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NURSING

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Originally appearing in Volume V19, Page 917 of the 1911 Encyclopedia Britannica.
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NURSING . The development of sick-nursing, which has brought into existence a large, highly-skilled, and organised profession, is one of the most notable features of See also:

History. See also:modern social See also:life. The See also:evolution of the sick-See also:nurse is mainly due to three very diverse influences—See also:religion, See also:war and See also:science—to name them in See also:chronological See also:order. It was religion which first induced ladies, in the earlier centuries of See also:Christianity, to take up the care of the sick as a charitable See also:duty. The earliest forerunner of the See also:great sisterhood of nurses of whom we have any See also:record was Fabiola, a patrician See also:Roman See also:lady, who in A.D. 380 founded a See also:hospital in See also:Rome with a convalescent See also:home attached, and devoted herself and her See also:fortune to the care of the sick poor. She had a See also:rival in the empress Flaccilla, the pious See also:consort of See also:Theodosius I. (A.D. 379-395), who also personally visited the' hospitals and attended on the sick. Organized nursing does not appear to have formed any See also:part of medical treatment, except in so far as the deacons of the See also:church attended on the poor, until the 4th See also:century of the See also:Christian era. After that date the employment of See also:women for this purpose must have See also:developed rapidly, for in the reign of See also:Honorius (A.D. 395-423) six See also:hundred women were engaged in the hospitals of See also:Alexandria.

These institutions were managed by the See also:

clergy, and throughout the dark and See also:middle ages the hospital and nursing systems were connected with religious bodies. Nurses were provided by the male and See also:female monastic orders, an arrangement which still continues in most Roman See also:Catholic countries, though it is gradually being abandoned through the increasing'demands of medical science, which have led the hospitals to establish training See also:schools of their own. The names of the See also:oldest See also:foundations which still survive, such as the Hotel Dieu in See also:Paris, St See also:Thomas's and St See also:Bartholomew's in See also:London, the order of St See also:Augustine, and (in the See also:form of a modern revival) that of St See also:John of See also:Jerusalem, sufficiently indicate the See also:original religious connexion. The order of St See also:Vincent de See also:Paul, founded in 1633 for the See also:express purpose, is still the largest nursing organization in the See also:world. Even in See also:Protestant See also:England, where purely See also:secular training schools have reached their highest development, the generic See also:title of See also:Sister, alike prized by its holders and honoured by the public, remains the popular and professional synonym for See also:head nurse, and perpetuates the old association. Nursing, as a popular or fashionable occupation, is not a modern invention. See also:Sir See also:Henry See also:Burdett quotes an order, dated 3oth May 1578, directing the See also:master and the See also:prior of the Hotel Dieu "not to receive henceforth any novices without speaking of it to the See also:company, because there are an excessive number of nuns and novices, who cause great expense to the said Hotel Dieu." In Protestant countries a secular nursing See also:system came in with the See also:Reformation. The See also:staff appointed for St Bartholomew's, on its re-See also:establishment by Henry VIII. in 1544, consisted of a matron and twelve nurses, who were engaged in domestic occupations when off duty. Thus nursing became a See also:menial See also:office and an inferior means of livelihood, adopted by women of the See also:lower orders without any training or See also:special skill; and so it continued down to the middle of the 19th century, when a new See also:movement began which was destined to revolutionize the status of the nurse. Its distinctive feature was the systematic training of nurses for their vocation. Previously a certain amount of See also:regular instruction had no doubt been given here and there by individual physicians and surgeons; lectures to nurses were delivered in the New See also:York Hospital as See also:early as 1790. But these were isolated efforts.

Such skill as nurses possessed was picked up in the wards. No qualifications were required, nor indeed would they have been forthcoming, so See also:

low had the calling sunk in public estimation. The See also:credit of inaugurating the new order of things belongs to See also:Germany, and here again the religious See also:influence came into See also:play. The beginning of the modern system See also:dates from the See also:foundation of the See also:institute for training deaconesses at See also:Kaiserswerth by Pastor See also:Fliedner in 1836. It is true that See also:state training schools for male nurses had previously existed in See also:Prussia, the oldest having been founded at See also:Magdeburg in 1799; but the employment of men in hospital wards is a feature of the See also:German system which has not been copied by other advanced countries, and seems to be in See also:process of See also:abandonment in Germany. It is a heritage from the middle ages, when the Knights Hospitallers undertook for men the duties discharged in female institutions by the nuns. The male schools, therefore, stand somewhat apart, though they See also:mark a See also:stage in the evolution of nursing as the earliest regular training establishments. The Kaiserswerth Institute, on the contrary, had a far-reaching and lasting influence, and may fairly claim to be the See also:mother of the modern system. England, in particular, owes much to it, for there See also:Florence See also:Nightingale acquired the See also:practical knowledge which enabled her afterwards to turn her remarkable See also:gift of organization to such brilliant See also:account. The example of Kaiserswerth was soon followed, and not in Germany only. In 1838 the Society of See also:Friends founded a nursing organization in See also:Philadelphia, and in 184o Mrs See also:Fry, a member of the same community, started the Institution of Nursing Sisters in London. In 1857 the nurses attached to it numbered ninety.

They received their practical training at See also:

Guy's and St Thomas's Hospitals. On the See also:continent institutes for nursing deaconesses were founded at See also:Strassburg, See also:Utrecht, See also:Berlin, See also:Breslau, See also:Konigsberg and Carlsruhe between 1842 and 1851. In London a Church of England training institution (St John's See also:House) was opened in 1848. There were three classes —(1) sisters, (2) probationers, (3) nurses. The nursing at See also:King's See also:College Hospital was for many years undertaken by this society, whose members were trained at the hospital. The training system, thus inaugurated on a semi-religious basis, received a new impetus from the See also:Crimean War, which was further emphasized by the See also:Civil War in See also:America and the subsequent great conflicts on the continent. The despatch of Florence Nightingale with a staff of trained nurses, to super-intend the See also:administration of the military hospitals was the See also:direct result of the publicity given to the details of the Crimean War by The Times, and it formed a new departure which riveted the eyes of the civilized world. The See also:work undertaken and accomplished by this lady was far more important than the See also:mere nursing of sick and wounded soldiers. She had grasped the principles of See also:hygiene, which were then beginning to be under-stood, and she applied them to the reform of the hospital administration. In civil life it had a marked effect in stimulating the training movement and raising the status of the nurse; but substantial results were only obtained by degrees. It was not until 186o that the modern hospital school system was definitely inaugurated by the opening of the Nightingale Fund School at St Thomas's Hospital, founded with the See also:money sub-scribed by the See also:British public in recognition of See also:Miss Nightingale's See also:national services, and worked on principles laid down by her. In the meantime several nursing See also:societies, in addition to those previously mentioned, had been founded in England, and else-where.

Among them the See also:

Baden Ladies' Society, founded in 1859 by the See also:Grand Duchess Luise, deserves mention. In the same See also:year the first See also:district nurse began work in See also:Liverpool; and in 1865 the reform of the much-neglected workhouse nursing was inaugurated by Miss See also:Agnes See also:Jones and twelve nurses from St Thomas's, who took up the work in Liverpool. At this See also:time England took a decided See also:lead, which she has never lost. Other countries gradually followed. In Germany the See also:Albert Nursing Society was founded by See also:Queen Carola of See also:Saxony, and the Alice Society by the Grand Duchess Alice of See also:Hesse, both in 1867. In See also:France, where the nursing was comparatively well performed by the religious orders, no See also:change was made until 1877, when a training school was opened in Paris by the See also:municipality, and two others by the Assistance Publique, in connexion with the Salpetriere and Bicetre Hospitals. In the See also:United States schools were opened in New York, New Haven and See also:Boston in 1873, The British colonies, See also:Austria, and other See also:European countries followed some years later. It remained for the third influence to See also:complete the work begun and to develop systematic nursing to its See also:present dimensions. Since 188o the increasing demands of medical knowledge have well-nigh revolutionized the See also:craft in the home, the hospital and the workhouse. A large part of the change may be summed up in the words " scientific cleanliness." The outcome has been to raise the dignity of the calling, to induce persons of a See also:superior class to adopt it in increasing See also:numbers, to enlarge the demand for their services, and to multiply the means of educating them. Nursing does not appear to be regulated by See also:law in any See also:country, though attempts in this direction had been made in England.' Its organization is voluntary, and even in Training state or municipal institutions is dependent on the and direction of the administration. In Great See also:Britain organizanearl•• all the See also:general and special hospitals and many tion.

of the poor-law infirmaries offer systematic professional training to nurses. The provisions differ considerably in detail, but in the larger schools the system is See also:

uniform in all important respects. Candidates must be between 23 (sometimes 21 or 22) and 35 years of See also:age, and must produce satisfactory See also:evidence of See also:character, See also:education, See also:health and physique; after a See also:personal interview and one, two or three months' trial they are admitted for three years' training. During this See also:period they receive regular instruction in theoretical and practical knowledge, and have to pass periodical See also:examinations. At the end of it they are granted certificates and may serve as staff nurses. They pay no See also:premium, and generally receive a See also:salary of £8 to £12 in the first year, rising annually to £30 or £35 as staff nurse, and subsequently to £40 or £50 as sister or head nurse. They live in a home attached to the institution, under a matron, and in the most modern establishments each nurse has a See also:separate bedroom, with See also:common dining and recreation rooms. Private nursing staffs are attached to several of the hospitals; they are recruited from the staff nurses and probationers on completion of their course, and See also:supply nurses to private patients. In the special ' In 1902 an See also:act was passed to establish a Central Midwives See also:Board and regulated the training and employment of midwives. hospitals the training is shorter, being for one or two years. There seems to be a See also:constant tendency to increase the requirements. At St Bartholomew's, St See also:George's, the London Hospital, St Thomas's and others, probationers must enter for four years, and at St Bartholomew's they have to pass an entrance examination in elementary See also:anatomy, See also:physiology and other subjects.

At all the more important schools the number of applications is many times greater than the vacancies. In Great Britain trained and certificated nurses generally belong to a society or association. The most noteworthy of the associations is Queen See also:

Victoria's See also:Jubilee Institute for Nurses. It was founded in 1887 with the See also:object of providing skilled nursing for the sick poor in their own homes. A great many of the provincial nursing associations are affiliated to it. The number of nurses supported by each See also:branch varies. The qualifications for a Queen's nurse are as follows: (1) training at an approved general hospital or infirmary for two years; (2) approved training in district nursing for not less than six months, including the nursing of mothers and infants after See also:child-See also:birth; (3) nurses in country districts must in addition have had at least three months' approved training in midwifery. Candidates possessing the first qualification are received on trial for one See also:month, after which they complete their six months' training for the second qualification, at the same time entering into an agreement to serve as district nurse for one or two years at the end of the six months. The salary during training is £12,105., and afterwards £30 to £35 a year, with board, lodging, See also:laundry and uniform. With regard to the earnings of nurses in general, the salaries paid in hospitals have already been mentioned; for private work the scales in force at different institutions vary considerably, according to the other advantages and benefits provided. At some the nurses receive all their own earnings, minus a percentage deducted for the See also:maintenance of the institute; at others they are paid a fixed salary, as a See also:rule from £25 to £30 a year, plus a varying percentage on their earnings or a periodical See also:bonus according to length of service. This is perhaps the commonest system, but some of the best nursing homes give a somewhat higher fixed salary without any percentage.

In all these cases the nurses receive in addition board and lodging, laundry and uniform, or an See also:

equivalent See also:allowance. For special cases—infectious, See also:massage, See also:mental and maternity—nurses on a fixed salary usually receive extra pay. The fees commonly charged by high-class institutions for the services of a trained and certificated nurse are—for See also:ordinary cases £2, 2s. a See also:week, for special cases £2, 12S. 6d. or £3, 3S. a week; but many provincial associations supply nurses for £1, Is. a week and upwards. The discrepancy between the fees paid by patients and the salaries received by nurses, especially in London, has occasionally excited unfavourable comment, but it is to be remembered that the nurses are maintained when out of work or See also:ill, and have other advantages; many institutions either provide See also:pensions or assist the members of their staff to join the Royal National See also:Pension Fund. To complete this account of the organization in Great Britain a few details with regard to special nursing are added. See also:Fever.—Regular training on the same See also:plan as in general hospitals is provided in London at the fever hospitals of the See also:Metropolitan Asylums Board (12-in number, with from 36o to 76o beds each), and at a considerable number of provincial institutions. See also:Insanity.—The Medico-Psychological Association of Great Britain and See also:Ireland holds examinations and grants certificates in mental nursing; candidates must undergo three years' regular training, with instruction by lectures, &c., which may be obtained in a large number of public asylums by arrangement with the Association; one See also:county See also:asylum (See also:Northampton) gives its own certificates after a three years' course. District Nursing.—In addition to the Queen's nurses, of whom details have been given above, many See also:local associations See also:train their own nurses for this work. Cottage and See also:village nursing are varieties of the same See also:department; the former is organized on the benefit. system, and aims at supplying domestic help and sick-nursing combined in rural districts for an See also:annual subscription of from as. to 1os., according to the class in life of the See also:family, and a weekly See also:fee of the same amount during attendance. Monthly Nursing and Midwifery.—Systematic instruction in these subjects is given at some fifty lying-in institutions in 'different partsof the See also:kingdom. The usual course for nursing is not less than three months, and for midwifery not less than six months; a premium is required of 12 or 13 guineas for three months, and 25 guineas for six months.

Male Nursing.—Two or three associations in London supply male nurses (fees 2 to 4 guineas a week), but there appears to be only one institution, apart from the military and See also:

naval services, at which they are systematically trained—namely, the National Hospital for the Paralysed and Epileptic. Massage is taught regularly at the hospital just named, and at a few other special hospitals. Competent operators are supplied by the Incorporated Society of Trained Masseuses and, to some extent, by other nursing associations; but this branch of the profession is still imperfectly organized (see MASSAGE). See also:Children.—A large number of children's hospitals throughout the country give regular training in the nursing of children; they take probationers at a somewhat earlier age than the general schools; the course is usually shorter (one or two years), and the salaries slightly lower. The State offers employment to nurses in the naval and military hospitals. Queen Alexandra's Imperial Nursing Service was organized in 1902. Candidates for it must be between 25 and 35 years, single or widows and of See also:good social status. They must have had three years' training in a general hospital. See also:Foreign Service must be taken as required. Nurses are eligible for a pension after to years' service, the amount increasing up to the age of 55 when retirement is compulsory. The Royal Naval Nursing Service is organized on much the same basis. Other organizations are The See also:Army Nursing Reserve and Queen Alexandra's Imperial Military Nursing Reserve, and there is also a nursing reserve attached to the territorial forces.

In the more important British colonies—See also:

Australasia, See also:Canada and See also:South See also:Africa—there are now a considerable number of hospital schools and other institutions formed and conducted on the See also:English See also:model. Salaries and fees are very much the same in See also:Australia; in Canada and South Africa they are higher. In the United States a similar system prevails in New York, Boston, See also:Brooklyn, See also:Chicago, See also:Baltimore, Philadelphia, New Haven and many other large towns. The period of training is either two or three years. At the Johns See also:Hopkins School at Baltimore twelve scholarships of $10o and $120 each are awarded annually; See also:graduate nurses are paid $360 (£72) a year. Salaries are altogether much higher in the United States. At the Boston See also:City Hospital graduate nurses receive $420 (£84) a year, and at the See also:Indianapolis City Hospital those on private duty are paid $72 a month, which is equivalent to £172 a year, with board, lodging, laundry and uniform. This may be taken to indicate the possible earnings of trained nurses working independently, as they usually do in America. The fees charged for trained nurses run from $12 to $25 a week, and even more for special cases. Male nurses are trained at the Bellevue Hospital, New York, the See also:Grace Hospital, See also:Detroit, and elsewhere. In the See also:American schools more See also:attention is paid to the preparation of nurses for private work than in the British (Burdett), and a See also:directory or registry of them is kept in most large towns. In Germany, their original home, both training schools and societies have multiplied and developed.

The period of training appears to be considerably shorter than in Great Britain and America. Members of the Albert Society of Saxony, however, spend two years in the wards at See also:

Dresden, and a third at See also:Leipzig, attending lectures and demonstrations. They are sent out to nurse See also:rich and poor alike, and their pay is very small. Most of the German institutes have pension funds. In France a great See also:deal of the nursing was formerly in the hands of religious orders, but there too the hospital school system, inaugurated in 1877, has grown. The schools managed by the Assistance Publique in Paris give a very thorough course of instruction. In See also:Russia nursing is mainly in the hands of the Red See also:Cross Society, whose members are, however, trained in the hospital schools. In See also:Italy, See also:Spain, See also:Portugal and See also:Belgium scientific nursing is in a backward state. The old religious system still prevails to a large extent, and, though some of the orders do their work with great devotion, the See also:standard of knowledge and skill is not up to modern requirements. At See also:San Remo and Rome institutions have been established for providing English trained nurses to private cases. Austria is also in a very backward state, in spite of the fame of the See also:Vienna cliniques. The Red Cross Society provides a certain amount of trained nursing, and next to it the best-organized work is done by religious orders; but the nursing in the hospitals appears to be still in a neglected state.

The See also:

Brothers of See also:Mercy have See also:charge of some of the men's hospitals, and also carry on a remarkable system of district nursing. In See also:Holland and the Scandinavian countries the organization is more modern and fairly adequate. For full details on the large subject of the duties and qualifica- tions of nurses the reader is referred to the numerous See also:text-books and other technical authorities. Only a few general See also:Dunes and observations can be made here. Many candidates 9uairca- aPAroach the calling with a very imperfect aPPrecia- doas. tion of its exacting character. The work is not easy or to be taken up lightly. It demands See also:physical strength, See also:sound health, scrupulous cleanliness, good See also:temper, self-See also:control, intelligence and a strong sense of duty. It embraces many duties—some of them menial and disagreeable—besides the purely medical and surgical functions. This is especially the See also:case with district nursing, which is the highest and most exacting branch of the profession, because it imposes the greatest responsibility with the fewest resources and demands the most varied qualifications, while affording none of the attractions incidental to hospital work or private nursing among the rich. It is comparatively easy to fulfil routine duties, when every means is at See also:hand and the See also:standing conditions are the most favourable possible; when See also:ventilation, warmth, See also:light and cleanliness are all provided of the best, and when assistance can be summoned in a moment. To be thrown on your own resources and make the best of adverse conditions is an entirely different See also:matter; it requires a thorough knowledge not of routine, but of principles.

It is impossible, therefore, for nurses to be over-educated in the fullest sense of the word; but it is possible for them to be inappropriately educated, and perhaps that is sometimes the case now. Probably nursing has been elaborated to the inevitablepoint of specialization, and a some-what different preparation is needed for different branches of the See also:

art. Allusion has been made above to the subject of male nursing. It hardly finds a See also:place in the British civil system, and was condemned for hospitals in Germany, where it is at its best, by so eminent an authority as See also:Professor See also:Virchow. In the South P frican War of 1899-1902 it was even suggested that female nurses should replace orderlies at the front. The only valid 'eason for preferring women to attend men rather than members -f their own See also:sex is the difficulty of obtaining a supply of equally well qualified and satisfactory male nurses. But this difficulty need not be permanent, and the See also:assumption is much to be deprecated. It is, indeed, most desirable that men should be nursed by men. The advantages are many and real. For one thing women do not possess the physical strength which is often required. They cannot lift a heavy See also:man, and ought not to be asked to do it. Then it is excessively irksome toa sensitive man to he attended by women for various necessary offices.

In order to avoid it he will endeavour to do without assistance, and seriously See also:

prejudice his chances of recovery. AUTnoRITIES.—Sir Henry C. Burdett, Hospitals and Asylums of the World; The Nursing Profession (annual); See also:Hampton, Nursing; See also:Percy G. See also:Lewis, Nursing, its Theory and Practice; Eva C. E. Luckes, Hospital Sisters and their Duties; Morten, How to become a Nurse; Florence Nightingale, Notes on Nursing; Nightingale See also:Boyd, " Nursing," in See also:Quain's See also:Dictionary of See also:Medicine.

End of Article: NURSING

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