The influence of positivistic thought on nineteenth century asylum nursing

The development of positivism, which had a considerable influence on the evolution of psychiatric thought and practice during the second half of the nineteenth century, is outlined. It was within this intellectual framework that figures such as Kraepelin, Bleuler and Schneider developed psychiatric nosologies and diagnostic criteria for certain mental illnesses. While there was little scientific evidence to support the claim that medical treatments had any beneficial effects on pyschiatric disorders, nevertheless psychiatric institutions were established in the mid-nineteenth century based on the medical model. Nurses were expected to observe, collect and report data on mental patients which were then presented to doctors for analysis. The intellectual climate of the asylums was such that nurses were not encouraged to question the scientific principles upon which the therapeutic regime was based, nor were they encouraged to seek a rationale for their daily observations and data collection. The specialized training for asylum nurses which was introduced towards the end of the nineteenth century did not give nurses their own professional identity, but rather reinforced the supremacy of medical knowledge in the care of the mentally ill. Trained nurses enhanced medical credibility, but did not progress care of the mentally ill because their training did not imply or encourage questioning of the positivistic basis of psychiatric treatment.

Nursing studies laid end to end form a circle

As early as 1915, leaders in the nursing profession were concerned with the "image problem of nurses," which they saw as needing improvement. Since then, countless studies, reports, and commissions have attempted to explain and solve perceived shortages of registered nurses, which have occurred regularly after brief periods of quiescence or oversupply. Usually, their recommendations have hinged on nurses changing their image. In fact, few of these studies have dealt with the real issues of nursing work, which are a narrow pay range, little extra pay for working on undesirable shifts, disincentives for full-time work, pay unrelated to education, and education unconnected to job level. The multiple studies and commissions do nothing more than recycle data and in the process obscure fundamental problems. Educational funding has been no more successful. Their ineffectiveness suggests the need for less "image enhancement" and more support from physicians and employers to bring about systemic reform. This includes licensing nurses according to their education, assigning them according to their competencies and education, and paying accordingly. These measures, and only these, will eventually curtail the cycles of nursing "shortages."

["A nurse fed with pompous words": working conditions and the primary nursing demands at the beginning of the 1900s]

Working conditions of nursing personnel at the beginning of the century varied widely from hospital to hospital: the number of working hours could range from 10 to 15 hours a day, with up to ten fold variability of (overall low) salary. Social security, holidays and retirement pensions were just dreams. Nurses had no right to proper meals and had to sleep in crowded, noisy and unhygienic rooms: the relationship between these conditions and quality of care was often debated on professional journals and in the Parliament. Unfortunately nursing Leagues were reluctant to go on strike because they did not want to harm patients. Pressures were put on hospital administrators in order to obtain more human living and working conditions for nurses: strike and claims were considered detrimental for the mission of nursing. The claim for a set of rules homogenous all over the country was opposed with the reason that extra money spent for nurses, would have been subtracted from resources available for patients.

[A window on the past: lay nurses and nun nurses in hospital modernization at the start of the 20th century]

The presence of nuns in Italian hospitals raised hot debates since the beginning of the century. Though recognised by a large majority as ideal nurses, for the devotion and the amount of time spent working in the hospital, physicians, feminist movements and nursing leagues expressed much criticism against nuns, for several reasons: a. nuns were more liable to the Mother Superior than to the hospital administration, therefore could not be neither controlled nor sanctioned; b. misplaced "religious" behaviors and beliefs (i.e. the body as an occasion of sin; suffering means spiritual salvation) which may threaten proper care for patients; c. nuns could not act as educators or role model for nurses because they were mainly involved in organizational and management activities and not in direct patient care; d. among other problems, the way of dressing, with large hats and long sleeves was a source of transport of microorganisms). Lack of properly educated and trained lay nurses, able to substitute nuns, some improvement in nuns' education, strongly promoted by Pope Pio X and the dissolution of nursing leagues put an end to the fight for the secularization of hospitals.

Changing attitudes towards families of hospitalized children from 1935 to 1975: a case study

The introduction of 'open' visiting and family involvement in the care of hospitalized children created a revolution in the care of children in hospitals. This historical study utilized the situation at the Hospital for Sick Children, Toronto (HSC), as a case study illustrating change. Although psychological research provided a strong rationale for including families in the care of hospitalized children, change occurred slowly. In this regard, HSC was typical of many children's hospitals. However, there seemed to be a significant failure to learn from innovations elsewhere. Paediatric nurses, in particular, were slow to encourage family visiting and participation in care.

Women healers of the middle ages: selected aspects of their history

The stellar role of women as healers during the Middle Ages has received some attention from medical historians but remains little known or appreciated. In the three centuries preceding the Renaissance, this role was heightened by two roughly parallel developments. The first was the evolution of European universities and their professional schools that, for the most part, systematically excluded women as students, thereby creating a legal male monopoly of the practice of medicine. Ineligible as healers, women waged a lengthy battle to maintain their right to care for the sick and injured. The 1322 case of Jacqueline Felicie, one of many healers charged with illegally practicing medicine, raises serious questions about the motives of male physicians in discrediting these women as incompetent and dangerous. The second development was the campaign--promoted by the church and supported by both clerical and civil authorities--to brand women healers as witches. Perhaps the church perceived these women, with their special, often esoteric, healing skills, as a threat to its supremacy in the lives of its parishioners. The result was the brutal persecution of unknown numbers of mostly peasant women.

Marguerite d'Youville: woman of compassion

The Church canonized one of our own: the "Mother of Universal Charity," as Pope John XXIII so aptly called her in 1959, a sister of action and contemplation who opened her heart to the urgent needs of her time, a Canadian wife and mother who innovated hospital and health care, a person for whom love knew no boundaries.

The development of Canadian nursing: professionalization and proletarianization

In this article, the development of nursing in Canada is described in terms of three major time periods: the emergence of lay nursing, including organization and registration, 1870-1930; the move to the hospital, 1930-1950; and unionization and the routinization of health care, 1950 to the present. This development is viewed in the light of the orienting concepts of professionalization, proletarianization, and medical dominance (and gender analysis). This historical trajectory of nursing shows an increasing occupational autonomy but continuing struggles over control of the labor process. Nursing is now using theory, organizational changes in health care, and credentialism to help make nursing "separate from but equal to" medicine and to gain control over the day-to-day work of the nurse. Nursing can thus be viewed as undergoing processes of both professionalization and proletarianization. As nursing seeks to control the labor process, its occupational conflicts are joined to the class struggle of white-collar workers in general. Analysis of nursing indicates the problems involved in sorting out the meaning of concepts that are relevant to occupational or class analysis but which focus on the same empirical phenomenon.

East London Hospital for Children, Shadwell, 1868-1963. Queen Elizabeth Hospital for Children, Shadwell

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