internships, we must bear our responsibility. The responsibility of passing on abilities, such as the purpose and idea of being a nurse, the essence, professional care, as opposed to personal care, the latter being innate or learned; in addition to providing theoretical knowledge, practical skills and attitudes.
While personal care is essential in life, as well as the evolution and health of people (which consists of unreflexive and unlearned actions and attitudes, rather one is born with them; actions such as feeding, cleaning or dressing oneself), professional care applied to all stages of the life cycle (children, adults and the elderly) require a series of knowledge, skills and techniques that only a nurse can apply, to maintain or regain health and to prevent illness. For example, caring for bedsores requires certain knowledge and skills that you cannot apply if you have not acquired them.
In the socialization process for nurses–that is, from the moment someone chooses to study nursing until the become a full-fledged member of a health organization–, there may be any number of reasons for choosing to study the profession. For example, they may have family members who work in the health industry, a vocational desire, because they want to provide a service to others, past life experiences that lead a person, in vulnerable health, to come into contact with a healthcare professional and to idealize the profession; or due to experiences with family members who have been in the hospital or have gone through a healthcare process and have seen the work of nurses up close.
The issue is that when those values inherent to the nursing professional are missing, which I believe reside in human beings with a calling for nursing–values such as patience, sensibility, affection, empathy, active listening, availability, the ability to help others without expecting anything in return, etc.–, it is very easy to become trapped by contradictions and to be unable to discover the true essence of nursing: professional care.
In the classroom, as an experienced teacher, I have met students who have asked whether they could skip internships at retirement homes, preferring instead a hospital. What do hospitals have that retirement homes do not? What does it mean for a student to complete an internship at a retirement home? What about at a hospital? The possibilities for learning at a retirement home are infinite (old-aged patients, often with multimorbidity, polymedicated, bedridden, in advanced stages, etc.) and nursing care is essential. Why do students prefer a hospital over a retirement home?
After speaking with students, you get a wide variety of answers, from hospitals offering more nursing techniques than a retirement home or the workload in a retirement home, as there are fewer staff, or more action at a hospital or even that the atmosphere at retirement homes is sadder.
I would like this presentation to be essential so that all of us who are involved in training nursing students involve ourselves fully when helping them in the process that helps them discover the essence of what it means to be a nurse. Especially during clinical practice, which is a critical moment for this idea to flourish.
It is also important to indicate that nursing isn’t what we are show so often by the press, the media identity. We cannot allow ourselves, after advancing so much as a profession in just a few years, to go back in time. We must make our students see that nursing is not only complex techniques, but that it goes even further. Nursing is observing, communicating and, most importantly, empathizing, putting ourselves in the shoes of others and listening actively and empathetically, which is different than hearing, which is simply perceiving a sound, without understanding the attitudes and gestures of the person.
One of the most important skills that a nurse must have is observation. Nurses are the professionals who are at the patient’s bedside 24 hours a day, and we must be able to anticipate and understand what his happening to our patient at all times through observation. Understanding any sign and/or symptom that might suggest worsening or an improvement, which also requires knowledge, attitudes and personal values such as responsibility, patience, sensibility, etc. Solid knowledge on its own is not enough for what the profession expects of a nursing professional.
Nursing isn’t about channeling a catheter, where the more you channel the better; it is not about inserting a probe or drawing blood or defibrillating. It is much more than that. It is about responding to alterations in the human needs of a person. If a person is admitted for a surgical procedure and is afraid of the operation, nurses are there to help them control their fear. And to do that, we have nursing science, based on the conceptual models of the profession and the nursing care process as a methodological tool through which theory is put into practice.
Nursing identifies problems and diagnoses independently. To do that, we use the NANDA-NOC-NIC nursing taxonomy, which is used to diagnose patients, objectives and nursing actions, so that nurses the world over use the same language when providing care, and we provide quality care based on scientific evidence.
We cannot go back in time and turn into what we were not so long ago, where healthcare was dominated by the physician-centric model and assistance was limited to learning techniques delegated by the physician.
Nor can we ignore the elderly, because without them we wouldn’t be here. They deserve respect and one day we will likely follow that same path. We need to destroy the retirement home myth.
“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible.” (Henderson V.)
Enric Valdés is professor of Nursing in the Grado en Enfermería
Martinez Martin, M.L.; Chamorro Rebollo, E. Historia de la enfermería. 2011. Elsevier.