Introduction
The past is where lessons have been learnt and the future is where those lessons learnt are applied. However, living in the past can hinder progress. In an unidentified source, âyou cannot tell where you are going unless you know where you have beenâ is the key theme of this chapter. Much is to be learnt from the past in order to help us in the future, to learn from our mistakes and to help us and the services we provide to develop in an appropriate and patientâcentred manner.
Before the midânineteenth century, nurses, whether employed in hospitals or in private homes, were very often uneducated and usually had no formal training. In Britain in the 1840s nursing sisterhoods were founded to improve standards of nursing, these mimicked the Catholic nursing orders in other European countries. St Johnâs House, an Anglican Nursing Sisterhood founded in 1848, was one example of these. As a thankâyou to Florence Nightingale for her accomplishments during the 1854â1856 Crimean War, a fund was raised by public donations to allow her to establish a training school for nurses in London, the Nightingale School set up at St Thomasâ Hospital in 1860. Other hospitals, both voluntary hospitals and workhouse infirmaries, formed their own training schools, and many of these were run by superintendents who had trained at the Nightingale School. Nightingale based her curriculum on the following beliefs:
- Nutrition is an important part of nursing care.
- Fresh, clean air is beneficial to the sick.
- Sick people require occupational and recreational therapy.
- Nurses should help identify and meet patientsâ personal needs and these include the provision of emotional support.
- Nursing should be directed towards two conditions: health and illness.
- Nursing is separate and distinct from the practice of medicine and as such should be taught by nurses.
- Nurses need continuing education.
Review
Think about the list of Nightingaleâs beliefs (those that were a part of her nursing curriculum) and reflect on the course or programme of study you are enlisted on and determine if these beliefs are still the foundation of nursing education today.
Provision was also provided to train district nurses to care for the sick and poor in their own homes, and in 1887 the Queenâs Institute of District Nursing was founded.
The 1919 Nurses Registration Act set up the General Nursing Council, which was charged with maintaining a register of nurses to ensure that in future all nurses were appropriately trained. As a result of a shortage of nurses, the Nurses Act established in 1943 provided a roll of assistant nurses.
In 1930 county councils took over the workhouse infirmaries from the Boards of Guardians and the London County Council also acquired all the hospitals that had been previously managed by the Metropolitan Asylums Board. Most hospitals and mental institutions in 1948 passed to the National Health Service (NHS), with the majority of them becoming the responsibility of the regional hospital boards. Four boards assumed responsibility in London and the South East, as well as the North East, North West, South East, and South West Metropolitan Hospital Boards. In each hospital region an Area Nurse Training Committee was established, with the aims of financing, advising and improving all nurse training institutions in the region.
County councils became responsible for district nursing as well as for other personal health services in 1948. All health services were transferred to the newly formed regional and area health authorities in 1974, replacing the regional hospital boards, and in 1982 area health authorities were abolished. There have been numerous other reorganisations that have followed.
