Overview of the Pre-Nightingale Years. This week, we’ll consider the impact of faith traditions on nursing service and practice, nursing prior to the 19th century, the relationship of nursing and medicine in the pre-Nightingale years, and famous nurses of that time period. Let’s explore the impact of this time period.
Nursing Prior to the 19th Century
Roman Catholic Nursing Nuns
As Christianity gained influence in the Middle Ages, nuns and monks served God by caring for the sick. While monks cared for men, nuns cared for ill women. Nutting and Dock (as cited in Hood, 2014) claimed that Hildegarde (a nun in the 12th century) greatly influenced the dominance of women in nursing. She was known for her powers in healing the sick, her outspoken manner, and her scientific writings.
By the 12th century, Nutting and Dock (as cited by Hood, 2014) reported, nursing was part of the work of French nuns. It was widely believed that nursing nuns provided more structured care for the sick. By the 16th century (Protestant Reformation), many hospitals were removed from church control and turned over to cities in England and France. Nursing nuns were replaced by lay servants who had little knowledge of the care of the sick. Conditions for patients and staff rapidly deteriorated.
In the United States, there are many religious healthcare systems that still carry the names of these healing-oriented religious orders.
Hospitals and Nursing
Hotel Dieu in Paris is generously known as one of the world’s oldest hospitals. Precursors of hospitals in America in the 17th and 18th centuries were almshouses (care for the sick poor) and pesthouses (hospitals for persons with contagious diseases). The first true hospital in America was founded in Philadelphia in 1751. Hospitals of that time period were filled with sick people too poor to afford private physicians in their own homes (Kalisch & Kalisch, 1995).
Nurses of the 17th and 18th centuries were usually women who were often illiterate and poor. Hospitals not overseen by churches were considered unclean places where the indigent went to die. Physicians and servants cared for wealthy persons in their own homes. Nurses of that time period included women who were offered the opportunity to serve as nurses rather than go to jail for drunkenness or prostitution (Donohue, 1996). The years 1550 to 1750 are known as the Dark Period of Nursing (Donohue, 1996).
Changes in society and nursing during the Protestant Reformation resulted in men being almost completely removed from nursing (Donohue, 1996). At this time in history, nursing became almost entirely a women’s pursuit.
Because few medications or treatments existed during this time period, nursing care consisted mainly of cleaning, cooking, and comfort care for the sick and dying. Although these were the duties, the hospitals remained unsanitary and understaffed. There were no clear job descriptions or qualifications for nurses, and they were rarely paid a living wage (Donohue, 1996).
During the 17th and 18th centuries, a great explosion of scientific knowledge changed medicine. These changes would later lead to nursing becoming a knowledge-based practice. As treatments became more complex, it was evident that caring and desire to help were not sufficient qualifications for nursing. Knowledge and skill would soon become essential components of nursing (Donohue, 1996).
What discoveries of the 17th and 18th centuries helped nursing to become a knowledge-based profession?
Nursing Education and Religious Institutions
Nursing education has long been influenced by religion and its institutions. Because many of the first hospitals in Europe and America were sponsored and supported by Catholic, Protestant, or Jewish religions, the nurses educated there were greatly influenced by those faith traditions. Although nursing students were not made to join religious orders, many nursing schools of the early through the mid-20th century accepted only unmarried female students. Discipline, devotion, obedience, service, and study were mainstays of the curriculum and life in the schools. Students as late as the mid-20th century were rarely allowed to live away from the school dormitory, which hearkens back to the days when nurses were nuns who lived in convents.
Relationship of Nursing to Medicine Prior to the 19th Century
Nurses in the 17th and 18th centuries were usually untrained women who cared for patients in homes or hospitals. Schools of nursing, as we know them today, did not exist. Physicians were usually men who had completed some readings from medical books and were primarily trained in apprenticeships with practicing physicians. After this short training, young physicians began independent practice. They earned small fees for their services and often supplemented their income with other occupations. Medical education in this time period was better developed in Europe than in America, but by 1767, there were two medical schools in the American colonies (Kalisch & Kalisch, 1995). In contrast to the developing system of medical education, nursing care at that time was still provided mostly by family members or servants.
Treating illnesses in those centuries was significantly different from the complex treatments of today. Communicable diseases limited patient lifespans. Infant and child mortalities were high. Adults often did not live to what we now consider middle age. Treatments consisted of herbs, folk remedies, bleeding, and purgatives. Patent medicines (unproven mixtures of unidentified ingredients) were often sold as treatments for numerous ailments (Kalisch & Kalisch, 1995). Nursing care was often centered on providing comfort and cleanliness.
Nursing in the U.S. Revolutionary War
The U.S. Revolutionary War (1775–1781) originally did not have the benefit of nurses. Donahue (as cited in Judd & Sitzman, 2014) reported that after General George Washington saw the need to provide care to sick or injured troops, women were hired for a sum of $2 per month to provide nursing services that mainly consisted of cooking and cleaning. No experience or education in nursing were necessary. There is little record of these nurses.
Faith-Based Influences on Nursing in the 19th Century
Elizabeth Seton was an American-born woman who founded the Sisters of Charity in 1807. This group was later called the Daughters of Charity. Seton and her followers developed a series of 44 reputable hospitals in the United States in the 19th century. These nursing nuns became successful at both hospital management and nursing (Nelson, 2001).
Nursing uniforms are often thought to be derived from nuns’ habits. Nursing caps were reminiscent of nuns’ veils. In some countries (most notably England and Australia), nurses were called sisters well into the 20th century. Although there are far fewer nursing nuns today than in the past, their impact is still felt in many areas. At a time in our history when women held little power, nursing nuns held many powerful posts in Catholic hospital administration.
The Religious Sisters of Mercy, led by Catherine McAuley in Ireland in the early 1800s, developed a system known as careful nursing. Their work included physical, emotional, and spiritual aspects of care. The 10 key concepts of careful nursing (Meehan, 2003, p. 102) included
These Irish nurses later used this system in the Crimean War, as well as in Ireland.
Reflection of the Overview of the Pre-Nightingale Years
How are the key concepts of careful nursing still used today?
This lesson focused on nursing prior to the Nightingale years. The impact of faith and religion on nursing service was explored. It is evident how these factors still influence nursing today.
Religious Sisters of Mercy
- What philosophy of nursing care was developed by the Religious Sisters of Mercy led by Catherine McAuley in Ireland?
Characteristics of Nurses
- What were some of the characteristics and duties of 17th and 18th century nurses?
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