Last month, we began our series on the history of nursing education with a discussion of how religious care formed the basis for nursing. From the most primitive of origins, with shamans caring for village members, to formal training provided by the Catholic Church, nursing’s beginnings in religion cannot be denied.
After the dissolution of the monasteries, where formal nursing education truly began, religion continued to play a part in nurses’ training. Traditional hospitals were being created by pastors, many of whom were not formally trained physicians themselves.
Instead, they too learned through practical work and pastoral care of their parishioners. They then passed this training on to the nurses who worked with them. Thus began the evolution of the nurse-doctor relationship, which grew to include physician training of nurses.
Deaconess Training
The next great phase of formal nurses training came with the deaconess movement. An extension of pastoral care, the deaconess movement was inspired by Phoebe, who was mentioned in the Bible as healing the sick.
In the late 18th and early 19th centuries, churches worldwide began emphasizing that followers do what they could for others. Pastors who could do so created hospitals and cared for the sick in their communities. One of the most famous of these hospitals was the Kaiserswerther Diakonie, founded by German pastor Theodor Fliedner.
This hospital served as a model for practical nurse training throughout the world and even nursing structures of today, such as the matron-sister model in the United Kingdom. Under Fliedner’s deaconess model, women spent at least five years training in nursing, child care, even social work. They were also prepared for marriage, and under the Anglican model, the ministry.
Hospital Diploma Schools
As hospitals became secular and more prolific, the way in which nurses were trained changed. This was due in part, of course, to physician training becoming more formalized. Advances in medical care and science necessitated improved training for those performing more complex procedures.
The role of the nurse began to change yet again. Instead of simply caring for patients like mothers who’d just given birth or patients dying of incurable diseases, nurses were assisting doctors with battlefield care or surgeries, which were becoming more complex.
Nursing students who trained at these hospitals, which became known as diploma schools, were difficult training grounds. Students not only had to work without regular supervision, they worked long hours and were not paid, thus giving the hospitals a free labor force.
Classes for nurses in diploma schools, where a nurse would receive a diploma at the end of her training, were scheduled on whims and canceled whenever the hospital wards were understaffed. According to nursing historians, this erratic training pointed to a pervasive system of undervaluing what nurses can offer patient care, even today.
Nurses educated in this system began agitating for more academic training for their successors. One of those was Florence Nightingale, who began her training at the Kaiserswerther Diakonie in 1850. After her experiences in nurse training schools and in the Crimean War, Nightingale worked to improve nursing training for the benefit of patients and nurses alike.
Next month, we’ll look at the evolution of the Nightingale Schools and their lasting impact on nursing today.