History and Nursing Knowledge
Meehan, Therese Connell, Nursing History Review
A worn, purple-covered nursing textbook rests in a recess of my library shelves, a marker to a professional homecoming; to recognition of the freedom, sentience, and creativity of the nursing imagination; and to the idea of distinctively nursing knowledge that can illuminate and guide practice. The purple book, An Introduction to the Theoretical Bases of Nursing, focuses on a particular approach to nursing knowledge. But arguably, the most enduring legacy of its author, Martha Rogers, was a love of ideas, oftinscribed with affection to her students: "Best wishes for an exciting future in ideas."
Martha loved the idea of nursing history. In the prologue of her purple book, she sketches nursing's history in ideas and symbols from earliest times. Perhaps drawing on the etymological root of the word history, "to know" or "to see," she believed that in developing nursing knowledge, nurses must never lose sight of the historical commitment of nursing to human service or to the age-old principle that "nurture of the human race has been its ever-present and central concern."
This historical commitment is compellingly illuminated in nurse symbols evident in archaeological literature reaching back around 7,000 years; from the Bear Madonna of Anatolia1 who symbolized the nourishment and protection of human life as it was continuously regenerated, to the "gentlehanded" Hygeia of Ancient Greece,2 the compassionate bearer of life's transforming power who nurtured the human spirit and fostered health in the injured and infirm. Such symbols are by nature timeless, living on in nurses today, embodied in their practice attitudes and actions. Yet they appear never to have been studied seriously from a nursing viewpoint, still awaiting a researcher with specialized preparation in the history of ancient cultures and their languages.
A more accessible example of this historical commitment to human service is the development of nursing in Ireland during the early to mid-19th century. Following Henry VIII's dissolution of the monasteries in the 16th century, nursing as a public service in Britain and Ireland had been virtually extinct for almost 300 years. However in Ireland of the 1820s, as soon as the infamous penal laws3 were relaxed, the human need for nursing services could be responded to again, and the human desire to practice nursing reemerged with alacrity and determination. This endeavor was led by Catherine McAuley4 and Mary Aikenhead5 who, to achieve their aims within the social structures of the time, formed new organizations of religious sisters-Sisters of Mercy and Irish Sisters of Charity, respectively. They, and the mainly well-educated women who joined them, went out daily to nurse the sick poor in their homes providing physical, emotional and spiritual care, education about how to cope with and prevent diseases and contend with adverse social conditions, and comfort and spiritual consolation for the dying. Gradually, skilled nursing as a public service was reformulated as a system composed of principles, concepts, and activities. In 1832, during a major cholera epidemic, they further developed their nursing system through working closely with surgeons and apothecaries in hospitals. In 1834, three Sisters of Charity went for a year to hospitals in Paris for specialized nurse training; and in 1835, Mary Aikenhead founded St. Vincent's hospital in Dublin, the first major hospital to be owned and operated by nurses in Britain and Ireland in modern times.
By the time of the Crimean war (1853-1856), they had "attained brilliant prestige in nursing."6 When the British War Office looked to Ireland for nurses to accompany Florence Nightingale, 12 Irish nurses volunteered and served with and alongside Nightingale. Their nursing contribution was largely eclipsed by overriding cultural and political conflict between Britain and Ireland, but some measure of it can be had from Nightingale herself. To one of the nurses, Mary Clare Moore, she wrote,
You were far above me in fitness for the General Superintendency, both in worldly talent of administration, & far more in the spiritual qualifications which God values in a superior. . . . what you have done for the work no one can ever say.7
And in a later reflection " . . . how I should have failed without your help."8
Although the Irish nurses considered it unbecoming to "broadcast" about their knowledge and practice, they kept private records. A range of others who worked with them or observed their practice also recorded their impressions. Thus, a 19th-century nursing system of purported "brilliant prestige" was documented and leftavailable for research and translation into a 21st century version of nursing knowledge; a nursing philosophy and professional practice model called Careful Nursing,9 the term used indirectly by the nurses to describe their practice. Careful Nursing is constructed from four concepts: the therapeutic milieu, practice competence and excellence, management of practice and influence in health systems, and professional authority, together with their total of 18 dimensions. Its philosophical foundation concerns the unitary, rational nature of the human person; patient, and nurse; the spiritual dimension of nursing and human life; and health as human flourishing. These ideas also are explained using rich historical sources including Aristotle and Aquinas, the latter being a master at explicating at least one dilemma of nurses: how to practically understand themselves and patients as unitary (holistic) persons. Careful nursing has a long way to go in its development, but nurses in hospitals and health systems in the United States and Ireland are drawing on its ideas and finding it relevant to their practice (evidence-based practice and nursing outcomes included).
And so it is that history naturally informs nursing knowledge, both imaginatively and practically. As historian Joan Lynaugh has observed, nursing history is "our source of identity, our cultural DNA."10 Nurses love nursing history when it illuminates their imaginations and they can feel its meaning in their bones. Indeed, nursing history offers all nurses an exciting future in ideas.
1. Marija Gimbutas, The Gods and Goddesses of Old Europe: 7000-3700 B.C. (Los Angeles: University of California Press, 1974).
2. Marie-Therese Connell, "Feminine Consciousness and the Nature of Nursing Practice: A Historical Perspective," Topics in Clinical Nursing 5, no. 3 (1983): 1-10.
3. Laws imposed in Ireland under British rule which discriminated against Catholics and Protestant dissenters in favor of members of the established Church of Ireland. They severely restricted the civil liberties of the indigenous Irish: forbidding them the most basic human rights.
4. Mary Vincent Harnett, A Member of the Order of Mercy, The Life of Rev. Mother Catherine McAuley (Dublin, Ireland: John Fowler, 1864).
5. Sarah Atkinson, Mary Aikenhead: Her Life, Her Work, and Her Friends (Dublin, Ireland: MH Gill & Son, 1879).
6. Lavinia Dock and Adelaide Nutting, A History of Nursing: The Evolution of Nursing Systems from the Earliest Times to the Foundation of the First English and American Training Schools, Vol. 3 (London: GP Putman's Sons, 1907), 86.
7. Letter from Florence Nightingale to Mary Clare Moore, April 29, 1856 (Archives of the Convent of Mercy, Bermondsey, London).
8. Letter from Florence Nightingale to Mary Clare Moore, October 21, 1863 ( Archives of the Convent of Mercy, Bermondsey, London).
9. Therese Meehan, "The Careful Nursing Philosophy and Professional Practice Model," Journal of Clinical Nursing (in press); and http://www.carefulnursing.ie 10. Joan Lynaugh, Editorial, Nursing History Review 4 (1996).
Therese Connell Meehan, RGN, PhD
Adjunct Senior Lecturer in Nursing
School of Nursing, Midwifery & Health Systems
University College Dublin
Belfield, Dublin 4, Ireland
Adjunct Professor, Graduate School of Nursing, Midwifery and Health
Victoria University of Wellington, New Zealand…
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Publication information: Article title: History and Nursing Knowledge. Contributors: Meehan, Therese Connell - Author. Journal title: Nursing History Review. Volume: 21. Publication date: January 1, 2013. Page number: 10+. © Springer Publishing Company 2009. Provided by ProQuest LLC. All Rights Reserved.
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